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Julie Rovner
KHN

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Julie Rovner is chief Washington correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Teen girls “are experiencing record high levels of violence, sadness, and suicide risk,” according to a new survey from the Centers for Disease Control and Prevention. In 2021, according to the survey, nearly 3 in 5 U.S. teen girls reported feeling “persistently sad or hopeless.”

Meanwhile, a conservative judge in Texas has delayed his ruling in a case that could ban a key drug used in medication abortion. A group of anti-abortion doctors is suing to challenge the FDA’s approval decades ago of the abortion pill mifepristone.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico, and Sandhya Raman of CQ Roll Call.

Panelists

Alice Miranda Ollstein
Politico

@AliceOllstein

Read Alice's stories

Joanne Kenen
Johns Hopkins Bloomberg School of Public Health and Politico

@JoanneKenen

Read Joanne's stories

Sandhya Raman
CQ Roll Call

@SandhyaWrites

Read Sandhya's stories

Among the takeaways from this week’s episode:

• American teenagers reported record rates of sadness in 2021, with especially high levels of depression in girls and teens identifying as LGBTQ+, according to a startling CDC report. Sexual violence, mass shootings, cyberbullying, and climate change are among the intensifying problems plaguing young people.
• New polling shows more Americans are dissatisfied with abortion policy than ever before, as a U.S. district court judge in Texas makes a last call for arguments on the fate of mifepristone. The case is undermining confidence in continued access to the drug, and many providers are discussing using only misoprostol for medication abortions. Misoprostol is used with mifepristone in the current two-drug regimen but is safe and effective, though slightly less so, when used on its own.
• There are big holes in federal health privacy protections, and some companies that provide health care, like mental health services, exploit those loopholes to sell personal, identifying information about their customers. And this week, Republican Gov. Glenn Youngkin of Virginia blocked a state law that would have banned search warrants for data collected by menstrual tracking apps.
• California plans to manufacture insulin, directly taking on high prices for the diabetes drug. While other states have expressed interest in following suit, it will likely be up to wealthy, populous California to prove the concept.

Plus, for “extra credit” the panelists suggest health policy stories they read this week that they think you should read, too:

Julie Rovner: NPR’s “Is the Deadly Fungi Pandemic in ‘The Last of Us’ Actually Possible?” by Michaeleen Doucleff

Alice Ollstein: The New York Times’ “Childbirth Is Deadlier for Black Families Even When They’re Rich, Expansive Study Finds,” by Claire Cain Miller, Sarah Kliff, and Larry Buchanan; interactive produced by Larry Buchanan and Shannon Lin

Joanne Kenen: NPR’s “In Tennessee, a Medicaid Mix-Up Could Land You on a ‘Most Wanted’ List,” by Blake Farmer

Sandhya Raman: Bloomberg Businessweek’s “Zantac’s Maker Kept Quiet About Cancer Risks for 40 Years,” by Anna Edney, Susan Berfield, and Jef Feeley

Also mentioned in this week’s podcast:

• The CDC’s “U.S. Teen Girls Experiencing Increased Sadness and Violence”
• The Fun Violence Archive’s “Mass Shootings in 2023”
• The Washington Post’s “Now for Sale: Data on Your Mental Health,” by Drew Harwell

Click to open the transcript

Transcript: The Kids Are Not OK

KHN’s ‘What the Health?’Episode Title: The Kids Are Not OKEpisode Number: 285Published: Feb. 16, 2023

Julie Rovner: Hello and welcome back to KHN’s “What the Health?” I’m Julie Rovner, chief Washington correspondent at Kaiser Health News. And I’m joined by some of the best and smartest health reporters in Washington. We’re taping this week on Thursday, Feb. 16, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Alice Miranda Ollstein of Politico.

Alice Miranda Ollstein: Good morning.

Rovner: Sandhya Raman of CQ Roll Call.

Sandhya Raman: Good morning.

Rovner: And Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico.

Joanne Kenen: Hi, everybody.

Rovner: Later in this episode we’ll have the winner of KHN’s health policy valentines contest. I hope everyone had a pleasant Valentine’s Day with someone that you love. But first, this week’s health news. I’m calling our lede segment this week “The Kids Are Not OK,” and we’ll get to the gun violence stuff in a minute. First is news from the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey. And let me just read from the press release, quote, “Nearly 3 in 5 — 57% — of U.S. teen girls felt persistently sad or hopeless in 2021, double that of boys representing a nearly 60% increase, and the highest level reported over the past decade.” According to the survey, teens who identify as LGBTQ+ have, quote, “ongoing and extreme distress. More than 1 in 5 of that group said they had attempted suicide in the year before the survey.” Now, clearly, 2021 was a bad year for most of us. The pandemic was still raging, but the political fights over things like vaccines and masking were raging, too. But these rates of mental health problems found by the biannual survey of high school students has gone up in every report since 2001. Why is this happening? What is wrong with our young people and what can we do to help?

Kenen: Well, whatever’s wrong with our young people is going to also be wrong with our old people. I mean, we create the world in which … I mean, I’m a mother and I’m an aunt and I’m an extended-family motherly person. There’s something about the world that we have created for our young people. Julie, we grew up in the Cold War. We grew up … we don’t remember the missile crisis and things like that. But we did grow up in an era of anxiety, existential threats. And yet, for our generation, it wasn’t as bad as it is for this generation. And in this generation, you look at kids who seem to be on top of the world, and they feel like the world is on top of them.

Rovner: Well, at least in my case, you couldn’t be bullied unless you were in person … which is not true anymore.

Kenen: But even 2000, 2001, it wasn’t. That’s not the only thing going on here. And it’s not only the pandemic. I mean, it’s lots of things.

Ollstein: What really jumped out to me in this data was the really high rates of rape and sexual violence. You know, the CDC has said that 1 in 5 teen girls have experienced sexual violence just in the past year, and more than 1 in 10 say they’ve been forced to have sex. This was grouped together with the mental health, depression, suicidal ideation data, indicating that these things are related. And so I think in order to pinpoint some factors, it really seems like … people don’t know how to relate to each other in a sexual way that’s healthy. I think a lot about the efforts to restrict education about sex and sexuality in schools and how that could potentially make this even worse.

Rovner: And remember, this is a survey of high school students. So these are younger young people, or at least early in their, you know, sexual awareness.

Kenen: Yeah, but there was assault and unwanted … there was ugly stuff in prior generations, tons of it. And it wasn’t … and in some ways it was more secretive and more shameful. I mean, I’m not saying it’s not a problem. It’s obviously a huge problem. Alice is right. But it’s not unique to this generation. It’s hard to measure because we weren’t looking for it. But it certainly wasn’t something that didn’t happen. But I think it was even more secretive in the past. So I agree with Alice, but I don’t think that’s all of it.

Rovner: Sandhya.

Ollstein: And you’re right that it’s hard to know for past generations.

Kenen: But they didn’t ask that question.

Ollstein: Since they’ve been asking, it’s gotten worse. They say it’s … sexual violence is up 20% since 2017. Rape is up 27% since 2019. So since they’ve been investigating this, it’s getting worse.

Raman: I would also add the cyberbullying element is a huge piece. You know, if we were looking at this maybe 20 years ago, that was not the same case. The amount of time that teens and young people spend online is much greater now, even within the data they looked at it — that cyberbullying was a lot higher for teens, for LGBTQ youth. And that has been a broad issue that, even this week in Congress, the Senate Judiciary Committee was looking at protecting kids online. And a huge element of that was cyberbullying. You heard from different parents who had lost a child due to excessive cyberbullying on a lot of these social media apps and due to suicide or other mental health issues. And I think that’s a huge piece of now versus, you know, several years ago.

Rovner: Yeah, I agree. Well, clearly, one factor in the declining mental well-being of high school students is the threat of being swept up in a mass shooting event. As if this week’s shooting at Michigan State University wasn’t awful enough, some of the students who had to shelter in place for hours in East Lansing were also survivors of the Oxford, Michigan, high school shooting in 2021. And there was even one student that we know of who was at Sandy Hook Elementary in 2012. Now, in college, there have been 71 mass shootings, defined as an incident in which four or more people are shot or killed, so far in 2023, according to the Gun Violence Archive, and it’s only the middle of February. And just in time, Gallup reports that 63% of Americans are dissatisfied with the nation’s gun laws. Up 7 percentage points from last year and the highest level in 23 years. Is there any way to get this any closer to the top of the issues for lawmakers to address? I mean, they got something tiny done last year, but it feels like the problem is just exploding.

Raman: No, I was going to say, even last year with the incremental stuff was really difficult to get across the board. And, even going back to the CDC data, there were survey results about how many kids are afraid to go to school right now. And that was one of the factors that was rising. And gun violence is obviously a factor in safety, especially for kids now. But I think on a federal level, getting something additional across the line, especially with this split Congress, is going to be really difficult. It might be more of a state-level thing. I think Michigan is already talking about doing something, but it might have to be more on that end than federal.

Ollstein: Yeah, absolutely. And not only with the divided Congress, but I think a lot of the champions of gun reform on the Republican side have since retired. I’m thinking of Sen. [Pat] Toomey, in particular. And so not only do you have a House-Senate divide, but you don’t have some of the voices on the right calling for this that you’re used to.

Rovner: Yeah, the sides seem to be retreating to the poles, as usual, and the public is not happy about it.

Kenen: Well, one last thing, Julie, really quickly. I mean, I think young people today are very aware of climate as an existential threat, which was not true of prior generations.

Rovner: Yes.

Kenen: And I think kids have this real profound fear. And I think that feeds into the anxiety part of it. At least, you know, they just …

Rovner: Yeah, I think that’s absolutely true. And that’s something that’s been ratcheting up over the past several years as we’ve seen this mental well-being …

Kenen: The pace of damage to the Earth is faster than the scientists had projected.

Rovner: All right. Well, now we’re going to turn to abortion, which is another place where the public is not happy with how it’s being regulated. Yet a different Gallup poll finds Americans more dissatisfied with U.S. abortion policy than any time in 23 years, with a record 69% of adults reporting dissatisfaction. That includes 46% who want less strict laws and only 14% who say they want more restrictions. Yet the political energy seems like it’s with the anti-abortion side, or am I misreading that?

Ollstein: I think there’s a lot of activity on both sides. I mean, Sandhya mentioned Michigan, and I think that’s a spot — along with Minnesota, where Democrats really won big in this past election and want to use their new state-level power to advance some abortion rights measures. But I think you’re seeing a lot more on the “anti-” side, and you’re seeing a lot more splits within the anti-abortion side over how to restrict abortion, how far to go, what kind of exemptions to include, if any. And so you’re seeing a lot more debate, whereas the left, who wants to protect abortion rights, seems a little bit more unified on what they want to do right now. And then, like guns, the federal level is pretty stalemate, roadblock. Nothing much is going to happen there.

Rovner: But also, I think it’s that, you know — and I’m as guilty of this as anybody — that the journalists would rather cover squabbles than people who are actually together. So maybe it’s getting a little more ink. Well, it continues to look like a single federal judge in Texas might well try to ban the abortion pill. mifepristone nationwide. Trump appointee Matthew Kaczmarek did not rule as expected last week in a case charging FDA with wrongly approving the drug 22 years ago. Rather, the judge gave the parties two more weeks to submit briefs, which seems to have prompted every party with the least bit of interest in this case to file amicus briefs. I have never seen anything like this at the federal district court level. It looks like a major Supreme Court case, but it’s not. Has anybody else seen anything like this? I mean, this case seems to be taking on as much importance as your average big Supreme Court case.

Ollstein: It very well could be a Supreme Court case in the future. And I think that’s reflected there, too. And I also want to note that part of the reason for the couple of weeks of delay the judge ordered was to allow the drugmaker to have time to submit arguments because the drugmaker, Danco [Laboratories], says that the different parties in the suit, even the FDA, aren’t really representing their interests and they want to argue for the right to market their product. So that’s pretty interesting. But then, yeah, you have the attorneys general, Democrats, and Republicans lining up on either side of the case. The Republican attorneys general saying, “We support banning this medication nationwide” and the Democratic attorneys general saying, “No, let’s trust the FDA and their scientific process to approve this drug.”

Kenen: I mean, I think there’s sort of a significance in how it’s described because you can say, well, Congress gave the FDA the power to approve drugs. But the anti-abortion movement does not call this a medication abortion. They call it chemical abortion. And therefore, they’re treating this not as a drug but as a lethal chemical. You know, whether the judge goes along with that thinking … we know he’s a strongly anti-abortion judge. There’s no question. And there’s a widespread anticipation that he is going to rule with the anti-abortion side. But we never know what a judge is going to do until a judge does it. And Alice has covered this much more closely than I have, so she’ll probably want to weigh in more. But the issue is, is he going to think that the court should overrule the FDA or is he going to think this is a, quote, “chemical,” not a, quote “medication,” and therefore that the FDA is irrelevant? And I mean, Alice, you can give a better restatement of what I just said since you’ve written about it.

Rovner: I want to respond to Alice’s earlier point about the drug company wanting to get involved, because the big question here, not to get into too much legal minutiae, is why did the people who are suing have standing to sue? They have not been injured by the ability to sell this drug for 22 years. No one’s making them buy it. Arguably, the only party that has standing is the drug company, because if it was cut off, they would lose money. They have an obvious injury here. So the legal niceties of this may not go together either. Alice, do you want to do a follow-up?

Ollstein: Yeah, I mean, to go to the standing issue, the people challenging the FDA approval here are conservative doctors who say that they’ve had to do follow-up treatment for patients who’ve taken the abortion pill and then need follow-up treatment, and that takes their time and attention away from treating other patients. I mean, doctors treating a patient, that’s kind of their job. So I think there’s definitely a question on harm and standing there. Just a couple of thoughts on the case. Abortion rights groups both say that this could be an absolute crisis, disaster across the country. But then they also point out that people will still be able to have medication abortions because the two-pill regimen that’s been used for 20 years, it can still work with just the second pill. So this case is about banning the first pill. The different providers who have spoken out say we’re preparing to just provide abortions via the second pill, if needed.

Rovner: And that second pill, misoprostol, is not going to be pulled off the market. It’s used for many, many things. It just happens it also can end a pregnancy.

Ollstein: Exactly. Way harder to ban. And that’s one thing. Medication abortions will still continue if the judge rules how people expect him to. You know, another thing with all the amicus briefs and the drug company intervening as people are bringing up, if we allow someone to come in 20 years after the fact and challenge FDA approval of something, doesn’t that open Pandora’s box to people challenging all kinds of things, I mean, vaccines and whatnot? And won’t that cause chaos and not make drug companies feel like they can trust the process and have confidence in bringing drugs to market in the U.S.? So that’s another piece of the puzzle as well.

Raman: I would add that there’s already a little bit of chaos because, you know, whatever ruling we have, likely later this month, is almost definitely going to be appealed and then probably appeals again. So it’s going … we could have a back-and-forth process where providers might go one way and then the other. And then, in the contingency stuff they’ve been doing, piggybacking on what Alice was saying, is that if they do this misoprostol regimen, it’s not as straightforward as the two-dose that you’re used to in that there are different amounts of dosage, you might have to do repeated dosages. It’s not as simple, even if that’s done in a lot of other parts of the world. And then some providers have said that they would also just switch to doing all surgical abortions. But that also is more timely. You’d have to do the whole thing in clinic rather than send someone home with the pill. And then that is going to take longer. You’re going to schedule fewer patients. There’s already that many different contingency plans that these clinics are going to have to do regardless of what we hear down the line and through the appeals process.

Rovner: We already know that clinics are backed up from women coming from other states. So patients are having to wait longer to get abortions. And, you know, as … it gets further along, you have to do different procedures that are more expensive. It’s already piling up in different places. Well, speaking of some other different places, we’re seeing a lot of national pro- and anti-abortion groups getting involved in a Wisconsin Supreme Court election, of all things. What is up with that?

Ollstein: Well, that could decide the fate of abortion access in that state. You know, you have the split of a Democratic governor and a Republican legislature. So things really could come down. You know, the state had a pre-Roe ban that went into effect. So things are expected to come down to the makeup of the Supreme Court. And so you’re having just tons of outside money being poured into this race for that reason and really putting a spotlight on how much power are these state supreme courts have. And it’s true in other states as well. And there are many cases pending in different states. You know, I’ve been following the Kentucky one, in particular, but there are a bunch of different cases pending before a state supreme court that could really re-legalize or maintain the ban on abortion.

Kenen: There are also election issues and, on abortion, in the state of Wisconsin, election rules, election certification issues that it’s one of the three or four states where that’s really a hot potato. And that’s another reason this race is getting so much attention. I mean, it’s the state Supreme Court race that’s getting a huge amount of national attention and national money. So there are several issues I would agree with Alice on. The No. 1 is probably abortion. But it’s not only abortion.

Raman: And it’s interesting because this is the first time that EMILY’s List has endorsed ever a state Supreme Court race. And I think another thing to consider is that, you know, this is still considered a nonpartisan race since it’s a court seat. I mean …

Rovner: In theory.

Raman: In theory, yes. Even though all of these groups are looking at the histories of how people have ruled in the past. But I think that’s another thing that makes it a little bit more interesting given it’s not strictly a Democrat or Republican endorsement, like a lot of the other things that we’ve been following.

Rovner: Yes. And I saw on the other side the Susan B Anthony List, the anti-abortion group, said … put out a press release this week saying they’re going to have six-figure spending in Wisconsin on this race. So …

Kenen: It’ll be very good for the Wisconsin economy.

Rovner: It will be very good for the Wisconsin economy. Well, anti-abortion lawmakers are busy in a bunch of states pursuing another new trend, giving tax breaks to so-called crisis pregnancy centers that, at least when abortion was legal, lured pregnant women in by pretending to be an abortion clinic and then trying to convince them not to terminate their pregnancies. Missouri has already allowed donors to these crisis pregnancy centers to write off contributions on their state taxes. Now, Kansas, Arkansas, and Oklahoma are considering similar programs, but Kansas is the only one of those states where abortion is still legal. What are CPCs going to do now that they can’t pose as abortion facilities?

Raman: I think there’s still a lot of confusion for folks. I mean, given how a lot of these laws have been changing back and forth. I mean, even as folks that follow this very closely, there’s so many different things where someone … I think we’ve looked at polling before where people don’t always know: Is abortion illegal or not legal in our state? Or at what point? It’s difficult to keep track of, with so many changes going back and forth. So I think that there could feasibly still be people who might be looking for an abortion that don’t understand or — we’ve seen that a lot of these clinics have also bought a lot of ads so that you might be searching for an abortion and you get redirected to one of these clinics. So I think there’s still overlap in folks that might be searching for one and end up at another.

Kenen: I don’t know how much online presence they have, because that could be across state lines. You know, if someone’s on or near a border, there’s all sorts of … people might think that surgical abortions are legal, but medication is not, or that they can or someone could help them order pills. You can never underestimate how confused Americans are about any number of things. So … but they also might …

Rovner: This is confusing, to be fair.

Kenen: Yes. But they also might concentrate their efforts less on the no-abortion states and move more to the abortion states. Or they may advertise in ways that captures or attempts to capture people who are looking to go out of state or to get a cross-state-line prescription, whatever. They can promote themselves in different ways. Or they may also just decide to not do as much in Texas and do a lot more in upstate New York. I mean, I don’t know how they’re going to totally respond to the legal landscape either.

Ollstein: Yeah. And they’ve also become sort of a legal force of their own. I know they’re involved in challenging some of California’s pro-abortion rights policies. The CDC is specifically. So they also have … are trying to play a role on that front, in addition to direct patients’ interface or however we want to phrase it.

Rovner: All right. Well, while we’re talking about patients’ privacy, I want to talk about data. First, a kind of terrifying story from The Washington Post this week details how data brokers have been selling the names and addresses of people with depression, anxiety, and other mental health disorders so they can be advertised to. A lot of this has come from people using mental health apps or websites that are not covered by the HIPAA privacy rules because they are not technically covered health entities. A separate story this week notes how Virginia Gov. Glenn Youngkin helped defeat a bill in the Virginia legislature to provide legal protections to women’s menstrual data contained in period tracking apps. A Virginia official who was opposing the bill said it would put limits on search warrants, which could lead to other problems down the road. One researcher described the privacy practices of the vast majority of mental health apps as, quote, “exceptionally creepy.” How concerned should we be about all of this?

Kenen: I found that really horrifying. And a family friend who had been looking for a therapist and I said, well, maybe — and they were having trouble finding somebody in network and it’s very expensive — and I said, “Well, maybe you should look into some of the online ones that do take insurance.” And after reading that, I told that person, “I’m not so sure that it’s a good idea.” And we do have a shortage of mental health providers in this country. We have an even greater shortage of mental health providers that take insurance. There’s been a lot of talk about how telemedicine for mental health is at least part of the answer. But this should really raise … because they’re not just selling de-identified data. Some of them in that article were selling people’s names, address, diagnosis, and medical history. If it was truly, truly, truly de-identified, it’s different then. And that can be used for research. But a lot of what’s so-called de-identified isn’t de-identified. And this doesn’t even pretend to be. This is, like, search, and you can find out who the person is, an awful lot of intimate detail about their lives. So unless there’s some real safeguards, would you want any of your medical data with your name on it being sold? No. It is. It is being. But …

Rovner: When the HIPAA rules first went into effect, which was around the year 2000, actually  it took a few years — researchers came to Capitol Hill screaming because they were afraid they weren’t going to be able to get any of this de-identified data and they weren’t going to be able to continue to do research. Now, we seem to have gone far in the other direction. And I know that there are efforts on Capitol Hill to do things to update the women’s reproductive information, keeping that private. Anybody think that they might get into an expansion of HIPAA? I mean, that’s really all it would take would be to create more covered entities.

Raman: Yeah, it isn’t as much about the expansion of HIPAA, but there have definitely been pretty concerted efforts to get … the U.S. doesn’t have a comprehensive data privacy law. You know, in contrast to, like, the EU or something. And that has been a big effort for the lawmakers that are focused on tech policy for a while. Even the hearing earlier this week with Senate Judiciary, they brought up several bills. And the issue has been that all of these issues are bipartisan, folks are on board. It’s just not enough people are on board, and little things that have been getting in the way there. And so that has been an issue. And I think even during that hearing, we had one researcher bring up different sites — like NEDA, which is mentioned in some of these lawsuits by some of the hospitals — have been collecting all of this data. But then they, as researchers, are not able to get access to that data, and that would be extremely beneficial for them to be able to say this is what the impact of some of these things are on kids. So it’s a Catch-22 where it’s, like, OK a) we’re not having the research be able to get the data, b) we’re having it sold in a malicious way and c) we haven’t been able to find a solution to mitigate all of this.

Kenen: Yeah, I don’t know about the prospects for a gigantic tech bill because it has many components and they’re controversial and hard to get 60 votes for. But I think there’s a difference between selling stuff about who bought shoes versus someone who is on an anti-psychotic or an antidepressant or whatever, or getting marital counseling, whatever. I mean, these are not the same issue as the whole constellation of tech issues. I can see this being something bipartisan. HIPAA has been updated a little bit, but the fundamental HIPAA law dates back to what, ’96, Julie? … I think that’s when it was.

Rovner: Yeah, although …

Kenen: It has been updated, but it hasn’t been overhauled to really fit the cyber universe we live in.

Rovner: But also Congress never really did HIPAA. People don’t remember this: The 1996 law basically had a provision that said Congress needs to fundamentally address privacy if we’re going to move more towards digital health records, which at the time was starting to happen. And if they don’t, then the secretary of Health and Human Services is authorized to put out regs. And guess what? Congress didn’t do it. So the HIPAA regs that we have now were put out at the end of the Clinton administration. Congress was never able to come together on this. So now things have obviously gotten worse.

Kenen: Yes. And since the Supreme Court now doesn’t like agencies regulating that, that seems to create an entire new existential question. But do I think that medical privacy is something that you could find some kind of bipartisan lanes on? I don’t think a lot of bipartisan things are going to happen in the next two years. This does seem to be one of the few areas that is not a red-blue ideological issue. And I can see Republicans and Democrats being horrified by some of this and maybe not totally sealing it up, but putting … better guardrails on what can be brokered.

Raman: One of the issues has been, I think even in the past, was that California is the one state that has implemented a few layers of very intense data privacy laws. And so, you know, when you have people in leadership that are in from California and it’s hard to get some of those compromises across when it might be more watered down than something California has and take precedent being federal. So it’s one of the many layers of why it’s been difficult over the past year to get any of this stuff done.

Rovner: Well, we should note that the Biden administration is actually working on some enforcement. Earlier this month, the Federal Trade Commission fined the prescription drug discounter GoodRx $1.5 million for illegally sharing customer’s personal health information. It was the very first enforcement action under a 2009 law that applies to health record vendors and others not covered by HIPAA. So at least there’s one avenue where this could be pursued. I imagine we’ll be seeing more of that if not, you know, whether or not they can reach all of these things seems unlikely.

Kenen: Yeah, doing it piecemeal does not seem to be the approach, and I’m not even sure how much $1.5 million is for GoodRx. I don’t think that’s a lot of money for any major pharmaceutical entity.

Rovner: No. And there are a lot of people who use it. All right. Well, finally this week, while we’re talking about drugs, I’ve been trying to get to this for a while. California has — speaking of California, things that other states haven’t done — California has decided to try to limit the cost of insulin for people with diabetes by manufacturing it itself. Could this set a precedent to really disrupt the insulin market, or is California just so big and wealthy that it’s basically the only state that could do something like this — or only state they would do something like this?

Ollstein: So I will note that Gov. [Gretchen] Whitmer in Michigan has also proposed state manufacturing of insulin. So California might not be the only one. I think the idea is that insulin is pretty cheap to manufacture. It’s become the poster child for out-of-control drug prices for that reason — the disparity between what it costs for patients and what it costs to make is so vast. And so I think you are likely to have a few states. But I think it will take a state doing it successfully to get a significant number of others to follow.

Rovner: I think there might be a thought that because California is so big, it could disrupt the market elsewhere — I mean, in the country. That strikes me as a reach. But it’s, you know, Congress, again — talking about things that Congress can’t do — they managed to limit insulin prices for people on Medicare, but not even for everybody else.

Kenen: There was also a good piece in The Atlantic, maybe two or three months ago, that some of these new diabetic drugs, which are injectables and very expensive, mean you don’t need insulin. So … but by addressing making insulin really cheap, which is a good … I mean so people who are on insulin and need insulin … but there are some people who actually could take one of these other drugs and then they wouldn’t be able to afford these other drugs, which might be better for them. And then they’ll end up on cheap insulin. So it’s always more complicated than it sounds. And I also think there’s different kinds of insulin. Someone else on the panel might, you know, that I’m not sure that …

Rovner: There are lots of different formulations.

Kenen: There are two major kinds of diabetes, obviously, Type 1 and Type 2. And then there’s different patients with different degrees of … you know, how far their other health conditions is advanced, etc., etc. So cheap insulin is not even a solution for diabetes. It’s one part of a solution for one of many chronic diseases in America.

Rovner: Well, we will never not have enough things to talk about. That is the news for this week. Now it is time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at khn.org and in our show notes on your phone or other mobile device. Joanne, why don’t you kick us off this week?

Kenen: Yes. This was a collaboration between NPR, Nashville Public Radio, and Kaiser Health News, aired on NPR by Blake Farmer. “In Tennessee, a Medicaid Mix-Up Could Land You on a ‘Most Wanted’ List.” And basically, Tennessee is cracking down on Medicaid fraud. Most Medicaid fraud is actually from doctors and other health care providers — there have been a bunch of home health scandals and so forth. The amount of fraud and the amount of money involved in patient fraud is small, and yet they’re spending a huge amount of money to try to capture a small amount of fraud. And there are huge mistakes. Like the person in this article was just … she was entitled to Medicaid. She did nothing wrong. But they publicly … like, they don’t even wait for you to be convicted. They’re publishing …  they’re making public the charge. This woman turned out to be … it had to do with an old address on … an expired driver’s license that got the system confused. She was doing nothing wrong, and yet she was completely blacklisted, employment and everything else because she was accused of being a felon in publicly available databases. So, a) are they looking in the right place for fraud? And b) are they protecting people’s rights? Clearly the latter they are not because they were publishing … people were accused but not convicted, and then they weren’t removing it in a timely, effective way. So this woman is, like, unemployable. She can’t rent an apartment, and she did nothing wrong. So there’s a whole series of abuses in this story. Not that Medicaid fraud is a good thing. Medicaid fraud is a bad thing, but this is not the way to go after it.

Rovner: This was one in a series of horrifying stories this week. Alice, you have another horrifying story.

Ollstein: Yes. Although this is under the banner of more evidence to bolster the upsetting things that we sort of already knew. This is a really good piece from The New York Times, laying out a lot of data to show that there is these differences in maternal mortality between Black and white women that can’t be attributed to income, showing that even wealthier Black women still face much worse outcomes. And so they say, you know, even when you account for income, even when you account for education and a lot of other factors, there are still these impacts of structural racism in the health system that continue to put Black mothers more in danger. And so this is coming at a time when there’s a lot of focus on this. But there has been sort of a lot of focus on the income, socioeconomic side and people recommending that states expand postpartum coverage of Medicaid. And that certainly is recommended, and experts think that would help. But this shows that it won’t completely solve the problem and there are other factors to address.

Kenen: And it’s not just in maternal mortality. I mean, the racial disparities in health care are not just income-related.

Rovner: And finally, Sandhya, you have a story from one of our fellow podcast panelists.

Raman: Yeah, the story I picked is “Zantac’s Maker Kept Quiet About Cancer Risks for 40 Years,” and that’s at Bloomberg News from Anna Edney, Susan Berfield, and Jef Feeley. And this was a really great story about Zantac, the heartburn and reflux drug that was once one of the world’s best-selling prescription medications. And then in 2020, it was pulled off the U.S. market over cancer risks. And the article goes through how since its beginnings, Glaxo’s own scientists, the drugmaker, had warned that it could be dangerous, but proving some of this has been a little difficult. … But the story goes through some of the documents that show that Glaxo chose not to look into this, even though the leading health agencies — EPA, FDA, WHO — all say NDMA is a carcinogen.

Rovner: Yeah, it’s quite the investigation. Well worth reading. Well, my story is a little less horrifying than everybody else’s. It’s from my former NPR Science Desk colleague Michaeleen Doucleff and it’s called “Is the Deadly Fungi Pandemic in ‘The Last of Us’ Actually Possible?” And I will cut to the chase. The answer is most almost certainly no. But that’s not to say we shouldn’t be worried about fungi and fungal diseases, particularly as the Earth continues to warm, which is what touches off the pandemic in the video game/HBO miniseries that’s airing now. There are new fungal diseases that can be pretty nasty, too, but zombies, almost certainly not. Well, maybe, certainly not. Anyway, listen to or read Michaeleen’s story. Before we go, this week was Valentine’s Day and, as promised, we have the winner of KHN’s best health policy valentine, as chosen by our editors and social media staff. This year’s winner is Jennifer Goldberg, and it goes as follows: “Roses are red, candy is sweet. Adding #Dental to #Medicare makes it more complete!” Congrats to Jennifer and thanks everyone for your creative health policy valentines.

OK, that’s our show for this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review — that helps other people find us, too. Special thanks, as always, to our ever-patient producer, Francis Ying. As always, you can email us your comments or questions. We’re at whatthehealth — all one word — @kff.org. Or you can tweet me. I’m @jrovner. Joanne?

Kenen: @JoanneKenen

Rovner: Sandhya?

Raman: @SandhyaWrites

Rovner: Alice.

Ollstein: @AliceOllstein

Rovner: We will be back in your feed next week. Until then, be healthy.

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KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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MRCP, PhD, clinical professor of respiratory infection and immunity at Barts and the London School of Medicine and Dentistry, Queen Mary University of London, told Healio. “Obviously

DM Neurology or Doctorate of Medicine in Neurology also known as DM in Neurology
is a super speciality level course for doctors in India that is done by them
after completion of their postgraduate medical degree course. The duration of
this super speciality course is 3 years, and it deals
with the nervous system and its functional disorders.
Neurologists diagnose and treat diseases of the brain, spinal
cord, and nerves.

The course is a full-time course pursued at various recognized medical
colleges across the country. Some top medical colleges offering this
course include All India Institute of Medical Sciences, New Delhi, Sree Chitra Thirunal Institute for Medical Science
and Technology, Thiruvananthapuram,
Jawaharlal Institute of Postgraduate Medical Education & Research,
Puducherry (JIPMER), and more.

Admission to this course is done through the NEET-SS Entrance exam
conducted by the National Board of Examinations, followed by counseling based
on the scores of the exam that is conducted by DGHS/MCC/State Authorities.

The fee for pursuing DM (Neurology) varies from college to college and
may range from Rs. 5000 to Rs. 30 lakhs per year.

After completion of their respective course, doctors can either join the
job market or can pursue certificate courses and Fellowship programmes
recognized by NMC and NBE. Candidates can take reputed jobs at positions as
Senior residents, Consultants, etc. with an approximate salary range of Rs.30
lakhs to Rs. 60 lakhs per year depending upon their expertise.

What is DM in Neurology?

Doctorate of Medicine in Neurology, also known as DM (Neurology) or DM
in (Neurology) is a three-year super speciality programme that candidates can
pursue after completing a postgraduate medical degree.

Neurology is the branch of medical science dealing with the nervous system and its functional disorders. Neurologists diagnose and treat diseases and disorders of the brain, spinal cord, and nerves.

The postgraduate students must gain ample knowledge and experience in
the diagnosis, and treatment of patients with acute, serious, and life-threatening
medical and surgical diseases.

PG education intends to create specialists who can contribute to
high-quality health care and advances in science through research and training.

The required training done by a postgraduate specialist in the field of Neurology
would help the specialist to recognize the health needs of the community. The
student should be competent to handle medical problems effectively and should
be aware of the recent advances in their specialty.

The candidate is also expected to know the principles of research
methodology and modes of the consulting library. The candidate should regularly
attend conferences, workshops and CMEs to upgrade her/ his knowledge.

Course Highlights

Here are some of the course highlights of DM in Neurology

Name of Course

DM in Neurology

Level

Doctorate

Duration of Course

Three years

Course Mode

Full Time

Minimum Academic
Requirement

Candidates must have a postgraduate medical Degree in MD/DNB
(General Medicine) or MD/DNB (Paediatrics) obtained from any
college/university recognized by the Medical Council of India (Now NMC)/NBE,
this feeder qualification mentioned here is as of 2022. For any further
changes to the prerequisite requirement please refer to the NBE website.

Admission Process /
Entrance Process / Entrance Modalities

Entrance Exam
(NEET-SS)

INI CET for various
AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS Bengaluru

Counselling by DGHS/MCC/State
Authorities

Course Fees

Rs.5000 to
Rs. 20 lakhs per year

Average Salary

Rs.30 lakhs to Rs. 60
lakhs per year

Eligibility Criteria

The eligibility criteria for DM in Neurology are defined as the set of
rules or minimum prerequisites that aspirants must meet to be eligible
for admission, which includes:

Name of DM course

Course Type

Prior Eligibility Requirement

Neurology

DM

MD/DNB (General Medicine)

MD/DNB (Paediatrics)

Note:

· The feeder qualification for DM in Neurology is
defined by the NBE and is subject to changes by the NBE.

· The feeder qualification mentioned here is as of
2022.

· For any changes, please refer to the NBE website.

· The candidate must have obtained permanent
registration with any State Medical Council to be eligible for admission.

· The medical college's recognition cut-off dates for
the Postgraduate Degree courses shall be as prescribed by the Medical Council
of India (now NMC).

Admission Process

• The admission process
  contains a few steps to be followed in order by the candidates for
  admission to DM in Neurology. Candidates can view the complete admission
  process for DM in Neurology mentioned below:

• The NEET-SS or National
  Eligibility Entrance Test for Super speciality courses is a national-level
  master's level examination conducted by the NBE for admission to
  DM/MCh/DrNB Courses.

• Qualifying
  Criteria-Candidates placed at the 50th percentile or above shall be
  declared as qualified in the NEET-SS in their respective speciality.

• The following Medical
  institutions are not covered under centralized admissions for DM/ MCh
  courses through NEET-SS:

1. AIIMS,
   New Delhi and other AIIMS
2. PGIMER,
   Chandigarh
3. JIPMER,
   Puducherry
4. NIMHANS,
   Bengaluru

• Candidates from all eligible
  feeder speciality subjects shall be required to appear in the question
  paper of the respective group if they are willing to opt for a super
  speciality course in any of the super speciality courses covered in that
  group.

• A candidate can opt for
  appearing in the question papers of as many groups for which his/her
  Postgraduate speciality qualification is an eligible feeder qualification.

• By appearing in the question
  paper of a group and on qualifying for the examination, a candidate shall be eligible
  to exercise his/her choices in the counselling only for those super speciality subjects covered in the said group for which his/ her broad
  speciality is an eligible feeder qualification.

Fees Structure

The fee structure for DM in Neurology varies from college to college.
The fee is generally less for Government Institutes and more for private
institutes. The average fee structure for DM in Neurology is around Rs.5000 to Rs. 30 lakhs per year.

Colleges offering DM in Neurology

There are various medical colleges across India that offer courses for
pursuing DM in (Neurology).

As per National Medical Commission (NMC) website, the following medical
colleges are offering DM in (Neurology) courses for the academic year 2022-23.

Sl.No.

Course Name

State

Name and Address of
Medical College / Medical Institution

Management of College

1

DM - Neurology

Andhra Pradesh

Andhra Medical College, Visakhapatnam

Govt.

2

DM - Neurology

Andhra Pradesh

Sri Venkateswara Institute of Medical Sciences
(SVIMS) , Tirupati

Govt.

3

DM - Neurology

Andhra Pradesh

Guntur Medical College, Guntur

Govt.

4

DM - Neurology

Andhra Pradesh

NRI Medical College, Guntur

Trust

5

DM - Neurology

Andhra Pradesh

Narayana Medical College, Nellore

Trust

6

DM - Neurology

Assam

Gauhati Medical College, Guwahati

Govt.

7

DM - Neurology

Bihar

Indira Gandhi Institute of Medical
Sciences, Sheikhpura, Patna

Govt.

8

DM - Neurology

Chandigarh

Postgraduate Institute of Medical Education &
Research, Chandigarh

Govt.

9

DM - Neurology

Delhi

All India Institute of Medical Sciences, New
Delhi

Govt.

10

DM - Neurology

Delhi

Atal Bihari Vajpayee Institute of Medical
Sciences and Dr RML Hospital, New Delhi

Govt.

11

DM - Neurology

Delhi

G.B. Pant Institute of Postgraduate Medical
Education and Research, New Delhi

Govt.

12

DM - Neurology

Delhi

Vardhman Mahavir Medical College & Safdarjung
Hospital, Delhi

Govt.

13

DM - Neurology

Delhi

Institute of Human Behaviour and Allied Sciences,
Delhi

Govt.

14

DM - Neurology

Gujarat

SBKS Medical Instt. & Research Centre,
Vadodra

Trust

15

DM - Neurology

Gujarat

Smt. N.H.L.Municipal Medical College, Ahmedabad

Govt.

16

DM - Neurology

Jammu & Kashmir

Sher-I-Kashmir Instt. Of Medical Sciences,
Srinagar

Govt.

17

DM - Neurology

Karnataka

National Institute of Mental Health & Neuro
Sciences, Bangalore

Govt.

18

DM - Neurology

Karnataka

Jawaharlal Nehru Medical College, Belgaum

Trust

19

DM - Neurology

Karnataka

S S Institute of Medical Sciences& Research
Centre, Davangere

Trust

20

DM - Neurology

Karnataka

Kasturba Medical College, Manipal

Trust

21

DM - Neurology

Karnataka

Father Mullers Medical College, Mangalore

Trust

22

DM - Neurology

Karnataka

JSS Medical College, Mysore

Trust

23

DM - Neurology

Karnataka

Vydehi Institute Of Medical Sciences &
Research Centre, Bangalore

Trust

24

DM - Neurology

Karnataka

St. Johns Medical College, Bangalore

Trust

25

DM - Neurology

Karnataka

Bangalore Medical College and Research Institute,
Bangalore

Govt.

26

DM - Neurology

Karnataka

M S Ramaiah Medical College, Bangalore

Trust

27

DM - Neurology

Kerala

Government Medical College, Kottayam

Govt.

28

DM - Neurology

Kerala

Sree Chitra Thirunal Institute for Medical
Science and Technology, Thiruvananthapura

Govt.

29

DM - Neurology

Kerala

Government Medical College, Kozhikode, Calicut

Govt.

30

DM - Neurology

Kerala

Medical College, Thiruvananthapuram

Govt.

31

DM - Neurology

Kerala

Pushpagiri Institute Of Medical Sciences and
Research Centre, Tiruvalla

Trust

32

DM - Neurology

Kerala

M E S Medical College , Perintalmanna Malappuram
Distt.Kerala

Trust

33

DM - Neurology

Kerala

Jubilee Mission Medical College & Research
Institute, Thrissur

Trust

34

DM - Neurology

Kerala

T D Medical College, Alleppey (Allappuzha)

Govt.

35

DM - Neurology

Kerala

Amrita School of Medicine, Elamkara, Kochi

Trust

36

DM - Neurology

Madhya Pradesh

All India Institute of Medical Sciences, Bhopal

Govt.

37

DM - Neurology

Madhya Pradesh

Sri Aurobindo Medical College and Post Graduate
Institute, Indore

Trust

38

DM - Neurology

Maharashtra

Seth GS Medical College, and KEM Hospital, Mumbai

Govt.

39

DM - Neurology

Maharashtra

Bombay Hospital Institute of Medical Sciences,
Mumbai

Govt.

40

DM - Neurology

Maharashtra

Topiwala National Medical College, Mumbai

Govt.

41

DM - Neurology

Maharashtra

Grant Medical College, Mumbai

Govt.

42

DM - Neurology

Maharashtra

Jawaharlal Nehru Medical College, Sawangi
(Meghe), Wardha

Trust

43

DM - Neurology

Maharashtra

Bharati Vidyapeeth University Medical College,
Pune

Trust

44

DM - Neurology

Maharashtra

Dr D Y Patil Medical College, Hospital and
Research Centre, Pimpri, Pune

Trust

45

DM - Neurology

Meghalaya

North Eastern Indira Gandhi Regional Instt. of
Health and Medical Sciences, Shillong

Govt.

46

DM - Neurology

Orissa

All India Institute of Medical Sciences,
Bhubaneswar

Govt.

47

DM - Neurology

Orissa

Kalinga Institute of Medical Sciences,
Bhubaneswar

Trust

48

DM - Neurology

Orissa

Instt. Of Medical Sciences & SUM Hospital,
Bhubaneswar

Trust

49

DM - Neurology

Orissa

SCB Medical College, Cuttack

Govt.

50

DM - Neurology

Pondicherry

Jawaharlal Institute of Postgraduate Medical
Education & Research, Pondicherry

Govt.

51

DM - Neurology

Punjab

Christian Medical College, Ludhiana

Trust

52

DM - Neurology

Punjab

Dayanand Medical College & Hospital, Ludhiana

Trust

53

DM - Neurology

Rajasthan

SMS Medical College, Jaipur

Govt.

54

DM - Neurology

Rajasthan

All India Institute of Medical Sciences, Jodhpur

Govt.

55

DM - Neurology

Rajasthan

Geetanjali Medical College & Hospital, Udaipur

Trust

56

DM - Neurology

Rajasthan

Mahatma Gandhi Medical College and Hospital,
Sitapur, Jaipur

Trust

57

DM - Neurology

Rajasthan

Government Medical College, Kota

Govt.

58

DM - Neurology

Rajasthan

Dr SN Medical College, Jodhpur

Govt.

59

DM - Neurology

Tamil Nadu

Sri Ramachandra Medical College & Research
Institute, Chennai

Trust

60

DM - Neurology

Tamil Nadu

Tirunelveli Medical College,Tirunelveli

Govt.

61

DM - Neurology

Tamil Nadu

Madurai Medical College, Madurai

Govt.

62

DM - Neurology

Tamil Nadu

Saveetha Medical College and Hospital,
Kanchipuram

Trust

63

DM - Neurology

Tamil Nadu

Stanley Medical College, Chennai

Govt.

64

DM - Neurology

Tamil Nadu

Madras Medical College, Chennai

Govt.

65

DM - Neurology

Tamil Nadu

Christian Medical College, Vellore

Trust

66

DM - Neurology

Tamil Nadu

Dhanalakshmi Srinivasan Medical College and
Hospital,Perambalur

Trust

67

DM - Neurology

Tamil Nadu

KanyaKumari Government Medical College,
Asaripallam

Govt.

68

DM - Neurology

Tamil Nadu

Govt. Mohan Kumaramangalam Medical College,
Salem- 30

Govt.

69

DM - Neurology

Tamil Nadu

K A P Viswanathan Government Medical College,
Trichy

Govt.

70

DM - Neurology

Tamil Nadu

Thoothukudi Medical College, Thoothukudi

Govt.

71

DM - Neurology

Tamil Nadu

Chengalpattu Medical College, Chengalpattu

Govt.

72

DM - Neurology

Tamil Nadu

Coimbatore Medical College, Coimbatore

Govt.

73

DM - Neurology

Tamil Nadu

Thanjavur Medical College,Thanjavur

Govt.

74

DM - Neurology

Tamil Nadu

Chettinad Hospital & Research Institute,
Kanchipuram

Trust

75

DM - Neurology

Tamil Nadu

Sree Balaji Medical College and Hospital, Chennai

Trust

76

DM - Neurology

Tamil Nadu

SRM Medical College Hospital & Research
Centre, Chengalpattu

Trust

77

DM - Neurology

Tamil Nadu

Meenakshi Medical College and Research Institute,
Enathur

Trust

78

DM - Neurology

Tamil Nadu

PSG Institute of Medical Sciences, Coimbatore

Trust

79

DM - Neurology

Telangana

Osmania Medical College, Hyderabad

Govt.

80

DM - Neurology

Telangana

Nizams Institute of Medical Sciences, Hyderabad

Govt.

81

DM - Neurology

Telangana

Gandhi Medical College, Secunderabad

Govt.

82

DM - Neurology

Telangana

Chalmeda Anand Rao Insttitute Of Medical
Sciences, Karimnagar

Trust

83

DM - Neurology

Telangana

Deccan College of Medical Sciences, Hyderabad

Trust

84

DM - Neurology

Uttarakhand

All India Institute of Medical Sciences,
Rishikesh

Govt.

85

DM - Neurology

Uttarakhand

Himalayan Institute of Medical Sciences, Dehradun

Trust

86

DM - Neurology

Uttar Pradesh

Institute of Medical Sciences, BHU, Varansi

Govt.

87

DM - Neurology

Uttar Pradesh

Sanjay Gandhi Postgraduate Institute of Medical
Sciences, Lucknow

Govt.

88

DM - Neurology

Uttar Pradesh

King George Medical University, Lucknow

Govt.

89

DM - Neurology

Uttar Pradesh

Dr. Ram Manohar Lohia Institute of Medical
Sciences,Lucknow

Govt.

90

DM - Neurology

West Bengal

Institute of Postgraduate Medical Education &
Research, Kolkata

Govt.

91

DM - Neurology

West Bengal

Calcutta National Medical College, Kolkata

Govt.

92

DM - Neurology

West Bengal

Burdwan Medical College, Burdwan

Govt.

93

DM - Neurology

West Bengal

Nilratan Sircar Medical College, Kolkata

Govt.

94

DM - Neurology

West Bengal

Govt. Medical College, Kolkata

Govt.

Syllabus

A DM in Neurology is a three years specialization course that provides
training in the stream of Neurology.

The course content for DM in Neurology is given in the Competency-Based Postgraduate Training Programme released by National Medical Commission, which can be assessed through the link mentioned below: 

NMC Guidelines For Competency Based Training Programme For DM Neurology

SYLLABUS

Course contents

AIM:

To produce specialists with necessary skills, judgement and sense of dedication to tackle all major and minor cardiac problems. The candidates will be trained in all aspects of Neurology starting from Basic Sciences to recent advances.

PAPER I: BASIC SCIENCES RELATED TO NEUROLOGY

NEUROANATOMY

The Neuroanatomy with special emphasis on development of:

· Neuroaxis (brain, spinal cord and neurons and glia),

· Autonomic nervous system and their maturation process in the post-natal, childhood and adolescent states;

· Location and significance of stem cells,

· CSF pathways,

· Blood supply and sino venous drainage of brain and spinal cord, the meninges,

· Skull and vertebral column, the cranial nerves, spinal roots, plexuses, and their relation to neighboring structures;

· Anatomy of peripheral nerves,

· Neuromuscular junction and muscles;

· Histology of cerebrum, cerebellum, pituitary gland, brain stem and

spinal cord, nerves and neuromuscular junction and muscle.

· Functional anatomy of lobes of cerebrum and white matter tracts of brain and spinal cord, craniovertebral junction, conus and epiconus and cauda equina, brachial and lumbosacral plexuses, cavernous and other venous sinuses;

· New developments in understanding of:

o Ultrastructural anatomy of neurons,

o axonal transport,

o neural networks and synapses and nerve cell function at molecular level.

NEUROPHYSIOLOGY

• Neurophysiology will cover all the physiological changes in the nervous system during its normal function with special reference to nerve impulse transmission along myelinated fibers,
• neuromuscular junction and synaptic transmission,

· muscle contraction;

· visual, auditory and somatosensory and cognitive evoked potentials;

· Regulation of secretions by glands, neural control of viscera such as heart, respiration, GI tract, bladder and sexual function; sleep-wake cycles;

· Maintenance of consciousness,

· special senses,

· control of functions of (a) pituitary, (b) autonomic system (c) cerebellum, (d) and extrapyramidal functions,

· reflexes,

· upper and lower motor neuron concepts and sensory system.

MOLECULAR BIOLOGY

Brain is the one structure where maximum genes are expressed in the human

body. The topics include:

· Principles of molecular biology including Gene Structure, Expression and regulation;

· Recombinant DNA Technology;

· PCR Techniques,

· Molecular basis for neuronal and glial function,

· Molecular and cellular biology of the membranes and ion-channels,

· Mitochondrial genome,

· Role of RNA in normal neuronal growth and functional expression,

· Receptors of neurotransmitters,

· Molecular and cellular biology of muscles and neuromuscular junction, etc.

· The Human Genome and its future implications for Neurology including

developmental and neurogenetic disorders,

· bioethical implications and genetic counselling,

· Nerve growth and other trophic factors and neuroprotectors,

· Neural Tissue modification by genetic approaches including Gene Transfer, stem cell therapy etc.

· Molecular Development of neural tissue in peripheral nerve repair

NEUROCHEMISTRY

· All aspects of normal and abnormal patterns of neurochemistry including:

· Neurotransmitters associated with different anatomical and functional areas of brain and spinal cord, especially with respect to dopaminergic, serotoninergic, adrenergic and cholinergic systems,

· Opioids,

· Excitatory and inhibitory amino acids and their role in pathogenesis of Parkinsonism, depression, migraine, dementia, epilepsy,

· Neuromuscular junction and muscle contractions,

· Carbohydrate, amino acid and lipid metabolism,

· Neural expression of disorders of their metabolism,

· Electrolytes and their effect on encephalopathies,

· Muscle membrane function, storage disorders,

· Porphyria.

NEUROPHARMACOLOGY

• Application of neuropharmacology in medical therapy of epilepsy, Parkinsonism, movement disorders, neuropsychiatric syndromes, spasticity, pain syndromes, disorders of sleep and dysautonomia syndromes.
• Antiepileptic drugs, usage during disorders of renal, hepatic function and in dementia.
• Adverse drug reactions of common drugs used in Neurological disorders including antiepileptic drugs, antiplatelets, anticoagulants etc.

NEUROPATHOLOGY

• Pathological changes in various neurological diseases with special reference to vascular, immune-mediated, demyelinating and dysmyelinating, metabolic and nutritional, genetic and developmental, infectious and iatrogenic and neoplastic etiologies and clinical correlation.
• Pathological changes in nerve and muscle in neuropathies and myopathies.
• Ultrastructural pathology such as apoptosis, ubiquitinopathies, mitochondrial diseases, channelopathies, peroxisomal disorders, inclusion bodies, prion diseases, disorders mediated by antibodies against various cell and nuclear components, paraneoplastic disorders etc.

NEUROMICROBIOLOGY

Microbiological aspects of infectious neurologic diseases including:

• Encephalitis, meningitis, brain abscess, granulomas, myelitis, cold abscess, cerebral malaria, parasitic cysts of nervous system, rhino cerebral mycoses, leprous neuritis, neuro leptospirosis, primary and secondary Neuro HIV infections, congenital TORCH infections of brain, slow virus infections such as CJD and SSPE.
• Neurological complications of viral infections such as Polio, EBV, Chickenpox, Rabies, Herpes, Japanese encephalitis and other epidemic viral infections.

NEUROTOXICOLOGY

Diagnosis and effective therapy of:

· Organophosphorus poisoning,

· hydrocarbon poisoning,

· lead, arsenic, botulinum toxin and tetanus toxicity,

· snake, scorpion, spider, wasp and beestings.

NEUROGENETICS AND PROTEOMICS:

· Autosomal dominant and recessive and X-linked inheritance patterns,

· disorders of chromosomal anomalies,

· Gene mutations, trinucleotide repeats, dysregulation of gene expressions,

· Enzyme deficiency syndromes,

· Storage disorders,

· Disorders of polygenic inheritance,

· Proteomics in health and disease.

NEUROEPIDEMIOLOGY:

• Basic methodology in community and hospital based neuro-epidemiological studies such as systematic data collection, analysis, derivation of logical conclusions,

· Concepts of case-control and cohort studies, correlations,

· Regressions and survival analysis,

· Basic principles of clinical trials.

PAPER II: CLINICAL NEUROLOGY INCLUDING PEDIATRIC NEUROLOGY and NEUROPSYCHIATRY.

GENERAL EVALUATION OF THE PATIENT

• The science and art of history taking,
• Physical examination including elements of accurate history taking, symptoms associated with neurological disease,
• Physical examination of adults, children, infants and neonates, syndromes

associated with congenital and acquired neurological disease, cutaneous

markers,

· Examination of unconscious patients,

· Examination of higher mental functions, cranial nerves, the ocular fundus,

· Examination of tone, power of muscles,

· Proper elicitation of superficial and deep reflexes including alternate techniques,

· Neonatal and released reflexes,

• Neurodevelopmental assessment of children, sensory system, peripheral nerves, signs of Meningeal irritation, skull and spine examination including measurement of head circumference, shortness of neck and carotid pulsations .and vertebral bruits.

DISTURBANCES OF SENSORIUM

• Pathophysiology and diagnosis of COMA,
• Diagnosis and management of coma, delirium and acute confusional states, reversible and irreversible causes,
• Persistent vegetative states and brain death,
• Neurophysiological evaluation and confirmation of these states,
• Mechanical ventilation and other supportive measures of comatose patient,
• Prevention of complications of prolonged coma,

· The significance of timely brain death in organ donation and ICU resource utilization.

SEIZURES and EPILEPSY and SYNCOPE

· Diagnosis of seizures, epilepsy and epileptic syndromes,

• Recognition, clinical assessment and management of seizures especially their electrodiagnosis, video monitoring with emphasize on phenomenology and their correlation with EEG,
• Structural and functional brain imaging such as CT and MRI and fMRI and SPECT scan, 
• Special situations such as epilepsy in pregnant and nursing mothers, driving, risky occupations, its social stigmas differentiation from pseudo seizures,

• Use of conventional and newer antiepileptic drugs, their drug interactions and adverse effects etc.,
• Modern lines of management of intractable epilepsies, such as ketogenic diet, vagal nerve stimulation, epilepsy surgery,
• Pre-surgical evaluation of patients,
• Management of status epilepticus and refractory status epilepticus,
• Differentiation of seizures from syncope, drop attacks, cataplexy, startles etc.

HEADACHES and OTHER CRANIAL NEURALGIAS

· Acquisition of skills in the analysis of headaches of various causes such as those from raised intracranial pressures, migraines, cranial neuralgias, vascular malformations,

· Meningeal irritation, Psychogenic etc. and their proper pharmacologic management.

CEREBROVASCULAR DISEASES

· Vascular anatomy of the brain and spinal cord,

• Various causes and types of cerebrovascular syndromes, ischemic and hemorrhagic types, arterial and venous types, anterior and posterior circulation strokes,

· OCSP and TOAST classifications,

· Investigation of strokes including neuroimaging using Dopplers,

• CT and MR imaging and angiography, acute stroke therapy including

thrombolytic therapy,

· Interventional therapy of cerebrovascular diseases,

· Principles of management of subarachnoid haemorrhage etc.

• Special situations like strokes in the young, strategies for primary and secondary prevention of stroke.

DEMENTIAS

· Concept of minimal cognitive impairment,

• Reversible and irreversible dementias causes such as Alzheimer’s and other neurodegenerative diseases and vascular and nutritional and infectious dementias, their impact on individuals, families and in society.
• Genetic and familial syndromes.
• Pharmacotherapy of dementias, the potential role of cognitive rehabilitation and special care of the disabled.

PARKINSONISM AND MOVEMENT DISORDERS

· Disorders of the extrapyramidal system such as Parkinsonism, chorea, dystonia, athetosis, tics, their diagnosis and management,

· Pharmacotherapy of Parkinsonism and its complications,

• management of complications of Parkinsonism therapy, including principles of deep brain stimulation and lesion surgeries.

· Use of EMG-guided botulinum toxin therapy,

· Management of spasticity using intrathecal baclofen and TENS.

ATAXIC SYNDROMES:

· Para infectious demyelination, cerebellar tumours, hereditary ataxias, vestibular disorders,

· Diagnosis and management of brainstem disorders,

· Axial and extra-axial differentiation.

CRANIAL NEUROPATHIES:

• Disorders of smell, vision, visual pathways, pupillary pathways and reflexes,
• Internuclear and supranuclear ophthalmoplegia,
• Other oculomotor disorders,
• Trigeminal nerve testing,
• Bell’s palsy,
• Differentiation from UMN facial lesions,
• Brain stem reflexes,
• Investigations of vertigo and dizziness,
• Differentiation between central and peripheral vertigo,

· Differential diagnosis of nystagmus,

· Investigations of deafness, bulbar and pseudobulbar syndromes.

CNS INFECTIONS:

• Diagnosis and management of viral encephalitides, meningitis bacterial, tuberculous, fungal, parasitic infections such as cysticercosis, cerebral malaria, SSPE, Neuro HIV primary and secondary infections with exposure to gram stain and cultures, bac tec, QBC, ELISA and PCR technologies.

NEUROIMMUNOLOGY DISEASES

• Diagnosis and management of CNS conditions such as Multiple Sclerosis, PNS conditions such as GBS, CIDP, Myasthenia gravis, polymyositis.

NEUROGENETIC DISORDERS

· Various chromosomal diseases,

• Single gene mutations such as enzyme deficiencies,
• Autosomal dominant and recessive conditions and X-linked disorders,

trinucleotide repeats,

• Disorders of DNA repair. Genetics of Huntington’s disease, familial dementias, other storage disorders, hereditary ataxias,
• Hereditary spastic paraplegias, HMSN, muscular dystrophies, mitochondrial inheritance disorders.

DEVELOPMENTAL DISORDERS OF NERVOUS SYSTEM

· Neuronal migration disorders,

· Craniovertebral junction diseases,

· Spinal dysraphism,

• Phacomatoses and other neurocutaneous syndromes- their recognition and management.

MYELOPATHIES

• Clinical diagnosis of distinction between compressive and non-compressive myelopathies,

· Spinal syndromes such as anterior cord, subacute combined degeneration,

· Central cord syndrome,

· Brown-Sequard syndrome,

· Tabetic syndrome,

· Ellsberg phenomenon.

· Diagnosis of spinal cord and root compression syndromes,

· CV junction lesions,

· Syringomyelia, conus cauda lesions,

· Spinal AVMs,

· tropical and hereditary spastic paraplegias,

· Fluorosis.

PERIPHERAL NEUROPATHIES

• Immune mediated, hereditary, toxic, nutritional and infectious type peripheral neuropathies; their clinical and electrophysiological diagnosis.

MYOPATHIES AND NEUROMUSCULAR JUNCTION DISORDERS

· Clinical evaluation of patients with known or suspected muscle diseases aided by EMG,

• Muscle pathology, histochemistry, immunopathology and genetic studies,
• Dystrophies, polymyositis, channnelopathies, congenital and mitochondrial myopathies,

· Neuromuscular junction disorders such as myasthenia, botulism, Eaton-lambert syndrome,

• Snake and organophosphorus poisoning, their electrophysiological diagnosis and management.

· Myotonia, stiff person syndrome.

PAEDITRIC NEUROLOGY:

· Normal development of motor and mental milestones in a child, Cerebral palsy,

· Attention deficit disorder,

· Autism,

· Developmental dyslexia,

· Intrauterine TORCH infections,

· Storage disorders,

· Inborn errors of metabolism affecting nervous system,

· Developmental malformations,

· Child hood seizures and epilepsies,

· Neurodegenerative diseases.

COGNITIVE NEUROLOGY AND NEUROPSYCHIATRY:

· Detailed techniques of higher mental functions evaluation,

• Basics of primary and secondary neuropsychiatric conditions such as anxiety, depression, schizophrenia, acute psychosis, acute confusional reactions (delirium), organic brain syndrome,

· Primary and secondary dementias, differentiation from pseudodementia.

TROPICAL NEUROLOGY

Conditions which are specifically found in the tropics like to be taught in detail;

· Neuro-cysticercosis,

· Cerebral malaria,

· Tropical spastic paraplegia,

· Snake/scorpion/ Chandipura

· Encephalitis,

· Madras Motor Neuron disease etc.

PAPER III: DIAGNOSTIC and INTERVENTIONAL NEUROLOGY INCLUDING NEUROLOGICAL INSTRUMENTATION, DIAGNOSTIC

NEUROLOGY

· Performing and interpreting Digital Electroneurogram, Electromyogram,

· Evoked potentials, Electroencephalography,

· Interpretation of skull and spine X-rays,

· Computerized tomography of brain and spine,

• Magnetic resonance images of brain including correct identification of various sequences, angiograms, MR spectroscopy,

· Basics of functional MRI,

• Interpretation of digital subtraction imaging, SPECT scans of brain, subdural EEG recording, transphenoidal electrode EEG techniques for temporal lobe seizures,
• video EEG interpretation of phenomenology and EEG-phenomenology correlations,
• EEG telemetry,
• Transcranial Doppler diagnosis and monitoring of acute ischemic stroke,
• Subarachnoid haemorrhage,
• Detection of right-to-left shunts etc;
• Colour duplex scanning in Carotid and vertebral extracranial segment screening.

NEUROINSTRUMENTATIONS

Acquire skills in procedures like:

· Intrathecal administration of antispasticity drugs, beta interferons in demyelination, opiates in intractable pain etc.,

· EMG-guided Botox therapy for dystonia,

· Subcutaneous administration of antimigraine and antiparkinsonian drugs,

• Intraarterial thrombolysis in extended windows of thrombolysis in ischemic strokes,
• Transcranial Ultrasound clot-bust intervention in a registry in acute stroke care unit,
• Planning in deep brain stimulation therapy in uncontrolled dyskinesias and on-off phenomena in long standing Parkinsonism,

· Planning in vagal nerve stimulation in intractable epilepsy.

PAPER IV:

RECENT ADVANCES IN NEUROLOGY:

ADVANCES IN NEUROIMAGING TECHNIQUES, BIONICS IN NEURAL PROSTHESIS and REHABILITATION, NEUROPROTEOMICS and NEUROGENETICS, STEM CELL and GENE THERAPY

ADVANCES IN NEUROIMAGING TECHNIQUES:

· Integration of CT, MR, SPECT, and PET images with each other and with EEG.

• EVOKED potentials-based brain maps in structural and functional localization in neurological phenomena and diseases.
• DSA interpretation and diagnosis.

BIONICS IN NEURAL PROSTHESIS AND REHABILITATION:

· Advanced techniques in neuro-rehabilitation such as TENS, principles of man-machine interphase devices in cord, nerve and plexus injuries, cochlear implants, artificial vision.

NEUROPROTEOMICS AND NEUROGENETICS:

Brain functions are regulated by proteomics and genomics linked to various proteins and genes relevant to the brain, the body’s maximum number of proteins and genes being expressed in brain as neurotransmitters or channel proteins and predisposing the brain to a number of disorders of abnormal functioning of these proteins.

STEM CELL AND GENE THERAPY:

· Principles of ongoing experiments on stem cell therapy for nervous system disorders such as foetal brain tissue transplants in parkinsonism; intrathecal marrow transplants in MND,MS, and Spinal trauma; myoblasts infusion therapy in dystrophies.

NEUROEPIDEMIOLOGICAL STUDIES AND CLINICAL TRIALS:

The students of the DM course will be trained in conducting sound Neuro-epidemiology studies on regionally and nationally important neurological conditions as well as on diseases of scientific and research interest to the department. They will also be trained in the principles of clinical trials.

Essential Practical Knowledge

1. Online certification in Research Methodology Course

• 2. Certification of NIHSS, MRS, mBI, EDSS
• 3. Interpretation of acute stroke imaging
• 4. Performance of cerebral angiography and interpretation of DSA
• 5. Performance of TCD
• 6. Performance and interpretation of electrophysiological tests

Career Options

After completing a DM in Neurology, candidates will get employment
opportunities in Government and the Private sector.

In the Government sector, candidates have various options to choose from
which include Registrar, Senior Resident, Demonstrator, Tutor, etc.

While in the Private sector, the options include Resident Doctor,
Consultant, Visiting Consultant (Neurology), Junior Consultant, Senior
Consultant (Neurology), and Neurology Specialist.

Courses After DM in Neurology Course

DM in Neurology is a specialization course that can be pursued after
finishing a Postgraduate medical course. After pursuing a specialization in DM in
Neurology, a candidate could also pursue certificate courses and Fellowship
programmes recognized by NMC and NBE, where DM in Neurology is a feeder
qualification.

Frequently Asked Questions (FAQs) –DM in Neurology Course

• Question: What is the
  full form of DM?

Answer: The full form
of DM is a Doctorate of Medicine.

• Question: What is a DM
  in Neurology?

Answer: DM Neurology
or Doctorate of Medicine in Neurology also known as DM in Neurology is a super
specialty level course for doctors in India that they do after
completion of their postgraduate medical
degree course.

• Question: What is the
  duration of a DM in Neurology?

Answer: DM in Neurology
is a super speciality programme of three years.

• Question: What is the
  eligibility of a DM in Neurology?

Answer:
The candidate must have a postgraduate medical Degree in MD/DNB (General Medicine) or MD/DNB
(Paediatrics) obtained from any college/university recognized
by the Medical Council of India (Now NMC)/NBE, this feeder qualification
mentioned here is as of 2022. For any further changes to the prerequisite
requirement please refer to the NBE website.

• Question: What is the
  scope of a DM in Neurology?

Answer: DM in Neurology
offers candidates various employment opportunities and career prospects.

• Question: What is the
  average salary for a DM in Neurology candidate?

Answer: The DM in Neurology
candidate's average salary is between Rs. 30 lakhs to Rs. 60 lakhs per year
depending on the experience.

• Question: Can you
  teach after completing DM Course?

Answer: Yes, the candidate
can teach in a medical college/hospital after completing the DM course.

14, 2021) – Doctor Alejandro Cambiaso, president of the Dominican Association of Health Tourism (ADTS), and Amelia Reyes Mora, president of AF Comunicación Estratégica, announced the celebration of the most important medical tourism event in Central America and the Caribbean, the “VI International Health and Wellness Tourism Congress,” which will be held on November 1 and 2 of this year, at the JW Marriott Hotel, in Santo Domingo.

“The activity features important conferences and panels with renowned national and international speakers, aimed at the top players of the sector, such as health centers, dentistry, clinical and pharmaceutical laboratories, hotels, insurers, banks, investment funds, investment, airlines, medical facilitators, government, transportation, legal advisors, accreditors, among others,” said Dr. Alejandro Cambiaso.

Medical tourism annually mobilizes more than 21 million people worldwide, presenting an annual growth rate of approximately 20%, constituting a market that oscillates between 74 and 92 billion dollars, according to Patients Beyond Borders.

“This international congress constitutes a platform for multi-sector integration, innovation, networking, business development, and investment opportunities, and public-private synergies at a local and international level,” expressed Amelia Reyes Mora.

The 2020-2021 Medical Tourism Index, the top ranking of the sector, included nine Latin American nations among the 46 most attractive countries for Americans to receive health services: Costa Rica, Dominican Republic, Argentina, Colombia, Brazil, Panama, Jamaica, Mexico, and Guatemala, which motivates us to draw up joint strategies to strengthen our regional positioning.

This prominent event, which was organized by the ADTS and the Communication and Public Relations firm, AF Comunicación Estratégica, has brought together in its last two recent editions more than 800 participants and around 70 local exhibitors, Canada, Costa Rica, the United States, India, Mexico, Puerto Rico, Panama, Spain, Colombia and Caribbean islands and more than 110 sponsors.

For more information about the event, registrations, and sponsorships, access the web portal: https://congresoadts.com/  (809) 567-2663.

About the Dominican Health Tourism Association (ADTS, for its acronym in Spanish): The Dominican Health Tourism Association is a non-profit organization that promotes the Dominican Republic as an ideal place for health tourism, because of its high-quality, cost-effective medical, dental, and wellness services, hospitality conditions, attractive geographical position, and climate.

PAHO provides guidance to countries in response to increased chikungunya cases

Cristina Mitchell

15 Feb 2023

USA: Long-term achievement of lower LDL-C levels, down to <20 mg/dL, is associated with a reduced risk of cardiovascular (CV) outcomes and no safety concerns in patients with atherosclerotic cardiovascular disease, according to an analysis of FOURIER-OLE. The study appeared in the journal Circulation on Feb 13 2023.

LDL-C (low-density lipoprotein cholesterol) is a well-known risk factor for atherosclerotic cardiovascular disease. However, there is no information on the optimal achieved LDL-C level concerning safety and efficacy in the long term.

FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) comprised 27 564 patients with stable atherosclerotic cardiovascular disease. They were randomized to evolocumab or placebo and followed for a median of 2.2 years. In FOURIER-OLE, the open-label extension, 6635 patients transitioned to open-label evolocumab irrespective of initial treatment allocation in the parent trial and were followed for an additional five years.

Prakriti Gaba from Brigham and Women's Hospital and Harvard Medical School in Boston, MA, and colleagues examined the relationship between achieved LDL-C levels, defined as an average of the first two measured LDL-C levels, in FOURIER-OLE (in 6559 patients) and the incidence of subsequent CV and safety outcomes. Sensitivity analyses were also performed to evaluate cardiovascular and safety effects in the whole FOURIER-OLE and FOURIER patient population.

The study led to the following findings:

· In FOURIER-OLE, 40%, 24%, 16%, 12%, and 7% patients achieved LDL-cholesterol levels of 20 to <40, <20, 40 to <55, ≥70, and 55 to <70 mg/dL, respectively.

· The team observed a monotonic relationship between lower achieved LDL-C levels—down to very low levels <20 mg/dL—and a lower risk of the primary efficacy endpoint (composite of myocardial infarction, cardiovascular death, stroke, or hospitalization for unstable angina or coronary revascularization) and the key secondary efficacy endpoint (composite of myocardial infarction, cardiovascular death, or stroke) that persisted after multivariable adjustment.

· No statistically significant associations were found between lower achieved levels of LDL-C and increased risk of the safety outcomes (new or recurrent cancer, serious adverse events, hemorrhagic stroke, cataract-related adverse events, neurocognitive adverse events, new-onset diabetes, muscle-related events, or noncardiovascular death) in the primary analyses.

· Similar findings were seen in the whole FOURIER-OLE and FOURIER cohort up to a maximum follow-up of 8.6 years.

To conclude, long-term achievement of lower LDL-cholesterol levels down to <20 mg/dL was linked with a lower risk of CV outcomes and no notable safety concerns in patients with cardiovascular disease.

Reference:

Gaba P, O'Donoghue ML, Park JG, Wiviott SD, Atar D, Kuder JF, Im K, Murphy SA, De Ferrari GM, Gaciong ZA, Toth K, Gouni-Berthold I, Lopez-Miranda J, Schiele F, Mach F, Flores-Arredondo JH, López JAG, Elliott-Davey M, Wang B, Monsalvo ML, Abbasi S, Giugliano RP, Sabatine MS. Association Between Achieved Low-Density Lipoprotein Cholesterol Levels and Long-Term Cardiovascular and Safety Outcomes: An Analysis of FOURIER-OLE. Circulation. 2023 Feb 13. doi: 10.1161/CIRCULATIONAHA.122.063399. Epub ahead of print. PMID: 36779348.