Patient Remote Monitoring and Constitutional Rights: Avoiding a Slippery Slope

 Our digitally connected world has created new opportunities - and potential perils - at the nexus of medical care and patient rights. Telemedicine played a huge role during the COVID pandemic, helping medical providers at least stay nominally connected to their patients, allowing for remote exams, prescription checks, and the like. 

But the same technology can become a tool that intrudes on the provider-patient relationship and medical privacy. Law enforcement can use it to monitor patients to whom doctors prescribe legal pain medication for legitimate purposes under the false presumption that patients will misuse them. That can inflict even more harm on a population of patients already collateral damage in America’s war on drugs.

Of course, advances in telemedicine technology and techniques were one of the few bright spots during the pandemic, and those provider-patient relationships remained voluntary and took place under the privacy protections afforded under the Health Insurance Portability and Accountability Act (HIPAA). 

But now, the ongoing controversy over opioid prescriptions and use has fueled interest by some in Congress to ask the Government Accountability Office (GAO) to study the possibilities on the “use of remote monitoring with respect to individuals who are prescribed opioids." That GAO study provision can be found in Section 118 of the Support for Patients and Communities Reauthorization Act, which passed the House Energy and Commerce Committee by a 49-0 vote on July 19.

There has been a wealth of literature on remote monitoring of patients for the outpatient management of opioid use disorder, including addiction specialists tapering their methadone patients gradually off of the drug in a way that avoids withdrawal symptoms. This is because, with the advent of telemedicine, it is hoped that doctors can manage all sorts of conditions remotely using sensing devices without the patients having to come to the doctor's office. 

The research is not limited to opioid monitoring. Technologies to remotely monitor blood pressure, EKGs, oxygenation, and more are either already available or soon will be. Private technology companies, funded by venture capital, continue to developthese devices, responding to the growing market for telehealth services. 

The government's only role here is to remove the 19^th and 20th-century regulatory relics that stunt the growth of telehealth services. These are welcome developments, but we must never lose sight of the potential for the compromise or even abuse of such collected and stored data.

The recent bill’s GAO study requirement is a solution in search of a problem. There is no need for legislation to fund studies to remotely monitor opioid use since these studies are already being done and are well underway. As such, the GAO study requirement in the bill appears to be a form of legislative political theater aimed at showing concern for the opioid overdose problem. 

Moreover, the wording of the study language is too broad. It doesn't talk about remote monitoring for treating opioid use disorder or dependency, but just remote monitoring of patients on opioids. Such expansive language can lead to unintended and harmful consequences. 

Despite abundant public data to the contrary, most lawmakers believe that all these people accessing fentanyl, cocaine, meth, and Tranq on the black market are the products of doctors prescribing opioids to their patients to treat their pain. That misinformation is, in many ways, at the heart of the problem in our public debate on how to deal responsibly with opioids. 

A government-sanctioned study like the proposed one by GAO will no doubt show that, given current or projected technologies, it is possible to remotely monitor how patients use opioids through their physiological responses. With such data in hand, misinformed anti-opioid crusaders in Congress will then take the next "logical" step - legislation requiring all patients prescribed opioids for any reason to be remotely monitored (another example of "cops practicing medicine.") 

This will intimidate health care practitioners into further curtailing opioid prescribing to their patients in pain. This simply exacerbates the misery that state and federal opioid prescribing policies have already inflicted on them that is driving many to suicide and some to homicide.

We already live in an over-surveilled country as it is, courtesy of draconian, sweeping laws like the PATRIOT Act and the FISA Amendments Act, along with the proliferation of automated license plate readers, facial recognition technology, etc. Such laws and technologies have badly compromised our privacy in our personal communications, and the last thing we need is a perversion of telemedicine technology to further compromise the already-endangered medical provider-patient relationship.

Jeffrey A. Singer, MD practices general surgery in Phoenix, Arizona, and is a senior fellow at the Cato Institute; Patrick G. Eddington is a senior fellow at the Cato Institute.

https://www.realclearhealth.com/blog/2023/08/31/patient_remote_monitoring_and_constitutional_rights_avoiding_a_slippery_slope_976700.html

Proximal Liars

 When the virologist Kristian Andersen testified before the U.S. House Select Subcommittee on the Covid Pandemic this summer, he was asked to explain a seeming contradiction between his public and private statements about the origins of Covid.

In March 2020, as one of the authors of a study about the “proximal origins” of Covid published in Nature Medicine, Andersen stated that evidence demonstrated that Covid had not emerged from a laboratory but rather from another species, after which it crossed over into humans. Although an earlier draft of the paper left some room for the possibility that Covid might have come from a lab leak, the published version stated flatly that “any type of laboratory-based scenario” was not plausible.

In fact, as internal messages among scientists later revealed, Andersen and his colleagues didn’t have anywhere near this level of certainty, either before or after the paper was published. On a Slack forum of scientists convened by Anthony Fauci, Andersen himself wrote, “Accidental escape [from a lab] is in fact highly likely—it’s not some fringe theory.” He had told Fauci the same thing just a few weeks earlier. Andrew Rambaut, a biologist from the University of Edinburgh also on the Slack forum, said, “I literally swivel day by day thinking it is lab escape or natural.” A few weeks later, the paper was published. How had Andersen and his colleagues moved off their position of doubt about Covid’s origins so quickly?

The question matters because the “proximal origin” paper became the ur-text for shutting down any further exploration of the idea that Covid might have emerged from a laboratory in Wuhan. It also conveniently shut down any discussion of the possibility that China and, by implication, the United States’ scientific funding apparatus—which had subsidized controversial “gain of function” research in Wuhan—were responsible.

And yet the only message from the designated scientific leaders at the time was that anything other than natural origins was rank speculation at best and harmful conspiracy-theorizing at worst. Speaking in the White House press briefing room, Fauci assured the public that the data from the proximal-origins study were “totally consistent with a jump of a species from an animal to a human.” Francis Collins of the National Institutes of Health posted a message on the NIH website declaring, “This study leaves little room to refute a natural origin for Covid-19.”

Media outlets immediately ran with the story, citing the paper as definitive proof that the lab-leak hypothesis was little more than a conspiracist’s fever dream. Facebook moved swiftly to censor posts that referenced lab-leak theories. Cable-news hosts denounced mention of lab leaks as conspiracy-mongering. Joy Reid declared the lab-leak theory “debunked bunkum,” and her fellow MSNBCers Joe Scarborough and Nicole Wallace called it a “conspiracy theory.” On CNN, Drew Griffin claimed there was “zero proof” behind the lab-leak “conspiracy theory,” later claiming, incorrectly, that it had been “widely debunked.” The New York Times even chided Senator Tom Cotton for raising the possibility of a lab leak, calling it a “fringe” idea that encouraged unhealthy thought patterns. As Andersen watched the media attention lavished on his and his colleagues’ work, he wrote to a fellow scientist, “We RUUUUUUULE. That’s tenure secured, right there.”

Tenure might have been secured for Andersen, but public trust in the scientific establishment has since plummeted. Scientists who had been uncertain about the origins of Covid nevertheless deliberately obfuscated and misled reporters to craft a narrative that suited their political ends. One of Andersen’s colleagues had warned him privately about “the shit show that would happen if anyone serious accused the Chinese of accidental release,” and Andersen agreed, noting, “I hate when politics is injected into science—but it’s impossible not to, especially given the circumstances.” An astonishingly incurious media were more than happy to help them.

The crucial media organ for embedding the narrative that the lab-leak argument was mere conspiracy was the New York Times. At the time, the paper’s Covid reporter, Donald McNeil Jr., was pursuing the story, repeatedly asking Andersen for comment and explanation of possible origins, including a lab leak. Andersen boasted about misleading McNeil. “Can’t ignore him and can’t just give him the scientific story,” he wrote a colleague. “That would only lead to follow up question.” He added, “I’m hoping that by including ‘extremely busy’ I’ll also be able to deflect requests for a call—and also gives me a get out of jail card for ignoring potential request.”

McNeil at least attempted to pursue the lab-leak hypothesis. When he was abruptly forced to resign from the Times over a trumped-up claim of making a racist remark, McNeil was replaced by Apoorva Mandavilli, who immediately fell into line with the approved narrative. In May 2021, she tweeted, “Someday we will stop talking about the lab leak theory and maybe even admit its racist roots. But alas, that day is not yet here.”

The Times continued to endorse the narrative. Even when some of Fauci’s emails were leaked to the press in 2021, showing far more ambiguity about the origins debate, the Times gave space to Andersen to defend scientists’ behavior as merely being the scientific process at work: “Overall, this is a textbook example of the scientific method where a preliminary hypothesis is rejected in favor of a competing hypothesis after more data became available and analyses are completed.” But given the behavior of Chinese officials in Wuhan, including barring any independent investigations of the laboratory, how could a full analysis of the possibility ever have occurred?

As recently as mid-July 2023, the Times was still defending Andersen and his colleague after their House testimony. “Two world-renowned virologists appeared on Capitol Hill on Tuesday and delivered a pointed defense of their findings that the coronavirus pandemic was natural in origin, and told skeptical Republicans that Dr. Anthony S. Fauci did not exert influence over a scientific paper they wrote to that effect,” the lede to the Times story read.

Other outlets, such the Atlantic, have indulged in convenient semantical arguments to downplay what the leaked Slack messages revealed. “From the start, the problem has been that a ‘lab leak’ could mean many things,” Daniel Engber wrote. He criticized the congressional hearing, saying it “gestures not toward the true origin of Covid, but toward the origin of the origins debate.” This is a rather tortured way of avoiding the topic of what the scientists in question did wrong. Rather than say, “We’re not sure but here are the possibilities for the origins of Covid,” the community closed ranks and declared the lab-leak theory verboten.

Also left unexplored by mainstream media outlets were potential conflicts of interest among the authors of the proximal-origins paper. For example, while Andersen was seeking guidance from Fauci about how to frame the arguments in the paper, he was also waiting to find out whether Fauci would approve an $8.9 million research grant he had submitted. Fauci approved Andersen’s grant four days after the proximal-origins paper was published. One would think an intrepid science reporter might want to find out whether this was merely coincidence or in fact a conflict of interest.

Of course, we know about any of these internal scientific debates only because Republicans in the House subpoenaed the Slack conversations and emails. They may have done so for their own political purposes, but that still raises the question of why journalists, who pride themselves on being the country’s truth-seekers, so quickly became eager, incurious purveyors of what those in power told them to say during the pandemic.

Contemporary media are siloed not only along partisan lines but also along elite and non-elite lines—in the case of the Covid origins debate, the Times and other mainstream outlets doubled down on serving as the mouthpiece of the elite. They could have examined their own editorial mistakes; taken responsibility for failing to realize they were being manipulated by the scientists; and vowed to do better in future by exercising a more vigorous journalistic skepticism about all sources, not merely the ones who question the newspaper’s preferred narrative. They could have done their jobs better. Instead, they aided and abetted the undermining of the public’s trust in scientific institutions. But at least they helped a bald-faced liar get tenure.

https://www.commentary.org/articles/christine-rosen/covid-origins-kristian-andersen-media-coverage/

Humana sues U.S. government to block Medicare clawback rule

 Humana on Friday sued the U.S. government to block a Biden administration policy that would let Medicare claw back billions of dollars of payments to insurers.

The lawsuit in federal court said the Centers for Medicare and Medicaid Services "did not even try" to justify its more aggressive approach toward determining whether private Medicare Advantage plans for people age 65 and older were overpaid.

Humana's lawsuit challenges a rule announced on Jan. 30 that would let the government recoup payments when audits uncover charges for diagnoses that are not in patients' medical records.

The administration said the increased oversight could help the government collect as much as $4.7 billion over 10 years.

Humana said the rule was "arbitrary and capricious," and threatened "unpredictable consequences for Medicare Advantage organizations and the millions of seniors who rely on the Medicare Advantage program for their healthcare."

CMS is part of the U.S. Department of Health and Human Services. The agency did not immediately respond to a request for comment.

Humana filed its lawsuit with the U.S. District Court in the Northern District of Texas, which has in recent years been sympathetic toward some challenges to federal rulemaking.

The case was assigned to U.S. District Judge Reed O'Connor, a Fort Worth judge who previously declared unconstitutional all or part of the Affordable Care Act, also known as Obamacare.

https://finance.yahoo.com/news/humana-sues-block-medicares-clawbacks-153147681.html

Bavarian Nordic abandons Covid booster

 Bavarian Nordic is abandoning its Covid-19 booster vaccine after Phase III results — even though it did hit the primary endpoint of the study — because it’s not as effective against newer variants of the virus.

https://endpts.com/bavarians-covid-booster-not-a-commercial-opportunity-after-data-show-its-not-as-effective-against-new-variants/

Post-COVID Cognitive Deficits Linked With Clotting Proteins

 Two distinct blood biomarker profiles predicted cognitive deficits 6 and 12 months after COVID-19, prospective U.K. data showed.

Both biomarker profiles featured proteins involved in coagulation, reported Maxime Taquet, PhD, of the University of Oxford in England, and co-authors in Nature Medicineopens in a new tab or window.

Among 1,800 patients hospitalized for COVID-19 during the first wave of the pandemic, a blood profile that included high levels of fibrinogen correlated with both objective and subjective cognitive deficits. A second profile linked elevated D-dimer relative to C-reactive protein (CRP) with subjective cognitive deficits and occupational impact, which was partly mediated by fatigue and shortness of breath.

The results could not be explained by cognitive problems preceding the infection, nor by depression or anxiety, the researchers noted. The D-dimer relationship appeared specific to COVID infection, whereas high fibrinogen was a risk factor for cognitive deficits, regardless of the cause.

The findings provide a clue about one mechanism that might cause post-COVID cognitive deficits, Taquet told MedPage Today. "The observation that raised levels of fibrinogen and D-dimer relative to CRP levels are associated with later cognitive deficits suggests that hypercoagulation is likely to be involved," he said.

"Subsequent analyses and interpretations in our research suggest three potentially distinct mechanisms," Taquet added. "One involves blood clots in the brain directly affecting cognition; another relates to the direct effect of fibrinogen on the brain; and a third one involves blood clots in the lungs [that] might lead to subsequent hypoxia or fatigue, which can have cognitive manifestations."

Brain fog and other cognitive problems often persist after COVID -- especially among patients hospitalized with acute SARS-CoV-2 infection

opens in a new tab or window -- but how and why they develop remain unknown.

Cognitive deficits appear to occur more frequently after COVID than other respiratory tract infections, Taquet noted. "In one of our studies, we showed they were 36% more commonopens in a new tab or window," he said. While they're less common after other infections, it's possible that mechanisms are similar: "COVID-19 may serve as a window into the possible brain consequences of respiratory infections," he suggested.

Taquet and colleagues studied 1,837 patients in the PHOSP-COVIDopens in a new tab or window cohort who had been hospitalized for COVID-19 in the U.K. between January 2020 and November 2021. Mean age was 58, and 37% were women.

The researchers used canonical correlation analysis to find covariation patterns between a set of six blood biomarkers measured on admission to hospital (CRP, D-dimer, fibrinogen, lymphocyte, and neutrophil and platelet counts) with a set of cognitive scores measured 6 and 12 months later. Cognitive scores included components of the Montreal Cognitive Assessment (MoCA) to assess objective deficits and cognitive items from the Patient Symptom Questionnaire (C-PSQ) to gauge subjective deficits.

In a subset of patients with C-PSQ scores before and after SARS-CoV-2 infection, subjective cognitive function declined at 6 and 12 months on average. High fibrinogen or high D-dimer levels relative to CRP were not more common in people with pre-existing cognitive deficits.

The researchers reproduced their analysis using electronic health records from a network of 57 healthcare organizations primarily in the U.S., and found that acute D-dimer level was significantly associated with post-COVID cognitive changes. Acutely raised fibrinogen level also was linked with post-COVID cognitive deficits.

The findings are limited to people who had COVID-19 in the first wave and who were ill enough to have been hospitalized, Taquet and colleagues emphasized. Blood samples were assessed only at the time of acute infection. Mechanisms are speculative, and further studies are needed to better delineate them, the researchers acknowledged.

"We're excited to see whether and how our findings will inform future research into possible treatments, which people currently living with post-COVID cognitive deficits urgently need," Taquet said.

Disclosures

This work was funded by MQ Mental Health Research, the Wolfson Foundation, UK Research and Innovation, National Institute of Health Research, and the National Institute for Health and Care Research Oxford Health Biomedical Research Centre.

The authors declared no competing interests.

Primary Source

Nature Medicine

Source Reference: opens in a new tab or windowTaquet M, et al "Acute blood biomarker profiles predict cognitive deficits 6 and 12 months after COVID-19 hospitalization" Nat Med 2023; DOI: 10.1038/s41591-023-02525-y.

https://www.medpagetoday.com/neurology/longcovid/106155

Extreme dietary habits for carbohydrates and fats affect life expectancy

 A new study, published in The Journal of Nutrition, suggests that extreme dietary habits involving carbohydrates and fats affect life expectancy. Researchers from Nagoya University Graduate School of Medicine in Japan led by Dr. Takashi Tamura found that a low carbohydrate intake in men and a high carbohydrate intake in women are associated with a higher risk of all-cause and cancer-related mortality and that women with higher fat intake may have a lower risk of all-cause mortality. Their findings suggest that people should pursue a balanced diet rather than heavily restricting their carbohydrate or fat intake.

 

While low-carbohydrate and low-fat diets are becoming popular as a way to promote weight loss and improve blood glucose levels, their long-term effects on life expectancy are less clear. Interestingly, recent studies conducted in Western countries suggest that extreme dietary habits for carbohydrates and fats are associated with a higher risk of mortality. However, few studies have explored these associations in East Asian populations, including Japanese individuals who typically have relatively low fat and high-carbohydrate dietary intakes.

 

The authors conducted a follow-up survey over a period of 9 years with 81,333 Japanese people (34,893 men and 46,440 women) to evaluate the association between carbohydrate and fat intakes and the risk of mortality. Daily dietary intakes of carbohydrates, fats, and total energy were estimated using a food frequency questionnaire and calculated as a percentage of total energy intake for carbohydrates and fats. Carbohydrate intake quality (i.e., refined compared with minimally processed carbohydrate intake) and fat intake quality (i.e., saturated compared with unsaturated fat intake) were also assessed to examine the impact of food quality on the association with mortality.

 

They found that men who consumed less than 40% of their total energy from carbohydrates experienced significantly higher risks of all-cause and cancer-related mortality. The trend was observed regardless of whether refined or minimally processed carbohydrate were considered. On the other hand, among women with 5 years or longer of follow-up, those with a high carbohydrate intake of more than 65% had a higher risk of all-cause mortality. No clear association was observed between refined or minimally processed carbohydrate intake and the risk of mortality in women.

 

For fats, men with a high fat intake of more than 35% of their total energy from fats had a higher risk of cancer-related mortality. They also found that a low intake of unsaturated fat in men was associated with a higher risk of all-cause and cancer-related mortality. In contrast, total fat intake and saturated fat intake in women showed an inverse association with the risk of all-cause and cancer-related mortality. They concluded that this finding does not support the idea that high fat intake is detrimental to longevity in women.

“The finding that saturated fat intake was inversely associated with the risk of mortality only in women might partially explain the differences in the associations between the sexes,” Dr. Tamura stated. “Alternatively, components other than fat in the food sources of fat may be responsible for the observed inverse association between fat intake and mortality in women.”

 

This study is extremely important because restricting carbohydrates and fats, such as extremely low-carbohydrate and low-fat diets, are now popular dieting strategies aimed at improving health, including the management of metabolic syndrome. However, this study shows that low-carbohydrate and low-fat diets may not be the healthiest strategy for promoting longevity, as their short-term benefits could potentially be outweighed by long-term risk.

 

Overall, an unfavorable association with mortality was observed for low-carbohydrate intake in men and for high carbohydrate intake in women, whereas high fat intake could be associated with a lower mortality risk in women. The findings suggest that individuals should carefully consider how to balance their diet and ensure that they are taking in energy from a variety of food sources, while avoiding extremes.

 

 

 Dr. Takashi Tamura, the lead researcher of this study
Credit: Department of Preventative Medicine, Nagoya University Graduate School of Medicine

 

The study, "Dietary carbohydrate and fat intakes and risk of mortality in the Japanese population: the Japan Multi-Institutional Collaborative Cohort Study," has been published in The Journal of Nutrition at DOI: 10.1016/j.tjnut.2023.05.027.

 

Authors:

Takashi Tamura, Kenji Wakai, Yasufumi Kato, Yudai Tamada, Yoko Kubo, Rieko Okada, Mako Nagayoshi, Asahi Hishida, Nahomi Imaeda, Chiho Goto, Hiroaki Ikezaki, Jun Otonari, Megumi Hara, Keitaro Tanaka, Yohko Nakamura, Miho Kusakabe, Rie Ibusuki, Chihaya Koriyama, Isao Oze, Hidemi Ito, Sadao Suzuki,^, Hiroko Nakagawa-Senda, Etsuko Ozaki, Daisuke Matsui, Kiyonori Kuriki, Keiko Kondo, Naoyuki Takashima, Takeshi Watanabe, Sakurako Katsuura-Kamano, and Keitaro Matsuo; for the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study

https://www.nagoya-u.ac.jp/researchinfo/result-en/2023/09/20230901-01.html

Why breast cancer survivors don’t take their meds

 For roughly 80% of breast cancer survivors, treatment doesn’t end with surgery, radiation and chemotherapy. Instead, for the next five to 10 years, doctors recommend that they take medication to block sex hormones, which can fuel tumor growth and spark recurrence.

The drugs, no doubt, are life-saving: They’ve been shown to cut risk of cancer recurrence by as much as half in patients with hormone receptor-positive tumors (HR+)—the most common form of breast cancer. Yet despite their promised benefits, 40% of patients stop taking them early and a third take them less frequently than directed.

New CU Boulder research, published this month in the “Journal of Clinical Oncology,” sheds light on why that is and what doctors and the health care system can do about it.

It found that, overall, interventions can increase medication adherence by nearly 1.5 times. But some strategies work better than others.

“Our bottom-line finding is that there are strategies that do work in supporting women to take these life-extending medications, and that we as a cancer care community need to do better,” said senior author Joanna Arch, a professor in the Department of Psychology and Neuroscience and member of the CU Cancer Center on the Anschutz Medical Campus.

Arch noted these so-called “adjuvant endocrine therapies,” like the estrogen-blockers Tamoxifen and aromatase inhibitors, can be costly and come with a host of side effects, including weight gain, sexual side effects, joint pain, depression and sleeplessness.

“Imagine going from your normal estrogen activity to little or no estrogen within days. That’s what these medications do,” she said. “But the women who take them as prescribed also have lower recurrence rates and live longer. It’s a dilemma.”

As more next-generation cancer drugs, including chemotherapy agents, shift from infusions provided in a clinic to oral therapies taken at home, the medical community has grown increasingly interested in developing ways to make sure patients take their pills.

In a sweeping meta-analysis, Arch and her colleagues analyzed 25 studies representing about 368,000 women to gain insight into what works and what doesn’t. 

Educational pamphlets are not enough 

The study found that cost-cutting policy changes, such as providing generic alternatives or requiring insurance companies to cover pills at the same level as infusions, consistently worked. Such “oral parity laws” have been passed in 43 states in recent years.

In one study, participants were asked to create stickers to put on their pill boxes.

Mobile apps and texts to remind patients to take their medication and psychological/coping strategies also yielded modest improvements.

The study’s findings around managing side effects were complicated: Simply educating women on side effects, via pamphlets or verbal explanations, generally failed to increase the likelihood that women took their medication as directed.

But things such as physical therapy, exercise and behavioral counseling aimed at alleviating or managing side effects often worked.

“Education in and of itself is not enough. That is a clear finding,” said Arch, suggesting that doctors write referrals to practitioners who specialize in side effects and follow up with appointment reminders. “Most oncologists, I believe, don’t realize how low adherence is for these women. They assume that if they write the prescription, it’s being taken.”

Addressing mental health is key

One study included in the meta-analysis was Arch’s own.

In it, women were asked to identify their primary motivation for taking their medication—whether it was living to see their child or grandchild grow up, pursuing their art or running a marathon someday. Via an online program, they created a sticker with a photo representing that goal, and the words “I take this for…” below it. Then, they stuck it on their pill box.

Participants were more likely to take their pills, at least for the first month, than those who didn’t.

“Even just a tiny thing like this can help,” said Arch.

Notably, very few studies looked at whether treating depression can help. Arch, aiming to fill this gap, recently launched her own pilot trial.

“One of the most consistent predictors of not adhering to any medication is depression,” she said. “Depression taps motivation.”

The new “Journal of Clinical Oncology” study is the first meta-analysis to show that interventions can be helpful, and that’s important, said Arch, because insurance companies need data to make decisions about what to cover.

But the study also showed that the effects are relatively modest and that there is room for improvement.

Arch said she hopes the study will spark more research into novel ways to support survivors:

“We have a lot of work to do.”

https://www.colorado.edu/today/2023/08/28/why-breast-cancer-survivors-dont-take-their-meds-and-what-can-be-done-about-it