By Clifton Leaf and Sy Mukherjee
September 11, 2017

Sixteen years ago this morning, two hijacked planes felled the sky-tipped towers of the World Trade Center. A third crashed into the Pentagon; a fourth was downed in a Pennsylvania field before the men who commandeered it could reach their intended target and commit even greater harm.

In all, 3,000 people were murdered that horrific morning and thousands more were wounded. But the impact did not end there. Rather, 9/11 changed everyday existence for untold numbers of people—and in ways that have yet to be fully measured: from the long-term illnesses that plague many first-responders, to the economic cost of airport security delays, to the lasting psychological impacts of emotional trauma.

Consider the last of these. Five to eight weeks after 9/11, Sandro Galea and colleagues randomly interviewed a thousand New Yorkers and found evidence of post-traumatic stress disorder in 7.5% of the group. Based on that rate of prevalence, the researchers estimated, in a 2002 New England Journal of Medicine study, that some 67,000 Manhattanites who lived south of 110th Street (within 11 miles of the Towers) had some indication of PTSD during that time. (Careful readers of Brainstorm Health Daily will recognize Dr. Galea, a well-cited expert in this newsletter, as the dean of the Boston University School of Public Health.)

Additional studies have found similarly wide-scale effects from 9/11 and other terrorist attacks. But the diagnosis of PTSD didn’t get its start with the warfare of terror; it came to light after the terror of war—being added to the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, after it was clear that many Vietnam War veterans were suffering from a constellation of psychological troubles. “The post-Vietnam syndrome was said to be characterized by hyperalertness, sudden reliving of the combat experience, emotional numbing…and guilt over having survived when others had died,” wrote John Helzer and colleagues in a 1987 NEJM article.

Notably, these were the same symptoms experienced by many who had survived major natural disasters—particularly when those events had led to a great loss of life or acute financial pain. A substantial number of people whose lives were upended by Hurricanes Katrina and Sandy have suffered from—and, in some cases, continue to suffer from—PTSD. And, unfortunately, we will see the same outcome in a significant share of those who witnessed their loved ones be harmed, or their homes be destroyed, in Hurricanes Harvey and Irma.

There is increasing evidence, moreover, that this syndrome isn’t just psychological. Several research studies have found a strong link between PTSD and systemic inflammation and other immune system responses. A paper published a year ago in the Journal of Psychiatric Research found elevated levels of c-reactive protein, a blood-based marker of inflammation (which I wrote about two weeks ago) in survivors of the World Trade Center attack; the more traumatic the experience, the higher the CRP. The association between this biomarker and PTSD is so strong, in fact, that some have proposed diagnosing the disorder with a CRP blood test. (It may even be that high levels of systemic inflammation predispose people to this stress pathology.)

Sixteen years after 9/11, we are still discovering the full health impacts of that dark day. On a more hopeful front: We are also still learning how to heal.

More news below.

Clifton Leaf, Editor in Chief, FORTUNE
@CliftonLeaf
clifton.leaf@fortune.com

DIGITAL HEALTH

IBM, MIT partner on artificial intelligence research. IBM is doubling down on its artificial intelligence ambitions with plans to build a new research lab at the Massachusetts Institute of Technology over the next decade. And the company’s planning to spend $240 million on the effort, which involves its supercomputer Watson and will be spearheaded by both IBM and MIT scientists. (Denver Post)


INDICATIONS

Allergan’s brazen Native tribe deal has pharma boosters nervous. On Friday, Allergan announced what was, until that moment, an unprecedented move for a pharmaceutical company: Housing patents for a key drug with a Native American tribe in upstate New York to prevent intellectual property challenges from rivals. I spoke with Allergan CEO Brent Saunders and chief legal officer Bob Bailey, and you can read up on the unusual mechanics and reasoning behind the deal here. The question that many industry observers are asking now, though, is: Has Allergan opened the flood gates for yet another major scandal? (Fortune)

Johnson & Johnson abandons play at crowded hepatitis C market. J&J drug making unit Janssen is choosing to abscond from the hepatitis C research market, citing the significant number of effective therapies now available in the field. Competitors like Gilead, Merck, and others have unleashed a wave of next-gen treatments, some of which can tackle all major hep C strains with as little as eight weeks of treatment. (Reuters)


THE BIG PICTURE

The last-ditch Obamacare repeal bill’s prospects are looking slim. There is one final, final attempt at repealing and replacing Obamacare underway—a bill proposed by Louisiana Sen. Bill Cassidy and South Carolina’s Lindsey Graham that would block grant large portions of health spending funds to states. But party leadership isn’t waxing optimistic that the bill (which isn’t even a finished product and has no CBO score) can whip up 50 votes before the end of the month, after which health care legislation would be require more votes to pass. (Politico)


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