(A) Rotten apples outsell the fresh ones in Kabul, Afghanistan's capital, but such only begins to describe the poverty here, for even bad apples—sold 21 a penny a pound—are luxuries in a city so overcome by tragedy and want. Each day, hundreds of thousands 22 on nothing more than weak tea and handouts of bread. This woebegone nation is enduring its 21^st 23 year of war, unable to escape the malign shadow that geopolitics has cast on its history. Since it 24 as a force five years ago, the Taliban militia has conquered 80 to 90 percent of the country. While they have brought a 25 of security to the territory they control, including Kabul, the better part of their attention is focused on what they know best—fighting in the battlefields, not the governing of a country.

      She canvassed experts, called up cancer centers, and spent hours doing research online, 38 she learned about immunotherapy, a new approach to cancer that oncologists are calling the most promising in decades—and probably ever. Veronica read of an ongoing Duke University trial of a drug called pembrolizumab that is approved and used to treat melanoma and was showing early promise against cancers in other parts of the body too. It’s the same drug that just a few months later would send former President Jimmy Carter’s melanoma, which had spread to his brain, into remission seemingly overnight. In August 2015, Mike learned he’d been accepted into a trial for that same drug. In principle, immunotherapy is simple.

        It’s a way to trigger the immune system’s ability to seek out and destroy invaders. That’s how the body fights off bacteria and viruses. But it doesn’t do that with cancer, which occurs when healthy cells ＿39＿ to outsmart those built-in defenses. That’s where immunotherapy comes in. “Instead of using ＿40＿ forces, like a scalpel or radiation beams, it takes advantage of the body’s own natural immune reaction against cancer,” says Dr. Steven Rosenberg, an immunotherapy pioneer and chief of surgery and head of tumor immunology at the National Cancer Institute (NCI). These strategies don’t target cancer itself but work on the body’s ability to fight it. These therapies, administered in pill or IV form, trigger the immune system to fight cancer cells while keeping healthy cells intact. For someone as frail as Mike, that was an especially appealing prospect.

        The news that one of the Hollywood superstars was diagnosed the aphasia drew everyone’s attention on the causes and effects of such disease. According to the medical statistics in the USA, approximately one-third of stroke survivors suffer from impaired communication abilities, and 30%–42% of these patients have longstanding symptoms of aphasia, and the most common, Broca’s aphasia, is caused by lesions on anterior brain regions, which often require long-term care, leading to substantial economic and mental health burdens on the family and society. 

     Community medical resources have confirmed that promoting full engagement with rehabilitation treatment for post-stroke patients has reduced the disability rate below 40% and increased activities of daily living by 35%. In addition, intensive speech and language therapy (SLT) improves the functional reorganization of the central nervous system； however, high-intensity and high-dose interventions may not be acceptable to all patients. Therefore, other treatments adjunct to SLT might be useful. More specifically, while intensive SLT is effective, recent evidence suggests that scalp acupuncture therapy (SAT) may have beneficial effects on comprehension, oral expression, repetition, denomination, reading and writing in postapoplectic aphasia (Tang, Tang, & Yang, 2019). One research group from Taiwan (Liu, Huang, Xu, Wu, Tao, & Chen, 2021) tried to appraise the costeffectiveness of combining SAT with SLT community patients with Broca’s aphasia after stroke,  compared to SLT alone. They found that combination therapy was cost-effective and reduced the use of non-standard treatments and medications, leading to lower direct non-medical costs and self-paid expenses. 

       In Liu et al.’s (2021) research, a within-trial cost-effectiveness analysis was applied among 203 participants with Broca’s aphasia after stroke who had been randomly assigned to receive scalp acupuncture with SLT (intervention) or SLT alone (control). Both groups underwent SLT, which roughly last 30 minutes each day, 5 days a week for 4 weeks； while the intervention group simultaneously received scalp acupuncture. Moreover, outcomes were measured using informal assessments and self-report questionnaires and the incremental cost-effectiveness ratios (ICERs) were calculated as a measure of the additional costs necessary to achieve greater treatment outcomes. The results of this economic analysis revealed that patients receiving combination therapy reduced their use of non-standard treatment interventions and medications, reflected in reduced direct non-medical costs and self-paid expenses. Combination therapy was less costly than SLT alone calculated according to the modified intention-to-treat principle. In other words, SAT is a cost-effective treatment option for patients with Broca’s aphasia after stroke, compared to SLT alone.

        In short, the study, which included the first economic evaluation of acupuncture treatment in patients with Broca’s aphasia after stroke, had valuable findings and methodological limitations. There are only a few studies on acupuncture treatment in patients with Broca’s aphasia after stroke, Liu et al. (2021) concluded that acupuncture seems to be effective in improving post-stroke aphasia, functional communication and language function, and the best curative effect was achieved with the combination of acupuncture with speech and language training. Potential limitations included lack of blinding, variability of treatment regimens, and a heterogeneous patient sample. While SAT appears to be an effective treatment for post-stroke aphasia, the real-world implementation of SAT in lowincome and middle-income countries and regions may be restricted by poor acupuncture services, inefficient systems, and a deficiency of therapists. Standardized education and training for the public, community physicians, and government agencies are needed to improve awareness of the benefits and cost-effectiveness of SAT. Still, although the effects of acupuncture appear to be persistent as the differences between the groups were slightly larger after 12 weeks follow-up investigation than those who received immediately post-treatment, long-lasting health economic effects require further study.