including Vicodin and fentanyl patches worked no better than Tylenol and
other over-the-counter pills at relieving chronic back pain and hip and
knee arthritis in a year-long study of mostly men at Minneapolis VA
clinics. Both groups had slight improvement. (AP Photo/Sue Ogrocki,
Chicago (AP) - A yearlong
study offers rigorous new evidence against using prescription opioids
for chronic pain.
In patients with stubborn back
aches or hip or knee arthritis, opioids worked no better than
over-the-counter drugs or other nonopioids at reducing problems with
walking or sleeping. And they provided slightly less pain relief.
Opioids tested included generic
Vicodin, oxycodone or fentanyl patches although few patients needed the
most potent opioids. Nonopioids included generic Tylenol, ibuprofen and
prescription pills for nerve or muscle pain. The study randomly assigned
patients to take opioids or other painkillers. That’s the gold standard
design for research.
If they don’t work better than less
risky drugs, there’s no reason to use opioids given “their really nasty
side effects - death and addiction,” said lead author Dr. Erin Krebs, a
physician and researcher with the Minneapolis Veterans Affairs Health
The results likely will surprise
many people “because opioids have this reputation as being really
powerful painkillers, and that is not what we found,” Krebs said.
The results echo less rigorous
studies and bolster guidelines against routine use of opioids for
The study was published Tuesday in
the Journal of the American Medical Association.
About 42,000 drug overdose deaths
in the U.S. in 2016 involved opioids, including prescription
painkillers, heroin and fentanyl. Many people get hooked while taking
opioids prescribed for injuries or other short-term pain and move on to
cheaper, more accessible illicit drugs like heroin.
A report released Tuesday by the
Centers for Disease Control and Prevention found emergency rooms saw a
big jump in overdoses from opioids last year. Opioid overdoses increased
30 percent late last summer, compared to the same three-month period in
2016. The biggest jumps were in the Midwest and in cities, but increases
occurred nationwide. The report did not break down overdoses by type of
U.S. government guidelines in 2016
said opioids are not the preferred treatment for chronic pain, and they
recommend non-drug treatment or nonopioid painkillers instead. Opioids
should only be used if other methods don’t work for chronic pain, the
guidelines recommend. Prescribing rates have declined slightly in recent
years although they are still much higher than two decades ago.
Krebs said the strongest evidence
from other studies shows that physical therapy, exercise or
rehabilitation therapy works best for chronic pain. And she said noted
that there are a variety of nonopioid drugs to try if one type doesn’t
The study involved 234 patients
from Minneapolis-area VA clinics who were assigned to use generic
versions of opioids or nonopioids for a year. Follow-up ended in 2016.
“This is a very important study,”
said Dr. David Reuben, geriatrics chief at UCLA’s medical school. “It
will likely change the approach to managing long-term back, hip and knee
He noted one limitation - most
study participants were men, but Krebs said the results in women studied
The study’s opioid patients started
on relatively low daily doses of morphine, oxycodone or generic Vicodin.
They switched to higher doses if needed or to long-acting opioids or
fentanyl patches. The nonopioid group started on acetaminophen,
ibuprofen or similar anti-inflammatory drugs. They also could switch to
higher doses or prescription nonopioid pain pills. Few in either group
used the strongest medicines.
Patients reported changes in
function or pain on questionnaires. Function scores improved in each
group by about two points on an 11-point scale, where higher scores
meant worse function. Both groups started out with average pain and
function scores of about 5.5 points.
Pain intensity dropped about two
points in the nonopioid group and slightly less in the opioid patients.
Other research has shown that
over-the-counter medicines can also work as well as opioids at treating
short-term pain, including from broken bones, kidney stones or dental
Dr. Sunil Singhal, second from right, directs a special
camera to view a tumor in his patient made visible with a
fluorescent dye, seen at monitor on right, at the Hospital of
the University of Pennsylvania in Philadelphia, Tuesday, Jan.
23, 2018. Researchers are testing fluorescent dyes that make
cancer cells glow to make them easier for surgeons to find,
giving patients a better shot at survival. (AP Photo/Matt
Philadelphia (AP) -
It was an ordinary surgery to remove a tumor - until doctors
turned off the lights and the patient’s chest started to glow. A
spot over his heart shined purplish pink. Another shimmered in a
They were hidden cancers
revealed by fluorescent dye, an advance that soon may transform
how hundreds of thousands of operations are done each year.
Surgery has long been the
best way to cure cancer. If the disease recurs, it’s usually
because stray tumor cells were left behind or others lurked
undetected. Yet there’s no good way for surgeons to tell what is
cancer and what is not. They look and feel for defects, but good
and bad tissue often seem the same.
Now, dyes are being tested
to make cancer cells light up so doctors can cut them out and
give patients a better shot at survival.
With dyes, “it’s almost
like we have bionic vision,” said Dr. Sunil Singhal at the
University of Pennsylvania. “We can be sure we’re not taking too
much or too little.”
The dyes are experimental
but advancing quickly. Two are in late-stage studies aimed at
winning Food and Drug Administration approval. Johnson & Johnson
just invested $40 million in one, and federal grants support
some of the work.
“We think this is so
important. Patients’ lives will be improved by this,” said Paula
Jacobs, an imaging expert at the National Cancer Institute. In
five or so years, “there will be a palette of these,” she
Making cells glow
Singhal was inspired a
decade ago, while pondering a student who died when her lung
cancer recurred soon after he thought he had removed it all. He
was lying next to his baby, gazing at fluorescent decals.
“I looked up and saw all
these stars on the ceiling and I thought, how cool if we could
make cells light up” so people wouldn’t die from unseen tumors,
A dye called ICG had long
been used for various medical purposes. Singhal found that when
big doses were given by IV a day before surgery, it collected in
cancer cells and glowed when exposed to near infrared light. He
dubbed it Tumor Glow and has been testing it for lung, brain and
other tumor types.
He used it on Ryan
Ciccozzi, a 45-year-old highway worker and father of four from
Deptford, New Jersey, and found hidden cancer near Ciccozzi’s
heart and in a lung.
“The tumor was kind of
growing into everything in there,” Ciccozzi said. “Without the
dye, I don’t think they would have seen anything” besides the
baseball-sized mass visible on CT scans ahead of time.
Singhal also is testing a
dye for On Target Laboratories, based in the Purdue research
park in Indiana, that binds to a protein more common in cancer
cells. A late-stage study is underway for ovarian cancer and a
mid-stage one for lung cancer.
In one study, the dye
highlighted 56 of 59 lung cancers seen on scans before surgery,
plus nine more that weren’t visible ahead of time.
Each year, about 80,000
Americans have surgery for suspicious lung spots. If a dye can
show that cancer is confined to a small node, surgeons can
remove a wedge instead of a whole lobe and preserve more
breathing capacity, said On Target chief Marty Low. No price has
been set, but dyes are cheap to make and the cost should fit
within rates hospitals negotiate with insurers for these
operations, he said.
Big promise for breast cancer
Dyes may hold the most
promise for breast cancer, said the American Cancer Society’s
Dr. Len Lichtenfeld. Up to one third of women who have a lump
removed need a second operation because margins weren’t clear -
an edge of the removed tissue later was found to harbor cancer.
“If we drop that down into
single digits, the impact is huge,” said Kelly Londy, who heads
Lumicell, a suburban Boston company testing a dye paired with a
device to scan the lump cavity for stray cancer cells.
A device called Margin
Probe is sold now, but it uses different technology to examine
the surface of tissue that’s been taken out, so it can’t
pinpoint in the breast where residual disease lurks, said Dr.
Barbara Smith, a breast surgeon at Massachusetts General
She leads a late-stage
study of Lumicell’s system in 400 breast cancer patients. In an
earlier study of 60 women, it revealed all of the cancers,
verified by tissue tests later.
But it also gave false
alarms in more than a quarter of cases - “there were some areas
where normal tissue lit up a little bit,” Smith said.
Still, she said, “you would
rather take a little extra tissue with the first surgery rather
than missing something and have to go back.”
Blaze Bioscience is testing
Tumor Paint, patented by company co-founder Dr. Jim Olson of
Fred Hutchinson Cancer Research Center and Seattle Children’s
Hospital. It’s a combo product - a molecule that binds to cancer
and a dye to make it glow.
“You can see it down to a
few dozen cells or a few hundred cells,” Olson said. “I’ve seen
neurosurgeons come out of the operating room with a big smile on
their face because they can see the cancer very clearly.”
Early-stage studies have
been done for skin, brain and breast cancers in adults, and
brain tumors in children.
Avelas Biosciences of San
Diego has a similar approach - a dye attached to a molecule to
carry it into tumor cells. The company is finishing early
studies in breast cancer and plans more for colon, head and
neck, ovarian and other types.
Cancer drugs have had a lot
of attention while ways to improve surgery have had far less,
said company president Carmine Stengone.
“This was just an
overlooked area, despite the high medical need.”
FILE - A
precision nutrition weight loss approach didn’t hold up in a study
testing low fat versus low carb depending on dieters’ genetic or
metabolic makeup. (AP Photo/Matt Rourke)
Chicago (AP) -
A precision nutrition approach to weight loss didn’t hold up in a study
testing low fat versus low carb depending on dieters’ DNA profiles.
has suggested that a person’s insulin levels or certain genes could
interact with different types of diets to influence weight loss.
researchers examined this idea with 600 overweight adults who underwent
genetic and insulin testing before being randomly assigned to reduce fat
or carbohydrate intake.
identified variations linked with how the body processes fats or
carbohydrates, which the researchers thought would make them more likely
to lose weight on a low-fat or low-carb diet.
But weight loss
averaged about 13 pounds over a year, regardless of genes, insulin
levels or diet type. Also, some people lost as much as 60 pounds and
others gained 15 pounds - more evidence that genetic characteristics and
diet type appeared to make no difference.
What seemed to make
a difference was healthful eating. Participants on both diets who
consumed the fewest processed foods, sugary drinks, unhealthy fats and
ate the most vegetables lost the most weight.
The results suggest
that “precision medicine is not as important as eating mindfully,
getting rid of packaged, processed food” and avoiding unhealthy habits
like eating while watching television, said lead author Christopher
The study was
published Tuesday in the Journal of the American Medical Association.
Participants had 22
health education classes during the study and were encouraged to be
physically active, but the focus was on what they ate. They were advised
to choose high-quality foods but were not given suggested calorie limits
nor were they provided with specific foods. Results are based on what
they reported eating.
During the first
two months, dieters in each group were told to limit carbohydrates or
fats to 20 grams daily, about the amount that’s in 1 1/2 slices of whole
wheat bread and a handful of nuts respectively. They were allowed to
increase that to more manageable levels during the rest of the study.
Fat intake in the
low-fat group averaged 57 grams during the study versus 87 grams
beforehand; carb intake in the low-carb group averaged 132 grams versus
247 grams previously. Both groups reduced their daily calorie intake by
an average of about 500 calories.
The study was
well-conducted but because participants were not provided with specific
foods and self-reported their food choices, it wasn’t rigorous enough to
disprove the idea that certain genes and insulin levels may affect which
types of diets lead to weight loss, said Dr. David Ludwig, a Boston
Children’s Hospital obesity researcher.
Dr. Frank Hu,
nutrition chief at Harvard’s School of Public Health, has called
precision nutrition a promising approach and said the study wasn’t a
comprehensive test of all gene variations that might affect individual
responses to weight loss diets.
“In any weight loss
diets, adherence to the diet and the overall quality of the diet are
probably more important than any other factors,” Hu said.
IVs are one of the most common things in health care.
Each year, tens of millions of people get one to prevent dehydration,
maintain blood pressure or receive medicines or nutrients if they can’t eat.
(AP Photo/Gerry Broome, File).
New research calls into
question what’s in those IV bags that nearly every hospitalized patient
gets. Using a different intravenous fluid instead of the usual saline
greatly reduced the risk of death or kidney damage, two large studies found.
The difference could
mean 50,000 to 70,000 fewer deaths and 100,000 fewer cases of kidney failure
each year in the U.S., researchers estimate. Some doctors are hoping the
results will persuade more hospitals to switch.
“We’ve been sounding
the alarm for 20 years” about possible harms from saline, said Dr. John
Kellum, a critical care specialist at the University of Pittsburgh. “It’s
purely inertia” that prevents a change, he said.
Kellum had no role in
the studies, which were discussed Tuesday at a critical care conference in
San Antonio and published by the New England Journal of Medicine. Federal
grants helped pay for the work.
IVs are one of the most
common things in health care. They are used to prevent dehydration, maintain
blood pressure or give patients medicines or nutrients if they can’t eat.
Saline - salt dissolved
in water - has been the most widely used fluid in the U.S. for more than a
century even as evidence has emerged that it can harm kidneys, especially
when used a lot.
Other IV solutions
called balanced fluids include saline but also contain potassium and other
things that make them more like plasma, the clear part of blood. They’re
widely used in Europe and Australia.
The studies involved
28,000 patients at Vanderbilt University who were given IVs of saline or a
balanced fluid. For every 100 people on balanced fluids, there was one fewer
death or severe kidney problem.
Since there are about
30 million people hospitalized in the U.S. alone each year, “there are tens
or hundreds of thousands of patients who would be spared death or severe
kidney problems by using balanced fluids instead of saline,” said one study
leader, Vanderbilt’s Dr. Matthew Semler.
After seeing the
results two months ago, Vanderbilt hospital officials decided to primarily
use balanced fluids. The University of Pittsburgh also has largely switched
to them, Kellum said.
The fluids cost about
the same - a dollar or two per IV - and many suppliers make both types, so
switching should not be hard or expensive, doctors said.
IV fluids have been in
the news since Hurricane Maria hit Puerto Rico last fall, shutting down
electricity to three plants owned by Baxter International, one of the
biggest makers of these fluids. The shortage has eased, but some supply