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Update April 2018


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Health & Wellbeing
 

April 14, 2018 - April 20, 2018

US OKs 1st drug aimed at women with inherited breast cancer

 

Lynparza is marketed jointly by UK-based AstraZeneca and Merck & Co., which is based in Kenilworth, New Jersey.


Prescription opioids fail rigorous new test for chronic pain

Opioids 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, File)

Lindsey Tanner

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 Care System.

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 chronic pain.

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 opioid.

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 work.

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 pain.”

He noted one limitation - most study participants were men, but Krebs said the results in women studied were similar.

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 work.


April 7, 2018 - April 13, 2018

How to find hidden cancers? Doctors try glowing dyes

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 Rourke)

Marilynn Marchione

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 lung.

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 predicts.

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, he said.

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 Hospital.

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.”

Other cancers

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.”


March 31, 2018 - April 6, 2018

Carbs, fat, DNA? Weight loss is finicky, new study shows

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)

Lindsey Tanner

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.

Previous research has suggested that a person’s insulin levels or certain genes could interact with different types of diets to influence weight loss.

Stanford University researchers examined this idea with 600 overweight adults who underwent genetic and insulin testing before being randomly assigned to reduce fat or carbohydrate intake.

Gene analyses 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 Gardner.

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.


What’s in the IV bag? Studies show safer option than saline

 

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).

Marilynn Marchione

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 issues remain.
 


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HEADLINES [click on headline to view story]

1

Prescription opioids fail rigorous new test for chronic pain


How to find hidden cancers? Doctors try glowing dyes


Carbs, fat, DNA? Weight loss is finicky, new study shows

What’s in the IV bag? Studies show safer option than saline


 



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