Health and Medical News and Resources

General interest items edited by Janice Flahiff

Is Preventive Medicine Really Overtreatment?

Is Preventive Medicine Really Overtreatment?

From the NPR Health News item

In Overdiagnosed: Making People Sick in the Pursuit of Health, Dr. H. Gilbert Welch argues that modern medicine is looking too closely for disease, and that unnecessary screenings, MRIs and CT scans turn healthy people into diseased patients, by revealing often harmless abnormalities….

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But overtreatment isn’t just a problem for patients diagnosed with cancer. It could sometimes be a problem for healthy people, as my next guest writes in his book “Overdiagnosed: Making People Sick in the Pursuit of Health,” because even healthy people are subject to more and more tests every time they visit the doctor.

Think about it, what do you do? You get the normal tests. You get your cholesterol level, maybe your liver test if you’re doing statins, you have a PSA, you have a body scan, tests that are often they often result in treatment. And because the traditional dogma is, as my next guest writes, more early diagnosis means better medical care, which means more treatment; and more treatment means better health.

But is that traditional view true? Is it accurate? Should we still be thinking about it that way? Are all these tests and treatments actually improving our health or are we looking too hard for disease?….

FLATOW: Why is it because doctors can do all these diagnoses, all these tests that they do, do them?

Dr. WELCH: Well, certainly, part of it is what’s possible, and what’s possible is, of course, changed dramatically over the last year. But it’s also part of our ethos, if you will, that it’s always a good thing to look for early forms of disease. And, of course, that message just been sent out to the public through the media and other sources that, of course, the thing you want to do is look for early forms of disease.

But the truth is there are really two sides to the story. I think patients are used to thinking of treatments as having side effects, but so does testing. And the side effect of looking for early forms of disease is that we find, virtually, all of us have some. That’s because we all harbor some abnormalities. And we never know which patients are those that have abnormalities that are going to cause problems in the future. So we tend to treat everybody we find with an abnormality and that means we’re just treating some patients who can’t benefit from our treatment because they were never going to develop the problem at hand if they’re overdiagnosed.

FLATOW: But how do you say to the person, you know, that maybe in the minority, as you say, that you may have saved that person’s life by overdiagnosing them? Is that worth of maybe one in a hundred cases?

Dr. WELCH: Well, I think that’s the question we all need to face. And, you know, sort of, traditionally, doctors have focused on the one out of a thousand we might help by looking for early forms of disease. But we haven’t really asked the question, what happens to the other 999? And this problem was really demonstrated to us in prostate cancer screening, which is really a poster child for the problem of overdiagnosis.

20 years ago, a simple blood test was introduced. And 20 years later, over one million Americans have been treated for a cancer that was never going to bother them. That test was the PSA, or prostate specific antigen. And it turned out an awful lot of men had abnormal PSAs. Many were found to have microscopic cancers far more than whatever suffer from prostate cancer.

Now, you might say, does it matter? Yeah, sure it matters because most of these men were treated with either radical surgery or radiation. And roughly a third suffered side effects of treatment generally related to bowel, bladder or sexual function. Even a few have died from it.

So this is a problem. It’s a matter of finding the balance between the question of just how hard we should be looking for problems in well patients……

February 13, 2011 Posted by | Health News Items | , , , , , , , , | Leave a comment

IU Personalized Medicine Institute to develop targeted and individualized treatments

IU Personalized Medicine Institute to develop targeted and individualized treatments

David Flockhart, M.D., Ph.D. Director, Indiana Institute for Personalized Medicine

 

 

From the February 9 2011 Eureka news alert

Indiana University has announced a major commitment to research in one of health care’s most promising fields with the creation of the Indiana Institute for Personalized Medicine.

The institute’s members will be drawn from the IU schools of medicine, informatics and nursing, with $11.25 million in funding provided by the School of Medicine, the school’s Department of Medicine, Indiana University-Purdue University Indianapolis, the Indiana Physician Scientist Initiative and the Indiana University Melvin and Bren Simon Cancer. The Indiana Physician Scientist Initiative is funded by a $60 million grant from the Lilly Endowment.

Building on modern research techniques that have made it possible to decipher the genetic code, detect slight genetic differences between patients and determine how those affect the way the body metabolizes drugs, physicians are beginning to be able to select more appropriate treatments for individual patients. Research to make such tools broadly available remains in the early but promising stages, institute leaders said.

“Much of the future of health care is in personalized medicine, meaning more precise targeting of the right medication to the right patient at the right time,” said David Flockhart, M.D., Ph.D., who has been named director of the institute.

“We believe it should lead to cost benefits – it clearly will be better for patients,” said Dr. Flockhart, Harry and Edith Gladstein Professor of Cancer Epidemiology and Genetics and director of the Division of Clinical Pharmacology.

“The Indiana Institute for Personalized Medicine is a not only a logical extension of our academic mission but is also part of our strategic plan to be a global leader in translational medicine,” said David S. Wilkes, M.D., executive associate dean for research affairs at the IU School of Medicine.

Some of the earliest examples of personalized medicine have come in the field of cancer treatment. Oncologists now can test a breast cancer patient’s tumor to determine not only whether it is the type that is stimulated to grow by the hormone estrogen, but whether it is a subtype that can be treated with hormone therapy or another type that requires chemotherapy. Cardiology, pediatrics and obstetrics also will be important areas of focus for the institute, said Dr. Flockhart.

“To identify more precisely which drugs are likely to be more effective — or less effective and more toxic — will have a substantial impact on optimizing health care delivery and rationally curbing costs. In no discipline is this more keenly needed than in cancer care where drugs can be extremely costly and toxic,” said Patrick J. Loehrer Sr., M.D., director of the IU Simon Cancer Center.

IU scientists have been working on related research for at least a decade, but creating an institute “allows you to really jump start research and raise the level participation of an institution in both the laboratory and in the clinic, in a broad range of research interests,” Dr. Flockhart said.

For example, Janet Carpenter, Ph.D., R.N., professor in the School of Nursing and a member of the institute, sees personalized medicine playing a key role in improving the treatment of menopause.

“About 6,000 American women enter menopause every day yet personalized medicine has not been well-integrated into their health care,” she said. “The institute will play a very important role in ensuring that women receive the most appropriate and effective menopausal symptom management therapies.”

Mathew Palakal, Ph.D., associate dean for graduate studies and research at the School of Informatics noted that “research in personalized medicine spans a broad spectrum from systems biology to nanomedicine to gene therapy. Our research in such areas as systems biology, biological network analysis and proteomics, along with our graduate programs in health informatics and bioinformatics, will enable informatics and the School of Informatics to play a significant role in the success of the institute.”

“This science will enable physicians to prescribe the right medicines at the right dosages and intervals to maximize efficacy and prevent unwanted toxicity. It should be a very exciting next 10 years of research,” said D. Wade Clapp, M.D., chairman of the Department of Pediatrics…..

 

 

February 13, 2011 Posted by | Health News Items | , , , , , | Leave a comment

Microsponges from seaweed may save lives

Microsponges from seaweed may save lives

Rice University scientists refine process at heart of diagnostic bio-nano-chip

From the February 9 2011 Eureka news alert

Microsponges derived from seaweed may help diagnose heart disease, cancers, HIV and other diseases quickly and at far lower cost than current clinical methods. The microsponges are an essential component of Rice University’s Programmable Bio-Nano-Chip (PBNC) and the focus of a new paper in the journal Small.

The paper by John McDevitt, the Brown-Wiess Professor in Bioengineering and Chemistry, and his colleagues at Rice’s BioScience Research Collaborative views the inner workings of PBNCs, which McDevitt envisions as a mainstream medical diagnostic tool.

PBNCs to diagnose a variety of diseases are currently the focus of six human clinical trials. McDevitt will discuss their development at the annual meeting of the American Association for the Advancement of Science (AAAS) in Washington, D.C., Feb. 17-21.

PBNCs capture biomarkers — molecules that offer information about a person’s health — found in blood, saliva and other bodily fluids. The biomarkers are sequestered in tiny sponges set into an array of inverted pyramid-shaped funnels in the microprocessor heart of the credit card-sized PBNC.

When a fluid sample is put into the disposable device, microfluidic channels direct it to the sponges, which are infused with antibodies that detect and capture specific biomarkers. Once captured, they can be analyzed within minutes with a sophisticated microscope and computer built into a portable, toaster-sized reader.

The biomarker capture process is the subject of the Small paper. The microsponges are 280-micrometer beads of agarose, a cheap, common, lab-friendly material derived from seaweed and often used as a matrix for growing live cells or capturing proteins.

The beauty of agarose is its ability to capture a wide range of targets from relatively huge protein biomarkers to tiny drug metabolites. In the lab, agarose starts as a powder, like Jell-O. When mixed with hot water, it can be formed into gels or solids of any size. The size of the pores and channels in agarose can be tuned down to the nanoscale.

The challenge, McDevitt said, was defining a new concept to quickly and efficiently capture and detect biomarkers within a microfluidic circuit. The solution developed at Rice is a network of microsponges with tailored pore sizes and nano-nets of agarose fibers. The sponge-like quality allows a lot of fluid to be processed quickly, while the nano-net provides a huge surface area that can be used to generate optical signals 1,000 times greater than conventional refrigerator-sized devices. The mini-sensor ensembles, he said, pack maximum punch.

The team found that agarose beads with a diameter of about 280 micrometers are ideal for real-world applications and can be mass-produced in a cost-effective way. These agarose beads retain their efficiency at capturing biomarkers, are easy to handle and don’t require specialized optics to see.

McDevitt and his colleagues tested beads with pores up to 620 nanometers and down to 45 nanometers wide. (A sheet of paper is about 100,000 nanometers thick.) Pores near 140 nanometers proved best at letting proteins infuse the beads’ internal nano-nets quickly, a characteristic that enables PBNCs to test for disease in less than 15 minutes…….

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Co-authors of the paper included first author Jesse Jokerst, a National Institutes of Health postdoctoral fellow at Stanford University; postdoctoral students James Camp, Jorge Wong, Alexis Lennart, Amanda Pollard and Yanjie Zhou, all of the departments of Chemistry and Biochemistry at the University of Texas at Austin; Mehnaaz Ali, an assistant professor of chemistry at Xavier University; and from the McDevitt Lab at Rice, Pierre Floriano, director of microfluidics and image and data analysis; Nicolaos Christodoulides, director of assay development; research scientist Glennon Simmons and graduate student Jie Chou.

The National Institutes of Health, through the National Institute of Dental and Craniofacial Research, funded the research.

Read the abstract at http://onlinelibrary.wiley.com/doi/10.1002/smll.201002089/abstract***

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February 13, 2011 Posted by | Medical and Health Research News | , , , , , , | Leave a comment

Brain researcher recognized for contributions to understanding, treatment of drug dependence

Brain researcher recognized for contributions to understanding, treatment of drug dependence

Warren K. Bickel, director of the Center for Substance Abuse at the Virginia Tech Carilion Research Institute, examines decision-making processes in the brain that support dysfunctional decision-making, including addiction, and seeks novel therapeutic means to repair those processes.

From the February 11, 2011 Eureka news alert

Warren K. Bickel, director of the Center for Substance Abuse at the Virginia Tech Carilion Research Institute, has been selected as the 2011 recipient of the American Psychological Association Don Hake Translational Research Award. Sponsored by the Association for Behavior Analysis International, the award recognizes individuals whose work spans basic and applied research.

According to awards chair Cythia Pietras, the award is being presented to Bickel for his contributions to understanding drug dependence and treatment, impulsivity, and behavioral economics, and for disseminating that work to a wide audience.

Bickel, who is a professor with the research institute and professor of psychology at Virginia Tech, examines decision-making processes in the brain that support dysfunctional decision-making, including addiction, and seeks novel therapeutic means to repair those processes. One area of his research is directed at the process involved in preferring instant gratification over a future health benefit. His research demonstrating that this preference for immediate rewards can be changed with a novel therapeutic approach appears in the February 2011 issue of Biological Psychiatry.***

According to Virginia Tech Carilion Research Institute Executive Director Michael Friedlander, “Dr. Bickel’s research is blazing a new path to understanding how the brain’s temporal discounting system –the ability to differentially value things based on how far into the future they may occur — contributes to decisions regarding substance abuse, as well as how the executive processes in the human brain can be enhanced through rehabilitative training to potentially improve outcomes for those who are affected by substance abuse. He also has a commitment and well honed skill for effectively communicating the significance of his work to the scientific and medical communities and the general public. We are very fortunate to have such a talented scientist and communicator as part of the research institute here in Roanoke.”

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February 13, 2011 Posted by | Medical and Health Research News | , , , , , , | Leave a comment

   

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