Health and Medical News and Resources

General interest items edited by Janice Flahiff

Colonoscopies: America’s gold standard, while Canada says they’re not justified (Reblog)

From the 26 February 2016 HealthNewsReview item

Excerpt

Do borders really exist in medicine, where the mere act of crossing political boundaries changes what screening programs are recommended? It seems that they do exist, and they’re well guarded.

Generating numerous headlines in major Canadian papers such as the National PostThe Toronto StarGlobe and Mail and Reuters, the Canadian Task Force on Preventive Health Care came out this week with new recommendations on colon cancer screening, essentially saying that routine colonoscopies were not justified. By contrast, in the United States, the U.S. Preventive Services Task Force (USPSTF) 2015 guidelines say that adults aged 50–75, should have a colonoscopy every 10 years; FIT (fecal immunochemical testing) or gFOBT (guaiac fecal occult blood testing ) annually or flexible sigmoidoscopy every 10 years plus FIT annually.

For this age group the Canadian Task Force says there is insufficient evidence to justify using colonoscopy for routine screening for colorectal cancer. They recommend patients should undergo the fecal occult blood testing every two years or flexible sigmoidoscopy – a procedure which examines the lower part of the colon and rectum every 10 years. These colon cancer screening guidelines, published in the Canadian Medical Association Journal, are for low-risk people: asymptomatic adults, aged 50 to 74 who have no prior history of the disease, no family history or symptoms such as blood in the stool, or a genetic disposition to the disease.

Advertisements

March 11, 2016 Posted by | health care | | Leave a comment

Precision Medicine at one year: A soaring White House summit and the potholes ahead (report)

From the 28 February 2016 post at HealthNewsReview

Excerpts

We’re pleased to publish the following guest post by Dr. Michael Joyner, a medical researcher at the Mayo Clinic who recently joined our team as a contributor. These views are his own. You can follow him on twitter @DrMJoyner.


syringe on targetLast week there was a big shindig at the White House reviewing progress from the first year of the million-person Precision Medicine Initiative (PMI).

As you might imagine, an event of this magnitude drew considerable (mostly glowing) coverage from major US health news media:

This is an exciting scientific undertaking — one that merits the attention these outlets have devoted to it. But the coverage sounded mostly like cheerleading, and none of these stories included a skeptical word about the many challenges ahead and how they could thwart the initiative’s lofty objectives. I watched the webcast of the event with a critical eye and took notes as I was watching. Here are a six of the things that I thought journalists should have been thinking about and writing about as they covered the event:

1) A number of new partnerships and pilot programs related to enrollment of participants, data sharing, analytics, biobanks and privacy were announced. There are no real results yet, so it is simply too soon to tell what elements of what was announced will succeed, partially succeed, or stall.

2) Francis Collins, the director of the National Institutes of Health and a prime mover in Precision Medicine, clearly stated that it should take three to four years to meet the one million person enrollment goal of the program. This is an ambitious timeline. The last time that something like this was tried in the National Children’s Study, enrollment goals were never met and the program was ultimately cancelled. As STAT has previously reported, experts in population health have observed similarities between the PMI and the National Children’s Study and the comments by Dr. Collins are a clear marker for evaluating the success of PMI going forward.

3) There were a number of interesting presentations of patient and family vignettes at the meeting. While PMI is supposed to transform health and healthcare for all Americans, three of the four stories were about extremely rare diseases that have nothing to do with the big killers like diabetes, cancer, and heart disease. There is no argument by PMI skeptics about the role of gene sequencing in rare diseases, but dealing more effectively with those diseases has nothing to do with the prediction, prevention, and improved treatment of the major causes of death. The fourth presentation was about breast cancer and it was unclear to me exactly what elements of precision medicine were involved in the care of this patient (who happened to be a surgeon). In the absence of big transformative population findings for common diseases, some might argue that the rare disease community is being leveraged to generate support for a much larger and perhaps misdirected program.

4) There was no mention of some of the potholes that are out there or that have emerged in the last year. For example, the National Cancer Institute’s MATCH trial, designed to match the genetic signatures of tumors with targeted therapy, is having trouble “matching” (subscription required). And a study from Europe has cast at least some doubt on just how effective broad-based used of “targeted therapy” will be. There is also plenty of room to question the idea that data mining electronic health records is going to be transformative. The barriers to actually getting this done are significant and range from the quality of the data in electronic health records, issues related to who owns the data, protocols for data sharing, and a host of technical and statistical issues. Big data can certainly be helpful but it can also mislead.

 

March 11, 2016 Posted by | Medical and Health Research News | , | Leave a comment

Consumer Reports Uses AHRQ’s Evidence Reports in Drug Comparisons

Featured Case Study: Consumer Reports Uses AHRQ’s Evidence Reports in Drug Comparisons

Consumer Reports magazine and affiliated publications use evidence reports from AHRQ’s Evidence-based Practice Centers Program to inform consumers and clinicians about prescription drugs’ effectiveness and safety. Read the case study.

(From the US Agency for Healthcare Research and Quality)

March 11, 2016 Posted by | Uncategorized | Leave a comment

1 percent of Americans with the highest health care expenses accounted for nearly 22 percent of the nation’s total health care expenditures [news release]

From the US Agency for Healthcare Research and Quality

AHRQ Stats: Per-Person Health Care Expenses

Among the U.S. noninstitutionalized population in 2013, the 1 percent of Americans with the highest health care expenses accounted for nearly 22 percent of the nation’s total health care expenditures. Members of that group had annual average expenses of $95,200. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #480: Differentials in the Concentration of Health Expenditures across Population Subgroups in the U.S., 2013.)

March 11, 2016 Posted by | Health Statistics | , | Leave a comment

Latest Biennial Review of Health Problems That May Be Linked to Agent Orange Exposure During Vietnam War Upgrades Bladder Cancer and Hypothyroidism, Downgrades Spina Bifida

From the 10 March 2016 National Academies Science Engineering Health news release

Excerpts

Latest Biennial Review of Health Problems That May Be Linked to Agent Orange Exposure During Vietnam War Upgrades Bladder Cancer and Hypothyroidism, Downgrades Spina Bifida 

Screen Shot 2016-03-11 at 5.12.55 AM

 

WASHINGTON – The latest and final in a series of congressionally mandated biennial reviews of the evidence of health problems that may be linked to exposure to Agent Orange and other herbicides used during the Vietnam War changed the categorization of health outcomes for bladder cancer, hypothyroidism, and spina bifida and clarified the breadth of the previous finding for Parkinson’s disease.  The committee that carried out the study and wrote this reportVeterans and Agent Orange: Update 2014, reviewed scientific literature published between Oct. 1, 2012, and Sept. 30, 2014.

 

Bladder cancer and hypothyroidism were moved to the category of “limited or suggestive” evidence of an association from their previous positions in the default “inadequate or insufficient” category.  A finding of limited or suggestive evidence of an association means that the epidemiologic evidence indicates there could be a link between exposure to a chemical and increased risk for a particular health effect.  A finding of inadequate or insufficient evidence indicates that the available studies are of insufficient quality, consistency, or statistical power to permit a conclusion regarding the presence or absence of such a link.  For both bladder cancer and hypothyroidism, new results from a large study of Korean veterans who served in the Vietnam War were compellingly suggestive of an association.  In combination with pre-existing supportive epidemiologic findings and substantial biologic plausibility, the new information provided evidence to merit a change in category of association for these two outcomes.

In addition to reviewing the evidence of health problems that may be linked to exposure to Agent Orange and other herbicides, the committee was asked to address the specific question of whether various conditions with Parkinson’s-like symptoms should qualify the assignment of Parkinson’s disease to the limited or suggestive category of association with herbicide exposure.  The committee noted that Parkinson’s disease is a diagnosis of exclusion, and therefore, the diagnostic standards for this condition should not be assumed to have been uniform in the epidemiologic studies that constitute the basis for this association or in the claims submitted by veterans.  Consequently, there is no rational basis for exclusion of individuals with Parkinson’s-like symptoms from the service-related category denoted as Parkinson’s disease.  To exclude a claim for a condition with Parkinson’s-like symptoms, the onus should be on the U.S. Department of Veterans Affairs (VA) on a case-by-case basis to definitively establish the role of a recognized factor other than the herbicides sprayed in Vietnam.

 

Given that this is the final report mandated by the Agent Orange Act, the committee developed recommendations for future actions to advance the well-being of Vietnam veterans, including that the VA should continue epidemiologic studies of the veterans; develop protocols that could investigate paternal transmission of adverse effects to offspring; and design a study to focus on specific manifestations in humans of dioxin exposure and compromised immunity, which have been clearly demonstrated in animal models.  The committee also called for a careful review of evidence concerning whether paternal exposure to any toxicant has definitively resulted in abnormalities in the first generation of offspring.  In addition, the committee formulated recommendations for improved assembly and evaluation of information necessary for monitoring possible service-related health effects in all military personnel, including creating and maintaining rosters of individuals deployed on every mission and linking U.S. Department of Defense and VA databases to systematically identify, record, and monitor trends in veterans’ diseases.

March 11, 2016 Posted by | Medical and Health Research News | | Leave a comment

Penn Study Shows a Form of Genetically Elevated “Good” Cholesterol May Actually be Bad [News release]

From the 10 March 2016 Penn Medicine news release

 

Research has implications for better understanding the relationship between “good” cholesterol function – in addition to level — and heart disease risk

PHILADELPHIA – The generally accepted medical maxim that elevated HDL cholesterol (HDL-C) is “good” has been overturned by a multi-center, international study, led by researchers from the Perelman School of Medicine at the University of Pennsylvania. They show that a certain genetic cause of increased HDL-C may actually be “bad,” noting that a specific mutation in a gene which encodes a cell receptor protein that binds to HDL prevents the receptor from functioning. The mutation causes an increased risk of coronary heart disease even in the presence of elevated levels of HDL-C or “good” cholesterol. Their findings are published this week in Science.

—–

—–

Previous research raised the possibility that HDL might not be quite as protective against heart disease as generally believed by cardiologists, especially after several clinical trials of HDL-raising drugs showed little or no effect. “The thinking about HDL has evolved recently to the concept that it may not directly protect against all heart disease,” said senior author Daniel J. Rader, MD, chair of the department of Genetics.  “Our results indicate that some causes of raised HDL actually increase risk for heart disease. This is the first demonstration of a genetic mutation that raises HDL but increases risk of heart disease.”

Rader and his colleagues sequenced the lipid-modifying regions of the genomes of 328 people with markedly elevated HDL (along with a control group with lower HDL) to identify genetic causes of high HDL. One of the genes they focused on was SCARB1, which encodes for Scavenger Receptor B1 (SR-B1), the major receptor for HDL on cell surfaces.

In the course of this sequencing, they identified, for the first time, a person without any SCARB1 function, typified by an extremely high HDL-C level of about 150 mg/dL, whereas the normal level is about 50 mg/dL. The subject had two copies of a SCARB1 mutation called P376L, which the team showed caused a breakdown in HDL receptor function.

 

March 11, 2016 Posted by | Medical and Health Research News | , | Leave a comment

Reducing Alzheimer’s risk through exercise – Two news releases

Burning more calories linked with greater gray matter volume, reduced Alzheimer’s risk (11 March 2016EurkAlert)

Excerpt – “Whether they jog, swim, garden or dance, physically active older persons have larger gray matter volume in key brain areas responsible for memory and cognition, according to a new study by researchers at the University of Pittsburgh School of Medicine and UCLA.

The findings, published today in the Journal of Alzheimer’s Disease, showed also that people who had Alzheimer’s disease or mild cognitive impairment experienced less gray matter volume reduction over time if their exercise-associated calorie burn was high.

A growing number of studies indicate physical activity can help protect the brain from cognitive decline, said investigator James T. Becker, Ph.D., professor of psychiatry, Pitt School of Medicine. But typically people are more sedentary as they get older, which also is when the risk for developing Alzheimer’s disease and other dementias increases.

Different kinds of physical activity shown to improve brain volume & cut Alzheimer’s risk in half (another 11 March 2016 EurkAlert)

Excerpt- “LOS ANGELES, CA/PITTSBURGH, PA, March 11, 2016: A new study shows that a variety of physical activities from walking to gardening and dancing can improve brain volume and cut the risk of Alzheimer’s disease by 50%.

This research, conducted by investigators at UCLA Medical Center and the University of Pittsburgh, is the first to show that virtually any type of aerobic physical activity can improve brain structure and reduce Alzheimer’s risk. The study, funded by the National Institute of Aging, was published on March 11 in the Journal of Alzheimer’s Disease.”

March 11, 2016 Posted by | Medical and Health Research News | , , | Leave a comment

Covering the debate over expanded use of dental therapists [news release]

Reminds me of my sister who is a pharmacist. She goes on yearly medical missions to Haiti. The folks working in the pharmacy at the clinic there have only a high school education. My sister is a stickler when it comes to pharmacy practice/licensing in the US. But very much in awe with her Haitian colleagues and what they know and are able to do.

Screen Shot 2016-03-11 at 4.09.32 AM

From the 10 March 2016 item at Covering Health:Monitoring the Pulse of Health Care Journalism

Excerpts

A recent news package in The Seattle Times by reporter Will Drabold took a look at how the controversy over dental therapists is unfolding in the state of Washington.

Drabold examined the challenges faced by poor Medicaid patients in seeking dental care. He spoke with health care advocates who believe that technically-trained mid-level providers could bring much-needed care to poor and isolated communities. He also interviewed tribal leader Brian Cladoosby, whose Swinomish tribe had just defied state restrictions to hire a dental therapist. And he spoke with state dental association officials, who made it clear that they – ­like the American Dental Association – believe dental therapists lack the training to perform these expanded duties.

Dental therapists, who often are compared to nurse practitioners, are trained to deliver a range of services including screenings, cleanings, preventive care, fillings and extractions. While the therapists do work under the supervision of dentists, dental groups often contend that dentists alone have the training to perform what they consider irreversible surgical procedures, such as drilling and extracting teeth.

In spite of resistance from organized dentistry, variations of the therapist model already are being used in Alaska’s tribal lands and in the state of Minnesota. Dental therapists have been approved in Maine and are being considered in a number of other states.

March 11, 2016 Posted by | health care | , , , , | Leave a comment

   

%d bloggers like this: