Dr. Bray Links

Saturday, December 16, 2017

Contemporary Hormonal Contraception and the Risk of Breast Cancer — NEJM

Risk estimates associated with current or recent use of various oral combination (estrogen–progestin) contraceptives varied between 1.0 and 1.6. Women who currently or recently used the progestin-only intrauterine system also had a higher risk of breast cancer than women who had never used hormonal contraceptives (relative risk, 1.21; 95% CI, 1.11 to 1.33). The overall absolute increase in breast cancers diagnosed among current and recent users of any hormonal contraceptive was 13 (95% CI, 10 to 16) per 100,000 person-years, or approximately 1 extra breast cancer for every 7690 women using hormonal contraception for 1 year.


These five tests better predict heart disease risk -- ScienceDaily

The five tests, and the information they provide:

    A 12-lead EKG provides information about hypertrophy, or thickening of the heart muscle.
    A coronary calcium scan, a low-radiation imaging test, identifies calcified plaque buildup in the arteries of the heart.
    A blood test for C-reactive protein indicates inflammation.
    A blood test for the hormone NT-proBNP indicates stress on the heart.
    A blood test for high-sensitivity troponin T indicates damage to heart muscle. Troponin testing is regularly used by hospitals to diagnose heart attacks, but high-sensitivity troponin fine-tunes that measure, pointing to small amounts of damage that can be detected in individuals without any symptoms or warning signs.


Experts Caution on CANTOS and Canakinumab's Future | Medpage Today

There were no significant differences in all cause or cardiovascular mortality, though the direction of the numbers favored canakinumab. However, canakinumab was associated with a significantly higher rate of fatal infection compared to placebo: 0.18 in the placebo group and 0.31, 0.28, and 0.34 in the 50, 150, and 300 mg canakinumab groups, respectively, all per 100 person-years. On the positive side, cancer mortality was lower in the canakinumab groups (see below for more on this).

"CANTOS has helped move the inflammatory hypothesis of coronary artery disease forward scientifically," wrote Bob Harrington (Stanford University), in an accompanying editorial in NEJM. "However, the modest absolute clinical benefit of canakinumab cannot justify its routine use in patients with previous myocardial infarction until we understand more about the efficacy and safety trade-offs and unless a price restructuring and formal cost-effectiveness evaluation supports it."


Analysis of Fusobacterium persistence and antibiotic response in colorectal cancer | Science

The bacterial species Fusobacterium nucleatum is associated with a subset of human colorectal cancers, but its role in tumorigenesis is unclear. Studying patient samples, Bullman et al. found that F. nucleatum and certain co-occurring bacteria were present not only in primary tumors but also in distant metastases. Preliminary evidence suggests that the bacterium is localized primarily within the metastatic cancer cells rather than in the stroma. Antibiotic treatment of mice carrying xenografts of F. nucleatum–positive human colorectal cancer slowed tumor growth, consistent with a causal role for the bacterium in tumor genesis. 


Little Blue Pill Goes Generic Today, and Pfizer Joins In

Pfizer Inc will bring its own generic version of its erectile dysfunction (ED) drug Viagra (sildenafil citrate) to the United States market today, seeking to preserve some sales as generic competition starts up for one of the world's most famous drugs. Teva Pharmaceutical Industries Ltd is launching its rival generic version today.

Viagra technically does not lose patent protection until 2020, but Pfizer reached a settlement with Teva in December 2013 allowing the company to launch its generic version on today's date.

New York–based Pfizer will start selling what's known as an "authorized generic," manufactured by its subsidiary Greenstone LLC, priced at $30 to $35 per pill, a company spokesman told Medscape Medical News. That's roughly half or less of the $65-a-pill cost for Viagra seen on pharmacy websites. Pfizer noted that it's difficult to determine how much of this discount will reach consumers because of markups and variations in pharmacy pricing. Israel-based Teva declined to comment to Medscape Medical News on its plans for pricing its version of generic Viagra.


Hormonal Contraceptives and the Lesser-Known Link With Suicide Risk

Hormonal contraceptives are used successfully by millions of women to prevent pregnancy and treat menstrual-related conditions and acne. For a small group, however, contraception is linked with adverse mood effects, including depression. A recent study[1] took this a step further to focus on the risk for suicide.

Almost half a million Danish women were followed prospectively from age 15, before they began using birth control. In women ages 15-33, hormonal contraceptives were associated with an increased risk for first suicide attempt. The risk peaked after 2 months of contraceptive use and decreased after 1 year.

Adolescent women had the highest relative risks. And use of the patch, vaginal ring, and progestin-only products had a higher risk than oral combined products.


Huntington’s breakthrough may stop disease - BBC News

The defect that causes the neurodegenerative disease Huntington's has been corrected in patients for the first time, the BBC has learned.

An experimental drug, injected into spinal fluid, safely lowered levels of toxic proteins in the brain.

The research team, at University College London, say there is now hope the deadly disease can be stopped.

Experts say it could be the biggest breakthrough in neurodegenerative diseases for 50 years.

Huntington's is one of the most devastating diseases. 


Huntington’s breakthrough may stop disease - BBC News

Haemophilia A trial results 'mind-blowing' - BBC News

British doctors say they have achieved "mind-blowing" results in an attempt to rid people of haemophilia A.

Patients are born with a genetic defect that means they do not produce a protein needed to stop bleeding.

Thirteen patients given the gene therapy at Barts Health NHS Trust are now off treatment with 11 producing near-normal levels of the protein. 


Friday, December 15, 2017

California Officials Release Guidelines To Avoid Cellphone Radiation

The research suggests cellphones could increase our risk for brain cancer and tumors, low sperm count, headaches, as well as impaired memory, hearing, and sleep.

Dr. Joel Moskowitz at UC Berkeley said, "Currently we're not doing a good job in regulating radiation from these devices. In fact, we're doing an abysmal job."


Wednesday, December 13, 2017

The Caregiver Crisis: Rising Demand, Short Supply Puts Elderly at Risk

    The median cost for a one-bedroom apartment in a senior assisted living community is $43,539. It ranges from roughly $30,000 (Missouri) to $80,000 (District of Columbia), according to Consumer Reports.

    The average cost of a private room in a full-service nursing home is over $87, 000 per year.

    At the other end of the age curve, childrens' daycare costs an average of about $20,000. In the last 25 years, childcare costs have doubled.


Monday, December 4, 2017

Pediatric non alcoholic fatty liver disease

Recently, interesting dietary supplements such as probiotics and long-chain omega-3 polyunsaturated fatty acids have been adopted in adults with NAFLD [91, 92]. Interestingly, these dietary supplements, although considered pharmacological interventions, are often based on natural compounds present in specific foods (yogurt, fish oil, etc.). Among the pathogenetic factors leading to NAFLD, the persistent crosstalk among the gut, the immune system, and the liver, plays a pivotal role [93]. In fact, it is now accepted that specific nutrients increase the intestinal permeability to bacterial endotoxins, activating an immune-mediated inflammatory response of liver resident cells, leading to a profibrogenic phenotype [94]. One recent study on animal models [95], has demonstrated a pivotal role of restoring gut microflora in protecting the liver from fat and preventing cardiovascular disease.


Friday, December 1, 2017

Taking Care of the Physician - NYTimes.com

"It has been shown in some studies that if the physician is exercising, if the physician is taking care of themself, eating well, sleeping better, they have patients who have better clinical outcomes," said Dr. Hilary McClafferty


Thursday, November 30, 2017

Benzodiazepines Tied to a 41% Increased Mortality Risk in AD

Patients with Alzheimer's disease (AD) who use benzodiazepines and related drugs (BZRDs) have a 41% higher risk for death than patients who do not use these drugs, new research shows.

Mortality rates in patients with AD who use BZDRs was 13.4 per 100 person-years, vs 8.5 per 100 person-years in nonusers during the 6-month study period (adjusted hazard ratio [HR], 1.4). The association was significant from initiation of use.

"I was surprised by how big the increased risk was," lead author Laura K. Saarelainen, a PhD candidate at the Kuopio Research Center for Geriatric Care, University of Eastern Finland, told Medscape Medical News.

"We would like clinicians to know that these drugs have major adverse events from the very beginning of use," she added.

The study was published online November 15 in the International Journal of Geriatric Psychiatry.


Tuesday, November 28, 2017

WellCare Ex-Exec Sentenced in $35M Florida Medicaid Fraud

Bereday was general counsel at WellCare's Medicaid HMOs StayWell and Healthease in 2006. According to a plea agreement, Bereday admitted that he and four other executives submitted inflated expenditures in the company's annual reports to the Florida Medicaid Program that reduced the HMOs' payback obligations for behavioral healthcare services.  


Medicare Pay-for-Performance Didn't Deliver

Medicare's Value-Based Payment Modifier program inadvertently shifted money away from physicians who treated sicker, poorer patients to pay for bonuses that rewarded practices treating richer, healthier populations, according to a study this week in Annals of Internal Medicine.

In addition, components from that failed pay-for-performance prototype that do not account for patient demographics remain its successor program, and could scuttle its chances for success, researchers said.

"As long as these programs do not account adequately for patient differences, which is very difficult to do, they will further deprive practices serving low-income populations of important resources," said Eric Roberts, assistant professor of health policy and management at the University of Pittsburgh Graduate School of Public Health and lead author of the study.

The research suggests that the Value Modifier may have hit a trifecta of failure. It did not reduce the cost of care, nor improve the quality of the care, nor improve the health of the patients. In fact, it may have made things worse.  


CDC urges consumers who drank raw milk product to seek treatment | Fox News

As a result, the CDC warned that anyone who has consumed the company's raw milk product may have been infected with Brucella abortus RB51, a rare germ that requires antibiotics.

The bacteria is used to vaccinate young female cattle against B. abortus, but can cause fever, muscle pain, lasting fatigue, joint pain, and swelling of the testicles in humans, according to Live Science. If left untreated it could lead to arthritis, heart problems, enlargement of the liver or spleen, meningitis or miscarriage.


Monday, November 27, 2017

Flavocoxid for OA Tied to Life-Threatening Health Problems

The US Food and Drug Administration (FDA) is investigating serious adverse events involving flavocoxid (Limbrel, Primus Pharmaceuticals), a prescription product in capsule form that is marketed as a medical food for the management of metabolic processes associated with osteoarthritis.

"While a range of adverse events have been reported, two serious and potentially life-threatening medical conditions are among them: drug-induced liver injury and hypersensitivity pneumonitis," the FDA said in a safety communication November 21.

The FDA said it has received 194 reports of adverse event involving flavocoxid. In 30 of those cases, there was sufficient information to determine that flavocoxid was likely associated with these adverse events, the FDA said.

Flavocoxid is available in capsule form in two doses: 250 mg and 500 mg. The labeling states that the products contain two types of flavonoids: baicalin (from Scutellaria baicalensis) and catechin (from Acacia catechu). The products also contain zinc. The product labels say flavocoxid is intended for the managaement of the metabolic processes associated with osteoarthritis.


Saturday, November 25, 2017

Urinary Excretion of the Herbicide Glyphosate in Older Adults, 1993-2016 | Toxicology | JAMA

The herbicide Roundup is sprayed onto genetically modified crops and applied as a desiccant to most small non–genetically modified grains. Use of this herbicide has increased since 1994 when genetically modified crops were introduced in the United States. Glyphosate, the primary ingredient in the herbicide, is found in these crops at harvest.1 Environmental exposure through dietary intake of these crops has potential adverse health effects and can be assessed by measuring urinary excretion.2- 4 We measured excretion levels of glyphosate and its metabolite aminomethylphosphonic acid (AMPA) in participants from the Rancho Bernardo Study (RBS) of Healthy Aging.


VA study shows parasite from Vietnam may be killing vets | Fox News

Liver flukes, parasites that infect a human when raw or undercooked fish is eaten, are being investigated as the cause of a rare bile duct cancer among veterans who served in the Vietnam War. It could take years for symptoms to show up, but when they do, the host is left with tremendous pain and given just a few months to live.

The Department of Veterans Affairs this spring commissioned a small pilot study to look into the link between liver flukes and the cancer. More than 20 percent of the 50 blood samples submitted to the study came back positive or bordering positive for liver fluke antibodies, said Sung-Tae Hong, the tropical medicine specialist who carried out the tests at Seoul National University in South Korea.