Why Preventing Cancer Is Not the Priority in Drug Development?

Most people would agree that it would be better to prevent cancer, if we could, than to treat it once it developed. Yet economic incentives encourage researchers to focus on treatment rather than prevention.

The way the patent system interacts with the Food and Drug Administration’s drug approval process skews what kinds of cancer clinical trials are run. There’s more money to be made investing in drugs that will extend cancer patients’ lives by a few months than in drugs that would prevent cancer in the first place.

That’s one of the findings from the work of Heidi Williams, an M.I.T. economics professor and recent MacArthur Foundation “genius” grant winner, who studied the problem along with Eric Budish, a University of Chicago economics professor, and Ben Roin, assistant professor of technological innovation, entrepreneurship and strategic management at M.I.T

“R & D on cancer prevention and treatment of early-stage cancer is very socially valuable,” the authors told me in an email, “yet our work shows that society provides private firms — perhaps inadvertently — with surprisingly few incentives to conduct this kind of research.”

To secure F.D.A. approval, after patenting a drug, drug companies race the clock to show that their product is safe and effective. The more quickly they can complete those studies, the longer they have until the patent runs out, which is the period of time during which profit margins are highest. Developing drugs to treat late-stage disease is usually much faster than developing drugs to treat early-stage disease or prevention, because late-stage disease is aggressive and progresses rapidly. This allows companies to see results in clinical trials more quickly, even if those results are only small improvements in survival.

Many more cancer trials focused on treatments for patients with late-stage cancers than for early-stage cancers, according to the study. Between 1973 and 2011, there were about 12,000 trials for relatively later-stage patients with a 90 percent chance of dying in five years. But there were only about 6,000 focused on earlier-stage patients with a 30 percent chance of dying. And there were over 17,000 trials of patients with the lowest chance of survival (those with recurrent cancers) but only 500 for cancer prevention, which confer the longest survival gains. The bias toward studies focused on patients with shorter survival duration is more prevalent among privately financed trials than for publicly financed ones.

Another approach is to extend the period of a drug’s market exclusivity to compensate for the commercialization lag. The Hatch-Waxman Act of 1984 already permits a partial extension — a half year for every year in clinical trial, up to a maximum of five additional years. Ms. Williams’s analysis suggests this is the right idea, but that there are still many potential drugs that receive only very short periods of market exclusivity. The Affordable Care Act includes a provision that grants 12 years of market exclusivity beginning from F.D.A. approval — a half year less than the typical 12.5 years remaining on a patent — but it applies only to biologic drugs.

Source: nytimes

Here’s why you should not sit too much during the day

Sleeping more than nine hours and sitting too much during the day — along with a lazy lifestyle — can send you to an early grave, warn researchers.


According to the findings from non-profit organisation Sax Institute’s “45 and Up Study”, a person who sleeps too much, sits too much and is not physically active enough is more than four times as likely to die early as a person without those unhealthy lifestyle habits.

Too much sitting equates to more than seven hours a day and too little exercise is defined as less than 150 minutes a week.

“This is the first study to look at how those things (sleep and sitting) might act together,” said lead author Dr Melody Ding.

When you add a lack of exercise into the mix, you get a type of “triple whammy” effect.

“Our study shows that we should really be taking these behaviours together as seriously as we do other risk factors such as levels of drinking and unhealthy eating patterns,” Dr Ding added.

Dr Ding and her colleagues from University of Sydney analysed the health behaviours of more than 230,000 of the participants in the “45 and Up Study”.

They looked at lifestyle behaviours like smoking, high alcohol intake, poor diet and being physically inactive and added excess sitting time and too little/too much sleep into the equation.

The team found another problematic triple threat: smoking, high alcohol intake and lack of sleep (less than seven hours a night) is also linked to a more than four-times greater risk of early death.

“The take-home message is that if we want to design public health programmes that will reduce the massive burden and cost of lifestyle-related disease we should focus on how these risk factors work together rather than in isolation,” explained study co-author professor Adrian Bauman.

The non-communicable diseases (such as heart disease, diabetes and cancer) now kill more than 38 million people around the world and cause more deaths than infectious disease.

“Better understanding what combination of risk behaviours poses the biggest threat will guide us on where to best target scarce resources to address this major – and growing – international problem,” the authors noted in a paper published in the journal PLOS Medicine.

Source: zee news

Testosterone Therapy may help older men live longer

Restoring testosterone in older men to normal level through gels, patches, or injections may lower their risk of heart attack, stroke, or death from any cause, says a large study co-authored by an Indian-origin researcher.

The study also found that men who were treated but did not attain normal levels did not see the same benefits as those whose levels did reach normal.

“It is the first study to demonstrate that significant benefit is observed only if the dose is adequate to normalise the total testosterone levels,” said corresponding author of the study Rajat Barua, assistant professor of medicine at the University of Kansas in the US.

“Patients who failed to achieve the therapeutic range after testosterone replacement therapy did not see a reduction in (heart attack) or stroke and had significantly less benefit on mortality,” Barua noted.

The findings may sway the ongoing debate over testosterone therapy’s benefits and risks, especially for the heart.
So far, the medical community lacks results from any definitive clinical trial that might provide clear guidance.

Meanwhile, the US Food and Drug Administration (FDA) issued guidance earlier in 2015 advising clinicians about the over-use of testosterone therapy, and pointing to a possible increased risk of heart attack and stroke.

The new study looked at data on more than 83,000 men with documented low testosterone, all age 50 or above, who received care between 1999 and 2014.

The researchers divided the men into three clinical groups: those who were treated to the point where their total testosterone levels returned to normal, those who were treated but without reaching normal, and those who were untreated and remained at low levels.

The average follow-up across the groups ranged from 4.6 to 6.2 years. The sharpest contrast emerged between those who were treated and attained normal levels and those whose low testosterone went untreated.

The treated men were 56 percent less likely to die during the follow-up period, 24 per cent less likely to suffer a heart attack, and 36 per cent less likely to have a stroke.
The exact reasons for testosterone’s apparent benefits for the heart and overall survival are not known. Possible explanations, the researchers said, could involve body fat, insulin sensitivity, lipids, blood platelets, inflammation, or other biological pathways.

Source: indiatoday

Acupuncture ‘safe and effective’ for chronic pain in children

Treating children with chronic pain is challenging; there is limited evidence on the efficacy of pain-relieving therapies among this population. But according to new research, acupuncture may be a safe and effective treatment strategy.

Chronic pain is defined as any pain that lasts at least 12 weeks. It is estimated that around 20-35% of children and teenagers across the globe have chronic pain.

Treating adults with chronic pain has its difficulties, but treating children with the condition is even more challenging; there is little evidence on effective drug therapies for chronic pain in children, and health professionals are often wary of providing certain treatments to youngsters because of their vulnerability during growth and the fear of possible long-term health implications.

“Effective treatment of pain can be particularly difficult because it’s subjective; but with children, it is increasingly difficult because a child may not be able to communicate effectively depending on the age and accurate recognition of pain,” adds Johnson.

As such, the search is on to identify safe and effective therapies for chronic pain in children, and with this latest study, Johnson and her team may have found one: acupuncture.

Acupuncture is a practice used in traditional Chinese medicine, which involves stimulating certain pressure points on the body, most commonly with the insertion of thin needles through the skin.

While acupuncture is considered an effective treatment for chronic pain in adults, there is little information on whether the procedure may be an effective form of pain relief for children.

“This study looked at the effect of acupuncture in children directly, rather than examining data collected from adults,” says Johnson. “This focus is especially important, since children experience pain in different ways than adults.”

Source: medicalnews today

Suffering from back pain? Try these five yoga poses!

Do you often suffer from agonizing back pain? Well, it has become one of the common physical pain that we face everyday. It happens because of the long sitting hours in office or because of the wrong sitting position. While most of us consult doctors to treat the pain but the best and easiest way to get rid of the pain is by doing yoga exercise.

Here are some yoga positions that will help to ease pain in the back:

Downward facing dog
This one is the most common yoga position known to everyone. The pose stretches out the cervical spine and strengthens the core, hamstrings and lower back.

downward_facing_dog

Bow pose
Bow pose is good for back as it helps in stretching and strengthening the upper back and shoulders which further improves posture and minimizes hunching.

BowPose

Upward facing dog
Another common yoga pose, it is similar to downward facing dog but in this one you just have to do the opposite. This pose helps to improve abdominal and back stretch.

upward

Seated forward fold
This one is an intense and awesome hamstring stretch. This pose helps to get rid of the back pain as it lengthens your back when you stretch forward.

seated_forward_bend_blog

Seated spinal twist
This pose helps in getting rid of back pain as it increases the flexibility in your upper body while stretching the shoulders, hips, and neck. It also improves your posture and spine mobility.

spinaltwist_

Source : zee news health

Weight Gain Between Pregnancies May Affect Infant Survival

Weight gain after a first pregnancy might raise the risk of infant death and stillbirth in a second pregnancy, a new study suggests.

In mothers who were previously a healthy weight, even moderate weight gain between the two pregnancies was associated with increasing the odds for infant death, researchers reported Dec. 3 in The Lancet.

“The public health implications are profound,” study author Sven Cnattingius, a professor at the Karolinska Institute in Sweden, said in a journal news release.

“Around a fifth of women in our study gained enough weight between pregnancies to increase their risk of stillbirth by 30 to 50 percent, and their likelihood of giving birth to babies who die in infancy increased by 27 to 60 percent, if they had a healthy weight during their first pregnancy,” Cnattingius said.

But while the study detected an association between mother’s weight gain and infant death and stillbirth, it didn’t actually establish a direct cause-and-effect relationship.

The research team analyzed data from more than 450,000 Swedish women who gave birth to their first and second child between 1992 and 2012.

Overall, they found that women whose body mass index (BMI) rose more than four units (about 24 pounds for an average-height woman) between pregnancies had a 50 percent greater risk of their second baby dying within the first four weeks of life compared to women whose weight remained stable between pregnancies. BMI is a measurement of body fat based on height and weight.

Among mothers at a healthy weight during their first pregnancy, a BMI increase of two to four points (13 to 24 pounds in someone of average height) by their second pregnancy was linked to a 27 percent higher risk of infant death. Among those whose BMI rose four points or more, the risk was 60 percent higher, the study found.

The study authors suggested that BMI gains in healthy-weight women may reflect a greater increase of fat mass than in obese women, and therefore present a greater risk.

Causes of infant death in the study included birth defects, lack of oxygen during birth, infections and sudden infant death syndrome.

The researchers also found that the risk of infant death fell about 50 percent among overweight women who lost at least 13 pounds before their second pregnancy.

Still, “the prevalence of overweight and obesity in pregnant women has reached epidemic levels. More than half of women in the [United States] and one in three women in Sweden are either overweight or obese at the start of their pregnancy,” said study co-author Dr. Eduardo Villamor, professor of epidemiology at the University of Michigan School of Public Health.

“Our findings highlight the importance of educating women about maintaining a healthy weight during pregnancy and reducing excess weight before becoming pregnant as a way to improve infant survival,” he said in the news release.

A woman 5 feet, 4 inches tall is deemed overweight (BMI of 25 to 29) if she weighs between 145 and 169 pounds. If she weighs 175 pounds (BMI of 30) or more, she is considered obese, according to the U.S. Department of Health and Human Services.

Source: medlineplus

Families can safely choose antibiotics over appendix surgery for kids

Offering the families of children with appendicitis the option of antibiotics instead of surgery is safe and may ultimately lead to slightly better outcomes, according to a new U.S. study.

Researchers found that when families chose antibiotic treatment for kids with simple appendicitis, instead of going immediately for surgery, the children often recovered without ever needing surgery. Kids were also out of commission for fewer days and ended up with a smaller healthcare bill than those whose families picked surgery.

important-warning-for-parents-your-child-may-appendicitis

“There is a relatively good body of literature in adults and also in children that shows patients and parents involved in the decision process do better,” said Dr. Peter Minneci, of The Research Institute at Nationwide Children’s Hospital in Columbus, Ohio.

Appendicitis occurs when the appendix, a small pouch of tissue off the large intestine, becomes inflamed. The condition can be caused by an infection, blockage, trauma or intestinal disorders like Crohn’s disease.

About 11 percent of all pediatric emergency room visits are due to appendicitis, Minneci and his colleagues write in JAMA Surgery.

Treatment historically has been surgery to remove the appendix, known as appendectomy. But that comes with the possibility of other complications and disruptions to family schedules while the patient heals.

More recent research suggests that treating appendicitis with intense regimens of antibiotics is also effective, but the people in those trials were randomly assigned to receive either surgery or antibiotics, they didn’t get to choose their treatment.

“By allowing the patient to be involved in the decision process you are allowing them to align their preference and beliefs with the care themselves,” Minneci told Reuters Health.

For the new study, the researchers screened 629 patients between ages seven and 17 who came to their emergency room between October 2012 and March 2013 with appendicitis. About 22 percent didn’t have severe or complex cases of appendicitis and were eligible for the study.

Ultimately, 102 enrolled in the study. Of those, 37 families chose to have their children treated with at least 24 hours of intravenous antibiotics followed by 10 days of oral antibiotics. The others elected surgery.

A year later, about 76 percent of kids whose family chose antibiotics were still healthy and didn’t need additional treatment.

Compared to those who got surgery, the children who got antibiotics also ended up needing an average of 13 fewer days of rest, and had medical bills that were an average of $800 lower.

There was also no significant difference in the number of appendicitis cases that became complicated during surgery or after treatment with antibiotics. Minneci said that shows the treatment options are similar in terms of safety.

However, he said, the study team doesn’t want to say one treatment is better than the other, merely that treatment of simple cases of appendicitis with antibiotics is a reasonable alternative.

An accompanying editorial cautions that more research is needed to strike the right balance between patient preference and a doctor’s best judgment.

“Many patients still want us to be ‘doctors,’ not Google impersonators,” write Drs. Diana Lee Farmer and Rebecca Anne Stark, of the University of California, Davis.

Dr. Russell Jennings told Reuters Health that it’s important to note that patients still need to see a surgeon regardless of the treatment, because they need to be evaluated to see if antibiotics are even an option.

“It’s important you don’t change the quality of care,” said Jennings, a surgeon at Boston Children’s Hospital in Massachusetts.

The option of antibiotics for simple appendicitis is likely already available in large medical centers for adults with appendicitis and probably a few large centers that treat children, said Jennings, who wasn’t involved in the new study.

 

Source: Foxnews

How much water should you drink every day to stay healthy and hydrated?

With a heat wave gripping much of the country, many people are guzzling more water than usual to try to stay cool and hydrated. The convention wisdom says we should be downing eight glasses of water a day. But that number isn’t based on any scientific studies, and doctors say it’s not necessarily the best advice.Drinking enough water is important to carry nutrients to your cells, flush bacteria from your system and prevent dehydration, especially during hot summer months when we lose more fluids through sweat. People who are getting a lot of exercise, or women who are pregnant or breastfeeding, may need more.

images

And while plain water is a healthy choice that won’t add extra sugar and calories to your diet, other fluids can be part of the mix. “It’s really about fluids in general. Doesn’t necessarily have to be water,” Dr. Sharmeela Saha, director of the dialysis center at University Hospitals Case Medical Center in Cleveland, told CBS News.

What you eat can make a difference too. Certain foods, including summer favorites like watermelon and other fruits, can count towards your daily water intake. “Lettuce, spinach, fruits in general, soups … those are all things that going to have a lot of water in them as well,” Saha said.

Experts say don’t ignore your thirst — it’s a sign your body needs more water. According to WebMD, other signs of dehydration may include weakness, dizziness, heart palpitations, sluggishness, fainting, or heart palpitations. Urine color may also indicate dehydration; if urine is dark yellow or amber colored, you’re probably not drinking enough fluids.

In addition to keeping you well hydrated, some research has shown drinking water right before a meal may benefit your diet, taking the edge off hunger to help you lose weight.

Source: cbsnews

Keeping heart healthy with tree nuts

Stanford University researchers performed a systematic review and meta-analysis of controlled trials to investigate the effects of tree nuts (almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts) on blood lipids, lipoproteins, blood pressure and inflammation in adults 18 years and older without prevalent cardiovascular disease (CVD). Tree nut consumption was shown to lower total cholesterol, triglycerides, LDL cholesterol and its primary apolipoprotein, ApoB.

431607-heart..w453

Accumulating evidence suggests that nut intake lowers the risk of cardiovascular disease. Our findings, showing that nut intake lowers LDL cholesterol, ApoB and triglycerides in clinical trials, provide mechanistic evidence to support this relationship, said lead author Liana Del Gobbo.

Nuts contain important nutrients such as unsaturated fats, high quality protein, vitamins (i.e., vitamin E, folate and niacin), minerals (i.e., magnesium, calcium and potassium) and phytochemicals–all of which may offer cardioprotective properties, prompting the U.S. Food and Drug Administration to announce a qualified health claim for nuts and heart disease in 2003. The claim states, “Scientific evidence suggests, but does not prove, that eating 1.5 ounces per day of most nuts, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.”

This new analysis provides further support that nuts can and should be part of a heart-healthy diet, states Maureen Ternus, Executive Director of the International Tree Nut Council Nutrition Research & Education Foundation (INC NREF), adding that just 1.5 ounces of nuts per day (about 1/3 cup) can provide many of the important vitamins, minerals and energy we need throughout the day.

Source: Zee news

Popular new approach slow down the spread of HIV : US Study

In recent months, public health officials around the country have started using a popular new method to prevent the spread of HIV called “test and treat.” But a USC study advises that this approach could be counter productive.

The new strategy calls for universal HIV testing of sexually active adolescents and adults as part of routine health screenings, followed by immediate drug therapy for all who test positive for the virus – instead of waiting until their immune system is more compromised.

Public health officials nationwide have embraced the strategy, as it’s been shown to substantially reduce the number of HIV cases and resulting deaths from AIDS. Some experts suggest “test and treat” could even eradicate HIV.

43252-full

But USC researchers from the Schaeffer Center for Health Policy and Economics say their mathematical models indicate the need for caution.

The models predicted that if the “test and treat” strategy were applied for ten years, the prevalence of multi-drug resistant HIV strains would nearly double, from 4.79 percent to 9.1 percent, says Neeraj Sood, an associate professor at the Schaeffer Center.

“That is a worry because if you have multi-drug resistant HIV, then treatment for HIV is less effective for you,” Sood says, adding that the uncertainty of how new strains may evolve and whether new drugs can be developed to battle them remains unknown.

Sood advises a more cautious approach, in which public health officials would continue with aggressive HIV testing, but postpone early-stage treatment of the virus.

The study showed this more modest strategy offers an almost 18 percent reduction of HIV infections, without the increase in drug-resistant HIV strains.

“So you’re getting half the short term benefits,” he says, “but you’re hedging your long term bets.”

The USC researchers said their study also calls into question the claim that “test and treat” could eradicate HIV.

Under a best case scenario, “test and treat” would generate about a 34 percent reduction in new infections and a 19 percent drop in the number of deaths over ten years, says Sood. “Sizeable benefits, but not close to eradicating the disease.”

Sood says he and his team of researchers based their assessment on mathematical models that focused on LA County’s population of sexually active gay men, which accounts for 82 percent of all county residents infected with HIV/AIDS.
Source: SCPR