Breast Cancer spread cut from Blood Pressure drug?
Source: BBC Health; European Breast Cancer Conference, Barcelona
As it sometimes happens in medicine, a drug that has been proven to work in less than stellar ways for a given condition may have a completely unintended but surprisingly beneficial medical outcome. What the heck am I talking about? Some examples may be in order here. You may have heard of a drug called Imitrex, used for the treatment of migraines. Well it was originally formulated as an anti-seizure drug with mixed results. A few accidental results and a new generation of migraine treatments was born.
Not familiar with that one? Okay, you may have heard of a drug called Viagra which is fairly well-knonw (to the internet spam community in particular). Well, Viagra, was an anti-hypertensive drug which despite years of development and testing did less for hypertension than it did for…well, you get the idea.
Enter beta blockers, a classification of blood pressure medications estimated to be currently prescribed to over two million people in the UK alone. A team of UK and German researchers has found that in a study of women with breast cancer tumors, those taking beta blockers had a 71% lower chance of dying from metastatic (spreading) disease.
Granted the study was small, focusing upon some 466 European women with breast cancer. However, the results could be significant. Breast cancer remains the single largest killer of women, with some 30,000 diagnosed in the UK each year. It is thought that beta blockers may also block hormones which trigger the spread of cancer cells beyond the breast. The chances of curing breast cancer differ remarkably where cancer can be confined to the breast or to a small area of the breast. Once cancer metastasizes (spreads) throughout the body, chances of a cure diminish.
Beta blockers attach to the same cancer cell receptors as metastatic associated hormones, thereby reducing the ability of the cancer cells to spread beyond the confines of a tumor. So it may just be that the hope for a “new” drug to treat breast cancer exists in an old drug, beta blockers, which have been used for years now with relative safety. It is hoped that a combination of existing chemotherapy drugs and beta blockers may offer breast cancer patients greater chance of cure and certainly greater chance of confining, and thereby surviving, breast cancer.
The even better news? Unlike the introduction of a completely new drug, the re-purposing (If I may) of a drug isn’t as rigorous a process and it appears that the studies are well into the clinical trial stages. Granted this is taking place in Europe and our FDA may not be as enlightened. However, this also means that it might not take another 7 years for beta blockers to emerge as accepted treatment for breast cancer.
~Posted by D.M. Schwadron, Esquire
Hospital X-rays miss "many fractures."
Source: American Journal of Roentgenology; BBC Health
A Duke University study published in the American Journal of Roentgenology (that’s x-rays) found that plain x-rays miss a surprising amount of fractures compared with MRI. How many? Out of 92 patients undergoing x-ray and then checked with MRI, 35 fractures were missed. That’s more than 1/3 of fractures for the slow at math. Oh and 11 patients had a fracture suggested by x-ray that wasn’t on the MRI (a false positive).
The problem? Well outside of the obvious, is that a negative finding read on an x-ray will not result in any additional study. In a Hospital Emergency Room Setting, the goal is to rule out traumatic fractures and move on to other diagnoses. Which means that patients are getting sent home with fractures that could potentially result in greater injury (ie. risk of fall, accident, extension of fracture, etc).
The suggestion of the authors was to use MRI in addition to x-rays, where doctors have doubts -particularly in the frail or elderly patient population. (Like you, I was looking to see if the study was funded by the MRI Manufacturers Association, but I could neither confirm nor deny that.) Hip and pelvic fractures are common among this group. (Who else thinks putting the call back upon the doctor is an inherently good idea?) Maybe I’m missing something (no pun intended) but if ER doctors are using x-ray to rule out fracture, why would they go any further once they get a negative result. Further, won’t the hospital administration and the Insurance Companies question the diagnostic rationale of obtaining an additional study when the first study was negative?
Okay, here is the point where I go off on an associated tangent, but a tangent, nonetheless. The point of this study was to use MRI as a back up where there were questions about an x-ray finding. Maybe the better practice would be to simply use MRI as the first study and do away with conventional and, apparently out-dated, x-ray technology?
What do I mean by “outdated?” A quick history lesson. It was 11/08/1895 when Wilhelm Conrad Röntgen accidentally discovered an image cast from his cathode ray generator. A week after his discovery, Rontgen took an X-ray photograph of his wife’s hand which clearly revealed her wedding ring and her bones. The photograph electrified the general public and aroused great scientific interest in the new form of radiation. Röntgen named the new form of radiation X-radiation (X standing for “Unknown”). Wilhelm’s wife, who served as chief tester would later die of radiation over-exposure. In 1913, William Coolidge invented the X-ray tube which then revolutionized the generation of X-rays and is the model upon which all X-ray tubes for medical applications are based. I’d consider that outdated. Hey, what do I know, I’m a lawyer, not a doctor.
~Posted by D.M. Schwadron, Esquire
This week let's recall something new, Salmonella! Oh, wait…
Source: U.S. Food & Drug Administration
Spice Barn, Inc. Voluntarily Recalls Two Lots of Black Pepper
Okay, I still don’t understand the pepper connection. (Even the FDA’s own reports say that it was “unusual”).
Spice Barn is recalling two lots of Black Pepper due to the possibility of contamination with Salmonella. Salmonella is a common food borne pathogen that can cause severe illnesses, including fever, abdominal cramps and diarrhea. (You really should know this by now). While most individuals recover without medical intervention, the infection can be life-threatening in some cases such as young children, the elderly and those with compromised immune systems. There have been no reports of Salmonella-related illness to date in relation to these products. (Right, we just recall things because it’s fun).
The Products are: Malabar Peppercorns Lot MTC-3258 in 1 and 5 Pound Bags Distributed between: 1/26/10 to 2/8/10; Ground Black Pepper Lot MO-3258T in 1 and 5 Pound Bags Distributed between:12/08/09 to 2/8/10.
All items packaged with this lot number are subject to this recall. The items were distributed to a small number of customers in the following states VT, NY, PA, MA, GA, VA, CA, TX, CO, MO, WA, FL, AL, MI, AZ, AR, WA. Spice Barn is contacting each customer directly and offering a replacement or refund. Consumers who have purchased these products are asked not to us them and to destroy the product. Consumers with questions regarding the products listed may call Spice Barn at 1-866-670-9040 8:30AM-2:30PM M-F(EST) and speak with customer service.
AND JUST IN CASE YOU THINK YOU ARE BEING ALL SAFE AND HEALTHY AND ALLERGEN FREE WITH YOUR GLUTEN FREE SELF…
GFN Foods, LLC of Cranford, NJ (Hi Cranford!) is voluntarily recalling:
Gluten-Free Naturals Pancake Mix – UPC 187058 000043
Lots 09159 (exp 12/8/2010), 09320 (exp 5/16/12) 09322 (exp 5/18/12)
Gluten-Free Naturals Light & Moist Yellow Cake Mix – UPC 187058 000067
Lots 09083 (exp 9/24/10) and 09322 (exp 5/18/12)
Gluten-Free Naturals Cookie Blend Flour – UPC 187058 000029
Lots 09086 (exp 6/24/10), 09219 (exp 11/7/10) and 10035 (exp 5/4/11)
These products, manufactured by GFN Foods, are being recalled because they have the potential to be contaminated with…You got it! Salmonella. The FDA and Thumb Oilseed Producers Cooperative of Ubly, MI found traces of salmonella in Thumb Oilseed’s facility. GFN Foods, LLC is voluntarily recalling the products that contain the ingredient supplied by Thumb Oilseed.
Salmonella is an organism…blah…blah…blah…say it with me…which can cause serious and in some cases fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with salmonella often experience fever, diarrhea (which can be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with salmonella can result into getting into the bloodstream and producing more severe illnesses such as arterial infections, endocarditis and arthritis.
The safety of our products is of paramount importance to GFN Foods. Customers that have purchased the above products should contact GFN Foods at 866-761-6147 for a refund or to arrange for replacement product. You can also email sales@gfnfoods.com or call with any questions.
Okay! It’s Friday. Weekend coming up. Safe eating.
~Posted by D.M. Schwadron, Esquire
Cervical cancer risk? Home testing on the horizon.
Source: BBC Health News
No, it is not anticipated that home testing for breast cancer, ovarian cancer or prostate cancer will be available any time in the near future. However cervical cancer is unique due to it’s associated risk with the human papillomavirus (HPV or genital warts), 13 of it’s 100 variants apparently cause cancer.
The issue is so serious that a vaccine for HPV was introduced in the past few years and made available to school-aged girls. So then what role does testing play? First, not all women are receiving vaccinations for HPV. Second, not all women are undergoing routine screening for HPV at their gynecologist’s or primary care provider’s office. For these women, the availability of a reliable home test could be an option.
HPV causes cellular damage even after the initial infection clears. A simple swab may collect damage cells and tell doctors a great deal about a woman’s risk for the development of cervical cancer. Were it only that all medical solutions were simple solutions.
~Posted by D.M. Schwadron, Esquire
Preventing Catastrophic Brain Injury with blood pressure checks.
Source: BBC Health; The Lancet
A stroke is the interruption of blood to the brain. It is most commonly caused by vascular interruption from a blood clot or cholesterol blockage or cholesterol embolus. Rarely, it may also be caused by fungal endocarditis and fungal emboli following mitral valve replacement surgery.
Strokes have been classified as “brain attacks.” Like heart attacks, strokes can damage and kill tissue and result in temporary or permanent brain, injury, nerve injury (palsy), paralysis, loss of coordination and balance,neurological impairment, loss of speech and death. Predicting them and treating them before they occur can be critically important.
Researchers are calling for new guidelines for GP’s (General Practitioners or Primary Care Providers here in the US) to ensure that blood pressure remains at a steady level. While lower is preferential, it appears to be the fluctuation (change up or down) of blood pressure that determines the risk of stroke. Current guidelines call for a re-check of a high blood pressure only. If that second pressure is normal there is rarely treatment in the form of medication. And medication alone might not be the answer. Studies published in The Lancet have suggested that beta blockers (a common class of heart medication) may increase variation in blood pressure.
Like the fable the tortoise and the hare, it appears that slow and steady really does win the race when it comes to blood pressure and decreasing the risk of stroke or at the very least predicting those patients at risk for stroke.
~Posted by D.M. Schwadron, Esquire
Hospital Medicine Errors in the UK. Lessons for US.
Source: BBC Health; National Patient Safety Agency (NPSA)
Roughly equivalent to our JCoHA (Joint Commission) here in the US, the NPSA has been taking notes on the administration of medications in English and Welsh Hospitals. Their findings? In every hospital in England and Wales, there were reports of patients not receiving their medications on time or at all.
From 9/06 to 6/09, the NPSA recorded reports of 68 cases of severe injury and 27 deaths with an additional 21,000 cases of drug administration delays or non-administration. Since reports to the NPSA are voluntary, the organization believes that these figures are underestimated.
Alarmingly, antibiotics (drugs to treat infection) and anticoagulants (blood thinners) and cardiac drugs are the most likely to harm patients if missed. Although even antidepressants and Parkinson’s Disease drugs can have dramatic effects upon patient wellness if they are not timely received.
And if this is happening in England and Wales, consider the implications for an area as populated as the US with all of its hospitals and nursing home facilities.
~Posted by D.M. Schwadron, Esquire
New drugs and tests for Prostate Cancer.
Source: Annual Genitourinary Cancers Symposium; Medline
192,000 men are diagnosed with prostate cancer annually. 27,000 cases are terminal. Currently under investigation is a new chemotherapy drug -Cabazitaxel which is being administered in conjunction with Mitoxantrone (a commonly used drug f0r prostate cancer). Men receiving this chemo cocktail (no pun intended) had a 30% increase in survival. To you or I 15.1 months to live vs. 12.7 may not seem like a lot but if you were dying and those were your options, wouldn’t you want more time? It is thought that giving the combination of drugs early in the diagnostic stage might translate to even greater survival times.
To that end researchers are developing better diagnostic tools for Prostate Cancer. Showing promise is the PCA3 urine test. Apparently overly expressed in men with prostate cancer, gene 3 is a fair predictor for advanced prostate disease. The current complaints against the standard PSA testing is the high rate of false positives resulting in biposy.
Finally, the tried and true cystoscopy procedure (Yes, the one where they insert a catheter with a small camera into the bladder. Over the river and through the woods…Well not quite. Cystoscopy has been found to be remarkable cost-effective. Accordingly, look for it to be featured more in insurance schemes and offered more by urologists. Cynical? Perhaps. But you’ll see.
~Posted by D.M. Schwadron, Esquire
As cold as a witch’s…Freezing breast cancer tumors?
Source: Annals of Surgical Oncology; Medline
It may be still in the early lab stages -how early? Well they are still testing the technique upon mice with tumors, however, researchers have found that freezing breast cancer tumors (cryoablation) helps to stop the spread of breast cancer.
Not only did the rapid freezing, through application of a cold probe to the tumor site, kill breast cancer tumors, there was a better outcome in terms of tumor spread (metastasis) to the lungs.
All is not lab mice though. Cryoablation is being actively used to treat actual human patients with prostate cancer, kidney cancers and cancers that have spread to the bone marrow with encouraging results. Hopefully this will be another tool to fight breast cancer in the near future.
~Posted by D.M. Schwadron, Esquire.
Revised Screening Guidelines for Prostate Cancer
Source: American Cancer Society
Men should discuss the benefits and risks of prostate cancer screening with their doctors, according to revised prostate cancer screening guidelines from the American Cancer Society (ACS). Yes. That’s what they said. Not much of a guideline is it?
Okay they say a little more. But really, only a little. The American Cancer Society recommends that doctors more heavily involve patients in the decision of whether to get screened for prostate cancer.
ACS recommends that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening. These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening. For them, the risks likely outweigh the benefits, researchers have concluded.
ACS recommends men at high risk – African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65 – begin those conversations earlier, at age 45. Men at higher risk – those with multiple family members affected by the disease before age 65 – should start even earlier, at age 40.
For men who choose to be screened after discussing the pros and cons with their doctor, the new guidelines make the digital rectal exam (DRE) optional and offer the option of extending the time between screening for men with low PSA levels.
There it is. No specific PSA recommendations, or even whether PSA testing should be considered mandatory. So start “talking to your doctor” about screening. Does this sound an awful lot like the burden of screening for Prostate Cancer is being placed back upon the patient? Yeah. It sounds that way to me too.
~Posted by D.M. Schwadron, Esquire
A whole 'lot of Salmonella going on.
Source: U.S. Food & Drug Administration
We elaborated on just one of these but apparently March is National Salmonella month here in the U.S. Among the products affected are dips, chips (a double whammy), spices and soup.
Just why are there so many products affected with Salmonella? Maybe it’s time we stopped mass producing food in factories and “engineering” foods genetically. Radical concepts, I’m aware but still, click through the evidence. The system is broken and needs some fixes.
March 2010
- March 03, 2010 – Earth Island Announces Voluntary Recall On Select Follow Your Heart Products That Contain Natural Flavor Because Of Possible Health Risk3
- March 03, 2010 – Homemade Gourmet Voluntarily Recalls “Tortilla Soup Mix” Because of Possible Health Risk4
- March 03, 2010 – Reser’s Fine Foods Inc Press Release5
- March 02, 2010 – Tim’s Cascade Snacks Recalls ‘Hawaiian® Kettle Style Potato Chips – Sweet Maui Onion’ and ‘Hawaiian- Sweet Maui Onion Rings’ Because of Possible Health Risk6
- March 02, 2010 – Castella Imports, Inc. Conducts Nationwide Recall of Castella Chicken Soup Base Because of Possible Health Risk7
- March 01, 2010 – Heartland Foods, Inc. voluntarily recalls Coarse Ground Black Pepper because of possible Salmonella Contamination8
- March 01, 2010 – T. Marzetti Company Announces a Voluntary Recall of Dips Due to Possible Health Risk
~Posted by D.M. Schwadron, Esquire