Thursday, September 15, 2016

Prostate Cancer Study Details Value of Treatments - The New York Times

A new study offers important information to men who are facing difficult decisions about how to treat prostate cancer in its early stages, or whether to treat it at all.

Researchers followed patients for 10 years and found no difference in death rates between men who were picked at random to have surgery or radiation, or to rely on "active monitoring" of the cancer, with treatment only if it progressed.

Death rates from the cancer were low over all: only about 1 percent of patients 10 years after diagnosis.

But the disease was more likely to progress and spread in the men who opted for monitoring rather than for early treatment. And about half the patients in the study who had started out being monitored wound up having surgery or radiation.

The patients are still being followed, which should reveal whether the death rate will eventually increase for the men assigned to monitoring.

Doctors say the findings should help reassure men that surgery and radiation are equally reasonable choices in the early stages of the disease.

"I can counsel patients better now," Dr. Freddie C. Hamdy, a leader of the study from the University of Oxford, in England, said in an interview. "I can tell them very precisely, 'Look, your risk of dying from cancer is very, very small. If you receive treatment you will get some benefit. It will reduce the disease from growing outside your prostate, but these are exactly the side effects you might expect.'"

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Monday, September 12, 2016

Cancer Survivorship Is On The Rise -- And That's Both Good News And Bad - Forbes

The Stand Up to Cancer (SU2C) telethon is tonight, and the hour-long TV event promises to offer a mix of inspiring cancer survivors and celebrities like Jon Hamm and Kristen Wiig hailing the accomplishments of the eight-year-old fundraising outfit, which has hauled in $370 million for oncology research so far. There's little doubt that cancer research benefits from such high-profile efforts to bring in more funding. SU2C-supported researchers, for example, had a hand in the recent FDA approvals of Pfizer's Ibrance (palbociclib) to treat breast cancer and Celgene's Abraxane (paclitaxel) plus gemcitabine to treat pancreatic cancer. But there's a flipside to more cancer patients surviving the disease—and it's one that the National Cancer Institute (NCI) says deserves more scrutiny.

First, the good news: The NCI predicts that the number of cancer survivors in the U.S. will jump from 15.5 million to 26.1 million by 2040, fueled in part by the graying of the Baby Boomer population, but also by the growth of new, more effective treatments, according to a study published in a recent edition of the American Association for Cancer Research journal Cancer Epidemiology, Biomarkers & Prevention.

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Risky Medicine: Our Quest to Cure Fear and Uncertainty - Aronowitz

Will ever-more sensitive screening tests for cancer lead to longer, better lives?  Will anticipating and trying to prevent the future complications of chronic disease lead to better health?  Not always, says Robert Aronowitz in Risky Medicine. In fact, it often is hurting us.  

Exploring the transformation of health care over the last several decades that has led doctors to become more attentive to treating risk than treating symptoms or curing disease, Aronowitz shows how many aspects of the health system and clinical practice are now aimed at risk reduction and risk control. He argues that this transformation has been driven in part by the pharmaceutical industry, which benefits by promoting its products to the larger percentage of the population at risk for a particular illness, rather than the smaller percentage who are actually affected by it. Meanwhile, for those suffering from chronic illness, the experience of risk and disease has been conflated by medical practitioners who focus on anticipatory treatment as much if not more than on relieving suffering caused by disease. Drawing on such controversial examples as HPV vaccines, cancer screening programs, and the cancer survivorship movement, Aronowitz argues that patients and their doctors have come to believe, perilously, that far too many medical interventions are worthwhile because they promise to control our fears and reduce uncertainty. 

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Failure to Improve Is Still Being Used, Wrongly, to Deny Medicare Coverage - The New York Times

Edwina Kirby was having a hard time. She had tripped over a rug in her home in Livonia, Mich., and the fall broke a femur. After she had surgery and rehabilitation, an infection sent her back into the hospital. Her kidneys failed, requiring dialysis; she was also contending with diabetes and heart disease.

By the time she entered Glacier Hills Care and Rehabilitation Center, a nursing facility in Ann Arbor, "she couldn't even feed or dress herself," said her daughter Deanna Kirby, 55. "She was basically bedridden."

For months, physical therapists worked with Mrs. Kirby, a retired civil servant who is now 75, trying to help her regain enough mobility to go home. Then her daughter received an email from one of the therapists saying, "Edwina has reached her highest practical level of independence."

Translation: Mrs. Kirby wouldn't receive Medicare coverage for further physical therapy or for the nursing home. If she wanted to stay and continue therapy, she'd have to pay the tab herself.

Medicare beneficiaries often hear such rationales for denying coverage of skilled nursing, home health care or outpatient therapy: They're not improving. They've "reached a plateau." They're "stable and chronic," or have achieved "maximum functional capacity."

Deanna Kirby wasn't buying it. "I knew they couldn't refuse you, even if you're not improving," she said.

She's right. A federal judge last month ordered the federal Centers for Medicare and Medicaid Services to do a better job of informing health care providers and Medicare adjudicators that the so-called improvement standard was no longer in effect.

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Sunday, September 11, 2016

Full ‘Medical Records’ for Trump and Clinton? That’s Fiction - The New York Times

One of Donald J. Trump's recent attack lines against Hillary Clinton focuses on her health: If she has nothing to hide, he asks in a tweet, why doesn't she release her medical records to the public?

For the moment, put aside Mr. Trump's own revelations about his medical history, which consist of a hyperbolic, undated letter with little detail from his gastroenterologist. And put aside Mrs. Clinton's own recent disclosures, which include a somewhat more detailed accounting of her health and medication history from the internist who has overseen her care in recent years. Put aside, finally, the question of whether complete medical records would allay the conspiracy theories of some of Mrs. Clinton's critics, who say a recent cough is a sign of disqualifying illness or believe she experienced a seizure during a recent news conference.

Instead, assume that Mrs. Clinton wished to take Mr. Trump's request seriously, and release full and detailed medical records. It would not be easy, even for a V.I.P. with an army of staffers. Mrs. Clinton is 68 years old, has lived in multiple states and been treated by many doctors and hospitals over the years. The notion of a single file, containing "medical records," is a fiction. Her medical records are in bits and pieces, in doctors' filing cabinets, hospital records departments, and in hard-to-access computers. Just like yours, probably.

The federal government has invested billions in helping to digitize medical records, but the process is still in its infancy, with data that is often nonstandard and hard to transfer between systems. And even as a growing number of medical professionals have made the transition to digital records, most of our medical histories exist only in the old world of paper, assuming they still exist at all. (Mrs. Clinton's pediatrician is unlikely to still be alive, and records of Mrs. Clinton's possible polio vaccination or childhood ear infections may be lost to history.)

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Major review aims to end controversy over cholesterol-lowering statin drugs - CBS News

Cholesterol-lowering drugs called statins​ have gotten a bad rap, say the authors of a comprehensive new review of 30 years' worth of studies on the medications. Statins – including such popular brand names as Lipitor, Crestor, Zocor and Pravachol – are taken by millions of people​.

The research, published today in The Lancet, will help doctors and patients make more informed decisions when it comes to using statins, the scientists said in a media briefing.

The review focused on the results of randomized clinical trials and other evidence on the effectiveness and safety of statin therapy.

"Our review shows that the numbers of people who avoid heart attacks and strokes by taking statin therapy​ are very much larger than the numbers who have side-effects with it," review author Dr. Rory Collins, of the University of Oxford, in England, said in a press statement. "In addition, whereas most of the side effects can be reversed with no residual effects by stopping the statin, the effects of a heart attack​ or stroke​ not being prevented are irreversible and can be devastating."

In their paper, the authors said lowering cholesterol by prescribing a standard 40-milligram daily dose of atorvastatin (generic for Lipitor) would, over the course of five years in 10,000 patients, prevent heart attacks, ischemic strokes and coronary artery bypasses in 1,000 people with pre-existing vascular disease. The drug would prevent those conditions in 500 additional people who are at an increased risk – due to age, hypertension or diabetes – but who haven't yet had a vascular event.

On the other hand, while statins can have some serious side effects, the researchers found the numbers are tiny in comparison. The same dose over the same period of time in the same number of patients would lead to five cases of patients developing muscle pain and weakness​ (myopathy). And only about one of those cases would result in full-blown muscle breakdown, called rhabdomyolysis​, if the drug treatment continued.

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