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Update February 2018


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Health & Wellbeing
 

February 24, 2018 - March 2, 2018

Usage remains low for pill that can prevent HIV infection

Truvada pills have been shown to reduce the risk of getting HIV from sex by more than 90 percent if taken daily. (AP Photo/Jeff Chiu)

David Crary

New York (AP) - From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which - in their view - remains woefully underused.

Marketed in the United States as Truvada, and sometimes available abroad in generic versions, the pill has been shown to reduce the risk of getting HIV from sex by more than 90 percent if taken daily. Yet worldwide, only about a dozen countries have aggressive, government-backed programs to promote the pill. In the U.S., there are problems related to Truvada’s high cost, lingering skepticism among some doctors and low usage rates among black gays and bisexuals who have the highest rates of HIV infection.

“Truvada works,” said James Krellenstein, a New York-based activist. “We have to start thinking of it not as a luxury but as an essential public health component of this nation’s response to HIV.”

A few large U.S. cities are promoting Truvada, often with sexually charged ads. In New York, “Bare It All” was among the slogans urging gay men to consult their doctors. The Los Angeles LGBT Center - using what it called “raw, real language” - launched a campaign to increase use among young Latino and black gay men and transgender women.

“We’ve got the tools to not only end the fear of HIV, but to end it as an epidemic,” said the center’s chief of staff, Darrel Cummings. “Those at risk have to know about the tools, though, and they need honest information about them.”

In New York, roughly 30 percent of gay and bisexual men are using Truvada now, up dramatically from a few years ago, according to Dr. Demetre Daskalakis, a deputy commissioner of the city’s health department.

However, Daskalakis said use among young black and Hispanic men - who account for a majority of new HIV diagnoses - lags behind. To address that, the city is making Truvada readily available in some clinics in or near heavily black and Hispanic neighborhoods.

“We like to go to the root of the problem,” said Daskalakis, who personally posed for the “Bare It All” campaign.

According to the U.S. Centers for Disease Control and Prevention , Truvada would be appropriate for about 1.2 million people in the U.S. - including sex workers and roughly 25 percent of gay men. Gilead Scientific, Truvada’s California-based manufacturer, says there are only about 145,000 active prescriptions for HIV prevention use.

Under federal guidelines, prime candidates for preventive use of Truvada include some gay and bisexual men with multiple sexual partners, and anyone who does not have HIV but has an ongoing sexual relationship with someone who has the virus.

Abroad, a few government health agencies - including those in France, Norway, Belgium, Kenya, South Africa, Brazil and some Canadian provinces- have launched major efforts to promote preventive use of Truvada or generic alternatives, providing it for free or a nominal charge. In Britain, health officials in Scotland and England recently took steps to provide the medication directly through government-funded programs, though in England it’s in the form of a trial limited to 10,000 people.

Truvada was launched in 2004, initially used in combination with other drugs as the basic treatment for people who have HIV, the virus that causes AIDS. It is primarily spread through sex.

Controversy arose in 2012 when the U.S. Food and Drug Administration approved Truvada to reduce the risk of getting HIV in the first place, for what’s called pre-exposure prophylaxis, or PrEP. It blocks the virus from making copies and taking hold. Critics warned that many gay men wouldn’t heed Truvada’s once-a-day schedule and complained of its high cost - roughly $1,500 a month.

Gilead offers a payment assistance plan to people without insurance that covers the full cost. Some cities and a few states - including Illinois, Massachusetts and Washington - also help cover costs. Activists have pressed Gilead to make its co-pay program more generous in light of its profits from Truvada.

“There’s no reason it has to cost so much,” said Krellenstein.

Gilead spokesman Ryan McKeel, in an email, said the company is reviewing the co-pay program.

“Like those in the advocacy community, we are committed to expanding access to Truvada for PrEP to as many people as possible,” he wrote.

In June, the FDA approved a generic version of Truvada, which is likely to push the price down, but it won’t be available in the U.S. for a few years.

The Truvada debate has taken many twists, as exemplified by the varying stances of the Los Angeles-based AIDS Healthcare Foundation - a leading HIV/AIDS service provider. In 2012, the group unsuccessfully petitioned the FDA to delay or deny approval of Truvada for preventive use. The foundation’s president, Michael Weinstein, belittled Truvada as “a party drug” and warned it would increase the spread of sexually transmitted infections by encouraging men to engage in sex without condoms.

But last year, the foundation, while still skeptical about some Truvada-related policies, urged Gilead to cut its price to make it more available.

“We have no dispute about its ability to prevent HIV transmission,” said spokesman Ged Kenslea. He noted that the organization’s 40 pharmacies across the U.S. handle many Truvada prescriptions.


February 17, 2018 - February 23, 2018

US OKs 1st drug aimed at women with inherited breast cancer

On Friday, Jan. 12, 2018, the Food and Drug Administration approved AstraZeneca PLC’s Lynparza, the first drug aimed at women with advanced breast cancer caused by an inherited flawed gene. (Courtesy of AstraZeneca via AP)

Linda A. Johnson

U.S. regulators have approved the first drug aimed at women with advanced breast cancer caused by an inherited flawed gene.

The Food and Drug Administration on Friday approved AstraZeneca PLC’s Lynparza for patients with inherited BRCA gene mutations who have undergone chemotherapy.

The drug has been on the market since 2014 for ovarian cancer, and is the first in a new class of medicines called PARP inhibitors to be approved for breast cancer. PARP inhibitors prevent cancer cells from fixing problems in their DNA.

Lynparza will cost $13,886 per month without insurance, according to AstraZeneca. The company is offering patients financial assistance.

“While there is currently no cure for metastatic breast cancer, today’s approval offers a new, targeted option that may help to delay disease progression for these patients,” Dr. Susan M. Domchek at the University of Pennsylvania’s Abramson Cancer Center said in a statement.

Until recently, cancer medicines targeted the disease based on where in the body it occurs.

This is a new approach to “target the underlying genetic causes of a cancer,” the FDA’s Dr. Richard Pazdur said in a statement.

The agency also approved a companion blood test from Myriad Genetic Laboratories Inc. for detecting BRCA mutations and determining which patients likely would benefit from Lynparza.

About 250,000 people each year are diagnosed with breast cancer and just over 40,000 die from it, according to the National Cancer Institute. About 20 percent to 25 percent of patients with hereditary breast cancers have a BRCA mutation. BRCA-related breast cancer often strikes younger people and is harder to treat than other breast cancers.

The latest approval was based on a study of 302 women with cancers that have spread beyond the breast and who had a BRCA gene mutation.

Lynparza modestly delayed the time until cancer worsened - 7 months versus 4 months for women given one of three commonly used chemotherapies. About half the study participants responded to Lynparza compared with about a quarter of those only treated with chemotherapy. It’s unknown whether treatment increases survival.

Possible side effects are less severe than for chemotherapy, but serious problems can include blood and bone marrow cancers. Common side effects include nausea, fatigue, respiratory infections and blood count problems.

Lynparza is marketed jointly by UK-based AstraZeneca and Merck & Co., which is based in Kenilworth, New Jersey.


UK allows doctors to make babies with DNA from 3 people

London (AP) - Britain’s fertility authority says it has granted permission to doctors at clinics in northeastern England to create babies from the DNA of three people, to help prevent two women from passing on fatal, genetic diseases to their children.

It is the first such approval for the U.K. but the technique has already previously been used: a baby was born in Mexico in 2016 using the experimental therapy.

The treatment fixes problems linked to mitochondria, the energy-producing structures outside a cell’s nucleus. Faulty mitochondria can result in conditions including muscular dystrophy and major organ failure. The technique uses DNA from two women and one man.

Last year, Britain granted Newcastle University a license to use the novel technique but approval is still needed for individual patients.


February 10, 2018 - February 16, 2018

Warning: Stifling sneezes can be health hazard in rare cases

According to a case study published Monday, Jan. 15, 2018, in the journal BMJ Case Reports, doctors in England say stifling a big sneeze can be hazardous for your health in rare cases, based on the very unusual experience of a man who ruptured the back of his throat when he tried to stop a sneeze. (AP Photo/Roberto Pfeil, File)

Maria Cheng

London (AP) - Tempted to stifle a loud or untimely sneeze? Let it out instead, doctors in England warned Monday based on the very unusual case of a man who ruptured the back of his throat when he tried to suppress a sneeze.

In a case study published in the journal BMJ Case Reports, doctors described their initial confusion when the previously healthy man turned up in the emergency room of a Leicester hospital, complaining of swallowing difficulties and “a popping sensation” in his swollen neck.

The 34-year-old patient told them his problems started after he tried to stop a forceful sneeze by pinching his nose and closing his mouth. He eventually lost his voice and spent a week in the hospital.

“When you sneeze, air comes out of you at about 150 miles per hour,” said Dr. Anthony Aymat, director for ear, nose and throat services at London’s University Hospital Lewisham, who was not involved in the case. “If you retain all that pressure, it could do a lot of damage and you could end up like the Michelin Man with air trapped in your body.”

While examining the sneeze-averse patient, doctors in Leicester heard “crackling in the neck” down to his ribcage, a sign that air bubbles had seeped into his chest. Worried about infection and other possible complications, they admitted him to the hospital, gave him a feeding tube and administered antibiotics, according to details published in BMJ Case Reports.

Dr. Zi Yang Jiang, a head and neck surgeon at University of Texas Health Science Center at Houston, said he sees one or two cases arising from repressed sneezes each year, making them an “exceedingly rare” occurrence.

Jiang said it was bizarre that a single sneeze could generate enough force to cause the kind of physical damage that usually results from trauma, such as a gunshot wound to the neck. A collapsed lung is among the problems that retaining the air from an imminent sneeze can cause, he said.

“The whole point of sneezing is to get something out of your body, like viruses and bacteria, so if you stop that, those may end up in the wrong part of the body,” he said. Jiang said in most cases, the excess air is later absorbed by the body.

The English patient made a full recovery and was advised to avoid plugging his nose while sneezing in the future. Doctors recommend letting sneezes rip into a tissue instead.

“The safest thing to do - although it’s not socially acceptable - is just to sneeze loud,” Aymat said.


Update Saturday, February 3, 2018 - February 9, 2018

Terminally ill Briton’s bid for assisted death can proceed

This is a July 19, 2017 file photo of terminally-ill British Noel Conway, a 68-year-old retired lecturer from Shrewsbury, England. Conway has been granted permission on Thursday, Jan. 18, 2018 to challenge the country’s law on assisted dying, after an earlier decision that rejected his case. (Aaron Chown/ PA via AP, File)

London (AP) - A terminally ill British man has been granted permission to challenge the country’s law on assisted dying, after an earlier decision that rejected his case.

Noel Conway, 68, has motor neuron disease. He applied to the High Court last July, asking for a declaration that Britain’s outlawing of suicide is incompatible with the European Convention on Human Rights. The court rejected his bid in October.

But two British judges in an appeal ruled Thursday that Conway’s case should proceed.

Conway, a retired college lecturer, said he brought the case “not only for myself but (for) all terminally ill people who believe they should have the right to die.”

Conway does not plan to die immediately, but wants the option of an assisted death when he is in his final months.

“Why should I have to endure unbearable suffering and the possibility of a traumatic, drawn-out death when there is an alternative that has been proven to work elsewhere?” he said in a statement.

A previous challenge to Britain’s ban on assisted dying was refused in 2014 after the Supreme Court ruled that Parliament should debate the issue before any legal decision.

“Noel’s case has confirmed that the courts do have the authority to declare the law incompatible with human rights legislation,” said Sarah Wootton, chief executive of Dignity in Dying, which is supporting Conway’s case. “This is a significant step forward.”

Wootton said the proposed change to the law is based on legislation first adopted by the U.S. state of Oregon, which restricts assisted dying to people with a fatal illness who have about six months to live.

Assisted dying, when doctors provide patients with the means to kill themselves, like a lethal drink, is legal in five other American states, as well as in Switzerland and Germany.


What about the memory test Trump aced? It’s not for everyone

In this Jan. 16, 2018, photo, White House physician Dr. Ronny Jackson speaks to reporters during the daily press briefing in the Brady press briefing room at the White House, in Washington. (AP Photo/Manuel Balce Ceneta)

Lauran Neergaard

Washington (AP) - Drawing a clock. Counting backward by sevens. Rattling off words that begin with “F’’ before a minute’s up.

They may not sound like difficult tasks, but they’re part of a cognitive exam that’s getting a lot of attention because President Donald Trump aced it.

For all their apparent simplicity, 10-minute quizzes like the Montreal Cognitive Assessment offer doctors a snapshot of someone’s memory and certain other neurologic functions, one piece of information to help determine if trouble’s brewing.

They’re not a routine part of check-ups, either for a president or a not-so-famous senior.

Trump’s doctor says he didn’t see any symptoms that would prompt the test but that the president, who has faced questions about his mental acuity, requested it.

So who really needs a cognitive assessment? They’re usually offered only if there are concerns about memory or other cognitive functions - concerns noticed either by the patient, a relative or the doctor.

“The value of screening without a complaint has not been established,” cautioned Dr. David Knopman, a Mayo Clinic neurologist who chairs the Alzheimer’s Association’s medical and scientific advisory council.

And people should understand that “it’s not considered definitive,” he said, adding, “It’s ultimately only a first pass at cognition.”

The Montreal Cognitive Assessment - MoCa for short - is one of a list of similar tests that all aim to tap into specific functions. Medicare covers them as part of seniors’ annual wellness visits.

“It’s not a diagnostic test, but it’s pretty sensitive in picking up subtle changes in cognition,” things involving memory, attention and language but not mental health issues, said Dr. Ranit Mishori, professor of family medicine at Georgetown University.

Drawing a clock, and putting the right time on it, is a classic evaluation of how the brain comprehends spatial relationships. Someone with even very mild cognitive impairment will draw a much wobblier clock, or aim the hands wrong, than someone who’s healthy.

Subtracting backward assesses things like attention and concentration.

Recalling a list of five words after five minutes of doing other tasks - or coming up with at least 11 words in a minute that begin with “F’’ - can assess short-term memory and language functions.

Failing doesn’t mean someone has dementia. There might be a fixable problem, like depression or medication side effects. Maybe the person isn’t a good test-taker, or, for that counting task, never was very good at math.

And while passing is reassuring, someone who passes despite forgetting appointments or losing their way home probably still needs a closer look.

That’s why doctors put together other information - including questions about day-to-day functioning - in determining who may need a next step, a three- to four-hour battery of neuropsychological testing.

“Cognitive concerns in middle-aged and elderly people need to be taken seriously. They can’t be evaluated with a snap of a finger,” Knopman said.

Getting that message out is an upside to all the publicity about Trump’s test.

The downside: By reading these examples, you might have cheated. “If people practice it, guess what? It’s invalid,” Knopman noted.
 


DAILY UPDATEE

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HEADLINES [click on headline to view story]

Usage remains low for pill that can prevent HIV infection


US OKs 1st drug aimed at women with inherited breast cancer

UK allows doctors to make babies with DNA from 3 people


Warning: Stifling sneezes can be health hazard in rare cases


Terminally ill Briton’s bid for assisted death can proceed

What about the memory test Trump aced? It’s not for everyone


 



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