February 24, 2018 - March 2, 2018
Usage remains low for pill that can prevent HIV infection
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)
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
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
“We like to go to the root of the
problem,” said Daskalakis, who personally posed for the “Bare It All”
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
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
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
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
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
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
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
(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.
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
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.”
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
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.
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.
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.
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
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
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
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.
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.
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
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)
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
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.
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.