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Update June, 2019


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Health & Wellbeing
 

Medical pot laws no answer for US opioid deaths, study finds

Head of cultivation at Loving Kindness Farms Jason Roberts checks one of his marijuana plants in a grow room wearing green lights not to wake them during their night cycle in Gardena, Calif. A new study shoots down the notion that medical marijuana laws can prevent opioid overdose deaths. (AP Photo/Richard Vogel, File)

Carla K. Johnson

A new study shoots down the notion that medical marijuana laws can prevent opioid overdose deaths, challenging a favorite talking point of legal pot advocates.

Researchers repeated an analysis that sparked excitement years ago. The previous work linked medical marijuana laws to slower than expected increases in state prescription opioid death rates from 1999 to 2010. The original authors speculated patients might be substituting marijuana for painkillers, but they warned against drawing conclusions.

Still, states ravaged by painkiller overdose deaths began to rethink marijuana, leading several to legalize pot for medical use.

When the new researchers included data through 2017, they found the reverse: States passing medical marijuana laws saw a 23% higher than expected rate of deaths involving prescription opioids.

Legalizing medical marijuana "is not going to be a solution to the opioid overdose crisis," said Chelsea Shover of Stanford University School of Medicine. "It would be wonderful if that were true, but the evidence doesn't suggest that it is."

Shover and colleagues reported the findings Monday in Proceedings of the National Academy of Sciences. It's unlikely, they said, that medical marijuana laws caused first one big effect and then the opposite. Any beneficial link was likely coincidental all along.

"We don't think it's reasonable to say it was saving lives before but it's killing people now," Shover said.

In the opioid crisis, dozens of forces are playing out across the nation in different ways. How widely available is the overdose antidote naloxone? Who has insurance? How broadly does insurance cover addiction treatment?

What's more, prescription pills once were involved in the largest share of overdose deaths, but that changed as heroin and then fentanyl surged. The studies on marijuana laws and opioid deaths don't account for that.

The new study undermines recent policy changes in some states. Last week, New Mexico joined New York, New Jersey and Pennsylvania in approving marijuana for patients with opioid addiction.

"I was told my paper helped change the law in New York. I was appalled," said Rosalie Liccardo Pacula of the Rand Drug Policy Research Center. She co-authored a 2018 study on marijuana laws and overdose deaths.

Experts agree evidence doesn't support marijuana as a treatment for opioid addiction. Drugs like buprenorphine, morphine and naltrexone should be used instead, Pacula said.

Authors of the original research welcomed the new analysis.

"We weren't happy when a billboard went up saying marijuana laws reduce overdose deaths," said Brendan Saloner of Johns Hopkins Bloomberg School of Public Health. "That was very hard for us to rein in."

Marijuana has been shown to help ease chronic pain, and other studies have suggested medical marijuana laws may reduce opioid prescribing. So there's still reason to believe that for some people, marijuana can substitute for opioids as a pain reliever.

As for addiction and the overdose crisis, "we should focus our research and policies on other questions that might make a difference," Shover said.


Companies report progress on blood tests to detect cancer

 In this Tuesday, April 28, 2015 file photo, a patient has her blood drawn at a hospital in Philadelphia to monitor her cancer treatment. Companies are trying to develop blood tests that can look for signs of many types of cancer at once. (AP Photo/Jacqueline Larma, File)

Marilynn Marchione

A California company says its experimental blood test was able to detect many types of cancer at an early stage and gave very few false alarms in a study that included people with and without the disease.

Grail Inc. gave results in a news release on Friday and reported them Saturday at the American Society of Clinical Oncology meeting in Chicago. They have not been published in a journal or reviewed by other scientists.

Many companies are trying to develop early detection "liquid biopsy" tests that capture bits of DNA that cancer cells shed into blood.

On Thursday, Johns Hopkins University scientists launched a company called Thrive Earlier Detection Corp. to develop its CancerSEEK test, which yielded results similar to Grail's more than a year ago.

Grail is closely watched because of the extraordinary investment it's attracted — more than $1 billion from Jeff Bezos, Bill Gates and other celebrities.

The new results included 2,300 people, 60% with cancer and 40% not known to have it. The test detected 55% of known cancers and gave false alarms for 1%. The detection rate was better — 76% — for a dozen cancers that collectively account for nearly two thirds of cancer deaths in the U.S., including lung, pancreatic, esophageal and ovarian.

The test found only about a third of cancers at the very earliest stage but as many as 84% that had started to spread but not widely.

It also suggested where the cancer may be in 94% of cases and was right about that 90% of the time.

That's the most encouraging part because you don't want to tell people they may have cancer and then need to do a lot of other tests to figure out where, said Dr. Richard Schilsky, chief medical officer of the oncology society.

"They still have a long way to go" to prove the test's worth as a screening tool, but these results are encouraging, he said.

Dr. Len Lichtenfeld, interim chief medical officer of the American Cancer Society, called the low rate of false alarms "remarkable."

"I have little doubt that in the next several years we're going to have what is probably a true early detection test" but the technology still needs to improve and to be tried in large groups of people without known cancers where the detection rate may not be as good, he said.

The biggest question, he said, is "will it make a difference in outcomes" such as whether it helps people live longer, the ultimate measure of a screening test's worth.

Grail's test has not been compared to mammography, colonoscopy or other screening tools and is not intended to replace them, said the company's chief scientific officer, Dr. Alex Aravanis. Many deadly cancers that the Grail test detected have no screening tests now, he noted.

It's not clear what evidence the U.S. Food and Drug Administration would require to consider for approval. Sometimes tests can be sold through looser lab accreditation pathways rather than by seeking FDA approval.

Grail and Thrive already have larger studies underway.

"We're not going to diagnose every cancer," but may not need to because so many are not found now until it's too late for effective treatment, said Dr. Minetta Liu, a Mayo Clinic cancer specialist who is presenting Grail's results at the cancer conference. (AP)


Drugs make headway against lung, breast, prostate cancers

At the age of 87, Roszell Mack, Jr., shown here in his office in May 2019 is able to work nearly fulltime at the horse farm nine years after being diagnosed with lung cancer that had spread to his bones and lymph nodes. Mack helped test Merck's Keytruda, a therapy that helps the immune system see and fight cancer. "I'm feeling well and I have a good quality of life." The biggest drawback of these drugs: They often cost $100,000 or more a year, although what patients pay out of pocket varies by insurance, income and other things. (Courtesy Roszell Mack, Jr. via AP)

Marilynn Marchione

Chicago (AP) — Newer drugs are substantially improving the chances of survival for some people with hard-to-treat forms of lung, breast and prostate cancer, doctors reported at the world's largest cancer conference.

Among those who have benefited is Roszell Mack Jr., who at age 87 is still able to work at a Lexington, Kentucky, horse farm, nine years after being diagnosed with lung cancer that had spread to his bones and lymph nodes.

"I go in every day, I'm the first one there," said Mack, who helped test Merck's Keytruda, a therapy that helps the immune system identify and fight cancer. "I'm feeling well and I have a good quality of life."

The downside: Many of these drugs cost $100,000 or more a year, although what patients pay out of pocket varies depending on insurance, income and other criteria.

The results were featured Saturday and Sunday at the American Society of Clinical Oncology conference in Chicago and some were published by the New England Journal of Medicine. Companies that make the drugs sponsored the studies, and some study leaders have financial ties.

Here are some highlights:

 Lung Cancer

Immunotherapy drugs such as Keytruda have transformed the treatment of many types of cancer, but they're still fairly new and don't help most patients. The longest study yet of Keytruda in patients with advanced lung cancer found that 23% of those who got the drug as part of their initial therapy survived at least five years, whereas 16% of those who tried other treatments first did.

In the past, only about 5% of such patients lived that long.

"I'm a big believer that it's not just about duration of life, quality of life is important," said Dr. Leora Horn, of the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee. She enrolled Mack in the 550-person study.

Mack said he had manageable side effects — mostly some awful itching — after starting on Keytruda four years ago. He went off it last winter and scans showed no active cancer; he and his doctor hope it's in remission.

Last year, a smaller study reported five-year survival rates of 16% for similar patients given another immunotherapy, Opdivo.

"From both studies we're getting a similar message: When these drugs work, they can have a really durable effect," Horn said.

Breast Cancer

The risk of this rises with age, but about 48,000 cases each year in the U.S. are in women under age 50. About 70% are "hormone-positive, HER2-negative" — that is, the cancer's growth is fueled by estrogen or progesterone and not by the gene that the drug Herceptin targets.

In a study of 672 women with such cancers that had spread or were very advanced, adding the Novartis drug Kisqali to the usual hormone blockers as initial therapy helped more than hormone therapy alone.

After 3 1/2 years, 70% of women on Kisqali were alive, compared to 46% of the rest. Side effects were more common with Kisqali.

This is the first time any treatment has boosted survival beyond what hormone blockers do for such patients.

 Prostate

The options keep expanding for men with prostate cancer that has spread beyond the gland. Standard treatment is drugs that block the male hormone testosterone, which helps these cancers grow, plus chemotherapy or a newer drug called Zytiga.

Now, two other drugs have proven able to extend survival when used like chemo or Zytiga in men who were getting usual hormone therapy and still being helped by it.

One study tested Xtandi, sold by Pfizer and Astellas Pharma Inc., in 1,125 men, half of whom also were getting chemo. After three years, 80% of those given Xtandi plus standard treatments were alive, compared to 72% of men given the other treatments alone.

The other study involved 1,052 men who were given hormone therapy with or without the Janssen drug Erleada. After two years, survival was 82% among those on Erleada and 74% among those who weren't.

Men now have a choice of four drugs that give similar benefits, and no studies yet have compared them against each other, said Dr. Ethan Basch, a prostate specialist at the University of North Carolina's Lineberger Comprehensive Cancer Center who has no financial ties to any drugmakers.

Cost and side effects may help patients decide, he said. Chemo can cause numbness and tingling in the hands and feet and may not be good for men with diabetes who already are at higher risk for this problem. Zytiga must be taken with a steroid; Xtandi and Erleada can cause falling and fainting.

Chemo has more side effects but costs much less and requires only four to six intravenous treatments. The other three drugs are pills that cost more than $10,000 a month and are taken indefinitely.

"I have patients who refuse to take these drugs because of cost," Basch said. "Patients have more choice, but it isn't clear more benefit is being provided" beyond what chemo gives, he said.


‘Zombie cells’ buildup in your body may play role in aging

This microscope photo shows two senescent human fibroblast cells, above, next to normal cells. (Matthew Yousefzadeh, Mariah Witt/University of Minnesota via AP)

Malcolm Ritter

New York (AP) — Call them zombie cells — they refuse to die.

As they build up in your body, studies suggest, they promote aging and the conditions that come with it like osteoporosis and Alzheimer’s disease. Researchers are studying drugs that can kill zombie cells and possibly treat the problems they bring.

Basically the goal is to fight aging itself, which hopefully will in turn delay the appearance of age-related disease and disabilities as a group, says geriatrics specialist Dr. James Kirkland of the Mayo Clinic in Rochester, Minnesota. That’s in contrast to playing a “whack-a-mole game” of treating one disease only to see another spring up, he said.

The research has been done chiefly in mice. Earlier this year, the first test in people was published and provided some tantalizing results.

Zombie cells are actually called senescent cells. They start out normal but then encounter a stress, like damage to their DNA or viral infection. At that point, a cell can choose to die or become a zombie, basically entering a state of suspended animation.

The problem is that zombie cells release chemicals that can harm nearby normal cells. That’s where the trouble starts.

What kind of trouble? In mouse studies, drugs that eliminate zombie cells — so-called senolytics — have been shown to improve an impressive list of conditions, such as cataracts, diabetes, osteoporosis, Alzheimer’s disease, enlargement of the heart, kidney problems, clogged arteries and age-related loss of muscle.

Mouse studies have also shown a more direct tie between zombie cells and aging. When drugs targeting those cells were given to aged mice, the animals showed better walking speed, grip strength and endurance on a treadmill. Even when the treatment was applied to very old mice, the equivalent of people ages 75 to 90, it extended lifespan by an average of 36 percent.

Researchers have also shown that transplanting zombie cells into young mice basically made them act older: their maximum walking speed slowed down, and their muscle strength and endurance decreased. Tests showed the implanted cells converted other cells to zombie status.

Kirkland and colleagues this year published the first study of a zombie-cell treatment in people. It involved 14 patients with idiopathic pulmonary fibrosis, a generally fatal disease that scars the lining of the lungs. Risk rises with age, and the lungs of patients show evidence of zombie cells.

In the preliminary experiment, after three weeks of treatment, patients improved on some measures of physical fitness, like walking speed. Other measures did not show improvement.

Overall, the results are encouraging and “it really raises enthusiasm to proceed with the more rigorous studies,” said Dr. Gregory Cosgrove, chief medical officer of the Pulmonary Fibrosis Foundation, who played no role in the study.

The field of zombie cells is still young. But Kirkland estimates at least a dozen companies have formed or have launched efforts to pursue treatments. He holds shares in one.

Apart from age-related diseases, anti-zombie drugs might be useful for treating premature aging among cancer survivors that brings on the early appearance of some diseases, said Laura Niedernhofer of the University of Minnesota.

Some of these drugs have been approved for other uses or are even sold as supplements. But Niedernhofer and Kirkland stress that people should not try them on their own, nor should doctors prescribe them, for the uses now under study because more research has to be done first.

Niedernhofer said the best drugs may be yet to come. The goal is not to prevent stressed cells from turning into zombies, she said, because they may become cancerous instead. The aim is to trigger death of cells that have already transformed, or to limit the harm they do.

And what about giving them to healthy people who want to ward off aging? That’s possible but a long way off, after studies have established that the drugs are safe enough, she said.

“We may not get there,” Kirkland said.

In any case, experts are impressed by the research so far.

“I think this is very exciting,” said Dr. George Kuchel of the University of Connecticut Center on Aging in Farmington. The results from animal studies are “very spectacular. It’s very compelling data.”

Nir Barzilai, a researcher of aging at the Albert Einstein College of Medicine in New York, said he believes targeting zombie cells will play a role in the overall effort to delay, stop and maybe reverse aging.

So much research suggests they promote aging that “we know that it should be true,” he said.

 


HEADLINES [click on headline to view story]

Medical pot laws no answer for US opioid deaths, study finds


Companies report progress on blood tests to detect cancer


Drugs make headway against lung, breast, prostate cancers


‘Zombie cells’ buildup in your body may play role in aging