Make Chiangmai Mail | your Homepage | Bookmark

Chiangmai 's First English Language Newspaper

Pattaya Blatt | Pattaya Mail |

 

Copyright 2018 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

 
Health & Wellbeing
 

September 22, 2018 - September 28, 2018

Aspirin disappoints for avoiding first heart attack, stroke

New studies find most people won’t benefit from taking daily low-dose aspirin or fish oil supplements to prevent a first heart attack or stroke. Results were discussed Sunday, Aug. 26, 2018, at the European Society of Cardiology meeting in Munich. (AP Photo/Patrick Sison)

 Marilynn Marchione

New studies find most people won’t benefit from taking daily low-dose aspirin or fish oil supplements to prevent a first heart attack or stroke.

Taking a low-dose aspirin every day has long been known to cut the chances of another heart attack, stroke or other heart problem in people who already have had one, but the risks aren’t worth it for most folks, major new research finds.

Although it’s been used for more than a century, aspirin’s value in many situations is still unclear. The latest studies are some of the largest and longest to test this pennies-a-day blood thinner in people who don’t yet have heart disease or a blood vessel-related problem.

One found that aspirin did not help prevent first strokes or heart attacks in people at moderate risk for one because they had several health threats such as smoking, high blood pressure or high cholesterol.

Another tested aspirin in people with diabetes, who are more likely to develop or die from heart problems, and found that the modest benefit it gave was offset by a greater risk of serious bleeding.

Aspirin did not help prevent cancer as had been hoped.

And fish oil supplements, also tested in the study of people with diabetes, failed to help.

“There’s been a lot of uncertainty among doctors around the world about prescribing aspirin” beyond those for whom it’s now recommended, said one study leader, Dr. Jane Armitage of the University of Oxford in England. “If you’re healthy, it’s probably not worth taking it.”

The research was discussed Sunday at the European Society of Cardiology meeting in Munich. The aspirin studies used 100 milligrams a day, more than the 81-milligram pills commonly sold in the United States but still considered low dose. Adult strength is 325 milligrams.

Who’s really at risk?

A Boston-led study gave aspirin or dummy pills to 12,546 people who were thought to have a moderate risk of suffering a heart attack or stroke within a decade because of other health issues.

After five years, 4 percent of each group had suffered a heart problem - far fewer than expected, suggesting these people were actually at low risk, not moderate. Other medicines they were taking to lower blood pressure and cholesterol may have cut their heart risk so much that aspirin had little chance of helping more, said the study leader, Dr. J. Michael Gaziano of Brigham and Women’s Hospital.

One percent of aspirin takers had stomach or intestinal bleeding, mostly mild - twice as many as those on dummy pills. Aspirin users also had more nosebleeds, indigestion, reflux or belly pain.

Bayer sponsored the study, and many researchers consult for the aspirin maker. Results were published by the journal Lancet.

Aspirin for people with diabetes?

People with diabetes have a higher risk of heart problems and strokes from a blood clot, but also a higher risk of bleeding. Guidelines vary on which of them should consider aspirin.

Oxford researchers randomly assigned 15,480 adults with Type 1 or 2 diabetes but otherwise in good health and with no history of heart problems to take either aspirin, 1 gram of fish oil, both substances, or dummy pills every day.

After seven and a half years, there were fewer heart problems among aspirin users but more cases of serious bleeding, so they largely traded one risk for another.

Fish oil results

The same study also tested omega-3 fatty acids, the good oils found in salmon, tuna and other fish. Supplement takers fared no better than those given dummy capsules - 9 percent of each group suffered a heart problem.

“We feel very confident that there doesn’t seem to be a role for fish oil supplements for preventing heart disease,” said study leader Dr. Louise Bowman of the University of Oxford.

The British Heart Foundation was the study’s main sponsor. Bayer and Mylan provided aspirin and fish oil, respectively. Results were published by the New England Journal of Medicine.

Other studies are testing different amounts and prescription versions of fish oil, “but I can’t tell people go spend your money on it; we think it’s probably better to eat fish,” said Dr. Holly Andersen, a heart disease prevention specialist at New York-Presbyterian/Weill Cornell who was not involved in the study.

The new research doesn’t alter guidelines on aspirin or fish oil, said Dr. Nieca Goldberg, a cardiologist at NYU Langone Medical Center and an American Heart Association spokeswoman. They recommend fish oil only for certain heart failure patients and say it’s reasonable to consider for people who have already suffered a heart attack.


New US survey shows some progress against opioid crisis

Carla K. Johnson

Figures from a U.S. government survey released Friday show some progress in the fight against the ongoing opioid addiction crisis with fewer people in 2017 using heroin for the first time compared to the previous year.

The number of new users of heroin decreased from 170,000 in 2016 to 81,000 in 2017, a one-year drop that would need to be sustained for years to reduce the number of fatal overdoses, experts said.

Fewer Americans are misusing or addicted to prescription opioid painkillers. And more people are getting treatment for heroin and opioid addiction, the survey found.

The Trump administration said the positive trends show government efforts are working.

Messages are reaching people about the dangers of heroin and the deadly contaminants it often contains on the street, Dr. Elinore McCance-Katz, an administration health official, said in a video presentation released with the figures.

Among the other findings:

- Marijuana use climbed in all age groups except young teenagers, with 2.5 percent of those 26 and older, or 5.3 million adults, reporting they use marijuana daily or almost daily last year.

- Methamphetamine and cocaine use climbed in young adults, ages 18 to 25. The uptick may indicate that users are shifting from opioids to other drugs, said Leo Beletsky, a public health policy expert at Northeastern University in Boston.

- Young adults have increasing rates of serious mental illness, major depression and suicidal thoughts.

- The number of new heroin users in 2017 - 81,000 - was lower than the numbers in most years from 2009 to 2016. But it was similar to the numbers of new heroin users in 2002 through 2008.

Experts said there’s still work to be done before success can be declared.

“Taken together, this does not look like the portrait of a nation with improving mental health and addiction issues,” said Brendan Saloner, an addiction researcher at Johns Hopkins Bloomberg School of Public Health. “It’s hard to look at this and not think we need to be doing a better job than we’re doing now.”

Earlier this month, the Centers for Disease Control and Prevention released preliminary figures that appear to show a leveling off in overdose deaths in late 2017 and the first two months of this year.

Health officials have said it’s too soon to say whether the nation’s drug crisis has peaked. But in an interview with The Associated Press this week, U.S. Health and Human Services Secretary Alex Azar said several measures of the crisis are improving.

“We are making progress,” he said. “We are seeing a flattening of our deaths from overdose.” (AP)


September 15, 2018 - September 21, 2018

Mom’s use of opioids in pregnancy may stunt kids’ learning

In this Feb. 13, 2018 file photo, a week-old baby lies in a neonatal intensive care unit bay at the Norton Children’s Hospital in Louisville, Ky. This particular NICU is dedicated to newborns of opioid addicted mothers, who are suffering with newborn abstinence syndrome. The area is kept dark and quiet due to increased production of neurotransmitters in newborns of addicted mothers, which can disrupt the nervous system and overstimulate bodily functions. (AP Photo/Timothy D. Easley)

Lindsey Tanner

Chicago (AP) - Learning disabilities and other special education needs are common in children born with opioid-related symptoms from their mother’s drug use while pregnant, according to the first big U.S. study to examine potential long-term problems in these infants.

About 1 in 7 affected children required special classroom services for problems including developmental delays and speech or language difficulties, compared with about 1 in 10 children not exposed to opioids before birth, the study found.

The study highlights the “absolutely critical” importance of early detection and intervention, before these children reach school age, to give them a better chance of academic success, said Dr. Nathalie Maitre, a developmental specialist at Nationwide Children’s Hospital in Columbus, Ohio. “It really confirms what those of us who do neurodevelopment follow-up of these children are seeing.”

The study involved about 7,200 children aged 3 to 8 enrolled in Tennessee’s Medicaid program. Nearly 2,000 of them were born with what doctors call “neonatal abstinence syndrome.” It’s a collection of symptoms caused by withdrawal from their pregnant mother’s use of opioid drugs like prescription painkillers, heroin or fentanyl. The drugs can pass through the placenta into the developing nervous system.

Tremors, hard-to-soothe crying, diarrhea and difficulty feeding and sleeping are among signs that infants are going through withdrawal.

In Tennessee, hard hit by the nation’s opioid epidemic, the rate of affected infants soared from less than one per 1,000 hospital births in 1999 to 13 per 1,000 births in 2015.

Whether the study results would apply elsewhere is uncertain but in Tennessee, most children born with withdrawal symptoms are enrolled in that state’s Medicaid program. Also in Tennessee, a syndrome diagnosis qualifies kids to receive early intervention services.

Maitre, who wasn’t involved in the study, said she suspects the research may underestimate the magnitude of the problem, because it only captures kids who haven’t slipped through the cracks.

The only previous comparable study was in Australia, published last year, showing that affected children had worse academic test scores in seventh grade than other kids.

The new study looked at how many kids were referred for possible learning disabilities and received school-based services for related difficulties. It did not examine academic performance.

Results were released Thursday by the journal Pediatrics.

The researchers said taking into account other factors that could affect children’s development - including birth weight and mothers’ education and tobacco use - didn’t change the results.

Study co-author Dr. William Schaffner of Vanderbilt University said it makes sense that opioid use in pregnancy could affect children’s later development. Some studies have found brain differences in affected children including in a region involved in certain types of learning.

But Dr. Mary-Margaret Fill, the lead author and a researcher with Tennessee’s health department, said these children “are definitely not doomed. There are great programs and services that exist to help these children and their families. We just have to make sure they get plugged in.”


Weight-loss drug Belviq seems safe for heart, study finds

Marilynn Marchione

For the first time, a drug has been shown to help people lose weight and keep it off for several years without raising their risk for heart problems - a safety milestone that may encourage wider use to help curb the obesity epidemic.

The drug, Belviq, has been sold in the United States since 2013 and is the first of several new weight-loss medicines to succeed in a long-term heart safety study now required by federal regulators to stay on the market.

“Patients and their doctors have been nervous about using drugs to treat obesity and for good reason. There’s a history of these drugs having serious complications,” said study leader Dr. Erin Bohula of Brigham and Women’s Hospital in Boston.

With this study, Belviq has been convincingly shown safe for the heart, she said.

Although Belviq did not raise heart risks, it didn’t lower them either, as many had hoped it would. The weight loss it produced was fairly modest - after 40 months, Belviq users had shed 9 pounds (4 kilograms), twice as much as those on dummy pills.

It may be that weight loss alone is not enough to lower heart risks, or that there needs to be more to do that, some doctors said.

Results were discussed Sunday at a European Society of Cardiology meeting in Munich and published by the New England Journal of Medicine. Belviq’s maker, Eisai Inc., sponsored the study and many of the researchers consult or work for the company.

Worldwide, 13 percent of adults are obese and 39 percent are overweight, raising their risk for a host of health problems. Diet and exercise are the first steps doctors recommend, but medicines also can be considered for people with dangerously high weight who cannot drop enough pounds by other means.

Several popular diet medicines were previously withdrawn from sale after they were found to raise the risk for heart valve damage, suicidal thoughts or other problems, prompting the new requirement for heart safety studies.

Belviq is an appetite suppressant that works by stimulating brain chemicals to give a feeling of fullness. It costs roughly $220 to $290 a month in the United States.

Researchers tested it in a study of 12,000 people who were either obese or overweight with heart disease risk factors such as high blood pressure or cholesterol. They were given Belviq or dummy pills to take twice a day and offered lifestyle and diet advice.

At one year, 39 percent on Belviq and 17 percent on dummy pills had lost at least 5 percent of their starting weight. Several previous studies also found the drug effective for weight loss.

After about three years, 6 percent of each group had suffered a heart-related problem or death.

Fewer people on Belviq developed diabetes - 8.5 percent versus 10.3 percent on dummy pills.

Serious side effects were similar, but more on Belviq stopped taking their pills because of them - 7 percent versus 4 percent. Common side effects included dizziness, fatigue, headache and nausea.

Dangerously low blood sugar happened in 13 people on Belviq versus four in the other group; all but one case involved people also taking diabetes medicines, which lower blood sugar.

Tests for heart valve damage were done on 3,270 participants but no big differences in rates were seen. Suicidal thoughts or behavior were reported in 21 people on Belviq versus 11 on dummy pills, but more on the drug had a history of depression and the difference was so small it could have been due to chance, Bohula said.

In a commentary, two of the journal’s editors, Drs. Julie Inglefinger and Clifford Rosen, said there might be alternatives to Belviq. Liraglutide, when used to treat diabetes, also causes weight loss and lowers heart risks, though it hasn’t been tested for cardiac safety at the dose used for weight loss.

For now, Belviq “may be best used on a cautious basis, according to the needs of individual patients,” they write. (AP)


September 8, 2018 - September 14, 2018

Hopes rise again for a drug to slow Alzheimer's disease

This Oct. 7, 2003 file photo shows a section of a human brain with Alzheimer's disease on display at the Museum of Neuroanatomy at the University at Buffalo, in Buffalo, N.Y. On Wednesday, July 25, 2018, two drug makers said an experimental therapy slowed mental decline by 30 percent in patients who got the highest dose in a mid-stage study, and it removed much of the sticky plaque gumming up their brains. The drug, called BAN2401, is from Eisai and Biogen. (AP Photo/David Duprey)

Marilynn Marchione

Chicago (AP) - Hopes are rising again for a drug to alter the course of Alzheimer's disease after decades of failures. An experimental therapy slowed mental decline by 30 percent in patients who got the highest dose in a mid-stage study, and it removed much of the sticky plaque gumming up their brains, the drug's makers said Wednesday.

The results have been highly anticipated and have sent the stock of the two companies involved soaring in recent weeks.

The drug from Eisai and Biogen did not meet its main goal in a study of 856 participants, so overall, it was considered a flop. But company officials said that 161 people who got the highest dose every two weeks for 18 months did significantly better than 245 people who were given a dummy treatment.

There are lots of caveats about the work, which was led by company scientists rather than academic researchers and not reviewed by outside experts. The study also was too small to be definitive and the results need to be confirmed with more work, dementia experts said. But they welcomed any glimmer of success after multiple failures.

"We're cautiously optimistic," said Maria Carrillo, chief science officer of the Alzheimer's Association, whose international conference in Chicago featured the results.

"A 30 percent slowing of decline is something I would want my family member to have," and the drug's ability to clear the brain plaques "looks pretty amazing," she said.

About 50 million people worldwide have dementia, and Alzheimer's is the most common type. There is no cure - current medicines just ease symptoms. Some previous efforts to develop a drug to slow the disease may have been tried too late, after much damage had already occurred. The new drug aimed sooner, in people with early Alzheimer's, and the drug works at an earlier step in formation of the sticky brain plaques.

Study participants were given one of five doses of BAN2401 or a dummy treatment via IV. After one year, the companies said the drug didn't meet statistical goals. But after 18 months, they saw a benefit in the highest dose group.

What makes it tricky, though, is that they used a new way to measure mental decline, a scale that combines parts of three other widely used tests. This is the first study to use that measure, and it's unclear how much of a difference a 30 percent slowing of decline makes - whether it allows someone to continue to bathe or feed himself, for instance.

"It's intriguing, but these are designs we're not used to seeing," and it will require more study for doctors to feel comfortable with this as a measure of success, said one independent expert, Dr. Julie Schneider of Rush University Medical Center in Chicago.

On one traditional measure of thinking skills, those at the highest dose declined 47 percent less than people given a dummy treatment.

Brain scans added evidence that the drug might be effective. All participants had signs of the sticky plaques that are the hallmark of Alzheimer's at the start of the study, but 81 percent of people on the highest dose saw all signs of them disappear after 18 months, an Eisai official said.

Side effects leading to discontinuation of treatment occurred in 19 percent of those on the high dose and 6 percent of the dummy treatment group. Cases of brain swelling, which have been seen in other treatments targeting the plaques in the brain, occurred in two people in the placebo group and 16 of those in the high dose group.

Other dementia experts were encouraged.

"That's a very hopeful outcome. It means we may be on the right track," said another scientist with no role in the work, Dr. Stephen Salloway, neurology chief at Brown University in Providence, Rhode Island.

Dr. Reisa Sperling, a neurologist at Harvard-affiliated Brigham and Women's Hospital in Boston, said it's important to realize that this is not a cure, just possibly a slowing of decline.

"We're not suddenly returning people back to their pre-Alzheimer's baseline," she said.

Dr. Lynn Kramer, chief medical officer of Eisai's neurology unit, said the companies would talk with regulators about further studies.

Shares of Biogen, based in Cambridge, Massachusetts, and Eisai, based in Tokyo, soared after July 5 when they announced that the drug had slowed the progression of early Alzheimer's disease for certain patients. Biogen's stock jumped 19.6 percent in one day, its biggest move in 14 years, and has continued to rise. Eisai rocketed 40 percent in two days.

Biogen stock gyrated in aftermarket trading after the study results were released. After switching between gains and losses several times, it fell 6.5 percent.


September 1, 2018 - September 7, 2018

Birth control app highlights emerging health tech market

A women demonstrates using the Natural Cycles smartphone app in London, Friday, Aug. 17. The mobile fertility app has become the first ever digital contraceptive device to win FDA (US Food and Drug Administration) marketing approval. (AP Photo/Nishat Ahmed)

Kelvin Chan

London (AP) - The condom, the pill and now, the smartphone?

Natural Cycles, a mobile fertility app, this month became the first ever digital contraceptive device to win FDA marketing approval. Women take their temperatures and track their menstrual cycle on the app, which uses an algorithm to determine when they’re fertile and should abstain from unprotected sex or use protection. In effect, it’s a form of the rhythm or calendar method.

The Swedish startup says it’s effective and lets women avoid side effects common with other methods like birth control pills. But reports of unwanted pregnancies and investigations by authorities in two countries in Europe, where it received EU certification in 2017, have raised questions about marketing what is essentially a health monitor as a contraceptive.

Natural Cycles boasts more than 900,000 users, and such fast growth underscores risks for regulators and concerns among health professionals as they grapple with the rapidly emerging market for mobile and digital health applications.

“Apps are incredibly popular and there’s nothing inherently wrong about using tech to support our health,” said Bekki Burbidge, deputy chief executive of the Family Planning Association, a British sexual health organization. “But they’re also an area that is fairly unregulated and it can be hard to sort the good, evidence- and research-based apps from the bad.”

The app is similar to hundreds of other period trackers already available, most of which are aimed at helping women conceive. But FDA approval means it can be marketed as a mobile contraceptive, giving it an edge in the mobile medical apps market, which is forecast to grow to $11.2 billion by 2025, up from at $1.4 billion in 2016, according to BIS Research. The makers of Natural Cycles acknowledge it’s not 100 percent effective and some women might still get pregnant even if used perfectly.

The Food and Drug Administration regulates apps and gadgets that collect or track medical information as medical devices, though it doesn’t scrutinize many more that merely perform simple tasks like tracking calories.

Marketing of contraceptive apps needs to be extremely careful to ensure that women understand exactly what they’re signing up for and the limitations, the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynecologists said in a statement.

The FDA gave its approval based on data from Natural Cycles involving 15,570 women who used the app for an average of eight months. The FDA said that if the app is used correctly all the time, 1.8 percent of women would get pregnant over one year. The “typical use” failure rate, which factors in human error, was 6.5 percent.

The birth control pill’s failure rate is 9 percent, while for condoms it’s 18 percent and 24 percent for fertility-awareness methods, but those figures are backed up by much more long-term data.

The company’s founders, Elina Berglund and Raoul Scherwitzl, are a married couple who are both former physicists. Berglund was part of a team of scientists looking for the Higgs boson particle at the European Organization for Nuclear Research, or CERN, in Switzerland. They pivoted from science to startups when they wrote the algorithm to help them have a baby and then developed an app to tap broader demand.

The app is free to download but the company charges $10 a month to use it. Its claims were called into question in January, after Swedish regulators started investigating reports that 37 women who used it became pregnant anyway.

The Swedish Medical Product Agency said it’s looking into whether the number of unwanted pregnancies falls within the app’s claimed effectiveness rate, and the investigation is expected to wrap up in September.

Natural Cycles said that as a condition of EU certification, it must continue monitoring user data, which it says show that the typical-use effectiveness rate remains at 93 percent.

“We care deeply each and every time one of our users becomes pregnant,” the company said in a statement. “One of the ongoing challenges with all forms of contraception is that there is always a statistical chance of unintended pregnancy, since no method is 100 percent effective.”

FDA spokeswoman Deborah Kotz said the agency was aware of the Swedish reports but felt they were consistent with its knowledge of risks associated with the app.

“An increase in the absolute numbers of unintended pregnancies is expected with a growing number of users,” she said.

Britain’s Advertising Standards Authority, meanwhile, says it’s looking into whether paid-for Facebook posts that claim Natural Cycles is a “highly accurate contraceptive app” and “clinically tested alternative to birth control methods” are misleading.

“We have launched a formal investigation and will publish our findings in due course,” the authority said.

Burbidge said more outside research into fertility apps is needed because “at the moment there’s not enough independent evidence” on their reliability. She added that women using such apps need to be motivated and aware of factors that can make it less effective, such as travel, alcohol, stress or not getting enough sleep, which can all affect temperature readings.

“There’s so much you can do that makes it not perfect,” she said.
 


Weekly Update
 

HEADLINES [click on headline to view story]

Aspirin disappoints for avoiding first heart attack, stroke

New US survey shows some progress against opioid crisis


Mom’s use of opioids in pregnancy may stunt kids’ learning

Weight-loss drug Belviq seems safe for heart, study finds


Hopes rise again for a drug to slow Alzheimer's disease


Birth control app highlights emerging health tech market