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Monthly Archives: October 2016

Markers for prostate cancer death

Prostate cancer (PC) is the second leading cause of male cancer death in the United States with an estimated 26,000 deaths in 2016. Two-thirds of all PC deaths observed in the US are men with localized disease who developed metastasis. Several markers for dying from prostate cancer exist, but whether these are markers for telling who is likely to die early from any cause, and how their performance compares, is unknown. Identifying such a marker is important because we can then identify which men may benefit from new, more aggressive treatments for prostate cancer.

Researchers at Brigham and Women’s Hospital found that a prostate specific antigen (PSA) nadir (the lowest level a PSA drops after treatment) greater than 0.5 ng/mL following radiation and androgen deprivation therapy (anti-hormone therapy), appears to identify men prior to PSA failure who are at high-risk for dying early as a result of treatment failure for their prostate cancer. The findings are published in the January 12 edition ofJAMA Oncology.

“By identifying and enrolling these men in clinical trials immediately, the hope is to take a prostate cancer that appears to be incurable and make it curable” stated Trevor J. Royce, MD, senior resident in the department of Radiation Oncology at BWH, and corresponding author of the study.

Using data from a randomized trial of 206 men treated with either radiation or, radiation and six months of hormonal therapy, researchers compared early markers of prostate cancer death to identify men at risk of dying early.

“This study’s results can have practice changing implications on how future prostate cancer trials are designed in terms of identifying the men for these studies who are at high risk for early death due to ineffective initial treatment for their prostate cancer,” stated Anthony Victor D’Amico, MD, PhD, chief, Genitourinary Radiation Oncology, Brigham and Women’s Hospital and senior author of the study.

Marijuana’s Health Effects

It can almost certainly ease chronic pain and might help some people sleep, but it may also raise the risk of getting schizophrenia and trigger heart attacks.

Those are among the conclusions about marijuana reached by a federal advisory panel in a report released Thursday.

The experts also called for a national effort to learn more about marijuana and its chemical cousins, including similarly acting compounds called cannabinoids.

The current lack of scientific information “poses a public health risk,” said theĀ reportĀ , from the National Academies of Sciences, Engineering and Medicine. Patients, health care professionals and policy makers need more evidence to make sound decisions, it said.

For marijuana users or those considering it, “there’s very little to guide them” on amounts and health risks, said Dr. Marie McCormick of the Harvard School of Public Health, who headed the committee.

Several factors have limited research. While the federal government has approved some medicines containing ingredients found in marijuana, it still classifies marijuana as illegal and imposes restrictions on research. So scientists have to jump through bureaucratic hoops that some find daunting, the report said.

A federal focus on paying for studies of potential harms has also hampered research into possible health benefits, the report said. The range of marijuana products available for study has also been restricted, although the government is expanding the number of approved suppliers.

Twenty-eight states and the District of Columbia have legalized marijuana for a variety of medical uses, and eight of those states plus the district have also legalized it for recreational use.

The report lists nearly 100 conclusions about marijuana and its similarly acting chemical cousins, drawing on studies published since 1999. Committee members cautioned that most conclusions are based on statistical links between use and health, rather than direct demonstrations of cause and effect.

The review found strong evidence that marijuana can treat chronic pain in adults and that similar compounds ease nausea from chemotherapy, with varying degrees of evidence for treating muscle stiffness and spasms in multiple sclerosis.

Limited evidence says marijuana or the other compounds can boost appetite in people with HIV or AIDS, and ease symptoms of post-traumatic stress disorder, the report concluded. But it said there’s not enough research to say whether they’re effective for treating cancers, irritable bowel syndrome, epilepsy, or certain symptoms of Parkinson’s disease, or helping people beat addictions.

There may be more evidence soon: a study in Colorado is investigating the use of marijuana to treat PTSD in veterans.

Turning to potential harms, the committee concluded:

– Strong evidence links marijuana use to the risk of developing schizophrenia and other causes of psychosis, with the highest risk among the most frequent users.

– Some work suggests a small increased risk for developing depressive disorders, but there’s no evidence either way on whether it affects the course or symptoms of such disorders, or the risk of developing post-traumatic stress disorder.

– There’s a strong indication that using marijuana before driving increases the risk of a traffic accident, but no clear link to workplace accidents or injuries, or death from a marijuana overdose.

– There’s limited evidence for the idea that it hurts school achievement, raises unemployment rates or harms social functioning.

– For pregnant women who smoke pot, there’s a strong indication of reduced birthweight but only weak evidence of any effect on pregnancy complications for the mother, or an infant’s need for admission to intensive care. There’s not enough evidence to show whether it affects the child later, like sudden infant death syndrome or substance use.

– Some evidence suggests there’s no link to lung cancer in marijuana smokers. But there’s no evidence, or insufficient evidence, to support or rebut any link to developing cancers of the prostate, cervix, bladder, or esophagus.

– Substantial evidence links pot smoking to worse respiratory symptoms and more frequent episodes of chronic bronchitis.

– There’s a weak suggestion that smoking marijuana can trigger a heart attack, especially for people at high risk of heart disease. But there’s no evidence either way on whether chronic use affects a person’s risk of a heart attack.

– Some evidence suggests a link between using marijuana and developing a dependence on or abuse of other substances, including alcohol, tobacco and illicit drugs.

Federal Judge Strikes Down Health

A federal judge ruled Monday that the new U.S. health-care reform law is unconstitutional, saying the federal government has no authority to require citizens to buy health insurance.

That provision is a cornerstone of the new legislation, signed into law in March by President Barack Obama.

The judge’s decision was not unexpected, and both supports and opponents of the legislation anticipate the validity of the new health law ultimately will be decided by the U.S. Supreme Court.

The ruling was handed down by U.S. District Judge Henry E. Hudson, a Republican appointed by President George W. Bush who had seemed sympathetic to the state of Virginia’s case when oral arguments were heard in October, the Associated Press reported.

Last week, White House officials said a negative ruling would not affect the implementation of the law because its major provisions don’t take effect until 2014, the AP reported.

Virginia Attorney General Kenneth Cuccinelli, a Republican, had filed a lawsuit in defense of a new Virginia law barring the federal government from requiring state residents to buy health insurance. He argued that it is unconstitutional for the federal law to force citizens to buy health insurance and to assess a penalty if they don’t.

The U.S. Justice Department said the insurance mandate falls within the scope of the federal government’s authority under the Commerce Clause. But Cuccinelli said deciding not to buy insurance is an economic matter outside the government’s domain.

By 2019, the law will expand health insurance access to 94 percent of non-elderly Americans. Advocates say that between now and then, it will also provide Americans with many new rights and protections.

Key provisions include:

  • Health plans may no longer deny coverage to people based on pre-existing health conditions.
  • Health plans that cover dependents must permit children to stay on a parent’s family policy until age 26.
  • Insurers may no longer place lifetime dollar limits on essential benefits.
  • New health plans must offer preventive services such as mammogramsand colon cancer screenings without charging a deductible, co-payment or coinsurance. (This provision does not apply to existing plans that are “grandfathered.”)

Communities Access for Health Care Strengthens

The study, “Beyond Health Effects? Examining the Social Consequences of Community Levels of Uninsurance Pre-ACA,” published by the Journal of Health and Social Behavior, is an effort by researchers Tara McKay and Stefan Timmermans to “broaden the conversation” about the effects of the Affordable Care Act (ACA).

“Given the strain that uninsurance places on individuals, providers and health care markets, it is not unreasonable to imagine that the consequences of uninsurance are likely to go beyond health and health care and impact the social lives of individuals and communities,” said McKay, assistant professor of Medicine, Health and Society at Vanderbilt University.

Timmermans is a professor of sociology at UCLA. “We find that living around a lot of people who have insurance makes you more likely to trust the people you live around, makes you more likely to have common goals and values and feel like those goals and values are shared,” McKay said of the results of the study. “That’s true for everyone in such a community, even those who don’t have health insurance. Conversely, low levels of insurance in a community strain relationships and trust among people who do live here.”

ACA Endangered

McKay and Timmermans’ research appears while the ACA, which has resulted in health insurance coverage for more than 20 million Americans, is endangered because of pledges from Republicans in Congress to repeal and replace the ACA in 2017. President-elect Donald Trump denounced the ACA during the presidential campaign.

Surveys conducted in 2000-2002 and 2006-2008 by the Los Angeles Family and Neighborhood Survey (L.A.FANS), provided data for the study along with information from the U.S. Census Bureau. The Vanderbilt study was funded by the National Science Foundation and Robert Wood Johnson Foundation.

Social cohesion increases by a third

L.A.FANS, a multistage probability sample of adults in Los Angeles County, was designed to probe the neighborhood effects on the health and well-being of a random sample of adults and children. These data have been used to examine a broad array of issues, including neighborhood and household effects on health and mortality, and health care access and utilization.

McKay and Timmermans based their analysis on 1,195 L.A.FANS survey respondents, and a series of multilevel regression analyses to “demonstrate that prior to the enactment of ACA, individuals living in communities with lower levels of insurance reported lower levels of social cohesion,” McKay said.

“After adjusting for individual and community characteristics, we find a 34 percent decrease in social cohesion scores when moving from a neighborhood with the highest levels of insurance to one with the lowest levels of insurance,” McKay said.

The L.A.FANS data were collected in a way in which it can account for potentially confounding factors, such as the age, race-ethnic, nativity and income composition of the communities.

Social cohesion continues to rise

Importantly, when the researchers estimate the effects of an ACA-type insurance expansion on the same respondents, they find that social cohesion increases over time.

“I think this is an important step — to consider the other ways that policies actually affect people beyond health and health care access. This can change how we see ourselves and how we interact with our communities too,” McKay said.

“You can’t participate in social life and civic engagement without having health first, right?”