Colonoscopy: Who Gets Treated Where and How Effective is that Treatment?

Dyeing to Prevent Dying

by Medpage Today staff

A finding that a common laboratory staining agent increased longevity in nematode worms may have implications for human lifespan as well, researchers suggested.

Thioflavin T is a widely used, yellow histological dye, used for such tasks as staining amyloid plaques and stabilizing protein fibrils in cultures.

But researchers led by Gordon Lithgow, PhD, of the Buck Institute for Research on Aging in Novato, Calif., thought the stabilizing effect might have a wider application. They exposed adult nematodes –- the standard lab species Caenorhabditis elegans -- to the substance and found that it extended their lives by about 60%.
It also suppressed some of the pathological features of aging in the worms, the group reported online in Nature.

The hypothesis is that the stabilizing effect of the substance helps to preserve normal protein homeostasis and prevent aggregation of proteins, including the accumulation of amyloid-beta that's characteristic of Alzheimer's.

Light Therapy May Aid Traumatic Brain Injury

By Charles Bankhead, Staff Writer, MedPage Today

Two patients with long-term deficits from traumatic brain injury (TBI) have shown substantial improvement in cognitive function with transcranial light therapy, investigators reported.

A TBI patient on medical disability returned to work as a technology consultant after four months of nightly, at-home treatment with near-infrared light-emitting diodes (LEDs) placed on the forehead and scalp.

Seven years after a closed-head TBI, another patient experienced improved sustained attention capability from 20 minutes to three hours with ongoing LED treatment.

Both patients regressed with discontinuation of the light therapy, Margaret A. Naeser, PhD, of Boston University and the Veterans Affairs Boston Healthcare System, and colleagues reported online in Photomedicine and Laser Surgery.

"Results from the two chronic TBI cases described here, along with those from previous [light therapy] studies with acute stroke patients and chronic, major depression cases, suggest that further, controlled research with this methodology is warranted," Naeser and her co-authors wrote in conclusion.

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Weekly Exenatide Misses Endpoint in Key Trial

By John Gever, Senior Editor, MedPage Today

An investigational once-weekly formulation of the injectable diabetes drug exenatide (Bydureon) failed to show noninferiority to daily liraglutide (Victoza), the trial's sponsors said.

In the open-label trial called DURATION-6, patients taking 2 mg of exenatide weekly showed a 1.3-point reduction in glycated hemoglobin (HbA1c) levels after 26 weeks, compared with a 1.5-point decrease in patients receiving liraglutide at 1.8 mg daily, according to a joint statement from Eli Lilly, Alkermes, and Amylin Pharmaceuticals, which are co-developing the once-weekly drug.

"Bydureon did not meet the prespecified primary endpoint of noninferiority to Victoza," the statement said.
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Early BP Lowering No Help in Acute Stroke

By Crystal Phend, Senior Staff Writer, MedPage Today

Lowering blood pressure early during acute stroke did nothing to improve outcomes and may actually impair patients' ability to live independently later on, researchers affirmed in a randomized trial.

Candesartan (Atacand) started within 30 hours of stroke onset and given over seven days did not affect the combined six-month rate of death from vascular causes, myocardial infarction, or stroke compared with placebo (11.7% versus 11.3%, adjusted hazard ratio 1.09, P=0.52), Eivind Berge, MD, of Oslo University Hospital Ullevål, and colleagues found.

Functional disability was 17% more common with the drug (P=0.048), the group reported here at the American Stroke Association's International Stroke Conference and simultaneously online in The Lancet.
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TIME GOES BY | Breakthrough Test for Early Alzheimer's Diagnosis

by Ronni Bennett

Except in autopsy, there has never been a way to diagnose Alzheimer's disease – until now. Last week, the U.S. Food and Drug Administration gave tentative approval to a new screening for early detection in living persons of the unique plaques that define Alzheimer's.

The test, involving a PET scan that uses a dye to make the plaques visible, is relatively inexpensive. The FDA approval is contingent on radiologists and physicians being trained in how to read the scans to help avoid false positives – something that can be done, according to the CEO of the company that developed the dye, in months not years.

A senior director at the Alzheimer's Association expects the test to be available before the end of this year.

In a New York Times story earlier this week, Dr. Norman Foster, a professor of neurology at the University of Utah, discussed a patient with a memory deficit who could have benefited from the test:

“I wish I had had the ability to do an amyloid PET scan to allow an earlier diagnosis,” Dr. Foster said. Approval of the scan, he said, “would be a historic advance in neurology and in the daily management of patients with memory complaints.”

Nothing this big comes along without new, difficult and disturbing questions. In an online video from The Picker Report, the TGB Geriatrician, Dr. Bill Thomas, and dementia expert Dr. Al Power, also a geriatrician, took a whack a some of them.
Long-term care insurance has always been unaffordable for many people and this test, as the doctors note, makes that worse, although it will be interesting to see how the new health care law, which no longer allows denial of coverage for pre-existing conditions, will be applied in this case.

And, there are workplace issues; would people be denied employment if their Alzheimer's test were positive?
The biggest personal question the two doctors discuss briefly is, of course – would you want to know, when you are still cognitively healthy, that you have the plaques identified with Alzheimer's, particularly since there is no treatment.

Practically, it makes sense. People can plan ahead and they might use their time - which could be many years still - differently than if they didn't know. But it could also be detrimental leading to depression and other life difficulties.

I've given this a great deal of thought in the past few days. If the scan showed no plaques, I'm home free and I wouldn't wonder every time I forget someone's name if I'm entering the early stages of Alzheimer's.

If the test were positive, however, I know I would monitor myself for every minor bit of forgetfulness. How far gone am I? Is my memory loss serious yet? How do I know I'm forgetting things if I don't remember what I once knew?

Is this something I want to discuss with anyone beyond my physician? Do I tell relatives? Friends? If so, when? Who decides when I am no longer capable? My physician? My health care proxy?

Because I live in Oregon which has a Death with Dignity law, would I want to take advantage of that before my mind is an empty shell? But if my brain is heading south, how would I know when I've hit the tipping point, so to speak? Obviously, one can make an informed decision to choose to die only when one's mind is coherent, so there are legal questions too.

It is difficult to work out and there are no precedents yet, no guides from others' experience.

But at my age, nearly 70, I've tentatively come down on the side of wanting to know, although I won't be first in line when the test becomes available. I'm certain there are ramifications that haven't occurred to me yet.
(I think it is an even tougher question for people who are a good deal younger than I am. Would you want to know 20 or 30 or 40 years before the disease begins to be evident? I'm glad I'm too old to confront that.)
Most of the people reading this blog are, like me, older than 50. So the question today is: do you, at your age now, want to know if your brain shows the Alzheimer's plaques? And will you have the test when it becomes available?

This is not a question that can be tossed off easily like what to have for dessert and you may not have an answer today. But I think it is useful for all of us to begin the conversation.

TIME GOES BY | Breakthrough Test for Early Alzheimer's Diagnosis

New Measure Trumps High-Density Lipoprotein (HDL) Levels in Protecting Against Heart Disease

ScienceDaily (2011-01-12) -- A new study shows that a different metric, a measure of HDL function called cholesterol efflux capacity, is more closely associated with protection against heart disease than HDL cholesterol levels themselves. Findings from the study could lead to new therapeutic interventions in the fight against heart disease.

Comparison of Medications for Heart Failure Finds Difference in Risk of Death

ScienceDaily (2011-01-13) -- In a comparison of the angiotensin II receptor blockers candesartan and losartan, used by patients with heart failure, candesartan was associated with a lower risk of death at 1 and 5 years, according to a new study.

Two Medicines Taken Together Improve Control of Blood Pressure

ScienceDaily (2011-01-12) -- New research shows that starting treatment of blood pressure with two medicines rather than the one produces better and faster results and fewer side effects -- findings that could change clinical practice world-wide.

Italy Plans Pharmaceutical Reforms for Baby Boomers

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from AARP Global Network

With countries around the world recovering from the recession, many have resorted to austerity measures to keep their economies afloat. Some also face unprecedented issues due to aging baby boomers, who will require more resources from national healthcare systems.

Italy, the country with Europe's oldest population, is just now enacting sweeping reforms that have cut the costs of healthcare, according to InPharm.com. Some of the spotlight has been on the pharmaceutical industry, where the government has announced there will be 17.156 billion euro worth of cuts in 2011.

One way that the Italian Ministry of Health is strategically planning for baby boomers is by reducing the price of generic drugs by 12.5 percent so that they cost around the same as those in other European countries. The organization also hopes to tighten control on hospital spending.

While some predict that the savings can be contributed to the development of new medications, many others are skeptical of the effectiveness of these initiatives.

"The Italian national health service might be able to save a certain amount on the reimbursement of generics, and this might free up funds for the purchase of more expensive drugs," IHS Global Insight analyst Brendan Melck told the news source. "But, considering the huge debts in the Italian regional healthcare authorities, this would be only a small contribution."

Still, Melck added that the plan may help with this boomer trend because it will encourage doctors to prescribe more affordable generic drugs instead of brand-name alternatives. In fact, the new measures restrict the reimbursement of prescription medication to the cheapest option, the news source reports.

In addition, if pills have not visibly improved a patient after six weeks, the pharmaceutical company will have to pay back 50 percent of the reimbursement cost. This may prove extremely helpful when it comes to finding the best way to aid boomers with chronic conditions, but many in the industry suggest that it will stifle innovation and experimentation.

This pay-for-performance system was initially launched in 2007, but its effects are just starting to emerge. One study found that the new regulations encourage the development of new drugs, because pharmaceutical companies greatly benefit if the medication proves to be beneficial.

Dr. Onofrio Lamanna, the chief medical director of a recent hospital built near Venice, applauds the overall approach, despite some reservations.

"All of the austerity measures are useful and bound to generate substantial benefits for patients, doctors and hospitals," he told the news provider.

Pharmaceutical industries across Europe have been affected by similar austerity measures as countries have tried to create more sustainable models for pharmaceuticals.

In the Netherlands, the aging population seems to be at least partially responsible for significant growth in healthcare spending - in 2009, the total expenditure rose by 7 percent, costing 57.69 billion euro. There is also worry that, as boomers retire, there will be fewer workers to contribute to social services.

These facts have pushed the Dutch government to propose a spending cut of 3.2 billion euro, partially by making taxes higher on tobacco and reducing medical benefits.

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Prostate CA Vaccine Stirs Interest, Lawsuits

By Charles Bankhead, Staff Writer, MedPage Today

For the second time in as many months, the Centers for Medicare and Medicaid Services (CMS) finds itself named in a lawsuit related to the agency's handling of the prostate cancer immunotherapy sipuleucel-T (Provenge).

Judicial Watch, a Washington-based public interest group, has sued HHS to gain access to documents related to the CMS decision to conduct a one-year national coverage analysis to assess whether the therapy is "reasonable and necessary," thus qualifying for Medicare coverage.

According to a Freedom of Information Act request filed in last November, Judicial Watch wants access to "all records concerning CMS' national coverage analysis of the vaccine Provenge, including but not limited to the criteria being used to analyze Provenge."

The legal action apparently has evolved from a suspicion that the national coverage analysis is the first step toward cost-based healthcare rationing.

In a statement posted on the Judicial Watch website, representatives of the organization noted that sipuleucel-T "costs $93,000 to administer the three necessary treatments. Medicare and the FDA are legally prohibited from denying approval of a medical treatment based solely on cost. Yet, multiple press reports suggest that cost is the major factor in the unusual decision by CMS to undertake a review of the treatment which could signal a move by the Obama administration to begin implementing healthcare rationing based on the cost of treatments."
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RA in Men Associated With Mortality Risk

By Nancy Walsh, Staff Writer, MedPage Today

Men with rheumatoid arthritis were more than twice as likely to die over a seven-year period as their counterparts in the general population, researchers found.
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Light Therapy May Brighten Up Depressed Seniors

By Charles Bankhead, Staff Writer, MedPage Today

Literally shining a light on a darkened mind may help older patients with major depression -- with three weeks of home-based light therapy producing a significant improvement in mood and sleep, according to the results of a Dutch randomized trial.

The trial, conducted among almost 90 outpatients ages 60 and older treated for major depressive disorder (MDD), also showed that the positive effects associated with light therapy persisted during three weeks of follow-up after the treatment ended (P=0.01 to P<0.001), Ritsaert Lieverse, MD, of VU University Medical Center in Amsterdam, and colleagues reported.

"We showed that bright-light therapy had beneficial effects in elderly patients with nonseasonal major depressive disorder and found indirect support for the contention that therapeutic effects may in part be mediated by enhancements of circadian system functioning," Lieverse and co-authors commented.

"These results support inclusion of chronotherapeutic strategies in the treatment options for nonseasonal major depressive disorder in elderly patients. Bright light treatment may provide a viable alternative for patients who refuse, resist, or do not tolerate antidepressant treatment," the team concluded.
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Bone Turnover Markers May Predict Fracture Risk

By Rita Baron-Faust, Contributing Writer, MedPage Today

High levels of bone turnover markers (BTMs) may help predict which people are at greatest risk of suffering fragility fractures due to osteoporosis, according to a position paper by an international team of researchers.

A review of 22 studies conducted over a decade found that high levels of BTMs may predict fracture risk independently from bone mineral density (BMD) in postmenopausal women, Samuel D. Vasikaran, MBBS, MD, of the Royal Perth Hospital in Perth, Australia, and colleagues reported online in the journal Osteoporosis International.
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Age No Barrier to Prostate Cancer Tx

By Todd Neale, Staff Writer, MedPage Today

Decisions about prostate cancer treatment may rely too heavily on age, research suggests.

In a study of nearly 12,000 men, older patients were less likely to get local therapy, regardless of disease risk, Matthew Cooperberg, MD, MPH, of the University of California San Francisco, and colleagues reported online in the Journal of Clinical Oncology.


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Anti-VEGF Drugs Making Leap to Diabetic Eye Disease

By John Gever, Senior Editor, MedPage Today

Drugs approved for "wet" age-related macular degeneration also appeared to be effective in diabetic macular edema in several clinical studies, researchers said here.

Ranibizumab (Lucentis) and pegaptanib (Macugen), both of which inhibit vascular endothelial growth factor (VEGF) signalling, were highly effective in improving visual acuity in patients with this form of diabetic retinopathy in a series of randomized, controlled trials, according to reports at the American Academy of Ophthalmology's annual meeting.
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Older Women Too Can Benefit from Trastuzumab - in Meeting Coverage, ESMO from MedPage Today

By Ed Susman, Contributing Writer, MedPage Today

MILAN -- Women in their 70s and 80s diagnosed with metastatic breast cancer appear to benefit from treatment with trastuzumab (Herceptin), researchers reported at the European Society for Medical Oncology Conference.
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Better Outcomes With Combo Therapy in Early RA from MedPage Today

By Nancy Walsh, Staff Writer, MedPage Today

Patients with rheumatoid arthritis who received initial combination therapy with adalimumab (Humira) plus methotrexate for two years had better long-term disease control than those who started on monotherapy, an open-label study showed.

At five years, 35% of patients whose initial treatment included both drugs met the stringent criteria of clinical remission, normal function, and no radiographic progression, compared with 13% of those who received only adalimumab and 14% of those taking methotrexate alone, according to Désirée van der Heijde, MD, PhD, of Leiden University in the Netherlands, and colleagues.

These findings "indicate a window of opportunity to influence the disease course with early, aggressive treatment and suggest that there are consequences associated with delay of combination treatment in patients whose disease activity warrants such therapy," the investigators wrote in a paper published online by the Journal of Rheumatology.

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All Cancer Therapies May Impair Memory from MedPage Today

By Ed Susman, Contributing Writer, MedPage Today

Cognitive impairments associated with breast cancer treatment are not limited only to "chemobrain," but may occur with radiation or hormonal therapies as well, a researcher said here.

About 14% of individuals who had undergone therapy for a variety of cancer diagnoses complained of post-therapy memory loss compared with 8% of individuals who had not received cancer treatments (P=0.001),

"Chemobrain is sort of a misnomer, because we observed this memory-loss phenomenon among people who have undergone chemotherapy, radiation therapy or hormonal therapy for treatment of various types of cancer," Jean-Pierre told MedPage Today during a poster session here at the American Association for Cancer Research Conference on the Science of Cancer Health Disparities.
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The Caregiver's Bookshelf: The Beginnings of Alzheimer's - NYTimes.com

By PAULA SPAN

It’s been nearly 30 years since Dr. Peter Rabins, a Johns Hopkins psychiatrist, and his co-author Nancy Mace published “The 36-Hour Day,” the best known guide to caring for someone with Alzheimer’s disease. Now in its fourth edition, it remains a trusted source of information and support.

But the landscape of dementia — its diagnosis, its treatment, how much neuroscience has advanced, how much the public understands — has changed dramatically, as Gina Kolata has been reporting in The Times.
As she also points out, this progress in diagnosing Alzheimer’s will mean that families are likely to face tough decisions sooner than ever.

“The book was a landmark twenty-some years ago when people were being diagnosed with what we’d call moderate to end-stage dementia,” said Dr. P. Murali Doraiswamy, a prominent researcher on the aging brain at Duke University Medical Center. “Now people are being diagnosed much earlier, when they’re still functioning well, and there’s a push to diagnose at even earlier stages.” With more medications available, with better understanding of the non-Alzheimer’s dementias, “people want to be more proactive,” Dr. Doraiswamy said. “They want to join clinical trials. They want ways to protect their brains.”

So Dr. Doraiswamy, with Lisa Gwyther, a social worker who directs Duke’s Alzheimer’s family support program, and Tina Adler, a science writer, intend for their book, “The Alzheimer’s Action Plan,” to fill a gap. “It’s essentially a book about the early stage of the disease,” Dr. Doraiswamy said.
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