Natural Defenses Against Cancer

We now know that cancer is a disease of a loss of control over cell division. A commonly-held belief is that larger animals such as humans (with more cells and hence more cell divisions) and animals that live a long time (with more opportunity for cell damage to occur over time) should be more prone to cancer than smaller, short-lived animals.

A recent study shows that the size-and-time belief is incorrect. In a study of 36 mammalian species, the authors found no evidence of increased incidence of cancer in larger or longer-lived animals. Elephants live much longer than humans and have many more cells, but fewer than 5% die of cancer, compared to a cancer death rate of 11-25% in humans. And a particular strain of rat called the naked mole rat lives up to 30 years - much longer than other rats - without being prone to cancer. So the question becomes, why is that?

It turns out that nature has developed defenses against cancer. During evolution, elephants developed extra copies of a cancer-fighting gene called p53. (Humans have one copy; elephants have more than 20.) The p53 gene causes damaged cells to commit suicide, effectively preventing them from becoming cancerous. The naked mole rat developed a protein that blocks the growth of fast-dividing (potentially cancerous) cells.

Researching the natural defenses against cancer in other long-lived or large animals might help us better understand how cancer develops in humans and how best to fight it.

Express Scripts Will Cover the Newest (Expensive) Cholesterol-Lowering Drugs

 I posted a blog recently about the two newest cholesterol-lowering drugs, made by Amgen and Sanofi SA (See this blog, Oct. 6, 2015). The new drugs will be very expensive; approximately $14,000 per year, compared to just a few dollars a month for the statins. I raised the question about whether insurers should cover the new drugs just because patients say they want them.

When the prices of the new drugs were announced, it seemed that the intent was to limit the use of the drugs to those patients who couldn't achieve adequate cholesterol reduction with the statins. According to FoxNews, insurers planned to "aggressively challenge" claims of statin intolerance before agreeing to pay for them. But how will insurers respond when physicians write prescriptions for the new drugs for their patients? I'm betting that patients will demand the new drugs once the drug companies start their ad campaigns, and that insurers will be pressured into paying the exorbitant bill.

At least one pharmacy benefits management company, Express Scripts, has included the new drugs in its 2016 list of approved drugs, but the company added that there would be "restrictions" on who could use them. Good luck with that! It will be interesting to see whether they actually do manage to restrict their use, or whether the costs to insurers will spiral out of control.

If you think it doesn't matter, consider this; high health insurance expenses by other insured individuals ultimately affects your insurance rates.

Governor Brown Signs California's Death with Dignity Bill

Last week California governor Jerry Brown signed the state's death with dignity bill, known officially as the End Of Life Option Act. The bill, inspired by the plight of Californian Brittany Maynard who had to move to Oregon to take advantage of a similar law there, will take effect next year. In a statement made after the signing, governor Brown said, "I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill." Governor Brown consulted with doctors and a Catholic bishop before he made his decision to sign the bill.

Opponents of the bill have already begun efforts to have the bill repealed. They'll have an uphill battle; a recent poll showed that 65% of Californians approve of the bill, while only 27% oppose it.

Do Some People Have a "WiFi Allergy"?

Is it possible for people to have an allergy, or at least an adverse reaction of some kind, to WiFi transmissions? Some people think so. They claim that their symptoms of headaches, itchy skin, a rash, heart palpitations and nausea are caused by what they call an "electromagnetic hypersensitivity" (abbreviated EHS; doesn't every disease have a three-letter designation these days?), which can be triggered by wireless Internet service transmissions. One couple has even sued their son's school, claiming that EHS is a disability and that the school must change their WiFi system to accommodate him.

It turns out that many cases of EHS are self-diagnosed. The condition is not a recognized medical diagnosis by any authoritative medical body. Although no one denies that some people experience symptoms, it appears that the symptoms result more from what is called a "nocebo effect" - the tendency for someone to feel unwell when they think they have been exposed to something hazardous. In a review published in 2010 of 46 published blind or double-blind studies, involving over 1,000 people who self-diagnosed themselves has having EHS, it was found that reactions similar to EHS were elicited when the persons thought they were being exposed but were not. In other words, the symptoms in these patients are most likely due to psychological factors.

Nevertheless, some people continue to push for EHS to be declared a disability, entitling them to the accommodation that such a declaration would allow. Let's hope they don't succeed.

New Drugs For Lowering Cholesterol

The Food and Drug Administration (FDA) recently approved two new drugs for lowering LDL, the "bad" cholesterol. The new drugs work by an entirely different mechanism from the current gold-standard cholesterol lowering drugs, the statins. The new drugs mimic the effect of a genetic mutation, described in two patients several years ago, that results in very low LDL levels (see this blog July 18, 2013). The two drugs, Praluent, made by Sanofi Regeneron, and Repatha, made by Amgen, should be available soon.

Now for the bad news; the new drugs will cost upwards of $14,000 a year. For most patients who need of a cholesterol-lowering drug, there will be no reason to switch from a statin to one of the new drugs. But some patients say (rightly or wrongly) that the statins cause them to have muscle pain, hazy memory, and problems sleeping.

Should health insurers pay for the new (expensive) drugs just become some patients say they can't tolerate the statins? Double blind studies have shown that patients taking statins have no more muscle pains than patients taking a placebo. Muscle pain is such a common complaint in the age group of patients likely to be taking cholesterol-lowering drugs that it's hard to pinpoint the source.

I guess the question is, should patients' perceptions trump good science? Or should the insurance companies just say "no"?