The FDA has approved a new home test for colon cancer. The new test, called "Cologuard", tests not only for hidden blood in the stool, but also for changes to DNA that may signal the presence of colon cancer.
Current recommendations by the U.S. Preventive Services Task Force for screening for colon cancer are that persons aged 50-75 should have an occult blood test every year and a colonoscopy every 10 years. Whether the Task Force will include Cologuard as an option in future recommendations is unknown. Nor is it clear yet whether Medicare or most insurance companies will pay for the test. That's critical to its acceptance because Cologuard costs nearly $600; much more than the standard occult blood test.
With any test, it's important to consider how accurate the test is. Cologuard appears to be better than the occult blood test at detecting cancers when they are present (92% of cancers detected, versus 74% for the occult blood test). However, Cologuard also has a higher "false positive" rate (reporting that cancer may be present when in fact it is not) of 13% versus 5% for the occult blood test. A positive result with Cologuard should be followed up with a colonoscopy, just to be sure.
Cologuard isn't perfect. But if it is used by people who refuse to go to the doctor for a blood test or especially for a colonoscopy, then it will serve a purpose.
Wednesday, October 8, 2014
Wednesday, October 1, 2014
First U.S. Ebola Case
A man who traveled to the U.S. from Liberia via Europe is now the first person to be diagnosed with Ebola while within the U.S. At least one of the major news services is giving this one "event" continuous coverage all day, which of course raises our fear level; it makes it sound like this one case of Ebola could lead to an epidemic in this country.
Nothing could be further from the truth. According to the CDC, Ebola is transmitted primarily in bodily fluids such as urine, saliva, or blood. In addition, Ebola patients can only infect others when they are actually sick - not before and not after. The patient in question didn't feel sick until several days after he arrived in the U.S. And four days after he began to feel sick, he was isolated in a hospital prepared to deal with diseases such as this. That means, for example, that he did not infect anyone on his incoming transatlantic flight, and he's probably not going to infect anyone else after the time he was hospitalized. At most, he could have infected some of the people with whom he had close contact in the four days during which he felt sick before he was hospitalized.
Public health officials certainly have their hands full finding all the people with whom the Ebola patient had direct contact, and monitoring them for 21 days. Surveillance is tedious, but it works. So relax; at least one expert doesn't think an Ebola epidemic is likely in this country. Ebola is just not transmitted easily enough.
Sensationalism sells. But the news services should dial back their continuous coverage of what is probably a non-event.
Nothing could be further from the truth. According to the CDC, Ebola is transmitted primarily in bodily fluids such as urine, saliva, or blood. In addition, Ebola patients can only infect others when they are actually sick - not before and not after. The patient in question didn't feel sick until several days after he arrived in the U.S. And four days after he began to feel sick, he was isolated in a hospital prepared to deal with diseases such as this. That means, for example, that he did not infect anyone on his incoming transatlantic flight, and he's probably not going to infect anyone else after the time he was hospitalized. At most, he could have infected some of the people with whom he had close contact in the four days during which he felt sick before he was hospitalized.
Public health officials certainly have their hands full finding all the people with whom the Ebola patient had direct contact, and monitoring them for 21 days. Surveillance is tedious, but it works. So relax; at least one expert doesn't think an Ebola epidemic is likely in this country. Ebola is just not transmitted easily enough.
Sensationalism sells. But the news services should dial back their continuous coverage of what is probably a non-event.
Monday, September 29, 2014
Ebola Update
The U.S. Centers for Disease Control and Prevention (CDC) reports that as of last week, over 6,000 people have been infected with the Ebola virus and more than 2,900 have died. Although Ebola infections have been identified in five countries, to date the epidemic is confined primarily to just three; Guinea, Sierra Leone, and Liberia. Senegal has had just one case (a man who traveled from Guinea) and Nigeria, with 8 deaths, hasn't had a new case in almost three weeks.
The death rate among infected persons remains close to 50%. This is a virus that kills its victims rather quickly and is difficult to treat. Fortunately, person-to-person transmission requires close contact in the form of exchange of fluids. But that means that the people at highest risk of becoming infected are health care workers. The World Health Organization reports that more than 120 health care workers have died since the outbreak began. The lack of proper facilities and equipment to effectively isolate patients and protect health care workers is a factor.
Most airlines have cancelled commercial flights to the three countries at the center of the outbreak. Travel between and within the three countries has been restricted as well. A side effect of travel bans is that the flow of health care workers and medical equipment/supplies to affected areas is made more difficult.
This epidemic is not over yet. It may not even have peaked.
The death rate among infected persons remains close to 50%. This is a virus that kills its victims rather quickly and is difficult to treat. Fortunately, person-to-person transmission requires close contact in the form of exchange of fluids. But that means that the people at highest risk of becoming infected are health care workers. The World Health Organization reports that more than 120 health care workers have died since the outbreak began. The lack of proper facilities and equipment to effectively isolate patients and protect health care workers is a factor.
Most airlines have cancelled commercial flights to the three countries at the center of the outbreak. Travel between and within the three countries has been restricted as well. A side effect of travel bans is that the flow of health care workers and medical equipment/supplies to affected areas is made more difficult.
This epidemic is not over yet. It may not even have peaked.
Tuesday, September 23, 2014
A National Strategy to Combat Antibiotic Resistance
In a 37-page document released this month, the Obama administration proposed a national strategy for combating the growing problem of antibiotic-resistant bacteria. It's about time. From an evolutionary point of view, the misuse and overuse of antibiotics in health care and food production will inevitably lead to the emergence of antibiotic-resistant strains of bacteria, because bacteria can adapt and evolve so quickly. We've been talking about this problem for a while now on this blog.
An interagency task force led by the secretaries of health and human services, agriculture, and defense has been tasked with developing a specific action plan within six months. The task force will then coordinate with government agencies to see that the required actions are taken. Finally, the task force will report regularly to the President on progress made toward specific goals outlined in the document.
The goals, objectives, and achievement targets listed in the document are clear, appropriate, and likely to be effective if they could actually be accomplished. It will be interesting to see, say five years from now, if any real progress has been made, or whether this is just a good plan without adequate follow-through. For example, one of the stated objectives; to "eliminate the use of medically important antibiotics for growth promotion in animals..." is likely to meet with stiff resistance from farmers.
I, for one, applaud the effort and hope for real progress.
For more on this subject, go to a previous blog post titled "First Official Report on Deaths from Antibiotic-resistant Bacteria."
An interagency task force led by the secretaries of health and human services, agriculture, and defense has been tasked with developing a specific action plan within six months. The task force will then coordinate with government agencies to see that the required actions are taken. Finally, the task force will report regularly to the President on progress made toward specific goals outlined in the document.
The goals, objectives, and achievement targets listed in the document are clear, appropriate, and likely to be effective if they could actually be accomplished. It will be interesting to see, say five years from now, if any real progress has been made, or whether this is just a good plan without adequate follow-through. For example, one of the stated objectives; to "eliminate the use of medically important antibiotics for growth promotion in animals..." is likely to meet with stiff resistance from farmers.
I, for one, applaud the effort and hope for real progress.
For more on this subject, go to a previous blog post titled "First Official Report on Deaths from Antibiotic-resistant Bacteria."
Thursday, September 18, 2014
E-cigarettes Help Smokers Quit
Say what you want about e-cigarettes, but the fact is that they work better than other methods at helping smokers quit on their own. According to a study just published in Addiction, smokers who choose e-cigarettes are more likely report that they have quit smoking than smokers who try to quit based on willpower alone and smokers who use nicotine replacement therapy products such as the nicotine patch.
And there’s the conundrum for regulators. On the one hand, they need to support regulations that keep e-cigarettes widely available, because if current smokers choose to use them and thereby ultimately quit smoking cigarettes, lives will be saved. On the other hand, they don’t want e-cigarettes to become too popular, especially among the young or people who have never smoked. The end result could be a lot of people who become nicotine addicts without ever having smoked cigarettes. And while e-cigarettes are thought to be much safer than cigarettes and probably don’t increase the risk of cancer, who wants a whole new generation of nicotine addicts? And how safe are e-cigarettes, anyway? It may be years before we know.
I expect regulators (the FDA) to focus on how e-cigarettes are marketed, and to develop regulations that try to prevent e-cigarettes from becoming too popular with young non-smokers. But of course, that’s precisely the market that manufacturers would like to reach, because it's a much larger market than just current smokers who seriously wish to quit. Regulators versus manufacturers - it’s the battle over the marketing of cigarettes all over again.
And there’s the conundrum for regulators. On the one hand, they need to support regulations that keep e-cigarettes widely available, because if current smokers choose to use them and thereby ultimately quit smoking cigarettes, lives will be saved. On the other hand, they don’t want e-cigarettes to become too popular, especially among the young or people who have never smoked. The end result could be a lot of people who become nicotine addicts without ever having smoked cigarettes. And while e-cigarettes are thought to be much safer than cigarettes and probably don’t increase the risk of cancer, who wants a whole new generation of nicotine addicts? And how safe are e-cigarettes, anyway? It may be years before we know.
I expect regulators (the FDA) to focus on how e-cigarettes are marketed, and to develop regulations that try to prevent e-cigarettes from becoming too popular with young non-smokers. But of course, that’s precisely the market that manufacturers would like to reach, because it's a much larger market than just current smokers who seriously wish to quit. Regulators versus manufacturers - it’s the battle over the marketing of cigarettes all over again.
Monday, September 15, 2014
Alcoholic Beverages Made From Non-GMO Grains
A leading manufacturer of distilled alcohol products has announced that it will begin manufacturing a line of neutral grain spirits from non-GMO grain, in addition to its traditional products made from genetically modified grains. The company says that it’s a market-driven decision, based on consumer perceptions that GMO foods may pose “unknown safety risks”.
If you oppose the development and planting of GMO plants because you think they might be bad for the environment, then you can rightfully cheer this decision. But if you think that drinking a distilled alcohol product made from GMO grains might be more harmful to drink than alcohol made from non-GMO grain, you’re misguided. Although the grain from GMO plants would contain a foreign protein or two, proteins are destroyed by the heat of the distillation process. And even if proteins weren’t destroyed by heat, they don’t vaporize and then condense again, so they wouldn’t end up in the final distillation product anyway. The final distillation product is essentially just alcohol and water.
The bottom line is that there aren’t any GMO proteins in distilled alcohol, even when it’s made from GMO grain. By making distilled alcohol products from non-GMO grain, the manufacturer is responding to the perception of a health risk by its potential customers, not the actual reality.
If you oppose the development and planting of GMO plants because you think they might be bad for the environment, then you can rightfully cheer this decision. But if you think that drinking a distilled alcohol product made from GMO grains might be more harmful to drink than alcohol made from non-GMO grain, you’re misguided. Although the grain from GMO plants would contain a foreign protein or two, proteins are destroyed by the heat of the distillation process. And even if proteins weren’t destroyed by heat, they don’t vaporize and then condense again, so they wouldn’t end up in the final distillation product anyway. The final distillation product is essentially just alcohol and water.
The bottom line is that there aren’t any GMO proteins in distilled alcohol, even when it’s made from GMO grain. By making distilled alcohol products from non-GMO grain, the manufacturer is responding to the perception of a health risk by its potential customers, not the actual reality.
Friday, September 5, 2014
The Connection Between HIV and Multiple Sclerosis
It began as an observation in 2011; an Australian doctor who treats patients with HIV noticed that he had never had an HIV patient who went on to develop multiple sclerosis (MS). A literature search essentially confirmed his observations - there was just one known HIV patient who developed MS, and that patient's symptoms went away after undergoing the usual treatment regimen for HIV. So, he thought; is HIV infection (or its treatment regimen) somehow protective against MS?
To find out, the doctor and his coworkers needed access to the records of a large number of patients, because the number of people in a population who are HIV-positive is not all that large, and the number who develop MS is smaller still. They found what they needed in the records of the National Health Service of England. Among over 21,000 HIV-positive patients, they found only seven MS patients, when (according to a non-HIV-infected control group) there should have been 18. In other words, HIV-positive patients being treated for their disease were 60% less likely to develop MS. The results are published in the Journal of Neurology, Neurosurgery, and Psychiatry.
MS develops when the patient's immune system attacks the sheaths protecting nerve cells in the central nervous system. Some researchers think that the trigger causing the immune system to attack is an unknown virus. If so, there's a good possibility that the antiviral cocktail used to treat HIV is also attacking this unknown virus, thereby reducing the risk of developing MS.
Much more research needs to be done before we can be sure. But here's a case where the curiosity of an observant doctor may ultimately lead to an effective treatment for MS.
To find out, the doctor and his coworkers needed access to the records of a large number of patients, because the number of people in a population who are HIV-positive is not all that large, and the number who develop MS is smaller still. They found what they needed in the records of the National Health Service of England. Among over 21,000 HIV-positive patients, they found only seven MS patients, when (according to a non-HIV-infected control group) there should have been 18. In other words, HIV-positive patients being treated for their disease were 60% less likely to develop MS. The results are published in the Journal of Neurology, Neurosurgery, and Psychiatry.
MS develops when the patient's immune system attacks the sheaths protecting nerve cells in the central nervous system. Some researchers think that the trigger causing the immune system to attack is an unknown virus. If so, there's a good possibility that the antiviral cocktail used to treat HIV is also attacking this unknown virus, thereby reducing the risk of developing MS.
Much more research needs to be done before we can be sure. But here's a case where the curiosity of an observant doctor may ultimately lead to an effective treatment for MS.
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