Category: Health
Biden’s Cancer “Moonshot Is 100 Percent Hype”
(p. A17) WASHINGTON — President Biden unveiled a plan on Wednesday to reduce the death rate from cancer by at least 50 percent over the next 25 years — an ambitious new goal, he said, to “supercharge” the cancer “moonshot” program he initiated and presided over five years ago as vice president.
Mr. Biden, joined by his wife, Jill Biden, and Vice President Kamala Harris, also announced a campaign to urge Americans to undergo screenings that were missed during the coronavirus pandemic.
. . .
More screenings are not the answer — the only cancers for which screening has indisputably lowered the death rate are colon and cervical. Death rates for other cancers, like breast, have fallen, but a large part of the drop, if not all of it, is because of improved treatment, said Donald A. Berry, a biostatistician at the University of Texas M.D. Anderson Cancer Center who has spent decades studying these issues.
“Everybody loves early detection, but it comes with harms,” he said — principally, the harm of finding and treating tumors that do not need to be treated because they are innocuous. “The harms we know, but the benefits of screening are very uncertain,” he said.
If the age-adjusted cancer death rate were to plunge by 50 percent, it would have to be because cancers were being cured. Some treatments, like a drug that treats chronic myelogenous leukemia, have slashed death rates for that disease, but such marked effects in cancer are few and far between.
. . .
The White House billed the event as a fresh push by the president to “reignite” the moonshot program and “end cancer as we know it.”
. . .
Yet one Wall Street analyst who specializes in biotechnology and pharmaceuticals said that the time, money and effort might be better spent on initiatives to prevent cancer, like reducing smoking and rates of obesity. The Centers for Disease Control and Prevention says being obese increases a person’s risk of cancer. And reducing smoking is a proven way to cut the cancer death rate.
“This moonshot is 100 percent hype; this is the absolute wrong way to do this,” said the analyst, Stephen Brozak, the president of WBB Securities.
Presidents since Richard M. Nixon have sought to tackle cancer, of which there are more than 100 types of disease that can vary in how they grow, spread and respond to treatment. The cancer institute estimates that nearly 40 percent of men and women will be diagnosed with some type of cancer at some point during their lifetimes. The American Cancer Society estimates there will be 1.9 million new cases of cancer in the United States this year, and more than 609,000 cancer deaths.
For the full story, see:
(Note: ellipses added.)
(Note: the online version of the story has the date Feb. 2, 2022, and has the title “Biden Presents Ambitious Plan to Cut Cancer Death Rate in Half.”)
Centenarians Can Be “Cognitive Super-Agers”
(p. D7) Fewer than 1 percent of Americans reach the age of 100, and new data from the Netherlands indicate that those who achieve that milestone with their mental faculties still intact are likely to remain so for their remaining years, even if their brains are riddled with the plaques and tangles that are the hallmarks of Alzheimer’s disease.
Findings from the Dutch study may eventually pave a path for many more of us to become “cognitive super-agers,” as researchers call people who approach the end of the human life span with brains that function as if they were 30 years younger.
One day everyone who is physically able to reach 100 may also be able to remain mentally healthy. By studying centenarians, researchers hope to identify reliable characteristics and develop treatments that would result in healthy cognitive aging for most of us. Meanwhile, there is much we can do now to keep our brains in tiptop condition, even if reaching 100 is neither a goal nor a possibility.
These hopeful prospects stem from the study of 340 Dutch centenarians living independently who were tested and shown to be cognitively healthy when they enrolled. The 79 participants who neither died nor dropped out of the study returned for repeated cognitive testing, over an average follow-up of 19 months.
The research team, directed by Henne Holstege at Vrije University in Amsterdam, reported in JAMA Network Open in January that these participants experienced no decline in major cognitive measures, except for a slight loss in memory function. Basically, the participants performed as if they were 30 years younger in overall cognition; ability to make decisions and plans and execute them; recreate by drawing a figure they had looked at; list animals or objects that began with a certain letter; and not becoming easily distracted when performing a task or getting lost when they left home.
Even those with genes linked to an elevated risk of developing Alzheimer’s disease were able to perform well on the tests.
Nearly a third of the participants agreed to donate their brains after death. Brain autopsies of 44 of the original centenarians revealed that many had substantial neuropathology common to people with Alzheimer’s disease although they had remained cognitively healthy for up to four years beyond 100.
For the full commentary, see:
Jane E. Brody. “Living to 100 and Staying Sharp.” The New York Times (Saturday, June 22, 2021): D7.
(Note: ellipsis, and bracketed year, added.)
(Note: the online version of the commentary has the date June 21, 2021, and has the title “The Secrets of ‘Cognitive Super-Agers’.”)
Expert Medical Advice Often Flip-Flops
(p. D6) A History of Medical Flip-Flops
Shifting medical advice is surprisingly common, and it tends to fall into three categories: emerging guidance, replacement advice and reversals.
Emerging guidance comes during times of crisis — like pandemics — and is destined to change quickly. In the past several months, guidance about the best way to treat Covid patients, masks to prevent transmission and the limits of vaccine protection have all shifted as knowledge of the coronavirus and its variants has evolved.
Sometimes it’s hard to tell the difference between replacement advice, which is issued when research improves on advice that came before it, and a full reversal, which comes about because a common medical practice got ahead of the science and never actually worked or even caused harm. Here are some examples of true medical flip-flops in recent years.
MENOPAUSE HORMONES TO PROTECT THE HEART: In 2002, decades of advice about the heart benefits of menopause hormones seemed to change overnight when a major study called the Women’s Health Initiative was halted after researchers detected more heart attacks in the women taking hormones. In hindsight, doctors had misinterpreted data from observational research. The current advice: Hormones can relieve menopause symptoms but shouldn’t be used for chronic disease prevention.
VIOXX AS A LOWER-RISK ARTHRITIS TREATMENT: In 1999, the Food and Drug Administration approved Vioxx as a breakthrough pain reliever because it lowered the risk of gastrointestinal problems. But by 2004, Merck had withdrawn the drug because studies showed it significantly raised the risk of heart attack.
ARTHROSCOPIC SURGERY ON AGING KNEES: For years, the partial removal of torn meniscus tissue was the most common orthopedic procedure in the United States, with about 700,000 performed a year. In 2013, a researcher in Finland compared the operation to a “sham” procedure and found there was no benefit. Most doctors now recommend physical therapy instead.
VITAMIN MEGADOSES TO LOWER CANCER AND HEART RISK: For years, doctors believed various vitamins could lower risk for cancer and heart disease, but a number of studies showed just the opposite. A study of beta carotene and vitamin A found that the supplements actually increased the risk of lung cancer in male smokers. A study of vitamin E and selenium, thought to protect against prostate cancer, increased risk for the disease.
STENTS FOR STABLE HEART DISEASE: Doctors used to insert stents — tiny wire mesh tubes that prop open arteries — in millions of otherwise stable patients with heart disease. A study found that the surgical procedure was no better than drug therapy for preventing heart attacks.
Dr. Vinay Prasad, associate professor at the University of California San Francisco, and Dr. Adam S. Cifu, a professor of medicine at the University of Chicago Department of Medicine, coined the term “medical reversal” and concluded that about 40 percent of common medical practices that they reviewed turned out to be useless or harmful. In their book, “Ending Medical Reversal: Improving Outcomes, Saving Lives,” they noted that most of these failed treatments were initially embraced because they were based on logical reasoning.
“The thing that’s often behind reversal: All of these things have a good story, they have good pathophysiological rationale,” Dr. Cifu said. “They should work. But things only work if they’ve been shown in people to work, and people are so complicated.”
For the full story, see:
(Note: the online version of the story was updated Oct. 24, 2021, and has the title “Is the New Aspirin Advice a Medical Flip-Flop, or Just Science?” The paragraphs on menopause hormones to protect the heart and on vitamin megadoses to lower cancer and heart risk appear in the online version, but not in the print version.)
The book co-authored by Prasad and mentioned above is:
Prasad, Vinayak K., and Adam S. Cifu. Ending Medical Reversal: Improving Outcomes, Saving Lives. Baltimore: Johns Hopkins University Press, 2015.
The Internet of Things Enables Better Indoor Air Measurement and Customization
(p. A1) “Indoor air quality is not a nice-to-have anymore—people have realized it’s essential,” says Arjun Kaicker, an architect at Zaha Hadid Architects, a London-based firm that has designed buildings around the world.
Many of the technologies bringing about this transformation are part of the oft-touted “Internet of Things.” It’s a combination of wireless, internet-connected sensors and automation, tied together by the cloud and millions of lines of code and sold as a service to solve a particular problem—in this case, the spread of communicable diseases and other air pollutants indoors.
As with other applications of the Internet of Things, such as in factories, much of the technology involved is about tying together existing systems so they can respond more dynamically to information their sensors are gathering, says Bobby George, chief digital officer of Carrier, which manufactures heating, ventilation and air-conditioning systems.
The goal is relatively simple: In more than 95% of buildings, air-conditioning systems are set on a schedule that remains largely untouched. Smart-building systems can pump more clean air into parts of an office as occupancy or other factors change throughout the day, adds Mr. George.
Wireless, battery-powered air-quality and occupancy sensors that can handle continuous monitoring are rapidly falling in price. They can be peppered throughout a building and don’t require opening up walls to connect to data and power.
. . .
In a May [2021] letter in the journal Science, 39 researchers and experts in public health, indoor air quality and engineering asserted that our understanding of transmission of respiratory infections, especially Covid-19, has progressed so rapidly that it should spur a “paradigm shift” for those responsible for the health and safety of office workers.
No longer, they continued, should people accept the idea that there is little we can do to prevent the spread of airborne infections at work. Just as we take pains to eliminate the spread of waterborne and foodborne disease, we now have the knowledge and tools to reduce the spread of germs in the air. And we should start demanding employers do something about it, they said.
To make that happen, businesses and schools should follow guidelines like those offered by the American Society of Heating, Refrigerating and Air-Conditioning Engineers, says William Bahnfleth, a professor of architectural engineering at Pennsylvania State University and the head of the committee that created these standards. Those guidelines include ensuring the right mix of fresh outdoor air and filtered indoor air, and using air filters that meet a higher standard of effectiveness.
Employees can use these types of published guidelines to inform their questions when talking to employers about returning to the office, Dr. Bahnfleth says. Similar guidelines are offered by the American Industrial Hygiene Association and the U.S. Centers for Disease Control and Prevention.
For the full story, see:
(Note: ellipsis, and bracketed year, added.)
(Note: the online version of the story has the same date as the print version, and has the title “KEYWORDS; The Pandemic Could Help Us Breathe Easier at the Office.”)
High Viral Load Increases Odds of Long Covid
(p. 18) It is one of many mysteries about long Covid: Who is more prone to developing it? Are some people more likely than others to experience physical, neurological or cognitive symptoms that can emerge, or linger for, months after their coronavirus infections have cleared?
Now, a team of researchers who followed more than 200 patients for two to three months after their Covid diagnoses report that they have identified biological factors that might help predict if a person will develop long Covid.
The study, published Tuesday [January 25, 2022] by the journal Cell, found four factors that could be identified early in a person’s coronavirus infection that appeared to correlate with increased risk of having lasting symptoms weeks later.
. . .
One of the four factors researchers identified is the level of coronavirus RNA in the blood early in the infection, an indicator of viral load. Another is the presence of certain autoantibodies — antibodies that mistakenly attack tissues in the body as they do in conditions like lupus and rheumatoid arthritis. A third factor is the reactivation of Epstein-Barr virus, a virus that infects most people, often when they are young, and then usually becomes dormant.
The final factor is having Type 2 diabetes, although the researchers and other experts said that in studies involving larger numbers of patients, it might turn out that diabetes is only one of several medical conditions that increase the risk of long Covid.
. . .
One persuasive conclusion, several experts said, was the suggestion that because patients with high viral loads early on often developed long Covid, giving people antivirals soon after diagnosis might help prevent long-term symptoms.
“The quicker one can eliminate the virus, the less likelihood of developing persistent virus or autoimmunity, which may drive long Covid,” Dr. Iwasaki said.
For the full story, see:
(Note: ellipses, and bracketed year, added.)
(Note: the online version of the story has the date Jan. 25, 2022, and has the same title as the print version.)
The “Gold Standard” of Randomized Clinical Trials “Has Its Own Issues”
(p. R2) . . ., closely held Epic Systems Corp., maker of one of the most widely used electronic health record systems, searched a segment of its database in the spring of 2020 to find that routine breast, colon and cervical cancer screenings in the U.S. had each dropped by more than 85% during the first weeks of the Covid-19 pandemic. The report helped spur efforts to persuade people to make up for missed screenings.
But researchers have a much more ambitious vision for this data: to help guide how doctors treat individual patients in real time.
“The evidence from real-world data is a different and exciting new path,” says Jackie Gerhart, a physician who works with the informatics team at Epic. “You can get a lot of outcomes information from medical records that can help change care for individual patients.”
. . .
To be sure, patient records are observational, and thus subject to confounders and other shortcomings that can undercut their reliability in pointing to treatment options.
But the gold standard has its own issues. Randomized clinical trials, which control for differences in patient health status and other variables, are the preferred evidence to inform patient care. Yet such trials generally exclude an especially common group of patients—those with multiple ailments. Moreover, the elderly, children, women, minority groups and people who live far from medical research centers have long been underrepresented in such studies.
As a result, the highest-quality evidence that medicine produces doesn’t apply to most patients doctors see in daily practice. “There are so many clinical situations where the evidence that is needed does not exist,” says Nigam Shah, professor of medicine and biomedical data science at Stanford University Medical School.
Researchers have believed for at least a half-century that data in patient medical records could help fill the gaps.
. . .
The struggles of International Business Machines Corp.’s Watson raises [a] . . . yellow flag. It had ambitions to develop a tool for cancer doctors that would mine patient health records and thousands of pages of research from the peer-reviewed medical literature for treatment advice. But it hit walls, including accuracy and the complexity of combining data from electronic health records, billing claims and published research to provide a cohesive product. Doctors who used the service rarely changed treatment plans. IBM says it discontinued Watson for Oncology at the end of 2020.
For the full story, see:
(Note: ellipses, and bracketed word, added.)
(Note: the online version of the story has the date December 3, 2021, and has the title “Medical Records Data Offers Doctors Hope of Better Patient Care.” In a couple of passages there are a few extra words in the online version, which is the version quoted above.)
Johan Hultin Self-Funded Trip to Find 1918 Flu Virus in the Permafrost
(p. B9) Dr. Hultin’s quest to find victims of the 1918 flu was sparked in 1950 by an offhand remark over lunch with a University of Iowa microbiologist, William Hale. Dr. Hale mentioned that there was just one way to figure out what caused the 1918 pandemic: finding victims buried in permafrost and isolating the virus from lungs that might be still frozen and preserved.
Dr. Hultin, a medical student in Sweden who was spending six months at the university, immediately realized that he was uniquely positioned to do just that. The previous summer, he and his first wife, Gunvor, spent weeks assisting a German paleontologist, Otto Geist, on a dig in Alaska. Dr. Geist could help him find villages in areas of permafrost that also had good records of deaths from the 1918 flu.
After persuading the university to provide him with a $10,000 stipend, Dr. Hultin set off for Alaska. It was early June 1951.
. . .
He removed still-frozen lung tissue from the victims, closed the grave and took the tissue back to Iowa, keeping it frozen on dry ice in the passenger compartment of a small plane.
Back in the lab, Dr. Hultin tried to grow the virus by injecting the lung tissue into fertilized chicken eggs — the standard way to grow flu viruses. He was caught up in the excitement of his experiment, he said, and had not thought about the possible danger of introducing a deadly virus into the world.
“I remember the sleepless nights,” he said. “I couldn’t wait for morning to come to charge into my lab and look at the eggs.”
But the virus was not growing.
He tried squirting lung tissue into the nostrils of guinea pigs, white mice and ferrets, but again he failed to revive the virus.
“The virus was dead,” he said.
Dr. Hultin never published his results but bided his time, working as a pathologist in private practice in San Francisco and hoping for another opportunity to resurrect that virus.
His chance came in 1997, when, sitting by a pool on vacation with his wife in Costa Rica, he noticed a paper published in Science by Dr. Jeffery K. Taubenberger, now chief of the viral pathogenesis and evolution section at the National Institute of Allergy and Infectious Diseases.
It reported a remarkable discovery. Dr. Taubenberger had searched a federal repository of pathology samples dating to the 1860s and found fragments of the 1918 virus in snippets of lung tissue from two soldiers who had died in that pandemic. The tissue had been removed at autopsy, wrapped in paraffin and stored in the warehouse.
Dr. Hultin immediately wrote to Dr. Taubenberger, telling him about his trip to Alaska. He offered to return to Brevig to see if he could find more flu victims.
“I remember getting that letter and thinking: ‘Gosh. This is really incredible. This is amazing,’” Dr. Taubenberger said in an interview this week. He thought the next step would be to apply for a grant for Dr. Hultin to return to Brevig. If all went well, Dr. Hultin might go back in a year or two.
Dr. Hultin had a different idea.
“I can’t go this week, but maybe I can go next week,” he told Dr. Taubenberger.
He added that he would go alone and pay for the trip himself so that there would be no objections from funding agencies, no delays, no ethics committees and no publicity.
. . .
Using the tissue Dr. Hultin provided, Dr. Taubenberger’s group published a paper that provided the genetic sequence of a crucial gene, hemagglutinin, which the virus had used to enter cells. The group subsequently used that tissue to determine the complete sequence of all eight of the virus’s genes.
. . .
Before results from the study of the Brevig woman’s virus were published, Dr. Hultin asked the villagers if they wanted the village to be identified in a news release and a journal article. They might be besieged by media. “Maybe you won’t like that,” he warned them.
The Brevig residents came to a consensus: Publish the paper and identify the village. Dr. Hultin was listed as a co-author.
For the full obituary, see:
(Note: ellipses added.)
(Note: the online version of the obituary was updated January 28, 2022, and has the title “Johan Hultin, Who Found Frozen Clues to 1918 Virus, Dies at 97.”)
Gina Kolata devotes a chapter to Hultin’s search for the 1918 flu virus in her book:
Kolata, Gina. Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It. New York: Farrar, Straus & Giroux, Inc., 1999.
IBM Sells Failed Watson Artificial Intelligence Health Unit
(p. B3) International Business Machines Corp. agreed to sell the data and analytics assets from its Watson Health business to investment firm Francisco Partners, the companies said Friday [January 21, 2022].
. . .
The Watson Health business uses artificial intelligence to analyze diagnostic tests and other health data and to manage care.
IBM had big aspirations for its Watson artificial intelligence to help in medical research and improve patient outcomes, but the technology’s impact has fallen short of early hopes. Partners and clients have moved away from projects that were built around Watson technology in recent years, although IBM had spent billions of dollars making acquisitions to bolster the business.
“IBM took a risk of becoming a disrupter in the complex health care industry but was only able to garner limited success,” UBS analyst David Vogt said in a note Friday.
For the full story, see:
(Note: ellipsis, and bracketed date, added.)
(Note: the online version of the story was updated Jan. 21, 2022, and has the title “IBM Sells Watson Health Assets to Investment Firm.”)
Instead of Centralizing With C.D.C., the Need for Speed Requires “Clinical and Commercial Labs to Create and Deploy Tests”
(p. A22) The faulty coronavirus testing kits developed by the Centers for Disease Control and Prevention in the early weeks of the pandemic were not only contaminated but had a basic design flaw, according to an internal review by the agency.
Health officials had already acknowledged that the test kits were contaminated, but the internal report, whose findings were published in PLOS ONE on Wednesday, also documented a design error that caused false positives.
. . .
The C.D.C.’s test was designed to detect three distinct regions, or target sequences, of the virus’s genetic material. The test kits contain a set of what are known as primers, which bind to and make copies of the target sequences, and probes, which produce a fluorescent signal when these copies are made, indicating that genetic material from the virus is present.
The primers and probes need to be carefully designed so that they bind to the target sequences and not to each other. In this case, that did not happen. One of the probes in the kit sometimes bound to one of the primers, producing the fluorescent signal and generating a false positive.
“It’s something that should have been caught in the design phase,” said Susan Butler-Wu, a clinical microbiologist at the Keck School of Medicine of the University of Southern California. “That’s one thing that you check for.”
. . .
The bigger lesson, Dr. Butler-Wu said, is that the responsibility for developing diagnostic tests should be distributed more widely during a public health emergency. Rather than relying on the C.D.C. to be the sole test developer, officials could also enlist clinical and commercial labs to create and deploy tests.
“It’s great that there’s all these additional checks in place, but what are you going to do when there’s a new emerging pathogen and we need to respond quickly?” she said. “I don’t think that’s a viable model for responding to a pandemic.”
For the full story, see:
(Note: ellipses added.)
(Note: the online version of the story has the date Dec. 15, 2021, and has the title “C.D.C. Virus Tests Were Contaminated and Poorly Designed, Agency Says.”)
The PLOS ONE article mentioned above is:
FDA Only Approves Drugs That Fight Diseases and FDA Does Not See Aging as a Disease
(p. R2) Will people eventually routinely live—and live healthily—longer? That’s the vision of the burgeoning field of aging research, where scientists are trying to extrapolate tantalizing life-prolonging findings from animal experiments into medicines that slow, prevent or even reverse the aging process for humans.
Leading candidates for stanching aging include two familiar drugs—metformin, a front-line diabetes treatment, and rapamycin, long used to prevent transplant patients from rejecting donated organs. Both have been shown to increase longevity in animal studies and both target molecular processes linked to the aging of cells.
Another approach is a new class of drugs called senolytics, which clear the body of so-called senescent cells, old cells that stop dividing but don’t die. They accumulate in tissues throughout the body and secrete factors that damage other cells. They are linked to such aging conditions as frailty, cognitive impairment and lack of physical resilience.
Also in the mix is a strategy called cellular reprogramming in which scientists are seeking to turn back the clock on aging cells, restoring functions characteristic of younger cells.
. . .
. . ., the Food and Drug Administration doesn’t recognize aging as a disease to be treated, meaning there isn’t a clear path to approval for a drug that targets the biology of aging. Researchers instead have to design trials that can quantify whether a drug improves health or extends survival in a specific age-related disease. A pill that a large and generally healthy population would take, perhaps for decades, would have to clear a high safety bar.
. . .
Researchers are working to develop biomarkers in blood or other bodily sources that can quantify the aging process and serve as drug targets or as proxies to indicate a drug is working or not. Without validated biomarkers, it could take 20 or 30 years in some cases to run a randomized trial to prove whether a drug safely extended life.
For the full story, see:
Ron Winslow. “A Pill to Turn Back the Clock.” The Wall Street Journal (Thursday, Jan. 13, 2022): R2.
(Note: ellipses added.)
(Note: the online version of the story has the date January 11, 2022, and has the title “Can You Fight Aging? Scientists Are Testing Drugs to Help.”)