Vitamin D Helps Cancer Patients Live Longer

Michigan State University physicians have found that vitamin D, if taken for at least three years, could help cancer patients live longer.

The findings suggest that the vitamin carries significant benefits other than just contributing to healthy bones and were presented at the American Society of Clinical Oncology annual meeting on June 3, 2019.

In the United States, cancer is the second leading cause of death, according to the Centers for Disease Control and Prevention.

Vitamin D had a significant effect on lowering the risk of death among those with cancer, but unfortunately it didn’t show any proof that it could protect against getting cancer,” said Tarek Haykal, a lead author on the study and an internal medicine resident physician at Michigan State University and Hurley Medical Center in Flint, Michigan.

The researchers looked at data related to disease prevention from more than 79,000 patients in multiple studies that randomly compared the use of vitamin D to a placebo over at least a three-year period. Haykal and his team zeroed in on any information that involved cancer incidence and mortality.

The difference in the mortality rate between the vitamin D and placebo groups was statistically significant enough that it showed just how important it might be among the cancer population,” Haykal said.

While these findings show promise, Haykal cautioned that the exact amount of the vitamin to take and what levels are needed in the blood are still unknown. He also said that it’s unclear how much longer vitamin D extends lifespan and why it has this result.

“There are still many questions and more research is needed,” Haykal said. “All we can say is that at least three years of taking the supplement is required to see any effect.”

Results show enough promise, however, that Haykal would like to see more doctors, especially oncologists, prescribe vitamin D to patients in general.

“We know it carries benefits with minimal side effects, he said. “There’s plenty of potential here.”

Article by Michigan State University. Other authors on the study included MSU and Hurley resident physicians Varun Samji, Yazan Zayed, Inderdeep Gakhal, Vijaysai Veerapaneni, Michele Obeid, Babikir Kheiri and Sunil Badami. Ghassan Bachuwa, internal medicine residency program director at Hurley, and Rizwan Danish, oncologist at Genesee Cancer and Blood Disease Treatment Center, also contributed to this research. Link to the original paper: https://ascopubs.org/doi/abs/10.1200/JCO.2019.37.15_suppl.1534

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Cost of Prescription Drugs Increases 9.5% Annually, Coordinated by Industry


Scripps Research analyzed pharmacy insurance claims from over 35 million Americans, finding ‘continual, marked, annual increases’ of popular brand-name drugs, with price jumps often timed with competitors.

After reviewing tens of millions of insurance claims for the country’s 49 most popular brand-name prescription drugs, a team from Scripps Research Translational Institute found that net prices rose by a median of 76 percent from January 2012 through December 2017—with most products going up once or twice per year.

The substantial price increases were not limited to drugs that recently entered the marketplace, as one might expect, or to those lacking generic equivalents. In addition, the increases often were “highly correlated” with price bumps by competitors.

The researchers concluded that the current rebate system, which incentivizes high list prices for drugs and relies heavily on privately-negotiated rebates to pharmacies, plays a central role driving up costs for consumers. The byzantine and secretive rebate system, they noted, prevents consumers from making informed decisions about purchasing medications.

The study appears in the latest issue of JAMA Network Open.

It’s no secret that health care prices are growing exponentially in the United States, but what has been less clear is the extent to which certain prescription drugs are contributing to that trend—especially when prices are clouded by a complicated rebate system,” says lead author Nathan Wineinger, PhD, director of biostatistics at Scripps Research Translational Institute and assistant professor in Scripps Research’s Department of Integrative Structural and Computational Biology. “By looking at price data for the most popular brand-name drugs, we found striking and consistent price increases occurring at regular intervals, regardless of competition in the marketplace.”

The Scripps Research team obtained the prescription data from a proprietary Blue Cross and Blue Shield data set known as BCBS Axis, which includes commercial insurance claims from more than 35 million Americans covered by independent Blue Cross and Blue Shield companies in the United States.

With a focus on the 49 most popular brand-name drugs with pharmacy claim data available for the entirety of their five-year research window, Wineinger and his team, led by Eric Topol, MD, conducted a high-dimensional data analysis to examine each claim’s total price. This was represented by the total out-of-pocket costs paid by the insured consumer and the amount paid by the insurer.

Researchers determined that prices of top-selling branded prescription drugs increased by a median of 9.5 percent annually, which equates to a doubling in price every seven to eight years. And they found that pairs of brand-name drug competitors that treat similar conditions—such as Humira and Enbrel, both for rheumatoid arthritis—demonstrated highly correlated price increases.

“It’s bad enough to see the relentless increase in drug prices, but this work underscores it is occurring without transparency or accountability,” says Topol, founder and director of Scripps Research Translational Institute and executive vice president of Scripps Research. “It is especially concerning to see drugs in the same class having increases that appear to be coordinated.”

Wineinger explains that a prescription drug’s list price is typically set by the pharmaceutical company that makes the drug, reflecting the payment shared by the insurer and the patient who buys the product at a pharmacy. However, drug companies increasingly offer rebates to organizations called pharmacy benefit managers, or PBMs, which negotiate with pharmacies and insurance companies to determine which drugs are offered as preferred “formulary” options to insurance plan members.

Those rebates are returned to the pharmacy at a later date, paid out by drug companies based on the total sales volume of their products, and cannot be linked directly to any individual purchase. This makes prices especially difficult to track.

Some drug companies have defended list price increases by reasoning that rebates have increased at a similar clip. However, the researchers found that is not the case, and concluded that increases in list prices and a greater reliance on rebates are making drugs more expensive overall.

“Accountability and transparency are essential to developing a better understanding of rising pharmacy costs,” said Maureen Sullivan, chief strategy and innovation officer for the Blue Cross Blue Shield Association (BCBSA). “The Blue Cross Blue Shield Association developed the Alliance for Health Research to engage researchers in collaborative efforts to explore critical health care issues and enable valuable insights that can benefit consumers and the medical community.”

Article by Scripps Research. Authors of the study, “Trends in Prices of Popular Brand Name Drugs in the United States, 2012-2017,” are Nathan Wineinger, PhD; Eric Topol, MD; and Yunyue Zhang, all of Scripps Research.

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Manuka Honey Better at Killing Respiratory Infections Than Antibiotics

Manuka honey alone outperforms antibiotics in treating respiratory infections. Combined with antibiotics, Manuka honey killed 90% of the bacteria tested

Manuka honey could provide the key to a breakthrough treatment for cystic fibrosis patients following preliminary work by experts at Swansea University.

Dr Rowena Jenkins and Dr Aled Roberts have found that using Manuka honey could offer an antibiotic alternative to treat antimicrobial resistant respiratory infections, particularly deadly bacteria found in Cystic Fibrosis (CF) infections.

Using lung tissue from pigs, experts treated grown bacterial infections mimicking those seen in CF patients with Manuka honey. The results showed that it was effective in killing antimicrobial resistant bacteria by 39% compared to 29% for antibiotics, whilst improving the activity of some antibiotics that were unable to function effectively by themselves, honey and antibiotics combined killed 90% of the bacteria tested.

CF is one of the UK’s most common life-threatening inherited diseases, with around 10,400 people in the UK suffering according to the CF Trust. A government review led by Lord Jim O’Neill also highlighted the threat of antimicrobial resistance, estimating that a continued rise in resistance by 2050 would lead to 10 million people dying every year from antimicrobial resistant infections.

A problem that CF patients suffer from are chronic and long-lasting respiratory infections which often prove fatal due to the presence of certain bacteria that are resistant to many (if not all) the antibiotics that doctors currently have at their disposal.

Bacteria that cannot be removed from the lungs through antibiotic treatment can, as a last resort, be removed by providing patients with newly transplanted lungs. This has some associated risks, however, as the bacteria that caused the original infection can still be found in the upper airway, and migrate into the new lungs, thus making the transplant ineffective.

Some patients have a worse prognosis as they are infected with deadly types of bacteria, such as Pseudomonas and Burkholderia cepacia complex, which are difficult to kill (due to multiple antibiotic resistance) and cause extensive damage to the lungs. In some instances, merely their presence within a patient can prevent them from receiving life-saving lung transplants.

The effectiveness of antibiotics against these deadly infections is a huge concern, making the need to find suitable, non-toxic alternatives, which are effective at killing the bacteria a top priority.

Honey has been used for thousands of years as a medicinal product. More recently, research has shown that Manuka honey is capable of killing antibiotic resistant bacteria present in surface wounds. Funding from The Waterloo Foundation and The Hodge Foundation has allowed research to look at it as an antibiotic alternative in CF infections.

Dr Rowena Jenkins, Lecturer in Microbiology and Infectious Diseases at Swansea University, said:

“The preliminary results are very promising and should these be replicated in the clinical setting then this could open up additional treatment options for those with cystic fibrosis infections.

“The synergy with antibiotics and absence of resistance seen in the laboratory has allowed us to move into the current clinical trial, investigating the potential for Manuka honey as part of a sinus rinse for alleviating infection in the upper airway.

Article and study by Swansea University.

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Cranberries Help Antibiotics Fight Bacterial Infections

Research conducted at McGill University and INRS has found that a cranberry extract makes bacteria more sensitive to antibiotics, a promising avenue for limiting resistance to these important drugs

The global spread of antibiotic resistance is undermining decades of progress in fighting bacterial infections. Due to the overuse of antibiotics in medicine and agriculture, we are on the cusp of returning to a pre-antibiotic era in which minor infections can once again become deadly. Therefore, countering the fall in antibiotic efficacy by improving the effectiveness of currently available antibiotics is a crucial goal.

Cranberries are highly sought after for their tangy taste and the antioxidants they contain, but a new study published in the journal Advanced Science provides evidence that they could also help in the fight against bacteria. When treated with molecules derived from cranberries, pathogenic bacteria become more sensitive to lower doses of antibiotics. What’s more, the bacteria don’t develop resistance to the antibiotics, according to the findings by researchers at McGill University and INRS (Institut national de la recherche scientifique) in Montreal.

Given the popular belief that drinking cranberry juice is helpful against urinary tract infections, the researchers sought to find out more about the berry’s molecular properties by treating various bacteria with a cranberry extract. The bacteria selected for study were those responsible for urinary tract infections, pneumonia, and gastro-enteritis (Proteus mirabilis, Pseudomonas aeruginosa, and Escherichia coli).

“Normally when we treat bacteria with an antibiotic in the lab, the bacteria eventually acquire resistance over time,” said McGill chemical engineering professor Nathalie Tufenkji, lead author of the study. “But when we simultaneously treated the bacteria with an antibiotic and the cranberry extract, no resistance developed. We were very surprised by this, and we see it as an important opportunity.”

Analyses showed that the cranberry extract increases bacterial sensitivity to antibiotics by acting in two ways. First, it makes the bacterial cell wall more permeable to the antibiotic, and second, it interferes with the mechanism used by the bacteria to pump out the antibiotic. Consequently, the antibiotic penetrates more easily, and the bacteria have a harder time getting rid of it, which explains why the drug is effective at lower doses.

“These are really exciting results,” said coauthor Éric Déziel, a professor of microbiology at INRS. “The activity is generated by molecules called proanthocyanidins. There are several different kinds of proanthocyanidins, and they may work together to deliver this outcome. We’ll need to do more research to determine which ones are most active in synergy with the antibiotic.”

After confirming the activity of the cranberry molecules on bacterial culture, the researchers tested to determine whether the pattern persisted in a preliminary animal model: infected insects. Since the synergistic effect of the extract and the antibiotic was also observed in the insects, further experiments will be conducted to clearly identify the active molecules.

If the results are confirmed in animals, certain classes of antibiotics subject to high levels of resistance could be made useful again by using cranberry extract to boost their potential.

“We are eager to pursue this research further,” Tufenkji said. “Our hope is to reduce the doses of antibiotics required in human and veterinary medicine as part of efforts to combat antibiotic resistance.”

Article by McGill University. Related journal article in Advanced Science. Image by Pixabay.

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Widespread Contamination of Antibiotics Found in Rivers Around the World

Concentrations of antibiotics found in some of the world’s rivers exceed ‘safe’ levels by up to 300 times, the first ever global study has discovered.

Researchers looked for 14 commonly used antibiotics in rivers in 72 countries across six continents and found antibiotics at 65% of the sites monitored.

Metronidazole, which is used to treat bacterial infections including skin and mouth infections, exceeded safe levels by the biggest margin, with concentrations at one site in Bangladesh 300 times greater than the ‘safe’ level.

In the River Thames and one of its tributaries in London, the researchers detected a maximum total antibiotic concentration of 233 nanograms per litre (ng/l), whereas in Bangladesh the concentration was 170 times higher.

Trimethoprim

The most prevalent antibiotic was trimethoprim, which was detected at 307 of the 711 sites tested and is primarily used to treat urinary tract infections.

The research team compared the monitoring data with ‘safe’ levels recently established by the AMR Industry Alliance which, depending on the antibiotic, range from 20-32,000 ng/l.

Ciproflaxacin, which is used to treat a number of bacterial infections, was the compound that most frequently exceeded safe levels, surpassing the safety threshold in 51 places.

Global problem

The team said that the ‘safe’ limits were most frequently exceeded in Asia and Africa, but sites in Europe, North America and South America also had levels of concern showing that antibiotic contamination was a “global problem.”

Sites where antibiotics exceeded ‘safe’ levels by the greatest degree were in Bangladesh, Kenya, Ghana, Pakistan and Nigeria, while a site in Austria was ranked the highest of the European sites monitored.

The study revealed that high-risk sites were typically adjacent to wastewater treatment systems, waste or sewage dumps and in some areas of political turmoil, including the Israeli and Palestinian border.

Monitoring

The project, which was led by the University of York, was a huge logistical challenge – with 92 sampling kits flown out to partners across the world who were asked to take samples from locations along their local river system.

Samples were then frozen and couriered back to the University of York for testing. Some of the world’s most iconic rivers were sampled, including the Chao Phraya, Danube, Mekong, Seine, Thames, Tiber and Tigris.

Dr John Wilkinson, from the Department of Environment and Geography, who co-ordinated the monitoring work said no other study had been done on this scale.

He said: “Until now, the majority of environmental monitoring work for antibiotics has been done in Europe, N. America and China. Often on only a handful of antibiotics. We know very little about the scale of problem globally.

“Our study helps fill this key knowledge gap with data being generated for countries that had never been monitored before.”

Antimicrobial resistance

Professor Alistair Boxall, Theme Leader of the York Environmental Sustainability Institute, said: “The results are quite eye opening and worrying, demonstrating the widespread contamination of river systems around the world with antibiotic compounds.

“Many scientists and policy makers now recognise the role of the natural environment in the antimicrobial resistance problem. Our data show that antibiotic contamination of rivers could be an important contributor.”

“Solving the problem is going to be a mammoth challenge and will need investment in infrastructure for waste and wastewater treatment, tighter regulation and the cleaning up of already contaminated sites.”

Article by University of York. Image from Pixabay

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Exposure to Flower Pesticides Gives Children Hypertension

In Ecuador, roses for Mother’s Day sold around the world is major export crop, but pesticides used to grow and treat those flowers may be affecting health of children living nearby

In a study published online May 21, 2019 in the journal Environmental Research, researchers at University of California San Diego School of Medicine found higher blood pressure and pesticide exposures in children associated with a heightened pesticide spraying period around the Mother’s Day flower harvest. This study involved boys and girls living near flower crops in Ecuador.

Mother’s Day is celebrated in May in most of the world and is a holiday with one of the highest sales of flowers. Ecuador is among the largest commercial flower growers in the world, with significant rose exports to North America, Europe and Asia. Commercial rose production relies on the use of insecticides, fungicides and other pest controls, but little is known about their human health effects.

“These findings are noteworthy in that this is the first study to describe that pesticide spray seasons not only can increase the exposure to pesticides of children living near agriculture, but can increase their blood pressures and overall risk for hypertension,” said first author Jose R. Suarez, MD, PhD, assistant professor in the Department of Family Medicine and Public Health at UC San Diego School of Medicine.

Researchers assessed 313 boys and girls, ages 4 to 9, residing in floricultural communities in Ecuador. The children were examined up to 100 days after the Mother’s Day harvest. The analyses are part of a long-term study of environmental pollutants and child development in Ecuador, directed by Suarez.

“We observed that children examined sooner after the Mother’s Day harvest had higher pesticide exposures and higher systolic and diastolic blood pressures compared to children examined later. In addition, children who were examined within 81 days after the harvest were three times more likely to have hypertension than children examined between 91 and 100 days.”

Research regarding the effects of pesticides on the cardiovascular system is limited, but Suarez said there is some evidence that insecticides, such as organophosphates, can increase blood pressure. Organophosphates and several other classes of insecticides and fungicides are commonly used to treat flowers for pests before export.

In a previous study, Suarez and colleagues had reported that children examined sooner after the harvest displayed lower performances in tasks of attention, self-control, visuospatial processing and sensorimotor than children examined later.

“These new findings build upon a growing number of studies describing that pesticide spray seasons may be affecting the development of children living near agricultural spray sites,” said Suarez. “They highlight the importance of reducing the exposures to pesticides of children and families living near agriculture.”

Article published by UC San Diego. Co-authors include: Fatimaezzahra Amchich, University of Minnesota; Jonathan Murillo and Julie Denenberg, UC San Diego.

Image by Johann Reinbacher from Pixabay

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Homeschoolers Sleep Better and Eat Healthier Than Normies

Study finds better sleep, diet habits help homeschoolers counter shortfalls in formal exercise. Homeschoolers see no added health risks over time. 

Years of home-schooling don’t appear to influence the general health of children, according to a Rice University study.

A report by Rice kinesiology lecturer Laura Kabiri and colleagues in the Oxford University Press journal Health Promotion International puts forth evidence that the amount of time a student spends in home school is “weakly or not at all related to multiple aspects of youth physical health.”

“Although there may be differences in the health of elementary through high school home-schoolers, those differences don’t seem to change with additional time spent in home school,” Kabiri said. “In other words, staying in home school longer isn’t related to increased health benefits or deficits.”

Earlier this year Kabiri and her Rice team reported that home-schooled students who depended on maintaining physical fitness through outside activities were often falling short.

The flip side presented in the new report should come as good news to parents and students. The study was conducted by Kabiri and colleagues at Texas Woman’s University and the University of Texas Health Science Center (UTHealth) at San Antonio.

The results from studies of more than 140 children in grades kindergarten through 5, who were tested against statistically normal data for children of their age and gender, accounted for prior published research that showed home-schooled children have less upper-body and abdominal muscle strength and more abdominal fat when compared to public school students. Additional studies also showed that home-schooling benefited sleep patterns, overall body composition and diet.

However, to the researchers’ surprise, these differences in home-schooler health did not appear to be affected either way by increased time in home school.

“Body composition can relate to sleep as well as diet,” Kabiri said. “And as far as muscular health goes, these kids are still active. We’re not saying there’s not an upfront benefit or detriment to their health, but after an initial gain or loss, there aren’t additional gains or losses over time if you’re going to home-school your children for one year or their entire careers. The relationship between their health and the time they spend in home school seems to be irrelevant.”

Article by Rice University. Co-authors of the study are doctoral student Allison Butcher and Associate Professor Wayne Brewer of Texas Woman’s University and Alexis Ortiz, the Berneice Castella Endowed Allied Health Chair in Geriatric Science in the department of physical therapy at UTHealth San Antonio. Read the abstract at https://academic.oup.com/heapro/advance-article-abstract/doi/10.1093/heapro/daz047/5492359.

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Eating Cholesterol and Eggs Does Not Increase Risk of Strokes

A new study from the University of Eastern Finland shows that a moderately high intake of dietary cholesterol or consumption of up to one egg per day is not associated with an elevated risk of stroke. Furthermore, no association was found in carriers of the APOE4 phenotype, which affects cholesterol metabolism and is remarkably common among the Finnish population. The findings were published in the American Journal of Clinical Nutrition.

Findings from earlier studies addressing the association of dietary cholesterol or egg intake with the risk of stroke have been contradictory. Some studies have found an association between high dietary cholesterol intake and an increased risk of stroke, while others have associated the consumption of eggs, which are high in cholesterol, with a reduced risk of stroke.

For most people, dietary cholesterol plays a very small role in affecting their serum cholesterol levels. However, in carriers of the apolipoprotein E phenotype 4 – which significantly impacts cholesterol metabolism – the effect of dietary cholesterol on serum cholesterol levels is greater. In Finland, the prevalence of APOE4, which is a hereditary variant, is exceptionally high, with approximately one third of the population presenting as carriers. Yet, research data on the association between a high intake of dietary cholesterol and the risk of stroke in this population group has not been available until now.

The dietary habits of 1,950 men aged between 42 and 60 years with no baseline diagnosis of a cardiovascular disease were assessed at the onset the Kuopio Ischaemic Heart Disease Risk Factor Study, KIHD, in 1984-1989 at the University of Eastern Finland. APOE phenotype data were available for 1,015 of the men participating in the study. Of those, 32% were known carriers of APOE4.

During a follow-up of 21 years, 217 men were diagnosed with stroke. The study found that neither dietary cholesterol nor egg consumption was associated with the risk of stroke – not even in carriers of APOE4.

The findings suggest that moderate cholesterol intake or daily egg consumption are not associated with the risk of stroke, even in persons who are genetically predisposed to a greater effect of dietary cholesterol on serum cholesterol levels. In the highest control group, the study participants had an average daily dietary cholesterol intake of 520 mg and they consumed an average of one egg per day, which means that the findings cannot be generalised beyond these levels. One egg contains approximately 200 mg of cholesterol.

In this study, about a fourth of the total dietary cholesterol consumed came from eggs. Furthermore, the generalisability of this study is also weakened by the fact that the study population did not have a pre-existing cardiovascular disease at baseline and the size of the study population was relatively small. Therefore, the findings of the study should be verified in a larger cohort as well as in people with a pre-existing cardiovascular disease, who are currently advised to limit their intake of cholesterol and eggs.

Article by University of Eastern Finland. Anna M. Abdollahi, Heli E.K. Virtanen, Sari Voutilainen, Sudhir Kurl, Tomi-Pekka Tuomainen, Jukka T. Salonen, Jyrki K. Virtanen American Journal of Clinical Nutrition, published online May 16, 2019. https://doi.org/10.1093/ajcn/nqz066

Image by congerdesign from Pixabay

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