Phlegm test for lung cancer
The University of Maryland School of Medicine has essentially come up with a spit test for lung cancer:
In the January 15 issue of Clinical Cancer Research, the researchers report that their fledgling test, designed to check whether two genes believed to be tumor suppressors are deleted in cells found in sputum, identified 76 percent of stage I lung cancer patients whose tumors also showed the same genetic loss. Existing sputum "cytology" tests, which look for changes in cell structure, identified only 47 percent of the patients, they say.
While no other simple sputum analysis has found such a high correlation with lung cancer, it is not yet good enough for the clinic, researchers say, and so they are now expanding their test to screen for up to eight genes.
This is pretty cool, and while it may not be good enough for the clinic, it does appear to have greater potential than say, the controversial PSA test for prostate cancer which misses 82% of tumors in men younger than 60, and 65% of cancers in men over 60. While you can't yet make a direct comparison between the two, this spit test does seem like it will end up being more accurate than the PSA test.
The researchers are hoping to drill down to the genes that are specific only to cancer. Current cytology tests show the extend of cell damage, but this doesn't correlate to lung cancer rates because most heavy smokers do not develop cancer. Looking for only the genes involved is a more precise approach to calculating lung cancer risk.
[tags]Medicine, cancer, lung cancer, oncology, genetics[/tags]
New (old) antibiotic (re-)discovered
I saw this when it first came out, but unfortunately I didn't give it a second thought. Details, unfortunately are scarce, but it's good news nonetheless. The NYT has more on the fun backstory of the plant-based remedy:
In some ways, it is a wonder that the work survived at all. In 1670, at the age of 42, Rumphius went blind. In 1687, his still unpublished manuscript and all of his illustrations were destroyed in a fire that swept through the European quarter of Ambon. Undaunted, he dictated a new version and commissioned artists to draw new illustrations.
Fortunately, the second time around he kept a copy of the manuscript. The original was lost when the ship carrying it back to the Netherlands was sunk by a French naval squadron. Still unfazed, Rumphius continued his work, finishing the last volume shortly before his death in 1702.
The extract shows some efficacy against E. coli and MRSA. It was used in ancient times as a remedy for dysentery.
The seeds of the tree, Rumphius wrote, "will halt all kinds of diarrhea, but very suddenly, forcefully and powerfully, so that one should use them with care in dysentery cases, because that illness or affliction should not be halted too quickly: and some considered this medicament a great secret, and relied on it completely."
Very cool story. I just wish researchers knew more about the active compound itself, and whether it is related to any other antibiotics on the market. I could see it being entirely new or being related to a current antibiotic: it could be from the seeds themselves, which would indicate that it's entirely new, or it could be from a fungus growing inside the seed (think a moldy peach pit), in which case it could be related to current antibiotics. I guess we'll have to wait and see — I don't have access to the BMJ, so any details about the extract itself are hidden from me, if they are even known. Alas.
Geographic isolation can make for some very interesting evolutionary developments. It would be really cool if this was completely new.
[tags]Medicine, MRSA, pharmacy, antibiotics, MDROs, drug discovery, botany[/tags]
TZDs may prevent brain injury during radiation therapy
There is a small body of research out there that indicates that thiazolidinediones (TZDs) — specifically rosiglitazone (Avandia) — may inhibit angiogenesis. Without new blood vessels to feed fuel tissue growth, there is no tumor growth. There aren't many researchers out there experimenting with these drugs, unfortunately, but new findings published in the International Journal of Radiation Oncology – Biology –Physics indicate that pioglitazone (Actos) may prevent brain damage in mice undergoing radiation treatment for tumors, which could mean more studies looking at the effects of TZDs on cancer and its management.
The study involved young adult rats that received either radiation treatment equal to levels received by humans or a "sham" treatment involving no radiation. Animals in both groups received either a normal diet or a diet containing the diabetes drug.
Cognitive function was assessed a year after the completion of radiation therapy using an object recognition test. Rats receiving radiation exhibited a significant decrease in cognitive function, unless they received the diabetes drug for either four or 54 weeks after radiation.
The researchers are hopeful that the findings may allow clinicians to give higher doses of radiation. There is a strong correlation between higher doses of radiation and longer lifespans, but there has always been some reluctance to prescribe these higher doses for fear of damaging healthy, surrounding tissues.
[tags]Medicine, pharmacy, Actos, cancer, radiation, oncology, pioglitazone[/tags]
Replacing doctors with pharmacists in geriatrics?
Kevin asks "How to get more medical students interested in geriatrics?" and suggests tuition loan forgiveness. Or rather, the article he links to, does.
My question is, do you *really* need more geriatric doctors?
I've opined extensively on pharmacists as prescribers, and I've basically concluded that it's not a bad idea, so long as they're not making the diagnosis. (Because that's not part of one's curriculum in pharmacy school.) With things like the CCGP certification, do you really need doctors who specialize in old people?
I'm inclined to think yes… and no. Surely you need some, but probably not the numbers that have traditionally done so. In fact, most of the CCGPs I know can, and do, run therapeutic circles around the doctors when it comes to managing drug regimens for the elderly. And that's not meant as an insult to the MDs, it's simply a fact.
Let the pharmacist deal with adjusting dosages and fixing interactions and managing polypharmacy; let the MD stick to making diagnoses. Clinical pharmacists are generally more interested in the management of drug regimens anyway.
I have a feeling this is the way geriatric medicine is going to mostly go in the near future. I wouldn't be surprised to see other, select fields do the same thing. Pharmacists are, after all, cheaper than doctors. 
[tags]Geriatrics, medicine, aging[/tags]
Doctors, what do you consider parts of a routine physical?
I had a physical last week that lasted an hour(!). My doctor (who I just started seeing) did two extra things that I've never had done before during the course of a routine physical: an EKG and a hearing test. Both of them made me scratch my head inwardly, and they were performed at the end of the physical by a nurse.
I'm a healthy male, in my mid-to-early twenties, with no history of heart problems, and I've not complained about anything hearing-related, save twice-a-year ear infections. I'm convinced the hearing test is part of what he does at every physical, because I mentioned my ear infection as an afterthought, after he'd already told me about the hearing test…
Is this normal for physical exams now? Or is it just so he can bill for a bit more from my insurance company?