Jewish Ethnicity and Pancreatic Cancer Mortality in a Large United States Cohort Pancreatic Cancer:

American Jews may be genetically predisposed to developing pancreatic cancer, according to a study in Cancer Epidemiology, Biomarkers and Prevention. Jewish ethnicity and pancreatic cancer have been examined in four previous studies dating to the 1950s, three of which reported higher mortality among Jews than non-Jews. This study is the first to consider the known risk factors for pancreatic cancer—smoking, obesity and diabetes—and the birthplace of Jews and their parents. Data were analyzed from an American Cancer Society study that followed 1,014,625 men and women from 1982 to 2006. Of the 6,727 deaths from pancreatic cancer during this period, 480 were among Jewish participants. Deaths were 43% higher among Jews than non-Jews and didn't vary significantly by age, family history or immigration background. Genetic factors and non-O blood type may contribute to the higher mortality, the study suggests. About 65% of U.S. Jews have non-O blood compared with 55% of white non-Jews. Understanding the reasons why Jews are at greater risk for pancreatic cancer may provide clues to its cause and lead to screening techniques, researchers said.

Caveat: The study lacked information on Ashkenazi or Sephardic Jewish origin. As the U.S. Jewish population is predominantly Ashkenazi, the results may not generalize to Sephardic Jews, researchers said. Information on the number of Jewish converts involved in the study wasn't available.

Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as
with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

For more health info and links visit the author's web site www.hookman.com

Drug Deals with Medical Insurance Carriers Tie Prices to How Well Patients Do.

So What’s in it for us?

Pressed by insurance companies, some drug makers are beginning to adjust what they charge for their drugs, based on how well the medicines improve patients’ health, reports A. Pollack. “Think of it as product guarantees by the drug industry.”


Traditionally, discounts and rebates that drug companies offer insurers have been based on how much drug is used, not how well patients do. But the emerging, outcomes-based contracts would — in theory — better align the incentives of insurers, drug companies and the employers that provide health coverage toward improving people’s health. Johnson & Johnson set what is considered the prototype deal in 2007 with Britain’s national health system, which had tentatively decided not to pay for the cancer drug Velcade. To avert that decision, the company offered essentially a money-back guarantee. If Velcade did not shrink a patient’s tumors after a trial treatment, the company would reimburse the health system for the cost of that patient’s drug.


In a current deal Merck will agree to peg what the insurer Cigna pays for the diabetes drugs Januvia and Janumet to how well Type 2 diabetes patients are able to control their blood sugar. Also the two companies that jointly sell the osteoporosis drug Actonel agreed to reimburse the insurer Health Alliance for the costs of treating fractures suffered by patients taking that medicine. “We’re standing behind our product,” said Dan Hecht, general manager of the North American pharmaceutical business of Procter & Gamble, which sells Actonel with Sanofi-Aventis. “We’re willing to put our money where our mouth is.” Under the Actonel deal, if a patient insured by Health Alliance suffers a nonspinal fracture despite faithfully taking Actonel, the drug makers will help pay for the medical care — spending $30,000 for a hip fracture, for instance, and $6,000 for a wrist fracture.


This clearly lowers the cost of the drug to Health Alliance, a small insurer in Illinois and Iowa. But Procter & Gamble and Sanofi-Aventis might benefit as well. The deal could reduce the pressure on the insurance company to move patients off Actonel, which costs about $100 a month, to less-expensive generic versions of Fosamax. And the insurer has kept Actonel in a tier of its drug list that requires a smaller co-payment than for a competing brand-name drug, Boniva.


Some experts hail such arrangements as a welcome step toward health care that rewards good outcomes for patients. “We’re going to see a growth in outcomes guarantees for pharmaceuticals, and it’s very healthy,” said Robert Seidman, a consultant who was formerly the chief pharmacy officer for WellPoint, an insurance company.


Such contracts started to take hold a few years ago in countries with national health systems, in which the government could effectively block a drug from being used if it was too costly. In the United States, where insurance companies do not have national monopolies — and where Medicare, by law, is precluded from negotiating drug prices — insurers have less leverage with drug makers. Even so, they can give favorable treatment to certain drugs, by reducing the required co-payments, for example.

The deal between Cigna and Merck is more complex.


Rather than getting paid more for good results, Merck will actually give Cigna bigger discounts on Januvia and Janumet. Some discounts will be granted if more people diligently take the drugs as prescribed. This helps both Cigna, because people who take their pills are likely to have fewer complications from the disease, and Merck, because it sells more pills. The assumption is that Cigna will push for patient-compliance programs that urge people to take their medicine at the right times and in the proper doses.


Moreover, in an unusual move, Merck will offer even greater discounts to Cigna on Januvia and Janumet if patients’ blood sugar is better controlled — regardless of whether the improvement comes through Merck’s drugs or other medications. In effect, though, Merck is betting not only that its drugs prove superior but that Cigna’s incentives to reap the benefits of the deeper Januvia and Janumet discounts will prompt the insurer to try to keep patients on those drugs. Januvia, approved in 2006, costs about $150 a month. Janumet, approved a year later, is a combination of Januvia and metformin, a widely used generic drug.


As part of the agreement, too, Merck will get better placement for Januvia and Janumet on Cigna’s formulary, meaning a lower co-payment for patients than for some other branded drugs. The deal was made with the pharmacy benefit management division of Cigna, which manages prescriptions for 7.1 million people.


So what’s in it for us patients?

If this does not translate to our pocketbooks there will be problems.

We’ll wait and see if and how much this will save we patients.

 Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as
with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

For more health info and links visit the author's web site www.hookman.com

TOO MANY X-RAYS ARE HARMFUL

CT scans is associated with significant radiation exposure in some patients; the risks should be considered carefully when imaging for chronic disease and when screening asymptomatic individuals .It is estimated that 1.5-2.0% of US population cancers may be caused by CT radiation exposure. A retrospective, cohort study at a tertiary academic medical center identified 31,462 patients undergoing diagnostic CT during 2007; and 190,712 CTs over 22 years. Estimated lifetime attributable risk (LAR) for cancer was calculated. In this cohort, baseline cancer rates predicted 13,214 cancers and 6,292 fatal cancers; 98 additional cancers (62 fatal) were predicted from CT.

REFERENCE: “Recurrent CT, Cumulative Radiation Exposure and Associated Radiation-Induced Cancer Risks from CT of Adults” by Sodickson A et al. Radiology 2009;251:175-184 Colonoscopy Prevents 15,000 Cancer Cases

 Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as
with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

For more health info and links visit the author's web site www.hookman.com

Use Genetic Tests To Help Make Prescription Decisions

Medco Health Solutions Inc. "is encouraging doctors to use genetic tests to determine whether drugs will work for particular patients -- saving money and reducing harm caused when prescriptions are wrong." Medco and CVS Caremark Corp. also have increased their investments in providers of genetic testing services. Bloomberg notes that the FDA requires genetic testing for six drugs, "recommends testing before prescribing for more than two dozen medicines, and mentions diagnostic tests in the labels...of more than 150 others."

Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as
with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com

For more health info and links visit the author's web site www.hookman.com

Whole-genome sequencing may soon become clinically useful.

Two newly published papers may reignite the once-"disappointing" search for the "genetic roots of major killers like heart disease, diabetes, and Alzheimer's." In the seven or so years "since first full genetic code of a human was sequenced for some $500 million, less than a dozen genomes had been decoded, all of healthy people." Now, researchers at Baylor College and the Institute for Systems Biology were able to demonstrate that it is "possible to sequence the entire genome of a patient at reasonable cost and with sufficient accuracy to be of practical use to medical researchers."

        

What makes the technology even more impressive, she said, is that these were whole genomes of people that provided 'very interesting stories about rare diseases.'" 

        University of Utah researchers, "used gene sequencing technology to take a closer look at a "four-member family. After completing and comparing the genomes, investigators were able to tell that the "two parents passed recessive genes to their two children, each of whom had a condition called Miller Syndrome that may cause cleft palates, misshapen ears, and short stature." According to the paper in Science, the children also had "a lung disorder called primary ciliary dyskinesia that can lead to pneumonia, bronchitis and other respiratory infections." 

        Indeed, "experts have long known that Miller syndrome is genetic."But they had never been able to pinpoint the gene." Having the entire family's genomes in their hands, however, "helped shrink the genetic haystack from thousands of genes to four likely targets," and investigators were also able to calculate the odds of inheriting the variants.

Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com

GARLIC CAN CAUSE INCREASED BLEEDING. RISKS OF “NATURAL” MEDICINES

Herbal medicines are not always the harmless nostrums that many patients and even some physicians think, but may actually contribute to cardiovascular morbidity and mortality, researchers warned in a review published in the Journal of the American College of Cardiology[JACC].
Many such products, including aloe vera, ginkgo biloba, ginseng, and green tea, can interact with conventional cardiovascular drugs and lead to serious adverse reactions, according to the Mayo Clinic.

The JACC article also listed 15 common herbal medicines known to interact adversely with conventional cardiovascular drugs.In many cases, the herbal products compete with the regular medicines for the same drug-metabolizing cytochrome P450 enzymes, potentiating the latter's effects. In other cases, the herbal products have their own cardiovascular effects.

Many physicians already know that even “natural” grapefruit juice occupies the CYP3A4 enzyme, leading to slower-than-expected metabolism and, therefore, higher blood levels of a host of pharmaceuticals.These include the statins, calcium channel antagonists, several common anti-arrhythmic drugs, and the angiotensin receptor blocker irbesartan (Avapro), Jahangir and colleagues noted.

Garlic is one of several common herbal remedies with specific cardiovascular effects in its own right (others include ginkgo biloba, ginseng, and saw palmetto). Garlic inhibits platelet aggregation and thus can lead to increased bleeding risks when combined with aspirin, clopidogrel (Plavix), or warfarin (Coumadin), the researchers noted.

The Mayo group identified 10 herbal products that increase bleeding risks with anticoagulant and antiplatelet drugs, and listed 27 herbal products that patients with cardiovascular diseases would do well to avoid. These include such common and harmless-seeming products as green tea, capsicum pepper, licorice, and kelp, as well as grapefruit juice and garlic.

Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com

Boxed Warning Added to Clopidogrel [PLAVIX] Label

Prescribing information for clopidogrel (Plavix) will now include a boxed warning that the drug can be less effective in poor metabolizers, the FDA indicated. The new warning suggests that many if not all patients on clopidogrel should undergo genetic testing to determine whether they have variants of the CYP2C19 gene associated with poor metabolism of the antiplatelet drug. Clopidogrel is actually a prodrug that requires metabolic activation by the CYP2C19 enzyme to become effective. Poor metabolizers get little or no benefit from the drug at standard doses, and therefore are at increased risk for thrombotic events and death, the FDA said. The drug's label has carried a similar warning since May 2009, but the FDA said today that "it was important to highlight this risk in a boxed warning" in light of a subsequent review of data. Seven different variants of the CYP2C19 gene are associated with poor metabolism of clopidogrel. According to the FDA, patients with two loss-of-function alleles, which do not have to be identical, will be poor metabolizers. The agency estimated that 2% to 14% of patients are poor metabolizers, with some racial-ethnic groups more likely to be affected than others. Whites have the lowest prevalence of poor metabolism and Asians have the highest. The boxed warning also includes this advice to healthcare providers: "Tests are available to identify a patient's CYP2C19 genotype and can be used as an aid in determining therapeutic strategy." A Cardiologist at Brigham and Women's Hospital and Harvard Medical School in Boston, claims the warning effectively means every patient on clopidogrel needs to be tested, although the new label does not say so directly. Some 25 million prescriptions for clopidogrel were written in 2008, according to Drugs.com. The FDA also recommended that physicians "consider alternative dosing" if patients are found to be poor metabolizers. The FDA urged patients currently taking clopidogrel not to stop the drug unless told to do so by their physician. Concerned patients should discuss the new information with their doctors before making any change. Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.Please remember, as with all our articles we provide information, not medical advice. For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice. Deepen your understanding of "medical malpractice"... www.MedMalBook.com For more health info and links visit the author's web site www.hookman.com