Health Newsfeed – Johns Hopkins Medicine Podcasts

Some children develop type 2 diabetes in childhood or teenage years, and now a study looking at what happens to them as they age into their twenties comes to some disturbing conclusions. Rita Kalyani, a diabetes expert at Johns Hopkins, explains.

Kalyani: The burden of diabetic complications was relatively high in this cohort. On average most of these individuals who were now young adults had had diabetes for a little over a decade. What they found was that the majority of them developed high blood pressure, they developed high cholesterol, they developed diabetic kidney disease, they also quite commonly developed nerve disease and also diabetic retinopathy. At least one of these complications occurred in 60% of them.  :31

Kalyani states that the longer someone has the complications of diabetes the worse the outcomes are likely to be, resulting in blindness, limb amputations, kidney failure, and cardiovascular disease. She says this study must act as a wake up call to those who develop diabetes early in life. At Johns Hopkins, I’m Elizabeth Tracey.

If you’re a parent of a child younger than 12 years of age you may be struggling with the simplest of decisions right now regarding their welfare, a recent survey suggests, largely because of concerns about COVID-19. Helen Hughes, a pediatrician at Johns Hopkins, says she is hearing this from parents again and again.

Hughes: I do personally really struggle with the balance of the risks of contracting the coronavirus with the risks of kind of not allowing children to exist in the world. You have to take your own family dynamic and your own children and make the best decision you can with the information you have, and then those decisions may change week to week, month to month, depending on the new information you have. It’s a really exhausting time to be a parent of young kids, because those normal decisions, which were always fraught with difficulties, where do you send your child to school, what activities do you do with them, now have these additional layers of confusion and frustration and anxiety.  :34

Hughes is hopeful vaccines will be provided for younger children soon. At Johns Hopkins, I’m Elizabeth Tracey.

Respiratory syncytial virus, or RSV, is a viral infection typically experienced early in life, and for most, isn’t a problem. Now more children seem to be experiencing RSV out of season, sometimes along with COVID infection. Helen Hughes, a pediatrician at Johns Hopkins, describes the dynamics.

Hughes: I think what we’re seeing is that a lot of the winter respiratory viruses including RSV and parainfluenza that we would often see in the fall and winter we did not see because kids weren’t around each other. Now we’ve seen very quickly with everything opening up and no mask mandates, circulation of a lot of the winter respiratory viruses that we would typically see.  All of these viruses are cocirculating  because no one’s been around each other and now everyone is around each other at the same time, and so you’re probably seeing some of those co-occur.  :31

Hughes says that keeping children masked along with all of the other measures known to limit infection risk is prudent. At Johns Hopkins, I’m Elizabeth Tracey.

Medicare could save billions of dollars simply by negotiating drug prices, a recent study found. One group that makes a lot of money acting as an intermediary between payers and patients are pharmacy benefits managers, or PBMs. Caleb Alexander, an internal medicine expert at Johns Hopkins, explains their role in maintaining high drug costs.

Alexander: Pharmacy benefits managers are a middle person between pharmaceutical manufacturers and insurers on the one hand, and patients and their loved ones on the other. They benefit from the status quo. They do use their power and their authority to help shape prescription drug utilization. In some ways the public benefits from that but in others they do not. Because PBMs, or pharmacy benefits managers are making billions of dollars off of the current system of pharmaceutical pricing in the United States.  :34

Alexander notes that many are calling for PBM reform. At Johns Hopkins, I’m Elizabeth Tracey.

Billions of dollars could be saved by Medicare if they simply negotiated drug prices for the ten most common prescription medicines in the same way Costco does, a recent study found. Caleb Alexander, an internal medicine expert at Johns Hopkins, says gathering the necessary political steam to do so is lacking.

Alexander: There have been many that have advocated for years to allow Medicare to negotiate drug prices. And there just hasn’t been the political will to get it done. I wouldn’t hold your breath on that one. Clearly Medicare is a major purchaser of prescription drugs in the country, and would have enormous leverage and enormous ability to negotiate down prices. I think that as a country we’re missing important opportunities to effectively and impactfully reduce prescription drug expenditures.  :30

Alexander urges people to be aware of this issue as programs such as Medicare come under scrutiny for cost cutting. At Johns Hopkins, I’m Elizabeth Tracey.

If Medicare adopted the approach taken by Costco in buying and providing common prescription medications the system would save billions of dollars, a recent study showed. Caleb Alexander, an internal medicine expert at Johns Hopkins, says he’s not surprised.

Alexander: I think that this study is a reminder of the potential cost savings for all of us in using generic drugs whenever possible. Generic drugs are just as good as their branded alternatives. For drugs that are dispensed where there’s the option of them being used either a generic or a branded product, the vast vast majority are dispensed as generics. Even when it’s a generic there may be cost savings with using a retailer, Costco, Walmart, Target, rather than filling this through one’s insurance.  :33

Alexander says until policy decisions are made individuals can choose options that cost them less. At Johns Hopkins, I’m Elizabeth Tracey.

The Alzheimer’s drug Aduhelm is just the latest misstep in the FDA’s mishandling of accelerated approval, with a recent study showing that almost half of drugs approved this way haven’t done the required confirmatory studies. Caleb Alexander, an internal medicine expert at Johns Hopkins and member of the panel recommending against Aduhelm’s approval, says reform is possible.

Alexander: When products are approved under accelerated review some have suggested that reimbursement for them be diminished so that the company has an economic incentive to complete the studies that we’re all waiting for. So one model might allow for or stipulate that manufacturers are only going to be paid a very modest amount for their product until the evidence is in as to whether or not it actually is safe and effective.  :28

Alexander doesn’t think scrapping accelerated approval entirely is the answer. At Johns Hopkins, I’m Elizabeth Tracey.

If you’re worried about your cancer risk you might want to consider your alcohol consumption, Elizabeth Tracey reports

Alcohol consumption is associated with a greater risk for cancer, a new global analysis concludes, with some cancers very strongly associated with consumption. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the data.

Nelson: They tried to look at cancer on a global scale and then look at alcohol on a global scale and then estimate alcohol intake per adult and they believe as many as 4% of all cancers newly diagnosed in 2020 were likely associated with drinking alcohol. There were 6.3 million cases of cancer of the mouth and pharynx. Most of that is attributable to alcohol and smoking. Of the voicebox or larynx, the esophagus, colon, rectum, liver and breast cancer all of which have pretty established connections to alcohol intake.  :33

Nelson says this study established a threshold of more than two drinks per day as associated with increased risk, especially if coupled with smoking for mouth and throat cancers. At Johns Hopkins, I’m Elizabeth Tracey.

Has a blood test for cancer reached a point where it can be useful clinically? Elizabeth Tracey reports

A blood test looking for modifications to DNA known as methylation is moving closer to usefulness as a screening test for many cancers, a new study finds. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says there’s still a ways to go, but this strategy has a good chance of success.

Nelson: And what they found was that when that test suggested that a cancer would be present it was 99.5% specific. And the sensitivity – were they finding all the cancers – was about 67% and seemed to be better if the cancer was at a higher stage. If you had a positive test how likely are you to have a problem and if you have a negative test how easy is it going to be to be for you to sleep at night? Those things are not tested in this model, they’re estimated, they haven’t rigorously tested them.  :29

Nelson says that the test performed best when cancers were advanced, but what is needed in a screening test is one that performs well at very early stages of disease, when the chance for a cure is greatest. He predicts that a blood-based screening test for cancer will be practical in just a couple of years. At Johns Hopkins, I’m Elizabeth Tracey.

What does the latest cancer report tell us? Elizabeth Tracey reports

The American Cancer Society produces an annual report to the nation on how we’re doing in the fight against cancer. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the latest statistics.

Nelson: Looking in the period from 2013 to 2017, cancer incidence rates were fairly stable. The good news is that cancer death rates, the propensity to die from a cancer, decreased for both men and women. Including 11 of the 19 more common cancers in men, and 14 of the more common cancers, 14 of the 20 more common cancers in women. Basically what we’re really seeing in the last few years is lung cancer death rates are falling, that’s almost certainly attributable to better treatment, a little bit to screening.  :32

Nelson says cancers that appear to be on the upswing include pancreas and colorectal. He notes that improved and expanded screening for cancer detects more cases, but for most kinds of cancer mortality is stable or declining. At Johns Hopkins, I’m Elizabeth Tracey.