The new Secretary of Health and Human Services is a member of a fringe medical organization. Here’s what that means. [Respectful Insolence]

I’m always hesitant to write about matters that are more political than scientific or medical, although sometimes the sorts of topics that I blog about inevitably require it (e.g., the 21st Century Cures Act, which never died and a retooled version of which is still being considered). This is one of those times. Yesterday, I woke up to the news that President-Elect Donald Trump had chosen Rep. Tom Price (R-GA) as his new Secretary of Health and Human Services. The Department of Health and Human Services (DHHS), of course, figures fairly prominently in a couple of frequent topics on this blog because major federal agencies that I write about are within the DHHS, including the CDC (vaccine issues), the FDA (drug approval and drug safety), and, of course, the National Institutes of Health (NIH). So the HHS Secretary matters, at least for purposes of discussing Science-Based Medicine. Then there’s also the issue of Donald Trump’s long history of rabid antivaccine views, coupled with the other issue of his having met secretly with Andrew Wakefield in August in Florida and, after the election, antivaccine activists seeking to influence him based on that meeting. I was looking for a signal in whomever Trump picked regarding whether he would actually do anything about vaccine policy potentially harmful to public health. Heck, as I’ve noted before, Vice President Mike Pence apparently doesn’t believe that smoking causes cancer and premature death.

So why did Tom Price catch my attention more than other Trump cabinet picks? Yes, he detests Obamacare and is likely to be fully enthusiastic about gutting it, but pretty much anyone Trump picked would have been expected to hold that view. It’s pretty much par for the course for the Republican Party these days. I would have been more surprised if whomever Trump picked was relatively neutral on Obamacare. No, what caught my eye was that I learned that Tom Price is a member of the Association of American Physicians and Surgeons (AAPS), and that told me a lot about him, none of it good. For instance, in 2015 Charles Pierce referred to Price as “one of Georgia’s wingnut sawbones” (Price is an orthopedic surgeon), and noted an article by Stephanie Mencimer, The Tea Party’s Favorite Doctors, which included this description of the AAPS:

Yet despite the lab coats and the official-sounding name, the docs of the AAPS are hardly part of mainstream medical society. Think Glenn Beck with an MD. The group (which did not return calls for comment for this story) has been around since 1943. Some of its former leaders were John Birchers, and its political philosophy comes straight out of Ayn Rand. Its general counsel is Andrew Schlafly, son of the legendary conservative activist Phyllis. The AAPS statement of principles declares that it is “evil” and “immoral” for physicians to participate in Medicare and Medicaid, and its journal is a repository for quackery. Its website features claims that tobacco taxes harm public health and electronic medical records are a form of “data control” like that employed by the East German secret police. An article on the AAPS website speculated that Barack Obama may have won the presidency by hypnotizing voters, especially cohorts known to be susceptible to “neurolinguistic programming”—that is, according to the writer, young people, educated people, and possibly Jews.

I realize that just because Tom Price is a member of the AAPS doesn’t necessarily mean that he subscribes to all its views—or even most of them. Maybe he’s like the Trump voters who were attracted by other things about him or hated Hillary Clinton more than they were disturbed by his racism, embrace of the alt right white supremacist movement, misogyny, and conspiracy mongering. Maybe Price was attracted by the AAPS view that rejects nearly all restrictions on physicians’ practice of medicine, purportedly for the good of the patient, its support of private practice and dislike of government regulation of medicine to the point that he ignored its promotion of dangerous medical quackery, such as antivaccine pseudoscience blaming vaccines for autism, including a view that is extreme even among antivaccine activists, namely that the “shaken baby syndrome” is a “misdiagnosis” for vaccine injury; its HIV/AIDS denialism; its blaming immigrants for crime and disease; its promotion of the pseudoscience claiming that abortion causes breast cancer using some of the most execrable “science” ever; its rejection of evidence-based guidelines as an unacceptable affront on the godlike autonomy of physicians; or the way the AAPS rejects even the concept of a scientific consensus about anything. Let’s just put it this way. The AAPS has featured publications by antivaccine mercury militia “scientists” Mark and David Geier. Even so, the very fact that Price was attracted enough to this organization and liked it enough to actually join it should raise a number of red flags. It certainly did with me, because I know the AAPS all too well.

I haven’t written much about the AAPS, but the first time I ever encountered the group was over a decade ago. Given that Tom Price is now in the news as Trump’s selection for DHHS, now appears to be a good time to revisit the AAPS, although I have already briefly done so because, not surprisingly, the AAPS has been a huge foe of Obamacare. Consistent with the conspiratorial bent of many AAPS leaders, AAPS CEO Dr. Jane Orient peddled medical conspiracy theories that Hillary Clinton was “medically unfit to serve.”

Since it’s been a long time, I decided to peruse the most recent episodes of the Journal of American Physicians and Surgeons (JPANDS), to see what the group has been up to, “scientifically” speaking. Not surprisingly, the Fall 2016 issue contained the usual rants against Medicare and taxes and complaints about the “end of fee-for-service medicine” (perhaps the “threat” that animates the AAPS perhaps more than anything else), but it also contained other typical AAPS bugaboos. For instance, there is this article decrying mandatory influenza vaccination for health care professionals, in which a fictional nurse named Rebecca is demonized by her coworkers for refusing the flu vaccine, along with some familiar anti-flu vaccine tropes.

Then, consistent with the hostility of the AAPS towards evidence-based medicine, there is this “gem” of an article, The Evidence-Based Transformation of American Medicine by Hermann W. Børg, MD. Let’s just say that Dr. Børg writes about evidence-based medicine as though it were a bad thing. If there’s another thing (besides Medicare or any hint of federal “control” of medicine) that the AAPS hates with a passion, it’s evidence-based medicine. It’s an article that combines the reasonable, such as questions about pharmaceutical influence in generating EBM guidelines and the contention that for preventative interventions we should pay attention to the number needed to treat and to absolute risk reductions more than relative risk reduction, and real howlers, like this paean to anecdotal evidence:

The very low level of quality assigned to anecdotal evidence in this system requires a brief comment. In keeping with the mantra that “the plural of anecdote is not evidence,” any usefulness of “anecdotes” in clinical practice is dismissed outright by EBM. However, as one wise professor observed, “Every epidemic starts with a single case report” (R.L. Kimber, personal communication, 2000). Serendipitous breakthroughs are made by individuals who make careful observations of patients from close range, seldom or never by a team encumbered by a rigid experimental protocol and the huge number of subjects needed to reach statistical signicance. Single observations may be extremely important, even if not statistically significant in the context of a large trial. Say, for example, a rare, otherwise unexplained event follows a medical intervention: a patient takes a drug and inexplicably goes blind. It might be a coincidence, or it might be a side effect of the drug. One cannot rule out a causal relationship based on lack of a statistically significant difference in this occurrence between the drug and placebo groups in a trial of insufficient power to detect a rare event. One is obligated to investigate further.

This is, of course, a straw man so massive that, were it real, the astronauts living on the International Space Station could see it from orbit. EBM (and science-based medicine) recognize the importance of anecdotes, but as hypothesis-generating observations, not hypothesis-confirming observations. Moreover, serious adverse events, such as blindness, are not dismissed as “correlation not equaling causation” without investigation. Certainly the FDA would not dismiss multiple reports of blindness after a drug dose as “the plural of anecdotes not being data.” While I will concede that sometimes skeptics use that quip about anecdotes a bit too freely, but in actual practice clinical observations of a reaction as serious as the example given by Dr. Børg are not dismissed as coincidence without investigation, consistent with the role of anecdotes as hypothesis-generating. Basically, Dr. Børg, again consistent with the AAPS view of the physician as supreme, wants the freedom to be able to use clinical observation in any way he wants without restriction by those pesky EBM guidelines and to interpret medical evidence any way he wants, even if it conflicts with how the vast majority of the field interprets it.

If you want a distillation of how the AAPS views EBM guidelines, Dr. Børg gives it:

Strict application of EBM implies a mechanistic algorithm- driven approach, similar to primitive pre-artificial-intelligence computer programs of the past. In such an approach, the doctor sees the patient as a statistic rather than an individual. This sort of medicine could be practiced by administrators. In the real world, however, clinical trials may tell which treatments are e ective, but not necessarily which patients should receive them.

Modern studies of the human genome and proteome have deepened our understanding of the importance and vast extent of biochemical individuality. The patient could be in a subset of patients whose excellent response to an intervention was diluted out in the large number of randomized subjects. It is recognized, for example, that two genes affect how patients process 25 percent of drugs now on the market. In fact, advances in pharmacogenetics may render the EBM model obsolete and replace it with “Genomic Medicine.” One of the major promises of pharmacogenomics is the ability to precisely predict the individual patient’s response to medical intervention, without the need to indirectly draw such conclusion from the large epidemiology-based studies.

Bloody hell. This is exactly the same sort of rationale that functional medicine quacks use to justify in essence, doing anything they believe in to treat patients, all in the name of respecting the patient’s “biochemical individuality” and as an excuse to make it up as one goes along. (Heck, he even uses the same term!) As I like to point out, there is already room in EBM guidelines for the physician’s clinical judgment. However, if a physician deviates from EBM guidelines significantly, it is expected that he or she should have a damned good reason for doing so.

Also, where nowhere near this precision medicine utopia yet, mainly because we lack understanding of the significance of various mutations and differences in gene expression when measured on a whole genome basis. Clinical trials are still necessary. They are also evolving in order to incorporate genomic data and biomarkers in treating patients. One form these new trials take is the so-called “adaptive trial,” which uses patient outcomes and biomarkers to immediately inform further treatment decisions. So, though, results from these trials have been disappointing. Again, Dr. Børg seems to be invoking genomics more as an excuse to dismiss EBM guidelines than anything else.

Now, one might say that Price might not know anything about articles like this, and that’s certainly possible. On the other hand, the reason I cited Dr. Børg is because his article represents what is perhaps the overarching view that is the cornerstone of the AAPS: The fetishization above all else of the individual doctor’s judgment and hostility to any restriction on physician autonomy, or, as I like to characterize it, anything that smacks of “telling doctors what to do.” Truly AAPS worships “brave maverick doctors” and castigates doctors following EBM as going with the herd. Basically, as I described the first time I discussed the AAPS, the leadership of the AAPS and apparently many who publish in JPANDS seem to be a bit too enamored of their self-proclaimed “maverick” status and give the appearance of thinking that, like Ayn Rand’s hero, they’re “supermen” whose egoism and genius will inevitably prevail over timid traditionalism and social conformism. Reigning them in with evidence only interferes with their autonomy and prevents them from exercising their genius for the good of their patients. If only the “herd” could appreciate that!

Oh, and as recently as the Summer 2016 issue of JPANDS, the AAPS was still publishing risible antivaccine pseudoscience in the form of an article by Neil Z. Miller entitled Combining Childhood Vaccines at One Visit Is Not Safe. Let’s just say that it lived down to the usual very low scientific standards of JPANDS, as I described in detail in June.

Tom Price probably doesn’t buy into all the quackery and Ayn Rand-worshiping wingnuttery of the AAPS, and, although I do believe he’s a very bad choice for DHHS, fortunately thus far I have found no evidence that he is antivaccine and have even heard that antivaccinationists are not happy with this choice for DHHS. I do know that the One Crank To Rule Them All, über-quack Mike Adams, is practically twisting himself into a pretzel justifying a “wait and see” attitude even though he is clearly very upset over this choice because Price voted against GMO labeling. (No, I’m not going to link to him.) However, you can learn a lot about a person by the people with whom he associates and the groups he joins and supports. By joining the AAPS, Price has shown that he is clearly attracted to a pre-Medicare vision of a golden era of absolute physician autonomy with minimal or no government interference or programs like Medicare, as well as a hostility towards evidence that conflicts with that vision. There is no arguing this, as these are beliefs that are baked into the DNA of the AAPS; they are central to the organization. Attraction to such beliefs is not a good trait for a Secretary of HHS to be attracted to, and I haven’t even really gotten into Price’s fundamentalist antiabortion beliefs, and his implacable opposition to gun control. It’s going to be a long four years when it comes to health policy.

from ScienceBlogs http://ift.tt/2gUx3qd

I’m always hesitant to write about matters that are more political than scientific or medical, although sometimes the sorts of topics that I blog about inevitably require it (e.g., the 21st Century Cures Act, which never died and a retooled version of which is still being considered). This is one of those times. Yesterday, I woke up to the news that President-Elect Donald Trump had chosen Rep. Tom Price (R-GA) as his new Secretary of Health and Human Services. The Department of Health and Human Services (DHHS), of course, figures fairly prominently in a couple of frequent topics on this blog because major federal agencies that I write about are within the DHHS, including the CDC (vaccine issues), the FDA (drug approval and drug safety), and, of course, the National Institutes of Health (NIH). So the HHS Secretary matters, at least for purposes of discussing Science-Based Medicine. Then there’s also the issue of Donald Trump’s long history of rabid antivaccine views, coupled with the other issue of his having met secretly with Andrew Wakefield in August in Florida and, after the election, antivaccine activists seeking to influence him based on that meeting. I was looking for a signal in whomever Trump picked regarding whether he would actually do anything about vaccine policy potentially harmful to public health. Heck, as I’ve noted before, Vice President Mike Pence apparently doesn’t believe that smoking causes cancer and premature death.

So why did Tom Price catch my attention more than other Trump cabinet picks? Yes, he detests Obamacare and is likely to be fully enthusiastic about gutting it, but pretty much anyone Trump picked would have been expected to hold that view. It’s pretty much par for the course for the Republican Party these days. I would have been more surprised if whomever Trump picked was relatively neutral on Obamacare. No, what caught my eye was that I learned that Tom Price is a member of the Association of American Physicians and Surgeons (AAPS), and that told me a lot about him, none of it good. For instance, in 2015 Charles Pierce referred to Price as “one of Georgia’s wingnut sawbones” (Price is an orthopedic surgeon), and noted an article by Stephanie Mencimer, The Tea Party’s Favorite Doctors, which included this description of the AAPS:

Yet despite the lab coats and the official-sounding name, the docs of the AAPS are hardly part of mainstream medical society. Think Glenn Beck with an MD. The group (which did not return calls for comment for this story) has been around since 1943. Some of its former leaders were John Birchers, and its political philosophy comes straight out of Ayn Rand. Its general counsel is Andrew Schlafly, son of the legendary conservative activist Phyllis. The AAPS statement of principles declares that it is “evil” and “immoral” for physicians to participate in Medicare and Medicaid, and its journal is a repository for quackery. Its website features claims that tobacco taxes harm public health and electronic medical records are a form of “data control” like that employed by the East German secret police. An article on the AAPS website speculated that Barack Obama may have won the presidency by hypnotizing voters, especially cohorts known to be susceptible to “neurolinguistic programming”—that is, according to the writer, young people, educated people, and possibly Jews.

I realize that just because Tom Price is a member of the AAPS doesn’t necessarily mean that he subscribes to all its views—or even most of them. Maybe he’s like the Trump voters who were attracted by other things about him or hated Hillary Clinton more than they were disturbed by his racism, embrace of the alt right white supremacist movement, misogyny, and conspiracy mongering. Maybe Price was attracted by the AAPS view that rejects nearly all restrictions on physicians’ practice of medicine, purportedly for the good of the patient, its support of private practice and dislike of government regulation of medicine to the point that he ignored its promotion of dangerous medical quackery, such as antivaccine pseudoscience blaming vaccines for autism, including a view that is extreme even among antivaccine activists, namely that the “shaken baby syndrome” is a “misdiagnosis” for vaccine injury; its HIV/AIDS denialism; its blaming immigrants for crime and disease; its promotion of the pseudoscience claiming that abortion causes breast cancer using some of the most execrable “science” ever; its rejection of evidence-based guidelines as an unacceptable affront on the godlike autonomy of physicians; or the way the AAPS rejects even the concept of a scientific consensus about anything. Let’s just put it this way. The AAPS has featured publications by antivaccine mercury militia “scientists” Mark and David Geier. Even so, the very fact that Price was attracted enough to this organization and liked it enough to actually join it should raise a number of red flags. It certainly did with me, because I know the AAPS all too well.

I haven’t written much about the AAPS, but the first time I ever encountered the group was over a decade ago. Given that Tom Price is now in the news as Trump’s selection for DHHS, now appears to be a good time to revisit the AAPS, although I have already briefly done so because, not surprisingly, the AAPS has been a huge foe of Obamacare. Consistent with the conspiratorial bent of many AAPS leaders, AAPS CEO Dr. Jane Orient peddled medical conspiracy theories that Hillary Clinton was “medically unfit to serve.”

Since it’s been a long time, I decided to peruse the most recent episodes of the Journal of American Physicians and Surgeons (JPANDS), to see what the group has been up to, “scientifically” speaking. Not surprisingly, the Fall 2016 issue contained the usual rants against Medicare and taxes and complaints about the “end of fee-for-service medicine” (perhaps the “threat” that animates the AAPS perhaps more than anything else), but it also contained other typical AAPS bugaboos. For instance, there is this article decrying mandatory influenza vaccination for health care professionals, in which a fictional nurse named Rebecca is demonized by her coworkers for refusing the flu vaccine, along with some familiar anti-flu vaccine tropes.

Then, consistent with the hostility of the AAPS towards evidence-based medicine, there is this “gem” of an article, The Evidence-Based Transformation of American Medicine by Hermann W. Børg, MD. Let’s just say that Dr. Børg writes about evidence-based medicine as though it were a bad thing. If there’s another thing (besides Medicare or any hint of federal “control” of medicine) that the AAPS hates with a passion, it’s evidence-based medicine. It’s an article that combines the reasonable, such as questions about pharmaceutical influence in generating EBM guidelines and the contention that for preventative interventions we should pay attention to the number needed to treat and to absolute risk reductions more than relative risk reduction, and real howlers, like this paean to anecdotal evidence:

The very low level of quality assigned to anecdotal evidence in this system requires a brief comment. In keeping with the mantra that “the plural of anecdote is not evidence,” any usefulness of “anecdotes” in clinical practice is dismissed outright by EBM. However, as one wise professor observed, “Every epidemic starts with a single case report” (R.L. Kimber, personal communication, 2000). Serendipitous breakthroughs are made by individuals who make careful observations of patients from close range, seldom or never by a team encumbered by a rigid experimental protocol and the huge number of subjects needed to reach statistical signicance. Single observations may be extremely important, even if not statistically significant in the context of a large trial. Say, for example, a rare, otherwise unexplained event follows a medical intervention: a patient takes a drug and inexplicably goes blind. It might be a coincidence, or it might be a side effect of the drug. One cannot rule out a causal relationship based on lack of a statistically significant difference in this occurrence between the drug and placebo groups in a trial of insufficient power to detect a rare event. One is obligated to investigate further.

This is, of course, a straw man so massive that, were it real, the astronauts living on the International Space Station could see it from orbit. EBM (and science-based medicine) recognize the importance of anecdotes, but as hypothesis-generating observations, not hypothesis-confirming observations. Moreover, serious adverse events, such as blindness, are not dismissed as “correlation not equaling causation” without investigation. Certainly the FDA would not dismiss multiple reports of blindness after a drug dose as “the plural of anecdotes not being data.” While I will concede that sometimes skeptics use that quip about anecdotes a bit too freely, but in actual practice clinical observations of a reaction as serious as the example given by Dr. Børg are not dismissed as coincidence without investigation, consistent with the role of anecdotes as hypothesis-generating. Basically, Dr. Børg, again consistent with the AAPS view of the physician as supreme, wants the freedom to be able to use clinical observation in any way he wants without restriction by those pesky EBM guidelines and to interpret medical evidence any way he wants, even if it conflicts with how the vast majority of the field interprets it.

If you want a distillation of how the AAPS views EBM guidelines, Dr. Børg gives it:

Strict application of EBM implies a mechanistic algorithm- driven approach, similar to primitive pre-artificial-intelligence computer programs of the past. In such an approach, the doctor sees the patient as a statistic rather than an individual. This sort of medicine could be practiced by administrators. In the real world, however, clinical trials may tell which treatments are e ective, but not necessarily which patients should receive them.

Modern studies of the human genome and proteome have deepened our understanding of the importance and vast extent of biochemical individuality. The patient could be in a subset of patients whose excellent response to an intervention was diluted out in the large number of randomized subjects. It is recognized, for example, that two genes affect how patients process 25 percent of drugs now on the market. In fact, advances in pharmacogenetics may render the EBM model obsolete and replace it with “Genomic Medicine.” One of the major promises of pharmacogenomics is the ability to precisely predict the individual patient’s response to medical intervention, without the need to indirectly draw such conclusion from the large epidemiology-based studies.

Bloody hell. This is exactly the same sort of rationale that functional medicine quacks use to justify in essence, doing anything they believe in to treat patients, all in the name of respecting the patient’s “biochemical individuality” and as an excuse to make it up as one goes along. (Heck, he even uses the same term!) As I like to point out, there is already room in EBM guidelines for the physician’s clinical judgment. However, if a physician deviates from EBM guidelines significantly, it is expected that he or she should have a damned good reason for doing so.

Also, where nowhere near this precision medicine utopia yet, mainly because we lack understanding of the significance of various mutations and differences in gene expression when measured on a whole genome basis. Clinical trials are still necessary. They are also evolving in order to incorporate genomic data and biomarkers in treating patients. One form these new trials take is the so-called “adaptive trial,” which uses patient outcomes and biomarkers to immediately inform further treatment decisions. So, though, results from these trials have been disappointing. Again, Dr. Børg seems to be invoking genomics more as an excuse to dismiss EBM guidelines than anything else.

Now, one might say that Price might not know anything about articles like this, and that’s certainly possible. On the other hand, the reason I cited Dr. Børg is because his article represents what is perhaps the overarching view that is the cornerstone of the AAPS: The fetishization above all else of the individual doctor’s judgment and hostility to any restriction on physician autonomy, or, as I like to characterize it, anything that smacks of “telling doctors what to do.” Truly AAPS worships “brave maverick doctors” and castigates doctors following EBM as going with the herd. Basically, as I described the first time I discussed the AAPS, the leadership of the AAPS and apparently many who publish in JPANDS seem to be a bit too enamored of their self-proclaimed “maverick” status and give the appearance of thinking that, like Ayn Rand’s hero, they’re “supermen” whose egoism and genius will inevitably prevail over timid traditionalism and social conformism. Reigning them in with evidence only interferes with their autonomy and prevents them from exercising their genius for the good of their patients. If only the “herd” could appreciate that!

Oh, and as recently as the Summer 2016 issue of JPANDS, the AAPS was still publishing risible antivaccine pseudoscience in the form of an article by Neil Z. Miller entitled Combining Childhood Vaccines at One Visit Is Not Safe. Let’s just say that it lived down to the usual very low scientific standards of JPANDS, as I described in detail in June.

Tom Price probably doesn’t buy into all the quackery and Ayn Rand-worshiping wingnuttery of the AAPS, and, although I do believe he’s a very bad choice for DHHS, fortunately thus far I have found no evidence that he is antivaccine and have even heard that antivaccinationists are not happy with this choice for DHHS. I do know that the One Crank To Rule Them All, über-quack Mike Adams, is practically twisting himself into a pretzel justifying a “wait and see” attitude even though he is clearly very upset over this choice because Price voted against GMO labeling. (No, I’m not going to link to him.) However, you can learn a lot about a person by the people with whom he associates and the groups he joins and supports. By joining the AAPS, Price has shown that he is clearly attracted to a pre-Medicare vision of a golden era of absolute physician autonomy with minimal or no government interference or programs like Medicare, as well as a hostility towards evidence that conflicts with that vision. There is no arguing this, as these are beliefs that are baked into the DNA of the AAPS; they are central to the organization. Attraction to such beliefs is not a good trait for a Secretary of HHS to be attracted to, and I haven’t even really gotten into Price’s fundamentalist antiabortion beliefs, and his implacable opposition to gun control. It’s going to be a long four years when it comes to health policy.

from ScienceBlogs http://ift.tt/2gUx3qd

Study: U.S. still lags behind on health care affordability and access [The Pump Handle]

The percentage of Americans who reported cost-related barriers to health care dropped from 37 percent in 2013 to 33 percent in 2016 — a change that directly corresponds to insurance expansions under the Affordable Care Act, a new study reports. On the flip side, Americans are still more likely than peers in other high-income nations to face financial obstacles to health care.

The study is based on findings from a survey of patients and providers in 11 countries and one that the Commonwealth Fund has been conducting annually since 1998. Those 11 countries are: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the U.S. The survey typically focuses on the experiences of patients and providers; however, this year the survey also collected data on self-reported health and well-being as well as material hardship, which is a significant contributor to a person’s physical and mental health status. Here’s what the study, which was recently published in the journal Health Affairs, found.

On average, American adults reported poorer health than their counterparts in other countries, with 28 percent of U.S. adults living with at least two chronic conditions. Twenty-six percent of U.S. adults reported emotional distress in the previous year that was difficult to deal with alone. Canadian adults reported similar levels of chronic conditions and emotional distress, while French and German adults reported the lowest rates of emotional distress. On the topic of material hardship, U.S. adults were more likely than adults in all other 10 nations to report they were “always” or “usually” concerned about having enough money to buy healthy foods or pay their housing expenses. Material hardship rates were lowest in Germany.

Americans were most likely to report financial barriers to health care in 2016 — at 33 percent — though that rate has declined in recent years, the study found. In comparison, between 7 and 8 percent of adults in Germany, the Netherlands, Sweden and the United Kingdom reported that costs prevented them from accessing needed medical care. About half of Canadian, German and Norwegian adults were not able to secure a medical appointment the same or next day; and about one in five adults in Canada, Germany, Norway, Sweden and the U.S. waited six or more days for an appointment. Adults in Canada were the most likely to say they waited two or more months to see a specialist; in contrast, fewer than 10 percent of adults reported similar waiting times in France, Germany, the Netherlands, Switzerland and the U.S.

In all of the countries surveyed, except the U.S., a majority of respondents with a regular doctor said their provider did not discuss healthy diets or exercise in the previous two years. Forty-one percent of Americans reported the absence of such discussions as well. On the issue of managing chronic conditions, 14 percent of chronically ill U.S. adults said they did not have the support they needed from their health care providers. Norway, Canada and France had a similar rate, while Australia, the Netherlands and New Zealand had the lowest.

Low-income adults — those living in households with less than half of the respective country’s median income — in every country were much more likely to report health problems and material hardship, the study found, noting that “their health care experiences shine a light on how well their country’s health system responds to the needs of some of its most complex and socially vulnerable patients.” The U.S. was home to the highest rate of low-income adults who reported cost barriers to care at 43 percent. Rates in other countries ranged from 8 percent to 31 percent. Low-income adults in Canada, France, Germany, Sweden, the United Kingdom and the U.S. reported longer waits for health care than the rest of the populations. In all the countries, between one-fourth and one-half of low-income adults said they used the emergency room in the previous two years. Study authors Robin Osborn, David Squires, Michelle Doty, Dana Sarnak and Eric Schneider write:

Although the United States has made significant progress in expanding coverage under the Affordable Care Act (ACA), it remains an outlier among high-income countries in ensuring access to health care. The major coverage expansions of the law were launched only in 2014 and are thus still in a ramping-up period. In addition, there are ongoing barriers to coverage, including the fact that — as of November 2016 — nineteen states have not chosen to expand eligibility for their Medicaid programs, the exclusion of undocumented immigrants from both Marketplace and Medicaid coverage, low awareness of coverage options, and concerns about affordability among those who remain uninsured. An estimated twenty-three million adults in the United States lack health insurance, while the other countries in our survey have universal coverage.

Schneider, senior vice president for policy and research at the Commonwealth Fund, told me that one possible explanation for why the U.S. spends so much on health care may be the higher levels of material hardship among its people, noting that “by not investing in the safety net or in housing, transportation and nutrition, people end up needing (health) services that are much more costly.” One way that other countries seem to be reducing the impact of material hardship, he said, was through integrating medical care and social services. For example, in the United Kingdom, the National Health Service embeds social services into its systems.

He also noted that while many provisions in the ACA offer financial incentives for hospital and health systems to engage community and social service partners toward reducing health care costs, it’s still early in the process. Making those linkages, he said, is a difficult, long-term endeavor.

“We probably do need to spend more on public health activities, social services and stress prevention so what are small health problems don’t become big health problems that require medical attention,” Schneider said of the U.S. system.

He also said that in many European countries, such as the United Kingdom and the Netherlands, the emphasis on providing no-cost primary care and ensuring timely access to primary care is making a significant difference for the health of their populations. In comparison, the U.S. devotes many more resources toward specialty care. In fact, Schneider told me that to improve America’s health, he would make two key investments: expanding population health and prevention measures and shifting more resources into strengthening primary care. Even though the ACA has certainly been a boost to primary care — for example, more people with insurance coverage as well as required coverage of preventive services benefits the bottom lines of primary care providers — the future is uncertain, Schneider said.

“Now with the change in administration, the concern is that many of those benefits, especially the essential health benefits, will be reversed,” he said. “Many of the (potential) repeals would take us backwards in terms of insurance coverage and benefits available. That would erode much of the progress we’ve made in primary care.”

Schneider said that even for Americans who can afford care and have insurance coverage, the U.S. health care delivery systems isn’t organized optimally — “we do really well at expensive treatments, but we just don’t have that cornerstone of primary care.”

“The No. 1 difference between the U.S. and other countries is that other countries either commit to universal insurance coverage or put a lot into making sure everyone (is covered),” he told me. “That universal coverage is fundamental because without it, it’s very difficult to create a high-functioning insurance market and a health care system that serves everyone.”

For a full copy of the 11-country study, visit Health Affairs or the Commonwealth Fund.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.

from ScienceBlogs http://ift.tt/2guZbg2

The percentage of Americans who reported cost-related barriers to health care dropped from 37 percent in 2013 to 33 percent in 2016 — a change that directly corresponds to insurance expansions under the Affordable Care Act, a new study reports. On the flip side, Americans are still more likely than peers in other high-income nations to face financial obstacles to health care.

The study is based on findings from a survey of patients and providers in 11 countries and one that the Commonwealth Fund has been conducting annually since 1998. Those 11 countries are: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the U.S. The survey typically focuses on the experiences of patients and providers; however, this year the survey also collected data on self-reported health and well-being as well as material hardship, which is a significant contributor to a person’s physical and mental health status. Here’s what the study, which was recently published in the journal Health Affairs, found.

On average, American adults reported poorer health than their counterparts in other countries, with 28 percent of U.S. adults living with at least two chronic conditions. Twenty-six percent of U.S. adults reported emotional distress in the previous year that was difficult to deal with alone. Canadian adults reported similar levels of chronic conditions and emotional distress, while French and German adults reported the lowest rates of emotional distress. On the topic of material hardship, U.S. adults were more likely than adults in all other 10 nations to report they were “always” or “usually” concerned about having enough money to buy healthy foods or pay their housing expenses. Material hardship rates were lowest in Germany.

Americans were most likely to report financial barriers to health care in 2016 — at 33 percent — though that rate has declined in recent years, the study found. In comparison, between 7 and 8 percent of adults in Germany, the Netherlands, Sweden and the United Kingdom reported that costs prevented them from accessing needed medical care. About half of Canadian, German and Norwegian adults were not able to secure a medical appointment the same or next day; and about one in five adults in Canada, Germany, Norway, Sweden and the U.S. waited six or more days for an appointment. Adults in Canada were the most likely to say they waited two or more months to see a specialist; in contrast, fewer than 10 percent of adults reported similar waiting times in France, Germany, the Netherlands, Switzerland and the U.S.

In all of the countries surveyed, except the U.S., a majority of respondents with a regular doctor said their provider did not discuss healthy diets or exercise in the previous two years. Forty-one percent of Americans reported the absence of such discussions as well. On the issue of managing chronic conditions, 14 percent of chronically ill U.S. adults said they did not have the support they needed from their health care providers. Norway, Canada and France had a similar rate, while Australia, the Netherlands and New Zealand had the lowest.

Low-income adults — those living in households with less than half of the respective country’s median income — in every country were much more likely to report health problems and material hardship, the study found, noting that “their health care experiences shine a light on how well their country’s health system responds to the needs of some of its most complex and socially vulnerable patients.” The U.S. was home to the highest rate of low-income adults who reported cost barriers to care at 43 percent. Rates in other countries ranged from 8 percent to 31 percent. Low-income adults in Canada, France, Germany, Sweden, the United Kingdom and the U.S. reported longer waits for health care than the rest of the populations. In all the countries, between one-fourth and one-half of low-income adults said they used the emergency room in the previous two years. Study authors Robin Osborn, David Squires, Michelle Doty, Dana Sarnak and Eric Schneider write:

Although the United States has made significant progress in expanding coverage under the Affordable Care Act (ACA), it remains an outlier among high-income countries in ensuring access to health care. The major coverage expansions of the law were launched only in 2014 and are thus still in a ramping-up period. In addition, there are ongoing barriers to coverage, including the fact that — as of November 2016 — nineteen states have not chosen to expand eligibility for their Medicaid programs, the exclusion of undocumented immigrants from both Marketplace and Medicaid coverage, low awareness of coverage options, and concerns about affordability among those who remain uninsured. An estimated twenty-three million adults in the United States lack health insurance, while the other countries in our survey have universal coverage.

Schneider, senior vice president for policy and research at the Commonwealth Fund, told me that one possible explanation for why the U.S. spends so much on health care may be the higher levels of material hardship among its people, noting that “by not investing in the safety net or in housing, transportation and nutrition, people end up needing (health) services that are much more costly.” One way that other countries seem to be reducing the impact of material hardship, he said, was through integrating medical care and social services. For example, in the United Kingdom, the National Health Service embeds social services into its systems.

He also noted that while many provisions in the ACA offer financial incentives for hospital and health systems to engage community and social service partners toward reducing health care costs, it’s still early in the process. Making those linkages, he said, is a difficult, long-term endeavor.

“We probably do need to spend more on public health activities, social services and stress prevention so what are small health problems don’t become big health problems that require medical attention,” Schneider said of the U.S. system.

He also said that in many European countries, such as the United Kingdom and the Netherlands, the emphasis on providing no-cost primary care and ensuring timely access to primary care is making a significant difference for the health of their populations. In comparison, the U.S. devotes many more resources toward specialty care. In fact, Schneider told me that to improve America’s health, he would make two key investments: expanding population health and prevention measures and shifting more resources into strengthening primary care. Even though the ACA has certainly been a boost to primary care — for example, more people with insurance coverage as well as required coverage of preventive services benefits the bottom lines of primary care providers — the future is uncertain, Schneider said.

“Now with the change in administration, the concern is that many of those benefits, especially the essential health benefits, will be reversed,” he said. “Many of the (potential) repeals would take us backwards in terms of insurance coverage and benefits available. That would erode much of the progress we’ve made in primary care.”

Schneider said that even for Americans who can afford care and have insurance coverage, the U.S. health care delivery systems isn’t organized optimally — “we do really well at expensive treatments, but we just don’t have that cornerstone of primary care.”

“The No. 1 difference between the U.S. and other countries is that other countries either commit to universal insurance coverage or put a lot into making sure everyone (is covered),” he told me. “That universal coverage is fundamental because without it, it’s very difficult to create a high-functioning insurance market and a health care system that serves everyone.”

For a full copy of the 11-country study, visit Health Affairs or the Commonwealth Fund.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.

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Cat-tongues inspire new technology? [Life Lines]

Giving Tuesday - Help us keep our materials free

Millions of K-12 students use ScienceBuddies' #science project ideas and resources each year. We need your help to keep our #STEM materials free.

from Science Buddies Blog http://ift.tt/2g3oRQm

Millions of K-12 students use ScienceBuddies' #science project ideas and resources each year. We need your help to keep our #STEM materials free.

from Science Buddies Blog http://ift.tt/2g3oRQm

Come back from the dark side

This post was sent in this afternoon by Armelle Hubault, spacecraft operations engineer working on the Cluster flight control team at ESOC.

Cluster eclipse timeline around 08:00 CET 29 Nov 2016. Credit: ESA

Cluster spacecraft 3 (Samba) and 4 (Tango) went through a Moon eclipse this morning at around 06:00z (08:00 CET). In both cases, the eclipse lasted on the order of 30 minutes.

The Cluster satellites don't have any operating batteries left, but because it was 'only' a penumbra eclipse – when the Sun, Earth and Moon are aligned to produce a shadow that is not complete – the solar arrays continued producing a little bit of power.

This was just enough to provide the 26.5W necessary to keep the volatile memory alive by temporarily and automatically disconnecting the on-board receiver.

In order to ensure minimal power consumption on the satellites, all switchable loads had been disconnected prior to the eclipse. This meant the payload instruments were off, as well as all the platform subsystems and even the on-board computer!

Penumbral lunar eclipse Credit: ESA

Only in this deep hibernation state can the satellites survive the eclipse.

This morning, shortly after they emerged from the penumbra of the Moon, both satellites were fully switched on again and are already back in science mode as if nothing had happened at all!

from Rocket Science http://ift.tt/2gFCeGv
v

This post was sent in this afternoon by Armelle Hubault, spacecraft operations engineer working on the Cluster flight control team at ESOC.

Cluster eclipse timeline around 08:00 CET 29 Nov 2016. Credit: ESA

Cluster spacecraft 3 (Samba) and 4 (Tango) went through a Moon eclipse this morning at around 06:00z (08:00 CET). In both cases, the eclipse lasted on the order of 30 minutes.

The Cluster satellites don't have any operating batteries left, but because it was 'only' a penumbra eclipse – when the Sun, Earth and Moon are aligned to produce a shadow that is not complete – the solar arrays continued producing a little bit of power.

This was just enough to provide the 26.5W necessary to keep the volatile memory alive by temporarily and automatically disconnecting the on-board receiver.

In order to ensure minimal power consumption on the satellites, all switchable loads had been disconnected prior to the eclipse. This meant the payload instruments were off, as well as all the platform subsystems and even the on-board computer!

Penumbral lunar eclipse Credit: ESA

Only in this deep hibernation state can the satellites survive the eclipse.

This morning, shortly after they emerged from the penumbra of the Moon, both satellites were fully switched on again and are already back in science mode as if nothing had happened at all!

from Rocket Science http://ift.tt/2gFCeGv
v

Pancreatic cancer and diabetes – a cellular case of chicken and egg

We’ve all heard the age-old question about the chicken and the egg.

Well scientists studying the link between diabetes (a condition where the amount of glucose in your blood is too high because the body cannot use it properly) and pancreatic cancer are facing a similar conundrum. It seems there’s a link between the two conditions, but it’s not clear which one comes first.

While the majority of people with diabetes will never develop pancreatic cancer, the question of whether diabetes could be a cause or a consequence of pancreatic cancer is an important one.

Answering this could help scientists better understand the biology of these two conditions, and might help spot people at higher risk of pancreatic cancer.

So, as it’s pancreatic cancer awareness month, we’ve dug into the evidence to see what is known about these links, and which questions remain unanswered.

We know there’s a link

Doctors first started exploring the possibility of a link between diabetes and pancreatic cancer in the 1940s and 1950s.

Several reports had come out saying that patients with pancreatic cancer were more likely to also have diabetes than other people. This has been shown for type 2 diabetes as well as type 1 and young onset diabetes.

Since then, many studies have shown a link between the two conditions. Overall, it seems that people with diabetes are around twice as likely to be diagnosed with pancreatic cancer than the general population.

And this makes sense, given that diabetes and pancreatic cancer are diseases that both affect the pancreas.

The next big question is: how does this work? Does diabetes increase a person’s risk of pancreatic cancer or is it the cancer that causes diabetes? Or is there something else increasing the risk of both conditions?

How pancreatic cancer could cause diabetes

8 in 10 people with pancreatic cancer have some level of intolerance to sugar, and up to 5 in 10 have diabetes.

In cancer patients who do have diabetes, the condition is often diagnosed shortly before, or after, their cancer diagnosis, suggesting that the diabetes is a symptom of the developing cancer, rather than its cause.

As the cancer may affect the insulin producing cells, or cause the insulin to be less effective, diabetes can sometimes be the first symptom [of pancreatic cancer]

– Dan Howarth, Diabetes UK

Dan Howarth, head of care at Diabetes UK, says that while it’s not yet known to what extent the diseases are linked, there is clearly a link.

“Although the evidence is mixed in terms of numbers, there are many studies which suggest that a small proportion of people with type 2 diabetes develop cancer of the pancreas within a year following their diabetes diagnosis.”

In 2015, the National Institute of Health and Care Excellence (NICE) added newly diagnosed diabetes together with weight loss in a person over 60 to the list of ‘red flags’ that should lead to a doctor sending that patient for a scan to look for pancreatic cancer.

But exactly how a growing cancer could result in sugar intolerance and diabetes is still a matter of debate.

The pancreas is responsible for producing hormones such as insulin, which regulate the amount of sugar in our blood. One theory is that changes in the pancreas caused by a growing tumour may affect the levels of insulin in the body, because the normal functions of the cells in the pancreas are disrupted.

“As the cancer may affect the insulin producing cells, or cause the insulin to be less effective, diabetes can sometimes be the first symptom [of pancreatic cancer],” says Howarth.

An interesting finding that supports the theory that diabetes could be a symptom of pancreatic cancer is the fact that in some cases the diabetes symptoms disappear, or at least improve, once the cancer is removed.

But there are other bits of research that tell a different story.

The other side of the story

Studies have shown that people with diabetes remain at a higher risk of pancreatic cancer, even many years after their diabetes is first diagnosed.

And there’s also some evidence of an increased risk of pancreatic cancer in people with type 1 and young onset diabetes, who’ve had diabetes almost all their life.

This suggests that the diabetes may not be a symptom of cancer. So could it be a cause?

Some of the hallmarks of diabetes are changes in how cells make and process energy (metabolism), increases in certain hormones, and persistent inflammation. All of these can have cancer-promoting effects, stimulating cells to grow and divide, which could in some cases increase the risk of pancreatic cancer developing.

So what comes first?

At this moment in time we do not have a definitive answer to the question of what comes first – diabetes or pancreatic cancer. Much like the chicken and egg debate, there is evidence for either side.

In fact, some researchers are now suggesting that the answer may actually be both.

In some people, diabetes may develop as a result of pancreatic cancer interfering with how the pancreas works. This is probably the case for patients who are diagnosed with pancreatic cancer shortly before or after being told they have diabetes.

In a small number of other cases, diabetes may eventually lead to pancreatic cancer. This could be the case in those who have lived with diabetes for a longer time and are diagnosed with pancreatic cancer many years after finding out they have diabetes.

One of the biggest challenges scientists are facing now is how to design the best study to answer these questions.

Both conditions are difficult to spot early and can go undiagnosed for many years. So studies that look at which was diagnosed first, before making links between the two, will have pitfalls.

And that’s not the whole story

Diabetes and pancreatic cancer also share several common risk factors. For example, both are more common in older age, both are linked to being overweight or obese, and the risk of both is affected by smoking and by how much alcohol we drink. This makes it harder for scientists to study how the two conditions are linked.

And the whole thing is further complicated by the fact that different drugs people take to control their diabetes also seem to affect their risk of pancreatic cancer. Different diabetes drugs, for example, may lower or raise the risk of this cancer.

Research suggests that metformin (Glucophage) and statins can reduce the chances of developing pancreatic cancer, while sulphonylureas may increase the risk.

There is not enough evidence to suggest that diabetes medications cause pancreatic cancer

– Dan Howarth, Diabetes UK

Evidence for the effects of drugs such as sitagliptin (Januvia) and vildagliptin (Galvus) on pancreatic cancer risk is still growing, as these drugs are relatively new. So far most studies show that these drugs seem to have no effect on pancreatic cancer risk, but studies that follow patients for longer periods of time are needed to confirm this.

Insulin – another medication used to control diabetes – also appears to increase the risk of pancreatic cancer, at least in the short term.

In the long term there is some conflicting evidence that seems to point to a protective effect, meaning it seems to reduce the risk.

But all these studies need to be interpreted with care, as they have flaws that could reduce the strength of their findings.

“There is not enough evidence to suggest that diabetes medications cause pancreatic cancer,” explains Howarth. “Previous studies have linked this, however there were many limitations to these studies and this area of research continues.”

And importantly, all these medications are vital for patients to manage their diabetes, with a recent study suggesting that those who control their blood sugar levels well may be at lower risk of pancreatic cancer than those who don’t.

So even if a medication could increase pancreatic cancer risk, the benefits of taking it are likely to outweigh any harms.

“Patients should not stop their medication, unless advised by their doctor,” says Howarth.

“If not managed, diabetes can lead to serious complications such as kidney disease, blindness, nerve damage and amputations. As well as heart attacks and strokes.

“For this reason taking care of diabetes and continuing medications is highly important and is likely to prove more beneficial than stopping them due to a small risk of cancer of the pancreas.

“At the same time, vigilance is required of patients on such therapies, for any side effects suggestive of pancreatic disease.”

What should we make of all this?

The conclusion is that it’s still not clear yet whether diabetes is a cause, or consequence, of pancreatic cancer. It seems likely that it can actually be either, depending on each individual case.

What’s important is that people affected by diabetes don’t panic. Someone who has diabetes won’t necessarily also develop pancreatic cancer.

In fact, less than 2 in 100 people with diabetes are diagnosed with pancreatic cancer in the 3 years after being told about their diabetes. And the more time that elapses after the diabetes diagnosis, the less likely it is that someone will develop pancreatic cancer – although their risk is still a little higher than that of someone who doesn’t have diabetes.

“The number of pancreatic cancer cases is small, which means although a higher risk than the general population, a relatively small risk for people with diabetes,” confirms Howarth.

And there could be benefits

There are also some benefits to knowing that there’s a link. For example, spotting a new case of diabetes could be used as a way to identify people at higher risk of pancreatic cancer so they can be monitored for changes that could be signs of the disease.

And due to its cancer risk reducing effects, the anti-diabetic drug metformin is being trialled as a possible cancer treatment, together with chemotherapy, to manage pancreatic cancer.

While the chicken and egg question hasn’t been resolved yet, in time the link between diabetes and pancreatic cancer will be understood more clearly.

And this will open up new ways to help those affected by these conditions.

In the meantime, our researchers are also working hard to find new ways to treat pancreatic cancer.

Jana Witt is a health information officer at Cancer Research UK

from Cancer Research UK – Science blog http://ift.tt/2gS3i9x

We’ve all heard the age-old question about the chicken and the egg.

Well scientists studying the link between diabetes (a condition where the amount of glucose in your blood is too high because the body cannot use it properly) and pancreatic cancer are facing a similar conundrum. It seems there’s a link between the two conditions, but it’s not clear which one comes first.

While the majority of people with diabetes will never develop pancreatic cancer, the question of whether diabetes could be a cause or a consequence of pancreatic cancer is an important one.

Answering this could help scientists better understand the biology of these two conditions, and might help spot people at higher risk of pancreatic cancer.

So, as it’s pancreatic cancer awareness month, we’ve dug into the evidence to see what is known about these links, and which questions remain unanswered.

We know there’s a link

Doctors first started exploring the possibility of a link between diabetes and pancreatic cancer in the 1940s and 1950s.

Several reports had come out saying that patients with pancreatic cancer were more likely to also have diabetes than other people. This has been shown for type 2 diabetes as well as type 1 and young onset diabetes.

Since then, many studies have shown a link between the two conditions. Overall, it seems that people with diabetes are around twice as likely to be diagnosed with pancreatic cancer than the general population.

And this makes sense, given that diabetes and pancreatic cancer are diseases that both affect the pancreas.

The next big question is: how does this work? Does diabetes increase a person’s risk of pancreatic cancer or is it the cancer that causes diabetes? Or is there something else increasing the risk of both conditions?

How pancreatic cancer could cause diabetes

8 in 10 people with pancreatic cancer have some level of intolerance to sugar, and up to 5 in 10 have diabetes.

In cancer patients who do have diabetes, the condition is often diagnosed shortly before, or after, their cancer diagnosis, suggesting that the diabetes is a symptom of the developing cancer, rather than its cause.

As the cancer may affect the insulin producing cells, or cause the insulin to be less effective, diabetes can sometimes be the first symptom [of pancreatic cancer]

– Dan Howarth, Diabetes UK

Dan Howarth, head of care at Diabetes UK, says that while it’s not yet known to what extent the diseases are linked, there is clearly a link.

“Although the evidence is mixed in terms of numbers, there are many studies which suggest that a small proportion of people with type 2 diabetes develop cancer of the pancreas within a year following their diabetes diagnosis.”

In 2015, the National Institute of Health and Care Excellence (NICE) added newly diagnosed diabetes together with weight loss in a person over 60 to the list of ‘red flags’ that should lead to a doctor sending that patient for a scan to look for pancreatic cancer.

But exactly how a growing cancer could result in sugar intolerance and diabetes is still a matter of debate.

The pancreas is responsible for producing hormones such as insulin, which regulate the amount of sugar in our blood. One theory is that changes in the pancreas caused by a growing tumour may affect the levels of insulin in the body, because the normal functions of the cells in the pancreas are disrupted.

“As the cancer may affect the insulin producing cells, or cause the insulin to be less effective, diabetes can sometimes be the first symptom [of pancreatic cancer],” says Howarth.

An interesting finding that supports the theory that diabetes could be a symptom of pancreatic cancer is the fact that in some cases the diabetes symptoms disappear, or at least improve, once the cancer is removed.

But there are other bits of research that tell a different story.

The other side of the story

Studies have shown that people with diabetes remain at a higher risk of pancreatic cancer, even many years after their diabetes is first diagnosed.

And there’s also some evidence of an increased risk of pancreatic cancer in people with type 1 and young onset diabetes, who’ve had diabetes almost all their life.

This suggests that the diabetes may not be a symptom of cancer. So could it be a cause?

Some of the hallmarks of diabetes are changes in how cells make and process energy (metabolism), increases in certain hormones, and persistent inflammation. All of these can have cancer-promoting effects, stimulating cells to grow and divide, which could in some cases increase the risk of pancreatic cancer developing.

So what comes first?

At this moment in time we do not have a definitive answer to the question of what comes first – diabetes or pancreatic cancer. Much like the chicken and egg debate, there is evidence for either side.

In fact, some researchers are now suggesting that the answer may actually be both.

In some people, diabetes may develop as a result of pancreatic cancer interfering with how the pancreas works. This is probably the case for patients who are diagnosed with pancreatic cancer shortly before or after being told they have diabetes.

In a small number of other cases, diabetes may eventually lead to pancreatic cancer. This could be the case in those who have lived with diabetes for a longer time and are diagnosed with pancreatic cancer many years after finding out they have diabetes.

One of the biggest challenges scientists are facing now is how to design the best study to answer these questions.

Both conditions are difficult to spot early and can go undiagnosed for many years. So studies that look at which was diagnosed first, before making links between the two, will have pitfalls.

And that’s not the whole story

Diabetes and pancreatic cancer also share several common risk factors. For example, both are more common in older age, both are linked to being overweight or obese, and the risk of both is affected by smoking and by how much alcohol we drink. This makes it harder for scientists to study how the two conditions are linked.

And the whole thing is further complicated by the fact that different drugs people take to control their diabetes also seem to affect their risk of pancreatic cancer. Different diabetes drugs, for example, may lower or raise the risk of this cancer.

Research suggests that metformin (Glucophage) and statins can reduce the chances of developing pancreatic cancer, while sulphonylureas may increase the risk.

There is not enough evidence to suggest that diabetes medications cause pancreatic cancer

– Dan Howarth, Diabetes UK

Evidence for the effects of drugs such as sitagliptin (Januvia) and vildagliptin (Galvus) on pancreatic cancer risk is still growing, as these drugs are relatively new. So far most studies show that these drugs seem to have no effect on pancreatic cancer risk, but studies that follow patients for longer periods of time are needed to confirm this.

Insulin – another medication used to control diabetes – also appears to increase the risk of pancreatic cancer, at least in the short term.

In the long term there is some conflicting evidence that seems to point to a protective effect, meaning it seems to reduce the risk.

But all these studies need to be interpreted with care, as they have flaws that could reduce the strength of their findings.

“There is not enough evidence to suggest that diabetes medications cause pancreatic cancer,” explains Howarth. “Previous studies have linked this, however there were many limitations to these studies and this area of research continues.”

And importantly, all these medications are vital for patients to manage their diabetes, with a recent study suggesting that those who control their blood sugar levels well may be at lower risk of pancreatic cancer than those who don’t.

So even if a medication could increase pancreatic cancer risk, the benefits of taking it are likely to outweigh any harms.

“Patients should not stop their medication, unless advised by their doctor,” says Howarth.

“If not managed, diabetes can lead to serious complications such as kidney disease, blindness, nerve damage and amputations. As well as heart attacks and strokes.

“For this reason taking care of diabetes and continuing medications is highly important and is likely to prove more beneficial than stopping them due to a small risk of cancer of the pancreas.

“At the same time, vigilance is required of patients on such therapies, for any side effects suggestive of pancreatic disease.”

What should we make of all this?

The conclusion is that it’s still not clear yet whether diabetes is a cause, or consequence, of pancreatic cancer. It seems likely that it can actually be either, depending on each individual case.

What’s important is that people affected by diabetes don’t panic. Someone who has diabetes won’t necessarily also develop pancreatic cancer.

In fact, less than 2 in 100 people with diabetes are diagnosed with pancreatic cancer in the 3 years after being told about their diabetes. And the more time that elapses after the diabetes diagnosis, the less likely it is that someone will develop pancreatic cancer – although their risk is still a little higher than that of someone who doesn’t have diabetes.

“The number of pancreatic cancer cases is small, which means although a higher risk than the general population, a relatively small risk for people with diabetes,” confirms Howarth.

And there could be benefits

There are also some benefits to knowing that there’s a link. For example, spotting a new case of diabetes could be used as a way to identify people at higher risk of pancreatic cancer so they can be monitored for changes that could be signs of the disease.

And due to its cancer risk reducing effects, the anti-diabetic drug metformin is being trialled as a possible cancer treatment, together with chemotherapy, to manage pancreatic cancer.

While the chicken and egg question hasn’t been resolved yet, in time the link between diabetes and pancreatic cancer will be understood more clearly.

And this will open up new ways to help those affected by these conditions.

In the meantime, our researchers are also working hard to find new ways to treat pancreatic cancer.

Jana Witt is a health information officer at Cancer Research UK

from Cancer Research UK – Science blog http://ift.tt/2gS3i9x

People are missing the importance of Trump’s voter fraud claims [Greg Laden's Blog]

You know that Donald Trump has been claiming very clearly and precisely that he won the electoral vote, and that it only looks like he did not because of voter fraud, meaning, that a certain number of American citizens voted twice, or otherwise rigged the elections. This would have to have involved thousand, tens of thousands, or if a matter of actual vote fraud, which is his claim, millions of people.

Messing with voting in this manner is a serious crime, perhaps often a felony.

What we have here is Donald Trump accusing a large number of his opponents of being criminals when he doesn’t even have to. More recently, he asserted that American citizens who express their First Amendment constitutional rights should have their citizenship stripped, and should also be jailed.

Trump isn’t even president yet, and he has made the assertion that he would prefer that a very large number of Americans who disagree with him politically should be jailed and/or their citizenship cancelled. He has previously said that many non-citizens should be rounded up. And once rounded up, shipped out of the country.

What happens if there is not a place to send such individuals? Or, if the government insists that people leave, but they don’t have way to do so, or a place to go? Since they are no longer citizens, they can be detained. Where? Well, if there are a few of them, in jails. If there are a lot of them, perhaps work camps along the Mexican border, where they can be pressed into labor building The Yuge Wall. Or, concentration camps.

But a lot of people are going to be expressing their First Amendment rights, and disagreeing with Trump, if that happens. But if he, along with the Congress he will fully control — because Republicans know nothing other than walking in goose step with their party — gets his way, and laws are passed that strip citizenship from Americans who speak their mind, those concentration camps are going to start getting pretty full.

For that, a solution will have to be found.

This is not funny, people. It is extreme sounding, I’ll give you that. Almost impossible to believe. It can’t happen here. .

from ScienceBlogs http://ift.tt/2fy62ss

You know that Donald Trump has been claiming very clearly and precisely that he won the electoral vote, and that it only looks like he did not because of voter fraud, meaning, that a certain number of American citizens voted twice, or otherwise rigged the elections. This would have to have involved thousand, tens of thousands, or if a matter of actual vote fraud, which is his claim, millions of people.

Messing with voting in this manner is a serious crime, perhaps often a felony.

What we have here is Donald Trump accusing a large number of his opponents of being criminals when he doesn’t even have to. More recently, he asserted that American citizens who express their First Amendment constitutional rights should have their citizenship stripped, and should also be jailed.

Trump isn’t even president yet, and he has made the assertion that he would prefer that a very large number of Americans who disagree with him politically should be jailed and/or their citizenship cancelled. He has previously said that many non-citizens should be rounded up. And once rounded up, shipped out of the country.

What happens if there is not a place to send such individuals? Or, if the government insists that people leave, but they don’t have way to do so, or a place to go? Since they are no longer citizens, they can be detained. Where? Well, if there are a few of them, in jails. If there are a lot of them, perhaps work camps along the Mexican border, where they can be pressed into labor building The Yuge Wall. Or, concentration camps.

But a lot of people are going to be expressing their First Amendment rights, and disagreeing with Trump, if that happens. But if he, along with the Congress he will fully control — because Republicans know nothing other than walking in goose step with their party — gets his way, and laws are passed that strip citizenship from Americans who speak their mind, those concentration camps are going to start getting pretty full.

For that, a solution will have to be found.

This is not funny, people. It is extreme sounding, I’ll give you that. Almost impossible to believe. It can’t happen here. .

from ScienceBlogs http://ift.tt/2fy62ss