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Anchor lead: How much does it really cost to bring a new drug to market? Elizabeth Tracey reports

Soaring drug costs have everyone concerned, but pharmaceutical companies have for years justified them with citation of research and development, or R and D costs needing to be recovered. Now a new study in JAMA Internal Medicine concludes that cancer drug makers reap on average 9 times their R and D costs four years after FDA approval. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, comments.

Nelson: R and D costs are not spiraling out of control, the biopharma industry is getting more efficient. There’s another trend that’s captured in this a little bit and that’s that large pharmaceutical companies have somewhat outsourced this process to smaller companies and then they build those relationships later, leading to a drug discovery and development ecosystem where the costs of developing a drug isn’t as high as we believed it was. Costs are born by the American public, who are paying for their treatment in one way or another.  :32

Nelson notes that public awareness is key. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What’s the relationship between alcohol consumption and blood cholesterol? Elizabeth Tracey reports

Does your consumption of alcohol impact your blood cholesterol levels, known to be important in cardiovascular disease? Research by Zach Kaminsky at Johns Hopkins and colleagues suggests the answer may be yes, via a protein made by the liver known as PCSK9.

Kaminsky: The liver is one of the primary organs that make PCSK9 that really help to regulate the body’s level of cholesterol or LDL cholesterol, the bad cholesterol. What’s important about this is that epigenetic patterns act like light switches to turn on and off genes. And so if alcohol is changing the epigenetic patterns, then alcohol could be regulating, through an epigenetic switch, the amount of this cholesterol regulating gene. And this has implications for cardiovascular health.   :30

PCSK9 inhibitors have been much in the news lately as they have been shown to further reduce blood cholesterol in those who are already taking statins, and epigenetics may explain how. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Viral hepatitis is a killer, Elizabeth Tracey reports

Hepatitis, where the liver becomes inflamed, is most often caused by a group of viruses, and the death toll worldwide from these infections is staggering, according to recently released data. Mike Klag, dean of the Johns Hopkins Bloomberg School of Public Health, describes the findings.

Klag: If you lump all the viral hepatitis together hepatitis A,B, C, D and E, the alphabet soup of hepatitis they account for an estimated 1.3million deaths around the world. That’s more than from tuberculosis or HIV or malaria alone. The other important thing is that we can screen for it and we can treat it. Unfortunately for some of these viral infections the treatment is very very expensive. Knowing that we have a way to treat these diseases, how do we set up systems to screen, find the people with it and then treat?  :31

Klag notes that domestically, baby boomers are recommended to be tested for hepatitis C so they can be identified and treated. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A worldwide survey indicates health problems that are increasing, Elizabeth Tracey reports

Taking a look at death and disease around the world reveals trends that are important from a public health perspective. The recent Global Burden of Disease study published in the Lancet reveals several such areas. That’s according to Mike Klag, dean of the Johns Hopkins Bloomberg School of Public Health.

Klag: These data also emphasize the increasing importance of depression and mental illness in terms of quality of life in terms of disability adjusted life years. These are conditions that are growing around the world and we need cost-effective interventions to help stem that burden of disease.  :17

Klag notes that we can all learn from this study.

Klag: There are countries that are doing well, where their life expectancy is improving at a much higher level than you would expect from their level of development. We can learn from those countries what it is that helps prevent noncommunicable diseases, and I think that’s the next step of these analyses.  :16

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What do death data worldwide tell us? Elizabeth Tracey reports

What do people worldwide die of? That’s the substance of the Global Burden of Disease study published recently in the Lancet. Mike Klag, dean of the Bloomberg School of Public Health at Johns Hopkins, describes the data.

Klag: Now over 70% of people around the world are estimated to die from causes that are not infectious. Noncommunicable diseases. So these are diseases like cardiovascular disease, lung disease, Alzheimer’s, obesity related diseases and risk factors that come from obesity. That’s not to say that there isn’t a big burden of infectious diseases. There are, and we can’t take our eye off that, but increasingly the drivers of why people get sick and why they die are noncommunicable diseases.  :28

Klag notes that the majority of noncommunicable diseases are under the control of the individual, and that prudent choices regarding diet, exercise, and smoking can dramatically impact the chance of developing one of these conditions and experiencing early death. At Johns Hopkins, I’m Elizabeth Tracey.

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Senior man communicating with a male doctor in the office.

This week’s topics include physician assisted suicide, preventing infection post-C-section in obese women, 12 year outcomes of bariatric surgery, and death among triathletes.

Program notes:

0:46 Triathlon events and death
1:43 Half with previously unknown cardiac problems
2:43 Trouble in water harder to resuscitate
3:36 Physician assisted suicide
4:36 In Oregon data gathered
5:36 Should be able to provide
6:40 No cancer excision if futile
7:15 12 year outcomes from bariatric surgery
8:15 3/4ths of diabetes remitted
9:07 Preventing infections in obese women with C-sections
10:45 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/09/23/should-doctors-assist-in-death/

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Anchor lead: Just how much abuse do nurses endure? Elizabeth Tracey reports

Occupational Safety and Health Administration data tell us that healthcare workers are four times more likely than others to experience workplace violence, a statistic that may not be surprising in light of the recent handcuffing of a Utah emergency department nurse by a policeman. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says the problem is escalating.

Davidson: There is a torrent of inappropriate behaviors from patients when they’re attributable to a medical condition. We are seeing an increasing intensity and really frequency of these events. We have to have better interventions for managing delirium, for managing challenging behaviors, particularly in people who are mentally incapacitated. How do we use conversational skills or conversational skills to cool conversations down, rather than heating them up?  :32

Davidson affirms that developing new protocols and communications channels is also key to de-escalating violence against nurses. At Johns Hopkins, I’m Elizabeth Tracey.

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