This week’s topics include best medication for initial diabetes therapy, Ebola update, lowering blood pressure after stroke, and an LDL variant and aortic valve disease.

Program notes:

0:41 Ebola update in NEJM
1:41 Case fatality rate 74%
2:39 Even with fever don’t have detectable virus for a few more days
3:34 Let’s base this on sound science
3:50 Blood pressure lowering after stroke
4:50 Blood pressure medicine initiated, continued or discontinued
5:51 Used to be based on ‘common sense’
6:11 Initial therapy for folks with DM
7:09 No difference in adverse events
8:07 Due to marketing of other medications
8:33 An LDL variant and aortic stenosis
9:23 There is a clear association
10:20 End

Related blog: http://podblog.blogs.hopkinsmedicine.org/2014/10/31/diabetes-drug-of-choice/

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Anchor lead: What does a huge analysis of inherited DNA variation tell us about prostate cancer? Elizabeth Tracey reports

Screening very large numbers of people for genetic variations is one benefit of a multitude of new research techniques employed recently at Johns Hopkins to assess DNA from men with prostate cancer compared to men without the disease.  William Nelson, director of the Kimmel Cancer Center, describes the study.

Nelson: They were examining inherited gene sequences from more than 43,000 men with prostate cancer more than 43,000 men who did not have prostate cancer, to see if there were sequences of DNA that were inherited differently.  What they found was 23 inherited sequences that were inherited differently. If a man inherited any one of these sequences his risk to develop prostate cancer was not really that much increased but if he had inherited several  or many then his risk became reasonably substantial.   :30

Nelson says this study points to the increasing role of genetic analysis with an eye toward predicting someone’s disease risk,  and may one day be used to help men decide whether to be screened for prostate cancer.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Does implanting stem cells help people with macular degeneration? Elizabeth Tracey reports

Stem cells implanted directly into the eye of people with macular degeneration appeared to result in improvements in vision, a recent study published in the Lancet reported.  Neil Bressler, a macular degeneration expert at Johns Hopkins, says the results must be viewed with a bit of skepticism.

Bressler: The main concern is that there was excitement due to claims of improvement in vision. The patients who were enrolled had vision that was legal blindness if that’s your seeing eye to as low as hand motion. That’s fine, you want to test these new therapies that have potential danger in eyes that have very little vision. The problem is they claim some of the eyes had improvement of 15 or more letters.  That amount of change in just a few eyes could be due to just repeating the measurement alone.  :32

That said, Bressler is in favor of expanding on the technique and studying it further. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Is the promise of stem cells coming to fruition?  Elizabeth Tracey reports

Macular degeneration is a leading cause of blindness as people age.  Now a study reported in the Lancet describes using stem cells, a type of cell that hasn’t fully developed yet, to treat the condition by injecting them directly into the eye, with impressive results.  Neil Bressler, a macular degeneration expert at Johns Hopkins, shares his view of the study.

Bressler:  I think the idea is very exciting and the nice thing about the article that was just published is that they showed no substantial safety issues.  It is important to recognize that there were a few eyes that developed some complications including a serious infection which had to be treated with antibiotics placed inside the middle cavity of the eye, and a few of the patients developed cataract which can happen as a result of this surgery, but overall the exciting part is that it was safe.   :29

Bressler says the technique will need to be improved upon and tested earlier in the course of the disease to demonstrate its utility, but he’s cautiously optimistic.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  How important was the invention of the birth control pill in the twentieth century? Elizabeth Tracey reports

“The Birth of the Pill,’ a book chronicling the invention of the oral contraceptive, written by Jonathan Eig, was the subject of a recent symposium at the Johns Hopkins Bloomberg School of Public Health. Eig says its very appearance was surprising.

Eig: The birth control pill comes out of nowhere really, it’s the first drug for healthy people, it’s the first lifestyle drug, and it really changes the way we think about the world  :08

A multitude of forces were arrayed against the pill’s development.

Eig: Got no support from any major institution, no drug company, no university, no government funding, and you’re trying to do something that’s illegal.  Contraception was illegal in the 1950s.  The Supreme Court did not grant women the right to use birth control until 1965. So they have this very small obstacle there, how do you run clinical trials on something that’s ostensibly illegal?   :19

The pill has been credited with allowing women to pursue education and career as well as shifting the power dynamic between men and women by allowing women to choose pregnancy and spacing of children, a WHO goal.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a book by Maryland delegate Dan Morehaim help inform your end of life choices?  Elizabeth Tracey reports

Representative Dan Morehaim, an emergency medicine physician and faculty member at the Johns Hopkins Bloomberg School of Public Health, strives to help people inform their end of life choices in his book ‘A Better End.’  Morehaim says for those who would like to address medicine’s always advancing technology, there’s another document they should consider.

Morehaim: In Maryland we have a MOLST from, m-o-l-s-t, medical orders for life-sustaining treatment.  In other states it’s called POLST, physician orders, but in Maryland it’s because nurse practitioners can complete the form. An advance directive is fairly general, how much care do you want? And who can make decisions if you can’t? MOLST gets very specific about what exactly to do. It’s a medical order it’s not completed by the patient, it’s completed by the physician in consultation with the patient. But it gets into very specific things, do you want antibiotics? Do you want major surgery? Do you want major diagnostic testing?   :32

Recent Institute of Medicine activity has once again brought the issue of advance directives to the forefront.  At Johns Hopkins,  I’m Elizabeth Tracey.

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This week’s topics include persistent banned substances in supplements, knowledge of central venous catheters among physicians, vitamin D levels and different types of milk, and MD versus hospital owned practices and costs.

Program notes:

0:44 Vitamin D levels and milk
1:37 High risk of having very low vitamin D level
2:40 Ricketts a possibility
3:13 Continued presence of FDA banned substances in supplements
4:11 2/3 had banned substances
5:23 MD and hospital owned practices
6:24 75% physician owned
7:24 ACOs are a medical fad
8:15 Central venous catheters and physician knowledge
9:15 21% of clinicians interviewed didn’t know it was there
10:37 End

Related blog:http://podblog.blogs.hopkinsmedicine.org/2014/10/24/cows-milk-wins-at-least-for-now/

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