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Anchor lead: How can recommendations from the Institute of Medicine help stem the tide of opioid overdose? Elizabeth Tracey reports

Even as debate over repealing many aspects of the Affordable Care Act continues in DC, the Institute of Medicine and other august agencies are issuing recommendations on how to manage the public health crisis of opioid addiction and overdose death. Eric Strain, an expert on drug abuse at Johns Hopkins, says public awareness is key.

Strain: The increased attention on this is very good. I think that the medical profession, and society is certainly more aware of it. What we need is we need quality treatment available, and it’s hard to get quality treatment up and scaled overnight. We don’t have good quality treatment. We actually have improving ways to pay for treatment through the affordable care act in many states but we don’t necessarily have the providers in place who can provide that treatment.  :28

Strain says a lack of qualified treatment professionals has allowed some opportunists to thrive. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: The FDA has approved use of a drug based on a new way to characterize cancers, Elizabeth Tracey reports

If you’ve received a diagnosis of cancer, you may also have been told your cancer cells will be tested for a type of genetic aberration known as a mismatch repair defect. That’s because the FDA has just approved use of one type of antibody drug based on the presence of this defect. Drew Pardoll, director of the Bloomberg Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, describes these cancers.

Pardoll: It’s a genetic subset of the cancer that because of a defect in the spell check system for fixing mistakes whenever DNA is copied. Those cancers have lots of mutations. If this is a cancer type that has fifty times more mutations because its spell check is defective then that should make it really really easy for the immune system to recognize it.  :29

Pardoll’s own work has led to this approval, and he notes that some cancers respond dramatically to therapy when they have a mismatch repair defect. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Senator John McCain’s brain tumor will likely require more than surgery to treat, Elizabeth Tracey reports

Brain tumors have come into focus with Senator John McCain’s diagnosis. Matthias Holdhoff, a brain cancer expert at Johns Hopkins, describes what’s known about glioblastoma, the type of tumor the senator has.

Holdhoff: Glioblastoma is the most common primary brain cancer in adults. Primary brain cancers are tumors that grow from within the brain. Glioblastomas belong to the family of gliomas, they are cells that are related to glial cells, that connect cells within the brain that have supporting function. Whenever these cells become cancerous they can have different appearance under the microscope and get different diagnoses.  :22

Holdhoff says glioblastoma usually isn’t treatable with surgery alone.

Holdhoff: These are cancers that grow with extensions into the surrounding tissue, surgery will take out part of the tumor, the challenge is that there’s always some additional part of the tumor left which means additional treatment to go after those cells that are left over.  :11

At Johns Hopkins, I’m Elizabeth Tracey.

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box-of-statin-tabletsThis week’s topics include football and CTE, discontinuing statins, intramuscular HIV meds, and long term risks of stroke and TIA.
Program notes:
0:32 Stroke and TIA risk
1:35 Adverse outcomes five years later
2:35 Be aggressive about managing risk
3:24 Statin discontinuation risk
4:24 Those who continued 12% had a stroke
5:25 Driven by internet
5:48 Football and CTE
6:46 About 87% of all
7:46 Right now we need to reduce this injury
8:06 Intramuscular injection of HIV meds
9:06 Domestic compliance versus international
10:37 End
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Anchor lead: The US attorney general has revealed a crackdown on some opioid treatment centers, Elizabeth Tracey reports

Imagine seeking help for your opioid addiction, only to be sent off to an out of state treatment facility where bogus treatment practices are employed. That’s been the sad reality for some, and now the US attorney general has revealed a crackdown on such centers. Eric Strain, an expert on drug dependency at Johns Hopkins, says many treatment centers do fine work, but some caveats are in order.

Strain: Clearly there are programs now that are catering to providing services, and we’ve seen these on television ads late at night. This is where family members need to be careful, I think we need to watch what is the outcomes that these programs can have, to ask them for data on their outcomes, to look at how long these programs have been established. There are certainly residential programs that have been in existence for literally decades that have good track records of success, can point to those track records and are established in the community.  :32

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: If typical antidepressants don’t work, adding another type of medicine may help, Elizabeth Tracey reports

In people with depression that doesn’t respond totally to the usual antidepressant medications, adding another type of drug known as an atypical antipsychotic may help, a recent study found. Eric Strain, a psychiatrist at Johns Hopkins, says adding a medicine that works via a different mechanism is an idea that’s been increasingly popular.

Strain: There are patients now who get put on antidepressants who respond to the antidepressant but don’t have a full therapeutic response. And I think the field is moving forward now with the idea that we shouldn’t be complacent if somebody is 70 or 75% better, that we need to be thinking about what can we do to get them back to 100%? So that’s where I start to think about using a second agent that has perhaps a different mechanism of action to augment the foundational antidepressant that they’re on.   :31

Strain says there is no substitute for clinical experience in use of additional types of drugs to those with treatment resistant depression and that the strategy is well worth trying. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Will Maryland’s new law to prevent generic drug price gouging spread nationally? Elizabeth Tracey reports

Should pharmaceutical companies be able to raise the price of generic drugs by thousands of percentage points overnight, in the absence of any increased costs on their part? No, the state of Maryland asserts in a new law. Jeremy Greene, one author of a perspective on the law in the New England Journal of Medicine from Johns Hopkins, says such state actions are increasing nationally.

Greene: We witness the Maryland law as part of the increasing wave of action on the part of the states to take steps to address this increasing problem of escalating drug prices and drug spending. States have seen a substantial portion of their budgetary increase go towards drugs over the past decade, certainly states as actors have become increasingly sensitive to drug prices. We have seen several years now of discussions of drug prices on a federal level that have not led to conclusive actions to actually close these loopholes.  :32

At Johns Hopkins, I’m Elizabeth Tracey.

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