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Anchor lead: Even paying people to make more healthful choices may not work, Elizabeth Tracey reports

Paying people who are at risk to develop diabetes, are overweight or who smoke cigarettes to make lifestyle changes to reduce their health risks didn’t work, a recent study in JAMA Internal Medicine found. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says these choices are difficult to impact, and paying or incentivizing people is just one tool.

Davidson: These are just not physical problems. These are psychological and social problems. Social problems are health problems. I think incentivizing people to lose weight, stop smoking, really fails to address the real reason why people do these things. This is often very driven by biological processes around pleasure seeking that become very socialized. These issues are much more complex than anybody ever thought about.   :30

Davidson thinks incentives plus personalized approaches are most likely to result in success. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Medication may help people with cancer avoid blood clots, Elizabeth Tracey reports

Apixiban is the name of an anti-blood clotting medicine that’s been used for some time in people with heart disease. Now a new study shows it can help people with some types of cancer avoid blood clots. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says about 10% of those with common cancers like breast or prostate may experience blood clots, which can be life threatening.

Nelson: With apixiban that was reduced to 4.2%. The major concern of any medicine you take to prevent blood clots is that you might bleed. Significant bleeding occurred in 3.5% of the apixiban treated folks and 1.8% of the placebo, so it’s effective, there is a little bit increased risk of bleeding and that’s the kind of calculus a physician can use to make recommendations as to whether an individual with a solid organ cancer is at a high enough risk to clot or high enough risk to bleed to make a choice whether or not to use a drug like this.  :31

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Opioids really aren’t always best when it comes to pain, Elizabeth Tracey reports

When it comes to pain treatment, opioid medications are best, right? Wrong, a recent study in the Journal of the American Medical Association found. The study found that for pain that is not related to cancer, opioids may not be effective while other types of treatments will. Eric Strain, a drug abuse expert at Johns Hopkins, says that’s all to the good.

Strain: We know now that opioids are not the panacea for all chronic pain conditions. Clearly there are some patients who do well on chronic opioids for chronic pain. We shouldn’t throw the baby out with the bathwater in that case. But there’s a lot of patients who develop side effects from opioids, and they may respond well to other non-opioid interventions, physical therapy, ice, medications that are not opioids for the treatment of their pain. And there’s a growing recognition of that.  :31

Strain says many patients now are asking their physicians for alternatives to opioids. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What are the possibilities when it comes to medicines for addiction? Elizabeth Tracey reports

As deaths from opioids continue apace, figuring out how best to help people overcome addiction is more important than ever, with one recent study comparing the cost effectiveness of a monthly injection called naltrexone versus a combination daily oral formulation, with the monthly injections emerging as less cost effective. Eric Strain, a drug abuse expert at Johns Hopkins, says they do have a place.

Strain: I think there’s a very important role for monthly injections of naltrexone, an opiate antagonist. I think it’s an effective medication, and I think it addresses nicely the adherence issue, so I am strongly in favor of it. Not at the expense of daily buprenorphine doses or methadone doses necessarily but I think it should be strongly considered as one of a multitude of treatment options.  :25

Strain says having a number of options is especially important as one size most certainly does not fit all when it comes to helping people overcome opioid addiction, which often requires multiple attempts. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: The opioid addiction medicine naltrexone may work best when used in a monthly injection form, Elizabeth Tracey reports, but may be expensive

What is the best medication to help people who are addicted to opioids stay off the drugs? There is a monthly injection called naltrexone, which interferes with the high people get when they misuse opioids, and which is also available in a daily form.  Eric Strain, a drug abuse expert at Johns Hopkins, says the monthly injection has advantages.

Strain: When we look at cost/benefit analysis and daily versus monthly dosing I think there are a number of different factors that we need to consider. One is the adherence to taking the medication. Another is the risk of misuse of this medication. The value of the once monthly injection is virtually no diversion in this use of the medication, and adherence is good. So for those reasons there may be value to a once monthly injection that counterbalances those cost considerations. :29

Strain notes that previous research has shown that people often stop taking the daily form of naltrexone after only a few days of use. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Preventing infection with Mgen is the best way to avoid it, Elizabeth Tracey reports

Mgen is shorthand for Mycoplasma genitalium, a sexually transmitted bacterial infection that can cause severe problems in women, including pelvic inflammatory disease and infertility, and for which there is currently no commercially available diagnostic test or effective treatment. And it’s being found more and more often. Yikes. Yet Maria Trent, a sexually transmitted infections expert at Johns Hopkins, says there is something you can do.

Trent: People can protect themselves, so many people are like there’s no test, there’s resistance to the common antibiotics, what can I do? Prevention is critically important. People can use condoms particularly if they’re not in a monogamous relationship or they have more than one partner using condoms can really be protective in terms of the prevention of sexually transmitted infections not only of Mycoplasma but all the others. There’s some data that suggest that it can restore vaginal health for women.  :29

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new drug resistant sexually transmitted infection may be cause for alarm, Elizabeth Tracey reports

Mycoplasma genitalium , or Mgen for short, is a bacterial infection transmitted sexually that’s being identified more and more often, at least when it is looked for. Maria Trent, a sexually transmitted infection or STI expert at Johns Hopkins, is advocating for widespread testing for the bug, starting now.

Trent: Based on what we know so far it can cause significant urethritis or inflammation of their urethral tract in men, that it’s hard to treat. In women it’s associated with pelvic inflammatory disease. I think we’re really concerned about those complicated infections because PID really does put women at risk for ectopic pregnancy, tubal infertility, chronic pelvic pain, and as a nation we have a priority to preserve fertility in young women.   :26

Trent says right now Mgen is not a reportable disease like gonorrhea or syphilis, so more reliable data regarding just how widespread it is is lacking. Also lacking is a commercially available diagnostic test and effective treatment, so for now, prevention is the best course. At Johns Hopkins, I’m Elizabeth Tracey.

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