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Anchor lead: Doctors may not be adequately describing risks and benefits of cancer screening, Elizabeth Tracey reports

When people with significant risk factors for lung cancer talked with their doctors about the risks and benefits of screening, those discussions lasted about a minute, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says this study illustrates the changing face of physician-patient interaction.

Nelson: I have found even when I believe adequately informing someone about a choice, very often the response will be I understand these things what would you do? In some ways medicine has evolved from a very paternalistic thing which is you have this problem we need to do this, to here are the options, which one would you like to select? And I think adequately explaining so that the options are understood and then providing an opinion I think both of those are going to be part of the solution.  :29

Many medical decisions fall under the so-called ‘shared decision making’ model, where a fully informed patient participates with their provider to decide a course of action. Nelson notes that such a partnership requires substantial education on the part of both physician and patient. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: With Medicaid expansion, more people are at least filling prescriptions for drugs to help them get off opioids, Elizabeth Tracey reports

Medicaid expansion in a few states has led to an increase in prescriptions for a drug combination called buprenorphine naloxone, intended to help manage opioid addiction, a recent study reported. Eric Strain, a drug abuse expert at Johns Hopkins, offers his opinion.

Strain: Those data are intrigued to see that there’s increased utilization of buprenorphine naloxone in those states where Medicaid expansion occurred. We don’t know if the patients are taking the buprenorphine naloxone what we know is that they’re being prescribed it. We do know that buprenorphine naloxone is diverted into the general community. But I think that removing barriers to access to treatment such as the financing of it, is a critical step, and that’s what Medicaid expansion really is helping with when it comes to substance use disorders.  :31

Strain is in favor of reducing barriers to addiction treatment as much as possible nationally. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Integration with drug treatment is needed when people come to the ED with an overdose, Elizabeth Tracey reports

Emergency departments are well-equipped to handle opioid overdose, but less so when it comes to getting people into drug treatment, a recent report found. Eric Strain, a drug abuse expert at Johns Hopkins, comments.

Strain: We have two factors going on. One is difficulty with treatment capacity and having insufficient treatment capacity for people who want treatment. But another factor that we need to consider is that some people aren’t ready to enter treatment despite our recommendation that they do so.  :16

Even so, Strain favors making sure the offer is always made.

Strain:I think that it would be extremely valuable and critical for emergency departments to develop protocols which allow people to be initiated into treatment for opiate use disorder or any other substance use disorder if they present to the ED asking for that kind of help.  :17

Strain says resources for providing these services must be found. At Johns Hopkins, I’m Elizabeth Tracey.

 

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Anchor lead: Amyloid and Alzheimer’s disease isn’t always important, Elizabeth Tracey reports

Aggressively removing amyloid from the brains of people who had Alzheimer’s disease only slightly slowed their rate of cognitive decline, a recent study found. Constantine Lyketsos, an Alzheimer’s expert at Johns Hopkins, says it’s clear that the clinical entity called ‘Alzheimer’s disease’ may be result of several different processes.

Lyketsos: So at one extreme we have people who are genetically endowed to make too much of this amyloid protein, and these people, as long as they live long enough, will get Alzheimer’s symptoms and they will die from the disease. But we also know that a lot of people who first get dementia at age 80 or 85 there’s probably little relationship with amyloid because by age 80, 85, 90, the brain is full of amyloid anyway for most people so the addition of dementia couldn’t be entirely the result of amyloid.  :30

Lyketsos says that a personalized approach is indicated. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A treatment for Alzheimer’s disease seems to offer modest benefit, Elizabeth Tracey reports

A drug that’s been under investigation for some time has finally produced some modest benefit in removing the substance called amyloid from the brains of people with Alzheimer’s disease and improving their cognition, a recent study found. Constantine Lyketsos, an Alzheimer’s expert at Johns Hopkins, comments.

Lyketsos: The hope is that over time, that benefit although small over the first 18 months, might accumulate and grow, so that at 5 or 6 or 10 years you would have a substantial benefit. So the upshot is the amyloid hypothesis that was almost lying dead is probably breathing a little bit better right now, but we still need to see what’s going to happen. Remember, dramatic removal of amyloid minimal improvement. :27

Lyketsos notes that it seems increasingly clear that the accumulation of amyloid is just one part of the Alzheimer’s development cascade, and one that may not be important for everyone, so identifying who’s likely to benefit is needed. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: While the nation is focused on opioids, other drugs are also causing overdoses, Elizabeth Tracey reports

Heroin is leading the headlines these days when it comes to drug overdoses, especially now that so much of it also contains fentanyl. The latest data from the CDC indicates that 72,000 people died last year of drug overdoses, and fentanyl gets much of the credit. Eric Strain, a drug abuse expert at Johns Hopkins, says even so, our focus on opioids may be misplaced.

Strain: In the latest overdose reports, it’s also the case that cocaine overdoses are creeping up as well. We are very focused right now on an opiate use disorder problem and we’re wrong in that approach. We need to be thinking of this as a substance use disorder problem because otherwise we’re playing whack a mole where we’re addressing opiates but in the meantime we’re going to see cocaine grow, and then in five years we’re going to be worried about our cocaine problem, and we’ll be whacking that as something else increases.   :30

Strain advocates for widespread public education to help people avoid such choices in the first place, and to understand the dangers of illicit drug use, as well as comprehensive treatment approaches. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: New CDC data estimate many more opioid deaths than previously thought, Elizabeth Tracey reports

72,000. That’s the number of deaths related to drug overdoses in the United States in 2017, the most recent data from the Centers for Disease Control and Prevention state. That represents a 10% increase from the previous year, and outpaces deaths from the flu and pneumonia, two big infectious disease killers. Eric Strain, a drug abuse expert at Johns Hopkins, offers his perspective.

Strain: What we’re seeing is the repercussions of the increased availability of fentanyl through illicit means. And so there’s been actually three waves of overdose deaths that we’ve seen over the last fifteen or so years in the United States. The first wave was related to prescription opioids, the second was due to heroin, and now the third is due to fentanyl. And what’s really remarkable is how dramatic that increase has been with fentanyl overdose deaths.  :26

Strain says strategies like providing inexpensive test strips to those who use drugs so they can test for the presence of fentanyl may help in the short term, but must be part of a comprehensive public health education strategy. At Johns Hopkins, I’m Elizabeth Tracey.

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