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Anchor lead: An even more powerful new gene editing tool has arrived, Elizabeth Tracey reports

CRISPR Cas 9, the gene editing tool, has been in the news for some time now as Chinese and Russian scientists announce editing of human embryos. Now an even more powerful version has arrived, and Jeffrey Kahn, director of the Berman Institute of Bioethics at Johns Hopkins, says we must develop guidelines for its use.

Kahn: It’s called Prime CRISPR and it’s more precise, more controllable. It will offer an even better tool. It’s a very promising and exciting time in molecular biology and applications of that. For human health and we can even talk about agriculture and food production, all sorts of things, where CRISPR and genome editing have applications, but when there’s a tool that’s even more precise and more alluring to use we have to talk about how to create appropriate controls.  :28

Kahn notes that international organizations are addressing this issue but participation is voluntary in the world scientific community. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: As unique therapies are developed, how do we allocate resources to pay for them? Elizabeth Tracey reports

Genetic techniques may soon enable many with sickle cell disease to be cured, but these treatments are very expensive. Jeffrey Kahn, director of the Berman Institute of Bioethics at Johns Hopkins, says one factor in their price is the huge amount of research and development that’s needed, and another is the relatively small size of the group who may need such an intervention.

Kahn: Among the features that are making these things even more expensive is that the population who could benefit from them is increasingly smaller. So these are therapies that can be used by fewer and fewer people. It’s great for the people who had what we used to think of as orphan diseases but that means there are just fewer people to spread the cost among and in some of these cases there are actually individualized therapies so that has to be a custom drug. A custom drug by definition by definition costs more money than one that can be used by millions of people.  :31

Kahn says medical resources are limited so this issue needs careful scrutiny. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How often are women with breast cancer offered genetic testing? Elizabeth Tracey reports

Only about a third of women with breast cancer were offered genetic screening, a recent study found, but such testing is cost effective. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says one of the greatest benefits of testing is for the relatives of a woman with the disease. 

Nelson: The real benefit is if you did that by identifying who were carriers of these genes and then doing cascade testing to their progeny who would also be carriers of these genes, where there are opportunities for prophylactic surgery, other accelerated intensified screening, the thought in the US is that we would prevent 9700 breast and ovarian cancer cases and more than 2400 deaths. It does look cost-effective to just offer all women with breast cancer this kind of germ line screening.  :32

Nelson notes that a lack of genetic counselors may hamper efforts to expand genetic testing. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A combination therapy improves survival for ovarian cancer, Elizabeth Tracey reports

Ovarian cancer survival is improved using a combination treatment developed in a partnership between two pharmaceutical giants, their recent study showed. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the results.

Nelson: In the group that would have gotten the standard of care the median progression free survival was only about 16 or 17 months, whereas if you look at the women with a BRCA defect most likely to respond half of them got out 37 months   :15

Nelson is optimistic about the treatment.

Nelson: It’s pretty clear this was a benefit, a 41% improvement. The benefits were even greater for women who had ovarian cancer that had defective genes of BRCA1 and BRCA2 and related genes, that matches the results of an earlier trial and so I suspect that this is well on its way to becoming the standard of care.   :20

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Diuretics may be your best bet when it comes to managing high blood pressure, Elizabeth Tracey reports

A study of close to five million people who were taking medication for high blood pressure for the first time shows that a class of medicines called thiazide diuretics is most likely best for most. Greg Prokopowicz, a high blood pressure expert at Johns Hopkins, says there are multiple benefits to this type of medicine.

Prokopowicz: Thiazide diuretics have been around since the 1960s. We know very well how they work, we know their risks and benefits and feel very comfortable using them. A lot of patients, I think, react negatively to diuretics because they are afraid they’re going to make them run to the bathroom all the time. In practice with the doses that are used for treating high blood pressure that’s typically not the case.  Now there are some patients who can’t take diuretics because they might affect certain levels of minerals in the blood like sodium or potassium but assuming there are no problems they remain excellent first choices.  :32

Prokopowicz notes that the most important thing is to treat high blood pressure. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: If you have high blood pressure, what is the best medicine to start with? Elizabeth Tracey reports

Drugs known as thiazide diuretics may be the best choice for most when it comes to beginning medication to treat high blood pressure, a recent very large study found. Greg Prokopowicz, a high blood pressure expert at Johns Hopkins, describes the results.

Prokopowicz: Close to five million people were looked at who were taking a variety of different categories of drugs and these were in databases in the US, Japan, the UK. And they looked specifically at people who were taking blood pressure medication for the first time. For the most part they found that the different classes of medications performed comparably but in particular they found that thiazide diuretics, which are a very commonly used class of drugs, performed even better than certain other classes of drugs, notably ACE inhibitors.  :29

Prokopowicz notes that thiazide diuretics are also very inexpensive so should prove affordable for the millions of people worldwide with high blood pressure, a major risk factor for cardiovascular disease. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Home monitoring is the best way to see if your blood pressure medicine is working as well as it should, Elizabeth Tracey reports

Blood pressure medicines should be taken at night to maximize their benefit, a recent study known as the Chronotherapy Trial found. Greg Prokopowicz, a blood pressure expert at Johns Hopkins, says one way to make sure your medicine is working as well as it can be is by monitoring your blood pressure at home.

Prokopowicz: We’ve increasingly come to appreciate the benefits of home monitoring anytime you make any change in blood pressure dosing or the type of medication. One of the issues here is that the main blood pressure measurement they’re interested in is sleep blood pressure, and that’s hard to get because even if you have a home machine it’s going to be difficult to get measurements while you’re sleeping. So typically to do that we do what’s called 24 hour ambulatory blood pressure monitoring, where you wear a monitor day and all night for 24 hours.  :31

Prokopowicz says devices that will enable consumers to monitor their own blood pressure even while sleeping are emerging on the market. At Johns Hopkins, I’m Elizabeth Tracey.