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Anchor lead: A new vaccine against tuberculosis brings hope, Elizabeth Tracey reports

A new tuberculosis vaccine protects about 50% of the people who receive it from contracting the infection, a recent study in the New England Journal of Medicine found. Richard Chaisson, a TB expert at Johns Hopkins, says this is actually very hopeful news.

Chaisson: For tuberculosis we need a variety of approaches that include diagnosing the people who have it and treating them and curing them, because when they’re treated and cured they’re not going to spread it to anybody else. We need preventive medicines so people who are at risk for getting TB can take medication and they can reduce their risk by up to 90+ percent. But a vaccine is something that would be more broadly applicable to large groups of people who you can’t go out and give drugs to but you can vaccinate them and even 50% protection could be pretty useful.  :32

Chaisson notes that flu vaccines are often only about 30% or so effective, but when large numbers of people are given the vaccine others are also protected, and feels sure that continued research will improve the TB vaccine even more. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a finding in gambling monkeys help people control risk taking behavior? Elizabeth Tracey reports

A specific brain area has been shown to impact a trained monkey’s risk-taking choices, a Johns Hopkins study reveals. Veit Stuphorn, a neuroscientist and senior author, says the finding may ultimately lead to effective treatments for compulsive behaviors, perhaps beginning with a training approach.

Stuphorn: Another and maybe more revolutionary approach would be to directly change activity in the brain. And that’s already being done in deep brain stimulation in very severe cases of certain diseases. In principle this could be done too in people that have very very strong problems in engaging risk in the right way, for example people that have a gambling addiction, or addiction in general can be seen as a case where someone really doesn’t value risk in the right way. However I should say before we start doing this sort of thing we need to understand the system much, much better.   :30

Stuphorn notes that when this brain area was stimulated, monkeys found risk taking much less attractive, reducing their risky choices by 30 to 40%. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: A new study in monkeys helps understand risk taking behavior, Elizabeth Tracey reports

Training monkeys to gamble has identified a new brain region involved in the actual process of choosing to take risks, researchers at Johns Hopkins have found. Veit Stuphorn, associate professor of neuroscience, says the results were really novel.

Stuphorn: We found that when we inactivated this brain region the monkeys systematically made different decisions, so this brain region really is causally involved in decision making, but then secondly, and that came as a big surprise to us, this brain region has a very specific effect. So what it does is the monkeys under normal circumstances like to take risks, so they’re really go for the gambles with big outcomes, even if there’s a very small probability that they’ll get the big outcome, but now when we inactivate SEF, that goes down.  :31

SEF stands for supplementary eye field, and while Stuphorn isn’t surprised by its proximity to brain areas involved in sight, he says the fact that it actually appears to reduce predilection for risk is surprising, and may improve our understanding of risk taking in people. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How can we promote genetic testing among close relatives of those with cancer-related mutations? Elizabeth Tracey reports

Cascade testing is a strategy for testing close relatives of someone with a known mutation for cancer, with a new study showing that if the price was lower, more people would come forward to be testing. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says there are many practical aspects to this.

Nelson: If someone comes in who we see who is a carrier of a gene that confers increased risk for a cancer, many of them are strategies for how they’re taken care of even if they don’t have a cancer, more intense screening, earlier screening, there are a whole variety of maneuvers. Yes, they are counseled fairly aggressively related to the risks of cancers in their first degree relatives and they fill out an Ancestry.com sort of whose mother, whose niece, nephew, etcetera, they are asked to recruit first degree relatives for cascade testing, are recommended that they should do so.  :29

Nelson notes that when cascade testing is a part of a clinical trial or other investigation it is often paid for, and predicts the price tag will decline. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What accounts for an increased risk of cancer in those taking aspirin in the ASPREE trial? Elizabeth Tracey reports

The ASPREE trial, which compared a group of healthy older people taking daily aspirin to another group who did not, found an increased rate of death in those taking aspirin, and this was not only related to the expected bleeding risk, but also to an increased rate of cancer. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says this may be a matter of timing.

Nelson: I would wonder whether aspirin functions to arrest the development of cancers at an early stage and it affects premalignancy more effectively than it does established cancers, but at a younger age might have more benefits because it would head off the cancers and that it does not have a consistent benefit, sometimes even a hazard, in treating people with established cancers.   :21

Nelson speculates that some of the people in the trial may have had very small, undetected cancers at the time. He notes that previous studies using aspirin for colorectal cancer have shown a benefit as have studies on melanoma risk in women, and says the relationship between aspirin use and cancer risk needs to be studied more carefully. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: If you’re at increased risk for a cardiovascular event, statins may be your best prevention strategy, Elizabeth Tracey reports

In the wake of the ASPREE trial, where daily aspirin in healthy older folks didn’t reduce cardiovascular disease but did increase the risk of death compared to the no aspirin group, people taking aspirin should pay attention. That’s according to Erin Michos, a cardiologist at Johns Hopkins.

Michos: Many patients are just taking this on their own because they think it’s over the counter, it’s safe, and there was so much marketing, people thinking oh I need to take an aspirin, it’s good for heart health, and I don’t think people understand the risk of bleeding. And I’m much more likely to recommend a statin, which has a very consistent relative risk reduction for heart disease and strokes, and actually has a very favorable safety profile. I far more endorse statins than aspirin, but my patients. They’re actually more likely to take aspirin than a statin even though the evidence would suggest it’s the reverse.  :32

Michos says an evaluation of the likelihood of a cardiovascular event in the next 10 years is needed before a statin is initiated. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Is there anyone who still should use aspirin daily? Elizabeth Tracey reports

A daily aspirin didn’t help reduce cardiovascular events in healthy older people, a recent large study called ASPREE found. Erin Michos, a cardiologist at Johns Hopkins, says there is still a role for aspirin in prevention of another cardiovascular event in someone who’s already had one, so-called secondary prevention.

Michos: I still use it in secondary prevention in known disease. And I may use it selectively in some primary prevention populations. This wasn’t studied in the trials. If someone had a very elevated coronary calcium score, which is a marker of plaque in their arteries, even if they hadn’t had a heart attack yet I would consider them to be more like the secondary prevention and as long as they’re not at bleeding risk they may consider aspirin in those, but not broadly.  :27

Michos says a personalized approach that takes each person’s risk into account is best. At Johns Hopkins, I’m Elizabeth Tracey.

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