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Anchor lead: Do you need two different medicines if you have a stent placed in your heart? Elizabeth Tracey reports

When stents are placed in the heart’s blood vessels, medicines called antiplatelet drugs are used to prevent blood clot formation. Now a new study shows that for many, the traditional two medicine approach after stent placement may not be needed. Michael Blaha, a preventive cardiologist at Johns Hopkins, explains.

Blaha: It used to be considered standard of care that you had to be on two different antiplatelet drugs, aspirin and another drug, for at least twelve months after stent placement, but we’re now realizing that there are groups of patients that may not need to stay on dual antiplatelet therapy as long, may need to have a course of aspirin let’s say three or six months, and then continue on another antiplatelet drug alone for an extended period of time to prevent that stent from creating blood clots.  :25

Blaha says the big advantage to dropping the aspirin is that aspirin is known to increase bleeding risk. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Will San Francisco’s ban on e-cigarettes get the FDA to step up? Elizabeth Tracey reports

Tobacco products fall under the purview of the FDA, but the agency has been slow to act in regulating them, including e-cigarettes. Now that San Francisco has outlawed the devices, Michael Blaha, a preventive cardiologist at Johns Hopkins, says the agency may be spurred to action.

Blaha: One interesting thing about this approach that San Francisco has taken is they said they’re going to ban electronic cigarette sales for only those products that haven’t been approved by premarket approval by the FDA. The catch is no products have been approved by the FDA to date, so this effectively bans the sales of all electronic cigarette products. This is a nudge to the FDA that they have to move faster to create a regulatory framework for electronic cigarettes, so we can really know which products might create a health benefit and which ones  are clearly harmful.  :32

Blaha says regulation by the FDA is important in imposing constraints where they are needed. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What are the implications of the new law to ban e-cigarettes in San Francisco? Elizabeth Tracey reports

E-cigarettes will not be sold in San Francisco if a new law takes effect. Michael Blaha, a preventive cardiologist at Johns Hopkins, says at least one at risk group from the devices will likely benefit.

Blaha: The city of San Francisco has chosen to ban the sales of electronic cigarettes to all individuals. And this also covers flavored tobacco products as well as the online sale of electronic cigarettes with their shipment to San Francisco. And I think this is really a good thing from the perspective of signaling that electronic cigarettes are a big problem, particularly when it comes to youth use, use by young people who’ve never used a tobacco product before but perhaps are using electronic cigarettes as their first tobacco product. :29

Blaha says use of e-cigarettes among teenagers is common and growing, so efforts to stem this addiction are needed. He notes that such a ban may also prevent smokers of traditional cigarettes from using the devices in quit attempts. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Stopping routine cancer screening is an option for some, Elizabeth Tracey reports

Sometimes it is appropriate to stop routine cancer screening, since all screening tests are associated with harms as well as benefits. Nancy Schoenborn, a geriatrics expert at Johns Hopkins, looked at attitudes toward stopping routine screening of both care providers and patients, and found patients welcomed advice from their doctor.

Schoenborn: For the patient who may not want to continue screening, to give them permission to stop, so that they don’t feel obligated, that they’re disobeying a recommendation from their doctor.  :12

Schoenborn says it’s also important to understand what patients are understanding about stopping screening.

Schoenborn: What do the patients actually think of these guidelines? Does that make sense to them, does that resonate with them? We’re trying to find patients’ preferred ways for clinicians to have these conversations.  :12

Schoenborn hopes this and further studies will help inform both clinicians and patients so the best individualized approach can be taken. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: When is it appropriate to stop routine cancer screening? Elizabeth Tracey reports

Cancer screening may entail some risk, and for some people, it may be appropriate to discontinue the practice. According to the American Cancer Society, those with less than 10 years of expected life remaining are one such group. Nancy Schoenborn, a geriatrics expert at Johns Hopkins, and colleagues, examined the perspectives of both patients and physicians on the issue.

Schoenborn: At some point for a certain patient the harms of cancer screening and the harms of detecting and the follow up testing related to a positive result, all that and just the burden of getting to the screening test and undergoing it, the harms and the risks and the burdens at some point may outweigh the benefit and I think that it should be at least discussed whether for that patient it still makes sense to continue.  :30

Schoenborn says thoughtful discussion helps both sides reach a decision. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Are blacks more likely to develop lung cancer if they smoke than whites? Elizabeth Tracey reports

Blacks who smoked less than whites as measured by pack years of smoking were still at risk to develop lung cancer, a recent study found, but would have been missed by current screening guidelines. Otis Brawley, professor of oncology and epidemiology at Johns Hopkins, says it’s a mistake to view these findings as evidence of increased risk based on ethnicity.

Brawley: Ninety, ninety-nine percent of the time that we have looked at a disparity it has been social or economic. There are biologic differences amongst populations, but those differences rarely parallel racial differences. Area of geographic origin can play a role, but race in itself is not a biologic categorization.  :26

Brawley notes that when a complete assessment of risk factors is made, those based on ethnicity largely disappear, so he advocates for such an approach to individualize care. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Are cigarettes more toxic for blacks than other ethnic groups? Elizabeth Tracey reports

Smoking causes lung cancer, and it may be more dangerous for blacks than for whites, a recent study found. Otis Brawley, professor of oncology and epidemiology at Johns Hopkins, describes the findings.

Brawley: It seems like in black Americans the number of pack years to get lung cancer is lower than in white Americans. A pack year is a pack of cigarettes per day for one year. They don’t realize that there’s a literature out there that a pack year as a measurement of smoke inhalation varies by socioeconomics, varies by culture. :30

Brawley notes that some groups inhale more deeply and smoke their cigarettes more completely, and may therefore experience more of the toxic effects of smoking. He cautions that making assertions of risk based on ethnicity is often disproved when other factors are identified. At Johns Hopkins, I’m Elizabeth Tracey.

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