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assorted medicine pills on black background with reflections

This week’s topics include hospital factors relative to readmission, hormone therapy, lymph node dissection in breast cancer, and the cost of bringing a new drug to market.

Program notes:

0:32 Cost of R and D versus profit in new drugs
1:32 Took 7.3 years
2:35 Reaping in sales far outstrips R and D
3:32 R and D with federal dollars
4:00 What is the long term impact of HRT
5:00 Should be reassuring for women
5:36 Lymph node dissection in breast cancer
6:36 Increases risk of complications
7:32 Least amount of therapy to be effective
7:48 Hospital factors in readmission
8:45 Patients readmitted to different hospitals
9:45 Need to correct poorly performing hospitals
10:31 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/09/18/drug-costs/

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Anchor lead: What is the best blood pressure? Elizabeth Tracey reports

What’s the best blood pressure to target in someone who has high blood pressure? That question has been avidly investigated for some time, and now a trial known by the acronym SPRINT may have provided an answer. Gregory Prokopowicz, a blood pressure expert at Johns Hopkins, explains.

Prokopowicz: The SPRINT trial looked a broad cross section of people, people with pre-existing hypertension, or high cardiovascular risk from across the country and Puerto Rico, and basically divided them into two groups, target of systolic blood pressure of 120 or a systolic blood pressure of 140. And the results were fairly dramatic and unexpected. The group randomized to a target systolic of 120 did significantly better than a target of 140, and this flew in the face of the existing trend in the field of blood pressure toward somewhat less aggressive goals. :31

Prokopowicz says there are some people in whom trying to lower blood pressure to 120 may come with too many side effects, so talk with your doctor. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Just how much blood thinning do you need? Elizabeth Tracey reports

If you have heart disease you may already be taking aspirin daily. Now a major new study known by the acronym COMPASS shows it might be wise for you to take another drug in addition to aspirin. Michael Blaha, a cardiologist at Johns Hopkins, explains the findings.

Blaha: Currently we treat these patients with aspirin alone. We always thought the addition of something like an antithrombotic drug would lead to unacceptable increases in bleeding. But this study showed that a low dose of an antithrombotic like rivaroxaban can reduce the risk of heart attack, stroke, or even death to a greater degree than a mild increase in bleeding. So we think now that there’s a net benefit in patients with stable coronary artery disease to actually thin the blood a little more than we had before.   :29

Blaha notes that previous drugs available for further blood thinning came with a constellation of issues, such as having to closely monitor drug levels to balance risks and benefits. Rivaroxaban is much easier to use, he says. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Using two drugs to lower cholesterol reduces heart disease risk, Elizabeth Tracey reports

If you’ve had a heart attack or stroke, or are at high risk for one, chances are good you’re taking a statin to lower your cholesterol. Now a new study presented at the recent European cardiology meeting adds evidence to the strategy of using more than one drug to accomplish this goal. Michael Blaha, a cardiologist at Johns Hopkins, frames up the issue.

Blaha: If you add an additional cholesterol lowering drug to a statin can you further reduce the risk of heart attack and stroke? Now we have several new trials which showed that adding new cholesterol lowering pills on top of a statin reduced the risk of heart attack or stroke. The new one that’s been recently reported is a drug called anacetrapib. This lowered cholesterol levels by about 17% and reduced the risk of heart attack or stroke by about 9%, adding further evidence to the notion that further LDL lowering on top of a statin leads to benefit in high risk patients. :30

Blaha says while this specific agent most likely won’t be FDA approved, it does support use of a second agent to reduce cardiovascular risk. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: You may not appreciate your sense of smell until it’s gone, Elizabeth Tracey reports

Chronic inflammation of the sinuses can compromise what’s known as the olfactory system, which gives us the ability to smell, but a low level of inflammation allows this tissue to be repaired. That’s the surprising finding of a study by Andrew Lane, an otolaryngologist at Johns Hopkins. Lane says loss of smell can also happen following injury or infection.

Lane: It’s a problem that’s probably not highly recognized, because people don’t necessarily understand for example your sense of taste is mostly smell. What you appreciate as flavor is mostly coming from your sense of smell not really from your tongue. People don’t appreciate while they have it how important your sense of smell is for detecting danger, for social interactions, just enjoyment of good smells in life. For the most part, loss of the sense of smell has very debilitating effects on people.  :27

Lane says his study points to a need to regulate inflammation so normal repair can proceed but chronic destruction can’t. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What can inflammation in the nose teach us about the body repairing itself? Elizabeth Tracey reports

You’re able to smell things because of the work of your olfactory system. Now research by Andrew Lane, an otolaryngologist at Johns Hopkins, shows that for patients with chronic sinusitis, inflammation on overdrive compromises this system.

Lane: The greater problem in patients at least is loss of sense of smell due to inflammation as in chronic sinusitis for example. It’s clear that chronic inflammation is bad for the olfactory system. This paper is about showing how critical inflammation is, at least in the early stages, to beginning the repair process. :19

Lane was surprised that inflammation actually plays a beneficial role in early repair of tissues that allow us to smell.

Lane: In order to understand what’s wrong you have to understand what’s normal. In a way that’s what this study is about is highlighting that inflammation has a normal role and actually a necessary role, in repair.   :10

Lane says the question now is how to regulate inflammation to preserve the good but mitigate the bad. At Johns Hopkins, I’m Elizabeth Tracey.

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036507010-vaccineThis week’s topics include a new antibody for asthma, early treatment in COPD, mumps vaccine to curtail an outbreak, and medical exemptions from routine vaccinations.
Program notes:
0:38 Avoiding vaccines with medical exemptions
1:38 More people who are vaccinated the less likely an outbreak
2:36 Total went down but others are gaming the system
3:23 A third dose of vaccine and a mumps outbreak
4:23 All students had been vaccinated with two doses
5:23 May have been exposed to mumps later
6:22 Currently no early intervention with COPD
7:21 Less likely to have exacerbations
8:01 An antibody in adults with asthma
9:01 Monthly injections
10:29 End
Related blog:https://podblog.blogs.hopkinsmedicine.org/2017/09/07/avoiding-vaccination/
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