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The ketogenic diet is a very high fat and very low carbohydrate diet that helps both children and adults with epilepsy control their seizures, and the diet is now celebrating its one-hundredth anniversary. Eric Kossoff, a neurologist and pediatric ketogenic diet expert at Johns Hopkins, says even then, it was known that such a strategy could help.

Kossoff: The diet was created in 1921 so 100 years ago with the idea being that it was going to mimic periods of starvation and fasting. They knew for decades, you might almost argue for millenia, before 1921, that fasting seemed to help this condition. So when the diet was created that was the intention, was that you would be potentially, okay, that was the idea, mimicking a starvation state. What we know now is that it’s much more complicated than that.  :30

Kossoff says why a high fat diet helps may vary between individuals, and notes that up to 20% of those with epilepsy who try it many not need medication at all. At Johns Hopkins, I’m Elizabeth Tracey.

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It’s the 100th anniversary of the so-called ‘ketogenic’ diet, which helps to control epilepsy in children and adults, and can even allow some of them to stop taking medications for the condition. Eric Kossoff, a neurologist and pediatric ketogenic diet expert at Johns Hopkins, describes what such a diet entails.

Kossoff: The diet is a 90+ percent fat diet. And in order to realistically be on a diet like that, most families really do need the guidance of a dietician in terms of measuring and calculating what to eat. Having a gram scale, weighing the foods is how we do the classic ketogenic diet, and there is a version called the modified Atkins diet which we created here at Hopkins, that even with that you’re still measuring carbohydrates per day using a book and keeping track.  :32

Kossoff says if you would like to try the diet, don’t go it alone. Expert advice and monitoring is needed. At Johns Hopkins, I’m Elizabeth Tracey.

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The ketogenic diet, which relies on fats and proteins as energy sources and avoids carbohydrates, actually began 100 years ago as a means to control epilepsy in both adults and children and was also used for a host of other conditions. Eric Kossoff, a neurologist at Johns Hopkins and ketogenic diet expert, says after a lull in popularity, the diet is now more popular than ever.

Kossoff: It is no doubt more work than taking a medicine. Not to say all medicines are perfect, they all have side effects but it certainly is less of an imposing situation on a lifestyle to take a medication. The ketogenic diet, which is a high fat, low carbohydrate diet, no matter which version of the diet you do, requires supervision, it requires often a dietician involved, to help with weighing and measuring and calculating. It’s not easy.  :26

Kossoff says depending on which type of epilepsy one has, the ketogenic diet can actually control seizures virtually entirely, and can work in both children and adults. At Johns Hopkins, I’m Elizabeth Tracey.

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Among doctors who specialize in cancer treatment, only very few broached the subject of end of life decisions with their patients, even when an analysis of recordings of their encounters pointed toward an opportunity to do so, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, examines the data.

Nelson: The trial had something like 141 patients talking and 31 providers at 2 academic centers. When they looked back at 423 encounters, and found that only 5% or 21 involved formal end of life discussions. They did believe that 38% of the recordings that they listened to provided an opportunity for an end of life discussion that may have been missed.  :24

Nelson says in his own practice he begins a discussion of end of life preferences at the very first visit, before such decisions really must be made. He advises patients to bring up the issue themselves if their physician doesn’t do so, so that their wishes are known. At Johns Hopkins, I’m Elizabeth Tracey.

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Bringing a new drug or biological agent to market is extremely expensive, a fact many manufacturer’s cite in pricing. Now a new study points to the fact that new agents are also very expensive in terms of human capital. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, explains.

Nelson: They ended up looking at 120 drugs and biologics. Thirteen of these secured FDA approval within this eight year span.  They found that almost 160,000 people had to be enrolled in more than 1300 clinical trials testing the agent, almost 48,000 in trials that led to approval, almost 111,000 in trials that didn’t lead to approval, and so they took a guess that there’s about 12, 217 participants in clinical trials per approved drug.  :30

Nelson says a single participant can cost between $10,000 to $100,000 to enroll and follow in a clinical trial. At Johns Hopkins, I’m Elizabeth Tracey.

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Clinical trial results are required by federal law to be posted within two years of a trial’s conclusion, with data available on a website called ClinicalTrials.gov. A recent study looked at how often researchers are complying. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says that number is just over half.

Nelson: Among the 7400, 7500 trials that did have their results reported, 38% of them were posted only on ClinicalTrials.gov, they did not appear in a scholarly publication. And I think what that probably is meaning is that ClinicalTrials.gov, as a registry function, may start to be a place where you can find trials results, even if the findings weren’t earthshattering enough to get into a scholarly publication. I think that’s probably where we’re headed.  :28

Nelson notes that even so-called ‘negative results’ are important in informing both the research community and the public about what doesn’t work, so moving toward 100% registration of results is an important goal. At Johns Hopkins, I’m Elizabeth Tracey.

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Black women often experience breast cancers that are more advanced at the time of diagnosis, and may be more difficult to treat. A recent study looked for the presence of different genes among Black and white women with breast cancer to perhaps explain this. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: They looked at a really large amount of data from a large consortium where the contributors were women with breast cancer back from 1993. These were women diagnosed with breast cancer, they’re not selected in any way for age, ethnicity, age of onset for breast cancer, whether they had a family history. They had data on inherited gene defects for 12 different breast cancer susceptibility genes that they know of, and the most interesting thing about this in looking for differences between black women and white women is that there aren’t many. It’s sort of a large non-story.  :34

Nelson says these findings suggest that screening and access to care likely are involved. At Johns Hopkins, I’m Elizabeth Tracey.