Here’s a look at a few health in the news stories recently you may have missed. There are also some positives in the middle of the murkiness we typically see reported.
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Apaluptamide Approved For Prostate Cancer
The UK’s NHS agency NICE (the National Institute for Health and Care Excellence) is not always NICE. The media often covers stories of medications being turned down for NHS use in the UK and inappropriate or unpopular guidelines. One of those stories is below, relating to a petition to have NICE re-evaluate their guidelines for chronic pain treatment. However, there are the odd positives amongst these stories that can be missed. One is the green light for a new treatment for prostate cancer.
Apalutamide (brand name Erleada) is the “second novel hormone therapy” and one for men with advanced prostate cancer who are not suitable for or responsive to chemotherapy or other hormone treatments. NICE suggest around 8,000 men in the UK could benefit from this drug being made permanently available to patients on the NHS after years of appraisals.
Until now, the choice of treatments has been very limited, with previous options like chemo not always tolerable, let alone successful. While not a cure, Apalutamide has been shown able to help control the condition or perhaps even extend the anticipated lifespan of patients taking it, giving them more time to spend with their families and live their lives with the condition better managed.
You can read more about Apalutamide and prostate cancer here.
Petition For NICE To Review Their Cruel Chronic Pain Guidelines
The so-called “opioid epidemic” has swept up parts of the world like the UK and US, and frustratingly the media attention and assumptions being made are having a severely detrimental impact in healthcare and on chronic pain patients.
Media and medical bodies are often confusing chronic pain patients appropriately taking prescription opioids, with individuals without pain addicted to opioids and often adding them alongside illegal drugs like heroin. The “opioid crisis” then refers to all individuals on opioids as though they’re in the same bracket, which they are not. It increases stigma, misunderstanding and ignorance, both in wider society and within healthcare. The potential knock-on problems could be anywhere between bad and fatal. I’ve written previously about why the so-called opioid crisis is dangerous for those with chronic pain.
In an effort to improve their image by reducing their figures for opioid prescriptions, healthcare services are drawing up inadequate alternative treatment options while healthcare workers take it upon themselves to reduce or remove prescriptions from patients.
In the UK, NICE revised their chronic pain guidelines in 2021. I wrote to them with my thoughts during their phase of debating the guidelines. It seems I, and all other chronic pain patients who had given their input, was ignored.
NICE are focusing on alternative therapies such as CBD and acupuncture for chronic pain, particularly where there’s no textbook root cause of the pain, such as when considering a condition like fibromyalgia. Even with other pain conditions, for instance arising from nerve damage, it’s likely the focus will be away from prescription pharmaceuticals.
This is all very well if the patient needs are taken into consideration. Sadly, it appears that’s not often the case. For many individuals with chronic pain, opioids are a last ditch option to keep them just about functional enough to get the basics done each day. There’s a reliance on the medication because it’s needed, not because there’s an addiction or a psychological attachment to it. Without that medication, pain can be intolerable, unbearable and incredibly debilitating.
For many with chronic pain, myself included, opioids are a literal life-saver. Taking this away wouldn’t just be cruel, it would be knowingly damaging and potentially life-threatening. This is the problem when big decisions are made by people who don’t have a clue what they’re dealing with and won’t be hurt by the fallout of their actions.
There’s a more recent petition that is desperately in need of thousands more signatures to ask for the NICE guidelines to be reviewed. 10,000 are required by September 2022 if there’s any chance for it to be considered. If you agree with this, you could make a difference with just your signature, so it would be greatly appreciated if you could sign and share.
Please take a look at the chronic pain petition to sign and share here.
Long Term Paracetamol Use Linked To Cardiovascular Risk
Paracetamol (acetaminophen in the US) has often been touted as a safe, all-rounder when it comes to colds, pain, illness, headaches and fever. Individuals may use it short or long term, but there are people, myself included, who find it does nothing for them. Many studies have been positive on its use and few have looked at the potential dangers of longer term use.
A more recent long-term study, albeit a small one of 110 participants, has concluded daily paracetamol can increase the risk of heart attack and stroke by 20%. Regular paracetamol use over time in this study has been defined as 4mg of Paracetamol every day (which could mean 8 standard tablets depending on the strength).
The participants were those with high blood pressure, and after just a couple of weeks on paracetamol 4 times a day, or 4mg in total, blood pressure had increased compared to a placebo group. Hypertension (high BP) can lead to serious illness and complications, including heart attack and stroke.
The researchers note the findings suggest more discussion should be had between doctors and their patients who take paracetamol regularly over an extended period of time, with more caution for those at risk of cardiovascular issues by weighing up any potential benefits versus risks.
You can read more about the study and implications here.
Multiple Sclerosis Treatment Breakthroughs
Immune cell implants may have shown promise as a potential treatment for Multiple Sclerosis (MS) in the future, with results showing slowing or even reversal of the condition.
24 individuals with MS were implanted with t-cells targeting the Epstein-Barr virus (EBV) that causes glandular fever (also referred to as ‘mono’). Those immune cells (referred to as ATA188) were taken from patients who had successfully overcome the virus and were given to the MS patients via injection.
20 out of the 24 MS patients reported a benefit after a year in terms of improvement or stability of their condition. 18 of the participants were followed up for around 3 years after treatment to monitor any changes, with “sustained disability improvement” found. After 3 years, 9 participants were found to have improvement visibly confirmed on their brain scans, which could suggest a potential for reversal of the condition with such a treatment and a link to EBV as a causal factor in MS. Nonetheless, it was a small study and full details on doses given or the mechanics of improvement were not specified or fully understood.
In other MS news, a new drug diroximel fumarate – known by the brand name Vumerity – has been given the go-ahead for use in the UK. This is a pill taken twice a day for those with relapsing remitting multiple sclerosis, believed to be a more stomach-friendly alternative that works as well as similar disease-modifying therapies. It contains the same active ingredient as the treatment Tecfidera does, but the different chemical structure appears to be better tolerated by patients.
The UK Medicines and Healthcare Products Regulatory Agency approved Vumerity in 2019, and NICE green-lighted it for use in April 2022. This means the treatment should now be available for patients on the NHS in England and Wales. It’s hoped that a decision for N.Ireland should follow shortly.
You can find out more about this latest MS treatment here.
Instant Insulin & An End To Diabetes Fingerprick Testing?
A “blisteringly brilliant” trial of a new high tech device could pave the way for a new method Type 1 Diabetes management.
A device is implanted under the skin with sensors to constantly measure glucose levels, doing away with the need to do routine fingerprick testing. If required, the device will then instantly administer a dose of insulin to the bloodstream, mimicking the job of the human pancreas. Not only could this do away with the need to undertake routine fingerprick testing, it could help prevent potentially life-threatening hypoglycaemic attacks by constant monitoring and not allowing sugar levels to drop too low.
You can read more about the ‘artificial pancreas’ development here.
Calcium Supplements Linked To Heart Damage
Calcium is important for all humans for strong, healthy teeth and bones, as well for muscles to move and nerves to send messages throughout the body. Supplementation is often sought by individuals or prescribed by doctors if a deficiency is found, and the NHS also recommends vitamin D and calcium together if the patient’s diet “isn’t as good as it should be”. It’s also used by many individuals with thin bones and at great risks of breaks and fractures. Some of these will be older adults, but even individuals under 40 can have osteopenia and osteoporosis, myself included before I was even 28 years old.
Taking calcium is typically seen as safe, but excess calcium in the body is known to be potentially dangerous, putting more strain on the kidneys to filter it. New research has indicated suggested calcium could have negative ramifications for heart health.
Previous research has noted some curious concerns with high levels of calcium but it hasn’t been robust or overly enlightening. In 2019, Massachusetts’ Tufts University look at the medical records of 27,000 adults in the US and discovered a link between higher doses of calcium and cancer. In 2010, a review in the BMJ (British Medical Journal) discovered significantly higher rates of heart attack in individuals using calcium, though the causal factors weren’t investigated.
In recent research, Ohio’s Cleveland Clinic Foundation followed 2,650 patients over a 5 year period. All individuals suffered with aortic stenosis, a condition that’s thought to affect 40,000 people in the UK, whereby the heart’s aortic valve doesn’t open adequately. This consequently reduces the flow of much-needed oxygen-rich blood around the body.
Within this pool of patients with aortic stenosis, those taking calcium (with or without Vitamin D) were found to be at twice the risk of fatal heart problems, compared to those who didn’t take calcium supplements. Not only did calcium supplementation double the chance of dying from heart problems, it put them at a 48% higher risk of requiring valve replacement surgery and 31% higher risk of dying from any cause.
Findings should be taken with caution as the study was relatively small without the controls required to definitively state a causal relationship or to what degree. It does suggest that the benefits of calcium should be more thoroughly evaluated as those with underlying heart problems face greater risks with supplementation. Future research is likely to focus on this issue further, along with evaluating the risks of calcium supplements available OTC generally.
At present, there’s uncertainty as to how beneficial calcium supplementation really is for those with osteoporosis. With supplements often containing high doses of this mineral, please speak to your doctor before supplementing or if you’re currently on supplements and have any concerns.
You can read more about this research into calcium and heart problems here.