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The CMG Voice

What are “right-to-try” laws?

Posted Monday, February 12, 2018 by Tyler Goldberg-Hoss

Recently, in his State of the Union speech, President Trump voiced support for a pending federal “right-to-try” bill.

Currently, there are approximately 33 states that have enacted similar laws (Washington thus far as not), which remove legal obstacles for terminally ill patients to get treatments that have not yet been approved by the FDA. Many of the remaining states are also seeing legislative efforts to enact similar legislation.

For the terminally ill patient, when options for treatment have become quite limited, the argument seems quite simple. If I am already going to die with the treatment options currently approved, why shouldn’t I have the right to attempt to save my life with other possible treatments. While the treatment may not be approved yet – and it may never be approved – it gives me a chance I otherwise don’t have.

However, the issue is more complex than just that. First, some bills as written may be too broad, including more patients than just those with terminal illnesses. Second, under at least the proposed federal legislation, the right-to-try scheme would eliminate the FDA completely from the transaction, sot that doctors and patients work directly with drug makers.

This is important because without the FDA, there would be no regulatory body to protect patient safety, and the opportunity is there for drug makers motivated by profit to put patients at unnecessary risk of harm. When such drugs have not been approved for use, there is not a full understanding of what the drug may do. So patients are not going to be fully apprised of the possible risks of taking the drug, let alone the potential benefits. Terminal patients may thus become willing guinea pigs of the pharmaceutical industry.

Further, the FDA currently has its own way of allowing terminally ill patients to access drugs that have not yet been fully vetted. Through its Expanded Access program, most all terminally ill patients are approved for access to experimental drugs already. The application process was streamlined in 2015, and one can get expedited approval over the phone in cases of emergencies.

Certainly, anecdotal stories are powerful motivators for legislatures to support such laws. However, there are regulatory processes in place (at least currently) for a reason, and without them all patients are a risk of harm, even those with nothing to lose.

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Is exercise really good for the brain?

Posted Thursday, February 8, 2018 by Tyler Goldberg-Hoss

Recently, the American Academy of Neurology recommended for the first time that their members should recommend regular exercise to patients with Mild Cognitive Impairment (MCI).

However, another study looking at the possible benefits of exercise on the brain found that there was not enough empirical support for that claim.

So who is right?

At this point, it seems that regular exercise is good for lots of other things, including cardiovascular health. So you should exercise in any event. And even if exercise doesn’t directly positively affect the brain, at least indirectly it does. Consider, if you have a healthy heart and good blood flow in the body, that means good blood flow to the brain. One would think that would be better than poor flow and poor brain perfusion.

And there is little downside to recommending exercise in most cases – it can’t hurt, right?

More than anything, this apparent conflict in the medical community has as much to do about how much proof one needs to make such a claim. My guess is neurologists are not going to be faulted for suggesting exercise, whether or not it is the miracle cure for cognitive decline.

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Does Coffee Prevent Liver Disease?

Posted Monday, February 5, 2018 by Gene Moen

We have written another blog post regarding a meta-analysis of studies focused on various possible health benefits of moderate coffee consumption. Here is another one, which may cause readers to wonder whether we are part of the Starbucks public relations team. A recent article in Medical News Today focuses only on coffee and the liver. The conclusion: the evidence is very strong that consuming 4 cups of coffee a day keeps the liver doctor away.

The article was about an event held at the Society of Medicine in London, chaired by Prof. Graeme Alexander, a senior advisor to the British Liver Trust of University College London. At the event, there was discussion about the rise of liver disease: an estimated 31,000 people in the U.S. die each year from cirrhosis. This is presumed to result from excess alcohol, calorie, and fat intake. And a major problem with liver disease is that it is often non-symptomatic, which means it is often undiagnosed until treatment is not effective.

Dr. Alexander stated about this problem “Liver disease is on the rise across Europe, and it is important that we understand how coffee, one of the most popular drinks in the world, and diet affects the disease.” Research papers discussed at the conference included one that suggested that coffee drinking, versus no coffee consumption, is associated with a 40% reduction in liver cancer risk. Another study found a 25-70% reduction in liver cirrhosis risk.

While recognizing that coffee may be good for the liver, there is uncertainty as to “why.” As one participant asked “How does coffee weave this hepatic magic?” There are some theories bouncing around. One is that caffeine might be involved, with a focus on paraxanthine (one of caffeine’s main metabolites). It decreased the synthesis of connective tissue growth, which in turn may decelerate the development of liver fibrosis, alcoholic cirrhosis, and cancer.

A major problem with this theory is that consumption of tea – which also contains caffeine — does not seem to have the same liver benefits as coffee. Another theory points to other constituents of coffee (kahweol and cafestol) because there is some evidence that these compounds may provide some anti-cancer effects.

There may be a range of compounds and mechanisms involved which benefit the liver, and whatever the scientific explanation, many researchers now think that having a few cups of coffee every day is just what your liver wanted for Christmas.

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In home primary care visits hope to improve health care, save money

Posted Tuesday, January 30, 2018 by Tyler Goldberg-Hoss

As many of us know, health care in our country is not perfect. One problem involves access to primary care, and the corresponding problem of people with non-emergent health care needs resorting to the local emergency department for help.

Concurrently, there has been an increase in the availability and use of technology in health care, including telemedicine – the ability to provide care to patients remotely. This has been the subject of recent blog posts here and here.

In this context, a community health center in Washington, D.C. has started a pilot program which brings primary care services to the homes of folks who can’t or won’t make it to primary care visits, and who are risks to use the local ER instead.

As described in a recent NPR article, a medical assistant goes to a patient’s home with a suitcase full of equipment to check his vital signs, and with a laptop which connects virtually with a doctor in another part of town. The medical assistant takes and records the patient’s blood pressure and pulse, weighs him, and listens to his lungs. While this is going on, a doctor is “seeing” the patient through the laptop, considering the new vital signs, and recommending treatment.

The purpose of such programs is at least two fold. First, health care organizations want to figure out a way to provide preventative care services to patients who either can’t make such visits (whether due to mobility, work, childcare, or some other reason). Offering in home telemetry-based services will hopefully make the population healthier.

Second, it will save money in the long run, not only as a result of a healthier population, but also with a reduction in the amount of non-emergent ER visits.

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Americans have low opinion of health care offered, ability of government to fix it

Posted Thursday, January 25, 2018 by Tyler Goldberg-Hoss

A recent poll found that 48% of Americans named health care as the top problem for the government to focus on in 2018. However, of those who named health care the top problem, 70% of them had little to no confidence that government will make improvements.

Reasons for dissatisfaction include particularly the cost of insurance and what that insurance actually covers. Many Americans still cannot afford even the most basic plans, and those who can afford a plan often need procedures that are not covered by it.

You can read an article on this new poll here:

In new poll, health care is the issue that won’t go away

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