Australian scientists in TB drug breakthrough
March 24, 2010 - 6:59PM
Australian scientists said Wednesday they had discovered a drug which could cure tuberculosis at its non-infectious stage and could be the first major breakthrough on the disease in 50 years.
Bacteriologist Nick West said researchers at Sydney's Centenary Institute had developed a drug which could essentially combat the disease before it takes hold, potentially saving millions of lives around the world.
"We have investigated a protein that is essential for TB to survive and we have had some success in developing a drug that will inhibit this protein," said West.
"Our goal over the coming months is to find out the full extent of this drug's potential."
West said it would be the first time in history that dormant or asymptomatic, non-infectious TB would be able to be treated, potentially stemming a deadly tide of infection which claimed two million lives every year.
"Unfortunately, the antibiotics we use to fight TB aren't effective against latent TB and can only be used when the disease becomes active," he explained.
"This is a major problem as one out of 10 people who have latent TB will develop the active disease, becoming sick and contagious."
"If we can figure out a way to treat TB when it's in a latent stage, then we could save millions of lives throughout the world," West added.
If successful the drug would be the the first new treatment for TB since 1962, according to the institute which is affiliated with the University of Sydney.
One third of the world's population, or two billion people, are estimated to be infected with TB, with the disease growing fastest in South East Asia.
Lethal multidrug-resistant strains of the disease were becoming a serious threat to global health, infecting almost half a million people in 2008, of whom one-third died, the World Health Organisation warned last week.
Almost half the drug resistant cases were estimated to have occurred in India and China, the WHO said, with an extensively drug-resistant form, found in 58 countries, "virtually untreatable".
© 2010 AFP
This story is sourced direct from an overseas news agency as an additional service to readers. Spelling follows North American usage, along with foreign currency and measurement units.
http://news.theage.com.au/breaking-news-world/australian-scientists-in-tb-drug-breakthrough-20100324-qwjt.html
17.3.10
Why doctor does not always know best
Why doctor does not always know best
MICHAEL HOCHMAN
March 17, 2010
Health research priorities should not be determined by corporate agendas, write Michael Hochman and Danny McCormick.
Some doctors treat patients with early-stage prostate cancer with radiation. Others favour surgery, while some advocate only close monitoring. Which approach is most successful? No one knows.
When it comes to diabetes management, doctors do not have answers to key questions: At what point should insulin be started? Is it safe to lower the blood sugar to normal levels? What is the best way to monitor blood sugar control?
Similarly, endocrinologists do not know what is the best way to treat patients with hyperactive thyroids. Doctors in Europe typically use medications, while those in the US more frequently give radioactive iodine. Only limited evidence is available to guide the decision.
It may seem perplexing that there is so much uncertainty about these relatively simple questions. All of the above treatments have been around for decades. Shouldn't we have definitive answers by now?
In The Journal of the American Medical Association last week we reported the results of a study that may help explain why we don't. In the study, we analysed 328 medication studies recently published in six top medical journals and found that just 32 per cent were aimed at determining which available treatment is best. The rest were either aimed at bringing a new therapy to market or simply compared a medication with a placebo. Whether the therapy was better or worse than other treatments was simply not addressed.
Research involving new therapies is, of course, crucial for medical progress, but there is also a need for research that compares the effectiveness of the rapidly growing array of existing therapies and approaches.
So why, then, did only a third of medication studies focus on helping doctors use existing therapies more effectively? The answer lies in the fact that pharmaceutical companies fund nearly half of all medication research, including the lion's share of large clinical trials. For obvious reasons, commercially funded research is primarily geared towards the development of new and marketable medications and technologies. Once these products have won approval for clinical use, companies no longer have incentives to study exactly how and when they should be used.
In support of this claim, we found that 87 per cent of the comparative effectiveness studies we analysed were funded entirely or in part by non-commercial sources, such as non-profit foundations or government institutions. In addition, 91 per cent of studies comparing medications with non-pharmacologic therapies (such as surgery or lifestyle changes) received non-commercial funding, as did 94 per cent of studies comparing different medication strategies (such as different blood sugar targets in patients with diabetes) and 90 per cent of studies comparing the safety profiles of medications. Non-commercial sources funded 100 per cent of studies comparing the cost-effectiveness of different treatments, though only 2 per cent of the studies we reviewed included such analysis.
We believe studies that address fundamental clinical decisions - such as when to use medications versus surgery or how to use therapies more effectively - should be favoured over those that simply compare two alternative medications. There is also clearly a need for more research on the comparative safety and costs of different treatments. Reform is also necessary to ensure that commercially funded research is designed in a way that is more helpful to doctors.
Our study showed that two-thirds of commercially funded randomised trials compared medications with a placebo rather than with another active therapy. Though placebos are appropriate when no alternative therapies are available, in many of the trials we examined, we suspect alternative therapies could have been used instead.
As medical science advances, decision-making will only become more complex. Only by expanding public funding for comparative effectiveness research can we hope to put existing treatments and healthcare services to their best use. Doing so would ensure that research priorities are determined by patient needs rather than by corporate agendas.
Los Angeles Times
Michael Hochman is an assistant professor of clinical medicine at the University of Southern California. Danny McCormick is an assistant professor of medicine at Harvard Medical School.
http://www.smh.com.au/opinion/politics/why-doctor-does-not-always-know-best-20100316-qchi.html
MICHAEL HOCHMAN
March 17, 2010
Health research priorities should not be determined by corporate agendas, write Michael Hochman and Danny McCormick.
Some doctors treat patients with early-stage prostate cancer with radiation. Others favour surgery, while some advocate only close monitoring. Which approach is most successful? No one knows.
When it comes to diabetes management, doctors do not have answers to key questions: At what point should insulin be started? Is it safe to lower the blood sugar to normal levels? What is the best way to monitor blood sugar control?
Similarly, endocrinologists do not know what is the best way to treat patients with hyperactive thyroids. Doctors in Europe typically use medications, while those in the US more frequently give radioactive iodine. Only limited evidence is available to guide the decision.
It may seem perplexing that there is so much uncertainty about these relatively simple questions. All of the above treatments have been around for decades. Shouldn't we have definitive answers by now?
In The Journal of the American Medical Association last week we reported the results of a study that may help explain why we don't. In the study, we analysed 328 medication studies recently published in six top medical journals and found that just 32 per cent were aimed at determining which available treatment is best. The rest were either aimed at bringing a new therapy to market or simply compared a medication with a placebo. Whether the therapy was better or worse than other treatments was simply not addressed.
Research involving new therapies is, of course, crucial for medical progress, but there is also a need for research that compares the effectiveness of the rapidly growing array of existing therapies and approaches.
So why, then, did only a third of medication studies focus on helping doctors use existing therapies more effectively? The answer lies in the fact that pharmaceutical companies fund nearly half of all medication research, including the lion's share of large clinical trials. For obvious reasons, commercially funded research is primarily geared towards the development of new and marketable medications and technologies. Once these products have won approval for clinical use, companies no longer have incentives to study exactly how and when they should be used.
In support of this claim, we found that 87 per cent of the comparative effectiveness studies we analysed were funded entirely or in part by non-commercial sources, such as non-profit foundations or government institutions. In addition, 91 per cent of studies comparing medications with non-pharmacologic therapies (such as surgery or lifestyle changes) received non-commercial funding, as did 94 per cent of studies comparing different medication strategies (such as different blood sugar targets in patients with diabetes) and 90 per cent of studies comparing the safety profiles of medications. Non-commercial sources funded 100 per cent of studies comparing the cost-effectiveness of different treatments, though only 2 per cent of the studies we reviewed included such analysis.
We believe studies that address fundamental clinical decisions - such as when to use medications versus surgery or how to use therapies more effectively - should be favoured over those that simply compare two alternative medications. There is also clearly a need for more research on the comparative safety and costs of different treatments. Reform is also necessary to ensure that commercially funded research is designed in a way that is more helpful to doctors.
Our study showed that two-thirds of commercially funded randomised trials compared medications with a placebo rather than with another active therapy. Though placebos are appropriate when no alternative therapies are available, in many of the trials we examined, we suspect alternative therapies could have been used instead.
As medical science advances, decision-making will only become more complex. Only by expanding public funding for comparative effectiveness research can we hope to put existing treatments and healthcare services to their best use. Doing so would ensure that research priorities are determined by patient needs rather than by corporate agendas.
Los Angeles Times
Michael Hochman is an assistant professor of clinical medicine at the University of Southern California. Danny McCormick is an assistant professor of medicine at Harvard Medical School.
http://www.smh.com.au/opinion/politics/why-doctor-does-not-always-know-best-20100316-qchi.html
Overuse of scans causes cancers
Overuse of scans causes cancers
MARK METHERELL
March 15, 2010
THE unjustified use of potentially cancer-causing CT scans has alarmed the Medicare watchdog and prompted calls from senior radiologists for doctors to stop the indiscriminate ordering of scans.
More than 400 new cases of cancer a year in Australia are attributable to diagnostic radiology, medical research has found. Despite this, the number of computerised tomography scans, which generate far more radiation than X-rays, is growing about 12 per cent a year.
The prevalence of CT scans has led the director of the Professional Services Review, Tony Webber, to take the unusual step of publishing an expert's call for doctors to reverse the trend towards use of CTs as a first-choice diagnostic tool for such conditions as lower-back pain.
''I have been alarmed at the number of these scans ordered without clinical justification,'' Dr Webber says in his Report to the Professions issued today.
The warning comes as a study shows that more than 50 per cent of senior medical students in Perth underestimated radiation doses from commonly used radiological procedures.
In the US, exposure to medical radiation is estimated to have increased by more than six times in 30 years but research has shown up to 40 per cent of CT scans could be avoided without compromising patient care.
Dr Webber, whose agency investigates doctors suspected of abusing Medicare payments, told the Herald he was surprised at how often he came across inappropriate CT referrals by doctors under investigation for other reasons.
In his report he cites several cases of doctors referring patients for CT scans without clinical justification, including one who ''regularly ordered CT scans on any patient presenting with back pain''.
The Report to the Professions includes an appeal from a leading radiologist, Richard Mendelson, who said most authorities on radiation accepted there was no dose of ionising radiation deemed to be without risk.
But Professor Mendelson, who heads radiology at Royal Perth Hospital, said that in the past 20 years there had been a marked increase in the population's exposure to medical ionising radiation, largely due to the increased use of CT.
''Although the risk of a CT scan is relatively small, a CT of the abdomen and pelvis may expose the patient to a dose of up to about 20 millisieverts and thus an increased risk of inducing a fatal cancer of one in 1000.''
Professor Mendelson said the risks of CT scans in young or middle-aged patients with lower- back pain or, for example Crohn's disease, were significant, especially where recurrent imaging was likely to be required since the risks were cumulative.
He said likely reasons for inappropriate referral for CT scans included some doctors' lack of knowledge about the role of imaging, lack of time to perform clinical assessment and the substitution of imaging, patient pressure for a scan and fear of litigation for a ''missed'' diagnosis.
Improved education of medical students about radiology is ''absolutely essential'', a director of research in diagnostic imaging at Melbourne's Southern Health Service, Stacy Goergen, says.
Associate Professor Goergen says there is a strong argument that many deaths have been delayed or prevented by use of diagnostic imaging.
But in an editorial in the Journal of Medical Imaging and Radiation Oncology, she says ''inappropriate use of imaging is commonplace and provides little or no benefit to the patient but exposes him or her to risk''.
''Paradoxically, as imaging has become more complex, the amount of time spent teaching it to non-radiologists has diminished in many tertiary institutions,'' Professor Goergen says.
http://www.smh.com.au/national/overuse-of-scans-causes-cancers-20100314-q675.html
MARK METHERELL
March 15, 2010
THE unjustified use of potentially cancer-causing CT scans has alarmed the Medicare watchdog and prompted calls from senior radiologists for doctors to stop the indiscriminate ordering of scans.
More than 400 new cases of cancer a year in Australia are attributable to diagnostic radiology, medical research has found. Despite this, the number of computerised tomography scans, which generate far more radiation than X-rays, is growing about 12 per cent a year.
The prevalence of CT scans has led the director of the Professional Services Review, Tony Webber, to take the unusual step of publishing an expert's call for doctors to reverse the trend towards use of CTs as a first-choice diagnostic tool for such conditions as lower-back pain.
''I have been alarmed at the number of these scans ordered without clinical justification,'' Dr Webber says in his Report to the Professions issued today.
The warning comes as a study shows that more than 50 per cent of senior medical students in Perth underestimated radiation doses from commonly used radiological procedures.
In the US, exposure to medical radiation is estimated to have increased by more than six times in 30 years but research has shown up to 40 per cent of CT scans could be avoided without compromising patient care.
Dr Webber, whose agency investigates doctors suspected of abusing Medicare payments, told the Herald he was surprised at how often he came across inappropriate CT referrals by doctors under investigation for other reasons.
In his report he cites several cases of doctors referring patients for CT scans without clinical justification, including one who ''regularly ordered CT scans on any patient presenting with back pain''.
The Report to the Professions includes an appeal from a leading radiologist, Richard Mendelson, who said most authorities on radiation accepted there was no dose of ionising radiation deemed to be without risk.
But Professor Mendelson, who heads radiology at Royal Perth Hospital, said that in the past 20 years there had been a marked increase in the population's exposure to medical ionising radiation, largely due to the increased use of CT.
''Although the risk of a CT scan is relatively small, a CT of the abdomen and pelvis may expose the patient to a dose of up to about 20 millisieverts and thus an increased risk of inducing a fatal cancer of one in 1000.''
Professor Mendelson said the risks of CT scans in young or middle-aged patients with lower- back pain or, for example Crohn's disease, were significant, especially where recurrent imaging was likely to be required since the risks were cumulative.
He said likely reasons for inappropriate referral for CT scans included some doctors' lack of knowledge about the role of imaging, lack of time to perform clinical assessment and the substitution of imaging, patient pressure for a scan and fear of litigation for a ''missed'' diagnosis.
Improved education of medical students about radiology is ''absolutely essential'', a director of research in diagnostic imaging at Melbourne's Southern Health Service, Stacy Goergen, says.
Associate Professor Goergen says there is a strong argument that many deaths have been delayed or prevented by use of diagnostic imaging.
But in an editorial in the Journal of Medical Imaging and Radiation Oncology, she says ''inappropriate use of imaging is commonplace and provides little or no benefit to the patient but exposes him or her to risk''.
''Paradoxically, as imaging has become more complex, the amount of time spent teaching it to non-radiologists has diminished in many tertiary institutions,'' Professor Goergen says.
http://www.smh.com.au/national/overuse-of-scans-causes-cancers-20100314-q675.html
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