(CNN)A preliminary decision from a California superior court judge in Los Angeles could affect thousands of coffee shops including Starbucks, 7-Eleven and even your local gas station.
(CNN)A preliminary decision from a California superior court judge in Los Angeles could affect thousands of coffee shops including Starbucks, 7-Eleven and even your local gas station.
Health issues hit us in different ways at different ages. Here are some big ones science and tech are helping to solve.
Roughly 8 percent of kids in the US suffer from food allergies—often from peanuts. Epicutaneous immunotherapy could help. It’s a skin patch with a layer of peanut protein that activates immune cells that travel to the lymph nodes (which help control allergic response) without entering the bloodstream. The patch is still in trials, but the hope is that it will promote tolerance without triggering a nutty reaction.
Studies show that interventions before age 4 result in significant gains in cognition, language, and adaptive behavior, but autism is difficult to predict early enough. Scientists have used artificial intelligence to create a method for analyzing brain connectivity in babies’ fMRIs; it was able to predict with greater than 96 percent accuracy whether a 6-month-old would develop autism by age 2.
By around 6 months old, a baby’s brain prunes itself to specialize in the language and sounds it has been hearing since birth. Deaf infants are at risk of missing this crucial turning point in development, even after receiving cochlear implants. Scientists have created a machine-learning algorithm that parses babies’ MRIs to predict language development and determine if they’ll need extra help.
Amblyopia, or lazy eye, is the most common visual impairment in US children. Early studies have shown virtual-reality games can be more effective than the traditional eye-patch treatment (yarrr!). VR systems beam different images to each eye to create the illusion of 3-D, so the game can be designed to deliver crucial information (flying asteroids, for example) in the image shown to the weaker eye. This trains the brain and both eyes to work together—and might give a head start to future e-athletes.
Nearly a tenth of high school sports injuries are concussions, but it’s notoriously difficult to gauge their severity. One recent study found that the level of tau protein in the blood of students who had suffered a concussion corresponded with the length of time the young athlete needed to recover. A simple blood test that can reliably predict recovery time might not be far off.
Some 3.1 million adolescents in the US suffered at least one major depressive episode in 2016. They might want to talk to a new chatbot that’s schooled in cognitive behavioral therapy. it inquires about mood daily and trains the user to reframe negative thinking (“Life comes at you pretty fast. A wise man named Ferris Bueller said that.”) and set manageable goals.
Type 1 diabetes often emerges in the early teen years, when managing the disease—measuring blood glucose levels and injecting insulin multiple times a day—can be tough. To alleviate the burden, an insulin pump system for patients 14 and up, called the MiniMed 670G, automatically monitors glucose levels and uses an algorithm to determine when to administer precise insulin infusions.
More than 4 million young people now live with HIV worldwide. Treatment has made huge strides—the illness is no longer necessarily a death sentence. But controlling the disease requires patients to follow a complicated daily regimen of pills. To ease that, scientists have designed a six-pronged capsule that patients take just once a week: The prongs are composed of different polymers that dissolve at different rates, delivering drugs over several days.
Most cancers don’t hit until later in life, but doctors recommend some patients in their thirties and forties get screened for colon, prostate, breast, and cervical cancers. Scientists are now developing so-called liquid biopsies to detect molecules shed by tumors in blood or urine—a less invasive, less painful, and more easily repeated process than a tissue biopsy.
For women under 35, the chance of one cycle of IVF ($12,000 and up!) working is only about 50 percent. Researchers have developed a small microfluidics device to help select which sperm to use for IVF: The cells swim through a sort of obstacle course that screens for the healthiest, fastest, most normal-shaped sperm. The hope is that the overachievers will raise the chances of IVF success.
Scientists are getting closer to creating a universal vaccine that would be effective against multiple influenza strains (eliminating yearly shots—yay!). One strategy is to target a protein on the virus’s outer surface called hemagglutinin, which the bug uses to invade cells. The protein’s head mutates often, but its stem usually stays the same across strains—making it a promising Achilles’ heel for antibodies.
In 2015, people age 35 to 54 made up more than a third of all suicides. Researchers are exploring using data from smartphone sensors to monitor mental health. Depressed people, for instance, move around less, which can be tracked with a phone’s GPS and accelerometer. Sleep patterns are often disrupted, which researchers can see via the hours when someone uses their phone. All this allows doctors to capture data beyond what patients self-report.
Earlier diagnosis of Alzheimer’s would allow for treatments that could reverse symptoms and slow cognitive decline. In 2017, scientists created an Alzheimer’s test by sifting through data from 70,000 seniors and zooming in on 31 genetic markers associated with the disease. It accurately determines one’s risk of developing Alzheimer’s—and how that risk changes as you grow older. (Spoiler alert: It gets higher.)
Kidney disease affects 14 percent of US adults, and the vast majority of them are older than 60. The treatment options are less than awesome: Dialysis is a short-term, expensive solution, and donor organs are scarce. Now a group of researchers and doctors are developing an implantable artificial kidney that filters blood through silicon membranes and runs on the body’s own blood pressure.
The median age of a lymphoma diagnosis is 67, and chemotherapy doesn’t always work to treat it. Scientists are exploring a new weapon called CAR T cell therapy. They collect a patient’s own T cells from their blood, affix receptors engineered to lock onto cancerous cells, and release them back into the patient to carry out search and destroy missions.
Mitochondria, the organelles that produce energy your cells run on, gather mutations as you age—and begin to malfunction. Scientists suspect they play a crucial role in aging, possibly because they’re involved with metabolic processes, which slow as people get older. A molecule called nicotinamide adenine dinucleotide could juice the system. It acts as fuel for a protein that helps produce mitochondria, and scientists think it could be used as a supplement to treat metabolic decline.
Age 0 — 12:
How to Reverse Infertility • Tools for Fetal Surgery • Save the Preemies • The Year's Best Tech Playthings • Cashing in on Kiddie YouTube • The #MiniMilah Effect • Rethinking Screen Time • A Brief History of Digital Worries
Age 27 — 54:
Real Wedding, Virtual Space • The Pursuit of Youth • The Digital Vision Problem • The True Screen Addicts • Gamers Age Out • Rebooting Reproduction • Silicon Valley's Brotox Boom • The Next Steve Jobs
This article appears in the April issue. Subscribe now.
CRISPR is a new biomedical technique that enables powerful gene editing. WIRED challenged biologist Neville Sanjana to explain CRISPR to 5 different people; a child, a teen, a college student, a grad student, and a CRISPR expert.
The three principles that define a good life will protect me from despair, says Guardian columnist George Monbiot
It came, as these things often do, like a gunshot on a quiet street: shocking and disorienting. In early December, my urine turned brown. The following day I felt feverish and found it hard to pee. I soon realised I had a urinary tract infection. It was unpleasant, but seemed to be no big deal. Now I know that it might havesavedmy life.
The doctor told me this infection was unusual in a man of my age, and hinted at an underlying condition. So I had a blood test, which revealed that my prostate-specific antigen (PSA) levels were off the scale. An MRI scan and a mortifying biopsy confirmed my suspicions. Prostate cancer: all the smart young men have itthisseason.
On Monday, I go into surgery. The prostate gland is buried deep in the body, so removing it is a major operation: there are six entry points and it takes four hours. The procedure will hack at the roots of my manhood. Because of the damage that will be caused to the surrounding nerves, theres a high risk of permanent erectile dysfunction. Because the urethra needs to be cut and reattached to the bladder, I will almost certainly suffer urinary incontinence for a few months, and possibly permanently. Because the removal of part of the urethra retracts the penis, it appears to shrink, at least until it can be stretched back into shape.
I was offered a choice: radical surgery or brachytherapy. This means implanting radioactive seeds in the parts of the prostate affected by cancer. Brachytherapy has fewer side effects, and recovery is much faster. But theres a catch. If it fails to eliminate the cancer, theres nothing more that can be done. This treatment sticks the prostate gland to the bowel and bladder, making surgery extremely difficult. Once youve had one dose of radiation, they wont give you another. I was told that the chances of brachytherapy working in my case were between 70 and 80%. The odds were worse, in other words, than playing Russian roulette (which, with one bullet in a six-chambered revolver, gives you 83%). Though I have a tendency to embrace risk, this was not an attractive option.
It would be easy to curse my luck and start to ask, Why me? I have never smoked and hardly drink; I have a ridiculously healthy diet and follow a severe fitness regime. Im 20 or 30 years younger than most of the men I see in the waiting rooms. In other words, I would have had a lower risk of prostate cancer only if I had been female. And yet I am happy. In fact, Im happier than I was before my diagnosis. How can this be?
The reason is that Ive sought to apply the three principles which, I believe, sit at the heart of a good life. The first is the most important: imagine how much worse it could be, rather than how much better.
When you are diagnosed with prostate cancer, your condition is ranked on the Gleason Score, which measures its level of aggression. Mine is graded at seven out of 10. But this doesnt tell me where I stand in general. I needed another index to assess the severity of my condition, so I invented one: the Shitstorm Scale. How does my situation compare to those of people I know, who contend with other medical problems or family tragedies? How does it compare to what might have been, had the cancer not been caught while it was still apparently confined to the prostate gland? How does it compare to innumerable other disasters that could have befallen me?
When I completed the exercise, I realised that this bad luck, far from being a cause of woe, is a reminder of how lucky I am. I have the love of my family and friends. I have the support of those with whom I work. I have the NHS. My Shitstorm Score is a mere two out of 10.
The tragedy of our times is that, rather than apply the most useful of English proverbs cheer up, it could be worse we are constantly induced to imagine how much better things could be. The rich lists and power lists with which the newspapers are filled, our wall-to-wall celebrity culture, the invidious billions spent on marketing and advertising, create an infrastructure of comparison that ensures we see ourselves as deprived of what others possess. It is a formula for misery.
The second principle is this: change what you can change, accept what you cant. This is not a formula for passivity Ive spent my working life trying to alter outcomes that might have seemed immovable to other people. The theme of my latest book is that political failure is, at heart, a failure of imagination. But sometimes we simply have to accept an obstacle as insuperable. Fatalism in these circumstances is protective. I accept that my lap is in the lap of the gods.
So I will not rage against the morbidity this surgery might cause. I wont find myself following Groucho Marx who, at the age of 81, magnificently lamented: Im going to Iowa to collect an award. Then Im appearing at Carnegie Hall, its sold out. Then Im sailing to France to pick up an honour from the French government. Id give it all up for one erection. And today theres Viagra.
The third principle is this: do not let fear rule your life. Fear hems us in, stops us from thinking clearly, and prevents us from either challenging oppression or engaging calmly with the impersonal fates. When I was told that this operation had an 80% chance of success, my first thought was thats roughly the same as one of my kayaking trips. And about twice as good as the chance of emerging from those investigations in West Papua and the Amazon.
There are, I believe, three steps to overcoming fear: name it, normalise it, socialise it. For too long, cancer has been locked in the drawer labelled Things We Dont Talk About. When we call it the Big C, it becomes, as the term suggests, not smaller, but larger in our minds. He Who Must Not Be Named is diminished by being identified, and diminished further when he becomes a topic of daily conversation.
The super-volunteer Jeanne Chattoe, whom I interviewed recently for another column, reminded me that, just 25 years ago, breast cancer was a taboo subject. Thanks to the amazing advocacy of its victims, this is almost impossible to imagine today. Now we need to do the same for other cancers. Let there be no moreterriblesecrets.
So I have sought to discuss my prostate cancer as I would discuss any other issue. I make no apologies for subjecting you to the grisly details: the more familiar they become, the less horrifying. In doing so, I socialise my condition. Last month, I discussed the remarkable evidence suggesting that a caring community enhances recovery and reduces mortality. In talking about my cancer with family and friends, I feel the love that I know will get me through this. The old strategy of suffering in silence could not have been more misguided.
I had intended to use this column to urge men to get themselves tested. But since my diagnosis, weve discovered two things. The first is that prostate cancer has overtaken breast cancer to become the third biggest cancer killer in the UK. The second is that the standard assessment (the PSA blood test) is of limited use. As prostate cancer in its early stages is likely to produce no symptoms, its hard to see what men can do to protect themselves. That urinary tract infection was a remarkably lucky break.
Instead, I urge you to support the efforts led by Prostate Cancer UK to develop a better test. Breast cancer has attracted twice as much money and research as prostate cancer, not because (as the Daily Mail suggests) men are the victims of injustice, but because womens advocacy has been so effective. Campaigns such as Men United and the Movember Foundation have sought to bridge this gap, but theres a long way to go. Prostate cancer is discriminatory: for reasons unknown, black men are twice as likely to suffer it as white men. Finding better tests and treatments is a matter of both urgencyand equity.
I will ride this out. I will own this disease, but I wont be defined by it: I will not be prostrated by my prostate. I will be gone for a few weeks but when I return, I do solemnly swear I will still be the argumentative old git with whom you are familiar.
George Monbiot is a Guardian columnist
Prostate Cancer UK can be contacted on 0800 0748383
Evidence is growing that the sunshine vitamin helps protect against a wide range of conditions including cancers
Vitamin D is having quite a moment. In the past few months, evidence has been growing that the sunshine vitamin not only has an important role in bone and muscle health, but might also help prevent a range of cancers, reduce the chance of developing rheumatoid arthritis, protect against multiple sclerosis and cut the risk of colds and flu.
But is vitamin D truly a cure-all? And if the benefits are real, should we all be taking vitamin D supplements or even fortifying our foods?
Vitamin D is not one chemical, but a label that covers a group of substances, including vitamin D2 and D3. The latter is the form made when sunlight hits your skin and is also found in other animals. Non-animal sources such as fungi and yeasts primarily produce the D2 form. Once in the body, these substances are converted into biologically active steroids that circulate in the blood.
One area where the impact on health appears to be clear is vitamin Ds role in keeping bones and teeth healthy and improving muscle strength.
The musculoskeletal stuff is really good and really strong, said Helen Bond, a spokesperson for the British Dietetic Association, pointing out that vitamin D is important in calcium and phosphate absorption.
Too little vitamin D can be serious: the skeletal disorders osteomalacia and rickets are known to be caused by a vitamin D deficiency, and the latter is on the rise in the UK, a finding some put down to the impact of poverty on poor nutrition.
But do the wider health claims stand up?
Intuition suggests that it cant all be right, said Julia Newton-Bishop, professor of dermatology and vitamin D expert from the University of Leeds. But while a recent review of evidence by the scientific advisory committee on nutrition only found strong evidence in the case of bone and muscle health, Newton-Bishop says a growing body of research is exploring other conditions.
Newton-Bishop says the fact that receptors for vitamin D are present on a huge array of body cells suggests the substance might indeed play a central role in our health, adding that human history offers further evidence: as humans moved to higher latitudes, skin tone became paler. [One] explanation is that vitamin D was so important that that was a selective pressure, she said. The fact that Inuits arent pale-skinned and for millennia they have had an exclusively fish diet is an argument for the fact that vitamin D was a driver, because why would they be different to everyone else?
Martin Hewison, professor of molecular endocrinology at the University of Birmingham, who carried out the recent study into vitamin D and rheumatoid arthritis, said evidence from cell studies backs up the idea that the vitamin is important.
In most of the models, vitamin D appears to have quite a positive effect, he said. If you are using cancer cell lines or cancer cells, vitamin D has anti-cancer effects, and likewise in cells that have been used for models for infection and immune disorders, vitamin D has quite clear antibacterial and anti-inflammatory effects.
But when it comes to studies in humans, the picture is far from clear-cut. While some studies find links to diseases, others do not.
That, say experts, could be partly down to the way they are conducted for example, not all studies take into account the starting levels of vitamin D in participants, or they may have been carried out in populations with different genetic factors that might affect the impact of vitamin D.
Other experts have doubts about vitamin Ds influence. Prof Tim Spector, author of The Diet Myth, wrote in the Independent: The evidence so far suggests (with the possible exception of multiple sclerosis and some cancers) that low vitamin D levels are either irrelevant or merely a marker of the disease.
Hewison says that while vitamin D might help prevent certain conditions such as tuberculosis, respiratory infections and autoimmune diseases,it should not be seen as a cure for them. It is good at protecting against things, he said, but once a disease is settled in, it is unlikely you are going to be able to give somebody who has got prostate cancer vitamin D and it is going to get dramatically better.
What about the case for supplements? With some having previously been found to cause more harm than good, Newton-Bishop says caution towards this apparent panacea is unsurprising. Everyone within the cancer world is nervous about supplements, she said. I would say to patients dont take supplements, with the exception of avoiding a low vitamin D level.
But how low is low? With the amount of sunlight needed varying with genetics, skin colour, time of day, how much one covers up and a host of other factors, the scientific advisory committee on nutrition said it was too difficult to say how much sun we need to make sure our vitamin D levels are up to scratch. In any case, from October until March the sun in the UK isnt strong enough to do the job.
The upshot is that national guidelines now recommend that during the autumn and winter at least, individuals should consider taking supplements or boosting their intake of vitamin-D-rich foods to get an intake of 10 micrograms a day, with higher-risk individuals such as some ethnic minority groups advised to follow the guidelines all year round.
However, Bond says it is hard to get enough from diet alone.
There are very few naturally rich sources of vitamin D, and most really good sources are of animal origin, which doesnt bode well for vegans and vegetarians, she said. A serving of oily fish like mackerel will give you easily your 10 micrograms of vitamin D a day, but if you drop down to a tin of canned tuna, you are only getting 1.5 micrograms.
And as Adrian Martineau, clinical professor of respiratory infection and immunity at Queen Mary University of London, points out, even in the summer, sunshine isnt going to be the answer, especially because there is an associated risk of skin cancer.
If you are considering taking supplements, it might be worth checking which form of vitamin D they contain. Some people dont want an animal form of vitamin D, said Hewison. However, What studies have shown is that if you want to raise your blood vitamin D levels, vitamin D3 is much more efficient at doing that.
Dr Benjamin Jacobs, a consultant paediatrician and spokesperson for the Royal College of Paediatrics and Child Health, says supplements are not enough as it is hard to make sure people actually take them. Instead, he suggests the UK consider food fortification.
Some countries, including Canada and Finland, have embraced fortification of milk. But although infant formula and some breakfast cereals, plant-based milks and fruit juices are already fortified in the UK, most foods are not.
Hewison believes the government should consider a national fortification plan and that the risks of it resulting in dangerously high vitamin D intake are negligible: I think most people in the field agree that if you want to have a large-scale improvement in peoples vitamin D levels then it can only really be done through fortified foods.
This weeks events will mark the first time that the science used to justify certain pesticides will be analyzed under oath for all to see
On Monday, a federal court hearing in San Francisco will turn a public spotlight on to the science surrounding the safety of one of the worlds most widely used pesticides, a weedkilling chemical called glyphosate that has been linked to cancer and is commonly found in our food and water, even in our own bodily fluids. Given the broad health and environmental implications tied to the use of this pesticide, we would be well served to pay attention.
As the active ingredient in Monsantos branded Roundup and hundreds of other herbicides, glyphosate represents billions of dollars in annual revenues for Monsanto and other companies, and is prominently used by farmers as an aid in food production. Its also favored by cities for keeping public parks and playgrounds weed free, and by homeowners who want a tidy lawn. But the chemical was deemed a probable human carcinogen by the World Health Organizations cancer experts in 2015 in a finding that has since triggered waves of liability lawsuits against Monsanto.
Heated debates over the safety or lack thereof of this popular pesticide have spanned the globe and sparked propaganda warfare with each side claiming the other has misrepresented the scientific record. Cancer victims allege Monsanto has ghost written research reviews, unduly influenced regulators and created front groups to falsely claim glyphosate safety. Monsanto, meanwhile, asserts multiple studies by international scientists are flawed and politically motivated, and says industry studies demonstrate the product is safe when used as intended.
This weeks events will mark the first time that the body of research, some that has been gathering dust in stuffy scientific journals or confidential corporate files, will be analyzed under oath for all to see.
It is no idle exercise. Real lives are at stake in this and broader debates about pesticide risks to our health. One in every two men and one in every three women are now expected to develop cancer in their lifetimes and childhood cancers are on the rise.
In children, pesticide exposure is linked not just to pediatric cancers, but also to decreased cognitive function, and behavioral problems. In adults, pesticides are linked to non-Hodgkins lymphoma, leukemia, brain, prostate and other cancers. More than 3,000 plaintiffs suing Monsanto allege exposure to the companys glyphosate-based Roundup caused them or their family members to develop non-Hodgkins lymphoma.
Monsanto has tried to persuade US judge Vince Chhabria to throw out the litigation, and sought to keep secret the many internal documents it has been forced to turn over in discovery. But Chhabria has ordered that the hearing be video-recorded and shared publicly over the internet. And he has granted permission for plaintiffs to explore in open court such things as the ghostwriting of science as well as a controversial 1983 study that EPA scientists at the time said showed evidence of glyphosates cancer-causing potential.
The court has dubbed the 5-9 March events as science week because the only evidence to be presented will come from experts in cancer science, including epidemiologists, toxicologists and others called to analyze relevant research. There will be no crying cancer victims to tug on heart strings; just opposing sides presenting science to a judge who will decide if the lawsuits can move forward.
To bolster its defense, the company and chemical industry allies have been working to discredit cancer scientists and others who have been warning of danger. That effort was highlighted when members of the House committee on science, space and technology held a hearing in Washington on 6 February to air Monsantos complaints about the International Agency for Research on Cancers (IARC) classification of glyphosate as a probable carcinogen, and to threaten to strip funding from the scientific body.
The committee effort effectively turning a war on cancer into a war on cancer science was applauded by the chemical industry. Monsanto, along with lobbyist CropLife America and other agricultural organizations, has also sued California to stop environmental regulators from requiring cancer warnings on glyphosate products, and on 26 February they won an injunction blocking such a warning.
The debate over glyphosate is but the latest example of how industry efforts often focus not on scrutinizing scientific evidence of harm, but on discrediting the offending science. Last year, for instance, Dow Chemical successfully lobbied the Environmental Protection Agency leadership to ignore warnings from its own scientists (and others) about extensive research tying a profitable Dow pesticide called chlorpyrifos to brain development problems in children.
The public offering of expert testimony in San Francisco about Monsantos pervasive pesticide presents an important opportunity to separate the science from the spin. We all should be watching.
Findings suggest increased consumption of ultra-processed foods tied to rise in cancers, but scientists say more research is needed
(CNN)California coffee shops may soon be forced to warn customers about a possible cancer risk linked to their morning jolt of java.
Two weeks ago, White House physician Ronny Jackson issued a highly anticipated statement on President Donald Trumps health following a complete physical exam. Trump, Jackson claimed, is in excellent health with no concern of physical or cognitive decline.
Jackson also revealed that, in addition to cholesterol medication and a multivitamin, the president pops the oral supplement finasteride (often sold as the brands Propecia, Propecia Pro-Pak, and Proscar) to treat male-pattern baldness. While the use of finasteride to help prevent male-pattern baldness is not newit was first approved for treating prostate enlargement in 1992 before being rebranded and sold in 1997 as a hair-loss drugit has come under fire in recent years for its supposed extreme side effects. In 2015, Merck, the drugs manufacturer, was hit with multiple class-action lawsuits alleging the drug caused severe sexual and emotional side effects.
According to Dr. Nikki Hill, a board-certified dermatologist and hair-loss specialist based in Tucker, Georgia, using finasteride in FDA-approved doses (1 milligram) is not harmful for the vast majority of her patients.
About 2 percent of men in their twenties have sexual side effects, Hill told The Daily Beast. Occasionally, Hills patients will report decreased sperm volume after taking the drug and sometimes even bouts of depressionbut that side effect is thankfully rare, Hill says. Ive had maybe three people in six years tell me that they feel a little more depressed, but they dont know if its circumstantial or due to taking the medicine. I end up taking them off it [if they report depression] just to make sure. The FDA lists depression as a possible side effect of finasteride on its website (PDF).
Finasteride works by blocking an enzyme that converts testosterone to dihydrotestosterone, or DHT. Paradoxically, DHT is the hormone responsible for sexual function and hair growth earlier in life. But as men age and their testosterone decreases, an imbalance of testosterone and DHT can actually cause hair follicles to shrink, inhibiting new hair growth.
In the past few years, however, a growing number of patients are reporting severe neurological side effects after taking finasteride so many that the National Institutes of Health (NIH) recognizes Post-Finasteride Syndrome on their list of genetic and rare diseases. Patients suffering from so-called Post-Finasteride Syndrome have reported mental and neurological side effects, like depression, suicidal ideation, anxiety, and impaired memory, and have reported such symptoms even after several months of discontinuing the drug. But these claims make little sense to most dermatologists.
Finasteride has a very short half-life, said Dr. Nicole Rogers, a board-certified dermatologist and assistant clinical professor of dermatology at Tulane University. The drug is fully metabolized within a week, so for people with Post-Finasteride Syndrome to be reporting decreased libido and brain fog, and having it continue despite stopping the drugfrom a neurological perspective, we dont really understand why that would be.
According to Rogers, finasteride is one of the most potent drugs on the market, and only one of two FDA-approved methods for hair loss (minoxidil, or Rogaine, being the other). While Rogaine needs to be applied to the hairline topically, finasteride is generally taken as an oral medication, which patients prefer since Rogaine can leave them looking greasy. Whats more, finasteride is typically much more effective. It can be a miracle medicine for people who take it, said Rogers, though she cautions that if patients are already prone to anxiety, depression, or have a family history of erectile dysfunction, this may not be the treatment for them.
In addition to possible sexual and neurological side effects, increasing the risk of high-grade prostate cancer may also be a concern.
Nobody who has a strong family history of prostate cancer should go on this medicine, Hill said. And if they do, they need to be closely monitored. According to Hill, doctors are able to screen patients for prostate cancer by checking the level of a chemical called PSA, or prostate-specific antigen, in the bloodstream. Finasteride, however, has been shown to artificially lower the numbereven when prostate cancer is present.
If youre taking finasteride, let your doctor know, and have digital rectal exams to assess prostate cancer, rather than a blood test, Hill suggested. If theres a family history of prostate cancer in my patients, I find other alternatives [to finasteride] because theyll be tested at a younger age, and their PSA levels are very important.
(CNN)When the end draws near, Dr. Roger Kligler, a retired physician with incurable, metastatic prostate cancer, wants to use a lethal prescription to die peacefully in his sleep. As he fights for the legal right to do that, an influential doctors group in Massachusetts has agreed to stop trying to block the way.
Nick Papadopoulos tracks down tumors for a living. Not with X-rays or CT scans, but with DNA. The oncologist and director of translational genetics at the Johns Hopkins Kimmel Cancer Center has spent decades uncovering the unique sets of mutations that define cancers—the kind of genetic signals that not only drive tumor formation and metastasis, but distinguish one cancer from another. And now, he’s working to develop a test that could sniff out those signals before a patient starts to get sick.
It’s the kind of test that Papadopoulos thinks could have saved his uncle’s life, had it been around a few years ago. “He had no symptoms until a cough showed up,” he says. But when it didn’t go away he went in for an X-ray, and there on the radiograph were the lesions. Dozens of them, filling his entire chest cavity. The doctors sequenced the tumors, and got him signed up for a clinical trial for a new, targeted drug. It worked for a few of them, shrinking them back to almost nothing. But the rest developed resistance.
“He was supposed to only live two months, and the drugs prolonged his life by a year. But that year wasn’t good.” says Papadopoulos. “I think it’s time to start thinking more about detecting cancers early and less about treating them when they are late.”
On Thursday, Papadopoulos’ research group at Hopkins revealed a novel blood test based on the combined analysis of DNA and proteins that correctly detected eight kinds of the most common cancers with a range of accuracies—from 98 percent for ovarian cancers to less than 40 percent for breast cancers. Published in Science, the test is just one among many so-called “liquid biopsies” in development; noninvasive tests that classify cancers by identifying the tiny bits of DNA that tumors shed into the bloodstream.
Most published studies, including this one, focus on measuring and monitoring advanced tumor stages. A few liquid biopsies have even been approved to help match tumors to targeted drugs. But the dream is to develop a simple blood test to actually diagnose solid tumors in healthy-looking people. The scarcity of circulating cancer biomarkers (both in quality and quantity; tumor DNA makes up less than 0.1 percent of blood) has held those aspirations back for decades. But now, sensitive assays and computational platforms are driving the discovery of biomarkers and better ways to measure them, luring a pack of well-financed startups into the field.
In 2016, for example, the world’s largest sequencing company, San Diego-based Illumina, spun out a new company called Grail. Its mission is described as “detecting cancer early, when it can be cured.” This ambitious aim is supported by $1.2 billion of venture capital Grail raised last year, which it intends to put toward financing massive, population-based clinical studies and optimizing its sensitive sequencing technologies.
Grail has yet to publish any actual data (its website does advertise a commentary published in Cell last year). And neither has its chief rival in the Valley, a machine learning startup called Freenome. That three-year old company snagged a $65 million Series A last March, led by Andreessen Horowitz. Freenome isn’t limiting itself to the genetic breadcrumbs left by tumor cells—it looks to capture other disease signatures in the blood, like how the immune system changes in response to tumor microenvironments.
Of course, Freenome has offered scant details on how exactly that kind of test would work. “You show your cards at the end, not while you’re playing poker,” says Andreessen partner Vijay Pande, who heads the investment firm’s biofunds. “Publications indicate that you’re not interested in building a company.” That said, he does expect Freenome to publish in a peer-reviewed journal ahead of its first foray into the market.
When that could be, though, is anyone’s guess. To evaluate any of these blood screens, thousands of patients will have to get tested—and then researchers will have to wait for some of them to actually get cancer. That’s the only way to determine not only their predictive power, but also whether they lead to improved patient outcomes. The noninvasive screening tests available today—mammography for breast cancer, a protein-measuring test for prostate cancer—are rife with their own issues. Incorrect diagnoses waste time and money on treatments and burden patients with unnecessary anxiety.
Liquid biopsy is likely to be beset by the same kinds of controversy, says Geoff Oxnard, a thoracic oncologist at the Dana-Farber Cancer Institute and a professor at Harvard Medical School. He routinely uses a single-gene liquid biopsy developed at Dana Farber to figure out which drugs represent the best options for his lung cancer patients. But will early detection versions one day be part of routine doctor’s visits? “No. I think these tests will help us better understand the risks for patients who already have a history of cancer in their family or who’ve already had something show up on a scan,” he says. “But I don’t think we have the kind of data we need to support liquid biopsy as a panacea for diagnosing cancer. At the end of the day, it’s still just a shortcut.”
Still, Oxnard pointed out that Papadopoulos’s test represents an important step forward. One, it starts to identify where a tumor might be located. That’s been a big limitation of liquid biopsies; OK, you’ve found cancer, but what do you do next? Where do you look for the tumor? Most mutations don’t tell you anything about location. But by layering in measurements for 31 additional proteins to their machine learning model, the Hopkins team was able, on the first try, to correctly identify the tissue of origin around 80 percent of the time colorectal cancers, pancreatic, and ovarian cancers.
The other advance is cost. Papadopoulos estimates the test could be commercialized for around $500, and cancer-spotting approaches that rely on ultra-deep sequencing could stretch costs for existing screening tests, which only look for a single gene. “This is great for the field and provides promise that these analyses will become a reality in the clinic,” says Victor Velculescu, an oncologist and colleague of Papadopoulos’ at Johns Hopkins, who has also developed liquid biopsy technologies, though he was not involved in the Science study.
The two have developed a sort of friendly turf war as they’ve turned Baltimore into its own little liquid biopsy hub. Both researchers have recently spun off diagnostics companies to further develop their own early detection technology platforms. Earlier this month, Velculescu’s venture, Personal Genome Diagnostics, hauled in a $75 million Series B led by pharma giant Bristol-Myers Squibb. That brings its total financing to $99 million, putting it on par with some of its better-known counterparts in the Valley, adding some bicoastal intrigue to the race to the market. Whatever the outcome, it’s patients who will ultimately be the winners.
“If it can even catch 50 percent of cancers that right now we have no way of screening for, that’s still 50 percent of patients who can now be treated in Stage 1, when they still have a chance,” says Papadopoulos. “It doesn’t have to be perfect to still save a lot of lives.”
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