How has medicine changed in the past 20 years? A look at dementia, cancer care and chronic disease

The 21st century began with the first draft of the human genome, and with it, the promise of immense new powers to treat, prevent and cure disease.

In high-income countries like Australia, rates of heart disease were falling, and life expectancy was rising.

Over the past two decades, lots has changed about the factors that affect our health, wellbeing and how long (and well) we live.

So what do we know now that we didn’t then, and how far have we come?

As part of Radio National’s Big 20 series, Dr Norman Swan speaks to three leaders in their field to find out what’s happened in dementia research, cancer care and chronic disease over the last 20 years.

Chronic disease has been getting worse

Dr Norman Swan talks to Professor Chris Murray, director of the Institute of Health Metrics and Evaluation at the University of Washington.

Dr Swan: Take us back to the year 2000. What was the pattern of disease?

Professor Chris Murray: In the year 2000, right before the big push globally on reducing health problems in low income settings, we were pretty much nearing the peak of the HIV epidemic and, particularly in sub-Saharan Africa, we still had a very large number of deaths under age five — 12 million or so a year.

We hadn’t yet had the big efforts to control malaria. And many middle-income countries were right in that transition from a profile of disease burden dominated by infectious diseases and starting that shift towards cancer, heart disease, chronic kidney disease.

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In the high-income world — Australia, Europe, North America — the [disease burden] looked pretty similar. It was already heavily dominated by heart disease and cancer, chronic kidney disease, but there was less obesity back then, there was less diabetes, and we were still back in the heyday of heart disease coming down pretty rapidly.

Dr Swan: What has happened in the two decades since?

Professor Murray: We’ve seen really dramatic progress bringing down child death rates.

In a place like Niger in West Africa, the improvements are just spectacular. You’ve probably halved child death rates in that period … bringing [it] down below the 5 million mark because of antiretrovirals for HIV.

There has been real progress on controlling malaria because of bed-net programs. So just lots of progress racked up, until COVID, on a number of fronts in the low-income world.

Then at the other end of the spectrum in the high-income world, we’ve seen heart disease progress slow, and in some places reverse.

We’ve seen this steady rise of obesity and bringing with it diabetes, high blood sugar, bringing up blood pressure levels in some countries, despite all the therapies that exist for them.

In the middle-income world we’ve seen progress but we’ve seen the rise of ambient air pollution in the last two decades. It’s becoming a bigger and

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More Potential Help for Chronic Hand Eczema

Two different Janus kinase (JAK) inhibitors, one systemic and the other topical, showed activity in preliminary clinical trials of difficult-to-treat chronic hand eczema.

The oral multitargeted drug gusacitinib reduced the target lesion symptom score (TLSS) by as much as 70% at 16 weeks, and almost a third of patients treated with the higher of two doses achieved Physician Global Assessment (PGA) of 0-1 (clear/nearly clear) at the same time point. Adverse events across the range of doses evaluated were mostly sporadic and mild or moderate in severity, reported Howard Sofen, MD, of Dermatology Research Associates in Los Angeles, during the European Academy of Dermatology and Venereology Virtual Congress.

“Gusacitinib showed rapid efficacy in moderate to severe chronic hand eczema,” said Sofen. “The 80-mg dose met the primary endpoint of percent reduction in the modified TLSS at week 16. Rapid and significant improvement in PGA 0-1 was observed versus placebo with 80 mg. There was dose-dependent and rapid improvement in pruritus. Gusacitinib was well tolerated, and the safety has been consistent across studies involving more than 350 patients.”

In another study, as many as 37% of patients treated with topical delgocitinib met criteria for Investigator’s Global Assessment (IGA) of treatment success at 16 weeks. Patients treated with the two highest concentrations had statistically greater improvement at 4 to 6 weeks and maintained the difference to the end of the study, reported Margitta Worm, MD, of Charite Hospital in Berlin.

Multitargeted Oral Drug

Chronic hand eczema is a complex disease that affects about 7 million people in the U.S. The disease has a multifactorial etiology and pathogenesis that includes genetics, atopy, contact allergens, and irritating substances, said Sofen. Gusacitinib inhibits JAK1, JAK2, JAK3, TYK2, and SYK to target TH1 and TH2 pathways, TH17 and TH22 pathways, and SYK-mediated interleukin-17 signaling in keratinocytes.

Sofen reported findings from the first part of a phase IIb trial involving 105 patients with chronic hand eczema. The patients were randomized to placebo or one of two doses of gusacitinib. Randomized treatment continued for 16 weeks, at which point placebo-treated patients could switch to the higher dose of gusacitinib for continued treatment. The primary endpoint was percent change in the modified TLSS.

The study population had a mean baseline mTLSS of 13 and a mean baseline hand eczema severity index (HECSI) score of 63; 39% of the patients had a baseline PGA score of 3.

The 16-week results showed that patients allocated to the higher dose (80 mg) of gusacitinib had a 69.5% reduction in mTLSS, as compared with 49% of patients in the 40-mg group, and 33.5% of those assigned to placebo. Both gusacitinib groups had significantly greater improvement in mTLSS compared with placebo by week 2 (P<0.005), and patients in the higher-dose arm maintained that difference to 16 weeks.

The proportion of patients who achieved PGA 0-1 status by week 16 was 31.3% in the gusacitinib 80-mg arm, 21.25% in the 40-mg arm, and 6.3% in the placebo group. Significantly more patients in both

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Residential area may impact risk of chronic conditions

Where you live may increase your risk for uncontrolled diabetes, high blood pressure, obesity, and depression, according to a study. Results indicate that local and regional factors significantly affect individuals with chronic health conditions.

The new study appears in the Journal of the American Medical Association.

The Centers for Disease Control and Prevention (CDC) estimate that 60% of United States adults have a chronic disease, with 40% having two or more. Chronic conditions are the primary causes of death and disability in U.S. adults, contributing to the nation’s $3.5 trillion annual healthcare costs.

The incidence of risk factors for developing or dying from chronic conditions depends on where you live in the U.S. For example, the prevalence of high blood pressure in 2019 was almost 44% in West Virginia, but only 26% in Utah.

Even within a U.S. city, the incidence of a chronic condition can vary dramatically. Data from the 500 Cities Project reports that adult rates of high blood pressure range from 4.9–71.0% in different areas of Chicago.

It is unclear if these geographic variations in health disparities are due to differences in socioeconomic status, age, and gender between the two areas or caused directly by the place where someone lives.

Previous studies used Medicare claim data to evaluate how diagnosis rates and healthcare use change when individuals move to a location with a different health outcome level.

However, prior research failed to observe health outcomes over time. To address these shortcomings, Aaron Baum, Ph.D., and other Mount Sinai researchers conducted a new study. They evaluated the incidence and changes in health outcomes 3 years before and 3 years after study participants moved once.

They did so in a quarterly fashion, evaluating health outcomes four times each year.

This retrospective study of approximately 5 million adults, conducted at the Veterans Affairs New York Harbor Healthcare System from 2008–2018, examined the national claims data from the Veterans Health Administration’s integrated healthcare records. About 1 million of the trial participants moved once during the study.

Researchers identified individuals who moved based on zip code and tracked primary health outcomes, including uncontrolled diabetes, high blood pressure, obesity, and depressive symptoms.

The trial used statistical methods to adjust for the participant’s characteristics, the period since they moved, and national trends that could interfere with the results’ accuracy.

The results demonstrate a 27.5% change in the incidence of uncontrolled blood pressure and a 15.2% change in depressive symptoms of the between-area difference after moving.

The incidence of uncontrolled diabetes and obesity changed to a lesser extent in movers: 5.0% and 3.1%, respectively.

The trial also shows an increased risk of an uncontrolled chronic condition after moving to a place where the uncontrolled disease is more prevalent.

Movers had a 7% increase in uncontrolled blood pressure, a 2% increase in obesity, a 1% increase in uncontrolled diabetes, and a 3% increase in depressive symptoms when moving from a 10th to a 90th percentile prevalence zip code for a health outcome.


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Op-Ed: COVID and Chronic Pain

The COVID-19 pandemic has made access to crucial healthcare services a challenge for many patients, especially those with chronic pain.

According to the CDC, chronic pain is one of the most common reasons adults seek medical care. In the United States, an estimated 20.4% (50 million) of adults had chronic pain according to 2016 National Health Interview Survey data.

Chronic pain has been linked to a lack of mobility and daily activity, socioeconomic status, access to healthcare, and opioid dependence. These correlations have recently been intensified as the pandemic has exacerbated income inequity, lack of access to affordable healthcare, and physical and emotional isolation making the treatment of chronic pain even more challenging.

The consequences of not seeking essential medical treatment for chronic pain can be dire. Patients waiting for a medical assessment often report high levels of pain that interfere with their ability to function and reports of severe pain are associated with increased levels of depression in 50% of patients and suicidal thinking in 34.6% of patients. In addition, as chronic pain patients are increasingly isolated many of them are at a higher risk for opioid addiction or overdose.

The pandemic has highlighted the necessity for patient care to encompass an individualized, multi-disciplinary, and multimodal approach that can include both telehealth and in-person care. And the multidimensional complexity of chronic pain with both pathophysiologic and psychosocial issues reinforces the need for patients to receive pain care under a physician-led team. Pain medicine physicians are specifically trained over many years through medical school, residency, and subspecialty training to diagnose and manage complex acute and chronic pain conditions, including those with life-threatening illnesses.

Many patients who are prescribed opioids need access to in-person medical treatment as monitoring opioid use is difficult through telemedicine and administering urine drug screenings are most effective and accurate in person. When in-person care is not feasible, it is important for physicians in California, for example, to meet state medical board mandates by documenting a patient’s inability to receive drug testing during the pandemic.

For other patients, telemedicine is a good option — especially those with low mobility or comorbidities — as long as there is a focus on ensuring equitable access as disadvantaged groups, older adults, and people with disabilities tend to use technology less often.

Future legislation must not create barriers for chronic pain patients to receive safe, effective treatment. The CDC has already issued guidelines for both opioid and nonopioid treatments for chronic pain. Regulations need to ensure and allow for individualized pain management strategies for patients dealing with chronic pain. Those patients who are stable and functional on opioids should be allowed continued access to opioids, just as all patients seeking nonopioid treatments, including interventional pain treatments, such as spinal cord stimulation, peripheral nerve stimulation, and others with high-quality evidence, should be allowed access to those therapies.

As noted in the journal PAIN: “Not treating chronic pain will have consequences for individuals, healthcare systems, and providers in the short- and long-term, increasing

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Rural living, chronic illness and COVID-19

PRAIRIE, Miss. (AP) — COVID-19 hit Prairie native Shirley Judd suddenly and hard. One day in late August, she felt fine; the next, she could barely move.

As soon as the symptoms struck, Judd called her aunt to take her to West Point to see a doctor, where she tested positive for COVID-19.

“When I got home, I had to go straight to bed. I couldn’t even sit up or do anything. I had headaches starting off, and I was just shaking, throwing up,” Judd said. “After about four days, or five, that’s when my throat got so sore I couldn’t swallow. I couldn’t eat anything.”

She visited another doctor in Houston on Labor Day and received shots and antibiotics. By Wednesday, her condition worsened. She was losing weight, and her mouth was swollen. At approximately 8 a.m., she checked into the North Mississippi Medical Center in Tupelo for treatment.

What made Judd’s experience more harrowing was that she has multiple sclerosis, a chronic illness that affects the central nervous system. Judd is 53 and has been on disability for the condition since 1987. She has had two hip replacements because of MS, and changes treatments every two years. She receives infusion treatments every six months and thought her initial illness resulted from MS flaring rather than a COVID-19 diagnosis.

The Centers for Disease Control and Prevention have long said people with underlying medical conditions and older adults are at increased risk for severe illness from COVID-19. While the National Multiple Sclerosis Society website states that current evidence suggests MS doesn’t increase the risk of dying from the COVID-19, possible long-term consequences of MS, age and higher levels of disability can increase the risk of being hospitalized for COVID-19.

Judd’s primary concern was maintaining her household while recovering, and she’s grateful family members stepped in to help. Family friend Lee Thomas did most of her cooking and cleaning, and cousins Yolanda Ewing and Chris Ewing helped bring supplies and food to her.

“Everything and everybody was really good about helping me out until I got straightened out and could get around,” Judd said. “That was a blessing.”

Judd also received financial support from Okolona-based nonprofit Excel Inc. by applying for the COVID-19 Support Fund, which is available to people affected by COVID-19. The organization paid her water and light bills while she was recovering.

“With Excel, I appreciate what they did because at the time, I couldn’t do anything,” Judd said. “It was a blessing and a miracle.”

Judd is also Black and lives in a rural community, both factors the CDC claims might require extra precautions against COVID-19. As of Oct. 11, Black Chickasaw residents of Non-Hispanic and unknown ethnicity were 49% of Chickasaw’s 777 cases since March 11, according to the Mississippi State Department of Health. The U.S. Census Bureau estimates Black people are approximately 45% of Chickasaw’s population. Statewide, Black people account for 48% of COVID-18 cases as of Oct. 4, despite only representing 38% of the

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Alternative Medicine for Chronic Diarrhea After Gallbladder Removal

People usually don’t like to talk about their bathroom issues, but for some it is an enormous problem. These days up to two billion people have diarrhea in one year – a colossal number. Diarrhea usually is not a sickness itself; it is a symptom of many harmful processes in our digestive system. Some people may experience a chronic diarrhea, which happens when diarrhea persists for more than two weeks, and there are more than 3 watery bowel movements daily.

This article focuses on chronic diarrhea after gallbladder removal. Why do many folks suffer from it? Is there non-drug, alternative medicine approach for this nasty condition?

The medical expression for the gallbladder removal surgery is cholecystectomy. This type of diarrhea is a symptom of the postcholecystectomy syndrome; disorder that often includes pain, gas, bloating, bile reflux, etc.

First let’s focus on unpleasant things. Even brilliant operation technique and surgical experience cannot prevent this complication after the gallbladder removal surgery. Statistically, approximately 10% of people without gallbladder sooner or later will have chronic diarrhea. In the US 700,000 gallbladders are removed annually, so we have a large number of sufferers with that issue after the surgery.

According to medical literature there is no cure for this disorder, there are just medications to control diarrhea. Even professionals recognize that cause of diarrhea after gallbladder removal is unknown. Anyhow, doctors call chronic diarrhea after gallbladder removal as “bile acids” diarrhea because bile acids are the culprit. Bile acids are essential parts of the bile.

Bile is produced by the liver and goes into the gallbladder for storage. When semi digested foods, come from the stomach into the first part of the small intestine-duodenum, gallbladder contracts. It pushes the bile through the bile duct and sphincter of Oddi into the duodenum to digest fatty foods.

Our body uses bile acids from the bile as detergent to make fat droplets smaller. It helps pancreatic enzyme lipase split up the fats on glycerol and fatty acids, which can be absorbed throughout the gut wall. This is a little complicated, but without understanding, it is difficult to realize how to get help.

In the normal situation, when bile is alkaline, bile acids are soluble. Any abnormal acidic changes in bile pH lead to precipitation of the bile acids. The insoluble bile acids are highly aggressive substances, which corrode and irritate gallbladder, bile ducts, sphincter of Oddi, duodenum causing inflammation, ulcers, and eventually cancer. The doctors found more incidence of the colon cancer in humans after gallbladder removal. Acidity of bile and precipitation of the bile acids is the main reason for the development of inflammation and gallbladder stones. There is a lot more medical information about this issue, in my eBook: healthy pancreas, healthy you.

By the way, people lose their gallbladders due to acidic bile causing inflammation and gallbladder stones. Gallbladder keeps bile for a long time; therefore, acidic, aggressive bile acids have more time to cause damage and inflammation. No wonder, gallbladder becomes first and …

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