Friday, April 26, 2013

"Miracle Foods" – Can They Decrease the Risk of Cancer?

Nutrition (Photo credit: Susan von Struensee)

(From: Routledge, A Member of the Taylor & Francis Group

Cancer is a disease that invokes fear, so it is not surprising that the public is eager to identify ways to decrease the risk. The media often features information on “Miracle Foods” and publicizes whether these foods can actually decrease the risk of cancer. 

Reality Check: There is No Such Thing as a Miracle Food, published in Volume 65, Issue 2 2013 of Nutrition and Cancer: An International Journal, is a commentary written by the University of Minnesota's Maki Inoue-Choi, Sarah Oppeneer, and Kim Robien that calls on both researchers as well as media sources to consider the validity of multiple studies as opposed to singular studies before assuming that media information is factual.

"Nutritional scientists and epidemiologists should be cognizant of the public health messages that are taken away from their individual studies and not sensationalize the findings or contribute to the media frenzy around a single study," the authors believe. 
The authors mention two separate studies that theorize a decreased risk of ovarian cancer due to flavonoids in red onions and omega-3 in sea bass. Both of these studies were reported as fact on a popular television talk show.  The authors assert that with further research, three other studies would have been found that can disprove the findings reported as true.  
"The public needs more information about the effect of diet as a whole on cancer risk, as well as the importance of achieving and maintaining an ideal body weight, regular physical activity, and avoiding a sedentary lifestyle," the authors wrote.     

*FREE ACCESS - Reality Check: There is No Such Thing as a Miracle Food


"A recent episode of the Dr. Oz Show suggested endive, red onion, and sea bass as foods that can decrease the risk of ovarian cancer by up to 75%. However, the scientific evidence supporting these recommendations is limited. This commentary discusses some of the concerns related to the promotion of “miracle foods” by the media. Nutritional scientists and epidemiologists should be cognizant of the public health messages that are taken from their individual studies and not sensationalize the findings of a single study."

About Nutrition and Cancer: An International Journal
Nutrition and Cancer: An International Journal reports on current research and findings relative to the effects of nutrition on the etiology, therapy, and the prevention of cancer. The Journal presents original papers by experts around the world.

EDITOR: Leonard A. Cohen
2.783 Impact Factor (© 2012 Thomson Reuters, 2011 Journal Citation Reports®)
Print ISSN: 0163-5581 • Online ISSN: 1532-7914
Volume 65, 2013, 8 issues per year

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Tuesday, April 16, 2013

Measuring Pain Using Functional MRI

Regions of the cerebral cortex associated with...
Regions of the cerebral cortex associated with pain. (Photo credit: Wikipedia)
Measuring Pain using Functional MRI | Now@NEJM:

Excerpt from NEJM Blog:

"The moment we find a useful biomarker, our ability to manage a condition improves:  we treat diabetes by following the glycemic index, we treat HIV by following a viral load and a CD4 count. Conditions without biomarkers often frustrate treatment – after all, like the business adage – “you can’t manage what you don’t measure.” Although some diseases fall into this category, frustratingly, so does the symptom of painThis week’s NEJM reports on a biomarker – specifically a neurologic signature through the use of functional MRI – with the hope that a method to objectively measure pain will allow for titration of medications to achieve effective symptomatic relief in the distressed patient."

Read full article here


Action Points

Read full article here.
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Friday, April 12, 2013

The Case of Avastin and Conflicting Advice – Should Medical Compendia Hold so Much Power?

LONDON, UK (GlobalData*), 10 April 2013 - Guidelines for off-label drug use hold immense commercial implications, and stricter controls are needed on medical compendia, given their influence in this field, states recent analysis by research and consulting firm GlobalData.

In all areas of healthcare, the line between the interests of regulators, insurers, physicians, and patients can be murky, and widespread off-label drug prescribing represents a growing grey area in oncology. This practice came under scrutiny by Rena Conti at the University of Chicago, in a recent study which shines a light on drugs that come with a hefty price tag, and are commended for numerous off-label uses despite uncertain clinical risks and benefits.

Medical compendia are meant to ensure that patients have access to the newest registered drugs when evidence emerges to support specific off-label indications, but their decisions can sometimes draw questions. A recent study lead by Conti establishes a benchmark for off-label use of certain expensive drugs with known safety issues, on the basis of guidance from privately published compendia. Insurers routinely rely on guidelines such as the National Comprehensive Cancer Network’s (NCCN) Drugs and Biologics Compendium to make coverage decisions for off-label indications, and Conti’s group found that from the US$12 billion spent on 10 leading chemotherapies in 2010, US$4.5 billion was spent off-label, and US$2 billion was spent on NCCN-supported uses.

Anita Angelica Moore, GlobalData’s Healthcare Analyst for Oncology, explains: “Advocates of medical compendia argue that off-label prescribing represents a crucial element in the oncology market, due to limited treatment options and the impracticability of FDA applications being submitted for every combination of agent and cancer type. However, critics contend that compendia publishers are too quick to recommend drugs based on limited research, and cite the possibility of conflicts of interest, especially in cases where compendia panel members are financially linked to drug manufacturers.

“Compendium guidelines play a large role in influencing prescribing patterns, and so their commercial implications are immense”, states Moore. “2011 saw the US’s largest payer Medicare base its reimbursement policy concerning the off-label use of Avastin for metastatic breast cancer on the NCCN compendia’s vote. That year, the US Food and Drug Administration (FDA) announced that Avastin, while still approved for other cancers, caused more harm than benefit in breast cancer patients. In a controversial decision, Medicare continued coverage for the off-label use of Avastin at a hefty annual price tag of US$88,000, a decision based largely on NCCN recommendations. Critics of this decision cite the fact that a third of the NCCN’s guideline-writing committee had financial ties to Avastin’s producers, Roche and Genentech.”

Conti also charted the prevalence and cost of off-label prescribing of 10 patent-protected, intravenous cancer drugs in 2010, and showed that Avastin was both more commonly used off than on label, and was the single largest contributor to off-label prescribing costs during that year.

Moore argues that such compendia are not the best judge, however: “Systematic analysis of major compendia has found a host of methodological problems, wide variety in recommendations, and a general lack of transparency. For instance, endorsements were given for Avastin in the 2010 NCCN compendia for adjuvant use in colorectal cancer, despite the drug having continually failed to improve outcomes when used in this capacity, and a negative study having been presented a full year earlier. This recommendation has since been updated, but the error showcases the failure of NCCN guidelines to update material.

*Article courtesy of GlobalData

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Thursday, April 11, 2013

The happy secret to better work - Shawn Achor on

Shawn Achor: The happy secret to better work | Video on

"We believe that we should work to be happy, but could that be backwards? In this fast-moving and entertaining talk, psychologist Shawn Achor argues that actually happiness inspires productivity. (Filmed at TEDxBloomington.)

Shawn Achor is the CEO of Good Think Inc., where he researches and teaches about positive psychology."

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Monday, April 8, 2013

Journal Club: Celecoxib in the Prevention of Capecitabine-related Hand-foot Syndrome

Welcome to the first installment of OncoPRN Journal club. This review looks at celecoxib as a possible agent to be used in the treatment of capecitabine-related hand-foot syndrome

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Saturday, April 6, 2013

Albertans may pay high cost for cheaper generic drugs

English: Close-up of 0.5mg tablets of the bran...
English: Close-up of 0.5mg tablets of the brand name benzodiazepine drug, Ativan. Generic name is Lorazepam. (Photo credit: Wikipedia)
Featured letter: Albertans may pay high cost for cheaper generic drugs:

Ontario did it first. Alberta followed suit, outdoing Ontario. Reducing generic drug reimbursement prices. Government paid advertisements (how much is that costing taxpayers? Actually just found out - $400,000!) would have you believe this is saving Alberta over $90 million big ones. The ramifications will be much more severe, more than what the government will let you know, maybe more than they fathomed.

Excerpt from featured Edmonton Journal letter:

"Beginning May 1, the Alberta government will force generic drug manufacturers to sell their products at 18 per cent of the price brand name drugs are sold at, compared with the current 35 per cent. 
Hypothetically, if a bottle of Druggin costs $100, its generic equivalent Drugsler must be sold at $18, decreasing the generic drug manufacturer’s profit by $17 per bottle. 
As profits decrease, the large generic drug manufacturers will react in two ways. 
First, they will reduce or eliminate the rebates they pay to pharmacies for using their products. Pharmacies will, in turn, be forced to reduce their hours and their staff, even though the demand for pharmacists’ services will increase as baby boomers grow old and require more medication. 
Second, generic drug manufacturers will reduce the supply of generic medications in Alberta."

Read the full article at The Edmonton Journal.

Support your pharmacists (and find out more) here.

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About Onco-PRN

Welcome and thanks for visiting Onco-P.R.N. - The oncology website with a focus on all things oncology pharmacy/pain/palliative care-related. It is intended to be an information resource for those pharmacist and relevant health care professionals involved in whatever fashion with cancer and palliative care. Stay tuned for the latest and greatest links and information with respect to: oncology medications, continuing education, pharmaceutical care initiatives, pain and symptom control, supportive care topics, and whatever else that might fit into the theme.

*Note: This website is not affiliated with Alberta Health Services (AHS) or CAPhO and the opinions expressed herewithin are that of the author(s).

Pharmacy History

"The earliest known compilation of medicinal substances was ARIANA the Sushruta Samhita, an Indian Ayurvedic treatise attributed to Sushruta in the 6th century BC. However, the earliest text as preserved dates to the 3rd or 4th century AD.
Many Sumerian (late 6th millennium BC - early 2nd millennium BC) cuneiform clay tablets record prescriptions for medicine.[3]

Ancient Egyptian pharmacological knowledge was recorded in various papyri such as the Ebers Papyrus of 1550 BC, and the Edwin Smith Papyrus of the 16th century BC.

The earliest known Chinese manual on materia medica is the Shennong Bencao Jing (The Divine Farmer's Herb-Root Classic), dating back to the 1st century AD. It was compiled during the Han dynasty and was attributed to the mythical Shennong. Earlier literature included lists of prescriptions for specific ailments, exemplified by a manuscript "Recipes for 52 Ailments", found in the Mawangdui tomb, sealed in 168 BC. Further details on Chinese pharmacy can be found in the Pharmacy in China article."

From Wikipedia:

Journal of Palliative Medicine - Table of Contents

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