Generic Hepatitis C Drugs as Effective as Pricey Brand Names: Study

SATURDAY, April 16, 2016 (HealthDay News) — Low-cost generic antiviral drugs are as effective and safe as more expensive brand-name drugs in treating people with hepatitis C, researchers report.

In many countries, people don’t have access to a course of brand-name direct-acting antiviral drugs due to the high cost — as much as $94,000 a patient, the researchers explained.

However, mass-produced generic versions are available for less than 1 percent of the retail price of the brand-name drugs, they added.

“Our interim data suggests a potential solution for hepatitis C patients in areas where treatment access has been restricted as a result of the high prices demanded for branded treatment,” said study author Dr. James Freeman, of GP2U Telehealth in Hobart, Australia.

The study of patients in the United States, Canada, Africa, Australia, Europe and Southeast Asia found that generic direct-acting antiviral drugs sofosbuvir (Sovaldi), ledipasvir, daclatasvir (Daklinza) and ribavirin (Rebetol) were as effective as brand-name versions.

The study was to be presented Saturday at the annual meeting of the European Association for the Study of the Liver (EASL) in Barcelona. Until published in a peer-reviewed medical journal, data and conclusions presented at meetings are usually considered preliminary.

A full course of brand-name direct-acting antiviral medication that costs $94,000 a patient in the United States can be obtained in generic form for less than $1,000. And, a 12-week course of treatment could cost as little as $200 in coming years, the researchers said in a meeting news release.

“At the price level of generic direct-acting antivirals, treating the entire global hepatitis C epidemic could be financially feasible. Furthermore, if a patient is cured of hepatitis C, there is evidence for improved survival and lower risks of liver cancer and liver cirrhosis,” Freeman said in the news release. He added that cured patients could return to work, delivering further economic benefits to society.

Another expert said there is a clear role for generic treatments such as these for people with hepatitis C.

“The implications of increased availability of these drugs could be enormous, presenting more people with the possibility of a ‘cure’ for what is often a debilitating condition,” Laurent Castera, secretary general of EASL, said in the news release.

Hepatitis C is a virus that can infect the liver, leading to inflammation, scarring and liver cancer.

More information

The U.S. Centers for Disease Control and Prevention has more on hepatitis C.

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Depression Common for Heart Attack Survivors, And More May Need Help

SATURDAY, April 16, 2016 (HealthDay News) — Although depression, stress and exhaustion are known to increase heart attack risk, people who’ve already had a heart attack may not be getting the treatment they need for these conditions, new research suggests.

The Swedish study included more than 800 people younger than 75. Their average age was 62. All had suffered one heart attack. The researchers compared this group to an equal number of similarly aged people who never had a heart attack.

Fourteen percent of those in the heart attack group had symptoms of depression, compared with 7 percent of those in the control group, the study found. Symptoms of depression or exhaustion were associated with a doubled risk of heart attack, though the study did not prove they actually caused the heart attacks.

However, only 16 percent of heart attack patients with depression were prescribed antidepressants, compared with 42 percent of people in the control group with depression. It’s unlikely that this gap in treatment was filled by counseling, the researchers added.

Heart attack patients were also more likely than those in the control group to have stress at home (18 percent vs. 11 percent) and at work (42 percent vs. 32 percent). The study found that even moderate levels of stress at home were linked to a doubled risk of heart attack.

The study was to be presented Saturday at the European Society of Cardiology (ESC) meeting in Athens, Greece. Findings presented at meetings are generally viewed as preliminary until they’ve been published in a peer-reviewed journal.

“Patients who had a heart attack had more stress both at work and at home, but interestingly there was no difference between the two groups as regards to financial stress,” lead researcher Dr. Barbro Kjellstrom, from the Karolinska Institute in Sweden, said in an ESC news release.

“Patients also reported that they had less control of their work situation. In addition, those who had a heart attack were more likely to be divorced whereas people in the control group more often lived with a partner,” she said.

The researchers also found that many more heart attack patients said they’d been angry in the past 24 hours compared to people in the control group.

“Stress-related disorders, such as depression and exhaustion, are increasingly common and have been the main reason for long-term sick leave in Sweden for more than a decade,” she noted.

“We know that stress and depression are big risk factors for heart attack and we confirmed this connection in our study. But what was new and astonishing was that heart attack patients less often receive treatment for depression,” Kjuellstrom added.

“It appears that patients who had a heart attack did not seek help for their depression, or if they did, their symptoms were not accurately recognized and managed. An important take-home message is for clinicians to ask patients, ‘How do you feel?’ and listen to the reply, rather than zoning out because they are stressed themselves,” Kjellstrom said.

Although there’s no specific treatment for stress, she noted, increasing levels of stress can lead to exhaustion. And, she added, if exhaustion isn’t treated, it can lead to depression.

“This is an escalating scale. Prevention of stress, exhaustion and depression is the optimal goal and we should remember that these are risk factors for many other diseases than heart attack,” Kjellstrom said.

More information

The U.S. National Heart, Lung, and Blood Institute has more on heart attack prevention.

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Low-Fat Diets May Help Older Women With Breast Cancer Survive Longer: Study

By Kathleen Doheny
HealthDay Reporter

FRIDAY, April 15, 2016 (HealthDay News) — Older women who follow a low-fat diet may be slightly less likely to die if they develop breast cancer, a new study suggests.

A decade after a breast cancer diagnosis, 82 percent of those eating low-fat fare were still alive, compared to 78 percent of those eating a higher-fat diet.

“Breast cancer mortality was less [in the low-fat group], but not significantly,” said Dr. Rowan Chlebowski, a medical oncologist at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center in Torrance, Calif.

Chlebowski plans to present the findings Monday at the American Association for Cancer Research annual meeting, in New Orleans. Studies presented at medical meetings are viewed as preliminary until they are published in a peer-reviewed journal.

In the new analysis, researchers looked at whether following a diet that limited fat intake to no more than 20 percent of calories helped women survive longer if they developed breast cancer. They were compared to women following a typical Western diet that had fat intake of more than 32 percent of total calories.

The low-fat diet won out.

“There were 20 percent fewer deaths after breast cancer in the low-fat group than the usual diet or control group” during the follow-up period, Chlebowski said.

The study is a secondary analysis of part of a U.S. study known as the Women’s Health Initiative. In that part of the study, researchers enrolled nearly 49,000 women, all past menopause, at 40 different clinical centers across the United States from 1993 to 1998.

The researchers assigned those women, all cancer-free at the start of the study, to follow a low-fat diet or their usual eating plan.

During the course of the eight-year study, about 1,700 women developed breast cancer. Those in the low-fat group were somewhat less likely to develop the disease and somewhat less likely to die from it, but the results were not dramatic.

Even so, the researchers continued to follow the women, looking to see if those on the low-fat plan were more likely to survive after a breast cancer diagnosis.

Ten years after diagnosis, the researchers found that women on the low-fat plan had a survival advantage when all causes of death were examined. Some of the reduction in all causes of death was due to fewer deaths from heart disease in the low-fat group, the researchers explained.

During the study, the low-fat group went to group sessions led by registered dietitians to learn how to limit their fat intake. The women were told they could eat the same foods, but to prepare them differently, Chlebowski said.

The findings can’t prove cause and effect, he said, but rather should guide future research about the value of low-fat diets. The results also suggest that women need to stay on that low-fat diet to maintain the survival benefit, Chlebowski said.

Dr. Courtney Vito is an assistant clinical professor of surgical oncology at the City of Hope, in Duarte, Calif. She endorsed the study, adding the message can help empower women who have had breast cancer.

Doctors have long known that women who are past menopause and overweight are at higher risk for getting breast cancer, Vito said. That is believed to be partly explained by higher levels of circulating estrogen, as fat cells produce estrogen, she said.

“So it would make sense that someone eating a lower-fat diet will overall be healthier,” Vito said.

Lowering fat intake to just 20 percent of calories is not easy, Vito acknowledged. For a typical 2,000-calorie-a-day diet, that would mean getting just 400 calories from fat, or 44 total fat grams. For perspective, a single 3.5-ounce serving of caramel chunk ice cream has 16 grams of fat.

Even so, it is a goal worth striving for, Vito said. “It empowers women who want to know what they can do to reduce the chance of their breast cancer coming back,” she added.

Her advice for women?

“I would say do your best to aim for that 20 percent,” Vito said, because falling short of that goal is better than not trying.

More information

To learn more about eating low-fat foods, see American Cancer Society.

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Depression More Common in Kids Who Join Gangs, Study Finds

FRIDAY, April 15, 2016 (HealthDay News) — Depression and suicidal thoughts or attempts are common among youth who join gangs, and these problems get worse after they join, a new study suggests.

The researchers analyzed data from more than 11,000 students in middle schools and high schools across the United States. The investigators found that gang membership was associated with greater levels of depression, a 67 percent increase in suicidal thoughts, and a 104 percent increase in suicide attempts.

“Youth who join a gang are much more likely to have mental health issues, and then being in the gang actually makes it worse,” said study co-author Chris Melde. He is an associate professor of criminal justice at Michigan State University.

“It [gang membership] doesn’t act as an antidepressant. And some people may be seeking that out — a sense of well-being or purpose,” he said in a university news release.

There are an estimated 850,000 gang members in the United States. Many young people — particularly those who are poor and are minorities — may believe gang membership will help them gain money, protection, status or a sense of belonging they don’t have in places such as home and school, the researchers said.

But, “if you think of gang membership as a coping mechanism — trying to cope with the hand you’ve been dealt in life — it doesn’t work,” Melde said.

“Kids join gangs for reasons, but when we try to find the benefits — whether it’s for protection, a sense of worth, whatever — we’re finding it actually makes an already significant problem in their lives even worse,” he added.

But the study did not prove that gang membership causes mental health problems.

The study was published online April 13 in the journal Criminal Justice and Behavior.

More information

The U.S. National Institute of Mental Health has more on child and adolescent mental health.

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Pair Gamblers Anonymous With Other Treatments for Best Results

FRIDAY, April 15, 2016 (HealthDay News) — Gamblers Anonymous helps people with gambling problems, and it’s even more effective when used along with other treatments, researchers report.

In a new review, investigators analyzed data from 17 studies published between 2002 and 2015 that examined problem gambling. The research included data on various aspects of problem gambling, and on treatments such as Gamblers Anonymous, a 12-step program based on peer support and shared desire to stop gambling.

“Gamblers Anonymous is one of the most cost-effective and easily accessible resources for individuals living with problem gambling issues,” said study author Flora Matheson. She is a medical sociologist at the Center for Research on Inner City Health at St. Michael’s Hospital in Toronto, Canada.

“However, despite the widespread use of Gamblers Anonymous, there has been little research exploring its effectiveness as a recovery approach, and those that have are largely inconsistent,” she said in a hospital news release. “We looked at the available data to identify gaps in knowledge and offer some insight for future focuses of study.”

Joining Gamblers Anonymous led to higher rates of gambling abstinence, fewer gambling symptoms and better quality of life, the researchers reported. This was especially true when it was combined with other treatments, such as stress management training and cognitive behavioral therapy.

In stress management training, people learn about coping methods, breathing techniques and muscle relaxation. And cognitive behavioral therapy is a form of psychological counseling where people learn to change negative thinking patterns and behaviors, the study authors explained.

Previous research has found that many problem gamblers also abuse drugs or alcohol, or have other mental health issues that stem from a traumatic experience, Matheson said.

“Gamblers Anonymous remains a viable and accessible option for people with problem gambling, but its effectiveness alone as a treatment option needs to be evaluated comprehensively to determine any gaps and improve care for these individuals,” Matheson said.

Problem gambling affects between 3 percent and 6 percent of people, but the rate is much higher among those with low incomes, the study authors said.

The study was published April 5 in the Journal of Gambling Studies.

More information

The National Council on Problem Gambling has more about gambling addiction.

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Can Eating a Big Meal Really Stretch Your Stomach?

Photo: Getty Images

Q: Does your stomach really shrink and stretch depending on how much you eat?

Your stomach is an elastic organ, so when you take in a large volume of food, liquid, or air (think carbonation), it does expand to accommodate everything that’s put into it. But it starts to shrink back to its normal size once the meal has passed out of the stomach. So overeating on occasion won’t permanently expand your stomach and in turn won’t make you hungrier.

RELATED: 10 Types of Hunger and How to Control Them

There is, however, some scientific research out there suggesting that regularly restricting your food intake may reduce stomach capacity over time, possibly because the stomach wall eventually becomes more resistant to being stretched. (And vice versa with overeating.) But I still wouldn’t recommend getting hung up on food restriction and stomach size as a weight-loss method. In fact, overweight people generally don’t have bigger stomachs than thinner people.

There are a number of more important components of weight control, including hormone levels and psychological factors. While portion sizes do count, it’s the quantity and quality of the calories that make up those portions that play the major role in weight management. Bottom line: Don’t obsess over your stomach getting stretched.

RELATED: The 50 Best Weight Loss Foods of All Time

Health’s medical editor, Roshini Rajapaksa, MD, is assistant professor of medicine at the NYU School of Medicine.

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Early Stage Breast Cancer Does Need Treatment, Study Finds

By Kathleen Doheny
HealthDay Reporter

FRIDAY, April 15, 2016 (HealthDay News) — Early stage breast cancers known as DCIS (ductal carcinoma in situ) should be treated with surgery, not a “wait-and-watch” approach, according to new research.

Experts have debated whether to treat early DCIS or simply monitor it to see if it progresses. The new study suggests excision of DCIS — cancer confined to the milk ducts in the breast — is best in nearly all cases.

“Regardless of [tumor] grade, surveillance alone without surgery is not adequate,” said Dr. Sadia Khan, advisor to the breast cancer program at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif. She presented the study results Thursday at the American Society of Breast Surgeons meeting in Dallas.

Grade describes the degree of tumor-tissue abnormality and how likely it is to grow. Lower grades have better outlooks.

With treatment, survival from DCIS is nearly 100 percent, Khan said. However, if the cancer recurs, it can become invasive and life-threatening.

For the study, Khan and her colleagues divided 720 patients with DCIS into two groups. Nearly 600 of the women had the tumor excised, with clear (cancer-free) margins of 1 millimeter or more after surgery. Those women were compared with 124 whose margins were less than 1 mm. These women declined a recommended second surgery. A margin of 2 mm of normal tissue around the tumor site is a common goal.

Those who declined the second surgery served as a surrogate for an observation-only group in the study.

After 10 years, about two-thirds of those with margins of less than 1 millimeter had a local recurrence, compared to up to 46 percent of those in the group with broader margins, the study found.

Recurrence was defined as the cancer returning to the original site.

Even in those who had the very earliest DCIS, with the lowest grades, the recurrence rate was 53 percent in those with margins less than 1 mm. The researchers termed this rate “too high” to be considered adequate treatment.

In comparison, only 13 percent of those with the very earliest DCIS and margins of more than 1 millimeter had recurrence after 10 years, the study found.

“Doing a needle biopsy and just watching someone with a mammogram is inappropriate and unacceptable for DCIS,” Khan said.

The study adds “very important information” for women who want to know their recurrence risk, and talk to their doctors about what to do and decide what risk they are comfortable with, said Dr. Linda Bosserman. She is a clinical assistant professor at the City of Hope Medical Group in Rancho Cucamonga, Calif. She played no role in the study.

Depending on a woman’s preferences and other medical conditions, she said, some women may accept a relatively low risk of recurrence. Adding radiation after surgery can reduce the recurrence risk of DCIS even more, Bosserman pointed out.

The study adds good information doctors can pass on to patients, she said. “We can now better advise our patients, based on this study, that if they have low grade (1-2) DCIS [the earliest grade] with less than a 1 mm margin, they would have an 18 percent chance — or about a one in five chance — of having their breast cancer recur in five years,” Bosserman said.

Over 10 years, their recurrence risk rises to about one in two, she added.

Another expert, Dr. Julie Margenthaler, professor of surgery at Washington University in St. Louis, said that the study reinforces the concept that “for the vast majority, the standard surgical excision [of DCIS] is still the appropriate course of treatment.” Margenthaler wasn’t involved in the new study.

“There are select patients who may be eligible for observation alone. But that should be closely monitored,” she said. Ideally, they should be in a clinical trial, Margenthaler suggested.

Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

More information

To learn more about DCIS, visit the American Cancer Society.

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Widely Used Type 2 Diabetes Drug May Reduce Cancer Death Risk

By Steven Reinberg
HealthDay Reporter

FRIDAY, April 15, 2016 (HealthDay News) — Metformin, a commonly prescribed diabetes drug, may reduce the risk of dying from some cancers for postmenopausal women with type 2 diabetes, a new study suggests.

The study found that for women with type 2 diabetes and cancer, the odds of dying from cancer appeared to be 45 percent higher compared to women with cancer who didn’t have diabetes. But, in women with cancer who took metformin to treat their type 2 diabetes, the risk of dying from cancer seemed about the same as it was for women without diabetes.

“Our findings from this large study may provide more evidence that postmenopausal women with diabetes and cancer may benefit from metformin therapy compared to other anti-diabetes therapy,” said lead researcher Zhihong Gong. She’s an assistant professor of oncology at the Roswell Park Cancer Institute, in Buffalo, N.Y.

Gong cautioned, however, that this study didn’t prove that metformin prevents or reduces the risk of dying from cancer, only that an association was found. And, she added that more studies are necessary to figure out metformin’s possible role in decreasing the risk of dying from cancer.

The report was published in the April 15 print issue of the International Journal of Cancer.

Metformin is a first-line drug in the treatment of type 2 diabetes, the American Diabetes Association (ADA) says. People with type 2 diabetes don’t use the hormone insulin efficiently, which leads the pancreas to pump out more and more insulin until it eventually fails, the ADA explains. Insulin is a hormone that’s necessary for the body to use the carbohydrates in food as fuel. Metformin makes the body more sensitive to insulin and reduces insulin resistance, the researchers said.

The study team reviewed data from nearly 146,000 postmenopausal women. They were between the ages of 50 and 79. The information was collected between 1993 and 1998 and came from the large Women’s Health Initiative study.

The researchers wanted to focus on women with type 2 in this study. So, in an effort to exclude women with type 1 diabetes, the researchers removed information on anyone who had been diagnosed with diabetes before age 21.

Looking at specific cancers, the risk for postmenopausal women with diabetes appeared to be about 25 percent to 35 percent higher for developing colon and endometrial cancers and non-Hodgkin lymphoma. The women’s risk was more than doubled for liver and pancreatic cancers, the researchers found.

“Our findings suggest that diabetes remains a risk factor for cancer and cancer-related death, and metformin therapy, compared to other diabetes medications, may have an important role in [managing] diabetes-associated cancer,” Gong said.

One diabetes expert who wasn’t involved with the study was cautious about interpreting the results.

Although the study found a slight risk reduction, it depended on taking the drug for a long time, said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City. More studies are in progress to determine the long-term effect of metformin in cancer risk, he added.

“We still don’t understand the exact mechanism of action of this old drug used in diabetes,” Zonszein said. “It may have positive effects in decreasing cancer mortality and or increasing longevity as shown in this paper.”

More information

For more information on type 2 diabetes, visit the American Diabetes Association.

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To Be a Safe Boater, Be a Smart Boater

FRIDAY, April 15, 2016 (HealthDay News) — The arrival of warm weather means millions of Americans will be heading out in their boats, so experts are offering a few safety reminders.

Launch your watercraft in designated areas, travel only in areas open to your type of craft, operate it at a safe speed and carry a Coast Guard-approved life vest for each person on board, says the nonprofit group Tread Lightly.

Obey all signs and respect barriers, including speed limits, no-wake zones and underwater obstructions. Always try to go boating with a partner, and never mix boating with alcohol or drugs.

Always designate a person to watch for other boaters, objects and swimmers. Never jump a wake. Instead, cross at low speed and keep an eye out for skiers and towables, Tread Lightly advises.

If you use a trailer, make sure it has no problems, that the lights work, and that your boat is secure on the trailer. Be sure to balance your trailer load, including items stowed inside the boat.

When planning a longer cruise, take these precautions, Tread Lightly advises:

• Make sure your boat is mechanically sound.
• Check the weather forecast for your destination and bring the appropriate clothing, equipment and supplies.
• Be sure you have enough fuel for the entire trip.
• Carry a fire extinguisher, warning flares and other emergency items.
• Have a Global Positioning System (GPS), and know how to use it.

It’s also important to know distress signals and warning symbols, get charts of your destination, always tell someone about your travel plans and file a float plan.

More information

The U.S. Coast Guard has more about boating safety.

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Simple Steps Can Keep Lawn Mowing Safe

FRIDAY, April 15, 2016 (HealthDay News) — April showers bring May flowers, green grass and the potential for lawn mower accidents.

More than 250,000 people in the United States were treated for lawn mower-related injuries in 2010, a 3 percent increase from the previous year, according to the U.S. Consumer Product Safety Commission.

The American Academy of Orthopaedic Surgeons offers some safety tips for lawn mowers, whether the riding, power or push style:

• Keep your lawn mower in good working order and have it serviced before you use it for the first time each season. Make sure the motor is off before you inspect or repair a lawn mower, and use a stick or broom handle, not your hands or feet, to remove debris.
• Always read the instruction manual, and never remove safety devices, shields or guards on switches. Add fuel before starting the engine, not when it is running or hot. Never leave a running lawn mower unattended. Avoid touching the engine cowling (covering), which can became extremely hot and burn unprotected flesh.
• Wear sturdy shoes, long pants, protective gloves and goggles when mowing. Never drink alcohol before using a mower. Check for and remove stones, toys and other objects from the lawn before mowing. Mow across slopes when using a push mower, and mow up and down slopes when using a riding mower.
• Teach children to stay away from running lawn mowers and never let them play in or near an area being mowed. Never let children ride on a mower. Children should be at least age 12 before using a push mower and 16 before using a riding mower.

More information

West Virginia University has more on lawn mower safety.

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