Monday, 18 August 2014

Antibiotic resistance: Cameron warns of medical 'dark ages'

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Antibiotic resistance: Cameron warns of medical 'dark ages'

David Cameron: "We are in danger of going back to the dark ages of medicine"

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The world could soon be "cast back into the dark ages of medicine" unless action is taken to tackle the growing threat of resistance to antibiotics, Prime Minister David Cameron has said.
He has announced a review into why so few anti-microbial drugs have been introduced in recent years.
Economist Jim O'Neill will lead a panel including experts from science, finance, industry, and global health.
It will set out plans for encouraging the development of new antibiotics.
'Taking the lead'
The prime minister said: "If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine where treatable infections and injuries will kill once again."
Mr Cameron said he discussed the issue at a G7 leaders meeting in Brussels earlier this month and got specific support from US President Barack Obama and German Chancellor Angela Merkel.
It is hoped that the review panel's proposals will be discussed at next year's G7 summit, which will be hosted by Germany.
"Penicillin was a great British invention by Alexander Fleming back in 1928," Mr Cameron told the BBC. "It's good that Britain is taking the lead on this issue to solve what could otherwise be a really serious global health problem."
He said the panel would analyse three key issues: the increase in drug-resistant strains of bacteria, the "market failure" which has seen no new classes of antibiotics for more than 25 years, and the over-use of antibiotics globally.
'Time bomb'
It is estimated that drug-resistant strains of bacteria are responsible for 5,000 deaths a year in the UK and 25,000 deaths a year in Europe.
bacteriaA resistant strain of bacteria
Chief Medical Officer for England Prof Dame Sally Davies has been a key figure helping to get the issue on the government and global agenda.
Last year she described the threat of antimicrobial resistance as a "ticking time bomb" and said the dangers it posed should be ranked along with terrorism.
She spoke at a meeting of scientists at the Royal Society last month which warned that a response was needed akin to efforts to combat climate change.
Dame Sally said: "I am delighted to see the prime minister taking a global lead by commissioning this review.
"New antibiotics made by the biotech and pharmaceutical industry will be central to resolving this crisis which will impact on all areas of modern medicine."
Antibiotics dates of discovery timeline
Medical research charity the Wellcome Trust is providing £500,000 of funding for Mr O'Neill and his team, which will be based at their headquarters in central London.
Antimicrobial resistance has been a key issue for Jeremy Farrar, since he became director of the Wellcome Trust last year.
"Drug-resistant bacteria, viruses and parasites are driving a global health crisis," he said.
"It threatens not only our ability to treat deadly infections, but almost every aspect of modern medicine: from cancer treatment to Caesarean sections, therapies that save thousands of lives every day rely on antibiotics that could soon be lost."
'Market failure'
Antibiotics have been an incredible success story, but bacteria eventually develop resistance through mutation.
One example is MRSA, which has been a major threat for years in hospitals. It is resistant to all but the most powerful of antibiotics, and the main weapon against it is improved hygiene, which cuts the opportunity for infection to spread.
Without antibiotics a whole raft of surgical procedures would be imperilled, from hip replacements to cancer chemotherapy and organ transplants.
Before antibiotics, many women died after childbirth after developing a simple bacterial infection.
Mr O'Neill is a high-profile economist who is best-known for coining the terms Bric and Mint - acronyms to describe countries which are emerging and potential powerhouses of the world economy.
He is not, though an expert on antibiotics or microbes. But Mr Cameron told the BBC it was important to have an economist heading the review:
"There is a market failure; the pharmaceutical industry hasn't been developing new classes of antibiotics, so we need to create incentives."
Jeremy Farrar said: "This is not just a scientific and medical challenge, but an economic and social one too which would require analysis of regulatory systems and behavioural changes to solve them."
Mr O'Neill will begin work in September and is expected to deliver his recommendations next spring.
Last month antibiotic resistance was selected as the focus for the £10m Longitude Prize, set up to tackle a major challenge of our time.
Fergus Walsh, Medical correspondentArticle written by Fergus WalshFergus WalshMedical correspondent

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A nine-year-old boy who was born without ears has had a pair created from his ribs.

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Friday, 15 August 2014

Daily aspirin 'reduces cancer risk', study finds

Jack Cuzick has been reported here for his trials on aspirin.

reposted from:
crabsallover highlightskey pointscomments / links.

Taking aspirin every day could cut your risk of developing cancer, report BBC News and The Daily Telegraph among other news outlets, after the publication of a large-scale review of the evidence.
People aged between 50 and 65 who take aspirin every day for 10 years could cut their risk of bowel cancer by 30% and cancers of the throat and stomach by 25%, according to the study published in the Annals of Oncology.
Aspirin is an antiplatelet, which means it reduces the risk of clots forming in your blood. Platelets may also protect cancer cells in the body, and it has been suggested aspirin's effect on them may hinder this process. However, the exact mechanism is not well understood and more research is needed.
Taking aspirin every day comes with a serious health warning as it can cause serious side effects such as ulcers and bleeding from the stomach, particularly in elderly people.
However, the researchers argue the benefits of taking the drug need to be balanced against the harms. 
While the findings of this study show promise, it is not clear whether the methods used in compiling it were systematic, so the results may not be entirely reliable.
Anyone thinking of taking aspirin for prevention should talk to their GP first.

Who may not be able to take aspirin?

Before taking aspirin, including for pain relief, you should talk to your GP or pharmacist if:
  • you are pregnant, trying for a baby or breastfeeding
  • you have a blood disorder
  • you have ever had a stomach ulcer
  • you suffer from asthma
  • you have liver or kidney problems
  • you have high blood pressure
  • you have haemophilia or any other bleeding disorder
  • you have had an unusual or allergic-type reaction to any medicine
  • you are taking other medicines
Aspirin should also not be given to children under 16 years of age

Where did the story come from?

The study was carried out by researchers from a number of institutions across Europe and the US, including Queen Mary University of London.
It was funded by Cancer Research UK, the British Heart Foundation and the American Cancer Society. The study was published in the peer-reviewed medical journal Annals of Oncology.
Several of the study's authors are consultants to, or have other connections with, pharmaceutical companies with an interest in antiplatelet agents such as aspirin.
As might be expected with cancer-related news, the research was widely covered in the press. Most of the coverage was uncritical, although most stories warned of the side effects of taking aspirin.

What kind of research was this?

This was a review of evidence on the association between aspirin and incidence of deaths from cancer and cardiovascular disease, and potential harmful side effects.
It is not clear whether this was a systematic review, where the evidence is rigorously appraised for its quality and risk of bias. The researchers did not carry out a meta-analysis of the results of studies included, but compiled their own estimates.
The authors say regular aspirin is known to reduce the incidence of cardiovascular disease both in the general population and in high-risk groups, although it is currently only recommended for those at high risk.
However, an increasing body of evidence suggests it may also have a role in cancer prevention. Aspirin is also associated with a risk of bleeding and peptic ulcers. The researchers argue the benefits of taking the drug need to be balanced against the harms.

What did the research involve?

Researchers gathered evidence on the effects of aspirin on cancer risk and cancer deaths from systematic reviews published between 2009 and 2012, as well as from some individual studies on specific cancers. Further systematic reviews undertaken by some of the researchers were not included, but were discussed at the "evidence review meeting".
It is not clear how these studies were chosen or whether further studies on the topic were excluded and, if so, what criteria were used to decide which studies to include or exclude.
Evidence for aspirin's effect on cardiovascular disease was taken from one large meta-analysis. The authors based their calculations of the effect aspirin would have on cardiovascular disease by using UK rates from 1998 for cardiovascular-related incidents and deaths, which they adjusted to take account of downward trends in recent years in both the UK and the US.
The researchers used a detailed unpublished analysis of the harmful effects of aspirin.
They calculated the overall benefits and harms for taking aspirin for 10 years, starting at ages 50, 55, 60 and 65, separately for men and women. They made several assumptions in their analysis:
  • the cardiovascular benefit and adverse effects only occur during active treatment (the 10-year period)
  • the protection against cancer begins three years after initiating aspirin and continues for an additional five years after stopping aspirin
  • the protection against cancer mortality begins five years after starting aspirin use and lasts for an additional 10 years after treatment is stopped
  • the protective effects are seen only in colorectal, oesophageal, gastric, breast, prostate and lung cancers

What were the basic results?

The researchers calculated that for average-risk individuals aged 50 to 65 taking aspirin for 10 years, there would be a relative reduction of between 7% (women) and 9% (men) in the number of cancer, myocardial infarction or stroke events over a 15-year period, and an overall 4% relative reduction in all deaths over a 20-year period.
Below are their calculations of the effect of aspirin in reducing the risk of cancers and cardiovascular events, giving what the researchers say are "conservative" estimates:
  • colorectal (bowel) cancer – 30% reduction in incidence and 35% reduction in deaths
  • oesophageal cancer – 25% reduction in incidence and 45% reduction in deaths
  • gastric cancer – 25% reduction in incidence and 30% reduction in deaths
  • lung cancer – no reduction in incidence, 10% reduction in deaths
  • prostate cancer – 5% reduction in incidence, 10% reduction in deaths
  • breast cancer – 5% reduction in incidence, no reduction in deaths
  • heart attack – 18% reduction in incidence, 5% reduction in deaths
  • stroke – 5% reduction in incidence, 21% increase in deaths
Their calculations on the risk of side effects from taking aspirin are:
  • major (extracranial) bleeding – 70% increase in incidence
  • gastric bleeding – 70% increase in deaths
  • peptic ulcer – 70% increase in deaths
They also say the effects are not apparent until at least three years after starting aspirin, and some benefits may be sustained for several years after stopping.
They found no difference between low and high doses of aspirin in terms of health benefits, although there were no studies that did direct comparisons.

How did the researchers interpret the results?

The researchers say once aspirin's effect on cancer risk and mortality is taken into account, the benefits of taking aspirin outweigh the risks.
They calculate that to get any benefit, people need to start taking a daily dose of between 75mg and 325mg for a minimum of five years. Longer use is likely to have greater benefits, they say.
Further research is needed to determine the optimum dose for taking aspirin and duration of use, and to identify those at increased risk of bleeding.
In an accompanying press release, lead author Professor Jack Cuzick of Queen Mary University of London said: "It has long been known that aspirin – one of the cheapest and most common drugs on the market – can protect against certain types of cancer.
"But until our study, where we analysed all the available evidence, it was unclear whether the pros of taking aspirin outweighed the cons.
"Whilst there are some serious side effects that can't be ignored, taking aspirin daily looks to be the most important thing we can do to reduce cancer after stopping smoking and reducing obesity, and will probably be much easier to implement."


While the findings on aspirin and cancer show promise, it is not clear that the results are reliable from the methods reportedly used to compile this review.
This is because it included studies of varying design and quality, with much of the evidence coming from observational studies, which, while useful, cannot be totally relied on to test the effectiveness of healthcare interventions.
It's not clear how the studies included in the review were chosen and whether others on the same topic were excluded. It is also not clear whether or not this was a systematic review, where studies are rigorously appraised for their quality, and criteria are established for their inclusion.
Aspirin can cause major side effects such as peptic ulcers and bleeding from the stomach, particularly in older people. It's important to consult with your GP before deciding to take aspirin regularly. 

Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.