Thursday, May 26, 2016

Morning Rounds by Megan Thielking

Happy Thursday! Hope your morning is off to a wonderful start. Here's what's driving the news in science today. 

VA proposes expanding nurses' medical authority

The VA wants nurses to help address the agency's issues with patient wait times. A new proposal would grant some registered nurses the authority to practice as nurse-midwives, nurse anesthetists, and certified nurse practitioners. In essence, nurses will be able to do everything they’re certified to do without the supervision of a doctor. The VA hopes that will help the agency make the most of its limited resources to provide better care to veterans. The agency is taking comments on the proposed rule here.

FDA decides to delay deciding on dystrophy drug

Sit tight: It’s still unclear when the FDA will make its decision on Sarepta Therapeutics’ controversial drug for Duchenne muscular dystrophy. Yesterday the agency pushed out the deadline for approval, originally set for this week. Anticipation of the decision drove Sarepta's stock prices up more than 20 percent this week. Patient advocates want to see eteplirsen receive an accelerated approval from the FDA, but the evidence used to back the drug is fiercely contested. An advisory panel recently recommended the FDA reject the drug application. Which way do you think the FDA will sway? Send me an email at

Alzheimer's amyloid plaques also catch bacteria

Salmonella cells (in green) stuck onto amyloid peptides (in red). (D.K.V. Kumar et. al)

Sticky amyloid plaques have long been blamed for the development of Alzheimer’s disease in the brain, and new research suggests their presence there could be a byproduct of infection. In mice and worms, researchers saw that amyloid-ß plaques create a spider web of sorts and catch bacteria, including salmonella, as they’re launching an invasion on the body. That leads scientists back to the controversial theory that the buildup of amyloid-ß in the brains of Alzheimer's patients is actually the product of an overactive immune system that’s trying to fight off threats. The paper was published in the new Science Translational Medicine.

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Inside STAT: What it's like to be one of the few doctors left in war-torn Syria

In the five years since the Syrian civil war began, the country's health care system has been completely ravaged. Helicopters drop barrel bombs stuffed with nails and shrapnel onto hospitals; suicide bombers target hospitals, keeping fearful patients from seeking care. “They’re places of death, not places that are saving lives,” said Susannah Sirkin, a Syrian health expert from Physicians for Human Rights. Doctors have reported there aren't enough coffins to bury the dead. In Aleppo, a city now home to 300,000, there is only one neurologist and one cardiologist left. Just seven ambulances serve the whole city. Syrian doctors describe their experiences, challenges, and fears working in the war-torn country — I have the story here

How the economic recession is tied to cancer deaths 

The recession that hit in 2008 and the two-year economic crisis that followed has been tied to a rise in cancer-related deaths, some of which may have been preventable. A new longitudinal analysis in the Lancet finds that there was an excess burden of 260,000 cancer-related deaths associated with that recession. The researchers observed that as unemployment increased, so did mortality for all cancer types examined. That held true even for those that, like breast and prostate cancer, typically have survival rates over 50 percent.

Interestingly, that trend wasn’t seen in all recession-hit countries. The UK, for instance, didn't see an appreciable rise in cancer deaths, likely thanks to its universal health care. 

Lab Chat: Breast cancer cells sneak into bones to avoid chemo

In some patients, breast cancer cells hide out in bone marrow and there avoid chemotherapy and hormone treatments. Scientists have examined how, exactly, they’re doing that, with the hopes they’ll be able to flush the cancer cells into the bloodstream and kill them. Here’s what Dr. Dorothy Sipkins of Duke told me about the discovery, described in Science Translational Medicine.

What’s the clinical concern about breast cancer cells hidden in bone marrow?

Even in the early stages of the disease, when people don’t have clinically apparent [disease], the breast cancer cells can get out of the primary tumor site and form small, metastatic deposits in the bone. The presence of these micro-metastases — which are found only in bone marrow biopsy — predicts the likelihood of later overt disease relapses. And once there’s an overt metastatic relapse, there’s no cure for that.

What did you discover about how those cells hide in bones?

There’s in vitro work that suggests the bone is a protective environment for these cancer cells, protecting against chemotherapy and hormone therapy. Our findings have identified a key entry point for these cancer cells into the bone, and a key interaction that lets them know it’s a metastatic site. We also saw that we can break molecular bonds to force them out of the bones and back into the bloodstream. One hypothesis, and our hope, is that without maintaining their interaction with the bone they’ll undergo apoptosis, or a type of cell death, because they’re so dependent on interaction with tissue.

Could genetic sequencing benefit children with intellectual disability? 

A new study in the New England Journal of Medicine suggests genetic sequencing is the way to tailor treatments for kids with intellectual disability, but it’s quite a small subset of patients that might benefit from the practice at this point. Researchers sequenced the genomes of 41 families with children who have developmental delays, epilepsy, and other neurological conditions. Doctors were able to suggest targeted treatments based on the sequencing for 16 of those families. It’s a practice that the authors acknowledge can help “a small yet meaningful percentage of patients.”  The research also turned up two previously unknown, rare conditions that can affect brain development but seem treatable if caught early — read about that here.

What to read around the web today

  • It's still hard to get birth control pills in California without a prescription. NPR
  • How therapy became a hobby of the wealthy. KQED
  • The dangers of shaking babies. BBC

More reads from STAT

Thanks for reading! Back tomorrow to round out the week, 


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