March 15th, 2011 by Elaine Schattner, M.D. in Opinion, Research
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Lupus, an autoimmune disease, [recently] turned up on the front page of the Wall Street Journal (WSJ). It cropped up, also, on the first page of the New York Times business section, and elsewhere. Scientific American published a nice online review just now. The reason is that the FDA has approved a new monoclonal antibody for treatment of this condition.
The drug belimumab (Benlysta), targets a molecule called BlyS (B-lymphocyte Stimulator). The newspapers uniformly emphasize that this drug marks some sort of triumph for Human Genome Sciences, a biotech company that first reported on BlyS in the journal Science way back in 1999. BlyS triggers B cells to produce antibodies that in patients with lupus tend to bind and destroy their own cells’ needed machinery, causing various joint, lung, liver, kidney, brain, blood vessel and other sometimes life-threatening problems. So if and when Benlysta works, it probably does so by blocking aberrant autoimmune B-cell activity.
The newspapers don’t give a lot of details on the drug’s effectiveness, except that it appears to help roughly one in 11 patients, and the main benefit may be that some lupus patients on Benlysta can reduce their use of steroids, which have long-term and toxic effects on many organs. The most recent major medical publication on a trial on the drug came out in the Lancet two weeks ago.
Some reported caveats are that the drug has not been adequately tested or approved for patients with severe kidney or neurological manifestations of the disease, and that its activity, marginal as it is, appears to be less in patients of African heritage based on trials completed thus far. Additional trials are in the works.
The drug is expensive, to the updated tune of $35,000 per year. According to the WSJ: “Estimates of how many Americans are affected range from 161,000 to 1.5 million.” (How’s that for a wide ballpark figure? Likely a function of how hard it is to define and establish diagnosis for this disease, which anticipates how hard it will be to measure this drug’s effects — see below.) The same WSJ piece says analysts expect the drug to become a blockbuster, with annual sales eventually topping $1 billion. Read more »
*This blog post was originally published at Medical Lessons*
April 28th, 2010 by DrRob in Better Health Network, Health Policy, Opinion
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A recent post on Kevin MD by Joseph Biundo, a rheumatologist, challenged my assertion that primary care doctors can save money:
(In reference to my claim…) That may be true in theory, but I see patients in my rheumatology office every day who have been “worked up” by primary care physicians and come in with piles of lab tests and X-ray and MRI reports, but are diagnosed in my office by a simple history and physical exam.
Prior to that, an article in the New York Times along with a post by Kevin Pho noted the fact that more solo practitioners are leaving private practice and joining hospital systems. Why are they doing this? Read more »
*This blog post was originally published at Musings of a Distractible Mind*
November 3rd, 2009 by Toni Brayer, M.D. in Better Health Network
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What medical condition costs the U.S. Health system the most in disability and overall costs? If you said heart disease or cancer or pulmonary disease you would be wrong! I would have said one of those myself.
The answer…slow drumroll….is musculoskeletal disease. Yes, 50% of the adult population reported having a disabling musculoskeletal condition in 2008. The expenditures for these problems include the costs of preventive care, the cost of direct care, the cost of care in hospitals, by physicians, therapists and other caregivers. It also includes the loss of productivity. In 2004 it was estimated that the cost of care for musculoskeletal problems was $840 billion. (Hey, isn’t that about equal to the bank bailout?)
What are musculoskeletal conditions? They include that old nemesis: Low back and neck pain. Spine problems are among the most common problems that bring patients for medical care. That’s why the chiropractic industry is booming. Read more »
*This blog post was originally published at EverythingHealth*
July 2nd, 2009 by Nancy Brown, Ph.D. in Better Health Network, Health Tips
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I went to a great grand rounds the other day about osteoporosis and learned that all teenage girls should be taking about 1,500 mg of calcium with Vitamin D a day in addition to a multivitamin. Three glasses of milk provide about 1,200 mgs, but most teens are not drinking that much milk. Dark green vegetables are another good source of calcium. Exercise and weight-bearing activity is also important in the prevention of osteoporosis.
Calcium is a mineral that gives strength to your bones. Calcium is also necessary for many of your body’s functions, such as blood clotting and nerve and muscle function. During the teenage years (particularly ages 11-15), your bones are developing quickly and are storing calcium so that your skeleton will be strong later in life. Nearly half of all bone is formed during these years.
Women develop most of their bone strength before they are between 25 and 35. After that, bone is broken down faster than it is created, leading to a small loss of bone mass every year. For women, bone loss accelerates during menopause, but slows again around age 60.
There are specific risk factors for osteoporosis that teens should know:
- Being white;
- Having irregular periods;
- Doing little or no exercise;
- Not getting enough calcium in your diet; Being below a normal weight;
- Having a family history of osteoporosis;
- Smoking; and
- Drinking large amounts of alcohol.
Osteoporosis can be prevented, but teens need to start early.
This post, How Much Calcium Do Teen Girls Need?, was originally published on
Healthine.com by Nancy Brown, Ph.D..
