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Tests for COVID-19: Has the FDA said yes too many times?

News Stories & Editorials, We're In the News, , , ,

By Robert M. Kaplan and Diana Zuckerman, The Hill Opinion Contributors, May 6, 2020

There are many controversies about the coronavirus, but there is one point of consensus: We need testing, testing, and then more testing. But yesterday, in response to criticisms from chairs of two House health subcommittees, the FDA tightened their standards for antibody tests intended to identify people who were previously exposed to the coronavirus. Why?

Typically, the FDA approves tests based on evidence of accuracy. But, under the urgency of the pandemic, the FDA temporarily lifted the requirement that tests be validated before they are marketed. Until the new policy was announced, it was not clear when or if the FDA would review the accuracy of each test.

The FDA website shows that, to date, the FDA has temporarily approved coronavirus testing for 84 different labs and companies. There were 14 new approvals in the last week alone and more than 400 more applications are waiting for FDA’s review. Unfortunately, none of the tests currently available – not the 84 and not the other 400 — have a record of proven accuracy that can be independently verified.

[….]

What happens when hundreds of unvalidated tests flood the market? Monitoring a pandemic requires accurate, consistent information. With so many tests, we can’t know when cases are peaking, stabilizing, or decreasing in different communities — and therefore, when it is possible to loosen restrictions on social distancing.

Read the article here https://thehill.com/opinion/healthcare/496403-tests-for-covid-19-has-the-fda-said-yes-too-many-times

 

Coronavirus Relief Act Gives Drug Makers New Sway Over FDA

In the News, News Stories & Editorials, We're In the News

By David S. Hilzenrath, Project on Government Oversight:

Last year, based on growing concerns about the safety of certain sunscreens, the Food and Drug Administration (FDA) published a plan of action.

It proposed concluding that, for two sunscreen ingredients, the risks outweigh the benefits, and it proposed declaring that there was insufficient data to support the safety of a dozen others—for example, one that has shown up in blood plasma, amniotic fluid, urine, and breast milk.

It proposed restricting properties of spray sunscreens to reduce the risk of inhaling them and suffering lung disease, and it proposed requiring that many sunscreens meet a stricter standard for protection against ultraviolet radiation.

It said it wanted to eliminate “potential confusion permitted by the current labeling regime,” under which a product labeled with a higher sun protection factor or SPF can provide “inferior protection” than one with a lower SPF because it filters a narrower spectrum of ultraviolet radiation.

The FDA’s proposal was apparently derailed by the coronavirus.

More specifically, by part of Congress’s response to the pandemic: the economic relief legislation known as the CARES Act, passed in late March.

While Americans were focused on a deadly plague and its devastating fallout, Congress fundamentally altered FDA oversight of thousands of drugstore items.

Little-noticed provisions of the CARES Act gave manufacturers new sway over the consumer protection agency and streamlined the process by which the FDA makes decisions about so-called over-the-counter or OTC drugs—products marketed for personal health and sold without a prescription.

[…]

“User Fees”

[…]

While the CARES Act requires the FDA to negotiate with industry, it requires the agency to “consult” with others, such as “representatives of patient and consumer advocacy groups.” In the realm of prescription drugs, the so-called patient advocacy groups the FDA consulted the last time user fees came up for renewal generally had ties to the pharmaceutical industry, POGO’s 2016 “Drug Money” investigation found.

The FDA and manufacturers have for years been laying the groundwork for adoption of user fees for over-the-counter products. In 2016 and 2017, they held a series of meetings on the subject. Industry participants included Procter & Gamble, Bayer, Sanofi, Johnson & Johnson, and a trade association, the Consumer Healthcare Products Association.

The plan the FDA and industry developed set out “performance goals” for the agency to meet under an anticipated user fee regime, including what the document describes as “substantially shortened timeframes” for the FDA to act on requests from manufacturers of over-the-counter drugs.

“This goals document represents the product of FDA’s discussions with the regulated Industry, and consideration of input by public stakeholders,” the document, called a “commitment letter,” says.

The performance goals “are important for facilitating timely access to safe and effective medicines,” the document says.

The plan the FDA and industry developed was contingent on action by Congress. Now that Congress has acted, the FDA plans to follow the performance goals in that document, FDA spokesman Charlie Kohler said in an email to POGO.

Diana Zuckerman, president of the National Center for Health Research, said the commitment letter “does not seem appropriate.”

“Performance goals should include at least as much attention regarding evidence of safety or effectiveness as it does to the issues that industry cares the most about,” Zuckerman said by email.

Historically, industries have embraced user fees as a means of reducing regulatory delays. For Congress, getting companies to pay for regulators’ salaries has been an easier pill to swallow than spending taxpayer dollars or adding to federal budget deficits.

The new user fees will enable the FDA to increase its budget and staffing for overseeing nonprescription drugs.

In the 2016 slide presentation, the FDA said it was spending just $8.2 million a year and had the equivalent of only about 30 full-time employees to oversee “hundreds of thousands of products consumed – in many cases, on a daily basis – by millions of Americans.”

The FDA compared the $8.2 million to what it said was the $8 million cost of producing “the ‘Blackwater’ episode of the hit TV series Game of Thrones.”

According to the industry’s Consumer Healthcare Products Association, over a five-year period, the user fee program will generate more than $130 million in fee revenue for the FDA.

 

[…]

Read the full article here. 

NCHR Comments on Public Access to Federally Funded Research

Legislation, , ,

National Center for Health Research, May 6, 2020

National Center for Health Research Public Comments on
OSTP’s Request for Information: Public Access to Peer-Reviewed Scholarly
Publications, Data and Code Resulting From Federally Funded Research

The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research, policies, and programs on a range of issues related to health and safety. We do not accept funding from companies that make products that are the subject of our work.

Our research center has long advocated for making federally funded research publicly available. As a think tank focused on research and data related to human health, we have supported data sharing and other efforts to make research results more freely available, particularly for research that was funded by federal agencies or submitted to federal agencies as part of application materials to the FDA and other federal agencies. Research data and results that are partially or fully funded by or conducted by the federal government should be freely available to the public.

In this comment, we will focus on two issues: 1) Access to peer-reviewed scholarly publications and 2) Access to data for analysis.

Despite efforts to make articles in scholarly publications freely available to the public, most are not. All journal articles based on research funded by the federal government should be freely available to the public, and that should not require the authors to pay thousands of dollars for each article to be available through open access. We understand the financial needs of scholarly publications, but U.S. taxpayers should not be required to pay to read an article based on research that they also paid for. Since journals depend on high quality data to succeed, the government should require that journals have an open access policy for federally funded research results; authors either should not be required to pay anything, or should be offered a greatly discounted rate that the federal government requires the researcher to pay using the research funding that supported the work.

Unfortunately, ClinicalTrials.gov has not fulfilled its goal of making research results publicly available in a transparent and timely fashion. Despite Congressional pressure, too often study results are not reported on the ClinicalTrials.gov website or are greatly delayed, and neither FDA nor NIH has enforced the requirements or penalized those who failed to comply. In addition, results reported on ClinicalTrials.gov are often subjective summaries rather than objective charts and graphs that present the aggregate data. The information most often provided is insufficient for other researchers or medical providers to scrutinize.

In addition, research conducted partially or entirely with federal funds is not always published in a timely manner, or at all. In some cases, the authors have submitted manuscripts that have been rejected by journals; in some cases, there are competing pressures that make it difficult for the researchers to finish writing and submitting manuscripts, and in other cases, the only journals willing to publish a specific article charge thousands of dollars for publication that the authors can’t afford. We strongly urge that PIs of federally funded studies be required to make the raw data available to other U.S. researchers if it hasn’t been published within 3 years of completion of the initial study. Such data sharing between researchers is essential for ensuring that federal agencies have not wasted taxpayers’ money on research that never becomes available to potentially benefit the public.

Even when federally funded research results are published, the results may be biased or inaccurate. Sharing of raw data after publication is an invaluable tool for confirming the accuracy of reported research findings and enabling other researchers to replicate results and understand any conflicting findings.

U.S. taxpayers deserve to have the government maximize the usefulness of the funds they’ve invested in research by making that research publically available. Efforts to improve public access to federally funded research will benefit the scientific community, the medical community, public health, and the public.

National Center for Health Research can be reached at info@center4research.org or at (202) 223-4000.

NCHR’s Public Comments on FDA’s Proposed Inclusion of Older Adults in Cancer Clinical Trials

Policy, Testimony & Briefings, ,

May 4, 2020

National Center for Health Research’s Public Comments on FDA’s Proposed Inclusion of Older Adults in Cancer Clinical Trials Guidance for Industry

[FDA-2019-D-5572-0002]

We are writing to express our views on the FDA Draft Guidance on Older Adults in Cancer Clinical Trials. The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research, policies, and programs on a range of issues related to health and safety. We do not accept funding from companies that make products that are the subject of our work.

We have long urged the FDA to require older adults in clinical trials of drugs for the treatment of cancer and other diseases that are likely to be used by people over 65. When our Center’s president served on CMS’ Medicare Evidence Development & Coverage Advisory Committee (MEDCAC), she pointed out at every meeting that there were few if any patients over 65 who had been tested in clinical trials for the drugs and devices that were seeking to be covered by Medicare. As a result, it was impossible for the MEDCAC members to determine if the likely benefits outweighed the risks of any of those products, including cancer diagnostic tests and treatments.

We strongly support FDA’s efforts to improve the diversity of clinical trials and analyses of demographic subgroups, but have been disappointed that these efforts have not been enforced in a meaningful way. Subgroup analyses of safety and efficacy are essential for new drugs and devices so that patients and clinicians can make informed treatment decisions. New medical products should only be approved for populations for which there has been sufficient testing to determine that the benefits outweigh the risks. This is of particular importance for older adults in cancer trials. Moreover, if the FDA refused to approve cancer drugs for patients over 65 or over 70 when those age groups were not adequately studied, it would provide a substantial incentive for sponsors to be more vigilant about recruiting and studying patients in older age groups.

As stated in the guidance, it is not sufficient to only study the safety and efficacy of treatments among younger adults and assume that the results would be the same for older adults as well. We also strongly support the recommendation to evaluate smaller, discrete age groups (such as ages 65-74 and 75 and up), as well as the recommendation to collect additional safety measures for older adults, such as cognitive functioning. However, there are additional aspects of subgroup analysis that must be taken into consideration.

Subgroup analysis must determine the unique benefit to risk ratio for each subgroup, rather than determine whether the benefits of a treatment differ between younger and older patients. Older adults are more likely to have comorbidities that can affect how drugs are absorbed, metabolized, or eliminated, which may impact the safety and efficacy of a particular treatment. Therefore, there must be an assessment of the unique risks and benefits for older adults. It is not important to know that a medical product is more or less safe or effective for older patients compared to younger patients; what matters to older patients is whether the benefits outweigh the risks for patients in their age group.

In addition, it is not necessary that the proportion of older patients studied is consistent with the proportion of older patients with the particular type of cancer. What matters is that there be sufficient numbers of older adults so that subgroup analyses can be conducted to assess the benefits and risks of treatment for patients in several older age groups. Subgroup analyses are not meaningful if the numbers of older patients in the trials are small.

Since older adults are likely to be more frail and to have other serious comorbidities, it is imperative to determine the adverse effects and the efficacy of new drugs for older adults prior to FDA approval. All too frequently, post-market research, even if required, is delayed, follow-up is inadequate, or for other reasons the results are not as informative as had been expected.

The National Center for Health Research can be reached at info@center4research.org or at (202) 223-4000.

 

NCHR Comments on CPSC Priorities for FY2021/2022

Policy, Testimony & Briefings, , , , , , , , ,

National Center for Health Research, April 2020

Diana Zuckerman, Ph.D., President of the National Center for Health Research

Comments on the U.S. Consumer Product Safety Commission
Agenda and Priorities for FY2021/2022

April 2020

The National Center for Health Research is a nonprofit research center staffed by scientists, medical professionals, and public health experts who analyze and review research on a range of health issues. Thank you for the opportunity to share our views concerning the Consumer Product Safety Commission’s (CPSC) priorities for fiscal years 2021 and 2022. We greatly respect the essential role of the CPSC, as well as the challenges you face in selecting the most important priorities.

We want to start by emphasizing two issues involving chemicals in products that affect our and our children’s health, (1) artificial turf and playground surfaces and equipment, and (2) organohalogen flame retardants. We will also briefly discuss sport and recreational helmets, sleep-related products for infants, furniture stability, home elevators, and liquid nicotine packaging. All these issues should be CPSC priorities.

Artificial Turf and Playgrounds: Risky Chemicals and Lead

We expressed our concerns about artificial turf and playgrounds last year. Our concerns are even greater this year because of increasing evidence of lead exposure from these products, as well as from playground equipment.

Requiring testing for artificial turf, playground surfaces, and the paint used for playground equipment needs to be a priority, because children are exposed to these synthetic rubber and plastic fields and playground surfaces as well as playground equipment – and the lead and harmful chemicals they contain – day after day, year after year.

A new issue that arose in the last year is research indicating that the paint used on outdoor playground equipment contains lead. Professor Alexander Wooten from Morgan State conducted studies in Maryland that indicate that paint with lead is widely used on playground equipment, such as climbing structures, in some cases at very dangerous levels.1 We have learned that there are no federal restrictions on lead used in outdoor paint, even for products used exclusively by young children. CPSC should investigate this issue immediately.

The rubber and plastic that make up turf and playground surfaces contain chemicals with known health risks, which are released into the air and get onto skin and clothing. Crumb rubber – whether from recycled tires or “virgin rubber”– includes endocrine disruptors such as phthalates, heavy metals such as lead and zinc, as well as other carcinogens and skin irritants such as some polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs).2,3,4,5,6 Other plastic or rubber surfaces used in playgrounds also contain many of these chemicals.7 Moreover, the plastic grass in artificial turf also has dangerous levels of lead, PFAS, and other toxic chemicals as well. PFAS are of particular concern because they are “forever chemicals” that get into the human body and are not metabolized, accumulating over the years. Replacing tire waste with silica, zeolite, and other materials also has substantial risks.

Tire crumb is widely used as infill for artificial turf fields and also used for colorful rubber playground surfaces. In addition to the chemicals noted above, these playground surfaces contain lead and create lead dust on the surface that is invisible to the eye but that children are breathing in when they play.8

The CPSC is well aware that no level of lead exposure is safe for children, because lead can cause cognitive damage even at low levels. Some children are even more vulnerable than others, and this vulnerability can be difficult or even impossible to predict. Since lead has been found in tire crumb as well as new synthetic rubber, it is not surprising that numerous artificial turf fields and playgrounds made with either tire crumb or “virgin” rubber have been found to contain lead. However, the Centers for Disease Control and Prevention (CDC) also warns that the “plastic grass” made with nylon or other materials also contain lead. Whether from infill or from plastic grass, the lead doesn’t just stay on the surface – it can get into clothes, on the skin, or into the air that children breathe.

While one-time or sporadic exposures are unlikely to cause long-term harm, children’s repeated exposures, especially during critical developmental periods, raise the likelihood of serious harm. There are few activities that children engage in for as many hours in their early years as those on playgrounds and playing fields.

We appreciate the CPSC’s ongoing efforts to investigate the safety of crumb rubber on playgrounds and playing fields. As your study using focus groups to examine children’s use of playgrounds and exposure to playground surfaces has shown, children who use playgrounds with artificial surfaces could be exposed to the chemicals in these surfaces.9 It is unfortunate that the EPA report on artificial turf (which did not include playground surfaces or playground materials) did not provide the scientific evidence needed to support their assumptions that the likely levels of exposure to dangerous chemicals was low enough that it was not likely to harm children. The EPA did not study the actual impact of the exposure to endocrine disrupting chemicals on children and did not study lead exposure from synthetic playground surfaces, leaded paint used on playground equipment, or artificial turf.10

Meanwhile, we have repeatedly heard the companies that make these products and those that install them make erroneous claims at the state and local government levels, falsely stating that CPSC and other federal agencies have concluded that these materials are proven safe. As we all know, that is not correct.

We encourage you to closely evaluate the research that has been done, focusing on independently funded research of short-term and long-term safety issues. We need information that can protect our children from harm. In addition, we strongly urge you to convene a Chronic Hazard Advisory Panel (CHAP) to examine the short-term and long-term risks of different types of artificial turf used in playing fields and children’s playgrounds, including surfaces and lead paint used on climbing equipment and other materials.

In addition to the risks of lead and the long-term risks of cancer and other health problems caused by hormone disruption, these fields can cause short-term harms. Artificial turf generates dust which may exacerbate children’s asthma.11,12 Fields heat up to temperatures far higher than ambient temperature, reaching temperatures that are more than 70 degrees warmer than nearby grass; for example, 180 degrees when the temperature is in the high 90’s and 150-170 degrees on a sunny day when the air temperature is only in the 70’s.13,14 We have measured the temperatures ourselves and been shocked by the results. These temperatures can cause heat stress and burns.

Fields made of crumb rubber have been marketed as reducing injuries compared to grass. However, research has shown that this is not the case. We have spoken to students terribly harmed by turf burn, and studies have indicated increased risk for some types of injuries, including joint, foot, and brain injuries.15,16,17 That is the reason that only two Major League Baseball parks use artificial turf and why the men’s soccer World Cup is now always played on grass.  In response to the demands of women soccer players, the Women’s World Cup will require grass in 2023.

Organohalogen Flame Retardants

The National Academies of Sciences, Engineering, and Medicine issued their scoping plan to assess the hazards of organohalogen flame retardants (OFRs) last year.18 The report concluded that OFRs can be divided into subclasses on the basis of chemical structure, physicochemical properties, and predicted biologic activity. As noted in their summary of the report:

“The committee identified 14 subclasses that can be used to conduct a class-based hazard assessment and concluded that the best approach is to define subclasses as broadly as is feasible for the analysis; defining subclasses too narrowly could defeat the purpose of a class approach to hazard assessment.”

We encourage you to convene a CHAP to use this scoping plan to evaluate OFRs and to develop regulations to address OFRs in children’s products, upholstered residential furniture, mattresses/mattress pads, and the plastic casing of electronic devices. In addition, it is essential to consider current flammability standards to determine if there are changes that would improve their safety from chemical exposures as well as exposures during a fire.

OFRs are not bound to products to which they are added, so they migrate out of products and into dust. This allows them to get onto our skin and food and into the air. Because of their widespread use and the long-lasting nature of OFRs, consumers are continuously exposed to OFRs19 and many bioaccumulate in our food supply.20,21 As a result, OFRs are present in nearly all people in the U.S.22,23 For these reasons, CPSC should focus on the potential for hormone disruption, altered brain development, reduced ability to get and stay pregnant, and the timing of puberty.24,25 While not all OFRs have been adequately studied to determine whether all are unsafe, those that have been sufficiently studied have proved to be harmful to health.

We share the Commission’s concerns about fire hazards as well, but there is evidence that these flame retardants may not be effective at preventing deaths in real world situations.26,27 When the chemicals burn during a fire, the inhaled smoke is more toxic to humans, and exposures could result in serious harms, including death.

Helmets for Sport and Recreational Activities

There are up to 3.8 million concussions reported each year related to sport or recreational activities, with most reported for children and adolescents.28 This number is likely an underestimate.29 We urge the CPSC to focus greater attention on the need to ensure the effectiveness of helmets intended to protect against brain injuries during athletic activities. Currently, CPSC only provides guidelines for bicycle helmets, even though many organized sports and recreational activities use helmets to reduce the risk for severe head injuries, including baseball, football, snow sports, skiing/snowboarding, and climbing. Unfortunately, these helmets are not necessarily designed to prevent mild concussions.30 We encourage CPSC to consider how design changes could improve the ability of helmets to prevent severe head injuries as well as mild concussions, and to develop guidelines for helmets that reduce these risks without interfering with vision or hearing or other safety concerns.

Baby Products and Products Posing Risks to Young Children

The CPSC is the major safeguard to protect infants and young children from unsafe products that are widely sold and inadequately studied. Crib bumpers and infant sleepers are two examples that have received CPSC attention but CPSC has not adequately protected families from the tragedies of infant deaths caused by these products.

There is nothing more tragic than when an infant or young child dies due to a product in the home that families or loved ones purchased because they erroneously assumed they were tested and found to be safe. The standard for these products should not be based on the number of deaths per year, but rather the 1) risk to benefit ratio of the product and 2) whether regulations or restrictions would make the product safer. In the case of crib bumpers, they have no benefit. In the case of inclined infant sleepers, products were sold that were promoted as superior to other available products but in fact had no comparative benefits and were less safe.

Furniture that tips over and home elevators are two other examples of products that have resulted in deaths of young children. In both cases, CPSC should do more to prevent the sale of products that can be redesigned or modified to make them safe.

Liquid Nicotine Packaging

We agree with other public health and consumer organizations that have urged CPSC to immediately remove from the market dangerous liquid nicotine products lacking the child-resistant packaging and flow restrictors required under the Child Nicotine Poisoning Prevention Act of 2015. The law requires the CPSC to enforce a mandatory child-resistant packaging standard for liquid nicotine containers, including the use of flow restrictors.

Liquid nicotine is a highly toxic product that can seriously harm or kill children. Since liquid nicotine can be quickly absorbed through the skin, flow restrictors are an essential safeguard to reduce the risk of nicotine poisoning in children.

Effective CPSC enforcement measures to remove noncompliant products from the market are long overdue, and that enforcement should be an immediate priority.

Final Thoughts

CPSC is the only federal agency whose mission is to protect children and adults from harmful products used in their daily life. Flame retardants and lead and many different chemicals in artificial turf and playground surfaces and equipment get into the air and dust and thus into our bodies. These chemicals tend to have greater risks for fetuses and children. There are large gaps in our knowledge about the chemicals in the products on the market, because the companies do not provide that information to the public. Ideally, the potential health impact of all of these chemicals would be evaluated in the final product before it was sold. If that doesn’t happen, CPSC must do more to identify the health risks as soon as possible after children and adults have been exposed.

Too often, the lack of independently funded and publicly available research has been used to mislead the public. Claims that “there is no evidence of harm” are misunderstood to mean “there is no harm.”

While reducing exposures to dangerous products is key, there will always be some potential for harm. Whether those harms are from the intended use of a consumer product or an unintended but foreseeable use, CPSC has a very important role to play in reducing harm. Improving the timeliness and targeting of information campaigns to warn parents and children about harmful products is also a key task of the CPSC.

References

  1. Wooten, Alexander, Lead and Playgrounds, Presentation at the Takoma community forum in Washington, DC, July 29, 2019.
  2. California Office of Environmental Health Hazard Assessment (OEHHA). Evaluation of Health Effects of Recycled Waste Wires in Playground and Track Products. Prepared for the California Integrated Waste Management Board. 2007. https://www2.calrecycle.ca.gov/Publications/Details/1206
  3. Llompart M, Sanchez-Prado L, Lamas JP, et al. Hazardous organic chemicals in rubber recycled tire playgrounds and pavers. Chemosphere. 2013;90(2):423-431. https://www.ncbi.nlm.nih.gov/pubmed/22921644/
  4. Marsili L, Coppola D, Bianchi N, et al. Release of polycyclic aromatic hydrocarbons and heavy metals from rubber crumb in synthetic turf fields: Preliminary hazard assessment for athletes. Journal of Environmental and Analytical Toxicology. 2014;5(2):1133-1149. https://www.hilarispublisher.com/open-access/release-of-polycyclic-aromatic-hydrocarbons-and-heavy-metals-from-rubber-crumb-in-synthetic-turf-fields-2161-0525.1000265.pdf
  5. Benoit G, Demars S. Evaluation of organic and inorganic compounds extractable by multiple methods from commercially available crumb rubber mulch. Water, Air, & Soil Pollution. 2018;229:64. https://link.springer.com/article/10.1007/s11270-018-3711-7
  6. Perkins AN, Inayat-Hussain SH, Deziel NC, et al. Evaluation of potential carcinogenicity of organic chemicals in synthetic turf crumb rubber. Environmental Research. 2018;169:163–172. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396308/
  7. KimS, Yang JY, Kim HH, et al. Health risk assessment of lead ingestion exposure by particle sizes in crumb rubber on artificial turf considering bioavailability. Environmental Health and Toxicology. 2012;27:e2012005. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278598/
  8. Baca, N. Parents demand answers on playground lead in DC. wusa9.com. October 2, 2019. https://www.wusa9.com/article/news/local/dc/parent-forum-lead-playgrounds/65-45401b01-3371-436a-8f55-a364be0c07d3
  9. Consumer Product Safety Commission. Summary of Playground Surfacing Focus Groups. 2018. https://www.cpsc.gov/s3fs-public/Playground_Surfacing_Focus_Group_Report_2018.pdf
  10. National Center for Health Research. Children and Athletes at Play on Toxic Turf and Playgrounds. Center4research.org. http://www.center4research.org/children-athletes-play-toxic-turf-playgrounds/
  11. Shalat, SL. An Evaluation of Potential Exposures to Lead and Other Metals as the Result of Aerosolized Particulate Matter from Artificial Turf Playing Fields. Submitted to the New Jersey Department of Environmental Protection. 2011. http://www.nj.gov/dep/dsr/publications/artificial-turf-report.pdf
  12. Mount Sinai Children’s Environmental Health Center. Artificial Turf: A Health-Based Consumer Guide. 2017. http://icahn.mssm.edu/files/ISMMS/Assets/Departments/Environmental%20Medicine%20and%20Public%20Health/CEHC%20Consumer%20Guide%20to%20Artificial%20Turf%20May%202017.pdf
  13. Serensits TJ, McNitt AS, Petrunak DM. Human health issues on synthetic turf in the USA. Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology. 2011;225(3):139-146. https://plantscience.psu.edu/research/centers/ssrc/documents/human-health-issues-on-synthetic-turf-in-the-usa.pdf
  14. Penn State’s Center for Sports Surface Research. Synthetic Turf Heat Evaluation- Progress Report. 2012. http://plantscience.psu.edu/research/centers/ssrc/documents/heat-progress-report.pdf
  15. Theobald P, Whitelegg L, Nokes LD, et al. The predicted risk of head injury from fall-related impacts on to third-generation artificial turf and grass soccer surfaces: A comparative biomechanical analysis. Sports Biomechanics. 2010;9(1):29-37. https://www.ncbi.nlm.nih.gov/pubmed/20446637
  16. Balazs GC, Pavey GJ, Brelin AM, et al. Risk of anterior cruciate ligament injury in athletes on synthetic playing surfaces: A systematic review. American Journal of Sports Medicine. 2015;43(7):1798-804. https://www.ncbi.nlm.nih.gov/pubmed/25164575
  17. Mack CD, Hershman EB, Anderson RB, et al. Higher rates of lower extremity injury on synthetic turf compared with natural turf among national football league athletes: Epidemiologic confirmation of a biomechanical hypothesis. American Journal of Sports Medicine. 2019;47(1):189-196. https://www.ncbi.nlm.nih.gov/pubmed/30452873
  18. National Academies of Sciences, Engineering, and Medicine; Division on Earth and Life Studies; Board on Environmental Studies and Toxicology; Committee to Develop a Scoping Plan to Assess the Hazards of Organohalogen Flame Retardants. A Class Approach to Hazard Assessment of Organohalogen Flame Retardants. Washington (DC): National Academies Press (US). 2019. https://www.ncbi.nlm.nih.gov/books/NBK545458/
  19. Allgood JM, Vahid KS, Jeeva K, et al. Spatiotemporal analysis of human exposure to halogenated flame retardant chemicals. Science of the Total Environment. 2017;609:272-276. https://www.ncbi.nlm.nih.gov/pubmed/28750230
  20. Lupton SJ, Hakk H. Polybrominated diphenyl ethers (PBDEs) in US meat and poultry: 2012-13 levels, trends and estimated consumer exposures. Food Additives & Contaminants. Part A, Chemistry, Analysis, Control, Exposure & Risk Assessment. 2017;34(9):1584-1595. https://www.ncbi.nlm.nih.gov/pubmed/28604253
  21. Schecter A, Colacino J, Patel K, et al. Polybrominated diphenyl ether levels in foodstuffs collected from three locations from the United States. Toxicology and Applied Pharmacology. 2010;243(2):217-224. https://www.ncbi.nlm.nih.gov/pubmed/19835901
  22. Centers for Disease Control and Prevention. Fourth National Report on Human Exposure to Environmental Chemicals, Updated Tables. 2019. http://www.cdc.gov/exposurereport/
  23. Ospina M, Jayatilaka N, Wong LY, et al. Exposure to organophosphate flame retardant chemicals in the U.S. general population: Data from the 2013-2014 National Health and Nutrition Examination Survey. Environment International. 2017;110:32–41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261284/
  24. Dishaw L, Macaulay L, Roberts SC, et al. Exposures, mechanisms, and impacts of endocrine-active flame retardants. Current Opinion in Pharmacology. 2014;19:125-133. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4252719/
  25. Kim YR, Harden FA, Toms LM, et al. Health consequences of exposure to brominated flame retardants: A systematic review. Chemosphere. 2014;106:1-19. https://www.ncbi.nlm.nih.gov/pubmed/24529398
  26. Shaw SD, Blum A, Weber R, et al. Halogenated flame retardants: Do the fire safety benefits justify the risks? Reviews on Environmental Health. 2010;25:261-305. https://www.ncbi.nlm.nih.gov/pubmed/21268442
  27. McKenna S, Birtles R, Dickens K, et al. Flame retardants in UK furniture increase smoke toxicity more than they reduce fire growth rate. Chemosphere. 2018;196:429-439. https://www.ncbi.nlm.nih.gov/pubmed/29324384
  28. Halstead ME, Walter KD, Moffatt K, et al. Sport-related concussion in children and adolescents. Pediatrics. 2018;142(6):e20183074. https://pediatrics.aappublications.org/content/142/6/e20183074
  29. Baldwin GT, Breiding MJ, Dawn Comstock R. Epidemiology of sports concussion in the United States. Handbook of Clinical Neurology. 2018;158:163-74. https://www.ncbi.nlm.nih.gov/pubmed/30482376
  30. Consumer Product Safety Commission. Which helmet for which activity? https://www.cpsc.gov/safety-education/safety-guides/sports-fitness-and-recreation-bicycles/which-helmet-which-activity
  31. Perry, C. Why Inclined Baby Sleepers Are So Dangerous. Parents.com. November 8, 2019. https://www.parents.com/baby/sleep/basics/why-inclined-baby-sleepers-are-so-dangerous/

Dietary Supplements Before and During Chemotherapy

Diet, Habits, & Other Behaviors, General Treatment Issues, Treatment & Management, ,

Meg Seymour, PhD, National Center for Health Research

Many Americans, including those with cancer, take dietary supplements. People take supplements because they believe it will help them stay healthy and give them vitamins and minerals they may not get from their diet. Chemotherapy patients often take supplements because their nausea makes it difficult to eat, and they want to be sure to get enough nutrients. 

People think of dietary supplements as a no-risk insurance policy to improve nutrition, but a study published in 2020 shows that supplements can have risks if you are undergoing chemotherapy. More than 1,000 breast cancer patients were asked whether or not they took any supplements either before or during their chemotherapy.[1] The researchers then continued to evaluate any subsequent cancer or death for up to 15 years (almost all of the women were followed for at least 5 years).

  Results showed that patients who took vitamin B12 before and during their chemotherapy were more likely to die or have their cancer return. They were also more likely to die from any cause, not just from cancer. This increase in cancer recurrence or death was only for people who took the B12 supplements both before and during their chemotherapy. Patients who only took the B12 supplements before chemotherapy or only took supplements during chemotherapy were not more likely to have a recurrence of their cancer or die. Patients who took Iron supplements both before and during chemotherapy were also more likely to have their cancer return or to die of any cause. However, the same was also true for people who only took iron supplements during their chemotherapy.

The researchers also looked at antioxidant supplements, which include vitamins A, C, and E. They found that most patients did not take these supplements both before and during chemotherapy, but those who did were more likely to have cancer return after treatment. However, this finding was not “statistically significant,” which means that more research is needed to determine whether these worse outcomes occurred by chance.  In addition, the 44% of the patients in the study who were taking multivitamins did not have better or worse outcomes than people who were not taking them.

This is what scientists call an observational study rather than a clinical trial. In a clinical trial, some patients would be randomly assigned to take supplements and others would be assigned to take a placebo (with no active ingredients). In an observational study, people make their own decisions about what treatment (in this case supplements) to take. Those who chose to take supplements might have different health issues or health habits than those who did not. For example, it is possible that the people who were more likely to take supplements both before and during their chemotherapy were less healthy to begin with. For example, they could have been taking B12 or Iron supplements because they had anemia, and anemia may have increased the possibility of cancer recurrence or death. Also, because patients were asked whether or not they took supplements (instead of being given the supplements by researchers), it is impossible to know whether what patients said about supplements was completely accurate. For example, some patients could have said that they were regularly taking a supplement, but really they only took it occasionally.   

Dr. Christine Ambrosone, the lead researcher of the study, said in an interview that this is only one observational study, and doctors should not necessarily base their recommendations on this single study. Doctors need to consider the specific needs of each patient. For example, someone with anemia might need a dietary supplement, and the benefits of those supplements might outweigh the potential risks. 

If you are considering taking a dietary supplement, it is important to keep in mind that the Food and Drug Administration does not regulate dietary supplements for purity and quality. There is no guarantee that a supplement will work or even that it contains exactly what the bottle says it contains.[2] It is always important to talk with your doctor to help you decide if the benefits of any dietary supplement you are considering outweigh the potential risks. 

 

  1. Ambrosone, C. B., Zirpoli, G. R., Hutson, A. D., McCann, W. E., McCann, S. E., Barlow, W. E., … & Unger, J. M. (2019). Dietary Supplement Use During Chemotherapy and Survival Outcomes of Patients With Breast Cancer Enrolled in a Cooperative Group Clinical Trial (SWOG S0221). Journal of Clinical Oncology, JCO-19.
  2. Brooks, J, Mitchell, J., Nagelin-Anderson, E. , & Zuckerman, D. National Center for Health Research. How Safe are Natural Supplements? Center4research.org. http://www.center4research.org/examining-safety-natural-supplements/. 2019.

What People With Cancer Need to Know about Coronavirus (COVID-19)

General Treatment Issues, Uncategorized, ,

Diana Zuckerman, Ph.D., Cancer Prevention and Treatment Fund: updated February 10, 2021.

The coronavirus can infect anyone, young or old, healthy or frail.  But, people diagnosed with cancer during the last year are at higher risk of dying from COVID-19 if they are infected. Here’s what you need to know.

People who are over 60 or who have cancer and other serious health conditions, and their loved ones, need to be especially careful to avoid getting infected.  A study published in December 2020 of more than 2 million cancer patients, found that people diagnosed with cancer during the previous year are much more likely to die of COVID compared to other COVID patients.  All cancer patients were at higher risk, but the ones in most danger had been diagnosed with leukemia, non-Hodgkin’s lymphoma, or lung cancer. The CDC has also updated their list of other health problems that put people at greatest risk, and they include many common health conditions: Anyone who is obese (BMI of 30 or higher) or has a serious heart condition, Type 2 diabetes, a weakened immune system (from cancer or an organ transplant), chronic kidney disease, COPD, or sickle cell disease is especially at risk if they are exposed to the coronavirus.  Smoking also increases the risk of being seriously harmed by the virus, as do many other medical conditions, including high blood pressure, pregnancy, HIV, and liver disease.

If you had scheduled medical appointments, surgery, screening, or other procedures in the past year that were considered not urgent or not immediately life-threatening, those were probably postponed. This was for everyone’s protection.  Many hospital staff, including doctors, nurses, receptionists, and cleaning staff, have been vaccinated against COVID but their facilities may be limiting procedures that are not essential because the doctors are vaccinating others or are treating COVID patients. You don’t want to be exposed to the coronavirus when you go in for surgery or testing procedures for other medical conditions.  And, you don’t want your medical center to be less able to fight the coronavirus at a time when it is spreading throughout your community.

Will the COVID vaccines make it safer to have medical procedures or doctor’s appointments? To visit friends and family members?

Many healthcare workers have been vaccinated, but some nurses and aides have refused the vaccine so far.  You should ask about that when you make an appointment. Pregnant healthcare workers and those with serious allergies may choose not to be vaccinated. Pregnant healthcare workers and those with serious allergies may choose not to be vaccinated.  More important, the vaccines do not prevent infection, even though they usually prevent people from getting obviously sick.  If your healthcare worker is vaccinated, he or she could have asymptomatic COVID without knowing it, and could possibly infect others.  For that reason, healthcare workers and patients need to continue to wear masks and keep their distance.

The coronavirus is still spreading in all 50 states, in urban, suburban, and rural areas, so it is important to listen to health experts who tell you to stay home, limit contact with others, wear a mask, and keep a distance of 6 feet away when you or your family members or caregivers go grocery shopping or other essential activities. It will be months before most people are vaccinated.  Unfortunately, some governors, mayors, and state legislators have reopened businesses for political reasons, even in states where the virus is spiking.  Even if you are staying at home as much as possible, the fact that others in your community are going to bars, parties, restaurants, stores, and hair salons will put you at greater risk when you make essential visits to the supermarket, to work, to the doctor, or spend time outdoors, because you may come into contact with people who are infected because they aren’t being as careful as you are.

What is coronavirus?

Coronaviruses are a large group of viruses that can cause respiratory illness. The new (novel) coronavirus is called SARS-CoV-2 and the illness it causes is called coronavirus disease 2019, which is why it’s abbreviated as COVID-19.

How does COVID-19 spread between people?

The virus usually spreads through close contact with other people, especially through invisible or very tiny droplets when a person coughs, sneezes, sings, exercises – or even when they breathe or talk normally. These droplets can travel through the air and can be inhaled or get into the noses, mouths, or eyes of people nearby.

The virus is thought to be most contagious in the days just before and just after a person develops symptoms, but it is possible to catch the virus from infected people who have no symptoms at all.  Experts still don’t know how contagious the virus is when a person has it but never develops symptoms.  This is crucial information that scientists are trying to find out, especially since experts believe that many young children never develop symptoms, while other children get very sick and some have died from the coronavirus.

What about children?  Unlike the flu, which is riskiest for the youngest children and oldest adults, infants and young children are much less likely to get sick from the coronavirus than adults.  Preliminary studies suggest that children over 10 are as contagious as adults, but that younger children are much less infectious. For example, there are few known examples of the virus spreading in daycare centers that follow coronavirus safety standards. Nevertheless, almost half a million children have been diagnosed with the virus in the U.S. (almost 10% of all cases) and 70,000 children were newly diagnosed in late August, which was 17% more than the weekly number of new cases two weeks earlier.  Fortunately, few children become so sick that they are hospitalized (estimates range from less than 1% to 8.5%), and less than half of 1% of children diagnosed with coronavirus in the U.S. have died.

The tiny droplets from coughing, sneezing, singing, talking, or breathing (as well as fecal matter containing the virus) can result in the virus on surfaces where it can survive for hours or even days. When you touch these surfaces and then touch your face, you can be exposed to the virus. However, there are no documented cases of anyone catching COVID from a surface.  Nevertheless, it’s important to wash your hands regularly.  If you’re concerned about exposure at home, you can wipe down surfaces in your bathroom, kitchen, and other rooms with bleach or rubbing alcohol to help prevent exposure.

What about food or food packaging?  The risk of catching the virus from packaging is extremely low, but it’s a good idea to wash your hands for at least 20 seconds after handling mail, takeout containers, and packaging from groceries. You don’t need to disinfect food packages using a cleaning product that kills viruses, and NEVER use bleach or disinfectants on fruit, vegetables, or any other food.

What about the vaccines?

If you are eligible to be vaccinated with either the Pfizer or Moderna vaccine, that is the best protection available for most people.  Keep in mind, however, that the vaccines were not studied on nursing home patients and not studied on many people with COVID who were ages 65 or older, so it might be less effective for older people.  (Flu vaccines are often less effective for older people, because their immune systems are weaker).  The vaccines were found to be as safe for adults of all ages and races. The vaccines were  studied on few people under 18, pregnant women, people with compromised immune systems, or those with serious allergies, so it will be a while before we have information about safety or effectiveness data for them.

Both of the vaccines have frequent side effects such as fatigue and chills, especially after the second dose.  These are not considered dangerous, but it is important that anyone getting vaccinated is told about those risks, since they could be frightening to patients who don’t understand that those symptoms are not thought to be reason for concern.

What are the symptoms of COVID-19?

Symptoms tend to start between 2 and 14 days after coming into contact with the virus.  Although some people have compared the symptoms to a cold or flu, not everyone with COVID-19 has those types of symptoms.  In fact, some people (especially children, teens, and younger adults) have very mild symptoms or none at all, which is why getting tested is so important before you spend time with others. The CDC says that people with these symptoms or combination of symptoms may have COVID-19:

  • Cough
  • Shortness of breath or difficulty breathing

Or at least two of these symptoms:

  • Fever
  • Repeated shaking with chills
  • Muscle pain
  • Headache
  • Sore throat
  • New loss of taste or smell
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Those are the most common symptoms.  However, children or adults can have other symptoms as well, including heart problems and “covid toes” that look like a minor case of frostbite.

Most people who are infected with this coronavirus have mild symptoms and can recover at home in about 2 weeks. However, symptoms can become severe.  These are the ones that require immediate medical attention:

  • difficulty breathing or shortness of breath
  • persistent chest pain or pressure
  • confusion or inability to awaken
  • blueish color in the lips or face

As described above, people who are older than 60 or with other medical conditions are more likely to develop severe illness and complications from COVID-19. The most serious complications include pneumonia, stroke, blood clots, organ failure, and death.

How else can I protect myself and others?

If you are not yet eligible to be vaccinated, the best way to protect yourself is to avoid being exposed to the virus. There are no proven cures, so don’t be fooled by claims, regardless of the source.  Two types of medications have been found to help people who are seriously ill, but are not a cure.  Remdesivir has been found to help very ill patients by reducing the number of days of hospitalization in one study, but was not effective in a WHO study published in October.  It has not been proven to save lives. Two inexpensive steroids, dexamethasone and hydrocortisone, have been found to reduce the chances of dying among COVID-19 patients on ventilators or those requiring oxygen, but not other patients. Regeneron, the experimental antibody drug that President Trump took when he was diagnosed, is not generally available but has been used with good results by some friends of the President.  However, it was found to have a potential safety concern and as of October 30 is no longer being administered experimentally to hospitalized patients receiving mechanical ventilation of intense oxygen.  It is still being studied on less seriously ill COVID-19 patients.

Experts now agree that hydroxychloroquine with or without azithromycin is not a good treatment for COVID-19 because it has been found to increase heart problems and has not been shown to prevent or treat COVID-19.  Another possible treatment is blood plasma from people who recovered from COVID-19.  Research has shown these transfusions are usually safe, but there is no clear evidence that they are beneficial.

Research is continuing to find out which of these treatments are safe and effective and for which patients.

“Social distancing” or “physical distancing” refers to staying away from other people because it is impossible to know who has the virus.  The safest people in your life are the ones you are living with who are not exposed to others who might have the virus (in other words, they are not going to work or spending time close to other people). Staying at home and not seeing your friends and loved ones is not fun, but it is essential for your own safety and for everyone else’s.  If everyone does that now, the spread of this virus will be reduced sooner, and some of these restrictions will no longer be necessary in a few weeks.

Spending time with friends, family, or people at work

In general, the more people you interact with, the more closely you interact with them, and the longer that interaction, the greater your chances of becoming infected or infecting others. That’s why there have been so many cases after Thanksgiving, and why hospitals are full all over the country. So, think about:

  • How many people will you interact with?  (The fewer the better)
  • Can you keep 6 feet of space between you and others?
  • Will you be outdoors or indoors? (Outdoors is somewhat safer. It can be heated but not if it has walls all around and a ceiling.)
  • What’s the length of time that you will be interacting with people? (Shorter is better)

Research conclusively shows that face masks that cover your mouth and nose help to prevent the spread of the coronavirus.  Some masks are more effective than others:  stretchy “gators” may actually do more harm than good, and bandanas and scarves are too loose to be very helpful.  The paper surgical masks worn in hospitals are effective and so are cloth masks you can make for yourself or buy, if they are made of cotton and at least two layers thick. Masks are important to prevent people from spreading the virus and also to help helps prevent infection or serious symptoms for the person wearing the masks. Experts suggest wearing two masks at the same time for extra protection.

Bottom line: Since most of us haven’t been vaccinated and can’t get coronavirus tests every day, it’s especially important to wear masks whenever you are out in public or with people you don’t live with.  But you should NOT be out in public or with people you don’t live with except when it’s essential.  Depending on your age, health, and who you spend time with, it may not be safe for you to go to all the places that are open.  Especially avoid indoor areas where you are likely to be close to others for more than a very short period of time (15 minutes) or whose workers are close to many other people, such as a tattoo parlor, hair or nail salon, restaurant, concert, party or movie theater.  If you must go to a store, try to go to one that makes appointments with customers or limits the number of customers, and spend less than one hour indoors to reduce exposure to any coronavirus that is in the air.

In summary:

  • Stay at home or go outside in your yard or neighborhood where you can keep at least 6 feet away from others
  • Avoid public spaces where there are other people, especially indoors
  • Avoid public transportation when possible and unnecessary travel
  • Avoid all social gatherings that are indoors or where people are close together
  • Work from home if possible
  • Stay at least 6 feet away from people when out in public (indoors or outdoors). Further away is even better, especially if people are singing or talking, or if there isn’t good air filtration.
  • Avoid physical contact in social situations, such as shaking hands, hugging or kissing

AND

  • Wash your hands using soap and water for at least 20 seconds, especially after being out in public
  • Use alcohol-based hand sanitizer when soap and water aren’t available (or wash your hands as soon as you get home)
  • Avoid touching your face when your hands aren’t clean or you are out in public
  • Avoid contact with people you don’t know very well
  • Put the toilet seat down before flushing in a shared or public bathroom
  • A lower priority would be to clean and disinfect surfaces, and only those in your home or workplace that could expose you frequently to the virus, including doorknobs, light switches, faucet handles, and phones. An antibacterial cleaning agent won’t kill a virus, so try to find one that is effective for killing viruses.

If you have a weakened immune system or other serious health problems, here are extra steps to protect yourself:

  • Make a plan with your doctor to monitor for symptoms
  • Avoid friends and family except those you live with or depend on for essentials.  Otherwise, rely on your phone or computer to maintain contact.
  • Have a plan with your loved ones or caregiver if you or they get sick
  • Have the medications you rely on and order any you need in advance (to be delivered, if possible)
  • Ask a friend or family member to shop for groceries for you
  • Wash your hands (20 seconds with soap and water) even more often if you are exposed to others

What should I do if I develop symptoms?

If you develop more than one of the symptoms listed above, call your doctor.  If you have severe symptoms, such as difficulty breathing, persistent chest pain or pressure, confusion or inability to awaken, or blueish color in the lips or face, you need to call 911. Tell the 911 operator that you think you have COVID-19 so the responders can take the necessary precautions to protect themselves.

People who experience mild symptoms can usually stay home and will recover in about 2 weeks. Do not just show up at the doctor’s office with symptoms:  Call them first so you have tell them about your symptoms and any other health problems so that they can help decide what to do.  If you do become sick, you can take the following steps to protect others:

  • Stay home, unless you need essential medical care
  • Wear a facemask when you are near others.  (People caring for you should also wear a facemask).
  • Stay away from others in your home as much as possible
  • Cover your mouth and nose when you cough or sneeze, properly dispose of tissues, and wash your hands
  • Monitor your symptoms and temperature

If you were not tested for COVID-19, you should follow those steps until at least one or two weeks have passed since you first noticed symptoms or your fever or other symptoms go  away for 3 full days without medicine.  If you have been diagnosed with COVID-19 based on test results, you should follow those same steps until you have 2 negative test results taken 24-hours apart, and your symptoms improve.

What if my other scheduled medical treatment is delayed?

When a person is diagnosed with a serious disease, they are likely to want treatment as soon as possible. If you don’t have COVID-19, you don’t want to be exposed to it during surgery, testing, or follow-up appointments. Treatment or testing may seem more urgent than it really is, but it is definitely more important than going to a restaurant, store, or party.  Some medical centers are overwhelmed with Covid-19 patients, and others are not. Talk to your doctor about what is the best strategy to get the treatment you need when it is safe to do so.

Questions?

We are here to help by answering your questions.  We do not provide medical care.  If you have questions contact info@center4research.org and we’ll get back to you as soon as possible.

‘Bad advice from the president’: Trump touts unproven coronavirus drugs

We're In the News, ,

Sarah Owermohle, Politico: March 20, 2020.

President Donald Trump said he will “slash red tape like nobody has even done it before” in a bid to get unapproved coronavirus treatments to patients faster and identify effective drugs.

The president said Thursday he directed the Food and Drug Administration to “eliminate out-of-date rules and bureaucracy so this can go forward fast” — but he did not offer any details. Instead, Trump and top health officials highlighted steps the government has taken in recent weeks to launch clinical trials of potential coronavirus treatments.

Trump’s remarks came one day after he teased that an “exciting FDA announcement” was on the way — news that reportedly caught some in the health agency by surprise as they scrambled to finalize details, said three HHS officials.

Food and Drug Administration Commissioner Stephen Hahn appeared to downplay the president’s optimism about speeding up access to three drugs in particular. “What’s important is not to provide falsehood but provide hope,” Hahn said.

“We need to make sure the sea of new treatments will get the right drug to the right patients, at the right dosage, at the right time,” he added. “That’s why it is important we have our professionals looking at these therapeutics in development.”

Trump suggested certainprograms that the administration could use to get experimental drugs to people quickly outside of clinical trials. One such route, known as “Right to Try,” was established by a 2018 law that Trump and Vice President Mike Pence supported to help people who are seriously ill and have no other treatment options.

“What we’re talking about today is beyond Right to Try,” Trump said, adding that the law “has been a tremendous success.”

But outside researchers were quick to sound the alarm.

“Wow, that is bad advice from President Trump,” said Diana Zuckerman, a drug safety expert at the National Center for Health Research. “Lives can be saved if red tape is cut in terms of making tests, respirators, and hospital beds more available. Making untested antivirals available is not a good strategy.”

The Right to Try program allows patients to appeal directly to drugmakers to use medicines that are still being developed and tested. Bioethicists and drug policy experts argue there are other ways to help people access experimental medicine — like the FDA’s compassionate use route, also name checked by the president — and that Right to Try fuels false hope, while making it difficult to collect data on how well the drugs work.

[…]

Read the full the article here. 

Do Vitamin D Supplements Prevent Cancer and Heart Disease? What the Research Says

Diet, Habits, & Other Behaviors, ,

Meg Seymour, PhD

Approximately 40% of Americans are low in vitamin D.[1] Low vitamin D has been linked to a number of health problems, including cancer, heart disease, and heart attack.[2, 3] 

Sunshine on your skin (without sunscreen) is a great way to get vitamin D (15 minutes between 10 a.m. and 3 p.m is key)[4], but many Americans don’t get that much sun, especially during colder months. Popular foods that provide vitamin D include fish and fortified milks or cereals.[5]  Scientists have studied whether taking vitamin D supplements could decrease the risk of developing health problems for people who do not get enough vitamin D from these natural sources. 

Do Vitamin D Supplements Help Prevent Cancer?

Researchers have conducted several long-term clinical trials to determine whether vitamin D supplements can decrease the risk of developing cancer. Randomized, controlled clinical trials are the “gold standard” of research. In these trials, some participants were assigned to take vitamin D supplements, and others were assigned to take a placebo (sugar pill). Then, the researchers measured whether or not the people given the supplements were less likely to develop cancer over time. 

A 2018 study found that vitamin D supplements did not prevent cancer. Researchers assigned 5,000 people, ages 50-84, to either take 100,000 IU of vitamin D or placebo once a month for 3 years. After 3 years, they found that monthly supplements of high doses of vitamin D did not decrease the percentage of people developing cancer.[6] An even larger study from 2019, of almost 26,000 patients over the age of 50, also found no benefit. The researchers assigned participants to take either 2000 IU of vitamin D or a placebo every day for over 5 years. People taking vitamin D every day were just as likely to develop cancer as the people taking the placebo.[7] 

A meta-analysis published in 2019 also looked at the impact of vitamin D supplements on cancer. A meta-analysis is a type of combination study that combines the results of many smaller studies. The study found that although vitamin D supplements did not prevent cancer, people who took daily vitamin D supplements were less likely to die from cancer.[8] The researchers suggested that even though vitamin D supplements do not prevent cancer, perhaps they affect the way that tumors grow. However, a bigger meta-analysis (combining more than 30 studies totaling 18,000 participants) found no difference in deaths from cancer for those who did or did not take the supplements.[9] The two meta-analyses had different methods and looked at different studies, so further research is needed in order to determine whether or not vitamin D supplements actually can prevent deaths from cancer. 

Most people taking vitamin D are taking it combined with calcium. For that reason, it is important to look at research that examines the effect of taking them both. A 2017 study looked at more than 2,300 women ages 55 and up. Half were assigned to take 2,000 IU of vitamin D and 1,500 mg of calcium per day, and the other half were assigned to take a placebo every day. The researchers followed them for 4 years and found no difference between the two groups in the chances of getting cancer.[10]

Why is it that people with low vitamin D are more likely to develop cancer, but vitamin D supplements do not prevent cancer? One possibility is that people low on vitamin D might be different from people with enough vitamin D in ways that are related to an increased risk of cancer. For example, people might be low in vitamin D because they do not go outside and exercise regularly, and people who exercise regularly are less likely to develop cancer [11]. Obese people are more likely to develop cancer, and obese people tend to have lower levels of vitamin D.[12]

Are Vitamin D Supplements Good for Your Heart?

People who do not have enough vitamin D are more likely to develop heart disease and have heart attacks.[13,14] Researchers have conducted clinical trials to find out if vitamin D supplements can help prevent heart disease. The same large study from 2019 that measured vitamin D supplements and cancer also looked at whether or not people taking the supplements had fewer heart attacks. The study found no benefit: there was no difference in the number of heart attacks between those taking vitamin D and those taking placebos.[7] 

Since people taking vitamin D supplements often take calcium supplements as well, researchers want to understand if taking both of these supplements affects heart health. The results of these studies are not consistent, with some showing an increase in strokes,[15] and others finding no impact on heart health.[13] More clinical trials on the combination of vitamin D and calcium are needed to draw any conclusions about whether these supplements are helpful or harmful to heart health. 

Vitamin D and COVID-19

Research has shown that Vitamin D supplements can help protect against acute respiratory infections like the flu[16]. That is why in 2020, research is underway to determine if vitamin D supplements can help protect against COVID-19. Thus far, the research has found that people low in vitamin D are more likely to have tested positive for the coronavirus than people who are not low in vitamin D.[17] This research is based on studies of people who tested positive at a time when testing in the U.S. was relatively rare and many of the people who were tested did so because they had respiratory symptoms such as coughs or flu-like symptoms. Since these were not clinical trials, it is not clear whether being low in vitamin D makes someone more susceptible to COVID-19 symptoms, or whether old age or other traits increases the chances of having low vitamin D levels and also increases the chances of developing COVID-19. Research is being conducted to determine if vitamin D can help prevent serious symptoms or help patients recover.

Potential Risks of Supplements 

Some older research found that taking a combination of vitamin D and calcium increased the risk of kidney stones.[18] However, more recent research has found that there is no increased risk of kidney stones in people taking the combination of vitamin D and calcium.[10] A large clinical study conducted in 2019 found that taking vitamin D supplements alone did not increase the chances of developing kidney stones, upset stomach, or hypercalcemia (too much calcium in the blood).[7] 

The Bottom Line

There is not enough evidence to conclude whether taking vitamin D prevents cancer or heart problems. The United States Preventive Services Task Force, a federally funded group that analyzes scientific research, has concluded that there is not enough evidence to say that the benefits of taking supplements, including vitamin D and calcium, to try to prevent heart disease and cancer outweigh the risks.[19]

If you are worried that you are not getting enough vitamin D, talk with your doctor about getting your vitamin D levels tested. If you choose to take a supplement, be sure to talk with your doctor about the amount of vitamin D you are taking. Unless you have a medical need and your doctor recommends it, it is not recommended to take more than 4,000 IU of vitamin D per day. It is better to try to get your vitamins from food or the sun.[20] The Food and Drug Administration requires that food packaging in the United States say what percentage of your daily vitamin D needs are included in a serving of packaged food. Read the labels on your food if you are concerned about getting enough vitamin D in your diet. For more information about vitamin D, what it does for the body, and getting vitamin D from food and the sun, click here. 

  1. Forrest, K. Y., & Stuhldreher, W. L. (2011). Prevalence and correlates of vitamin D deficiency in US adults. Nutrition Research, 31(1), 48-54.
  2. Hossain, S., Beydoun, M. A., Beydoun, H. A., Chen, X., Zonderman, A. B., & Wood, R. J. (2019). Vitamin D and breast cancer: A systematic review and meta-analysis of observational studies. Clinical Nutrition ESPEN, 30, 170-184.
  3. Garland, C. F., Garland, F. C., Gorham, E. D., Lipkin, M., Newmark, H., Mohr, S. B., & Holick, M. F. (2006). The role of vitamin D in cancer prevention. American Journal of Public Health, 96(2), 252-261. 
  4. U.S. News and World Report. How Much Time in the Sun Do You Need for Vitamin D? Health.usnews.com. Updated July 2018.  https://health.usnews.com/wellness/articles/2018-07-18/how-much-time-in-the-sun-do-you-need-for-vitamin-d
  5. Dietary Guidelines 2015-2020. Vitamin D: Food Sources Ranked by Amounts of Vitamin D and Energy per Standard Food Portions and per 100 Grams of Foods. Health.gov https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/appendix-12/
  6. Scragg, R., Khaw, K. T., Toop, L., Sluyter, J., Lawes, C. M., Waayer, D., … & Camargo, C. A. (2018). Monthly high-dose vitamin D supplementation and cancer risk: a post hoc analysis of the vitamin D assessment randomized clinical trial. JAMA Oncology, 4(11), e182178-e182178.
  7. Manson, J. E., Cook, N. R., Lee, I. M., Christen, W., Bassuk, S. S., Mora, S., … & Friedenberg, G. (2019). Vitamin D supplements and prevention of cancer and cardiovascular disease. New England Journal of Medicine, 380(1), 33-44.
  8. Keum, N., Lee, D. H., Greenwood, D. C., Manson, J. E., & Giovannucci, E. (2019). Vitamin D supplementation and total cancer incidence and mortality: a meta-analysis of randomized controlled trials. Annals of Oncology, 30(5), 733-743.
  9. Goulão, B., Stewart, F., Ford, J. A., MacLennan, G., & Avenell, A. (2018). Cancer and vitamin D supplementation: a systematic review and meta-analysis. The American Journal of Clinical Nutrition, 107(4), 652-663.
  10. Lappe, J., Watson, P., Travers-Gustafson, D., Recker, R., Garland, C., Gorham, E., … & McDonnell, S. L. (2017). Effect of vitamin D and calcium supplementation on cancer incidence in older women: a randomized clinical trial. JAMA, 317(12), 1234-1243.
  11. Willer, A. (2005). Cancer risk reduction by physical exercise. World Review of Nutrition and Dietetics, 94(R), 176.
  12. Nair, R., & Maseeh, A. (2012). Vitamin D: The “sunshine” vitamin. Journal of Pharmacology & Pharmacotherapeutics, 3(2), 118.
  13. Chin, K., Appel, L. J., & Michos, E. D. (2017). Vitamin D, calcium, and cardiovascular disease: a “D” vantageous or “D” etrimental? An era of uncertainty. Current Atherosclerosis Reports, 19(1), 5.
  14. Vanga, S. R., Good, M., Howard, P. A., & Vacek, J. L. (2010). Role of vitamin D in cardiovascular health. The American Journal of Cardiology, 106(6), 798-805.
  15. Khan, S. U., Khan, M. U., Riaz, H., Valavoor, S., Zhao, D., Vaughan, L., … & Murad, M. H. (2019). Effects of nutritional supplements and dietary interventions on cardiovascular outcomes: an umbrella review and evidence map. Annals of Internal Medicine, 171(3), 190-198.
  16. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz G, Esposito S, Ganmaa D, Ginde AA, Goodall EC. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017; 356.
  17. The Scientist. Trials Seek to Answer if Vitamin D Could Help in COVID-19. https://www.the-scientist.com/news-opinion/trials-seek-to-answer-if-vitamin-d-could-help-in-covid-19-67817. August 2020. 
  18. Jackson, R. D., LaCroix, A. Z., Gass, M., Wallace, R. B., Robbins, J., Lewis, C. E., … & Bonds, D. E. (2006). Calcium plus vitamin D supplementation and the risk of fractures. New England Journal of Medicine, 354(7), 669-683.
  19. Moyer, V. A. (2014). Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 160(8), 558-564.
  20. Harvard Health Publishing. Harvard Medical School. Taking too much vitamin D can cloud its benefits and create health risks. health.harvard.edu. https://www.health.harvard.edu/staying-healthy/taking-too-much-vitamin-d-can-cloud-its-benefits-and-create-health-risks. Published November 2017. Updated December 2019. 

Celebrities Are Getting Coronavirus Tests Faster Than Everyone Else

In the News, We're In the News, ,

Shira Feder and Julia Naftulin, Insider: March 13, 2020

When news broke that Tom Hanks and his wife Rita Wilson had become the first celebrities diagnosed with the coronavirus, it was a moment that struck fans — particularly in countries that have yet to feel the brunt of the virus — just how far and fast it is spreading.

But amid the praise for how Hanks and Wilson are handling the situation, many people have also called into question how quickly the couple were tested and diagnosed, while most of the general public in the US and many European countries struggle to even find out where to get a test.

[…]

It was a dramatic moment when medical officials raced onto the Chesapeake Energy Arena basketball court in Oklahoma City on Wednesday night to prematurely shut down the game the Jazz and Oklahoma City Thunder teams were playing. They’d received a tip that Rudy Gobert, a basketball player for Utah Jazz, had tested positive for the new coronavirus.

Up until that point, testing had been sluggish. On Tuesday, 2,728 people were tested across the US — just over 50 people for each state. On Wednesday night, 58 tests were performed on athletes and team staff.

That day, the same day the World Health Organisation declared COVID-19 a pandemic, new stats emerged showing the US had done a total of five tests for every one million people, compared to with almost 4,000 tests per million people in South Korea.

“Other countries are testing much more broadly than we are,” William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine, previously told Business Insider. “We are trotting along while they’re racing along.”

The only other people who were tested nearly as quickly appeared to be political officials, like Ted Cruz, Paul Gosar, and Matt Gaetz, who were exposed at conservative conference CPAC.

According to Diana Zuckerman, the president of the National Center for Health Research in Washington, DC, it makes sense that high-profile celebrities and athletes have more access to COVID-19 testing than the general public.

“I think there’s a lot of benefit for a physician to have celebrity patients, and that means that those physicians are going to do their very best to please their patients in ways that they might not work quite so hard for in a non-celebrity patient,” Zuckerman told Insider. “When something is available but limited, and there’s limited access but it exists, people with more fame are and more money are more likely to get it.”

America is lagging behind every other country when it comes to coronavirus testing

Without testing widely, it is impossible for public health officials to measure exactly how dangerous this outbreak is. As of Friday, CDC criteria states that anyone who had close contact with a confirmed COVID-19 patient within the past 14 days should get tested, as should people who traveled from a high-risk area within the past 14 days.

But many people who may have coronavirus do not fit this criteria.

The US has fallen far behind other countries when it comes to testing, plagued by delays, errors, and limited testing supplies. Finally, on Thursday, the FDA approved Roche’s test to be rolled out free. There are now also testing drive-thrus in Colorado and California. To speed things up, private labs like Quest Diagnostics have begun offering their own coronavirus tests for people with the money or insurance to pay for it.

“We’re certainly in a situation where there’s such a limit to the number of tests available. We hope the situation will change soon, but currently it’s a big problem,” Zuckerman said.

Regardless, she hopes there will be less favorable treatment.

“It’s a little bit hard to make the case that celebrities deserve to be tested before people who actually have symptoms,” said Zuckerman. “It isn’t just the celebrities, it’s also the people taking the subway to work.” 

There’s another problem: tests are free for Americans, but ambulances and treatment are not

Those that have sought treatment for the coronavirus have faced another conundrum: some have gotten stuck with hefty bills.

The Miami Herald reported that one man was charged $3,270 for a test at the hospital. The New York Times reported that one man left a mandatory quarantine and received a bill for thousands. Another uninsured person was issued a $1,295 bill out-of-pocket.

“Anybody that wants a test can get a test,” Trump announced to reporters on March 6. But testing supplies are limited and to-test-or-not-to-test is a decision that has been left up to individual clinicians and healthcare provider’s judgments.

Trump also announced that insurers will pay for coronavirus treatments. The next day vice president Mike Pence clarified that insurers have waived copays for the coronavirus tests — not the coronavirus treatment, which may require respirators and hospital stays and can quickly get expensive.

Read the full article here.