For Alzheimer’s Caregivers, Patience and Compassion Are Key

News Picture: For Alzheimer's Caregivers, Patience and Compassion Are KeyBy Serena Gordon
HealthDay Reporter

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FRIDAY, Feb. 22 (HealthDay News) — The picture isn’t necessarily pretty when it comes to Alzheimer’s disease.

More than 5 million Americans currently have the degenerative brain condition, there’s no sure way to prevent it and current treatment options don’t work for everyone. Even more millions are tasked with the sometimes difficult and frustrating daily care of those stricken with the memory-robbing disease, often with little experience or training.

But as the number of Americans with Alzheimer’s has risen in the past few decades and continues to spiral upward, anecdotal and research evidence has accumulated on ways to make everyday life more bearable for those with the disease and to help those caring for them. It includes expanded knowledge of what works and what doesn’t in areas of medication, living situations, everyday contact and more, and ranges from complex to simple solutions.

“There are times that it can be difficult to handle someone with Alzheimer’s, but you have to have patience, and you have to put yourself in their shoes,” said Teresa Dinau, a caregiver for Home Care Assistance, based in Palo Alto, Calif. “It’s important to try to understand what they’re going through.”

Dr. Jacobo Mintzer, chairman of the Medical and Scientific Advisory Board for the Alzheimer’s Foundation of America, said that the biggest initial problem for caregivers is often that “they’re trying to preserve the person they knew as long as possible.”

“That’s usually where they get themselves into trouble,” he said. “Because of this desperate need to try to preserve the person, caregivers will put themselves in dangerous situations, like letting the person with Alzheimer’s drive because it has always been important to them.”

Not pushing someone with Alzheimer’s to be who they used to be makes some caregivers feel like they’ve given up on their loved one, added Mintzer, who’s also a physician at the Ralph H. Johnson VA Medical Center in Charleston, S.C.

But he said that’s not the case and that there are plenty of safe ways to keep a connection. If someone with Alzheimer’s used to like to swing dance, for instance, and you put on music and swing dance with them, it will often be calming, he said. Or, people with Alzheimer’s usually enjoy looking at photos from the past, according to the Alzheimer’s Association.

Mintzer said there are no treatments currently available to alter the course of the disease. However, two types of medications have been approved in the United States to help with memory loss: a group of drugs called cholinesterase inhibitors (brand names include Aricept, Exelon, Razadyne and Cognex) and memantine (brand name Namenda). However, the Alzheimer’s Association reports that these medications don’t work for everyone and, on average, delay worsening of symptoms only by about six to 12 months.

Also, antidepressants, anti-anxiety and antipsychotic medications are used to ease some of the behavioral symptoms that can be a part of Alzheimer’s disease, including agitation and anxiety. None of these medications have been specifically approved to treat Alzheimer’s, however, so the Alzheimer’s Association recommends discussing the risks and the benefits of any medication with a doctor.

Despite the limitations of existing medications, problem behaviors can sometimes be overcome with the right type of stimulation and care.

“We need to see ourselves as a therapeutic agent,” said Mintzer. “Patients have needs. When social stimulation is diminished, patients tend to get agitated.” He noted that sundowning — increased confusion and agitation that some people with Alzheimer’s experience later in the day — “may occur because the amount of care goes down in the evening, whether at home or in a nursing home.”

“Sit down and talk with them for five minutes every hour,” Mintzer suggested. “Talk with them in a non-threatening manner. Share a meal, or even sit down and split a cookie. It may not meet your needs for a social interaction, but that’s not the purpose of it.”

Using a calm voice is always important, and it’s often easier to redirect attention than to try to get your friend or loved one to change a behavior. It’s important to acknowledge any questions or requests, even though it may be the fifth time in 10 minutes that you’ve been asked what the time is. Each request is new to them.

Dinau said that she tries to keep routines as normal as possible. Instead of letting someone have dinner in bed, she guides them to the table to eat and then has a conversation with them during dinner. “A little activity here and there really helps,” she said.

Mintzer also said it’s important to have routine structure. Things can change within a day, but try to keep activities similar. For example, if Tuesday is the day you go out to lunch together, make a doctor’s appointment for Tuesday. Then, while you’re on your way to lunch, you can say something like, “Do you mind if we stop at the doctor on our way?” That way, he said, you’re not changing the routine but just adding an element to it.

An array of devices also exist now that can help make a home safer for someone with Alzheimer’s. He said these range from the very simple drawer and cabinet locks used to keep young children away from dangerous items to more high-tech safety devices like motion sensors for the stove and tracking devices that can be worn by people with Alzheimer’s in case they wander.

But there does come a time when the disease ravages the brain so significantly that someone with Alzheimer’s can’t consistently control their behavior, Mintzer said. “When they get this impaired, they lack the ability to understand reality and suffer from delusions,” he said, adding that medications that treat symptoms can be helpful at this point.

Though people with Alzheimer’s can often stay in their homes, Mintzer said that if that’s no longer safe, it’s time to start looking into long-term care.

“When this time comes may be very different for different patients,” he said. “If you live in the middle of New York City and you have a grocery store downstairs, it’s irrelevant that your loved one can’t drive anymore. If you’re loved one lives in rural North Carolina and can’t drive anymore, they will starve and need assistance or long-term care earlier.”

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Copyright © 2013 HealthDay. All rights reserved.

SOURCES: Teresa Dinau, professional caregiver, Home Care Assistance, Palo Alto, Calif.; Jacobo Mintzer, M.D., chairman, Medical and Scientific Advisory Board, Alzheimer’s Foundation of America, vice chairman, clinical research, and professor, neuroscience, Medical University of South Carolina, and physician, Ralph H. Johnson VA Medical Center, Charleston, S.C.



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Better Pap Smear Follow-Up Needed Among Lower-Income Women

THURSDAY, Aug. 20 (HealthDay News) — In the Canadian province of Ontario, fewer than half of women with abnormal Pap tests receive proper follow-up care and low-income women are less likely to be screened for cervical cancer than high-income women, a new study has found.

“Cervical cancer is one of the most preventable forms of cancer, yet in Ontario more than 1 million women have not been screened, and a disproportionate number of these women are living in lower-income communities,” principal investigator Dr. Arlene Bierman, a physician at St. Michael’s Hospital in Toronto, said in a news release from the hospital.

She and her colleagues found that less than 50 percent of women who had a Pap test that detected a low-grade abnormality received appropriate follow-up care within the recommended time period, including either a repeat test or a medical procedure called a colposcopy, which examines a woman’s cervix and vagina. The low rate of follow-up in these women is cause for concern because they tend to be at greatest risk for eventually developing cervical cancer, the study authors noted.

The study also found that the overall rate of cervical cancer screening in Ontario was 69 percent, with screening rates of 61 percent for low-income women and 75 percent for high-income women.

“We need to make special efforts to reach women who are screened, but do not receive the necessary follow-up and may eventually fall through the cracks. To improve surveillance and treatment, we need a system that ensures all abnormal Pap tests are followed-up so that Ontario women can receive the best care possible,” Bierman said in the news release.

The Project for an Ontario Women’s Health Evidence-Based Report (POWER) study was a joint effort by St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences.

More information

The U.S. National Cancer Institute has more about Pap tests.


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Health Tip: The Skinny on Carbohydrates

(HealthDay News) — Carbohydrates include foods with fiber, sugars and starches.

Simple carbohydrates have one or two sugars, while complex carbohydrates contain at least three sugars, says the U.S. National Library of Medicine.

Simple carbohydrates with natural sugars include milk products, fruits and vegetables. Simple carbs with refined sugars — including candy, soda and syrups — have little nutritional value and should be avoided in excess, the agency says.

Examples of complex carbohydrates include starchy vegetables, legumes (such as dried peas, beans and lentils) and whole-grain foods.

The NLM says between 40 percent and 60 percent of your daily total caloric intake should come from carbohydrates, mostly from complex carbohydrates.


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Staff 'took' drugs from hospital

25 February 2013 Last updated at 09:29 ET

Rebecca LeightonRebecca Leighton admitted removing medication

A nurse cleared over the poisoning deaths of patients at Stepping Hill Hospital claimed staff habitually took drugs from the premises.

Rebecca Leighton, 29, spent six weeks in jail after her arrest but was released when prosecutors said there was not enough evidence against her.

She was sacked when police found painkillers at her home.

But at a disciplinary hearing, the nurse alleged staff took drugs in “case of emergencies” during holidays.

Ms Leighton admitted removing the medication from the hospital in Stockport, Greater Manchester, and conceded her fitness to practice was impaired.

During police interviews, she claimed staff regularly took drugs such as the painkiller ibuprofen for their own use, a Nursing and Midwifery Council (NMC) disciplinary panel heard.

Tom Hoskins, for the NMC, said: “She said that if the police were to search any number of employees from Stepping Hill Hospital, a random person, they would find them also in possession of such tablets.”

Twenty-two people suffered hypoglycaemic episodes after saline drips were allegedly sabotaged with insulin between June and July 2011 at Stepping Hill.

Second arrest

Eight of these victims – who were treated on acute care wards for seriously ill patients – have now died.

A second nurse who worked on the same wards, Victorino Chua, was later held on suspicion of three counts of murder and 18 counts of causing grievous bodily harm.

He was further arrested on suspicion of tampering with medical records and has been released on police bail.

Mr Chua was held over the deaths of Tracey Arden, 44, Arnold Lancaster, 71, and Derek Weaver, 83.

Alleged poisoning victims William Dickson, 82, Linda McDonagh, 60, John Beeley, 73, Beryl Hope, 70, and Mary Cartwright, 89, are believed to have eventually died from natural causes.

The panel is hearing evidence to decide whether her fitness to practice is impaired.

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Staff ‘took’ drugs from hospital

25 February 2013 Last updated at 09:29 ET

Rebecca LeightonRebecca Leighton admitted removing medication

A nurse cleared over the poisoning deaths of patients at Stepping Hill Hospital claimed staff habitually took drugs from the premises.

Rebecca Leighton, 29, spent six weeks in jail after her arrest but was released when prosecutors said there was not enough evidence against her.

She was sacked when police found painkillers at her home.

But at a disciplinary hearing, the nurse alleged staff took drugs in “case of emergencies” during holidays.

Ms Leighton admitted removing the medication from the hospital in Stockport, Greater Manchester, and conceded her fitness to practice was impaired.

During police interviews, she claimed staff regularly took drugs such as the painkiller ibuprofen for their own use, a Nursing and Midwifery Council (NMC) disciplinary panel heard.

Tom Hoskins, for the NMC, said: “She said that if the police were to search any number of employees from Stepping Hill Hospital, a random person, they would find them also in possession of such tablets.”

Twenty-two people suffered hypoglycaemic episodes after saline drips were allegedly sabotaged with insulin between June and July 2011 at Stepping Hill.

Second arrest

Eight of these victims – who were treated on acute care wards for seriously ill patients – have now died.

A second nurse who worked on the same wards, Victorino Chua, was later held on suspicion of three counts of murder and 18 counts of causing grievous bodily harm.

He was further arrested on suspicion of tampering with medical records and has been released on police bail.

Mr Chua was held over the deaths of Tracey Arden, 44, Arnold Lancaster, 71, and Derek Weaver, 83.

Alleged poisoning victims William Dickson, 82, Linda McDonagh, 60, John Beeley, 73, Beryl Hope, 70, and Mary Cartwright, 89, are believed to have eventually died from natural causes.

The panel is hearing evidence to decide whether her fitness to practice is impaired.


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Child alcohol contracts considered

25 February 2013 Last updated at 10:45 ET

Youths drinking in parkSeven 13 to 18-year-old typically attend A&E for alcohol-related issues each week

Contracts to be signed by parents pledging not to give their children alcohol are being considered by authorities in Brighton and Hove.

It comes after a report found children in the city were almost twice as likely as youngsters elsewhere in England to report they have been drunk three or four times in the previous four weeks.

The figure, at 9%, compares to 5% in the rest of the country.

The report said parents and siblings often bought alcohol for youngsters.

Written by Tom Scanlon, the city’s director of public health, the report will be discussed by councillors on Tuesday.

It is against the law for under 18s to buy alcohol and for an adult to buy alcohol for them.

It is also illegal for under 18s to drink alcohol in licensed premises, except where they are 16 or 17 years old and accompanied by an adult.

In that instance it is legal for them to drink – but not buy – beer, wine or cider with a meal.

‘Alcohol-free childhood’

The report said contracts with parents to not provide their children with alcohol has been signed at some schools in Rotterdam, which had a “very strong abstinence message for young people”.

“The possibility of developing something similar in Brighton and Hove is under discussion, with a view to changing attitudes towards young people drinking alcohol,” it added.

The report said seven 13 to 18-year-olds and 46 adults in the city typically attend A&E for alcohol-related issues each week.

It also found two people die as a result of alcohol abuse in the city every week and excessive drinking is estimated to cost taxpayers £107m a year.

“For many years alcohol consumption has been recognised as a serious public health issue in Brighton and Hove,” it said.

A spokesman from Alcohol Concern said studies had shown that parents were often the main source of alcohol for underage drinkers.

“Many parents mistakenly believe they are introducing their children to sensible drinking, or preventing them from drinking outside the house by giving them alcohol at home,” he said.

“In fact, all the evidence is that the best thing parents can do is set clear rules and boundaries for their children about alcohol, and give them an alcohol-free childhood.”


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Mediterranean diet can ward off heart disease: study

Food is seen on a table at a restaurant at the port of El Masnou, near Barcelona May 16, 2008. REUTERS/Albert Gea

Food is seen on a table at a restaurant at the port of El Masnou, near Barcelona May 16, 2008.

Credit: Reuters/Albert Gea

By Genevra Pittman

NEW YORK | Mon Feb 25, 2013 1:21pm EST

NEW YORK (Reuters Health) – A Mediterranean diet high in olive oil, nuts, fish and fresh fruits and vegetables may help prevent heart disease and strokes, according to a new large study from Spain.

Past research suggested people who eat a Mediterranean-like diet have healthier hearts, but those studies couldn’t rule out that other health or lifestyle differences had made the difference.

For the new trial, researchers randomly assigned study volunteers at risk of heart disease to a Mediterranean or standard low-fat diet for five years, allowing the team to single out the effect of diet, in particular.

“This is good news, because we know how to prevent the main cause of deaths – that is cardiovascular disease – with a good diet,” said Dr. Miguel Angel Martinez-Gonzalez, who worked on the study at the Universidad de Navarra in Pamplona.

He and colleagues from across Spain assigned almost 7,500 older adults with diabetes or other heart risks to one of three groups.

Two groups were instructed to eat a Mediterranean diet – one supplemented with extra-virgin olive oil and the other with nuts, both donated for the study – with help from personalized advice and group meetings. The third study group ate a “control” diet, which emphasized low-fat dairy products, grains and fruits and vegetables.

Over the next five years, 288 study participants had a heart attack or stroke or died of any type of cardiovascular disease.

People on both Mediterranean diets were 28 to 30 percent less likely to develop cardiovascular disease than those on the general low-fat diet, the researchers reported Monday in the New England Journal of Medicine.

The new study is the first randomized trial of any diet pattern to show benefit among people initially without heart disease, said Dr. Dariush Mozaffarian, who studies nutrition and cardiovascular disease at the Harvard School of Public Health in Boston.

NOT DUE TO SINGLE INGREDIENT

It’s the blend of Mediterranean diet components – not one particular ingredient – that promotes heart health, according to Martinez-Gonzalez.

“The quality of fat in the Mediterranean diet is very good,” he told Reuters Health. “This good source of calories is replacing other bad sources of calories. In addition, there is a wide variety of plant foods in the Mediterranean diet,” including legumes and fruits as desserts, Martinez-Gonzalez added.

“I think it’s a combination of what’s eaten and what’s not eaten,” agreed Mozaffarian, who wasn’t involved in the new research.

“Things that are discouraged are refined breads and sweets, sodas and red meats and processed meats,” he told Reuters Health. “The combination of more of the good things and less of the bad things is important.”

Martinez-Gonzalez suggested people seeking to improve their diet start with small changes, such as forgoing meat one or two days per week, cooking with olive oil and drinking red wine with meals rather than hard alcohol.

Replacing a high-carbohydrate or high-saturated fat snack with a handful of nuts is also a helpful change, said Teresa Fung, a nutrition researcher at Simmons College in Boston who also wasn’t on the study team.

“All of these steps are making, at the end of the day, a big difference,” Martinez-Gonzalez said.

Fung pointed out many people in the new trial were already on medications, such as statins and diabetes drugs.

“The way I see it is, even if people are on medication already, diet has substantial additional benefit,” she told Reuters Health.

That’s likely the case for people without heart risks – including high blood pressure or cholesterol – as well, Fung added.

“This is a high-risk group, but I don’t think people should wait until they become high-risk in order to change,” she said.

SOURCE: bit.ly/YuyV7v New England Journal of Medicine, online February 25, 2013.

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Insight: Cancer drugs proving worth earlier in testing

Dr. Michael Weitz, MD, poses in the emergency room at St. John's Health Center in Santa Monica, California, February 13, 2013. Drug makers are finding out much earlier in the testing process whether cancer drugs work and Dr. Weitz, whose lung cancer was quickly eradicated in a Phase 1 trial, is an example of this trend. Picture taken February 13, 2013. REUTERS/Bret Hartman

1 of 7. Dr. Michael Weitz, MD, poses in the emergency room at St. John’s Health Center in Santa Monica, California, February 13, 2013. Drug makers are finding out much earlier in the testing process whether cancer drugs work and Dr. Weitz, whose lung cancer was quickly eradicated in a Phase 1 trial, is an example of this trend. Picture taken February 13, 2013.

Credit: Reuters/Bret Hartman

By Bill Berkrot and Ransdell Pierson

NEW YORK | Mon Feb 25, 2013 1:43am EST

NEW YORK (Reuters) – Michael Weitz was out of options. The Californian had endured chemotherapy, radiation and surgery but his lung cancer still spread to his bones and brain.

With time running out, the emergency room physician entered a Phase I study – the earliest stage of human testing for a new medicine – of crizotinib. The drug works for about 4 percent of advanced lung cancer patients with a mutated form of a protein called ALK.

“Once I knew that I had that mutation, I knew that I had an exciting new chance,” said Weitz, now 55, who is cancer-free after three years of taking the drug now sold by Pfizer as Xalkori after an unusually swift development process.

It typically has taken a decade and $1 billion to bring a new treatment to market. But in the last two years a handful of cancer drugs – including Onyx Pharmaceutical Inc’s Kyprolis for multiple myeloma, Roche’s Zelboraf for melanoma, and Pfizer’s Xalkori – were approved in about half that time because of improved genetic screening, more definitive Phase I trials and the dire need for new, effective treatments.

“We hope to be able to shave years off the time it takes to get final approval and save hundreds of millions of dollars per drug,” said Robert Schneider, director of translational cancer research at New York University Cancer Institute. “We’re going to see this as a sea change over the next five years.”

Weitz’s story is a dramatic example of how personalized medicine is advancing 10 years after researchers sequenced the human genome, enabling drugs to target specific genetic variations. The emerging trend is likely to bring more effective treatments to desperate patients faster, increase the number of annual drug approvals and cut research costs through earlier and more reliable data. It will also help drugmakers identify ineffective therapies sooner, although it may not necessarily lead to lower priced medicines.

There are some concerns about the faster approval process but most agree that the benefits of a potentially life-saving drug outweigh the risks. “The accelerated development of new drugs can be a double-edged sword,” said Mace Rothenberg, head of oncology for Pfizer. “As you move more quickly some questions may be unanswered.”

He said those answers can come from trials conducted after drugs are approved, and the Food and Drug Administration often requires post-marketing studies following expedited approvals

Historically, Phase I trials did little more than reveal the dose of an experimental drug that could safely be tolerated before larger studies determined clinically meaningful benefit. But advances in genetic screening and an improved understanding of the biology of cancer are enabling researchers to identify patients most likely to benefit from specific cancer treatments.

“You can see positive signals much more quickly, and clinically you can spare patients for whom the drug is not likely to work,” said Dr. Michael Davies, assistant professor in the department of melanoma medical oncology at MD Anderson Cancer Center in Houston.

Richard Scheller, head of research and early development for Roche’s Genentech unit, which has produced most of the company’s top-selling cancer medicines, said, “you can cut a couple of years out of the clinical trial process by basically doing your pivotal trial straight from Phase I.”

Drugmakers who have benefited from the expedited approval process declined to discuss how much money was saved from the industry average for drug development.

FDA’S NEW “BREAKTHROUGH” DESIGNATION

With impressive enough early results, health regulators are more willing than ever to accept early or midstage trials as adequate proof of safety and effectiveness, rather than insisting on larger, more expensive and time-consuming pivotal Phase III studies that have been a standard requirement.

“The drugs are simply better,” Dr. Richard Pazdur, director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research, said of the new targeted cancer medicines.

With older highly toxic chemotherapy drugs, he said, “many of the discussions we had at the agency dealt with whether we should approve the drug or not. With some of these newer drugs, the issue is how fast we can approve them, not whether they should be approved,” Pazdur said.

The FDA has come up with a new breakthrough designation for drugs it views as a substantial improvement over existing therapies. With the designation – five have been awarded so far with 12 more drugs currently under consideration – the agency works more closely with drugmakers to identify approval requirements and work out commercial manufacturing issues.

DRAMATIC RESPONSE

Key to faster approval is that drugs are becoming more narrowly targeted as researchers better understand the pathways of cancer – a series of biochemical steps that fuel the growth of cancer cells. The aim of the treatments is to block the culprit proteins, or biomarkers, within a pathway.

“It’s much easier for us to offer patients in Phase I studies the real possibility of a dramatic response,” said Paul Sabbatini, an oncologist at Memorial Sloan-Kettering Cancer Center in New York.

Now far fewer patients need to be tested in order to get definitive results in early trials because they are selected only if their tumors contain proteins or gene mutations that the experimental drug is targeting. Patients typically learn about these studies from their doctors or websites such as ClinicalTrials.gov.

“What we’re looking at many times is Phase I data where we’re seeing levels of response that we haven’t seen before in patients that have exhausted most of the therapies in a disease,” said FDA’s Pazdur.

Scheller estimated that cancer researchers are working on 50 different targets that could yield effective future therapies.

NYU’s Schneider, a co-founder of the biotech company ImClone, said historically perhaps only 3 percent of oncology drugs that began Phase I trials went on to be approved. With new diagnostic tools and targeted drugs, he said, “one would hope that 10 or even 15 percent of drugs might be approved for the right patient populations in the next five years.”

Roche’s Zelboraf and Pfizer’s Xalkori both were developed along with companion diagnostic tests to identify the specific gene mutations in patients that the drugs were designed to target. They proceeded relatively rapidly through clinical trials.

The company said development of Zelboraf, which costs $56,000 for a six-month course of treatment, was the fastest conducted by Genentech and Roche. The clinical trial process took less than five years.

Pfizer’s Xalkori took just over four years to develop. Had it been tested in the traditional manner among the general lung cancer population rather than on those with the specific ALK mutation, it would likely have been dismissed as a failure or required further research to try to glean which subgroup of patients were helped by the drug that costs $115,000 a year.

FINDING FAILURES FASTER

In the past, large pharmaceutical companies were reluctant to develop drugs for limited patient groups, preferring to search for medicines to treat ailments such as high cholesterol and arthritis that could be taken by a large swath of the population and become huge money-makers.

Pfizer Chief Executive Ian Read has embraced the newer personalized approach. Noting recent advances in genetic understanding, Read said: “We can get clearer results earlier. That will clearly speed up our development, as you saw with Xalkori.”

The recent advances may also grant a long-held wish of drugmakers – identifying failed drugs faster.

“It’s much better to find that out in Phase I than half a billion dollars later in Phase III,” Genentech’s Scheller said.

“If you have a targeted therapy and you don’t see activity in your first 10 or 20 patients that have your particular diagnostic marker or particular biomarker that you’re looking for, forget it, we’re through, project ends,” Scheller said.

Even with all the recent successes, many hurdles remain. Researchers have yet to figure out why drugs that work by spurring the immune system to fight cancer, such as Bristol-Myers Squibb’s Yervoy, have long-lasting effects on some patients and not others. And they need to figure out why cancer often comes back even when targeted therapies worked.

“We need to know why these drugs stop working sometimes,” said Sloan Kettering’s Sabbatini. “If we understand the cause, we could preemptively combine drugs, or at the first sign of (disease) progression, understand what is the most logical next step as we learn more about the pathways.”

But as long as the United States does not have price controls for medicines as Europe does, and the FDA does not consider economics in its approval decisions, quicker, less expensive development may not translate into lower prices.

“I would hope it would bring down the cost of drugs, but whatever the market bears is what the market will get,” Schneider said.

(Reporting by Bill Berkrot and Ransdell Pierson; Editing by Jilian Mincer, Edward Tobin and Claudia Parsons)

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Need help with your health care costs?

Susan, a woman in her mid-80’s went to her local SHIP for help with her finances and healthcare decisions. Her previous prescription drug plan ended in 2011 and she currently isn’t getting any help to pay her prescription drug costs. After talking with Susan and looking at her situation, the SHIP counselor found that Susan could get Extra Help paying for her prescription drug costs. Susan is now enrolled in a plan where she can afford her medications.

Like Susan, if you have limited income and resources, you may be eligible for “Extra Help” or one of Medicare’s savings programs. These programs may help you save on premiums, deductibles, copayments, or prescription costs.

Get help with one of our 4 savings programs

Medicare offers 4 kinds of programs that may help with your costs.

1.     Qualified Medicare Beneficiary (QMB) Program

2.     Specified Low-Income Medicare Beneficiary (SLMB)

3.     Qualified Individual (QI) Program

4.     Qualified Disabled and Working Individuals (QDWI)

Applying for Extra Help is simple and free.

You won’t have to go without your prescriptions even if you’re having trouble paying for them. If you have limited income or resources, you may qualify for Extra Help to help pay Medicare prescription drug costs, like premiums, deductibles and copayments.

Take a minute to see if you qualify to get help with your health care costs – it could mean money in your pocket.

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Brain's 'stroke shielding' cracked

24 February 2013 Last updated at 14:33 ET

By James Gallagher Health and science reporter, BBC News

Brain

A part of the brain’s ability to shield itself from the destructive damage caused by a stroke has been explained by researchers.

It has been known for more than 85 years that some brain cells could withstand being starved of oxygen.

Scientists, writing in the journal Nature Medicine, have shown how these cells switch into survival mode.

They hope to one-day find a drug which uses the same trick to protect the whole brain.

Treating a stroke is a race against time. Clots that block the blood supply prevent the flow of oxygen and sugar to brain cells, which then rapidly die.

But in 1926, it was noticed that some cells in the hippocampus, the part of the brain involved in memory, did not follow this rule.

“They’re staying alive when the prediction would say that they should die,” said Prof Alastair Buchan from Oxford University who has investigated how they survive.

I’m a survivor

Experiments on rats showed that these surviving-cells started producing a protein called hamartin – which forces cells to conserve energy. They stop producing new proteins and break down existing ones to access the raw materials.

When the researchers prevented the cells from producing hamartin, they died just like other cells.

Prof Buchan said: “We have shown for the first time that the brain has mechanisms that it can use to protect itself and keep brain cells alive.”

Their aim is to develop a drug that can produce the same effect, which could be given when an ambulance arrived. This would buy the brain time until clot-busting drugs could be given in hospital.

The researchers do not know why these cells have this defence, but other nearby cells in the hippocampus do not. There are differences in function. The cells that die are known as CA1 cells which are very plastic and are involved in laying down memories whereas the surviving, or CA3, cells are less adaptable.

Speaking to BBC News online, Prof Buchan said the focus of this research was on “ways to keep brain cells alive” which could have impacts beyond stroke – such as in Alzheimer’s disease and spinal cord injuries.

Commenting on the study, Dr Clare Walton from the Stroke Association said: “Previous research has shown that some brain cells are naturally more resilient than others, and this study has identified a particular protein in the cells that is responsible.

“In the future, researchers could try to turn on this protein in other, less resilient brain cells to reduce the brain damage caused by stroke.

“The findings of this research are exciting, but we are still a long way off from developing a new stroke treatment.”

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