Kaiser Permanente Puts in $200M, Links with Mayors, CEOs on Housing Stability

Kaiser Permanente, the nation’s largest integrated health system, announced an impact investing commitment today of up to $200 million through its Thriving Communities Fund to address housing stability and homelessness, among other community needs. The organization’s initial focus will be on preventing displacement or homelessness of lower- and middle-income households in rapidly changing communities; reducing homelessness by ensuring access to supportive housing; and making affordable homes healthier and more environmentally sound.

Impact investing is a form of investment used to deliver a measurable social benefit. Kaiser Permanente’s impact-investing pledge will deliver national and local social and environmental returns with an initial focus on housing, a significant community health challenge.

Housing stability is a key factor in a person’s overall health and well-being, with homelessness affecting more than 550,000 people every day. By investing in community needs, such as housing, this unique investment strategy is designed to advance Kaiser Permanente’s mission to provide high-quality, affordable health care services and to improve the health of its 12 million-plus members along with the health of the 65 million-plus residents who live in the communities it serves.

“Affordable housing will be a significant focus of Kaiser Permanente’s impact investing portfolio to generate housing stability and improve health outcomes,” said Bernard J. Tyson, chairman and CEO of Kaiser Permanente. “We hope our commitment creates a broader national conversation on homelessness, and encourages other companies to join with us to advance economic, social and environmental conditions for health.”

Kaiser Permanente also has joined the Mayors and CEOs for U.S. Housing Investment, a first-of-its-kind coalition comprised of local government officials and business leaders working to advance key federal housing priorities. Together with mayors from Alexandria, Virginia; Baltimore, Maryland; Charlotte, North Carolina; Oakland, California; and Portland, Oregon, Kaiser Permanente will convene stakeholders to discuss national housing challenges at a meeting today in Washington, D.C.

“Many of the communities we serve are grappling with some of the highest rates of housinginsecurity and homelessness in the United States. As a family physician, I’ve provided medicalcare to the homeless, and have seen first-hand the impact that living without a home can haveon someone’s health. To improve the health of an entire community we must step beyond thefour walls of our hospitals and medical offices to help those most in need,” said BecharaChoucair, MD, Kaiser Permanente’s chief community health officer. “We hope this nationalcommitment to impact investing in housing stability will inspire other companies to share theresponsibility of this critical issue growing in the United States.”

There will be additional details shared in the coming weeks about Kaiser Permanente’s investments in local communities across the United States.

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Novo Nordisk and UC San Francisco Pushing Toward a Diabetes Cure

Danish company Novo Nordisk is a leader in diabetes treatment, but this week announced it was upping its commitment to stem-cell-based therapies and expanding its focus. To do so, it’s developed an exclusive collaboration with the University of California San Francisco (UCSF)and licensed technology to generate human embryonic stem cell (hESC) lines using good manufacturing practice (GMP) manufacturing technology.

In early May, the university and Novo Nordisk inaugurated a new GMP laboratory at UCSF. They indicate they have hit preclinical proof-of-concept in getting pluripotent stem cells to develop into insulin-producing beta cells. Working with Cornell University, Novo Nordisk is working to develop an encapsulation device that will protect the beta cells when they are transplanted into patients. The encapsulation device is designed to keep the patients’ immune system from attacking the cells. Novo Nordisk expects it will enter the clinic in the next couple years.

“Finding a cure for diabetes is part of Novo Nordisk’s vision and recent progress in our stem cell research and the access to robust and high-quality cell lines raises hopes for people with type 1 diabetes,” said Mads Krogsgaard Thomsen, Novo Nordisk’s executive vice president and chief science officer, in a statement. “Our collaboration with UCSF is also expected to accelerate current and future partnerships to develop stem cell-based therapies for treatment of other serious chronic diseases.”

The company’s work in this area is not limited to diabetes. It has deals with Biolamina and Lund University to develop stem cell-based therapies for Parkinson’s disease. And it has another collaboration with Biolamina and the DUKE National University Singapore Medical School working on chronic heart failure and age-related macular degeneration.

Novo Nordisk brings in $17.5 billion in annual revenues, with the bulk of it coming from diabetes-related products. It is currently expanding its manufacturing activity for its current and future GLP-1 and insulin drugs in Clayton, North Carolina. The new facility, expected to be fully operational in 2020, will have 833,000 square feet and create 700 new jobs for a total of 1,700 in the small town near Raleigh. Novo Nordisk is investing $2 billion into production facilities in Clayton; Malov, Denmark; and Kalundborg, Denmark, with $1.8 billion of it going into the Clayton site.

In February, Novo Nordisk reported positive results from a Phase III trial of GLP-1 oral semaglutide. It lasted 26 weeks and evaluated the efficacy and safety of three doses of the drug compared to placebo in 703 patients. It met is primary statistical endpoint, showing significant and superior improvements in HbA1c for all three doses. The 14-mg dose also showed significant and superior weight loss compared to placebo.

“We are very encouraged by the results of the PIONEER 1 trial, which confirm the unprecedented oral efficacy of semaglutide that was reported in the Phase II clinical trial in type 2 diabetes,” Thomsen said in a statement at the time. “We look forward to providing data from the remaining nine PIONEER trials throughout this year and an expected regulatory submission in 2019.”

If approved, the launch of the new drug would be in 2020. GLP-1s are a new class of drugs that stimulate insulin production. The first of these drugs was derived from the venomous bite of North America’s Gila monster lizard. To date, all GLP-1s have been injections.

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Breath test breakthrough for early diagnosis of oesophageal, gastric cancer

A breath test can successfully detect oesophageal and gastric cancer and could be used as a first-line test for patients, say researchers.

In a multi-centre clinical trial of 335 patients, the breath test can identify cancer from benign diseases with 85 per cent accuracy. Unlike other methods, the test is non-invasive. The study was led by researchers at Imperial College London.

Scientists hope that this test, published in JAMA Oncology today, can be used to help clinicians decide whether patients need further investigations. They believe that in future clinicians would order a breath test in the same way as routine blood tests.

Professor George Hanna, lead author of the study at Imperial College London, said:

“We have been able to validate our cancer breath test for oesophageal and gastric cancer on a larger group of patients from multiple centres for the first time. Gastric and oesophageal cancers are mostly diagnosed a late stage when curative treatment might not be possible. There is a real need for early detection of cancer when symptoms are non-specific and shared by benign diseases. Our breath test could be used as a first-line test before invasive investigations. Early detection of cancer gives patients more treatment options and save more lives.”

Credit: Imperial College London

There are more than 15,000 new cases of gastric and oesophageal cancers in the UK and those cancers account for 15 per cent of cancer-related deaths globally. Both cancers are usually diagnosed in the advanced stages as symptoms only become noticeable once the disease develops.As a result, the long-term survival rate is about 15 per cent in the UK. Detection of oesophageal and gastric cancers at an early stage can improve survival rates.

Doctors diagnose oesophageal and gastric cancers by carrying out an endoscopy. This is a procedure where the inside of the body is examined using a probe with a light source and video camera at the end via the mouth and down the gullet. However, the procedure is invasive and only two per cent of patients who are referred for an endoscopy by GPs are diagnosed with oesophageal or gastric cancer. In addition, it would not be possible to refer large numbers of patients who present with non-specific symptoms such as indigestion and reflux for an endoscopy due to the financial cost. At present the procedure costs the NHS around £400-£600 per endoscopy.

The test looks for chemical compounds in exhaled breath that are unique to patients with oesophageal and gastric cancer. The cancers produce a distinctive smell of volatile organic compounds (VOC), chemicals that contain carbon and are found in all living things, which can help doctors detect early signs of the disease. Researchers were able to identify and quantify the number of VOCs in breath samples by using mass spectrometer, an analytical instrument used to identify what chemicals are present in a sample.

Researchers took breath samples of 335 patients from The Royal Marsden NHS Foundation Trust and UCLH (University College London Hospitals NHS Foundation Trust) between 2015-2016. Of these, 163 had been diagnosed with oesophageal or gastric cancer and 172 patients had other benign diseases or normal stomach. To take the test, patients breathed into a device and the volatile compounds in their exhaled breath were analysed at the Division of Surgery’s breath analysis laboratory at St Mary’s Hospital, part of Imperial College Healthcare NHS Trust.

The team are undertaking further investigations to improve the test and will conduct a larger clinical trial to validate the results in GP surgeries where the test is intended to be used and to see if the test can diagnose other cancers in the body such as the pancreas.

 Explore further: Researchers develop new breath test to diagnose oesophageal and gastric cancer

More information: Sheraz R. Markar et al. Assessment of a Noninvasive Exhaled Breath Test for the Diagnosis of Oesophagogastric Cancer, JAMA Oncology (2018). DOI: 10.1001/jamaoncol.2018.0991

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Pediatricians urged to warn vulnerable kids on ’13 Reasons Why’ Netflix series

A report in the journal Pediatrics warns that watching “13 Reasons Why,” a popular Netflix series about a teen girl’s suicide, may be inadvisable for some youngsters.

Mental health professionals have raised alarms that the series – which closes with a graphic depiction of the main character killing herself – could push other young people toward suicide. The second season of the show will air on May 18, while the first season remains available on Netflix.

In an article titled, “13 Things Pediatricians Should Know (and do) About 13 Reasons Why,” Dr. Michael B. Pitt and colleagues of the University of Minnesota Masonic Children’s Hospital in Minneapolis encourage doctors to warn vulnerable young patients – and their parents – away from the show.

“The first thing that we have been surprised by is how few of our colleagues even know about this show,” Pitt told Reuters Health by email. While “13 Reasons” raised a pop culture buzz amid concerns the show might trigger a wave of suicides, he added, “there hasn’t been much digging deep into what the science was.”

Best practices established by the World Health Organization, the International Association for Suicide Prevention, the Centers for Disease Control and Prevention and others address how the media can portray suicide in ways that do not trigger “copycat” deaths among vulnerable individuals.

The CDC guidelines, published in 1994, state that simplistic explanations for suicide, reports that serve as a “how to” for suicide, and coverage that glorifies the person who died by suicide, among other factors, can promote suicide contagion.

“One of the best practices is not to portray suicide, period,” Pitt said. “What struck me watching this now as a parent is the nature of the kind of hero worship that happens. It essentially makes her the most popular kid in school after she’s killed herself.”

In reviewing records at their own health system, the authors identified more than 60 documented references to the show by 31 pediatric patients treated in the six months after “13 Reasons” first aired. Three-quarters of the patients were receiving treatment related to a suicide attempt, and more than half of the children’s parents said they feared the show had made their child’s mental health symptoms worse.

The authors urge pediatricians to follow the American Academy of Pediatrics’ new guidelines calling for universal depression screening for patients aged 12 and older, and to ask their patients about their media consumption.

“Physicians need to not only be aware of the show and the potential ramifications, but also really become comfortable asking their patients about whether or not they are thinking of suicide,” Dr. Kimberly O’Brien, a research scientist at Boston Children’s Hospital Education Development Center and an instructor of psychiatry at Harvard Medical School, told Reuters Health by phone. Dr. O’Brien’s research focuses on suicidal adolescents, but she did not take part in the new study.

O’Brien said she and her colleagues saw a “huge spike” in people admitted to inpatient psychiatric care who reported identifying with the show’s main character, and wanted to kill themselves like she did, in the few months after the show first aired in 2017. In recent years, she noted, suicide has climbed from the third to the second leading cause of death among teens.

“We’re also seeing a spike in attempts in this age range, and it’s disproportionately affecting certain demographics like sexual- and gender-minority youth,” she said.

While watching the show may not be harmful for someone who has never had suicidal thoughts, “for the kids who have been struggling with suicidal thoughts for perhaps their whole lives, this could be really detrimental for them to watch,” O’Brien said.

“I think really the most problematic piece of the whole show was how they depicted Hannah Baker’s suicide. I really feel they could have had the same positive impact without actually showing it in such graphic detail,” she added.

“I do have some hope for the second season that they will really listen to us and make the changes that need to be made,” she said.

In an email to Reuters Health, a Netflix spokesperson cited a recent survey from Northwestern University that found the show led to conversations about bullying, suicide and mental health between teens and their parents.

“That said, we want viewers to be informed and make the right choice for themselves and their families, which is echoed in the video warning message from the cast that plays before each season,” the spokesperson said, noting that Netflix offers a range of parental controls to restrict what kids can watch.

Netflix said it is offering other resources including a discussion guide for families and educators, a video discussion series and a website where viewers can find support locally (13reasonswhy.info).

SOURCE: bit.ly/2rNvBJ9 Pediatrics, online May 15, 2018.

https://reut.rs/2rQ5GBC

HCA, KKR team up for Envision bid

U.S. hospital operator HCA Healthcare Inc (HCA.N) and private equity firm KKR & Co (KKR.N) have joined forces to make an offer for U.S. physician services provider Envision Healthcare Corp (EVHC.N), people familiar with the matter said on Friday.

The move is aimed at giving HCA and KKR an edge over buyout firms that are also pursuing Envision, which has a market capitalization of $5.1 billion and long-term debt of $4.6 billion, the sources said.

HCA, which has a market capitalization of $36 billion and long-term debt of $31.6 billion, wants to acquire Envision’s AmSurg ambulatory surgery business, with KKR taking the over the remainder, according to the sources.

Nashville-based Envision has asked potential acquirers to submit final offers later this month, the sources said. Other private equity firms competing for Envision include a consortium of Carlyle Group LP (CG.O) and TPG Global, the sources added.

The sources asked not to be identified because the matter is confidential. KKR, Carlyle and TPG declined to comment. Envision and HCA did not immediately respond to requests for comment.

Envision announced last year it was reviewing a range of strategic alternatives after reporting disappointing third-quarter earnings, which it attributed partly to the effects of hurricanes Harvey and Irma as well as a slowdown in the growth of patient demand.

Last year, Envision agreed to sell its ambulance unit, AMR, to Air Medical, a medical helicopter business owned by KKR, for $2.4 billion.

HCA Healthcare Inc103.67

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The year prior, it merged with AmSurg in an all stock deal that valued the combined companies at the time at around $10 billion. HCA’s and KKR’s bid would reverse that combination.

A sale of Envision would be the latest in a spate of mergers and acquisitions activity among physician networks, a business that has struggled in recent years to adapt to changes in how U.S. health insurers reimburse providers.

Federal reimbursement programs such as Medicare and Medicaid, for example, have been trying to shift to a “value-based” payment model, whereby providers sometimes receive fixed payments to encourage them to control costs.

Last year, U.S. kidney care-provider DaVita Inc (DVA.N) agreed to sell its medical group business, Davita Medical Group, to UnitedHealth Group Inc. (UNH.N) for $4.9 billion.

Envision’s rival MEDNAX Inc (MD.N) has also been exploring strategic alternatives, including a sale, Reuters has reported.

In 2016, buyout firm Blackstone Group LP (BX.N) acquired hospital staffing provider Team Health Holdings Inc for $6.1 billion.

https://reut.rs/2wW6cmk

Stroke: Clinical trial results ‘likely to change care practice’

Both transient ischemic attacks and minor strokes only last a few hours and rarely have any enduring effects. But they can lead to a major stroke, which is much more dangerous and may impact an individual’s health more severely. “How can this best be prevented?” researchers ask.

An international trial suggests that aspirin and anticoagulants might be the best treatment after a TIA or minor stroke.

As in the case of a major stroke, in a transient ischemic attack (TIA), or mini-stroke, blood supply to the brain is disrupted.

This major organ becomes starved of oxygen, which might lead to trouble speaking, visual disturbances, and numbness in the body’s extremities.

A minor stroke is similar, but it is normally taken to have a more persistent impact, and the term “is often used for stroke patients with mild and nondisabling symptoms.”

However, unlike a major stroke, TIAs do not tend to cause serious, lasting damage. Still, many who experience a mini-stroke may go on to experience a major stroke within the next 90 days, with more serious consequences.

To avoid this, people who have had a TIA should receive immediate medical attention — within 3 hours from the event — and they may be prescribed an anticoagulant drug to prevent further blockages that may obstruct the circulation of blood to the brain.

But researchers are now asking if there are even more effective preventive methods to keep major stroke at bay after a TIA or minor stroke.

Clay Johnston, a professor of neurology at Dell Medical School in the University of Texas at Austin, suggests that patients taking an anticoagulant and aspirin combo might reduce their risk of experiencing a major stroke even further.

In a new study — the results of which were published in The New England Journal of Medicine — Prof. Johnston and team suggest that taking the anticoagulant clopidogrel, as well as aspirin, can lower an individual’s risk of major stroke post-TIA.

Drug combination shows promise

The researchers analyzed medical data sourced from 4,881 adults across 10 countries who had had a TIA or a minor stroke. Specifically, they were interested in evaluating the outcomes for those patients who had been administered both clopidogrel and aspirin.

They found that this aspirin plus anticoagulant combo resulted in a 25 percent lower risk for experiencing a major stroke, heart attack, or death caused by the formation of blood clots within 3 months from the initial event.

Yet this approach does not come without specific risks of its own. Thus, “The study gives […] solid evidence that we can use this drug combination to prevent strokes in the highest-risk people, but not without some risk of bleeding,” notes Prof. Johnston.

The participants who took both aspirin and clopidogrel rather than just aspirin after a TIA or minor stroke had an increased risk of hemorrhage. Therefore, for every thousand patients receiving this drug combo, five extra major bleeding events would be expected, as well as 15 fewer strokes and major ischemic events.

The researchers note that, despite the heightened possibility that a hemorrhage might occur, the benefits of the clopidogrel-aspirin treatment far outweigh the risks, as bleeding is normally reversible and therefore easier to attend to.

Treatment benefits outweigh the risks

“Of the 33 major hemorrhages that occurred in these 4,881 patients,” explains study co-author Dr. J. Donald Easton, from the University of California, San Francisco School of Medicine, “more than half involved the gastrointestinal tract, and none of them [were] fatal.”

“These largely preventable or treatable bleeding complications of the treatment,” he adds, “have to be balanced against the benefit of avoiding disabling strokes.”

A trial that had already tested the waters with the clopidogrel-aspirin combination had also pointed out its benefits, but it had not spotted the risk of bleeding as an adverse event.

Still, the results of the existing research all add up, suggesting that this approach may be a highly desirable one going forward.

As Dr. Ralph Sacco, from the Miller School of Medicine at the University of Miami in Florida, reports, “The results of this large international trial, when added to the results of previous research, provide evidence to support the use of clopidogrel plus aspirin for 90 days among patients with minor ischemic stroke and high-risk TIA treated within 12 hours.”

And the consistently promising outcomes, the researchers believe, will probably change the way in which patients are treated after a TIA or minor stroke.

https://bit.ly/2rQfxr4

‘Metastasis-blocking’ compound may stop the spread of cancer

Using a new approach, scientists have located a compound that stops the spread of breast, pancreatic, and prostate cancers in mice.

Cancer metastasis could one day be halted by metarrestin.

The compound — which they call metarrestin — destroys a unique structure inside the nucleus of cancer cells that can spread and form new tumors.

A paper on the work — in which researchers from the National Institutes of Health (NIH) collaborated with those from Northwestern University Feinberg School of Medicine in Chicago, IL — is published in Science Translational Medicine.

In describing how metarrestin works, co-corresponding study author Sui Huang, who works as an associate professor of cell and molecular biology at Northwestern University Feinberg School of Medicine, likens it to a “dirty bomb against cancer.”

“It could potentially result in a better outcome for patients with solid tumor cancers with high potential to spread to other organs,” she adds.

Metastasis — ‘the final frontier’

Cancer would not be such a potentially serious disease if it were not capable of metastasis, which is a complex process wherein cancer cells escape the primary tumor and invade nearby or distant tissue to form new, secondary tumors.

“What kills people,” Prof. Huang explains, “is when cancer spreads to other organs, such as when breast cancer spreads to the brain, liver, lungs, or bones.”

Metastasis is sometimes referred to as “the last frontier of cancer research.” It accounts for around 90 percent of cancer deaths and this figure has not altered much in half a century.

Once a cancer reaches the metastatic stage, it becomes very difficult to treat with current methods, which are much more effective at tackling the primary tumor.

“Many drugs,” explains co-corresponding study author Dr. Juan Jose Marugan, group leader of the Chemical Genomics Center at the NIH’s National Center for Advancing Translational Sciences in Rockville, MD, “are aimed at stopping cancer growth and killing cancer cells.”

But so far, no drug has been approved that is designed specifically against metastasis, he adds.

Metarrestin kills perinucleolar compartments

Metarrestin destroys a little-understood structure inside the nucleus of cancer cells that is known as the “perinucleolar compartment (PNC).”

Tests on laboratory-cultured cancer cells and cells sampled from human tumors have shown that “PNCs selectively form in cells from solid tumors.”

Also, in previous work, Prof. Huang and her team had discovered that the likelihood of cancer spread was greater when tumor cells had more PNCs.

This led the team to wonder whether attacking PNCs might reduce cancer spread and improve patients’ prospects.

In this study, the scientists used “high-throughput screening followed by chemical optimization” to assess which compound, from a list of at least 140,000, might have the greatest power to destroy PNCs in metastatic cancer cells.

They whittled down the list to 100 compounds, and then they identified one that destroyed PNCs in metastatic prostate cancer cells.

A modified version of the compound became metarrestin, which “significantly inhibited metastasis” in mice grafted with human pancreatic, breast, and prostate cancer. The treated mice also lived longer than untreated mice.

The researchers intend to apply for metarrestin to enter the Food and Drug Administration (FDA) new drug investigation process later this year, after they have run more preclinical tests and collected the data required.

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