Cognitive behavior therapy tops psychotherapies in cutting inflammation

A review of 56 randomized clinical trials finds that psychological and behavioral therapies may be effective non-drug treatments for reducing disease-causing inflammation in the body.

The results of the analysis, published in JAMA Psychiatry, found that cognitive behavior therapy, or CBT, was superior to other psychotherapies at boosting the immune system.
The senior author of the new study is Dr. George Slavich, director of the UCLA Laboratory for Stress Assessment and Research. Along with two of his colleagues at UC Davis and San Diego State University, the team looked at whether interventions typically used for treating mental health problems, such as anxiety and depression, might also boost biological processes involved in physical health. They further analyzed the duration and types of psychotherapy received, including group versus non-group therapy. Finally, they examined how the treatments affected different markers of inflammation and other immune system processes in the body.
“People automatically go to medication first to reduce chronic inflammation, but medications can be expensive and sometimes have adverse side effects,” Slavich said. “In this review, we wanted to know whether psychotherapies can also affect the immune system and, if so, which ones have the most beneficial effects over the long term.”
The researchers analyzed randomized clinical trials that investigated the effects of several different types of interventions, including CBT, CBT plus medication, grief and bereavement support, a combination of two or more psychotherapies, and psychoeducation, among others.
“This seems to be a case of mind over matter,” Slavich said. “Psychotherapies like CBT can change how we think about ourselves and the world, and changing these perceptions can in turn affect our biology. The results of this study take this idea one step further and suggest that psychotherapy may be an effective and relatively affordable strategy for reducing individuals’ risk for chronic diseases that involve inflammation.”
Through their analyses, the researchers sought to better understand how the body reacts to non-drug treatments for chronic inflammation, which increases the risk of developing several deadly diseases and can lead to premature death.
They looked at several different immune outcomes. Of those outcomes, pro-inflammatory cytokines were most strongly affected by psychotherapy in general and CBT in particular. Pro-inflammatory cytokines are notable because they help the immune system heal physical wounds and battle infections. If these proteins remain persistently elevated, though, they can lead to chronic inflammation, which increases the risk of physical illnesses, such as heart disease, cancer and Alzheimer’s disease, as well as mental health problems, including anxiety disorders, depression, PTSD, schizophrenia, self-harm and suicide.
“There are many people who would prefer to use non-drug interventions for improving their immune system function,” Slavich said. “In some cases, they can’t take certain medications because of medical reasons, and in other instances the medications they need are too expensive. And then there are people who simply prefer a more holistic approach to improving their health.”
Slavich said that these findings provide strong evidence that psychotherapy may be helpful in this regard.
“Out of all of the interventions we examined, CBT was the most effective for reducing inflammation, followed by multiple or combined interventions,” Slavich said. “Moreover, we found that the benefits of CBT on the immune system last for at least six months following treatment. Therefore, if you’re looking for a well-tested, non-drug intervention for improving immune-related health, CBT is probably your best choice.”

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Story Source:
Materials provided by University of California – Los Angeles Health Sciences. Note: Content may be edited for style and length.

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Journal Reference:

1. Grant S. Shields, Chandler M. Spahr, George M. Slavich. Psychosocial Interventions and Immune System Function. JAMA Psychiatry, 2020; DOI: 10.1001/jamapsychiatry.2020.0431

https://www.sciencedaily.com/releases/2020/06/200603132527.htm

NYC Life Sciences Sector A ‘Bright Spot’ Amid Pandemic

While office real estate has taken a hit amid the coronavirus pandemic, the life sciences sector has remained strong throughout this year. Life sciences construction, leasing activity and funding for new projects has held stable throughout the global health crisis.

There are between 800K and 900K SF of active lab requirements in New York City — some of which is coming from companies trying to combat the coronavirus, according to a CBRE report.

“The steady stream of life science projects under construction in NYC, coupled with continued flow of private and public funding, have positioned the market to continue the upward trajectory that we’ve seen over the last 18 months,” CBRE Vice Chairman Steve Purpura said in a release Wednesday.

“We are anticipating another surge in activity following the lift of shelter-in-place orders given some pent-up-demand and the possibility of more requirements in response to the current health crisis.”

Since March 20, when the city shut down, interest in leasing at major life sciences properties in the city, such as 345 Park Ave. South, owned by Deerfield Management; the Taystee Lab Building, owned by Janus Property Co.; and Hudson Research Center, owned by Silverstein and Taconic has remained high. Cell therapy engineering company BlueRocks Therapeutics announced in April that it would expand by 20K SF at Alexandria Real Estate Equities’ 728K SF Alexandria Center for Life Science at 430 East 29th St.

CBRE predicts that total annual funding for New York City life sciences from the National Institutes of Health will hit its highest amount in the past 10 years at $2.2B. Life sciences employment retention amid the current financial crisis has remained comparatively high, as the country’s total number of jobless claims has eclipsed 40 million.

New York City is shaping up to be a cluster at the intersection of the pharmaceutical and finance industries, Thor Equities Senior Vice President for Life Sciences Bill Hunter said on Bisnow’s New York Life Science Repositioning 101 webinar Thursday.

“When you look at life sciences clusters overall, they all have a personality that goes along with them. Boston being one of the primary clusters, an educational cluster. San Francisco is really tech-oriented, and educational as well,” Hunter said.

“I think when you look at the confluence of pharmaceutical and finance, you really look to Manhattan for that demand generator in that cluster.”

The sector will continue to rise because of the infrastructure that exists or has been built in the past, SGA New York Studio Manager Brooks Slocum said. The city has a growing tech sector, plenty of housing stock for high-paid workers and premier hospitals, he said.

“New York has enormous potential because it has all of the pieces that make an important cluster in New York itself already,” Slocum said.

East Egg Project Management principal Yasmeen Ahmed Pattie pointed to the number of companies looking for space in New York, even as office leasing has slowed to a halt, as a sign the life sciences sector is growing.

Both the public and private sectors have seen New York City’s life sciences sector as a lucrative investment over the past few years. Last year, the city committed to putting $500M to the sector and the state appropriated $650M in its budget. Developers bet hundreds of millions on the sector. Now, with the city’s success in reopening reliant on rapid testing, it has been on the lookout for new life sciences properties to build walk-in testing centers in. City officials and economic experts predict that economic development planning around the life sciences sector will be key in the city’s recovery. https://www.bisnow.com/new-york/news/life-sciences/life-science-is-a-bright-spot-amid-the-pandemic-market-report-shows-104694

Switch Found To Turn Off Gene That Causes Aggressive Breast Cancer

Researchers at Tulane University School of Medicine are celebrating a breakthrough in the fight against an aggressive breast cancer.
They’ve identified a gene that causes an aggressive form of breast cancer to rapidly grow. And most importantly, they’ve found a way to flip the switch and turn the gene off to prevent cancer from occurring.
They say their studies on mice are so compelling they are seeking FDA approval to begin clinical trials.
Dr. Reza Izadpanah and his team examined the role two genes play (including one they discovered) in causing triple negative breast cancer (TNBC), which is considered the most aggressive type of breast cancer.
They specifically identified an inhibitor of the TRAF3IP2 gene, which they found suppressed the growth and spread of TNBC in mouse models that closely resemble humans.
In parallel studies, they examined how TRAF3IP2 and another gene called RAB27a play roles in the secretion of substances that can cause tumor formation.
They found that suppressing the expression of either gene led to a decline in tumor growth and spread of cancer to other organs.
When Rab27a was suppressed, the tumor didn’t grow but it continued to spread a small number of cancer cells to other parts of the body. But when researchers turned off the TRAF3IP2 gene, they found no spread (metastasis) of the original tumor cells for a full year following treatment.

In addition, they say inhibiting the TRAF3IP2 gene not only stopped future tumor growth, but caused existing tumors to shrink to undetectable levels.
Dr. Izadpanah says “Our findings show that both genes play a role in breast cancer growth and metastasis. This exciting discovery has revealed that TRAF3IP2 can play a role as a novel therapeutic target in breast cancer treatment.”

Other researchers, such as Dr. Bysani Chandrasekar of the University of Missouri, have joined in the Tulane research efforts and found that targeting TRAF3IP2 can stop the spread of glioblastoma, a deadly brain cancer.
https://www.forbes.com/sites/marlamilling/2020/06/04/scientists-find-a-switch-to-turn-off-a-gene-that-causes-aggressive-breast-cancer/#bd66d9c769ec

Competitive Medicare For All — Its Time Has Come

Covid-19 is wreaking terrible destruction. Over 110,000 deaths, output down some 40 percent, 43 million unemployed, millions of businesses going bankrupt, and entire industries decimated. Ironically, this includes healthcare.
Yes, there’s a huge demand for docs and nurses to treat the plague’s victims. But the rest of the healthcare system has been locked down, leading to massive layoffs. In fact, job losses in healthcare are second only to the restaurant industry. Moreover, tens of millions of the industry’s customers, with more to come, are losing employer-provided coverage and thus, the means to buy what the healthcare industry sells. By year’s end, one in five Americans will likely be uninsured, putting the teetering sector in the ICU.

There’s little political appetite for bailing out a system that delivers so little to so few for so much. Instead, the demand for universal healthcare will increase dramatically. Over half of Americans already support such reform. The question is, thus, not whether or when, but what reform is best.
Further segmenting our balkanized healthcare system is no answer. As it is, we have Medicaid for the poor, two systems (traditional and Part C) of Medicare for retirees, employer-provided coverage in large firms, subsidized Obamacare for the otherwise uninsured (with incomes above the poverty line), private insurance, and the ER-dependent uninsured. Each of these systems has major financial and structural problems.

If our healthcare system were, on balance, delivering superior outcomes, it might be tolerable. It’s not. Our system’s convoluted components collectively provide substandard care on virtually every metric. Worse, they do so at an astronomical price — twice the share of GDP spent, on average, by other advanced countries. Our healthcare system is both awful and awfully expensive for two reasons. We do a terrible job purchasing care and we fail miserably in adopting data-driven best practices, including team care.
Senator Sanders’ traditional Medicare for All is one solution — the government pays for all the healthcare we want. This cuts out the middleman. But with no gatekeeper — no one to say, “Sorry, you can’t see ten specialists for your tennis elbow” — we’ll all overuse the system. This will lead to rationing — e.g., the six month waits for knee surgery reported by Canadians.
The best option is Competitive Medicare for All (CMA). Under CMA, each American would enroll, annually, with the healthcare provider of their choice. CMA would include all forms of healthcare, including home healthcare, assisted living, and nursing-home care. Health Maintenance Organizations (HMOs) would operate throughout the country, be required to accept any and all participants, and be paid by Uncle Sam on a per participant, not a per-procedure or per office visit basis. Most important, the HMO’s payment would be adjusted for our pre-existing conditions. Hence, if I’m a diabetic, HMOs will not just be required, but be delighted to take me on because they will be fully compensated for my extra cost.
HMOs will receive a reasonable profit margin per participant providing them the incentive to compete on quality alone. If they under provide care, they’ll lose their customers. If they overprovide or overpay for care, they’ll lose their shirts. In short, CMA properly aligns all incentives. The result would be 50 or more intensely competing HMOs (think Kaiser Permanente or Cleveland Clinic) to choose from no matter where we live. Each of the HMOs would hire their own doctors, own their own hospitals, buy their own equipment, pay for their own medications. This is the basic system that’s delivering far better care at half the cost in most developed countries.
The government would establish an annual CMA formulary the services each provider must offer. In setting the formulary, congress would, at long last, gain control of its annual healthcare outlays. Through time, as CMAs systematically eliminates waste, exorbitant administrative costs, mismanagement of chronic conditions, and price gouging by drug companies and other providers, the US share of GDP spent on healthcare will drop from 18 percent now to roughly 12 percent.
A new American healthcare system will arise from the Covid-19 ashes. The question is whether it will continue to provide mediocre care at an exorbitant price or marvelous, innovative, coordinated care at a reasonable price. Competitive Medicare for All is just what the doctor ordered.
Laurence Kotlikoff is a Boston University economist, author of The Healthcare Fix, and President of Economic Security Planning, Inc.
https://www.forbes.com/sites/kotlikoff/2020/06/05/competitive-medicare-for-all—its-time-has-come/#7cabd3aa6091

Pandemic May Change Care For Some Allergy Patients After Severe Reactions

Families of children with food allergies know to inject epinephrine if they have a severe reaction, but the playbook for next steps may shift for some patients as coronavirus fears make them skittish about seeking emergency medical care.
Instead of automatically calling 911 after administering epinephrine, a modified plan suggests some families may be able to manage symptoms at home after injecting epinephrine, unless symptoms persist or worsen — but only after doctors and patients discuss the risks and benefits, said Dr. Thomas Casale, chief medical advisor for operations at the nonprofit Food Allergy Research & Education (FARE).
About 5.6 million U.S. children have food allergies, and 20% of them had an emergency-room visit in the last year due to a life-threatening reaction to food, according to FARE. Adults comprise more than 26 million of the 32 million Americans with food allergies. Severe and even fatal allergic reactions to food can happen at any age, but teenagers and young adults are at highest risk of death. Every year, food-related allergic reactions require 200,000 people to seek emergency medical care.

If patients are worried about potential exposure to Covid-19, Casale advises they talk with their allergists or physicians through telehealth visits, if possible, to review or revise their emergency plan during the coronavirus crisis.
Depending on local and personal factors, a modified plan may involve managing a severe reaction with autoinjectors such as EpiPens and careful follow-up at home instead of calling 911 after injecting the first dose of epinephrine, he said.

“We came to these conclusions to a large extent because a lot of patients were asking us what to do….because there’s great apprehension about going to the E.R.”
“It’s got to be a shared decision between patient and doctor and what’s appropriate for them,” he said.
Not a universal recommendation
Doctors can evaluate appropriateness based on the patient’s medical history, patient and caregiver knowledge and comfort, local Covid-19 burden and access to emergency services, he noted.  A patient in hard-hit New York City or an emerging hotspot, for example, may be more reluctant to seek emergency care than one in a small town that’s relatively untouched by Covid-19.
The modified algorhithm is not a universal recommendation, said Dr. Julie Wang, professor of pediatrics at the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai in N.Y. “It’s not a blanket plan for all allergy patients.”
It provides guidance to doctors based on local risk assessment, she said. “There has to be an assurance that families will be capable and will be adherent and there will be at least two epinephrine autoinjectors available.”
It also comes with a kind of black box warning for patients who have had a severe reaction in the past that required intubation, ventilation or treatment with more than two doses of epinephrine. Patients who meet these criteria should activate emergency services immediately after injecting epinephrine, as usual.
What’s more, the most important medical advice for anaphylaxis treatment remains the same, Wang said.
“Epinephrine is and always was the first choice to treat anaphylaxis,” she said. “The number one recommendation is that epinephrine needs to be used early, and that has not changed and will not be changed.”
The modifications come at a time when Americans dramatically altered their use of emergency room care, according to data released early on June 3 from the Centers for Disease Control and Prevention (CDC).
Visits to emergency departments dropped 42% in April 2020 compared with April 2019 as the pandemic took hold, the CDC found. Decreases were most striking among children 14 and younger, women and people in the Northeast over those four weeks.
How it works
The pandemic-revised management protocol, published April 18 as an editorial in the Journal of Allergy and Clinical Immunology, has six steps. The first step is the same as the standard protocol: Inject epinephrine immediately upon signs and symptoms of anaphylaxis, keeping a telephone within reach. Note the time the dose was given.
It helps to remain as calm as possible. Prompt treatment with epinephrine, also called adrenaline, is associated with better outcomes. Anaphylaxis can be unpredictable, causing a range of signs and symptoms including shortness of breath, wheezing, hoarseness, trouble breathing or swallowing. Other symptoms may include abdominal pain, vomiting, faintness, dizziness, hives, and confusion or a feeling of doom.
After the first injection, alert a housemate or neighbor to the patient’s distress to recruit assistance. Next, the patient should lie down with legs elevated near an unlocked or open doorway to allow easy access in case people need to enter to help, according to the modified protocol.
Patients and caregivers should know they can call 911 any time after initial epinephrine use if symptoms escalate or they feel additional medical intervention is needed, said Casale, first author of the paper.
Families should not let fear of Covid-19 paralyze them, said Wang, also an author of the modified protocol. “If a patient needs to go to the hospital emergency room, there are enhanced measures in place” for safety. “We do not want patients to avoid seeing doctors…because of this concern.”
At this point, patients sticking with the home management plan can be administered an oral antihistamine such as cetirizine, although be aware it takes much longer to work and doesn’t work as well as epinephrine, Casale said. Patients with respiratory symptoms can use their prescribed albuterol inhaler for relief.
The final step is monitoring symptoms. Families that have home blood pressure monitors are encouraged to use them. If the top number (systolic) of the reading drops below 90 and the low number (diastolic) dips below 60, that’s typically low for a patient over age three, Casale said. Low blood pressure combined with a high pulse rate are warning signs of a more severe reaction, he said.
Don’t have a blood pressure monitor at home or don’t have a child size cuff? Watch for signs of low blood pressure, including dizziness or lightheadedness; nausea; fainting; lack of concentration; blurred vision; and cold, clammy, pale skin.
If symptoms improve after the first epinephrine injection, call your doctor on a non-urgent basis, according to the algorithm. If there is no improvement after five minutes, give the second injection, Casale said. “If symptoms don’t resolve after five minutes, then call 911. If they do, then notify your physician this has happened.”
Recovering patients need to be monitored for a potential biphasic reaction, a recurrence of symptoms within four to six hours after recovery. Caregivers may need to call the doctor once the patient’s initial severe reaction has resolved to request a refill of epinephrine autoinjectors to prepare for this possibility.
Plan ahead to reduce anxiety
Even before the pandemic, FARE has offered a Food Allergy & Anaphylaxis Emergency Care Plan and algorithm that doctors can customize for patients with known allergies. It can be used as a benchmark for recommended treatment in case a child has an allergic reaction. Some schools require students with allergies to keep a copy at the office or to go along on field trips. The American Academy of Pediatrics has a similar customizable document that can walk people through what to do in case of a mild to severe allergic reaction.
The last thing you want is added anxiety when minutes count. Planning ahead can ease the mental load during a crisis. Epinephrine autoinjectors are dispensed in sets of two in case the patient needs to have a second dose, so keep them stored together in original packaging where they’re easy to find and ready for use. Make sure they’re not expired.
The pandemic protocol modifications aren’t for everyone, and patients considering this route should seek input from their doctor, Casale said.
“You need to discuss this with your physician ahead of time so you’re not making these decisions when you’re having an acute problem,” he said.
https://www.forbes.com/sites/kristengerencher/2020/06/05/coronavirus-crisis-drives-alternate-anaphylaxis-plan-for-some-allergy-patients/#3a3259cf2da4

Bald Men At Higher Risk Of Severe Coronavirus Symptoms

New research is showing why a larger percentage of men—particularly bald men—are having worse Covid-19 outcomes than women.
Researchers at Brown University point to androgens, the group of hormones which causes hair loss in men. They’ve determined androgens are linked to severe cases of Covid-19 and suggest their discovery could be called the “Gabrin Sign,” named for the first U.S. physician to die of Covid-19 in the United States. Dr. Frank Gabrin was bald.
Lead author Dr. Carlos Wambier said, “We think androgens or male hormones are definitely the gateway for the virus to enter our cells. We really think baldness is a perfect predictor of severity.”
Wambier and his team conducted two studies in Spain. The results of one of those studies, published in the American Academy of Dermatology, showed that 79% of 122 men who tested positive for Covid-19 and admitted to three hospitals in Madrid were bald.
A separate study of 41 patients in Spain showed that 71% of them were bald.

Could androgens also signal a problem for some female patients?
The study that was published in the American Academy of Dermatology says, “it would be interesting to observe for severe Covid cases in female patients who present with increase androgens, for example, females with metabolic syndrome or whom are using birth control methods with progestogen hormones that bind to androgen receptor. Additionally, there are many medical conditions that could increase androgen activity in females and might correlate with increasing vulnerability to Covid-19.”

The investigation continues and Wambier and his colleagues believe if their theory is correct that anti-androgen therapy could be used as a Covid-19 treatment.
They write in the study, “A vaccine might ultimately be found for SARS-CoV-2; however, if a vaccine is not found or found to be ineffective, androgen suppression as a prophylactic treatment could reduce Covid-19 disease burden.”
https://www.forbes.com/sites/marlamilling/2020/06/06/bald-men-at-higher-risk-of-severe-coronavirus-symptoms/#15664a129e48

AstraZeneca blood cancer drug shows signs of helping COVID-19 patients

AstraZeneca’s cancer drug Calquence has shown initial signs of helping hospitalised COVID-19 patients get through the worst of the disease, as researchers scramble to repurpose existing treatments to help fight the deadly infection.
Results from the preliminary research involving 19 patients, which was backed by the United States National Institutes of Health, encouraged the British drugmaker to explore the drug’s new use in a wider clinical trial announced in April.
Eleven patients had been on oxygen when they started the 10-14 day Calquence course and eight of them could afterwards be discharged, breathing independently, according to results in a paper co-authored by Astra’s head of oncology research, Jose Baselga.

Eight patients were on mechanical ventilation when they were put on Calquence, and four of them could be discharged, though one died of pulmonary embolism.
“These patients were in a very unstable situation, they would have had a dire prognosis … Within one to three days the majority of these patients got better in terms of ventilation and oxygen needs,” Astra’s Baselga told Reuters.
Severe cases of COVID-19 are believed to be triggered by an over-reaction of the immune system known as cytokine storm and initial research has brought Calquence, and other drugs that suppress certain elements of the immune system, into play.

Autoimmune disease drugs that are being tested for their ability to quell the cytokine storm include Regeneron and Sanofi’s Kevzara, Roche’s Actemra as well as Morphosys and GlaxoSmithKline’s otilimab.
In its approved use, Calquence competes with AbbVie and Johnson & Johnson’s established treatment Imbruvica as a treatment for chronic lymphocytic leukaemia, a common type of adult leukaemia.
https://www.reuters.com/article/us-health-coronavirus-astrazeneca/astrazeneca-blood-cancer-drug-shows-signs-of-helping-covid-19-patients-idUSKBN23C2P4