Should We Be Concerned About These BP Medications Causing Cancer?

 A 50-year-old White woman presents for evaluation of a new skin lesion on her face that has been present for the past 4 months. Biopsy reveals a squamous cell carcinoma (SCC). She previously had an SCC removed from her left arm 2 years ago. She is currently taking lisinopril, amlodipine, hydrochlorothiazide, omeprazole, turmeric, and sertraline.

Which medication would it be appropriate to replace? 
    A) Lisinopril
    B) Amlodipine
    C) Hydrochlorothiazide
    D) Omeprazole
    E) Sertraline

We think replacing her hydrochlorothiazide would be appropriate, given that she has developed two SCCs at a young age.

Thiazides

As we continue to prescribe thiazides for hypertensive patients, it may be worthwhile to initiate and discuss skin protection alongside treatment. The photosensitizing properties of thiazide diuretics have raised concerns that these treatments may increase the risk for skin cancer.

Douglas S. Paauw, MD

A meta-analysis conducted by Shin and colleagues analyzed nine observational studies to investigate the association between thiazide use and skin cancer. Thiazide use was significantly associated with small SCCs with an adjusted odds ratio (AOR) of 1.86 (95% CI, 1.23-2.80). Thiazide use had marginally increased associations with basal cell carcinoma (BCC) (AOR, 1.19; 95% CI, 1.02-1.38) and malignant melanoma (AOR, 1.14; 95% CI, 1.01-1.29). 

Pedersen and colleagues studied a Danish database and found that high use of hydrochlorothiazide (> 50,000 mg) was associated with ORs of 1.29 (95% CI, 1.23-1.35) for BCC and 3.98 (95% CI, 3.68-4.31) for SCC. They found that there was a dose-response effect; the highest cumulative dose category (> 200,000 mg hydrochlorothiazide) had ORs of 1.54 (95% CI, 1.38-1.71) for BCC and 7.38 (95% CI, 6.32-8.60) for SCC.

Rahamimov and associates  looked at the risk in kidney transplant patients of developing skin cancer on thiazide diuretic treatment. As we know, immunosuppression increases the risk of developing cancer in general; however, there is concern that this risk will increase with a concurrent thiazide prescription. Rahamimov’s group conducted a retrospective analysis of 520 kidney transplant recipients on immunosuppressants and thiazides in 2010-2015. Exposure to thiazides 3 years after transplant was associated with an increased risk for skin cancer (P =.004), particularly nonmelanoma skin cancer.

Hareen Seerha 

Rahamimov's group suggests establishing dermatology care for kidney transplant patients receiving thiazide treatments in areas with high ultraviolet light. It is also important to assess skin malignancy risk factors, do thorough skin exams before and while prescribing thiazides to patients, and educate patients about ultraviolet light protection. This is especially important for patients with light complexions, as there did not appear to be an increased risk in a large study of an Asian population in Taiwan. 

It makes sense to avoid thiazide diuretics, if possible, in the highest-risk patients — those with multiple previous skin cancers and those who are chronically immunosuppressed. 

ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors have been revolutionary for patients with cardiovascular disease; however, recent studies have raised concerns over whether this mortality-reducing drug increases the risk for lung cancer. 

A study published by the American Heart Association used a nested case-control design to assess lung cancer associated with ACE inhibitor use compared with angiotensin II receptor blocker (ARB) use. The researchers conducted a population-wide study using Danish national and administrative registries from 2000 to 2015. They found that while low cumulative ACE inhibitor doses showed neutral associations with lung cancer, high cumulative doses were associated with increased odds of lung cancer. 

A meta-analysis conducted by Wu and colleagues analyzed records from 11 studies to assess the association between ACE inhibitor use and lung cancer. The researchers accounted for factors such as smoking, race, and age. They concluded that ACE inhibitors are a relevant factor in lung carcinogenesis and pose a higher risk compared with ARBs, especially among Asian populations. Another study within this meta-analysis showed that statins may mitigate this association, reducing the risk when a statin and an ACE inhibitor are prescribed together. 

In recent years, there has been increasing evidence supporting the connection between ACE inhibitors and the development of lung cancer. ACE inhibitors result in the accumulation of bradykinin and substance P. Not only does this often cause a notorious cough, but these inflammation markers are associated with tumor proliferation and angiogenesis. However, more randomized controlled trials are needed to determine the causal association between ACE inhibitors and lung cancer. ARBs, although currently second-line drugs, do not cause accumulation of bradykinin. Perhaps it is time to rethink our approach to cardiovascular disease treatments.

• Considering the risk that thiazides and ACE inhibitors can pose for developing malignancies, it is important to screen patients for risk factors prior to prescribing treatment.
• Although skin exams can be tedious and patients may push back on sunscreen use, these conversations may be important for those taking thiazides; avoidance of thiazides in high-risk patients may be warranted.
• Perhaps it is time to consider ARBs over ACE inhibitors.

https://www.medscape.com/viewarticle/should-we-be-concerned-about-these-bp-medications-causing-2025a10004rp

'RFK Jr. targets childhood psychiatric drugs; doctors push back'

 Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. has made psychiatric medications a focus of his review of the country’s childhood chronic disease crisis, claiming the drugs have been “insufficiently scrutinized” and are addictive. 

Childhood psychiatrists insist the drugs, for attention-deficit/hyperactivity disorder (ADHD) and depression, are nonaddictive and proven safe and say they are more concerned about young Americans unable to access psychiatric medications that could help. 

Kennedy emphasized his skepticism of these medications during his Senate confirmation hearings. 

“Fifteen percent of American youth are now on Adderall or some other ADHD medication. Even higher percentages are on SSRIs and benzos. We are not just overmedicating our children, we are overmedicating our entire population,” Kennedy told the Senate Finance Committee. 

The exact rate at which American youths are using ADHD medications is hard to ascertain. Kennedy may have been referring to the results of a Monitoring the Future (MTF) survey released in 2023 that found 15 percent of high school seniors reported using a stimulant or nonstimulant ADHD medication. 

Kennedy told HHS staff in closed-door meeting last week about the plans for his Make America Healthy Again Commission.

“Some of the possible factors we will investigate were formally taboo or insufficiently scrutinized,” he said, adding, “nothing is going to be off limits.” Among the factors he named were the childhood vaccine schedule, psychiatric drugs and environmental issues such as microplastics. 

The commission has 100 days to produce a report on “what is known and what questions remain regarding the childhood chronic disease crisis, and include international comparisons.” 

Kennedy has claimed selective serotonin reuptake inhibitors (SSRIs) can be more addictive than heroin, of which he is a longtime recovering addict, and has falsely linked them to school shootings. He avoided denouncing this belief about shootings during his confirmation hearings, only saying, “I don’t think anybody can answer that question.” 

According to psychiatrists who work with children, rhetoric like that of Kennedy’s does not help children with mental illnesses. 

“Those statements, in my perspective, don’t address the reality of psychiatric treatment,” said Tami Benton, president of the American Academy of Child and Adolescent Psychiatry as well as psychiatrist in chief for the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children’s Hospital of Philadelphia. 

“These medications are not addictive and they’re not at all like heroin,” Benton told The Hill. “People use them for different reasons. … So no, they’re not as addictive as, you know, narcotics.” 

As for the claim that U.S. children are being overmedicated, physicians and psychiatric experts who spoke with The Hill said they are more concerned that many children who could benefit from SSRIs or other such medications lack access to these drugs.

“There is some concern, even more so in the field, that many children with depression and mental health disorders do not get access to the mental health services that they need, and that includes the comprehensive treatment that we would recommend, which is beyond just SSRIs, but also therapy and other supports,” said Lisa Fortuna, a child psychiatrist and chair of the American Psychiatric Association’s Council on Children, Adolescents and Their Families. 

Previous studies, such as a 2019 report published in the Pediatrics medical journal by the American Academy of Pediatrics, found that 70 percent of U.S. counties had no child psychiatrists between 2006 and 2017 despite a broader increase in the profession during that time frame.

The researchers noted that “more than half of the children in the United States with a treatable mental health disorder do not receive treatment from a mental health professional.”

Christine Crawford, psychiatrist and associate medical director for the National Alliance on Mental Illness, said the perception that more children are taking medications for mental illness or psychiatric disorders may be due to growing awareness of these conditions.

“We’re in 2025, and in this day and age, there’s a greater awareness of a variety of psychiatric illnesses that can impact kids. We have treatments that are quite effective that are available for kids, and I appreciate the fact that the stigma kind of related to having a kid on psychiatric medications has decreased over time,” Crawford said. 

Psychiatrists say there are issues around children and psychiatric drugs that need to be addressed, such as including them more in medical research. 

“We have very few psychiatric medications that are FDA-approved for the use in children,” Crawford noted, referring to the U.S. Food and Drug Administration. “The reason for that is that there aren’t enough studies that have been conducted, long-term studies, on a variety of different medications.” 

“We only have a couple of medications — and this has been the case for years — that are technically FDA-approved, and so the majority of prescribing is done off-label when it comes to kids,” she added. 

Should Kennedy seek to limit access to these medications, there are some avenues available to him in his new role.

Typically, drugs are removed from the market by manufacturers if a new, better drug is introduced into the market or the margins aren’t profitable. The FDA can also choose to withdraw approval if clinical evidence demonstrates that a drug is not safe or effective. 

But Benton noted that SSRIs such as fluoxetine, better known as Prozac, have been around since the ’80s and have decades of evidence supporting their safety and efficacy. She noted there is another method through which federal authorities could theoretically decrease use of certain drugs, though: their labeling.

“When the black box warning was issued, it decreased the number of people who were actually using SSRIs. And the black box warning suggested that when initiating SSRIs, suicidality is a possible side effect,” Benton said. “The study that supported that warning turned out to not be well-supported.” 

“These medications are supported by research. They’re supported by clinical process,” she added. “They really do help people when they’re applied and used in the right way.” 

https://thehill.com/policy/healthcare/5164123-robert-kennedy-jr-psychiatric-drugs-children/

Starmer tells Zelensky he has 'full backing' of UK

Sir Keir Starmer has told Volodymyr Zelensky he has "full backing across the United Kingdom" as the two met in Downing Street.


The Ukrainian president told the prime minister he was happy his country had "such friends", after arriving in the UK in the wake of a White House meeting with US President Donald Trump that descended into a row between the two leaders.

Zelensky and Sir Keir embraced outside No 10 before heading inside to discuss efforts to bring the Russia-Ukraine war to an end.

The PM will host a summit of European leaders on Sunday on the matter - as well as wider European defence - while Zelensky will also meet King Charles III.

Those meetings will now be overshadowed by events in Washington and concerns about a hardening of relations with the US.


In recent weeks, the prime minister has sought to cast himself as a bridge between the US and Europe as it adapts to the Trump administration's desire to be less involved in European defence, having a cordial meeting with Trump a day before Zelensky's.

During that meeting, he hand-delivered a letter from the King inviting Trump - who is fond of the Royal Family - to an unprecedented second state visit, which SNP MPs called on the PM to withdraw following the Oval Office spat.

Sir Keir has also attempted to be a conduit for Ukraine as it seeks US security guarantees in any peace deal - contacting both Trump and Zelensky by phone in the aftermath of their row.

The visit to Downing Street on Saturday was an opportunity for the PM to demonstrate his continued support for Zelensky following the public falling-out with Trump.

Remarking on cheers he heard outside, Sir Keir told the Ukrainian leader: "That is the people of the United Kingdom coming out to demonstrate how much they support you, how much they support Ukraine."

He added: "We stand with you and Ukraine for as long as it may take."

Zelensky replied: "I saw a lot of people and I want to thank you, the people of the United Kingdom, [for] such big support from the very beginning of this war."

He said he was happy about meeting the King on Sunday, and was thankful for the European summit.

It is understood the meeting between Zelensky and the King was requested by the Ukrainian president, and the UK government agreed to it.

Following the acrimonious White House meeting, Zelensky has attempted to paper over the cracks.

In a statement, he said of Trump: "Despite the tough dialogue, we remain strategic partners. But we need to be honest and direct with each other to truly understand our shared goals."


When his plane landed at Stansted, the Ukrainian leader wrote in a string of social media posts: "It's crucial for us to have President Trump's support. He wants to end the war, but no one wants peace more than we do.

"We are the ones living this war in Ukraine. It's a fight for our freedom, for our very survival."

Sunday's summit in London is the latest round of top-level European meetings in response to Washington's new approach to ending the war in Ukraine, which began with Russia's full-scale invasion just over three years ago.

The Trump administration has so far excluded Europe from preliminary talks with Russia, while the president has been accused of parroting Russian propaganda.

Top of the agenda on Sunday will be increasing Europe's defence capabilities as the US steps back, as well as seeking security guarantees for Ukraine from the White House as part of any peace deal.

Ahead of the last summit in Paris, Sir Keir proposed deploying British troops to Ukraine as part of a European peacekeeping force - but said this would require a US security "backstop".

Trump has consistently resisted fully committing direct military support to a Ukraine peace deal, but has offered closer economic ties including a minerals deal, which he said could act as a deterrent.

Since Friday's row, media reports from the US suggest Trump is considering cutting off aid to Ukraine altogether.

At the same time, European leaders have recognised the need to increase defence spending - but experts have warned the UK's military was currently not ready to take on an expanded defence role.

On Sunday, Sir Keir and Zelensky will be joined by the leaders of France, Germany and Poland, the heads of the European Commission and European Council, and Nato's secretary general.


A special European Commission defence package will be announced on 6 March, according to Polish Prime Minister Donald Tusk.

The Oval Office spat prompted European allies to mount a spirited defence of the embattled Ukrainian president.

While diplomatic efforts to bring the war to a close continue, fighting rages on.

Seven people were injured in an overnight drone attack on the north-eastern city of Kharkiv.

Ukraine's state emergency service said 64 people - most of them patients - were evacuated from a three-storey medical facility that caught fire after being hit by a drone.

In Russia, the country's defence ministry reported 48 Ukrainian drones had been "intercepted and destroyed" overnight.

https://www.bbc.com/news/articles/cg4k137ezlgo

Rubio Demands Apology From Zelensky, Who Attempts Belated 'Gratefulness' For All The Billions

 Secretary of State Marco Rubio is demanding an apology from Ukrainian President Volodymyr Zelensky after Friday's Oval Office fireworks and heated exchange. Trump had sarcastically quipped the whole scene will make for "great television" before he shut it down and kicked Zelensky out of the White House, prior to a planned lunch.

Rubio told CNN’s Kaitlan Collins that the Ukrainian leader should "apologize for turning this thing into the fiasco for him that it became. There was no need for him to go in there and become antagonistic. Look, this thing went off the rails."

"When you start talking about that aggressively, and the President’s a deal maker. He’s made deals his entire life, you’re not going to get people to the table," the US top diplomat added.

Rubio looking uncomfortable at Zelensky's outbursts. via Getty Images

Many sources say that before the blow-up which started when Zelensky specifically called out Vance to 'answer' a question (after which the vice president appropriately unleashed on Zelensky), a final minerals deal was all but assured and ready to be signed.

But Rubio in his Saturday comments said he's unsure whether Zelensky actually wants to see any kind of peace agreement at all.

"And so you start to perceive that maybe Zelensky doesn’t want a peace deal. He says he does, but maybe he doesn’t, and that active, open undermining of efforts to bring about peace is deeply frustrating for everyone who’s been involved in communications with them leading up to today," Rubio explained.

Zelensky just prior to these fresh remarks of Rubio's expressed what perhaps came close to regret, but something far short of an apology...

"No, I respect the president, and I respect the American people and if, I don’t know, I think that we have to be very open and very honest and I’m not sure that we did something bad," Zelensky responded when asked by Fox News’s Bret Baier if he would apologize for the meeting. 

"This is not good for both sides, anyway, and I was very open, but I can’t change our Ukrainian attitude toward Russia," he said. 

Still, on the same day Zelensky issued a very lengthy thread on X, at over a dozen full posts, which many will see as reeking of desperation.

He wrote that he knows that the US is on 'our' side and that "America’s help has been vital in helping us survive, and I want to acknowledge that." This appears a response to Vance the day prior noting that he had not once said "thank you" during Friday's meetings. "Peace can only come when we know we have security guarantees, when our army is strong, and our partners are with us," Zelensky also said.

"It will be difficult without the U.S. support. But we can’t lose our will, our freedom, or our people. We’ve seen how Russians came to our homes and killed many people," he continued in the long message.

At one point he further expressed: "I want the U.S. to stand more firmly on our side. This is not just a war between our two countries; Russia brought this war onto our territory and into our homes."

Zelensky had two explicit verbal commitments from Trump that he was going to continue arming Ukraine, which is the most acute policy issue from Ukraine's perspective. But then later he decided to stupidly interject with Vance, and everything went haywire. Epic diplomatic meltdown pic.twitter.com/J4t5HVtNia

— Michael Tracey (@mtracey) February 28, 2025

And again, more after-the-fact efforts to salvage that disaster of an Oval Office meeting: "Our relationship with the American President is more than just two leaders; it’s a historic and solid bond between our peoples. That’s why I always begin with words of gratitude from our nation to the American nation."

...though that's not what President Trump and Vice President J.D. Vance are saying. All of this from Zelensky is likely too little, too late.

Below is Zelensky's full thread on X...

We are very grateful to the United States for all the support. I’m thankful to President Trump, Congress for their bipartisan support, and American people. Ukrainians have always appreciated this support, especially during these three years of full-scale invasion. pic.twitter.com/Z9FlWjF101

— Volodymyr Zelenskyy / Володимир Зеленський (@ZelenskyyUa) March 1, 2025

https://www.zerohedge.com/geopolitical/rubio-demands-apology-zelensky-who-attempts-belated-gratefulness-all-billions 

 

Car-hating NYC bureaucrats quietly making congestion worse with plan to cut vehicle lanes

 It’s a cycle of insanity.

Gov. Hochul claims congestion pricing reduces traffic in Manhattan — but rather than enjoy the purported benefits, car-hating city bureaucrats are quietly taking steps to make traffic worse, The Post has learned.

The Department of Transportation’s latest scheme — which requires no government approvals and could happen as soon as the spring — calls for widening Sixth Avenue’s bike lane from 6 feet to 10 feet between West 14th Street in Chelsea to West 35th Street in Herald Square.

4

The Department of Transportation is calling for the widening of Sixth Avenue’s bike lane from 6 feet to 10 feet.Helayne Seidman

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A rendering shows what the extended bike lanes would look like.DOT

To do that, the agency will completely eliminate one of the four vehicle lanes – welcoming back gridlock to the bustling thoroughfare even as the controversial tolls are supposed to eliminate traffic, critics said.

“This is New York City, not the Tour de France,” raged NYC Council Minority Leader Joann Ariola (R-Queens).

“The anti-car insanity has gotten so extreme. The Department of Tyrants is not just trying to make it impossible for anyone to drive in this city, it is willing to jeopardize the safety of New Yorkers by creating conditions that will seriously impede emergency responders. Where is Elon Musk and DOGE when you need them?”

Eliminating a car lane will just make the avenue less safe because vehicles “will have a harder time navigating,” predicted Manhattan activist Maria Danzilo.

“This is really serving the delivery-app lobby and delivery workers who use [electric bikes] because regular bikes aren’t served by this change,” she said.

The DOT unveiled the controversial plan Monday before Community Board 5’s transportation committee.

DOT’s project manager Preston Johnson tried to drum up support by citing statistics showing bike volume increased along the targeted strip by 20.6% from 2019 through 2024 and 35.2% on weekends.

Bike accidents involving cars and bikes along the strip over the same period resulted in 345 injuries, including four deaths, he also told the board, whose committee OKed the proposal 10-2, but worried about more gridlock and questioned why the public didn’t get an earlier warning.

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Gov. Kathy Hochul and the New York transportation honchos who pushed congestion pricing claim it’s reduced Manhattan’s most clogged roadways.Hans Pennink

Critics who learned of the plan from The Post called it an insult to everyday New Yorkers.

DOT Commissioner Ydanis Rodriquez’s “hypocrisy is off the chart,” said Councilman Robert Holden (D-Queens)

“What he’s really doing is giving a giant middle finger to hardworking New Yorkers, proving exactly why we need President Trump to not only kill the congestion scam tax for good, but also crack down on the DOT’s insane street designs that manufactured the gridlock in the first place.”

Critics say the project specifically thumbs its nose at President Trump, who told The Post last month he plans to “kill” congestion pricing in Manhattan through the federal Department of Transportation and also vowed to rid Big Apple streets of traffic-clogging bike lanes. 

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Manhattan activist Maria Danzilo says that eliminating car lanes could make the avenue less safe as vehicles “will have a harder time navigating.”DOT

“It sounds like revenge over Trump weighing in on congestion pricing and promising to axe bike lanes, and also further proof that the DOT has been completely co-opted by radical bike nuts that don’t care about the biz world,” ripped Jason Curtis Anderson, a co-founder and policy director at the nonprofit One City Rising.

Eric McClure, executive director of StreetsPAC, said the street-safety group “strongly supports” the redesign.

“We’ve all seen the data on the reduction in traffic volumes since congestion pricing was implemented, and the eye test shows that three travel lanes are plenty for free-flowing motor vehicle traffic,” said McClure, who lives in Park Slope, Brooklyn.

The project is also warmly endorsed by Transportation Alternatives, the powerful anti-car group that critics say has incestuous relationship with DOT, indirectly lobbies for Uber and Lyft and wields a lot of power with lefty officials.

DOT spokesman Scott Gastel insisted the project was conceived off community input, and the data used to justify it was pulled from the strip’s traffic volume before the first congestion tolls were collected in January and more cars were on the road.

He claimed the “project is designed to specifically address congestion” and said he agency doesn’t anticipate “any significant changes” to travel speeds.

Pedestrians and motorists on Sixth Avenue panned the plan.

“It’s a horrible idea,” said Madigata Gassama, a 27-year-old Uber driver. “[City officials] don’t care about anybody.”

“It’s just bulls–t! This city is run by corruption,” barked Ana Mani, 35, a Chelsea resident who drives daily.

“I hate it. I can’t even park my car in front of my house, and now they’re removing all these things. It’s dangerous for cyclists, too.”

https://nypost.com/2025/03/01/us-news/nyc-dot-to-cut-car-lane-on-busy-midtown-strip-to-extend-bike-lane/