I Fought the Last Measles Epidemic. Can We Stave Off the Next One?
With measles once again sickening large numbers of American children, I can't help recalling 1990, the year I began my career as a pediatrician—and the year a measles epidemic swept across the U.S.
There was a nationwide dearth of primary care for children and families at the time, and I began working in a community health center, bringing services to New York City's homeless family shelters aboard mobile medical clinics. The overcrowded shelters were to measles what dry tinder is to wildfires, and the spread of infection ravaged them.
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Fox News
an hour ago
- Fox News
Common menopause medication might prevent breast cancer while treating hot flashes
A drug intended to treat menopause symptoms could double as breast cancer prevention. New research from Northwestern University in Illinois found that Duavee, a Pfizer-made drug, "significantly reduced" breast tissue cell growth, which is a major indicator of cancer progression. A phase 2 clinical trial included 141 post-menopausal women who had been diagnosed with ductal carcinoma in situ (DCIS), also known as stage 0 breast cancer, according to a press release from Northwestern. This non-invasive breast cancer affects more than 60,000 American women each year, often leading to an outcome of invasive breast cancer. The women were separated into two groups — one received Duavee and the other took a placebo for a month before undergoing breast surgery. Duavee is a conjugated estrogen/bazedoxifene (CE/BZA) drug, which combines estrogen with another medication that minimizes the potential harmful side effects of the hormone. "The key takeaway from the study is that CE/BZA slows the growth (proliferation) of cells in milk ducts of DCIS that expressed the estrogen receptor significantly more than placebo," Dr. Swati Kulkarni, lead investigator and professor of breast surgery at Northwestern University Feinberg School of Medicine, told Fox News Digital. Another major finding is that the quality of life did not differ significantly between the two groups, but patients who took the CE/BZA reported fewer hot flashes during the study, she noted. "This would be expected, as the drug is FDA-approved to treat hot flashes." "What excites me most is that a medication designed to help women feel better during menopause may also reduce their risk of invasive breast cancer." Kulkarni presented the study last week at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago. The findings are preliminary and have not yet been published in a medical journal. "What excites me most is that a medication designed to help women feel better during menopause may also reduce their risk of invasive breast cancer," said the doctor, who is also a Northwestern Medicine breast surgeon. Women who face a higher risk of breast cancer — including those who have experienced "high-risk lesions" — and who also have menopausal symptoms are most likely to benefit from the drug, according to Kulkarni. "These women are typically advised against standard hormone therapies, leaving them with few menopausal treatment options," the release stated. The researchers said they are "encouraged" by these early results, but more research is required before the medication can be considered for approval as a breast cancer prevention mechanism. "Our findings suggest that CE/BZA may prevent breast cancer, but larger studies with several years of follow-up are needed before we would know this for sure," Kulkarni told Fox News Digital. Dr. Sheheryar Kabraji, chief of breast medicine at the Roswell Park Comprehensive Cancer Center in Buffalo, New York, was not involved in the study but commented on the findings. "While intriguing, this study is highly preliminary, and more research will be needed before we can conclude that conjugated estrogen/bazedoxifene (CD/BZA), a form of the hormone estrogen commonly prescribed to address symptoms of menopause, prevents invasive breast cancer or is effective at reducing cancer risk," she told Fox News Digital. Kabraji also noted that the study focused on reducing levels of one specific protein, "which does not always predict reduced recurrence of breast cancer." "This study did not directly show that CE/BZA treatment reduces the risk of DCIS recurrence or development of invasive cancer," she noted. "While intriguing, this study is highly preliminary." "Importantly, however, patients who received this therapy experienced no worsening of quality of life, and saw improvement in vasomotor symptoms, such as hot flashes. If found to be effective in preventing breast cancer, CE/BZA is likely to have fewer side effects than current medications used for breast cancer prevention." For more Health articles, visit Lead researcher Kulkarni emphasized that this medication is not for the treatment of invasive breast cancer or DCIS. "Right now, we can say that women who are concerned about their risk of developing breast cancer can consider this medication to treat their menopausal symptoms," she added.
Associated Press
an hour ago
- Associated Press
New online tool helps women on Medicaid find prenatal care and family planning
At the University of Mississippi Medical Center, one researcher's full-time job for the past nine months has been to find out which clinics around the state offer different kinds of women's health care, and whether they accept various forms of Medicaid. The final result is a recently launched database aimed at helping women locate the nearest clinic that can offer the care they need. The work that went into creating it highlights a pervasive problem: Even making an appointment can be a barrier that keeps women from improving their lives. 'We Need to Talk' is a compilation of all Mississippi clinics offering prenatal care – specifying which ones also offer family planning, and whether they take Medicaid insurance, Medicaid waivers and see women whose Medicaid applications are pending. There is also a hotline designed to give additional support to anyone having questions or feeling overwhelmed about the process. 'Having gone through the work, it was remarkable. It wasn't easy to figure out where you should go for care,' said Dr. Thomas Dobbs, former state health officer and dean of the John D. Bower School of Population Health at UMMC, who oversaw the project. 'And that should be one of the most basic bits of information we have.' The idea was born from the recent 900% increase in babies born with syphilis, Dobbs explained, which he called a 'canary in a coal mine' signaling more danger to come. An investigation into the epidemic showed that one of the driving factors was delayed prenatal care, caused in large part by inaccessible information and concerns about cost, Dobbs said. Finding reproductive and prenatal care can be difficult for several reasons. For one thing, there are many different kinds of clinics in Mississippi, making it hard for patients to know what to search for. The list includes federally qualified health centers, county health department clinics and private OB-GYNs. Another reason is that many clinics don't specify online whether they take Medicaid, much less what their policy is on specific or temporary Medicaid coverage. Calling doesn't always guarantee patients a comprehensive or accurate answer. The new database is an initiative of UMMC's Myrlie Evers-Williams Institute – housed in the Jackson Medical Mall – which is committed to eliminating health disparities by studying the intersection of health and social issues. The institute has a clinic on site that practices what's called 'social medicine,' a key element of eliminating those disparities, the institute's executive director Victoria Gholar explained. 'If you have a patient who has asthma and they're living in a situation where mold is in their environment, it will really be hard for them to get better,' Gholar said. 'Or, if we have a patient who has to use an electronic (medical) device, and their electricity is no longer available because they weren't able to take care of their utility bill, then we try to work with them and connect them to resources that might be able to help.' The institute employs a wide range of professionals who work on health from a non-clinical standpoint, such as researchers, community engagers, social workers and registered dietitians. It hosts events like food drives and offers free support from budgeting strategies to meal preparation for those with conditions like diabetes or high blood pressure. Aside from knowing what to search for, finding clinics that accept Medicaid can also be complicated because Mississippi Medicaid eligibility is constantly changing for a woman based on her age and circumstance – what kinds of services she's seeking, as well as whether she's pregnant. Medicaid eligibility in Mississippi is among the strictest in the nation, with one exception – pregnant women. That means many low-income women only become eligible for Medicaid once pregnant. And since an application can take up to eight weeks to be processed, the chances that a woman in this situation will be able to use her newly acquired Medicaid insurance in the first trimester are slim. A law that would cut out this interim period and allow low-income pregnant women to be immediately seen by a doctor passed the Legislature in 2024, but was never implemented because of legislative errors. The policy went back through the Legislature in 2025, passed overwhelmingly again, but is not yet in effect. Some doctors already see women whose Medicaid application is pending, and the UMMC tool specifies at which clinics that's the case. Women of reproductive age seeking reproductive health care are also eligible for leniency in the typical Medicaid stipulations. These women can apply for a Medicaid family planning waiver, which allows them to access Medicaid for family planning purposes, even if they don't qualify for general Medicaid coverage. The income requirement for pregnancy Medicaid and the family planning waiver is a household income of less than 194% of the federal poverty level, or about $2,500 a month for one person in 2025. Dobbs, who has been the main point person on the project, said he hopes the online database is one more resource improving health care accessibility and women's health metrics in Mississippi. 'This isn't about getting patients to UMMC at all,' Dobbs said. 'It's about empowering patients to be able to get the care they need where they live.' ___ This story was originally published by Mississippi Today and distributed through a partnership with The Associated Press.
Medscape
an hour ago
- Medscape
A PCP Guide to Emerging Therapies for Resistant Hypertension
This transcript has been edited for clarity. Matthew F. Watto, MD: Welcome back to The Curbsiders . I'm Dr Matthew Frank Watto, here with my great friend and America's primary care physician, Dr Paul Nelson Williams. Paul, this is a topic you know a ton about, isn't it? Paul N. Williams, MD: It's one I always have questions about; I think this is our 37th episode on high blood pressure, if I'm not mistaken. Watto: The audience can't get enough of it — turns out, neither can I. Williams: Me neither! Watto: I love talking about high blood pressure, and this was with a great guest, Dr Jordy Cohen. She's a hypertension expert and a nephrologist. Paul, to start us off, what are we doing with blood pressure cuffs these days? Those manual ones on the wall, those are the way to go, right? Williams: This is a scenario we talk about all the time, and we've beat this drum a lot in prior episodes. I think we've all experienced a patient whose initial triage blood pressure reading is elevated, and either you or the patient will ask for a recheck and you're tempted to use a blood pressure cuff that's been hanging on the wall, has not been calibrated in 17 years, has a decaying spiral cord, and looks like it would fall apart if you touched it. Turns out that's probably not the best way to do it, Matt. So, to reiterate: Automated cuffs are the preferred option. They are more accurate. In this episode with Dr Cohen, we talked about making sure we use the appropriate cuff size and when we have patients who have large arms, you may have to use a wrist measurement every so often. In these circumstances, positioning matters: feet flat, back supported, elbow resting on a table, and have two fingers on the opposite clavicle so that everything is at heart level. If you're taking the blood pressure reading using a cuff around the arm itself, again, you should make sure the patient's arm is resting on a tabletop, bedside, or even on your own arm to ensure it's at heart level. You also shouldn't talk with the patient during that process so you can give them every chance to have an accurate blood pressure reading. That's the first thing: Get an accurate reading. Then everything else follows that step, as you should only treat a diagnosis that you've appropriately made. Watto: All the goals are based on a properly taken blood pressure, so if your patient's blood pressure hasn't been appropriately measured, you might overtreat or undertreat someone. For most patients who are nonfrail, we're now shooting for a blood pressure that is below 130/80 mm Hg. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for patients with chronic kidney disease state that normal blood pressure should be below 120/80, which is very hard to do. If we're getting people with a systolic in the 120s, that's probably about as good as we're going to get. For treatment, Dr Cohen and I have adopted this practice of using combination pills for hypertension management — either a calcium-channel blocker with an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker (ARB). I usually prefer a calcium-channel blocker with an ARB or the 'triple pill,' a single-pill combination of a calcium-channel blocker, an ARB, and a diuretic. That's what I go to now as my first-line agent. I'm using a lot of either low-dose or medium-dose combination therapy. I don't usually go to the highest dose unless I'm in a situation where I have to decide between starting a fourth medication or going to a higher dose. That's really been a practice change for me. Dr Cohen reiterated that point and emphasized that it's easiest for the patient and they usually experience fewer side effects when you choose a low-to-moderate dose in comparison to a high dose. Williams: It's a point that we've made in prior episodes, as well. As you start to max out the doses of these medications, you get diminishing returns in terms of their efficacy in lowering blood pressure efficacy and patients can start to experience increased side effects. It's a far better option to start with a kind of median dose as opposed to really trying to crank up the dose, because you just don't get that much more benefit with that approach. Watto: We're going to discuss some of the newer blood pressure–lowering agents. Paul, the first one I want to ask you about is not quite a blood pressure medication, but it does lower blood pressure. Which medication am I talking about here? Williams: I think you're probably referring to semaglutide, Matt. I think we all have a fair amount of comfort with these diabetes and weight loss medications. These are remarkable medications and the indications keep piling on, which is great. Semaglutide, in particular, is not approved for hypertension, but it does lower blood pressure, likely as a result of the weight loss that is achieved with the medication. So, it's not technically an antihypertensive, but it provides a great blood pressure benefit. I think there's also some 'fancy pants' medications coming down the pipeline that we should probably be aware of, right? Watto: Yes, and the first one I'll mention is endothelin receptor antagonists. As a generalist, you're probably not going to be prescribing these; they will probably be prescribed by a hypertension specialist. Compared with placebo, they have a modest effect in lowering blood pressure (~4 mm Hg), but they are officially approved, so they're out there. What's more exciting, Paul, are aldosterone synthase inhibitors. The generic names for these include baxdrostat and lorundrostat. They're not yet approved, but I believe they are in phase 2 or phase 3 trials, depending on the indications. They seem promising, as they have a much stronger effect on blood pressure (~10-15 mm Hg) compared with placebo. Dr Cohen thinks these medications are probably going to be in the primary care wheelhouse soon. Cost will probably an issue with these medications at the start, but otherwise, these are pills that are taken once a day and they don't have the antiandrogen side effects that you can get with the mineralocorticoid receptor antagonists (MRAs), like spironolactone. Dr Cohen was really excited about being able to prescribe these at some point. Williams: And the MRAs are traditionally a fourth-line medication (unless you have compelling indications), so to have something else in your armamentarium that has less side effects is super exciting. It'll be great to see these in the pipeline. Watto: Now, what would you say, Paul, if I told you there was a medication for blood pressure that is only administered once every 6 months and will shut down the renin-angiotensin-aldosterone system (RAAS)? How does that sound? Williams: As someone who's taken medical school physiology, it sounds lightly terrifying! It feels like you do need the RAAS for some things, but I think for patients that are less interested in taking medications — which turns out to be most patients — it could potentially be exciting. I think as long as we have a way to reverse the effects of this medication if needed, then I think there's potential for excitement around this medication. Watto: I'm of course talking about a small interfering RNA (siRNA) agent. The one we talked about in this episode was zilebesiran; it's an siRNA agent and is administered once every 6 months. But no one would feel comfortable giving this unless there's an antidote, because if a patient gets septic, they probably need their RAAS to help them out there. Williams: Or if you have a patient who is pregnant — lots of reasons why you might actually want that system working. Watto: Exactly. Now, some people just don't want to take medications even if they need them, Paul. What else might be offered to a patient with high blood pressure? And how excited should we be about this next therapy? Williams: I feel like you're asking the wrong guy, Matt! I think you're alluding to renal denervation therapy. I feel it had a lot of wild enthusiasm initially, then it kind of waned, and now I feel like enthusiasm is back, baby — we're back into renal denervation. It sounds like a great option and I think we're doing a little better job with it, but its effect on lowering blood pressure is about equivalent to the effect you observe with a single-agent medication. So, realistically, these patients may still need to be on medications for blood pressure control. It's only effective for about two thirds of patients who get the procedure; that's 33% of your patients who would go through this invasive procedure where we're frying a nerve and in the end, they may not actually experience any blood pressure benefit. I think there's still a population that would benefit from and be interested in this option, but I don't think it's something that we should consider as first-line therapy for the majority of folks because of that potential for treatment failure and the continued need for medications among a substantial portion of the patients who undergo this procedure. It's still exciting that there's evidence for it and it does cause significant blood pressure lowering, so it's nice to have another option. Watto: Yeah, and I think patients are going be coming in and asking about it, so having some knowledge about the pros and cons of the procedure is important.
