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Medscape
5 days ago
- Health
- Medscape
Primary Care Can Address Complex Lung Diseases, Too
Primary care physicians (PCPs) often face challenges in diagnosing complex pulmonary issues in patients, particularly when nonspecific symptoms appear similar to cardiovascular issues, asthma, or chronic obstructive pulmonary disease. However, clinicians can cover both pulmonary and cardiovascular concerns during an exam, potentially shortening delays in the diagnosis of interstitial lung diseases (ILDs), including pulmonary fibrosis (PF). Tejaswini Kulkarni, MD 'ILDs are complex, chronic progressive diseases with a great impact on a patient's quality of life and survival. These are often underdiagnosed, or there is significant delay in diagnosis after onset of symptoms due to a multitude of reasons,' said Tejaswini Kulkarni, MD, associate professor of pulmonary, allergy, and critical care medicine and director of the interstitial lung disease program at the University of Alabama at Birmingham, Alabama. 'Early intervention can slow disease progression, improve quality of life, and potentially extend survival in ILD patients,' she said. 'For primary care physicians, increased awareness of the signs and symptoms of ILD and early recognition are crucial.' Timely Diagnosis Tools Although most PCPs try to evaluate the root causes of nonspecific symptoms, about 2 in 5 tend to bypass symptom evaluation if the patient is already on inhaled therapy for a pulmonary condition, according to a survey by the American College of Chest Physicians (CHEST). Instead, they often modulate therapy — for what may be an incorrect diagnosis. William Lago, MD 'As a practicing primary care physician, it doesn't surprise me that PF and ILD are generally misdiagnosed or experience delays in diagnosis. These diseases are on the rare side, so when a patient comes to their PCP, that doctor first will opt to rule out heart issues that can quickly end a life,' said William Lago, MD, a family medicine physician with the Cleveland Clinic-Wooster Family Health Center in Wooster, Ohio. 'That said, lung diseases like PF are incredibly difficult to live with and can progress rapidly if untreated,' he said. 'An earlier diagnosis means starting treatments to slow fibrosing of the lungs, and with slowed disease progression, a patient's quality of life is often improved.' In general, high-resolution computed tomography (HRCT) is considered the gold standard for imaging when it comes to detecting ILD. However, only 62% of PCPs said they order HRCT when a patient's chest radiograph shows lower lobe opacity, and only half said they order it when a patient has inspiratory crackles or other abnormalities during a pulmonary exam, according to the CHEST survey. In response, CHEST and the Three Lakes Foundation sponsored a clinician toolkit, which was created by PCPs and pulmonologists to help clinicians better identify, manage, and treat ILDs. The toolkit includes a patient questionnaire, a decision-making module with patient case studies, an online module with in-depth ILD symptoms and sounds of crackles, and videos of radiologic features of ILDs. The project, called Bridging Specialties: Timely Diagnosis for ILD, also includes white papers and podcast episodes on overcoming barriers to diagnosis. 'In working on this initiative with my pulmonary colleagues, I'm already finding myself thinking more about PF and ILDs as potential diagnoses when seeing patients,' said Lago, who served on the Bridging Specialties expert steering committee. 'Between the patient questionnaire, the decision-making module, and the other resources in the clinician toolkit, I can see this having an incredible impact on how we diagnose patients.' This teamwork approach can help PCPs improve diagnosis rates alongside other specialists, said Kulkarni, who also served on the Bridging Specialties committee. 'Many patients present with vague or nonspecific symptoms, and ILDs can mimic other, more common respiratory disorders or coronary artery diseases, along with shared features of older age and history of smoking,' she said. 'The differential diagnosis is complex and often requires a multidisciplinary team of pulmonologists, rheumatologists, radiologists, and pathologists to identify the subtype of ILD.' Other medical societies have created informational resources as well, including the American Thoracic Society's ILD and idiopathic pulmonary fibrosis (IPF) resources and the Pulmonary Fibrosis Foundation's webinars and clinical resources. Jeffrey Horowitz, MD 'My top advice is to go to reputable sources. I've had one patient ask me about drinking hydrogen peroxide to treat their condition, which they read on a forum online. Others have asked about stem cell therapy in other countries, which isn't regulated and can do real harm,' said Jeffrey Horowitz, MD, professor of medicine and division director of Pulmonary, Critical Care, and Sleep Medicine at Ohio State University, Columbus, Ohio. 'Overall, I tell clinicians that if somebody is short of breath, has crackles, and has a normal echocardiogram, it's probably not the heart, so do those pulmonary function studies early,' he said. 'Since most nonpulmonologists don't have substantial expertise in this area, it's a good idea to have patients evaluated at an academic medical center with expertise in ILD, which also opens the doors for patients to be enrolled in clinical trials.' Ongoing Research and Treatments Ohio State, for instance, recently joined the IPF-PRO/ILD-PRO Registry, an industry-academic collaborative started by Duke University, Durham, North Carolina, in 2014 to maintain a registry of patients for potential therapies and clinical trials. 'There can be a sense of nihilism regarding this entire spectrum of fibrotic lung disease, which wouldn't be without merit if we were talking about 20 years ago,' Horowitz said. 'Today, there are a lot of reasons to be optimistic as we're making gains and improving care for these patients.' Numerous clinical trials are underway, including positive phase 3 results for FIBRONEER-IPF from Boehringer Ingelheim. The trial found that nerandomilast, an oral form of a phosphodiesterase 4B inhibitor, improved forced vital capacity (FVC) at 52 weeks, as compared with placebo. The drug hasn't yet been approved for use, but full efficacy and safety data are expected sometime in 2025. In addition, United Therapeutics offers inhaled forms of treprostinil, which was initially approved to treat pulmonary arterial hypertension, as well as pulmonary hypertension associated with ILD. New data indicate the medication could also benefit patients with IPF who don't have pulmonary hypertension, Horowitz said. The ongoing trial is enrolling patients across the United States. Other ongoing studies include lysophosphatidic acid, a bioactive lipid mediator that can affect lung inflammation and fibrosis, and bexotegrast, a dual selective inhibitor of α v ß 6 and α v ß 1 integrins developed to treat IPF. Although Pliant Therapeutics announced the discontinuation of a phase 2b trial in March, early data showed efficacy for improved FVC. 'I'm optimistic that the next breakthrough is just around the corner,' Horowitz said. 'After 15 years of doing high-quality, informative studies, we're now opening the doors for new therapeutic targets, and as long as we keep doing trials, we're going to make a breakthrough that's going to transform care for these patients.' Horowitz and colleagues are also studying the cellular matrix and cell death of fibroblasts, including the way lung cells interact with other cells in an aberrant wound repair response, ultimately leading to lung scarring. The latest research is focused on enhancing cell susceptibility to apoptosis, or cell death, and decreasing disease progression. 'These lung diseases are heterogeneous, just like cancer. So viewed through the lens of cancer biology, different patients with their own fibrotic diseases have underlying mechanisms that drive the disease process,' Horowitz said. 'We're pursuing the idea that, if we can target the metabolic pathways that cells use, it might be beneficial for developing therapeutics.' Additional developments are occurring in diagnosis and patient care as well, particularly with a focus on genetic testing and coordinated care across specialists. 'The landscape of ILD treatment is evolving with the introduction of new pharmacological agents, advanced diagnostic techniques, and improved interdisciplinary care models and offers a brighter outlook for patients and healthcare providers,' Kulkarni said. 'Looking ahead to 2025 and beyond, as our understanding of disease pathogenesis continues to grow, the integration of precision medicine and genetic insights has the potential to make patient-centered, individualized care a reality.' Kulkarni, Lago, and Horowitz reported receiving grants, consulting fees, and serving in advisory roles for numerous pharmaceutical and medical organizations.
Medscape
06-05-2025
- Health
- Medscape
Benralizumab Maintains Remission in Asthma in Some, Not All
Clinical remission was achieved and sustained in nearly one third of patients with severe eosinophilic asthma (SEA) receiving benralizumab for up to 2 years, with better outcomes in biologic-naive patients than in biologic-experienced patients. METHODOLOGY: Researchers conducted a real-world study to evaluate if long-term remission was viable among adult patients with SEA (mean age at the index date, 55.2 years; 58.7% women) who received benralizumab for up to 96 weeks between 2018 and 2023. Of the 1070 patients included, 662 were biologic naive and 404 were biologic experienced; 55% received maintenance oral corticosteroids at baseline. The major outcome was clinical remission (defined as a composite of the absence of exacerbations, no use of maintenance oral corticosteroids, and well-controlled asthma) at weeks 0, 48, and 96. The association between baseline characteristics and the status of clinical remission at weeks 48 and 96 was also determined. TAKEAWAY: Clinical remission was achieved in 0.4% of patients at baseline, in 39.0% at week 48, and in 31.0% at week 96, with biologic-naive patients showing higher remission rates than biologic-experienced patients (36.0% vs 23.0%). Exacerbation-free status was achieved in 3.3% of patients at baseline, in 72.0% at week 48, and in 60.0% at week 96, with a greater number of biologic-naive patients being exacerbation-free than biologic-experienced ones (67.0% vs 55.0%). Overall, the proportion of patients not using maintenance oral corticosteroids increased from 65% at baseline to 76% at weeks 48 and 96. A lower dose of maintenance oral corticosteroids, lower body mass index, and higher blood eosinophil count at baseline were associated with achieving remission at week 96. IN PRACTICE: 'Outcomes were maintained irrespective of previous biologic use and key baseline characteristics that clinicians typically consider in their therapeutic decision-making. Patients with lower disease burden were more likely to achieve clinical remission, reinforcing the importance of early treatment intervention,' the authors wrote. SOURCE: This study was led by Girolamo Pelaia, MD, Università Magna Graecia in Catanzaro, Italy. It was published online on April 19, 2025, in CHEST . LIMITATIONS: This study lacked a control arm. The limited availability of data on lung function restricted its inclusion in the remission composite. The COVID-19 pandemic overlapped with the period of data collection, potentially affecting outcomes. DISCLOSURES: This study was supported by AstraZeneca. Several authors reported being employees of and owning stock in AstraZeneca. Some others reported having other ties with AstraZeneca and various sources.
Scientific American
01-05-2025
- Health
- Scientific American
The Scary Implications of U.S. Government Attacks on Medical Journals
In April, I decided to make public a leaked letter from the acting U.S. attorney for the District of Columbia to the editor-in-chief of CHEST, a leading pulmonology and critical care journal. I did so because the letter represents an authoritarian threat to science, and I knew it wasn't an isolated, bizarre incident. It is a warning sign, another move in a broader campaign to exert control over research, medicine and media. The letter asserts that 'publications like CHEST Journal are conceding that they are partisans in various scientific debates.' It was written by recently appointed acting U.S. attorney Edward R. Martin, Jr., who gives no examples that might demonstrate partisanship; nor does he cite any laws or legal principles to indicate a matter that should concern the U.S. government. Instead, without justification or jurisdiction over a private medical journal based in Illinois, he simply invokes his federal office to demand that CHEST explain if it accepts 'competing viewpoints,' and how it is now developing 'new norms' to adjust its editorial methods in view of its alleged—by Martin—biases. Since I publicly shared this, at least four additional journals, including the New England Journal of Medicine, have confirmed receipt of similar letters, according to MedPage Today, STAT News, the New York Times and Science. Aside from Eric Rubin at the NEJM, none of the targeted editors have been willing to go on record, fearing retribution from the Trump administration. It's likely that letters were sent to many more journals; CHEST 's was simply the first to leak. On supporting science journalism If you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today. Why CHEST? It's a specialty outlet—not even among the top 50 medical journals. Is this a keyword-driven campaign like those we've seen at the CDC and NIH? Under Robert F. Kennedy, Jr., terms like 'diversity,' 'minority' and 'equity' have been systematically flagged. This has led to elimination of federal positions and programs, cancellation of research grants, and scrubbing of government websites and statistics —all related to these words. A search of CHEST 's archive for 'transgender,' for example, returns 33 hits—articles acknowledging the clinical implications of caring for trans patients (e.g., ventilator settings may need to be adjusted). Add in other Trump-targeted terms like race, disparity, female and disability, and we can see the outlines of a new DOJ-led front in the administration's campaign to target minorities for denial of care, legalized discrimination and bureaucratic erasure. Kennedy has also previously objected to medical journals not publishing studies that support his debunked and baseless theories, such as false claims that vaccines cause autism, declaring a plan to 'create our own journals' to publish such studies. Last year, while running his own presidential campaign, he stated he would take legal action against editors in response: 'I'm going to litigate against you under the racketeering laws, under the general tort laws. I'm going to find a way to sue you unless you come up with a plan right now to show how you're going to start publishing real science.' Kennedy is not a scientist and has no training in medicine. He has not volunteered to submit his claims to the types of critical, anonymized expert reviews that are designed to support scientific rigor at scientific journals. Kennedy frequently makes evidence-free claims on podcasts and television shows and now in government press conferences, regardless of the consequences. However, peer-reviewed journals like CHEST require extensive scrutiny as part of their evaluation process. Outside scientists examine submitted studies for biases, errors, and unsupported claims or conclusions, and authors are required to include statements about conflicts of interest—including reasons for even just the appearance of bias in the eyes of others—and to disclose their funding sources. This is routine procedure at journals, about which Martin's letter indicates he knows strikingly little. We don't know Martin's, Kennedy's or Trump's specific motivations in sending a letter to CHEST, but it is clear that Martin's threat to journals is not a one-off stunt. Like Trump's actions that cut off or threaten federal research funding at Columbia, Harvard and other universities, it appears to be part of a calculated strategy to identify, isolate and intimidate researchers who, and institutions that, acknowledge realities like inequality, social differences and structural violence. American health institutions have long been entangled with state violence: forced sterilizations of Black and Indigenous women, repression of civil rights protesters, collaboration with anti-immigrant policing, the push to categorize queer people as pathological and dangerous, and denial of reproductive and gender-affirming care. These alliances are enabled by a professional culture that rewards compliance and punishes dissent. In that respect, the Trump administration's mounting ideological control over medicine represents not a historical rupture but rather a continuation of sordid legacies. To understand what is now transpiring, it is important to note that Martin has never before been a prosecutor. He has no experience in criminal litigation, appointed to his post to serve political ends. Since taking office, he has hired Michael Caputo —Trump's disgraced first-term COVID spokesman who then infamously accused government scientists of ' sedition '—as an advisor at the U.S. Attorney's Office. The message is clear: this is not about law enforcement. It is about using state power to intimidate scientists and suppress dissent. Against this backdrop, if journal editors refuse to speak out and organize to defend academic freedom, they will not only ultimately fail to protect themselves and their journals. They will also sacrifice targeted communities. When confronted by government intimidation driven by personal ideological agendas instead of the public good, silence is complicity—not neutrality. We must refuse to compromise when the Trump administration comes first for stigmatized and vulnerable groups—such as trans individuals, disabled people, or immigrants they label as 'criminals' —as a means of normalizing state violence and expanding its unconstitutional reach. This is not the time to issue hollow statements condemning the supposed ' politicization of science '—a line that conflates partisan interests with what should be bipartisan political principles upon which rigorous scientific practice, ethical clinical care and genuine public health depend. Science is always already political, and we must organize politically to defend it against authoritarian threats. That requires calling out the Trump administration's intimidation campaign for what it is: a McCarthyite attempt to purge science of inconvenient truths and ethical foundations. The production of knowledge, the allocation of care, and the very questions we ask and answer, are all shaped by systems of power. When medical professionals pretend otherwise, we create a vacuum. And that vacuum is quickly filled by the loudest ideologues and most craven opportunists. To fight back, we need coordinated action and solidarity with those most targeted. And we need to stop pretending that defending science means staying above politics. Provoked by the revelation of Martin's letter, The Lancet —a world-leading, London-based medical journal—has taken on this public responsibility and done what its American counterparts have so far declined to do: published a clear and forceful editorial stance condemning the Trump administration's assault on science, medicine, and public health, and calling for Kennedy's resignation. Other journal editors and health leaders should now join in taking such principled political stands. To do so, they must give up on the naïve fantasy that, if they just keep their heads low enough, they can avoid becoming targets and simply wait out the Trump administration as it destroys essential scientific infrastructure. Martin's letter is a declaration that scientific inquiry is no longer safe unless it aligns with state ideology. If we let that stand, we don't just lose our journals. We lose the right to ask questions that matter—and the ability to care for those most in need.
Epoch Times
21-04-2025
- Health
- Epoch Times
US Prosecutor Sends Letter to Medical Journal, Alleging Bias
A federal prosecutor sent a letter to a medical journal, asking for answers on how it chooses articles, the journal's publishers have confirmed. 'The American College of Chest Physicians, publishers of the journal CHEST, can confirm that we received a letter from the U.S. Department of Justice, and its content was posted online without our knowledge,' a spokeswoman for the college told The Epoch Times in an email on April 21. 'Legal counsel is currently reviewing the DOJ request. Beyond our statement, we have no additional comment at this time.' The missive, dated April 14, came from Edward Martin, the U.S. attorney for the District of Columbia. Martin He asked Dr. Peter Mazzone, editor-in-chief of CHEST, to answer five questions, including whether the journal accepts articles or essays of competing viewpoints. Related Stories 4/9/2025 3/4/2025 'I am also interested to know if publishers, journals, and organizations with which you work are adjusting their method of acceptance of competing viewpoints,' Martin wrote. 'Are there new norms being developed and offered?' He asked for a response by May 2. Martin's office did not respond to a request for comment by publication time. The American College of Chest Physicians The college also said that the journal complies with ethical guidelines and that it respects the journal's editorial independence. It's not clear if similar letters were sent to any other journals. A spokesperson for PLOS told The Epoch Times in an email that it has not received one. Other journals did not return inquiries. Several free speech groups decried the letter, including the Foundation for Individual Rights and Expression. 'The First Amendment couldn't be clearer: A publication's editorial decisions are none of the government's business. Newspaper, blog, medical journal—it doesn't matter. Back off,' the organization 'When a U.S. Attorney wields the power of his office to target medical journals over their content, he isn't doing his job, let alone upholding his constitutional oath. He's abusing his authority to try to chill protected speech.'
Washington Post
18-04-2025
- Health
- Washington Post
DOJ questions science journal about bias, triggering free speech concerns
Amid brewing conflict between scientists and the administration of President Donald Trump, the U.S. attorney for the District of Columbia sent an unusual letter this week to a scientific journal focused on diseases and medicine related to the chest, asking about its editorial policies. 'It has been brought to my attention that more and more journals like CHEST journal are conceding that they are partisans in various scientific debates,' U.S. Attorney Ed Martin wrote. In the letter, Martin said that he has been told some journals 'have a position for which they are advocating due to advertisement (under postal code) or sponsorship (under relevant fraud regulations).' Martin's letter states, 'The public has certain expectations and you have certain responsibilities.' It then poses questions about the journal's view of its role in protecting the public from misinformation, its publication of 'competing viewpoints' and its handling of allegations that authors have misled readers. Martin requested that the journal's editor in chief, Peter Mazzone, respond by May 2. Chest, an Illinois-based monthly journal published by the American College of Chest Physicians with a global circulation of more than 13,000 and more than 156,000 average monthly visits online, confirmed that it received the letter and was having it reviewed by legal counsel. 'Its content was posted online without our knowledge,' the journal said in a brief statement, declining to comment on the requests made by Martin in the letter. Free speech experts raised alarm over the letter. 'It's baffling that the chief federal prosecutor in the District of Columbia could send a letter like this,' said David Snyder, executive director of the nonpartisan, nonprofit First Amendment Coalition. 'I cannot imagine what purpose a letter like this would serve other than to chill freedom of expression.' 'The government has no authority under the First Amendment to regulate the editorial decisions of publications, and the letter suggests that's what Martin intends to do,' Snyder added. A spokesman for The U.S. Department of Health and Human Services declined to comment, referring questions to the office of the U.S. attorney. The Justice Department and Martin's office did not respond to requests for comment. The letter comes as the scientific community has raised alarm over Trump administration actions that have halted or disrupted research and science. Since Trump's inauguration on Jan. 20, funding from the National Institutes of Health has dropped by more than $3 billion compared with grants issued during the same period last year, according to a review of publicly available grant data as of late March. Universities that power research and innovation across the country fear losing billions in federal funding amid the administration's actions against elite institutions it views as bastions of 'woke' ideology and anti-Israel sentiment. And the White House budget draft for the Department of Health and Human Services calls for massive cuts to federal programs dealing with health and science. It's unclear whether similar letters have been sent to other journals. Three other major publishers of medical and scientific journals, including the New England Journal of Medicine and Health Affairs, said they had not received similar letters from Martin. Springer Nature, a large publisher of such journals, said there was no one available to comment when asked whether any of its publications had been contacted by Martin. 'When a U.S. Attorney wields the power of his office to target medical journals over their content, he isn't doing his job, let alone upholding his constitutional oath,' JT Morris, supervising senior attorney for the Foundation for Individual Rights and Expression, said in a statement. 'These letters are just the latest in a pattern of Ed Martin sticking his nose in places where it doesn't belong, all in an effort to pursue speakers who express views he doesn't like,' he added. Martin has sent letters to critics of Elon Musk and the U.S. Supreme Court admonishing them for comments he viewed as threatening or bullying. Snyder said that he did not see 'any legal compulsion that would require [Chest] to respond.'
