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New York Times
2 days ago
- Health
- New York Times
What Happens When Doctors Can't Trust the Government?
The other day I was talking to one of my patients about her vaccinations, and I noticed that she hadn't had a Covid-19 vaccine since the early days of the pandemic. 'The virus has changed so much since then,' I told her, 'so we recommend that you get the current vaccine——' And then I stopped dead in my tracks, the words 'we recommend' lingering in the air. This is how I'd always phrased these types of recommendations, but I was suddenly unsure of who the 'we' was. Up until recently, it meant a medical community that included not just my health care colleagues, but also the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, respected medical journals and the research community. It's not remotely feasible for practicing clinicians to review every medical study out there, so we rely on trusted colleagues and institutions with the relevant expertise to help guide us. The 'we' suddenly rang hollow. The institutions I trusted to be deliberative and evidence-based sources of knowledge that extend my medical abilities are no longer that. In the first Trump administration, despite relentless attacks from the president, the nation's public health institutions remained largely intact, if wearied. But the plunder of the second Trump administration has disemboweled them and installed fox-guarding-the-henhouse leadership. Medical professionals can no longer fully trust federal health guidance, and our patients are the ones who will suffer the most. For most of my colleagues and me, the C.D.C. and the N.I.H. were the medical Mount Olympus, the towering pillars of medical authority. Contrary to right-wing portrayals, these were not dictatorial authorities. These were earned authorities, comprising our best, brightest and most dedicated peers. The formidable talents of these doctors and scientists would have commanded enviable salaries had they taken jobs in industry, but they chose the public sector instead — something that we clinicians were forever grateful for. Were there egos, missteps and shortcomings? Sure. But by and large, the people I met who worked for the C.D.C. or N.I.H. were brilliant and rigorous, and cared passionately about the science they were pursuing. While there are some doctors who viewed our public health institutions with disdain — some of them now are running these very organizations — most practicing physicians relied heavily on them to deliver the best care possible to their patients, despite occasional quibbles. What a relief, I always felt, that there were people organizing the things I can't do — testing new treatments, conducting population studies, keeping tabs on worldwide diseases, issuing guidelines and more. Want all of The Times? Subscribe.
Medscape
18-07-2025
- Health
- Medscape
Rapid Review: Endometrial Cancer
In endometrial cancer, the majority of cases are diagnosed at an early stage, largely due to the hallmark symptom of postmenopausal bleeding. Despite relatively favorable survival rates when caught early — with a 5-year relative survival rate of approximately 95% for localized disease — disparities remain in detection, treatment access, and mortality. ctDNA testing has shown strong value as a noninvasive and highly sensitive method for detecting recurrence in endometrial cancer. ctDNA detects tumor-specific mutations in the bloodstream and is being actively evaluated to track cancer progression, detect early-stage cancers, and monitor therapeutic responses. ctDNA's role for detecting hormone receptor status and tumor histology has not been established for endometrial cancer, and it appears to not be correlated with myometrial invasion depth. Learn more about the presentation of endometrial cancer. In the past year, evidence has emerged which demonstrates that GLP-1 receptor agonists — medications originally approved for diabetes and obesity — reduce the risk for obesity-related cancers. A major research effort found that these drugs decreased cancer incidence, and further research found GLP-1 receptor agonists to be comparable to bariatric surgery for obesity-related cancer prevention. GLP-1 therapies now offer a less-invasive alternative to bariatric surgery. Research is ongoing to evaluate the use of GLP-1 medications as a potential therapeutic strategy for endometrial cancer. The other classes have not been shown to reduce risk or are not used in endometrial cancer management. Learn more about the differential diagnosis for endometrial cancer. Recent advances in molecular and genomic profiling have significantly refined the precision with which therapies can be selected for patients with endometrial cancer. These tools enable clinicians to pinpoint genetic and molecular characteristics that dictate tumor behavior and response to treatment, improving personalized treatment strategies and overall survival outcomes. Rather than uniformly applying treatments, clinicians have the ability to tailor therapies based on individual molecular profiles. Adjuvant therapy may still be warranted depending on the risk associated with the molecular/genomic subtypes identified, and best practice histopathology evaluation is still needed even when advanced profiling is done. Further research continues to expand the depth and breadth of genomic profiling, making it a crucial element of modern oncology practice. Learn more about the workup for endometrial cancer. The TCGA molecular classification divides endometrial cancers into four biologically distinct subtypes: POLE-ultramutated, MSI-H, copy number-low (endometrioid), and copy number-high (serous-like). These molecular profiles provide prognostic insights and increasingly guide therapeutic strategies beyond traditional histology and staging. For example, POLE-mutated tumors, despite high mutation burdens, have excellent outcomes and may not require aggressive adjuvant therapy. In contrast, copy number-high tumors are associated with poor prognosis and may benefit from more intensive treatment and HER2-targeted therapies. This classification is part of a shift toward personalized medicine in gynecologic oncology. Learn more about guidelines for endometrial cancer. Compared to traditional open surgery, MIS dramatically shortens hospital stays, decreases blood loss, and has fewer overall complications, although it does lengthen operation time. Furthermore, minimally invasive approaches maintain oncologic outcomes comparable to those of traditional open surgery, providing reassurance regarding their safety and efficacy. Because endometrial cancer patients often have obesity, MIS has the potential to reduce the risk for postoperative wound complications. It also is likely to decrease other postoperative morbidities by supporting faster recovery and earlier resumption of normal daily activities. Additionally, lymph node assessment may still be needed after MIS. Learn more about risk assessment in patients with endometrial cancer.
France 24
17-07-2025
- Health
- France 24
US health experts to reassess hormone replacement therapy risks
HRT is taken to replace estrogen the body stops producing after menopause -- when periods end permanently -- and helps relieve symptoms such as hot flashes and vaginal discomfort. But its use has plummeted in recent years amid concerns over rare side effects, including a potential link to invasive breast cancer. Food and Drug Administration (FDA) chief Marty Makary, who convened Thursday's meeting of outside experts, has long advocated for HRT, saying its risks have been overstated. "For decades, hormone replacement therapy for women -- that is estrogen or estrogen plus progesterone -- has helped women alleviate the symptoms of menopause, including hot flashes, dryness, mood swings, weight gain and poor sleep quality, to name a few," he said in a video. He added that when initiated within a decade of the onset of the transitional period before menopause, HRT may even reduce cognitive decline, the risk of Alzheimer's, and prevent osteoporosis and cardiovascular disease. Makary blamed the drop in HRT use on a landmark clinical trial, the Women's Health Initiative, which was halted in the early 2000s after it flagged increased risks of breast cancer and stroke. But he said subsequent studies had not replicated the findings on breast cancer. Critics of the trial argue it was flawed because the participants were too far from menopause, and that the formulations used are now outdated. Still, the issue remains divisive within the medical community. The FDA's own warning label for HRT -- which can be administered through various means including orally, through skin patches, or vaginally -- cites risks including endometrial cancer, breast cancer, and life-threatening blood clots. This week, the American Journal of Physicians published an editorial that found limited benefits and significant harms associated with HRT. "Menopause is a positive life experience for many women and should not be medicalized," the authors concluded. The nature of the FDA expert meeting is also unusual. Unlike standard practice before the Trump administration, no agenda was publicly posted. Several of the named panelists have ties to companies offering menopause treatments or who belong to the advocacy group "Let's Talk Menopause," which receives funding from pharmaceutical companies and campaigns to revise the FDA warning label.
Health Line
15-07-2025
- Health
- Health Line
Understanding the Types of Multiple Myeloma
Key takeaways The types of active multiple myeloma are categorized by the overproduced immunoglobulin, with IgG being the most common and IgE the rarest and most aggressive. Smoldering multiple myeloma is a precancerous condition without symptoms that can progress to active myeloma, requiring monitoring but not always immediate treatment. Multiple myeloma is a cancer of the plasma cells. Plasma cells are found in the bone marrow. They help your body produce immune system proteins, also known as immunoglobulins or antibodies, that target and destroy pathogens. Pathogens are disease-causing organisms. With multiple myeloma, plasma cells multiply too quickly. They overproduce an irregular protein called a monoclonal protein (M protein). Unlike a healthy immune system antibody, this protein cannot fight pathogens. Common symptoms of myeloma include bone pain, fatigue, and nausea, but not everyone experiences them. This article overviews multiple myeloma types and subtypes and their features. Smoldering vs. active multiple myeloma Smoldering multiple myeloma (SMM) is a precancerous condition that can develop into multiple myeloma over time. People with SMM don't have symptoms, so they're not likely to know they have it. Indeed, most cases are detected incidentally. For example, a doctor might notice increased protein levels during a routine blood or urine test and discover SMM upon further testing. If you have SMM, you may not require any treatment. A doctor might suggest regular monitoring to look for signs of your condition progressing to active myeloma. How often does smoldering multiple myeloma become active? Most cases of SMM eventually progress to active multiple myeloma. According to research cited in a 2022 article: SMM carries a 50% risk of progressing to myeloma within 5 years. SMM carries a 65% risk of progressing to myeloma within 10 years. About 25% of people with SMM never develop myeloma symptoms. Still, the risk can vary a lot from person to person. Higher M protein levels and bone marrow plasma cell percentages carry a higher risk of progression to myeloma within a few years. Types of active multiple myeloma In contrast to healthy plasma cells, myeloma cells only produce one type of immunoglobulin, resulting in a surplus of that type. Myeloma is categorized according to the type of immunoglobulin that's overproduced. There are five types: IgG myeloma: This is the most common type. In a 2020 study including 8,468 people with myeloma, about 57% had IgG. IgA myeloma: In the same study, IgA accounted for 20% of myeloma cases. According to 2020 research, IgA may have lower long-term survival rates than IgG. IgM myeloma: While similar to IgG and IgA, this type is much rarer, making up only 1% of myeloma cases. Overproduction of IgM usually develops into other disorders, like Waldenstrom macroglobulinemia. IgD myeloma: This rare type accounts for less than 2% of myeloma cases. It's more common in males and more likely to start at a younger age. It's typically more aggressive. IgE myeloma: Only 0.1% of myeloma cases are IgE, making it the rarest type. It's more aggressive than other types and has lower survival rates. Light-chain myeloma Light-chain myeloma is the third most common type of multiple myeloma after IgG and IgA. It makes up about 15% of myeloma cases, according to a 2018 review. The term 'light chain' refers to the structure of immunoglobulins, which have two larger heavy chains and two smaller light chains. In light-chain myeloma, myeloma cells produce incomplete immunoglobins that do not have heavy chains. They only have light chains, also known as Bence-Jones proteins. Nonsecretory myeloma Nonsecretory myeloma is a rare form of myeloma that accounts for around 3–5% of cases. It occurs when cancerous myeloma cells are present in the bone marrow but don't make or release any immunoglobulins. This type of myeloma is sometimes more challenging to detect since it doesn't cause elevated levels of immunoglobulins in urine or blood. Doctors may use bone marrow scans, such as CT scans or PET scans, to make a diagnosis. Related plasma chain disorders Myeloma is a type of plasma chain or plasma cell disorder. That means it affects plasma cells' ability to produce immunoglobulins or antibodies. Related plasma chain disorders include: MGUS Monoclonal gammopathy of undetermined significance (MGUS) is a relatively common condition in which M proteins are present in your blood without affecting your health. Different countries have reported MGUS rates ranging from 0.05–6.1%. It's more common among certain groups, such as older adults and Black people. MGUS doesn't usually cause symptoms. Only around 1% of people who have it go on to develop active myeloma each year. Doctors typically suggest monitoring MGUS with regular blood tests. Solitary plasmacytoma A plasmacytoma is a plasma cell tumor. Most plasma cell tumors, including myeloma tumors, grow in the bone marrow. Multiple myeloma causes many tumors in bone marrow all over the body. In contrast, solitary plasmacytoma only causes one tumor. Because solitary plasmacytoma is limited to a single area, it's easier to treat. Doctors can usually remove the tumor via radiation, surgery, or both. Extramedullary plasmacytoma Extramedullary plasmacytoma occurs when a single plasma cell tumor grows in soft tissue rather than bone. In a 2022 study, 62% of these tumors were in the head and neck area. As with solitary plasmacytoma, the cancer is localized to a single area, and treatment with radiation or surgery is usually effective. Light-chain amyloidosis Light-chain amyloidosis is when light-chain proteins produced by abnormal plasma cells accumulate throughout the body. These deposits, known as amyloid deposits, can lead to organ damage. This condition can occur independently of myeloma cancer. However, it can also be a complication of multiple myeloma. Waldenstrom macroglobulinemia Waldenstrom macroglobulinemia (WM) is a rare form of cancer that shares features in common with multiple myeloma. WM cells overproduce IgM, an M protein that's sometimes overproduced in myeloma. Despite this similarity, experts classify WM as a type of non-Hodgkin's lymphoma because it affects the lymphatic system. Hyperdiploid vs. hypodiploid myeloma Doctors sometimes classify multiple myeloma tumors according to the number of chromosomes found in tumor cells: Hyperdiploid myeloma tumors have 47–74 chromosomes. Hypodiploid myeloma tumors have 44 or fewer chromosomes. The authors of a 2021 case report cite research suggesting that hyperdiploid multiple myeloma is typically less aggressive than the hypodiploid type. Frequently asked questions What is the most common type of multiple myeloma? Accounting for more than 50% of all myelomas, IgG is the most common type of multiple myeloma. The next most common types are IgA and light-chain myeloma. What is the most aggressive type of multiple myeloma? According to a 2020 study, IgA and light-chain myeloma are associated with poorer overall survival than other common types. The median overall survival was 4.7 years after diagnosis for people with IgA myeloma and 4.8 years after diagnosis for people with light-chain myeloma. The Canadian Cancer Society reports that IgE is the most aggressive type of myeloma. However, it is extremely rare. What is the difference between kappa and lambda multiple myeloma? Kappa and lambda are two types of light chains. In multiple myeloma, one or the other may be overproduced. According to a 2017 study, myeloma with lambda light chains carries a poorer overall outlook. Takeaway Multiple myeloma is a cancer that causes uncontrolled plasma cell growth. The hallmark of myeloma is the presence of M proteins in blood or urine. The type of M protein overproduced determines the type of myeloma.
Bloomberg
14-07-2025
- Health
- Bloomberg
RFK Jr. Vows to Halt ‘Attack' on Fats in Whole Milk and Cheese
Health and Human Services Secretary Robert F. Kennedy Jr. and other top public health officials said Monday that saturated fats, long blamed for increased risk of heart disease, have been unfairly demonized by the medical community, indicating a pivot on government health guidelines is taking shape. 'There's a tremendous amount of emerging science that talks about the need for more protein in our diets, more fats in our diets,' Kennedy said Monday at a US Department of Agriculture event.
