A WORD FROM HIPPOCRATES…
Dear Mr Browning,
GRONTE: It seems to me you are locating them wrongly: the heart is on the left and the liver is on the right.
SGANARELLE: Yes, in the old days that was so, but we have changed all that, and we now practice medicine by a completely new method.
ALN-PCS CUTS ‘BAD’ CHOLESTEROL
For those patients unable to take statins, a new type of cholesterol-lowering drug could help those at risk of heart disease, new research has revealed.
The treatment referred to as ‘ALN-PCS’ cuts the levels of ‘bad’ cholesterol by more than half – a reduction similar to statins.
Experimental findings from the first tests in humans do show the potential benefits of an agent that works in a different way to statins. The drug blocks production of a protein that destroys receptors that normally clear harmful LDL cholesterol from the bloodstream.
Related:
The first trial has involved 32 volunteers with high LDL (or ‘bad ‘cholesterol). People from this group were then randomly assigned to receive either an injection of ALN-PCS or a saline placebo.
A single dose of the drug cut LDL levels by as much as 57 per cent. The research findings have been published in the medical journal, The Lancet. The researchers suggest that the bigger the dose, the greater reduction in LDL.
Kevin Fitzgerald, a trial investigator from Alnylam Pharmaceuticals, was integral to developing the new treatment. He says the drug – which would likely be developed in tablet form – could be used for the one in five heart disease patients intolerant or resistant to statins, or even to enhance their effects.
ALN-PCS works by blocking the production of the cholesterol regulator PCSK9 – a protein that destroys low-density lipoprotein (LDL) receptors that normally clear LDL cholesterol from the blood.
Genetic research has shown previously that mutations’ resulting in a rise in PCSK9 activity does lead to a major increase in LDL cholesterol. This contributes to the build-up of plaque inside blood vessels, while genetic variants that cause a reduction in PCSK9 activity are known to lower cholesterol dramatically.
The 32 volunteers selected for the trial, aged between 18 and 65 years old, were deemed to have raised cholesterol levels ranging from between mild to moderate. The volunteers were randomly assigned to receive injections containing one of six doses of ALN-PCS, or saline.
For those given the highest dose of ALN-PCS, LDL cholesterol dropped up to 57 per cent – with an average of 40 per cent overall – compared with the results from those who had taken the saline placebo.
Professor Peter Weissberg is medical director at the British Heart Foundation. He said:
… People with extremely high cholesterol are at increased risk of a heart attack and this approach could offer new hope for those who are resistant to statins.
… These initial results add to growing evidence that blocking the action of a certain protein can dramatically lower ‘bad’ LDL cholesterol.
… More research is now needed to confirm this approach is both safe and effective at preventing heart attacks in the long term before it becomes widely available.
According to further research in the United States, statins may also help keep the mouth as well as the heart healthy. Significantly reduced levels of inflammation associated with gum disease were found in patients taking statin pills for heart conditions.
Dr Ahmed Tawakol, the study leader, and from the Harvard Medical School, said gum and heart disease were often ‘co-existing inflammatory conditions’ and that their chemical biologies ‘may be intertwined’.
OUT-OF-HOURS CARE
The crisis facing out-of-hours primary care services is largely down to the health policy pursued by the last Labour government. Whilst it is a bit rich for Andy Burnham, the shadow health secretary, to accuse the present Government of ‘an epic U-turn’ for announcing a financial package intended to encourage GP surgeries to stay open in the evenings and at weekends – in reversing the mess the Government inherited from Labour – Mr Burnham has a case if we put hypocrisy aside. As the implications of the new contract began to take hold, the last government offered something very similar to what is being offered to GPs now – but funding was withdrawn by the Coalition when they came to office on the basis that there was no demand for the services. Now, though, an additional £50 million is being earmarked for doctors’ surgeries that want to remain open during unsociable hours or those GPs that wish to embrace new, hi-tech consultation methods.
Surely, the time has come to repair the huge damage caused by Labour’s poorly-judged contract with GPs in 2004. The contract removed responsibility for out-of-hours care from GPs, the majority of who opted out of providing it. The consequences are well-documented: demand has been pushed on to hospital A&E services with the resultant pressures making many A&E units unable to cope with a winter crisis. Worse still, has been the non-emergency telephone advice service which has been found seriously wanting with patients left frustrated in their efforts to make appointments at times convenient to them rather than to the practitioners.
The current Health Secretary, Jeremy Hunt, says he wants GPs to ‘rediscover family doctoring’, an ambition no-doubt that will be shared by most people. Innovative ideas such as wider use of email and Skype are good ones that could help to restore an element of personal contact with surgeries when people need it most.
Who would doubt that it is in the interests of GPs that they play their part in bringing about a more modern, proactive and flexible service for their patients?
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