Health
“Although mortality from many cancers has been steadily falling, particularly those of the blood [I.e., leukemias], the more important statistic may be that so many epithelial cancers (carcinomas) and effectively all mesenchymal cancers (sarcomas) remain largely incurable.”
With these words as preface, Nobel laureate James D. Watson, Ph.D., in a newly published paper that he regards “among my most important work since the double helix,” sets forth a novel hypothesis regarding the role of oxidants and antioxidants in cancers that are currently incurable, notably in late-stage metastatic cancers.
At the heart of his thesis are the group of molecules that scientists call reactive oxygen species, or ROS. Noting their fundamental two-sidedness, Watson calls ROS “a positive force for life” because of their role in apoptosis – an internal program that highly stressed cells use to commit suicide.
It’s one of the key mechanisms that have arisen through eons of evolution to weed out biological dysfunction that poses a threat to the survival of organisms.
On the other hand, ROS are also well understood – indeed are notorious – “for their ability to irreversibly damage key proteins and nucleic acid molecules [e.g., DNA and RNA].”
When they’re not needed to curb wayward or out of control cells, which is to say under normal circumstances, ROS are constantly being neutralized by anti-oxidative proteins.
We are often urged to eat foods rich in antioxidants such as blueberries; but, if Watson is correct about the role of ROS and antioxidants in late-stage cancer, as he writes in his new paper, “blueberries best be eaten because they taste good, not because their consumption will lead to less cancer.”
Understanding why this might be so – why antioxidants can in late-stage cancers actually promote cancer progression – is central to Watson’s paper, which appears online January 9 in Open Biology, a journal of Great Britain’s Royal Society.
He proposes that the cell-killing ability of currently used anti-cancer therapies – toxic chemotherapeutic agents such as Taxol as well as radiation treatment – is mainly due to the action of ROS to induce apoptosis, or programmed cell death.
This would explain “why cancers that become resistant to chemotherapeutic control become equally resistant to radiotherapy.” The common feature would be their common dependence upon a ROS-mediated cell-killing mechanism.
Watson, who is Chancellor Emeritus of Cold Spring Harbor Laboratory, then takes up the case of cancer cells largely driven by mutant proteins such as RAS and MYC.
These, he notes, are often hardest to get to respond to treatment. He suggests this could be due to their high levels of ROS-destroying antioxidants.
He cites recent research showing up-regulation of a gene transcription factor called Nrf2 when cells proliferate as well as when oncogenes such as RAS, MYC and RAF are active. Nrf2 controls the synthesis of antioxidants, and “this makes sense because we want antioxidants present when DNA functions to make more of itself,” Watson writes.
In calling for “a much faster timetable for developing anti-metastatic drugs,” the Nobel laureate wants those reading his new paper to consider a proposition he considers grossly underexplored: “Unless we can find ways of reducing antioxidant levels, late-stage cancer 10 years from now will be as incurable as it is today.”
- Details
- Written by: Editor
Doctors and health care providers have formed 106 new Accountable Care Organizations (ACOs) in Medicare, ensuring as many as 4 million Medicare beneficiaries now have access to high-quality, coordinated care across the United States, Health and Human Services (HHS) Secretary Kathleen Sebelius announced.
Doctors and health care providers can establish ACOs in order to work together to provide higher-quality care to their patients.
Since passage of the Affordable Care Act, more than 250 Accountable Care Organizations have been established.
Beneficiaries using ACOs always have the freedom to choose doctors inside or outside of the ACO. ACOs share with Medicare any savings generated from lowering the growth in health care costs, while meeting standards for quality of care.
“Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare,” Secretary Sebelius said. “Thanks to the Affordable Care Act, more doctors and hospitals are working together to give people with Medicare the high-quality care they expect and deserve.”
ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely.
The Centers for Medicare & Medicaid Services (CMS) has established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. Federal savings from this initiative could be up to $940 million over four years.
The new ACOs include a diverse cross-section of physician practices across the country. Roughly half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries.
Approximately 20 percent of ACOs include community health centers, rural health centers and critical access hospitals that serve low-income and rural communities.
The group announced also includes 15 Advance Payment Model ACOs, physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems, or other infrastructure required to improve care coordination. Medicare will recoup advance payments over time through future shared savings.
In addition to these ACOs, last year CMS launched the Pioneer ACO program for large provider groups able to take greater financial responsibility for the costs and care of their patients over time. In total, Medicare’s ACO partners will serve more than 4 million beneficiaries nationwide.
Also HHS issued a new report showing Affordable Care Act provisions are already having a substantial effect on reducing the growth rate of Medicare spending.
Growth in Medicare spending per beneficiary hit historic lows during the 2010 to 2012 period, according to the report.
Projections by both the Office of the Actuary at CMS and by the Congressional Budget Office estimate that Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade, breaking a decades-old pattern of spending growth outstripping economic growth.
- Details
- Written by: Editor
How to resolve AdBlock issue?