Stopping Herpes From Going Viral

herpes-simplex-virusOn Wednesday SRxA’s Word on Health reported on a link between memory loss and cognitive decline and the herpes virus.  Today, we bring a glimmer of hope to the 65% – 90% of people worldwide affected with either type 1 or Type 2 herpes simplex virus.

In the US alone, it’s estimated that nearly 60 percent of U.S. men and women between the ages of 14 and 49 carry the HSV-1 virus, while >16.2% are infected with herpes simplex virus type 2 (HSV-2).

HSV-2 is a lifelong and incurable infection that can cause recurrent and painful genital sores and can make those infected with the virus two-to-three times more likely to acquire HIV.

Now, according to a study just published in the Journal of the Federation of American Societies for Experimental Biology (FASEB), researchers from Albert Einstein College of Medicine of Yeshiva University have discovered a novel strategy for preventing, treating or suppressing herpes virus infections.

molecule_key_chains-We’ve essentially identified the molecular “key” that herpes viruses use to penetrate cell membranes and infect cells of the human body,” said Betsy Herold, MD of The Children’s Hospital at Montefiore.

Dr. Herold and her colleagues had previously shown that infection by the herpes viruses depends on calcium released within the cells. In this study, they found that calcium release occurs because the viruses activate a critical cell-signaling molecule called Akt [also known as Protein Kinase B (PKB) ] at the cell membrane.

As part of their investigation of Akt’s role in herpes infections, the researchers took laboratory cultures of human cell and mixed them for 15 minutes with four different drugs known to inhibit Akt. The cells were then exposed for one hour to herpes simplex virus 2.

The drugs tested were:

  • MK-2206 – an experimental drug being studied as adjunct therapy for cancer
  • Akt Inhibitor VIII
  • Miltefosine, a drug licensed for treatment of leishmaniasis and other protozoal infections
  • Perifosine, an experimental agent in phase 3 clinical trials for treatment of several cancers

STOPAll four of the drugs significantly inhibited HSV infection in each of the cell types.  Miltefosine was the most potent and reduced viral plaques by 90% in all cell types.

By contrast, cells not pre-treated with the Akt inhibitors were readily infected on exposure to the virus.

For people infected with herpes, the drug acyclovir helps prevent herpes outbreaks from recurring and lowers the risk of transmitting the infection to others,” said Dr. Herold. “But some people have herpes infections that don’t respond to acyclovir, and unfortunately there is no effective vaccine. So new approaches for suppressing and treating herpes infections are badly needed, and our findings indicate that inhibiting Akt should be a useful therapeutic strategy to pursue.”

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Testing, Testing… $, $$, $$$

healthcare-costsIf doctors knew the exact price of expensive medical tests would they order fewer of them?

That’s exactly what Johns Hopkins researchers wanted to know.

The answer has just been published in the Journal of the American College of Radiology, and it’s a resounding: No!.  According to the investigators, revealing the costs of MRIs and other imaging tests up front had no impact on the number of tests doctors ordered for their hospitalized patients.

Cost alone does not seem to be the determining factor in deciding to go ahead with an expensive radiographic test,” says the study’s senior author, Daniel J. Brotman, M.D., director of the hospitalist program at The Johns Hopkins Hospital. “There is definitely an over-ordering of tests in this country, and we can make better decisions about whether our patients truly need each test we order for them. But when it comes to big-ticket tests like MRI, it appears the doctors have already decided they need to know the information, regardless of the cost of the test.”

MRISome earlier studies have suggested that much of the expense of laboratory tests, medical imaging and prescription drugs is unknown or hidden from providers and patients at the time of ordering, leaving financial considerations largely out of the health care decision-making process and likely driving up costs. Other studies have shown that doctors ordered fewer laboratory tests in some cases when they were given the price up front.

But, imaging tests appear to be “a different animal.”

Although there are certain inherent disincentives, aside from cost, to ordering some major tests, such as the potential danger of radiation used, physicians also need to learn how to explain to patients why they may not need them.

For the six months of the study, Brotman and his colleagues identified the 10 imaging tests most frequently ordered for patients at The Johns Hopkins Hospital. Five of these were randomly assigned to the active cost display group and 5 to the control group. During a 6-month baseline period from November 10, 2008, to May 9, 2009, no costs were displayed. During a seasonally matched period from November 2009, to May  2010, costs were displayed only for tests in the active group. At the conclusion of the study, the radiology information system was queried to determine the number of orders executed for all tests during both periods.

And, when they compared the ordering rates to the rates from a six-month period a year earlier, when no costs were displayed at all, they found no significant difference in ordering patterns.

Is this a good or a bad thing?

MRI of strokeCertainly there are many instances when expensive tests are justified. When a key diagnosis is needed there are limited options for comparison shopping.  For example, when a patient appears to have had a sub-acute stroke, an MRI is needed regardless of cost.

That is not to say there aren’t times when physicians need to look more closely at whether too many imaging tests are being ordered. Do ventilated intensive care unit patients really need a daily chest X-ray to look for potential lung problems?  Especially when there is good medical evidence that outcomes aren’t compromised if X-rays are ordered only when the patient’s condition appears to be worsening.

For too long, there has not been enough attention paid to the bottom line in health care,” Brotman says. This isn’t about rationing care to hold down costs, he says, but about choosing tests a little more wisely.

health-care-costEven though price transparency didn’t influence the way physicians ordered imaging tests in this study, financial considerations may play a role in other circumstances if tied to clinical evidence.

If you show a provider that he or she is ordering four times as many CT scans as a colleague whose patients have similar outcomes, it could change the decision-making calculus for the better.

Cost transparency must be part of the solution to solving fiscal challenges in medicine,” Brotman says. “Providers have no idea how much they’re spending. Patients don’t know either. Having everyone understand more of the economics of health care is a great place to start cutting costs in medicine.”

Seems logical to us.

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A Question of Health

As we’ve said before, and will doubtless say again – the more patients become more actively involved in their own health, the better the outcome.

So we were pleased to learn of a new public education initiative from the U.S. Agency for Healthcare Research and Quality (AHRQ), which encourages patients to have more effective two-way communication with their doctors and other clinicians.

The “Questions are the Answer,” campaign features a website packed with helpful advice and free educational tools for doctors and patients. Among the offerings:

  • A 7-minute video featuring real-life patients and clinicians who give firsthand accounts on the importance of asking questions and sharing information. The video has been designed for use in a patient waiting room area and can be set to run on a continuous loop
  • A brochure, titled “Be More Involved in Your Health Care: Tips for Patients,” that offers helpful suggestions to follow before, during and after a medical visit
  • Notepads to help patients prioritize the top three questions they wish to ask during their medical appointment.

In addition, the site has a series of patient and clinician videos in showing how simple questions can help you take better care of yourself, feel better, and get the right care at the right time. In one of these, Rachelle Toman, M.D., Ph.D., a family physician from Washington D.C., says if you are happy to ask your doctor and grocery store clerk a question, then why not your healthcare provider?

Patients need to come forth with questions, and providers need to be open about asking their patients questions, and asking their patients to ask questions,” she continues.

Put simply, questions allow doctors to take better care of you.

Are you ready to become an active member of your health care team and get your questions answered?