CVS-Aetna Deal Could Mean End of Era in How Drugs Are Paid For

If Aetna Inc. is eventually swallowed by CVS Health Corp., an important part of the health-care business will be changed — perhaps for good.

For years, pharmacy benefits were largely carved out from the rest of a medical coverage plan. But increasingly the two services are being combined, a move that in theory will make it easier to verify whether expensive drugs are worth the cost. A merger of the third-biggest health insurer with the largest U.S. drugstore chain, which also operates a pharmacy-benefit management company, could speed the process.

“You are hearing the warning for the end of the road for the classic standalone” pharmacy-benefit business, said Pratap Khedkar, managing principal at consulting firm ZS Associates.

Drugmakers are producing more pricey treatments for cancer and rare diseases. Combining drug and medical benefits in the same place is “the only way” payers will figure out whether such expensive new drugs are actually making people better and saving money by keeping them out of the hospital, he said.

A merger of CVS and Aetna would create a health-care behemoth and put huge pressure on standalone players such as Express Scripts Holding Co. and Walgreens Boots Alliance Inc. Express Scripts would become the last major standalone pharmacy-benefit manager not allied with a major insurer. 

All Channels

CVS and Aetna have held discussions about a potential deal, according to people familiar with the matter who asked not to be identified as the details aren’t public. A newly combined company would “own the entire chain, from prescribing and filling prescriptions to the health plans that pay for them,” said Michael Rea, of Rx Savings Solutions, which has an app that helps patients find lower cost drugs.

Under a combined roof, the insurance arm of CVS-Aetna could help keep costs down by routing patients needing basic urgent care to CVS-owned walk-in clinics and keeping them out of expensive hospital emergency rooms, analyst Ann Hynes of Mizuho Securities said in a note to clients. The company would also become a formidable competitor to UnitedHealth Group Inc., the biggest health insurer and owner of its own PBM unit, OptumRx.

But even with the new clout, a merger isn’t likely to be derailed by federal antitrust authorities, said John Briggs, an antitrust attorney at Axinn Veltrop & Harkrider in Washington.

CVS and Aetna declined to comment.

Walgreens, the No. 2 drugstore operator, could also feel the pressure. A CVS-Aetna marriage could cause the drugstore chain to look for its own acquisition targets, with Express Scripts being the most likely, Charles Rhyee, an analyst at Cowen & Co., wrote in a note to clients Friday.

And then there’s Amazon.com Inc., which recently gained drug-wholesaler licenses in 14 states. The looming threat of the e-commerce behemoth entering the mail-order pharmacy business and pushing down profit margins for drug distributors, benefit managers and retail pharmacies intensifies the pressure on standalone players.

For CVS, the move is “a natural defense against the potential threat of Amazon entering the retail pharmacy market,” Rhyee said.

Another possibility is that Amazon could buy Express Scripts. That would give the internet retailer an instant and large foothold in both the PBM industry and the mail-order pharmacy business.

‘Strong’ Model

Health insurer Anthem Inc., Express Scripts’ biggest current client, announced earlier this month that it would leave Express Scripts when its contract ends at the end of 2019 to form its own PBM unit. And Prime Therapeutics, another major player, manages drug benefits for nonprofit Blue Cross and Blue Shield plans in numerous states.

“Our model is strong and thriving,” said Jennifer Luddy, a spokeswoman for Express Scripts. “We believe in the value that we provide to our customers as an independent PBM.”

On an earnings call this week, Express Scripts Chief Executive Officer Tim Wentworth said he was open to a deal with Amazon to help serve cash-paying patients.

Walgreens declined to comment.

In terms of the CVS-Aetna deal, antitrust authorities will look closely at the competition between the companies in selling Medicare Part D plans for the elderly, said Briggs, the attorney.

There could be fight between the Justice Department and the Federal Trade Commission, which share antitrust enforcement, over which agency will investigate the merger, according to Briggs. The Justice Department handles insurer mergers and successfully stopped the combination of Aetna and Humana Inc. this year. The FTC investigates retail pharmacy deals. In September, it cleared Walgreens’ acquisition of 1,900 Rite Aid Corp. stores after Walgreens shrank the size of the deal.

Still, a CVS-Aetna deal would likely win approval because a number of other major players will remain in the Part D market, he said.

“That’s an easy fix,” Briggs said. “The whole deal is not going to crater on account of Part D.”

    Read more: http://www.bloomberg.com/news/articles/2017-10-27/cvs-aetna-deal-could-mean-end-of-era-in-how-drugs-are-paid-for

    Acid reflux drug linked to more than doubled risk of stomach cancer study

    There are more than 50m prescriptions for proton pump inhibitors in the UK, though they have previously been linked to side-effects and increased risk of death

    A drug commonly used to treat acid reflux is linked to a more than doubled risk of developing stomach cancer, researchers have claimed.

    Proton pump inhibitors (PPIs) reduce the amount of acid made by the stomach and are used to treat acid reflux and stomach ulcers.

    A study published in the journal Gut identified an association between long-term use of the drug and a 2.4 times higher risk of developing stomach cancer. In the UK, there are more than 50m prescriptions for PPIs every year but they have been linked to side-effects and an increased risk of death.

    A link between PPIs and a higher stomach cancer risk has previously been identified by academics but never in a study that first eliminates a bacteria suspected of fuelling the illnesss development.

    Research by the University of Hong Kong and University College London found that after the Helicobacter pylori was removed, the risk of developing the disease still rose in line with the dose and duration of PPI treatment.

    They compared the use of PPI against another drug which limits acid production known as H2 blockers in 63,397 adults. The participants selected had been treated with triple therapy, which combines PPI and antibiotics to kill off the H pylori bacteria over a week, between 2003 and 2012.

    Scientists then monitored them until they either developed stomach cancer, died or reached the end of the study at the end of 2015.

    During this period, 3,271 people took PPIs for an average of almost three years, while 21,729 participants took H2 blockers. A total of 153 people developed stomach cancer, none of whom tested positive for H plyori but all had long-standing problems with stomach inflammation, the study found.

    While H2 blockers were found to have no link to a higher risk of stomach cancer, PPIs was found connected to an increased risk of more than double.

    Daily use of PPIs was associated with a risk of developing the illness that was more than four times higher (4.55) than those who used it weekly. Similarly, when the drug was used for more than a year, the risk of developing stomach cancer rose five-fold, and as high as eight-fold after three or more years, the findings showed.

    The study concluded no firm cause and effect could be drawn, but doctors should exercise caution when prescribing long-term PPIs even after successful eradication of H plyori.

    Responding to the study, Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, said: Many observational studies have found adverse effects associated with PPIs.

    The most plausible explanation for the totality of evidence on this is that those who are given PPIs, and especially those who continue on them long-term, tend to be sicker in a variety of ways than those for whom they are not prescribed.

    Read more: https://www.theguardian.com/science/2017/oct/31/acid-reflux-drug-linked-to-more-than-doubled-risk-of-stomach-cancer-study

    Opioid Billionaire’s Indictment Opens New Window on Epidemic

    More than a decade after opioid painkillers first exploded across the U.S., John Kapoor found an aggressive way to sell even more, according to prosecutors: He began bribing doctors to prescribe them.

    Speakers’ fees, dinners, entertainment, cash — federal charges unsealed Thursday claim Kapoor’s striving company, Insys Therapeutics Inc., employed all of that and more to spur prescriptions of a highly addictive fentanyl-based drug intended only for cancer patients.

    As President Donald Trump declared at a White House event that opioid abuse represents a public-health emergency, authorities arrested Kapoor in Arizona and painted a stark portrait of how Insys allegedly worked hand in glove with doctors to expand the market for the powerful agents.

    “Selling a highly addictive opioid-cancer pain drug to patients who did not have cancer makes them no better than street-level drug dealers,” Harold Shaw, the top FBI agent in Boston, said of Kapoor and other Insys executives charged earlier in the case.

    The story of the 74-year-old billionaire and the company he founded traces the arc of a crisis that claims 175 lives each day. What began with the over-prescription of painkillers in the late 1990s soon became a race by manufacturers to dispense more and more pills.

    Overdose Risks

    Charged with racketeering conspiracy and other felonies, Kapoor became the highest-ranking pharma executive to be accused of an opioid-related crime, and his arrest may portend charges against companies far larger than Insys, which has a modest $417 million market capitalization.

    In Connecticut, prosecutors have begun a criminal probe of Purdue Pharmaceutical Inc.’s marketing of OxyContin. Scores of states, cities and counties have sued companies including Purdue, Endo International Plc, and Johnson & Johnson’s Janssen Pharmaceuticals, alleging they triggered the opioid epidemic by minimizing the addiction and overdose risks of painkillers such as Percocet.

    But so far, no recent case has been so sweeping as the one against the executives including Kapoor, who made his initial court appearance late Thursday in Phoenix. A U.S. magistrate judge set bail at $1 million and ordered Kapoor to surrender his passport and submit to electronic monitoring. His lawyer, Brian Kelly, said Kapoor posted bail after the hearing.

    This week, a Rhode Island doctor admitted accepting kickbacks from Insys in exchange for writing prescriptions. Earlier this year, two doctors were sentenced to more than 20 years behind bars for accepting bribes from companies including Insys to sell fentanyl-based medications.

    The Kapoor indictment pinpoints the start of the alleged scheme.

    Oral Spray

    It was early 2012, and Insys’s new oral spray of the opioid fentanyl wasn’t selling well. Because it was so addictive, the pain-relief drug was subject to a tightly controlled distribution system, and regulators demanded to be notified about suspicious orders by manufacturers, wholesalers and pharmacies. And the drug wasn’t cheap, so insurers set up barriers for patients seeking it.

    That was when Kapoor and others at Insys went to extremes to dramatically boost sales of the painkiller, prosecutors said. Doling out speaker fees, marketing payments and food and entertainment perks, they allegedly began bribing doctors to prescribe the drug, and then tricked insurers into paying for it.

    One Insys sales executive told subordinates that it didn’t matter whether doctors were entertaining, according to the indictment: “They do not need to be good speakers, they need to write a lot of” Subsys prescriptions, the official said, referring to the brand name of the painkiller.

    Over a two-year period starting in 2013, Chandler, Arizona-based Insys set aside more than $12.2 million for doctors’ speaking fees, prosecutors said. One doctor received as much as $229,640 in speaker fees for appearing at what amounted to “sham events that were mere social gatherings also attended by friends and office staff,” according to the indictment.

    Friends, Family

    The company encouraged doctors to write more prescriptions by hiring their friends and family members to serve as “business liaisons’’ and “business-relation managers,’’ prosecutors said. These support-staff employees worked in the doctors’ offices but were paid by Insys in what the indictment called bribes and kickbacks.

    Insys even made a video featuring a sales rep dressed as a giant fentanyl spray bottle, rapping and dancing to a song that pushed the idea of getting doctors to prescribe higher doses, prosecutors said.

    Others previously charged include Michael Babich, Insys’s former CEO, Alec Burlakoff, the ex-vice president of sales, and Richard Simon, once the company’s national sales director. They all deny wrongdoing.

    Joe McGrath, an Insys spokesman, declined to comment on Kapoor’s indictment in Boston federal court. The company, which wasn’t charged, has reportedly been in settlement talks with the U.S. Justice Department to resolve a probe into its Subsys marketing. The company’s shares fell more than 22 percent to $5.74 in Nasdaq trading.

    The Lawyer Who Beat Big Tobacco Takes On the Opioid Industry

    The first person in his family to attend college, Kapoor rose from modest means in India to become a wealthy health-care entrepreneur, after earning a doctorate in medicinal chemistry at the University of Buffalo in 1972, according to a work-history the school posted.

    He was a plant manager at Invenex Laboratories in New York and later became chief executive officer of LyphoMed, a hospital-products company. He sold LyphoMed to Fujisawa Pharmaceuticals and formed a venture capital firm that invested in health-care companies.

    In 2010, he merged privately held Insys with NeoPharm Inc. to get access to technology to develop pain drugs for cancer patients. Even though he has stepped down as Insys’s chairman and chief executive officer, he still holds more than 60 percent of its stock.

    Kapoor and Babich are also accused of misleading insurers about patients’ diagnoses and the types of pain they suffered that were covered by the Subsys prescriptions tied to the payment scheme, prosecutors said.

    The company’s agents allegedly told insurers that patients were receiving Subsys for “breakthrough pain’’ to secure coverage. They also misled insurers about what other pain drugs patients had tried before being proscribed Subsys, according to the indictment.

    Some lower-level Insys employees have pleaded guilty and are cooperating with prosecutors, according to court papers. Elizabeth Gurrieri, a former manager who oversaw insurance reimbursements, pleaded guilty to one count of conspiring to commit wire fraud in June.

      Read more: http://www.bloomberg.com/news/articles/2017-10-26/insys-therapeutics-founder-charged-in-opioid-fraud-case

      Trump Officials Dispute the Benefits of Birth Control to Justify Rules

      When the Trump administration elected to stop requiring many employers to offer birth-control coverage in their health plans, it devoted nine of its new rule’s 163 pages to questioning the links between contraception and preventing unplanned pregnancies.

      In the rule released Friday, officials attacked a 2011 report that recommended mandatory birth-control coverage to help women avoid unintended pregnancies. That report, requested by the Department of Health and Human Services, was done by the National Academies of Sciences, Engineering and Medicine — then the Institute of Medicine — an expert group that serves as the nation’s scientific adviser.

      “The rates of, and reasons for, unintended pregnancy are notoriously difficult to measure,” according to the Trump administration’s interim final rule. “In particular, association and causality can be hard to disentangle.”

      Multiple studies have found that access or use of contraception reduced unintended pregnancies. 

      Claims in the report that link increased contraceptive use by unmarried women and teens to decreases in unintended pregnancies “rely on association rather than causation,” according to the rule. The rule references another study that found increased access to contraception decreased teen pregnancies short-term but led to an increase in the long run.

      “We know that safe contraception — and contraception is incredibly safe — leads to a reduction in pregnancies,” said Michele Bratcher Goodwin, director of the Center for Biotechnology and Global Health Policy at the University of California, Irvine, School of Law. “This has been data that we’ve had for decades.”

      Riskier Behavior

      The rules were released as part of a broader package of protections for religious freedom that the administration announced Friday.

      The government also said imposing a coverage mandate could “affect risky sexual behavior in a negative way” though it didn’t point to any particular studies to support its point. A 2014 study by the Washington University School of Medicine in St. Louis found providing no-cost contraception did not lead to riskier sexual behavior.

      The rule asserts that positive health effects associated with birth control “might also be partially offset by an association with negative health effects.” The rule connects the claim of negative health effects to a call by the National Institutes of Health in 2013 for the development of new contraceptives that stated current options can have “many undesirable side effects.” 

      The rule also describes an Agency for Healthcare Research and Quality review that found oral contraceptives increased users’ risk of breast cancer and vascular events, making the drugs’ use in preventing ovarian cancer uncertain.

      Federal officials used all of these assertions to determine the government “need not take a position on these empirical questions.”

      “Our review is sufficient to lead us to conclude that significantly more uncertainty and ambiguity exists in the record than the Departments previously acknowledged.”

        Read more: http://www.bloomberg.com/news/articles/2017-10-06/trump-officials-dispute-birth-control-benefits-to-justify-rules

        Color Genomics goes beyond cancer with a test for heart health

        Cancer and heart disease are the two leading causes of death in the United States. So far, Color Genomics has been focused on testing for mutations leading to a higher risk of certain cancers. But, today the four-year-old company is introducing a new category of genetic testing for cardiovascular health.

        The new Color Hereditary High Cholesterol Testwill tell you if you have a genetic mutation for something called Familial Hypercholesterolemia (FH), a hereditary condition that causes high cholesterol levels leading to coronary heart disease.

        Possibly 34 million people are affected by the disease worldwide. About one in fifty people with high cholesterol have the mutation. The problem? Most people with the genetic mutation dont know they have it until they have a potentially fatal heart attack.

        Like cancer testing, earlier detection of the mutation can prevent the disease, improve survival rates and reduce medical costs. And thats where Color hopes its new test can help.

        We started with cancer because it was one of the leading causes of death and the science around genetics and cancer was well-established, Color chief marketing officer Katie Jacobs Stanton told TechCrunch. Similarly, there is well-established science around genetics and cardiovascular diseaseGiven that cardiovascular disease is the leading cause of death (and combined with cancer costs over $1.1trillion per year), we saw an opportunity to help more people learn their risk of developing hereditary cardiovascular conditions and proactively managing their heart health using genetic data.

        Unlike at-home genetic tests like 23andMe, you order this one through your doctor. The test is $249 for new customers. However, those whove gone through Colors cancer testing can purchase the cardiovascular test for an additional $150.

        Read more: https://techcrunch.com/2017/08/10/color-genomics-goes-beyond-cancer-with-a-test-for-heart-health/

        BOOM: John McCain tweets gratitude, reminds Twitter he’s still kicking ass and taking names

        Can’t keep a good senator down … especially not John McCain:

        Read more: http://twitchy.com/samj-3930/2017/07/20/boom-john-mccain-tweets-gratitude-reminds-twitter-hes-still-kicking-ass-and-taking-names/

        John McCain has been diagnosed with brain cancer, spokesman says

        Statement reveals brain tumor known as glioblastoma was removed along with blood clot above senators right eye during surgery last Friday

        John McCain, the Arizona senator and former Republican presidential candidate, has been diagnosed with brain cancer.

        A brain tumor known as a glioblastoma was removed from McCain along with a blood clot in a surgery at the Mayo Clinic on Friday, a spokesperson said on Wednesday.

        McCains office had only previously announced that the blood clot had been removed from above the 80-year-olds left eye.

        The Mayo Clinic said in a statement released by McCains office: The senator and his family are reviewing further treatment options with his Mayo Clinic care team. Treatment options may include a combination of chemotherapy and radiation. The senators doctors say he is recovering from his surgery amazingly well and his underlying health is excellent.

        The surgery had forced McCain to stay in Arizona this week and miss votes in the Senate. It had led to a delay in the vote on the Senate Republican bill to repeal and replace the Affordable Care Act (ACA), which was originally scheduled for Monday. Since the delay was announced, a sufficient number of Republican senators came forward to express their opposition to the bill and forced the majority leader, Mitch McConnell, to shelve it and instead try to push a vote on a clean repeal of the ACA.

        In a statement, the Arizona senators spokesperson said that in the aftermath of his diagnosis, further consultations with [the] Mayo Clinic care team will indicate when he will return to the United States Senate.

        An extended absence would likely make it even more difficult for Republicans to repeal or replace the ACA, popularly known as Obamacare. Senate Republicans have a narrow 52-48 majority and, with the tie-breaking vote of Mike Pence, can only afford to lose two votes if McCain is present. His absence means that two Republican no votes would now sink any legislation if all 48 Democrats are unified in opposition.

        McCain, who was re-elected to his sixth term in the Senate in 2016, was the Republican partys presidential nominee in 2008 and finished second to George W Bush in the 2000 GOP presidential primary. Prior to his career in politics, McCain served as an aviator in the US navy, and was held as prisoner of war for five and a half years during the Vietnam war. While being held captive by the north Vietnamese, McCain was repeatedly subjected to torture. He retired as a captain after earning a number of decorations including the Silver Star, the Bronze Star and the Distinguished Flying Cross.

        The Arizona senators illness sparked an outpouring of support from both sides of the aisle.

        In a statement, Donald Trump said: Senator John McCain has always been a fighter. Melania and I send our thoughts and prayers to Senator McCain, Cindy, and their entire family. Get well soon. Trump, who famously set off a political firestorm in 2015 by saying McCain was not a war hero, said earlier in the week of the Arizona senator: We hope John McCain gets better very soon because we miss him. Hes a crusty voice in Washington. Plus we need his vote. And hell be back.

        Barack Obama, against whom McCain ran in the 2008 presidential election, tweeted: John McCain is an American hero & one of the bravest fighters Ive ever known. Cancer doesnt know what its up against. Give it hell, John.

        Barack Obama (@BarackObama)

        John McCain is an American hero & one of the bravest fighters I’ve ever known. Cancer doesn’t know what it’s up against. Give it hell, John.

        July 20, 2017

        A number of McCains colleagues in the Senate also expressed their well wishes. In a statement, Mitch McConnell said: John McCain is a hero to our Conference and a hero to our country. He has never shied from a fight and I know that he will face this challenge with the same extraordinary courage that has characterized his life. The entire Senate familys prayers are with John, Cindy and his family, his staff, and the people of Arizona he represents so well. We all look forward to seeing this American hero again soon.

        Outside a meeting of Senate Republicans to discuss healthcare reform on Wednesday night, senator John Hoeven of North Dakota said they had learned of the diagnosis during the meeting.

        It was very emotional almost kind of stunned disbelief, Hoeven told reporters. Senator James Lankford, of Oklahoma, then led them in prayer.

        Hoeven said the senators had received a message from McCain via South Carolina senator Lindsay Graham, a close friend. The senator told them he was eager to get back and get to work, Hoeven added.

        Graham was visibly emotional as he recalled his conversation with McCain when he learned of the diagnosis.

        He says, Ive been through worse, Graham told reporters. Five minutes into the call, however, McCain wanted to talk the legislative priories, Graham said.
        God knows how this ends, he said. But I do know this: This disease has never had a more worthy opponent.

        In a statement, McCains daughter Meghan said: He is a warrior at dusk, one of the greatest Americans of our age, and the worthy heir to his fathers and grandfathers name. But to me, he is something more. He is my strength, my example, my refuge, my confidante, my teacher, my rock, my hero my Dad.

        Meghan McCain (@MeghanMcCain)

        Statement regarding my father @SenJohnMcCain: pic.twitter.com/SMte9Hkwkq

        July 20, 2017

        Lauren Gambino contributed to this report.

        Read more: https://www.theguardian.com/us-news/2017/jul/19/john-mccain-brain-cancer

        Mendel.ai nabs $2 million to match cancer patients with the latest clinical trials

        Dr. Karim Galil was tired. He was tired of losing patients to cancer. He was tired of messy medical records. And he was tired of trying to stay on top of the avalanche of clinical trials touting one solution or another. Losing both patience and too many patients, Galil decided to create an organized and artificially intelligent system to match those under his care with thebest diagnostic and treatment methods available.

        He called his new system Mendel.ai after Gregor Mendel, the father of modern genetics science, and has just raised $2 million in seed funding from DCM Ventures, Bootstrap Labs and Launch Capitalto get the project off the ground.

        Mendel.ai is similar in many ways to the U.K.-based BenevolentBio, which is focused on skimming through scientific papers to find the latest in cutting-edge medical research. But rather than using keyword data, Mendal.ai uses analgorithm that understands the unstructured, natural language content within medical documents pulled from clinicaltrials.gov,and then compares it to a patients medical record. The search process returns a fully personalized match and evaluates the patients eligibility for each suggested treatment within minutes, according to Galil.

        The startup could prove useful for doctors whoincreasingly find it difficult to keep up on the exhaustive amount of clinical data.

        Patients are also overwhelmed at the prospect of combing through mountains of clinical trial research. A lung cancer patient, for example, might find 500 potential trials on clinicaltrials.gov, each of which has a unique, exhaustive list of eligibility criteria that must be read and assessed, says Galil. As this pool of trials changes each week, it is humanly impossible to keep track of all good matches.

        Mendel.ai seeks to reduce the time it takes and thus save more lives. The company is now integrating with the Comprehensive Blood & Cancer Center (CBCC) in Bakersfield, Calif, which will allow the centers doctors to quickly match their patients with available clinical trials in a matter of minutes, according to Galil.

        The plan going forward is to workwith hospitals and cancer genomics companies like the CBCC to improve Mendel.ai and introduce the system. A more immediate goal, Galil says, would be challenging IBMs Watson against his system to see which one can match up the patients better.

        This is the difference between someone dying and someone living. Its not a joke, Galil told TechCrunch.

        Read more: https://techcrunch.com/2017/07/01/mendel-ai-nabs-2-million-to-match-cancer-patients-with-the-latest-clinical-trials/

        Dogs trained to sniff out cancer are helping Japanese residents

        A town in Japan with high rates of stomach cancer is turning to sniffer dogs for help.

        Kaneyama, a town in northeastern Japan with 6,000 residents, has Japan’s highest fatality rates stemming from stomach cancer, local reports say.

        The town is now taking part in a research programme, in which residents’ frozen urine samples are sent to the Nippon Medical School, just east of Tokyo. At the school, dogs are trained to sniff out signs of disease.

        Dogs have some 300 million sensors in their nose, compared to five million in a human. They also have a second smelling device in the back of their noses, the combination of which allows trained dogs to detect cancerous tumours which is said to give out a specific odour.

        “Nearly 100 percent accuracy.”

        “In our research so far, cancer detection dogs have been able to find [signs of] cancer with an accuracy of nearly 100 per cent,” said Professor Miyashita, of the Nippon Medical School.

        There are only five dogs trained to work as cancer detection dogs in Japan, according to a training facility in the country. It costs about $45,000 to train each dog.

        Cancer sniffing dogs are not unique to Japan.

        In the UK, a major trial was conducted last year at Medical Detection Dogs, where dogs were taught to sniff out prostrate cancer from urine samples. The group claimed to have a 93 percent success rate.

        In a training session, dogs are taken around a room with different samples only one sample will contain cancer cells.

        When the detect the smell, they are trained to sit down in front of the sample and touch it with their nose.

        “We are now understanding the huge potential dogs have,” Claire Guest, founder of the Medical Detection Dogs told news outlet the Huffington Post.

        “I think the potential for this is absolutely huge and we’re only just beginning to scratch the surface.”

        Read more: http://mashable.com/2017/06/19/cancer-sniffer-japan/

        Painless cancer detection could become routine thanks to ‘liquid biopsies’

        Biopsies are seen as the best way of detecting the illness but they have traditionally often required invasive techniques

        Researchers are developing tests that could make cancer detection so painless that it becomes part of routine check-ups, experts said, as new developments in such liquid biopsy technology were presented at the worlds largest cancer conference in Chicago this weekend.

        Collecting tumor tissue through biopsies is considered the gold standard for diagnosing and treating cancer. However, necessary surgery is often invasive and sometimes unsuccessful.

        That has fueled interest in technology that uses blood samples to examine bits of DNA shed into the bloodstream by tumors. The hope, researchers say, is to save patients the pain of surgery, monitor tumor growth to tailor treatment, and ultimately to save lives.

        Its fair to say that if you could detect all cancers while they are still localized, you could diminish cancer deaths by 90%, said Dr Bert Vogelstein, a professor of oncology at Johns Hopkins School of Medicine who co-authored a study presented at the American Society of Clinical Oncology (ASCO) in Chicago.

        But thats a theoretical figure. The available data suggests that its going to take quite a while, and there are a lot of obstacles to overcome.

        Like all cells, cancerous cells shed DNA as they die. Tests in development examine these bits of DNA in the bloodstream, finding mutations in already diagnosed cancers or, experts hope, diagnosing cancer early.

        Part of the challenge in developing such tests is scale. Pieces of DNA represent a tiny portion of a blood sample. Pieces of cancer DNA represent an even tinier sliver of all the DNA present in blood.

        Pieces of genetic material, called cell-free DNA, are found in blood plasma. But plasma contains cell-free DNA from all over the body not just cancer. In some cases, cell-free DNA from cancer represents just 0.1% of all cell-free DNA, new research has found. That makes the search a needle in a haystack.

        One of the studies presented at ASCO sequenced 100 times more data than ever before. Using such high-intensity sequencing, researchers from Memorial Sloan Kettering Cancer Center scanned regions of the genome up to 60,000 times to look for 508 specific genes.

        Dr Pedram Razavi and his research team collected blood samples from 124 patients with metastatic breast, non-small cell lung or prostate cancer. Biopsies were collected to provide a baseline, and researchers also sequenced each patients white blood cells to rule out benign mutations.

        In 89% of the patients, researchers identified at least one gene mutation. The highest success rates were for breast cancer patients, in whom researchers were able to find 97% of gene mutations.

        Ravazi said simple tests to screen for cancer were a very long way from development, but the new research brought doctors one step closer. This is a promising first step in patients with metastatic DNA, he said, referring to advanced cancer patients.

        Another abstract presented at ASCO took the opposite approach. US and Australian researchers at Johns Hopkins and the Walter and Eliza Hall Institute of Medical Research in Melbourne screened 119 pancreatic cancer patients for just one mutation found nearly all pancreatic cancers.

        Though only four patients had advanced cancer, researchers found cell-free DNA in all of them. In patients with stage two cancer, the largest group, researchers found cell-free DNA in 54.5% of 99 cases. Authors said tests showed promise for screening, and could help guide treatment.

        One of the researchers, Peter Gibbs, said he could envision that within five years, people would receive tests that search for about 20 cancer gene mutations.

        Its potentially very close by, said Gibbs. The potential impact on screening and prevention is huge.

        Read more: https://www.theguardian.com/science/2017/jun/04/cancer-detection-liquid-biopsies