Latest / Morning Medical with Dr. Chow / Aspirin and Cancer Risk, Semaglutide & Tirzepatide Trials, and Teen Mental Health Trends

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Aspirin and Cancer Risk, Semaglutide & Tirzepatide Trials, and Teen Mental Health Trends · Morning Medical with Dr. Chow

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  Good morning, everyone, and welcome to another episode of Morning Medical with Dr.
• 0:03
  Chow.
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  I'm your host, Dr.
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  Chi-Ming Chow.
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  Today, we’re diving into some fascinating new research that suggests regular aspirin use may
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  help lower the risk of colorectal cancer, particularly for those with unhealthy
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  lifestyles.
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  This study, published in the journal JAMA Oncology, has garnered a lot of attention, and
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  for good reason.
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  Colorectal cancer is the second most common cause of cancer death worldwide.
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  In the United States alone, it was predicted to cause over fifty-two thousand five hundred
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  deaths in 2023.
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  The condition has become increasingly prevalent among individuals under fifty-five, with the
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  number of cases in this group more than doubling over the past decade.
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  While genetic factors can play a role, lifestyle choices such as diet, exercise,
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  alcohol consumption, smoking, and body mass index are significant risk factors.
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  In 2016, the United States Preventive Services Task Force recommended low-dose aspirin to
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  reduce the risk of colon cancer.
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  However, they reversed this recommendation in 2022 due to concerns about bleeding and
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  gastrointestinal issues caused by aspirin.
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  This shift in guidelines prompted researchers to investigate whether certain groups might
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  still benefit from regular aspirin use despite the risks.
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  For this new study, researchers examined data from over one hundred seven thousand six
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  hundred fifty-five people who participated in the Nurses’ Health Study and the Health
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  Professionals Follow-Up Study.
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  These participants were tracked for at least a decade and were monitored for colorectal
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  cancer.
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  They also completed surveys assessing their body mass index, alcohol intake, diet, smoking
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  habits, and exercise routines.
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  Regular aspirin use was defined as taking two or more regular-strength aspirin or six or more
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  low-dose aspirin per week.
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  The findings were quite revealing.
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  Regular aspirin users had an eighteen percent lower risk of developing colorectal cancer
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  compared to non-users.
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  Interestingly, those with less healthy lifestyles—particularly smokers and individuals
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  with a body mass index over twenty-five—saw the most significant benefits.
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  Dr.
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  Daniel Sikavi, the lead author of the study and a gastroenterologist at Mass General Brigham,
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  explained that aspirin seems to lower the markedly elevated risk in those with multiple
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  risk factors for colorectal cancer.
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  While the study couldn’t pinpoint exactly why aspirin appears to be so beneficial, previous
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  research has suggested that aspirin may inhibit pro-inflammatory signals that can lead to
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  cancer.
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  Despite some inconsistencies in past research, the new study's authors argue that doctors
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  should consider lifestyle risk factors when recommending aspirin for colorectal cancer
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  prevention.
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  Dr.
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  Christina Annunziata from the American Cancer Society emphasized that the study found the
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  greatest effect of aspirin in people with the most risk factors for colon cancer.
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  She noted that this research isn't a gold-standard randomized clinical trial, so
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  there are limitations and more research is needed.
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  However, the study serves as a reminder that cancer isn’t inevitable, and lifestyle changes
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  can significantly lower risk.
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  Dr.
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  Raymond DuBois, a past president of the American Association for Cancer Research, said
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  this study might help resolve why some studies show a benefit from aspirin while others don’t.
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  He highlighted that taking just two regular aspirin per week might alleviate some concerns
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  about bleeding risks.
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  This could be especially helpful for those who find it difficult to lose weight or quit
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  smoking.
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  Dr.
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  Jennifer Davids, chief of colon and rectal surgery at Boston Medical Center, echoed the
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  sentiment that while aspirin is accessible and inexpensive, it’s not without risks.
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  She advises people to consult their doctors before starting a regular aspirin regimen.
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  Importantly, she stresses that aspirin is not a substitute for healthy eating, exercise, and
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  other lifestyle changes.
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  When the final results of the SELECT trial were reported last fall, investigators touted a 20%
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  reduced risk of a major cardiovascular event with semaglutide, also known as Wegovy,
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  compared with placebo.
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  On the surface, this figure sounds impressive.
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  However, experts have pointed out that the absolute benefit—a 1.5 percentage-point
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  difference between the two groups of patients who were overweight and had preexisting
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  cardiovascular disease—is much smaller.
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  Indeed, 6.5% of people taking the glucagon-like peptide-1 receptor agonist experienced a major
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  cardiovascular event, compared to 8% of those on placebo.
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  While that is a significant difference, it is a relatively small one, several experts told
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  MedPage Today.
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  Diana Zuckerman, Ph.D., president of the National Center for Health Research in
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  Washington, D.C., commented, “That sounds very impressive, 20%, but it is misleading.
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  I mean, it is still good.
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  But as an individual person making a decision about how much money they are willing to spend
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  for this drug, and all the side effects, whether it is nausea, vomiting, or diarrhea ...
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  it just may not be worth it to them.”
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  David Phizackerley, B.Sc., MRPharmS, deputy editor of The BMJ's Drug and Therapeutics
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  Bulletin, penned an editorial on the absolute cardiovascular benefits in the SELECT trial.
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  He noted that the 1.5% absolute risk reduction means that 67 people would need to take the
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  drug for 34 months—the length of the study—to prevent just one primary endpoint event, which
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  includes heart attack, stroke, or cardiovascular death.
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  The other 66 people would not see any cardiovascular benefit at all.
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  Phizackerley added, “If it was over a year, you would have to treat three times as many people
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  to have one person benefit.” On top of that, he pointed out that only one of the three
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  components of the composite endpoint was significant.
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  There was a significant benefit for non-fatal myocardial infarction, with a hazard ratio of
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  0.72, but even that was quite small at a 1% absolute risk reduction.
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  This means you would have to treat 100 people to prevent one event.
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  Phizackerley elaborated, “Say you are sitting with a patient who wants a realistic
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  explanation of what this drug might do for them.
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  If I said, 'We have a room of 100 people, and if I give it to all 100, one of you will walk
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  out with a benefit.
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  The other 99 will not.' That is redressing the balance.”
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  The other two parts of the composite endpoint were death from cardiovascular causes and
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  non-fatal stroke, neither of which were significant.
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  Michael Lincoff, M.D., of the Cleveland Clinic, the lead author on the SELECT study, disagreed
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  with Phizackerley's and Zuckerman's interpretations of the trial results.
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  He argued that a 20% relative risk reduction is “a big deal in cardiovascular medicine.”
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  Lincoff stated, “We consider a successful trial a 15% reduction, some are 20% or 25%.
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  That is a significant reduction in terms of being clinically relevant.” As for the
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  non-significant components of the composite endpoint, Lincoff said trialists “never expect
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  components to be significant unless we do a trial powered for that.
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  We powered the trial for the composite endpoint.”
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  Lincoff noted that the lack of effect on non-fatal stroke was interesting because other
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  trials of glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes
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  showed very big effects on stroke.
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  This includes the SUSTAIN-6 trial of semaglutide in type 2 diabetes, which had a
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  significant hazard ratio of 0.61.
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  “Whether or not that is real, or just a play of chance in these patients, we do not know,” he
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  said about the SELECT findings.
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  Less is known about cardiovascular outcomes for tirzepatide as a weight-loss agent, which has a
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  slightly different mechanism of action from semaglutide.
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  While a cardiovascular outcomes study for tirzepatide is ongoing, a pre-specified
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  cardiovascular meta-analysis of seven randomized controlled trials from the SURPASS
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  program focused on patients with type 2 diabetes found a lower risk of a primary
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  composite cardiovascular endpoint, but it was not significant.
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  Despite questions about the true benefit of glucagon-like peptide-1 receptor agonists in
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  cardiovascular disease, Medicare will now pay for semaglutide in adults with cardiovascular
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  disease and either obesity or overweight, an indication the Food and Drug Administration
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  approved in March.
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  The federal insurer is still not allowed to cover weight loss drugs for shedding pounds,
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  but that could change if Congress passes the Treat and Reduce Obesity Act.
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  At a cost of more than one thousand dollars per month, some question whether the potential
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  cardiovascular benefit is worth it—not just because of the small absolute risk reduction in
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  the SELECT trial, but also because patients do not stay on the drug, for both tolerance and
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  cost reasons.
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  In that trial, people in the semaglutide group were twice as likely to drop out as those in
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  the placebo group, with about 17% versus 8%, respectively.
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  “Everyone picked up on the 20% relative reduction in cardiovascular risk, but no one
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  picked up on the 100% increase in the dropout rate,” Phizackerley told MedPage Today.
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  “If you were on the drug, you were twice as likely, if I am going to use a relative risk,
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  to stop taking the drug and drop out of the trial.” In this case, the number needed to harm
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  would be 12, meaning for every 12 people treated, one would drop out.
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  Zuckerman said other research has shown that about 44% of people stopped taking semaglutide
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  within 6 months, and 60% had dropped it by the end of a year.
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  While that study is a retrospective claims analysis, it may better reflect real-world use
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  than a clinical trial, she said.
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  “Talking about these drugs as a way to make people healthier, therefore, Medicare and
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  Medicaid should pay for it, is very misleading, because the vast majority of people do not take
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  it long enough to benefit,” Zuckerman said.
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  “If you have got millions of people trying it for a few months, that is an enormous amount of
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  money with zero benefit.”
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  Lincoff acknowledged that the costs of treating patients with cardiovascular disease and
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  obesity “can appear staggering,” even if patients only stay on the drug for four or six
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  months.
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  “We are having this discussion because these drugs are so expensive,” he said, noting that
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  people frequently abandon other cardiovascular drugs, like statins, but that is less
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  controversial because they cost far less.
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  Lincoff added, “We know that the natural evolution of this is that more drugs will come
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  on the market and prices will change.
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  But that does not change the fact that we have to grapple with it now.”
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  Rates of overweight and obesity are “exploding around the world, despite 20 or 30 years or
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  more of people trying to address the root causes,” Lincoff said.
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  “The traditional approaches of diet, exercise, counseling, whatever we have been doing, are
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  not working.”
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  Lincoff concluded, “I think we all worry about medicalizing a large proportion of the world's
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  population.
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  But the reality is that overweight and obesity are associated with increased risk—not just
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  cardiovascular risk, but a variety of other metabolic and orthopedic conditions and cancer.
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  No one would suggest semaglutide takes the place of public health efforts to help control
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  the explosion.
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  But as it stands now, we do not have other good therapies.”
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  Maybe a hug from a parent no longer solves problems for a teen as it did in their
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  childhood.
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  But when it comes to teenage mental health, adults can do a lot to help, according to new
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  data.
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  “We want to bear in mind that the emotional lives of young people are a very complex and
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  mixed picture with very real ups and also downs,” said Dr.
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  Lisa Damour, a clinical psychologist in Ohio who partnered with the Walton Family Foundation
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  and Gallup in the research.
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  The survey published Tuesday asked one thousand six hundred seventy-five people ages ten to
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  eighteen about their emotional lives and their needs from the adults who care for them.
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  The sullen, withdrawn stereotype many people have about teens isn’t the full picture,
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  according to the research.
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  Of the preteens and teens who were surveyed, forty-five percent said they felt stressed the
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  day before, thirty-eight percent felt anxious and twenty-three percent felt sad, according to
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  the data.
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  But nearly all of them—ninety-four percent—said they also felt happiness for much of that day.
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  The survey found that one in six parents have a hard time comforting and communicating with
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  their teen.
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  Fortunately, the teens told adults exactly what they need in this survey as well.
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  Teen brains are going through big transitions, experts said.
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  “What I hope that families can take from these results is that kids have ups at least as much
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  as they have downs, kids have terrific, really healthy ways of managing their own emotions,”
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  said Damour, author of “The Emotional Lives of Teenagers: Raising Connected, Capable, and
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  Compassionate Adolescents.” “That listening, offering space, comfort and reassurance is
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  often all that kids are looking for.”
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  Years ago, your child may have come running to you with a scraped knee or a friend who
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  wouldn’t share, and your hug would do just the trick.
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  But entering the teen years presents more complex problems with higher stakes, Damour
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  said.
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  “If your big kid’s upset, it may be a grade, it may be a blowup with a friend, it may be
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  something actually that has to do with risky behavior,” she said.
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  And the approaches that worked with your kids before often stop working in adolescence,
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  Damour added.
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  Yes, teens are often facing greater challenges than the generations before them, and it is
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  easy to blame that on the COVID-19 pandemic, said Stephanie Marken, a senior partner at
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  Gallup who worked with the Walton Family Foundation in designing, architecting and
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  implementing the research.
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  But research showed that difficulties with anxiety and isolation were on the rise even
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  before the outbreak, she said.
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  The worsening mental health and rising stakes of teens often puts parents in a difficult
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  place.
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  How can you be centered, approachable and helpful in offering perspective when you as the
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  adult are also full of anxiety over the problems of your teens?
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  That scenario is why it’s important for parents and caregivers to have their own mental health
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  resources, said Dr.
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  Whitney Trotter, a doctor of nursing practice, psychiatric and mental health nurse
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  practitioner and registered dietitian in Austin, Texas.
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  She was not involved in the survey.
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  Not only can seeing a therapist or employing your own coping strategies make you more
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  available for your teen, but it is also a powerful way to model positive mental health to
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  them, she added.
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  When your kid puts on their headphones and seems to tune out the world, that isn’t just
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  angst—it may be an effective coping strategy.
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  Among the top coping strategies preteens and teens listed were playing video games,
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  listening to music, cuddling a pet, talking about their feelings and connecting with
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  friends.
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  Research has shown that music is an effective way to experience an emotion to work through it
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  and get the feeling out, Damour said.
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  “What I have learned from teenagers is it’s actually a very elaborate and specific
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  process,” she added.
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  “Many of them have playlists that match a mood.
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  They have angry playlists, they have sad playlists, they have get-excited, pump-up
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  playlists.”
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  And video games get a bad reputation, but they can be an effective way to distract oneself,
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  Damour said.
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  “As long as it’s done in moderation, distraction is a perfectly effective way to
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  handle a feeling,” she added.
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  Social media and other screen-based entertainment often is talked about in terms of
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  the risks, but “the potential benefits of social media to a large proportion of teens
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  have received insufficient attention,” said Dr.
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  Laurence Steinberg, a professor of psychology and neuroscience at Temple University in
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  Philadelphia.
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  He was not involved in the survey research.
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  The data also showed that teens used time with friends and talking about their feelings as a
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  way to cope, which Damour described as “wildly adaptive.”
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  “Young people themselves have very adaptive ways for handling their distress, and I think
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  as adults, we can be very quick to blow past or minimize all of the incredibly adaptive
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  strategies they use,” she said.
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  The thing preteens and teens going through something tough want most from their parents is
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  to be listened to, the data showed.
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  That was followed closely by giving them space and taking their feelings seriously.
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  Physical comfort and advice lagged behind.
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  “In my experience as a psychologist, if they want advice, they’ll ask for it, or we should
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  ask them if it’s what they want,” Damour said.
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  It might seem obvious to listen first and then offer help, but that can be hard to do when you
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  so badly want your child to feel better, Marken said.
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  Often adults find themselves jumping right to a solution.
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  That instinct can be particularly difficult for a teen, many of whom doubt their own emotions,
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  Damour said.
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  Having an adult listen and take them seriously tells teens their emotions make sense, even if
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  they are feeling them more deeply than they used to, she added.
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  It’s essential to empower teens when working through difficult things by talking with them,
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  not at them, Trotter said.
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  She recommends asking questions more, such as “why do you think that happened?” or “what do
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  you think you should do next?”
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  And while it’s important to still maintain boundaries as the adult, getting teens’ input
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  on their own lives is also helpful, Trotter said.
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  What do they think about their pediatrician?
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  Are they comfortable with their therapist?
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  “There’s no one silver bullet to help solve some of these issues students are facing,”
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  Marken said.
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  “It’s going to be multiple things that we have to do to help students become more resilient
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  and …
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  help them also get some tools in their own tool belt to overcome some of these challenges.”
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  Athletes at the Paris 2024 Olympics are sleeping on cardboard bed frames for the second
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  summer games in a row.
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  First introduced at Tokyo 2020, the cardboard beds have made a comeback as an environmentally
• 20:09
  friendly solution in the Olympic Village, according to reports.
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  The athletes can extend the beds to accommodate their size and can choose the firmness of the
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  mattress, as shown in a video posted to the Olympics YouTube page.
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  The sustainable beds, which are one hundred percent made in France, will be fully recycled
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  after the games, Olympic organizers have said.
• 20:32
  Virginia-based neurologist Dr.
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  Chris Winter, a sleep adviser for Mattress Firm and a sleep consultant for major-league sports
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  teams in the United States, reacted to the sleeping arrangements in an interview with Fox
• 20:45
  News Digital.
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  "I was not part of the French Olympic planning, but given the overall theme of the games as
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  being ‘more responsible, more inclusive and more equal,’ I think the cardboard bed checks
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  those boxes," he said.
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  "For an Olympic swimmer, weightlifter or gymnast, to awaken with a tweak or catch in
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  their back could be disastrous."
• 21:07
  Winter noted that past Olympic events have been associated with "tremendous amounts of waste."
• 21:13
  The cardboard beds are not only more economical, but also "much easier on the
• 21:18
  environment," he said.
• 21:21
  "When the games are over, organizers are not tasked with what to do with thousands of real
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  twin beds," Winter said.
• 21:29
  "This creates significant cost savings, I imagine." Having the same beds also gives
• 21:35
  everyone a "performance advantage" when it comes to sleep, the expert noted.
• 21:40
  "I'm sure the fact that they could more easily break if jumped on or if lots of athletes are
• 21:45
  on the bed is probably a plus, as an indirect way to control behavior," he added.
• 21:51
  "Plus, if an overzealous athlete throws theirs out the window, damage and risk is minimized."
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  While there are benefits to the cardboard solution, Winter stressed that these structures
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  could pose some health risks for athletes.
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  "For an Olympic swimmer, weightlifter or gymnast to awaken with a tweak or catch in
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  their back could be disastrous," he said.
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  A poor night’s sleep can even affect an athlete psychologically, the expert added.
• 22:20
  Chafen Watkins Hart, M.D., sleep specialist at National Jewish Health in Denver, Colorado,
• 22:25
  also weighed in on the importance of proper sleep for athletes.
• 22:30
  "Getting used to a new environment, including a new bed, is daunting, especially with jet lag
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  and the intensity of athletic competition," she told Fox News Digital.
• 22:40
  Although the mattresses reportedly have been improved from the ones used in Tokyo, they are
• 22:45
  still "very firm," according to Hart.
• 22:48
  "In general, it appears that the materials are washable and reusable, which is the primary
• 22:54
  reason they are being employed for thousands of athletes in the village," she said.
• 22:59
  For some athletes, a mattress that is too firm can cause muscle soreness, she cautioned, while
• 23:03
  others may prefer firmness.
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  Beyond the bed and mattress, Hart also noted that temperature and roommate considerations
• 23:12
  can also adversely affect athletes' sleep.
• 23:15
  "The rooms do not have air conditioning, and many athletes are supplementing with their own
• 23:19
  portable units," she said.
• 23:22
  "Sleeping in a hot, humid environment can be really disruptive and can increase the number
• 23:28
  of arousals during the night and severity of insomnia."
• 23:32
  Many athletes may also get a random roommate assignment with someone who has different sleep
• 23:37
  habits.
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  "Someone who is a night owl will not love bunking with an early bird," Hart said.
• 23:42
  "Or someone used to sleeping in a silent, dark space may have trouble adjusting to a roommate
• 23:46
  who likes to play music and keep a light on."
• 23:50
  For a good night’s sleep, Winter advised athletes to bring their own pillows and attempt
• 23:54
  to keep the room cool.
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  He also suggested bringing items that remind them of home, such as a partner’s pillowcase,
• 24:01
  favorite nighttime tea, stuffed animals, sleep masks or posters.
• 24:06
  "Getting that Parisian apartment to feel like home can be a great advantage," he said.
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  Hart agreed, adding that familiar scents, calming music and chats with loved ones can
• 24:16
  help reduce anxiety about sleeping in a strange or uncomfortable place.
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  That’s all for today’s episode of Morning Medical with Dr.
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  Chow.
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  Thank you for joining us as we explored the latest in health and medical news.
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  Remember to tune in tomorrow for more updates and insights.
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  Have a great day and stay healthy!