Latest / Morning Medical with Dr. Chow / Menopause Insights, Physical Inactivity Costs, and AI in Cancer Screening

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Menopause Insights, Physical Inactivity Costs, and AI in Cancer Screening · Morning Medical with Dr. Chow

• 0:00
  Welcome to Morning Medical with Dr.
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  Chow, where we bring you the latest medical and health news from around the world.
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  I'm Dr.
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  Chi-Ming Chow, your host for today's episode.
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  Let's dive into our first topic: menopause, a subject that's often surrounded by curiosity
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  and confusion, even among healthcare professionals.
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  Menopause is not a medical condition, but rather a phase of life that can bring about a
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  variety of symptoms impacting function and quality of life.
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  As such, treatments often involve a combination of pharmacotherapy, mind-body modalities, and
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  lifestyle modifications.
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  Despite the recognition of these commonly experienced symptoms, the fact that menopause
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  occurs during a time of aging complicates the identification of specific causes for the
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  symptoms.
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  Hormone therapy, or HT, is a highly effective treatment option for certain menopause-related
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  symptoms, but it comes with risks.
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  Recently, HT has become a controversial topic, particularly due to the underpreparedness of
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  physicians in prescribing it.
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  This has led to policy initiatives aimed at strengthening training on a national level.
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  Some states have already passed laws mandating physician training and insurance coverage for
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  menopause-related treatments.
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  While these initiatives aim to improve care, they can also stigmatize physicians and
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  oversimplify the complexity of healthcare during midlife.
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  The complexity of menopause care goes beyond just prescribing HT.
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  Pioneers in menopause research have enhanced our understanding by studying the
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  pathophysiology of menopause, racial and ethnic differences, and the efficacy and safety of
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  treatments.
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  Landmark studies, like the ongoing longitudinal Study of Women's Health Across the Nation,
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  highlight that menopause is not a one-size-fits-all syndrome.
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  Personal beliefs, sociocultural factors, and underlying conditions all play a role in the
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  menopause experience.
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  Therefore, care during the menopause transition requires a nuanced approach, not just a
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  prescription for hormone therapy.
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  The decline in HT prescriptions after the Women's Health Initiative trial, which was
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  stopped due to increased health risks in the treatment group, has contributed to a lull in
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  clinician training and patient education.
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  However, the fear that initially surrounded HT has now transformed into criticism of
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  physicians for not prescribing it universally.
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  This pendulum swing has put evidence-based recommendations and existing warnings into the
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  spotlight, emphasizing the need for proper education.
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  Professional organizations like The Menopause Society are stepping up to fill the knowledge
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  gap by educating clinicians.
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  Their growing membership, packed scientific meetings, and certification exams demonstrate a
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  rising interest in understanding menopause.
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  Specialty boards have also incorporated menopause management into continuing medical
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  education, and some residency programs have added it to their curriculum.
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  This leads us to question whether policy changes should focus on mandating physician
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  education or ensuring accessible healthcare coverage and sustainable research funding.
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  While hormone therapy is safe and effective for many, it is not without risks and is not
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  suitable for everyone.
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  Non-hormonal treatments and lifestyle changes, such as diet and exercise, are also crucial
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  components of menopause care.
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  The Menopause Priority Setting Partnership, a global initiative, has identified top research
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  priorities, highlighting non-hormone treatments and lifestyle modifications.
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  Comprehensive clinician training is vital, but improving menopause care requires a broader
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  approach that includes high-quality medical treatment, proper reimbursement, and support
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  for innovative research.
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  Legislative efforts that overly burden physicians may seem beneficial in the short
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  term, but they do little to enhance care in the long run.
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  Menopause care should be part of a comprehensive healthcare plan that accommodates
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  the needs of both providers and patients, ensuring that individuals receive the support
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  they need during this significant life transition.
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  In today's segment, we're diving into the financial and legal challenges faced by Novo
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  Nordisk, a major player in the pharmaceutical industry.
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  Recently, Novo Nordisk has significantly lowered its sales forecasts for its obesity
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  drug, Wegovy.
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  This decision comes amid increasing competition from compounding pharmacies, which are
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  producing alternative versions of Wegovy at a lower cost.
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  Compounding pharmacies are allowed to create these alternatives when a drug is in short
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  supply.
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  Although the Food and Drug Administration recently declared the shortage of Wegovy over,
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  the practice of compounding continues.
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  These pharmacies tailor medications to meet specific patient needs, often bypassing the
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  typical Food and Drug Administration approval process.
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  This has led to a surge in compounded versions of Wegovy, impacting Novo Nordisk's market
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  performance.
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  Novo Nordisk's shares took a significant hit, plunging by more than twenty percent after the
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  announcement.
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  The company had initially predicted a growth rate of up to twenty-one percent for Wegovy
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  sales this year, but that figure has now been revised down to a maximum of fourteen percent.
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  This highlights the growing influence of compounded drugs in the market.
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  The company is actively pursuing strategies to counter this trend, including litigation, as it
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  tries to protect its market share.
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  Compounding pharmacies, on the other hand, argue that they are filling a critical need by
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  customizing medications for patients who cannot use commercially available options.
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  They emphasize that their practices are legal under the Food, Drug, and Cosmetic Act, as long
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  as the compounded drugs meet specific criteria.
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  Adding to the company's challenges, Novo Nordisk has announced a change in leadership.
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  Maziar Mike Doustdar will be taking over as the new Chief Executive Officer, following the
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  departure of Lars Jorgensen.
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  Doustdar has promised to focus on efficiency, growth, and shareholder value as he navigates
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  the company through these turbulent times.
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  Health economist Rena Conti from Boston University notes that the rise in compounding
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  sales isn't surprising.
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  She points out that compounding pharmacies have been aggressively marketing their services,
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  leading to increased profits.
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  Meanwhile, Novo Nordisk's main competitor, Eli Lilly, is also gaining ground by offering
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  discounted vials directly to consumers, thereby converting some from using compounded versions
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  to their brand.
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  Despite Novo Nordisk's efforts to boost Wegovy sales by selling directly to cash-paying
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  consumers, the results have been underwhelming.
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  The company launched NovoCare Pharmacy earlier this year to facilitate these sales, but the
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  penetration in the cash channel has not met expectations.
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  This is an ongoing challenge for Novo Nordisk as it tries to navigate the complexities of the
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  pharmaceutical market.
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  Today we're taking a closer look at a compelling new study that highlights the
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  financial impact of physical inactivity on healthcare costs in the United States.
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  According to research published in the American Journal of Health Promotion, inadequate
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  leisure-time aerobic physical activity accounts for a staggering $192 billion in annual
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  healthcare costs among American adults.
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  That's a whopping 12.6% of total national healthcare spending.
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  The study analyzed data from over 76,000 adults between 2012 and 2019, revealing some
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  eye-opening statistics.
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  It found that while 52.4% of adults met aerobic activity guidelines, 20.4% were insufficiently
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  active, and 27.3% were completely inactive.
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  This inactivity comes at a cost: the average adult incurs $6,566 in annual healthcare
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  expenses.
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  When comparing costs, the study found that insufficiently active adults incurred $1,355
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  more than their active counterparts in annual healthcare costs, while completely inactive
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  adults faced an additional $2,025 per year.
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  Dr.
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  Adam Chen, one of the study's co-authors from the University of Georgia's College of Public
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  Health, emphasized the benefits of aerobic physical activity, noting that it strengthens
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  the heart, reduces chronic disease burdens, and empowers individuals to live with energy and
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  freedom.
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  Despite some modest national gains in physical activity, healthcare expenditures continue to
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  rise, primarily driven by preventable chronic conditions.
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  Laurie Whitsel, PhD, another co-author and National Vice President of Policy Research at
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  the American Heart Association, stresses the need for healthcare systems to integrate
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  physical activity assessment, prescription, and referral into healthcare delivery.
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  She calls for inspiring and supporting people to make physical activity a regular part of
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  their day.
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  Jennifer Matjasko, PhD, from the Centers for Disease Control and Prevention's Division of
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  Nutrition, Physical Activity, and Obesity, underscored the power of a simple solution:
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  moving more throughout the day.
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  She highlighted that every step counts toward a healthier future and can help improve health
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  outcomes while reducing healthcare costs.
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  The Physical Activity Alliance, the nation's largest coalition advancing physical activity
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  policy and systems change, is calling for immediate cross-sector action.
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  Their recommendations include making physical activity a standard of care in healthcare,
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  redesigning workplaces to encourage movement, and transforming communities through policies
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  that make physical activity safe, easy, and unavoidable.
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  Michael Stack, President of the Physical Activity Alliance, summed it up well by
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  pointing out that nearly one out of every eight healthcare dollars is spent on something we can
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  prevent.
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  He urges us to view physical activity as an essential healthcare solution, inspiring people
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  to move throughout their day in various settings—be it recreation, commuting, or at
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  work, home, and school.
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  Today, we're exploring an exciting new study that shines a light on how something as simple
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  as walking can significantly impact our brain health, especially when it comes to reducing
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  the risk of Alzheimer's disease.
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  This research, shared with Global News, highlights the potential of regular walking to
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  combat cognitive decline, a concern that looms large as we age.
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  The study, led by Dr.
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  Cindy Barha, a researcher in neuroscience, brain health, and exercise at the University of
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  Calgary, involved around 3,000 participants aged 70 to 79.
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  These individuals, who initially had no cognitive impairments, reported their daily
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  walking habits over a decade.
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  The researchers then tested their cognitive functions periodically to observe any changes.
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  Dr.
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  Barha's findings are compelling.
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  She noted that higher amounts of self-reported walking were linked to protection against
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  declines in overall cognitive abilities and executive function in both men and women.
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  This was true even for those with a higher genetic risk for Alzheimer's, emphasizing the
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  critical role physical activity can play in preserving brain health.
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  The study's results underscore the importance of lifestyle factors, like habitual walking, as
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  potential strategies to slow or prevent cognitive decline.
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  For those at greater genetic risk, such as carriers of the APOE e4 gene variant, walking
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  was particularly beneficial.
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  Interestingly, female participants, who statistically face a higher risk of
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  Alzheimer's, showed even greater cognitive improvements from regular walking compared to
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  their male counterparts.
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  Dr.
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  Barha suggests that a baseline of just 15 minutes of walking per day can make a
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  difference.
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  However, she points out that further research is needed to determine the optimal type and
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  amount of exercise.
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  Future studies might explore varying intensities and controlled exercise regimens to
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  personalize interventions for those at risk.
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  This research not only highlights the role of exercise in maintaining cognitive health but
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  also calls attention to the broader implications for public health strategies.
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  Encouraging walking as a regular activity could be a simple yet effective intervention to help
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  mitigate the risks associated with cognitive decline and Alzheimer's disease.
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  Today, we're discussing an intriguing development in the field of breast cancer
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  screening.
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  A recent study has shown how artificial intelligence, or AI, is making strides in
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  identifying interval breast cancers that were missed during original mammogram reviews.
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  This advancement is significant because interval breast cancers tend to be more
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  aggressive and have poorer outcomes than those detected during routine screenings.
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  The study, conducted at Massachusetts General Hospital in Boston, involved a retrospective
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  analysis of more than 200 interval breast cancers.
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  AI was able to correctly identify about one-third of these cancers on digital breast
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  tomosynthesis exams, also known as DBT.
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  To put it into perspective, AI identified 73 out of 224 interval breast cancers that were
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  initially missed.
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  This is a promising step forward, as previous research primarily focused on two-dimensional
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  mammography and did not explore the potential of AI in DBT, which is now the standard of care
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  in the United States.
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  In a separate review of 1,000 screening DBT exams, AI demonstrated its ability to
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  accurately identify 84% of true-positive cancers and 86% of true negatives, while also
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  generating 73% of false positives.
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  These results suggest that AI could significantly reduce the rate of interval
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  breast cancers, offering a valuable tool in the early detection and treatment of this more
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  aggressive cancer type.
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  Dr.
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  Manisha Bahl, one of the study's lead researchers, shared that AI's application to
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  DBT is unique and demonstrates real promise for clinical use.
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  As Dr.
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  Bahl noted, while the introduction of DBT was expected to reduce interval breast cancer
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  rates, long-term data have not yet shown a meaningful decrease.
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  This implies that women at risk for interval breast cancer may benefit from additional
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  imaging techniques, such as contrast-enhanced magnetic resonance imaging or contrast-enhanced
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  mammography.
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  One of the strengths of AI is its potential to be applied universally to screening mammograms,
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  potentially identifying which patients might develop interval cancers and benefit from
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  further imaging.
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  However, the study was limited to data from a single institution, and the accompanying
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  editorial by Dr.
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  Christoph Lee and Dr.
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  Hannah Milch emphasizes the need for prospective randomized controlled trials.
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  These trials are essential to validate AI's role in real-world breast cancer screening and
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  to understand the complexities of AI-radiologist interactions.
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  The study highlighted the aggressive nature of interval breast cancers, which are known for
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  their rapid growth and poor prognosis.
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  By employing an FDA-cleared AI algorithm, researchers were able to assign scores to
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  AI-marked lesions, with higher scores indicating a greater likelihood of cancer
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  presence.
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  The study found that AI-detected cancers were often larger and more likely to be lymph-node
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  positive than those missed by AI.
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  Dr.
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  Bahl was particularly impressed with AI's ability to detect subtle findings that might
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  have been missed by radiologists, especially in dense breast tissue.
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  Although the AI missed some lesions, it also revealed instances where no lesion existed at
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  the time of screening.
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  This underscores the importance of continuing to refine AI algorithms and conducting further
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  research to enhance detection capabilities.
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  To sum up, this study offers a glimpse into the future of breast cancer screening, where AI
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  could play a crucial role in improving detection rates and outcomes.
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  As technology continues to advance, we can expect AI to become an increasingly integral
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  part of healthcare, helping clinicians provide more accurate and timely diagnoses.
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  Thank you for joining me on this episode of Morning Medical with Dr.
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  Chow.
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  We've covered some exciting developments in medical research today, and I hope you found it
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  insightful.
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  Be sure to tune in next time for more updates on the latest in health and medicine.
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  Until then, stay healthy and informed!