Ethics

Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model

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Abstract

Importance  The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model.

Objective  To examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients’ social risk.

Design, Setting, and Participants  A cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021.

Exposure  Composition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics.

Main Outcomes and Measures  Use of home dialysis, waitlisting, or transplant; model performance score; and financial penalization.

Results  Using data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P < .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P < .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P < .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001).

Conclusions  In the first year of the Centers for Medicare & Medicaid Services’ ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties.

Discussion

In the first year of CMS’ ETC model, dialysis facilities serving more patients in the highest quintile of social risk had lower performance scores and received markedly higher financial penalties. The performance differences were driven by lower home dialysis achievement, rather than transplant and transplant waitlisting, and occurred despite CMS’ incentives of rewarding improvement for the use of home dialysis and receipt of kidney transplants in addition to overall achievement. The higher financial penalization was most pronounced for facilities serving patient populations with the highest social risk. Social risk characteristics that were most highly associated with financial penalties and lower home dialysis use were the share of those who were uninsured or covered by Medicaid and were non-Hispanic Black patients. The share of patients from disadvantaged neighborhoods was most associated with lower transplant achievement and improvement. Finally, compared with for-profit facilities, not-for-profit facilities had lower use of home dialysis and were more likely to be financially penalized.

Other studies have demonstrated that pay-for-performance models can have the unintended consequence of disproportionately penalizing and transferring money away from safety-net facilities or clinicians in favor of those that serve populations with lower social risk.4,6,7,14,15,24–28 When payments are assigned without accounting for social risk, program performance may in part reflect socioeconomic case mix rather than the intended measures of quality.15 In kidney failure care, an evaluation of the 2012 ESRD Quality Incentive Program29 demonstrated that dialysis facilities that served high proportions of patients with dual Medicaid-Medicare coverage, living in low-income areas, or who were Black or Hispanic had poorer performance and were more frequently penalized than their counterparts serving lower proportions of such patients. In an effort to address these issues, CMS designed the ETC model to reward both overall achievement as well as improvement in use of home dialysis and kidney waitlisting and receipt of transplants. Our analysis of the first year of the ETC model finds that despite this approach, dialysis facilities serving patients with higher social risk experienced markedly higher receipt of financial penalties.

Extensive research has demonstrated significant disparities in access to optimal kidney failure care across the US.1,4,30–32 Structural barriers such as institutional and interpersonal racism, residential segregation, and neighborhood poverty are influential in driving these care gaps.1,33 Furthermore, non-Hispanic Black, uninsured, Medicaid-covered, and socioeconomically disadvantaged patients are highly concentrated within dialysis facilities that have lower use of home dialysis and receipt of transplants. Although the financial margins on Medicare dialysis payments are highly variable (approximately <0.5% on average),29,34 facilities that serve high proportions of patients who are uninsured or are covered by Medicaid likely operate on particularly narrow margins. The magnitude of the ETC model’s 5% to 10% penalty on all Medicare reimbursements, larger than previous quality kidney failure programs,29 may threaten the solvency of these safety-net centers. Their closures would likely have harmful consequences, including extended travel and missed sessions.

Beginning in 2022, CMS applied a new health equity adjustment to the modality performance score, which accounts for the proportion of Medicare beneficiaries per aggregation group who are dually insured or low income.16 Our analysis demonstrates social risk factors like race, ethnicity, and neighborhood disadvantage are associated with model performance yet will not be directly addressed in the new scoring system. Furthermore, this study found that only 57 facilities (2.6%) in the sample may be eligible for the future health equity adjustment, when approximated using a proxy for the stratum cutoff proposed by CMS (>50% dually insured or low income). Only about 10% of the cohort with the highest social risk score (≥2) and 17.6% of those currently penalized met this threshold. These findings suggest that relatively few facilities serving patients with substantial social disadvantage may benefit from this adjustment, given that the 50% or higher threshold is substantially greater than the national proportion of patients with kidney failure who are eligible for both Medicaid and Medicare.5 CMS could consider defining a broader construct of social risk, rather than exclusively focusing on eligibility for Medicaid or low-income subsidies or revising the proposed stratum cutoff to be the median proportion of patients who are dually insured or low income. In 2021, the first year after the 21st Century Cures Act expanded Medicare Advantage enrollment to persons with kidney failure, nearly 1 in 4 dual beneficiaries with kidney failure switched to Medicare Advantage coverage.35 Given this disproportionate shift ,36 smaller proportions of dialysis facilities may qualify for CMS’ health equity scoring adjustment going forward.

Limitations

This study has 4 limitations. First, the use of historical (2017-2020) data on incident patients to characterize facilities’ 2021 social risk may lead to misclassification. However, it is likely that the sociodemographic characteristics of a facility’s population in 2021 are strongly associated with the composition of patients who initiated dialysis in that facility over the prior 3 years. Second, the approach to identifying facilities eligible for the health equity scoring adjustment used the proportion of patients who were uninsured or were covered by Medicaid at initiation, but CMS uses the proportion of prevalent traditional Medicare patients with dual coverage or who are eligible for a low-income subsidy. Third, CMS assesses outcomes and provides data at the aggregation-group level and then attributes performance and applies payment adjustments to all member facilities. Therefore, although the analyses in this study align with CMS’ approach, it was not possible to assess facility-level variations in home dialysis and transplant waitlisting or transplant rates. Fourth, although not-for-profit facilities had received substantially higher financial penalization driven by lower use of home dialysis, the small number of such facilities (n = 130) precludes more extensive analyses. The experience of not-for-profit facilities under the ETC model should be closely monitored in future work.

Conclusions

In this observational study of 2191 dialysis facilities, those serving higher proportions of patients who were non-Hispanic Black or Hispanic, living in a highly disadvantaged neighborhood, or were uninsured or covered by Medicaid at dialysis initiation received lower performance scores and had experienced more financial penalization, driven primarily by lower use of home dialysis. These findings, coupled with the escalation of penalties to as much as 10% in future years, support monitoring the ETC model’s continued impact on dialysis facilities that disproportionately serve patients with social risk factors, as well as its influence on outcomes and disparities in care among patients treated in these sites.

The War on Parkinson’s: Stem Cells Successfully Injected into Patient’s Brain

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A team of Australian researchers have successfully performed a procedure injecting stem cells into the brain of a Parkinson’s Disease patient. The researchers are hopeful that this could be the future of Parkinson’s treatment.

MORE HUMANE

Doctors from the Royal Melbourne Hospital successfully injected stem cells onto the brain of a 64-year old Parkinson’s Disease patient. This operation, the first of its kind, marks a positive step towards developing better Parkinson’s treatment.

Researcher Garish Nair, a neurosurgeon at Royal Melbourne, led the procedure. He and his team injected millions of stem cells at 14 sites in the patient’s brain. “The challenge was to do it in a way that you minimize the number of times that you pass your instrument through the brain, to minimize the damage,” explains Dr Nair. To do so, they had to perform around 4 dummy rounds on a 3D model before the actual procedure.

Reuters

NOT A QUESTION OF ETHICS

The stem cell injection, the researchers hope, would boost the levels of the neurotransmitter dopamine in the brain. Parkinson’s is known to exhibit symptoms of “tremor, rigidity, and being unable to express emotions, affecting walking. All of those functions are mediated by dopamine,” Dr. Nair explains. If successful, patient would display improvement in these areas.

The use of stem cells in medical treatment is largely controversial because of ethical concerns, particularly with embryonic stem cells. The procedure, however, does not present an ethical problem. The stem cells used were created using neural cells in a lab of a biotech company in California.

“So the beauty of this technique is that this is an unfertilized egg activated in a lab, so there are no ethical issues surrounding this to be used as mainstream treatment down the line,” says an optimistic Dr. Nair.

Ethical concerns aside, there is also concern that its too soon for clinical trials of stem cell treatments. Earlier this year, Dr. Patrik Brundin, Director of the Center for Neurodegenerative Science at Van Andel Research Institute in Grand Rapids, MI, warned against the dangers of clinical trials being done too soon. “Acting prematurely has the potential not only to tarnish many years of scientific work, but can threaten to derail and damage this exciting field of regenerative medicine.”

The researchers understand these concerns but feel they have received the proper approvals and adequate animal testing has been done to warrant a clinical trial.

At present, statics show that more than 10 million people are affected by Parkinson’s, with about 60,000 in the US and 80,000 in Australia.

5 Ways to Make a Meaningful Difference in the World.

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If you can’t feed a hundred people, then feed just one. ~Mother Teresa

One question we should all try to have answered before we go to sleep is “What have I done to move humanity forward today?” Opportunities present, even in the most subtle or miniscule manner, whereby we can take an action that makes this world a little better place to live. We have a moral and ethical obligation not only to advance humanity, but to also understand our role in preserving the delicate balance of the natural world that is integral part of us.

diffrence

That is the beauty of our capacity as Human Beings, the realization that there is no limit to what we can accomplish if we really want an end result.  When we take an action, not for selfish recognition, but for the Purity of doing the act simply because it is the “right” thing, the doors that are then magically opened revealing rewards not for individuals, but for all living beings in our Universe.

Start the process by taking 5 steps to get outside of the Self and looking at how to enhance the world around you..

1. Accept who you are and your unlimited capacity

Many of us are confused in what we can offer because we do not recognize who we are and what gifts lie within. The process of making the decision to look outside yourself is a part of your spiritual journey. The realization that there is more than the Ego, the Me, and what I can gain out of this life is a huge step for many of us. We are encouraged to take those actions that enhance the Me, without really considering the Us. Our minds are molded from birth by many forms of media and even our families to think about the self. Under the guise of increasing our self-esteem from the outside, we have forgotten the much bigger picture.

Step outside your comfort zone and use the intuitive side to escape this box and begin to think of others. There is no doubt that you will encounter uncomfortable situations that test your mettle and challenge you to the core of the belief systems which have taken decades to develop. Going to Honduras with a religious group whose form of worship was foreign to me changed the course of my life when I realized how petty my “problems” were compared to people who were trying to just survive. Once you realize that when you look outside of yourself all that happens is growth as a person, you will begin the never ending process which catapults you to achieve your fullest potential.

Thousands of candles can be lighted from a single candle, and the life of the candle will not be shortened. Happiness never decreases by being shared. ~Buddha

2. Be an agent of change

By saying to the world I am an Agent of change, you have now altered the mindset that has restricted your actions and belief in yourself. By saying I Matter, you recognize your intrinsic worth and translate that to the myriad of interactions with the world as you recognize the value in all that are connected to you.

3. Determine your intention

Major movements in recent human history seem like seismic shifts, but their germination occurred years before and the final action is the culminations of many intertwined circumstances. There is not one act of kindness that is too small, so long as the intention is present. Combining our minds and hearts leads to action. With the right frame of mind, we innately know what to offer in order to better other people’s lives. This may be as simple as smiling at or wishing a total stranger to have a nice day to helping a neighbor with a plumbing issue.

4. Use your talents

Each of us is born with gifts that are unique to us. People can play an instrument that has the same six strings, but how that tool transforms is up to our own innate ability. Share what you have for the simple sake of sharing. Asking nothing in return you will gain everything.

5. Look for places to volunteer

Look at your community and see where your talents are needed. Even if places don’t advertise for help, make the offer. If you are volunteering somewhere outside the norm, cherish the lessons you will learn from the uncomfortable situations you are placed.  By volunteering at a school, the impact on a child’s life by act of kindness is immeasurable. By becoming a part of a community clean up, your labor to enhances and preserves the natural world around you.

We value and are selfish with our time. Thinking outside of the Me and sharing what you have to offer with those around you will change your life and how you look at everything in the world around you. We are all connected to each other and we have to accept that the Universe has weaved a very delicate tapestry that is always in danger of slowly being unraveled. When we finally start to reflect on what is happening, we sometimes doubt our own power and wonder what can one individual do about the human condition.

To quote my partner when others were lukewarm as to what she was trying to accomplish by a humanitarian project, “no one seems excited about things, but it just takes one, and I’m excited.”

Get excited, make a difference!

Source: Purpose Fairy

 

China to Stop Using Prisoners’ Organs for Transplants.

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China will start phasing out its decades-long practice of using the organs of executed prisoners for transplant operations from November, a senior official said on Thursday, as it pushes to mandate the use of organs from ethical sources in hospitals.

China remains the only country in the world that still systematically uses organs extracted from executed prisoners in transplant operations, a practice that has drawn widespread international criticism. Many Chinese view the practice as a way for criminals to redeem themselves.

But officials have recently spoken out against the practice of harvesting organs from dead inmates, saying it “tarnishes the image of China.”

The health ministry will begin enforcing the use of organs from voluntary donors allocated through a fledging national program at a meeting set to be held in November, former deputy health minister Huang Jiefu, who still heads the ministry’s organ transplant office, told Reuters.

“I am confident that before long all accredited hospitals will forfeit the use of prisoner organs,” Huang said.

The first batch of all 165 Chinese hospitals licensed for transplants will promise to stop using organs harvested from death row inmates at the November meeting, he added. Huang did not specify the exact number.

MEETING “ACCEPTED ETHICAL STANDARDS”

An Australian-trained liver transplant surgeon, Huang said the China Organ Transplant Committee will ensure that the “source of the organs for transplantation must meet the commonly accepted ethical standards in the world.”

That effectively means the use of prisoner organs at approved hospitals will come to an end, but the timeframe remains indefinite, he added.

China has launched pilot volunteer organ donor programs in 25 provinces and municipalities with the aim of creating a nationwide voluntary scheme by the end of 2013.

By the end of 2012, about 64% of transplanted organs in China came from executed prisoners and the number has dipped to under 54% so far this year, according to figures provided by Huang.

At a meeting in August last year, Huang, deputy health minister at the time, told officials that top leaders had decided to reduce dependency on prisoners’ organs, according to a transcript of the meeting obtained by Reuters.

Rights groups say many organs are taken from prisoners without their consent or their family’s knowledge, something the government denies.

So far, more than 1,000 organ donors have come through the new system, benefiting at least 3,000 patients, Huang said.

Voluntary organ donation in China has already risen from 63 cases in all of 2010 to a current average of 130 per month so far this year, Huang added.

However, not all donated organs are currently allocated through the new program, leaving room for human interference, one of the main challenges the reform faces.

Supply still falls far short of demand due in part to the traditional Chinese belief that bodies should be buried or cremated intact. An estimated 300,000 patients are waitlisted every year for organ transplants and only about one in 30 ultimately will receive a transplant.

The shortage has driven a trade in illegal organ trafficking and in 2007 the government banned organ transplants from living donors, except spouses, blood relatives and step or adopted family members.

 

Source: Medscape.com

 

 

Source: http://www.sciencedirect.com

 

Patient-Targeted Googling: The Ethics of Searching Online for Patient Information.

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With the growth of the Internet, psychiatrists can now search online for a wide range of information about patients. Psychiatrists face challenges of maintaining professional boundaries with patients in many circumstances, but little consideration has been given to the practice of searching online for information about patients, an act we refer to as patient-targeted Googling (PTG). Psychiatrists are not the only health care providers who can investigate their patients online, but they may be especially likely to engage in PTG because of the unique relationships involved in their clinical practice. Before searching online for a patient, psychiatrists should consider such factors as the intention of searching, the anticipated effect of gaining information online, and its potential value or risk for the treatment. The psychiatrist is obligated to act in a way that respects the patient’s best interests and that adheres to professional ethics. In this article, we propose a pragmatic model for considering PTG that focuses on practical results of searches and that aims to minimize the risk of exploiting patients. We describe three cases of PTG, highlighting important ethical dilemmas in multiple practice settings. Each case is discussed from the standpoint of the pragmatic model.

Source: Hhttp://informahealthcare.com/

Physician-Assisted Suicide.

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John Wallace is a 72-year-old man with metastatic pancreatic cancer. At time of diagnosis, the cancer was metastatic to his regional lymph nodes and liver. He was treated with palliative chemotherapy, but the disease continued to progress. Recently he has become jaundiced, and he has very little appetite. He has been seeing a palliative care physician and a social worker on an ongoing basis. His abdominal pain is now well controlled with high-dose narcotics, but the narcotics have caused constipation. In addition to seeing the social worker, he has also been seeing a psychologist to help him to cope with his illness.

Mr. Wallace has been married to his wife, Joyce, for 51 years, and they have three children and six grandchildren. He and his wife have lived in Salem, Oregon, for the past 23 years, and most of his family lives nearby. He understands the prognosis of the disease, and he does not wish to spend his last days suffering or in an unresponsive state. He discusses his desire for euthanasia with his wife and family members, and they offer him their support. The next day, he calls his physician and asks for information about physician-assisted suicide.

TREATMENT OPTIONS

Do you believe that Mr. Wallace should be able to receive life-terminating drugs from his physician? Which one of the following approaches to the broader issue do you find appropriate? Base your choice on the published literature, your own experience, and other sources of information.

To aid in your decision making, each of these approaches is defended in the following short essays by experts in the field. Given your knowledge of the patient and the points made by the experts, which option would you choose? Make your choice and offer your comments at NEJM.org.

  • Option 1: Physician-Assisted Suicide Should Not Be Permitted
  • Option 2: Physician-Assisted Suicide Should Be Permitted

 

 

OPTION 1

Physician-Assisted Suicide Should Not Be Permitted

J. Donald Boudreau, M.D., Margaret A. Somerville, A.u.A. (pharm.), D.C.L.

We recognize that a patient in Mr. Wallace’s situation is in a state of grief. We appreciate his desire to be of sound mind at the end of his life and not to have to suffer as death approaches. We also recognize the obligations of physicians to respect a patient’s refusal of treatment, to relieve pain and suffering, and to provide palliative care. However, we believe that the art of healing should always remain at the core of medical practice, and the role of healer involves providing patients with hope and renewed aspirations, however tenuous and temporary. Within the realm of palliative care, there exists a well-recognized paradox that one can die healed.1 Physicians have a duty to uphold the sacred healing space — not destroy it. Therefore, physicians must hear Mr. Wallace’s request for death but never carry it out.

Supporters of physician-assisted suicide justify their position by placing the value of individual autonomy above all other values and ethical considerations. Giving individual autonomy absolute priority runs roughshod over competing values, protections, and needs and ignores the harmful effects on other people, societal institutions (the medical profession in particular), and the general community.

Permitting physician-assisted suicide creates a slippery slope that unavoidably leads to expanded access to assisted suicide interventions — and abuses. Advocates of euthanasia deny that slippery slopes exist, arguing that legal constraints and administrative safeguards are effective in preventing them. But the evidence is clearly to the contrary, as the High Court of Ireland recently affirmed. In upholding the constitutionality of the prohibition on assisted suicide, the justices wrote, “. . . the fact that the number of LAWER (`life-ending acts without explicit request’) cases remains strikingly high in jurisdictions which have liberalised their law on assisted suicide . . . speaks for itself as to the risks involved.”2 Vulnerable communities in our societies — persons who are old and frail and those who are disabled or terminally ill — perceive themselves to be threatened.3Physicians must not be willfully blind to these serious dangers.

Many aspects of physician-assisted suicide breach physicians’ long-standing ethical norms. For instance, the 2011 annual report on the Death with Dignity Act in Oregon shows that physicians were present at fewer than 10% of “assisted deaths.”4 Why might they want to disconnect themselves from what they have enabled? Perhaps they have a moral intuition that intentionally facilitating or inflicting death is wrong. Patients expect an empathic presence from their physicians, and authentic healers commit to accompanying patients throughout the illness trajectory.

Referring to physician-assisted suicide as “treatment” is a new rhetorical tool that is used by the advocates of euthanasia. The goal is to make assisted suicide seem less alarming to the public and to promote the idea that legalizing the practice is just another small step along a path already taken and ethically approved. By intentionally confusing physician-assisted suicide with legitimate palliative care, pro-euthanasia advocates hope that the public will conclude that it is a medically and ethically accepted end-of-life treatment.5

For palliative care to remain a healing intervention, it cannot include “therapeutic homicide.”6Euthanizing and healing are intrinsically incompatible. Involvement of physicians in such interventions is unethical and harms the fundamental role of the doctor as healer.

 

 

OPTION 2

Physician-Assisted Suicide Should Be Permitted

Nikola Biller-Andorno, M.D., Ph.D.

To many of us — physicians and nonphysicians alike — death appears as a menace, as something we fear and want to avoid at all cost. At the same time, most of us know someone for whom death has come as a relief. These deaths were sometimes long-awaited or they were actively sought out, prepared for in secrecy, and endured alone. For those persons, the opportunity to ask a competent professional for assistance in ending their lives in a legally and socially accepted way would be a clear improvement. Mr. Wallace is fortunate that this is an option in the state in which he lives and that he can discuss it openly with his family and his physician.

The role of physicians is not simply to preserve life but also to apply expertise and skills to help improve their patients’ health or alleviate their suffering. The latter includes providing comfort and support to dying patients. Such patients may, after careful consideration, come to the conclusion that in their particular situation, asking a physician for assistance in suicide best reflects their interests and preferences. Responding to such a carefully considered request can be compatible with the goals and ethos of medicine, as well as with a trusting patient–physician relationship.

There is broad consensus about the importance and desirability of palliative medicine and hospice care, and physician-assisted suicide is in no way a repudiation of those practices.7 Yet in some cases, symptoms cannot be sufficiently controlled; in many other instances, what is at stake is a perceived loss of autonomy and dignity.8 Some patients wish to proactively shape the end of their life; to those patients, taking action to end their life is better than passively waiting for death to occur.

Physician-assisted suicide is now legal in a number of states in the United States, including Oregon and Washington State, as well as in Switzerland and in the Netherlands. The data from these places show that the implementation of physician-assisted suicide, when it is accompanied by certain safeguards (including comprehensive screening and informed consent processes), does not lead to uncontrolled expansion or abuse. In Switzerland, the number of assisted suicides has risen steadily over the past decade, but the total number of suicides has declined.9 The data from Oregon and Washington show that the majority of persons who request physician-assisted suicide are white, educated men — not a population that would be considered particularly vulnerable. Also, only a minority of persons who inquire about suicide assistance actually complete the process; this indicates that the option is perceived as a choice that can be abandoned.10

Even in societies with broad public support for physician-assisted suicide, a certain uneasiness and ambivalence remain, particularly among physicians who have to carry the emotional burden and moral responsibility of having enabled someone to end his or her life.11,12 The decision to provide suicide assistance cannot be forced on physicians but needs to be left to their individual conscience. However, if a physician is prepared to respond to a request for assistance in suicide, there are no compelling ethical reasons not to allow that physician to do so. In any case, careful regulation, comprehensive monitoring, and an ongoing critical debate are required to ensure that physician-assisted suicide remains a choice that is based on caring relationships among the patient, the family, and health care professionals.

 

Source: Nejm

Hebrew University Researchers Demonstrate Why DNA Breaks Down In Cancer Cells .

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black-dna-dna-double-helix-dna-helicase-abstractdna-replication-model-145x88Damage to normal DNA is a hallmark of cancer cells. Although it had previously been known that damage to normal cells is caused by stress to their DNA replication when cancerous cells invade, the molecular basis for this remained unclear.

Now, for the first time, researchers at the Hebrew University of Jerusalem have shown that in early cancer development, cells suffer from insufficient building blocks to support normal DNA replication. It is possible to halt this by externally supplying the “building blocks,” resulting in reduced DNA damage and significant lower potential of the cells to develop cancerous features. Thus, hopefully, this could one day provide protection against cancer development.

In laboratory work carried out at the Hebrew University, Prof. Batsheva Kerem of the Alexander Silberman Institute of Life Sciences and her Ph.D. student Assaf C. Bester demonstrated that abnormal activation of cellular proliferation driving many different cancer types leads to insufficient levels of the DNA building blocks (nucleotides) required to support normal DNA replication.

Then, using laboratory cultures in which cancerous cells were introduced, the researchers were able to show that through external supply of those DNA building blocks it is possible to reactivate normal DNA synthesis, thus negating the damage caused by the cancerous cells and the cancerous potential. This is the first time that this has been demonstrated anywhere.

This work, documented in a new article in the journal Cell, raises the possibility, say the Hebrew University researchers, for developing new approaches for protection against precancerous development, even possibly creating a kind of treatment to decrease DNA breakage.

 

 

argin�C tm�>� �:� ne-height:11.25pt;background: white;vertical-align:baseline’>Furthermore, unlike meats, caffeinated beverages, and alcohol, fruits and vegetables do not improve the taste of cigarettes.

 

“Foods like fruit and vegetables may actually worsen the taste of cigarettes,” remarked Haibach in the statement.

The research team states that more research needs to be done to see if the results can be replicated. If the findings are replicated, the investigators will work to determine the mechanisms in fruit and vegetables that help smokers quit the habit. They also want to look into research based on other dietary factors and smoking cessation.

“It’s possible that an improved diet could be an important item to add to the list of measures to
help smokers quit. We certainly need to continue efforts to encourage people to quit and help them succeed, including proven approaches like quitlines, policies such as tobacco tax increases and smoke-free laws, and effective media campaigns,” concluded researchers in the statement.

 

Source:  redOrbit.com