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Genetic analyses can benefit those at risk of hereditary cancer

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By Dr. Gurdeep Sethi & Dr. Sudhir Borgonha

Genomics and genetic analysis are the most effective ways to manage cancer, not only in India but also across the globe.

Hereditary cancers are seen in approximately 10 per cent of the Western population, with a higher incidence in India. Hereditary cancer has high prevalence in breast and ovarian cancer patients. We see a very strong shift in this trend, with an increased incidence of cancer in India’s younger population. The section of the population that is at risk of hereditary cancer will certainly benefit from genetic analysis.

With genetic testing, we can understand the genetic profile of the cancer. This knowledge leads to choice of targeted drugs that are designed to counter the cellular functions of the mutant proteins. Patients on active chemotherapy regimens are reassured that they do have alternative directed treatments if they do not respond to the ongoing treatment regimen. In the long run, targeted therapeutics would replace generic chemotherapy.

There is a great potential for targeted therapeutics. Cancer medicine, however, is evolving every day. There is much research and data to process and we still do not understand the full potential of genetic analysis and the benefits of targeted therapy based on the gene mutation. In such a scenario, if there is a targeted protein identified with effective medication available, then it would be better to treat the patient based on literature available after they have failed conventional treatment options.

New therapeutic drugs are being developed every year and their side effects are better controlled. Even though the cost of chemotherapy has drastically come down over time, targeted therapy has fewer side effects and causes lesser collateral damage to normal tissue. It is almost four to five times the cost of current chemotherapy regimens. As time progresses and these medications become generic, they would replace chemotherapy in the long run.

Genetic analysis of a tumour can support the choice of therapy at the initial stages of diagnosis as well as throughout the course of treatment. Cancer cells can mutate (change) and be present as a disease in multiple variant forms. This essentially means that we need a fresh “snapshot” of the genetic profile of each patient’s cancer at every stage of the disease. New target proteins are produced due to these mutations.

To introduce new drugs to target these changes, an understanding of the genetic profile of a cancer — quite like time-lapse photography to capture a sequence of events — is absolutely vital. Liquid biopsy is precisely the technique to use to achieve this.

The challenge in this setting is getting the patient to understand the concept in the first place and then accept the increasing cost with the recurring tests. This process of longitudinal cancer care with follow-up liquid biopsies is already the norm in the United States. It makes sense scientifically, and insurance companies cover the cost. In the long run, liquid biopsy-based personalised cancer therapy will become the norm in India as well.

(Dr. Gurdeep Sethi is Founder, Millennium Cancer Center, Gurugram. Dr. Sudhir Borgonha is Chief Medical Officer, Strand Life Sciences, Bengaluru. The views expressed are personal. They can be contacted at [email protected] and [email protected])

IANS

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Decoded: How Omega-3 fatty acid helps inhibit cancer’s spread

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fish oil-WEFORNEWS

New York, July 16: While eating foods rich in omega-3 fatty acids, such as fatty fish, certain nuts and seeds, have been known to prevent heart diseases and arthritis, a new research, led by one of Indian-origin, showed that omega-3 fatty byproducts may also have anti-cancer effects.

The new study, led by Aditi Das from University of Illinois at Urbana-Champaign, US, showed that when the human body metabolises omega-3 fatty acids, it produces a class of molecules called endocannabinoid epoxides, or EDP-EAs. These have anti-inflammatory properties and can inhibit cancer’s growth and spread.

The EDP-EAs have similar properties to cannabinoids found in marijuana — but without the psychotropic effects — and they target the same receptor in the body that cannabis does.

“We have a built-in endocannabinoid system which is anti-inflammatory and pain-reducing. Now we see it is also anti-cancer, stopping the cells from proliferating or migrating,” said study leader Aditi Das from University of Illinois at Urbana-Champaign.

“These molecules could address multiple problems: cancer, inflammation and pain,” Das added.

For the study, published in the Journal of Medicinal Chemistry, the team studied the effect of the molecule in mice with tumours of osteosarcoma — a bone cancer that is not only painful but also difficult to treat.

The results showed that the endocannabinoids slowed the growth of tumours and blood vessels, inhibited the cancer cells from migrating and caused cancer cell death.

The higher concentrations of EDP-EAs did kill cancer cells, but not as effectively as other chemotherapeutic drugs on the market. But, the compounds slowed tumour growth by inhibiting new blood vessels from forming to supply the tumour with nutrients. They also prevented interactions between the cells, and most significantly, they appeared to stop cancerous cells from migrating.

While dietary consumption of omega-3 fatty acids can lead to EDP-EAs, for those with cancer, something concentrated and fast acting is needed, Das said.

“That’s where the endocannabinoid epoxide derivatives come into play – you could make a concentrated dose of the exact compound that’s most effective against the cancer. You could also mix this with other drugs such as chemotherapies,” she added.

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Regulation of healthcare needed to check corruption: Salman Khurshid

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Salman Khurshid

New Delhi, July 12 : Congress leader Salman Khurshid on Thursday said a strong regulatory system is needed to check widespread corruption in the Indian healthcare sector where 25 per cent of the money spent on health is lost due to fraud.

“What you need really is a profound regulatory system. Regulation is itself something that can go wrong but if we have a good clear regulatory system it will help,” he said at the launch of book “Healers or Predators? Healthcare Corruption in India”.

Khurshid said private hospitals who get land from the government are obliged to provide 30 per cent of their beds to the poor for free but these obligations are hardly met. Patients with no real ailment and hence no expenditure are admitted to account for the 30 per cent.

The former Union Law Minister also said even the judges are not familiar with what constitutes a medical malpractice.

“We could have a death because of cardiac attack as the patient was put through tests that were not advisable and all that the hospital says is pay and we will release the body. How many cases have you heard where sanctions have been imposed on such malpractice?”

The book, which highlights corruption in India’s healthcare and medical system, is a compilation of various reports written by medical doctors on the various crises plaguing the sector and edited by Samiran Nundy, Keshav Desiraju and Sanjay Nagral.

BMJ Group Non-executive Director David Berger, who first highlighted deep-rooted but widely accepted corruption in Indian healthcare, said he was struck by the lack of trust between doctors and patients that destroys the healing relationship.

BMJ, a subsidiary of the British Medical Association, is a provider of journals, clinical decision support, events and medical education.

“The solutions are upstream, not downstream. Ranting about individual doctors being corrupt is no use. As a start, the Medical Council of India (MCI) needs to be reformed or replaced by an effective system of professional regulation where doctors are held to account,” Berger said.

Gastrointestinal surgeon and writer Nundy said there is wide asymmetry of information — doctors know everything and the patients know nothing. Patients look at doctors as god or near god and it is terrible to betray that trust, he said.

He said the Indian health system is the second most corrupt sector after police, as per a report by Transparency International. As part of solution, the country needs to first accept the National Medical Commission Bill, he said.

Other panelists at the book launch expressed deep concern over the Modi government’s flagship healthcare protection scheme, popularly called Modicare, because of the lack of basic regulation of the private sector, which accounts for 70 per cent of the country’s hospitals. The government will be heavily dependent on the private sector for the success of Ayushman Bharat.

However, NITI Ayog Member Health Vinod Paul, who believes self-regulation is essential, believes in the power of technology and analytics to raise a red flag at the possible points of corruption, and then “match it with a deterrent in terms of penalties and prosecution”.

“I think in a transparent, information technology driven system using analytics and artificial intelligence gives us an additional, very powerful tool which the developed nations have used to avert cases of corruption,” he said.

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India heading for comprehensive healthcare crisis: Amartya Sen

The Medical Council of India (MCI), which aims to provide quality medical care to all Indians through promotion and maintenance of excellence in medical education, Sen blames the organisation for not only failing to perform its duties but also for its designated role of looking after medical colleges.

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Amartya Sen

India spends just a little over one per cent of its GDP on healthcare and this is leading the country into “a comprehensive healthcare crisis”, according to Nobel laureate and noted economist Amartya Sen, who has called for greater allocation on healthcare in India and highlighted what he calls “three general failures” in the country’s healthcare segment.

“The fact that India allocates only a little over 1 per cent of its gross domestic product on public healthcare contrasts sharply, for example, with nearly three times as much by China. We reap as we sow, and cannot expect to get what other countries achieve by allocating much more resources — as a proportion of their respective levels of the gross national product– to healthcare,” Sen writes in his elaborate foreword to “Healers or Predators? Healthcare Corruption in India”, which will be launched here on Thursday.

Sen, a recipient of the Bharat Ratna in 1999, further claims that the entire organisation of Indian healthcare has become “deeply flawed”, leading the country into “a comprehensive healthcare crisis”.

“Despite being one of the fastest growing economies in the world, India ranks among the poorest achievers of good health. The shortfall of India’s health achievements compared with those of, say, China or Thailand is large and has been growing larger. Even within South Asia, Bangladesh and Nepal have overtaken India in health accomplishment, including in life expectancy.

“If India’s bad record in healthcare is not much discussed in the Indian press, this neglect does not indicate the presence of a tolerable level of healthcare in India, but reflects instead the narrow reach of the Indian news media, with its traditional neglect of elementary education and healthcare,” writes the 84-year-old economist.

Sen has extensively written on welfare economics and social justice and in the given book, he also highlights the plight of patients suffering at the hands of “private caregivers”.

He says private clinics “will not budge” without “the promise of payment”. Noting that even though some public services are offered freely, Sen highlights that many critically important services are denied unless the patient can cough up demanded sums, which can be “unaffordable” for many underprivileged Indians.

Taking a dig at the Medical Council of India (MCI), which aims to provide quality medical care to all Indians through promotion and maintenance of excellence in medical education, Sen blames the organisation for not only failing to perform its duties but also for its designated role of looking after medical colleges.

“In particular, in the use of the power — and responsibility — to set up new private medical colleges, there seems to be clear evidence of fairly straightforward corruption,” he claims.

He ends the over 1,500-word foreword to this “splendid, if depressing, book” with what he calls “three general failures” in India’s healthcare segment — “the amazing neglect of primary healthcare compared with health interventions needed at later stages”; “India’s hasty and premature reliance on private healthcare, which goes hand in hand with neglect of public healthcare”; and the deficiancy of “informed public discussion on healthcare” in the country.

Published by Oxford University Press, “Healers or Predators? Healthcare Corruption in India” has been edited by by Samiran Nundy, Keshav Desiraju and Sanjay Nagral.

“This hard-hitting volume”, according to the publisher, “shows a mirror to the society and, more specifically, to those associated with the health sector — on how healers, in many cases, are shifting shape to becoming predators”.

(Saket Suman can be contacted at [email protected])

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