Harvard stem cell researcher Kenneth Chien speaks about a cardiac stem cell discovery that may be the first step on the path to regenerating healthy heart muscle.

In my recent post about Andrew McAfee Enterprise 2.0 I referred to the practice of demanding a sound business case of any innovation initiative  and how McAfee (supported by Robert Kaplan) deals with this requirement. This recent posts reflects also on return on investment myth.

Found at http://chieftech.com.au/the-enterprise-it-return-on-investment-myth-a

Read more at http://chieftech.com.au/the-enterprise-it-return-on-investment-myth-a

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• SearchCIO-Midmarket.com, 03.12.2009: How to drive a successful Web 2.0 technology implementation (searchcio-midmarket.techtarget.com)
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By Joe McKendrick

A new study of 4,000 hospitals by Harvard Medical School concludes that IT systems actually are costing healthcare institutions more money than they save.  And any improvements in healthcare processes or quality have been minimal.

The report, Hospital Computing and the Costs and Quality of Care: A National Study, makes the following conclusion:

“As currently implemented, health information technology has a modest impact on process measures of quality, but no impact on administrative efficiency or overall costs.  Predictions of cost-savings and efficiency improvements from the widespread adoption of computers are premature at best.”

Dr. David Himmelstein, an associate professor at Harvard Medical School and lead author of the study, says computing tends to drive up administrative costs, but only has a mild impact on productivity and quality.  The study also did a comparison of hospitals at the cutting edge of computerization (as indicated by their inclusion on the “100 Most Wired List” compiled by Hospital and Health Networks magazine for 2005 and 2007) with those of other hospitals.

“First, you spend $25 million dollars on the system itself and hire anywhere from a couple-dozen to a thousand people to run the system,” he said in a Network World interview.  “And for doctors, generally, it increases time they spend [inputting data].”

The problem “is mainly that computer systems are built for the accountants and managers and not built to help doctors, nurses and patients,” he is quoted as saying.

While there have been many promises over the years that IT in healthcare settings would cut paperwork and speed up or improve processes, there has been little documentable evidence so far to back up such claims, Himmelstein says.  “For 45 years or so, people have been claiming computers are going to save vast amounts of money and that the payoff was just around the corner,” he said.  “So the first thing we need to do is stop claiming things there’s no evidence for.  It’s based on vaporware and [hasn't been] shown to exist or shown to be true.”

As stated in the report, the data just isn’t there yet:

“Unfortunately, these attractive claims rest on scant data.  A 2006 report prepared for the Agency for Healthcare Research and Quality, as well an exhaustive systematic review, found some evidence for cost and quality benefits of computerization at a few institutions, but little evidence of generalizability.  Recent Congressional Budget Office reviews have been equally skeptical, citing the slim and inconsistent evidence base.  As these reviews note, no previous studies have examined the cost and quality impacts of computerization at a diverse national sample of hospitals.”

There’s no question that the healthcare system is broken — it’s overloaded, overburdened, over-administered, over-litigated, and way more costly than it should be.  When it comes to adding IT, there’s an old maxim that comes into play:  “When you automate a mess, you get an automated mess.”   As with automation in any industry, organizations need to first clear up and address underlying processes and issues before throwing software and systems at them.

All too often, executives think if they throw enough technology at a problem, it will somehow turn their organizations into shining beacons of success.  But in the end, technology is rarely the cure, it simply amplifies the existing organizational culture.   [Source:  http://www.smartplanet.com/business/blog/business-brains/harvard-study-says-computerization-costs-hospitals-more-than-it-saves/3545/?promo=019&tag=nl.e019&cval=EditorsPick&ctype=default]

Drinking coffee could help cut the risk of advanced prostate cancer, a Harvard Medical School study suggests.

Source:
http://news.bbc.co.uk/1/hi/health/8395865.stm

Drinking coffee could help cut the risk of advanced prostate cancer, a Harvard Medical School study suggests.

Source:
http://news.bbc.co.uk/1/hi/health/8395865.stm

You can, you know, especially you guys out there who drink coffee. According to a new study by Kathryn M. Wilson from the Harvard Medical School, men who drink the most coffee have a 60% lower risk of aggressive prostate cancer as opposed to men who do not drink coffee. Coffee effects insulin and glucose metabolism as well as sex hormones and those have an effect on prostate health. The findings of this study are based on the approximate 50,000 men who were appraised every four years. But I’m not seeing how long the study was. Among them, during the study, about 10% of those men developed prostate cancer. There was also no conclusive evidence, however, that drinking coffee is a healthy habit. But we all know by next week, coffee will have its adverse effects on something or other and some group will be touting the need for a ban on the stuff…until the following week when a new benefit of a steaming hot cup of java will be discovered.

But if you got ‘em, you can’t smoke ‘em in New Jersey. Is that any wonder, you can’t do something in New Jersey? Yes, it’s true, a ban has been placed on the sale of electronic cigarettes to anyone under the age of 19 and the use by adults at work and public places. Did you ever even hear of such a thing anyway? It’s an alternative that looks, feels, tastes, and acts just like a real cigarette, except it’s battery powered. Besides the battery, the “e-cig“, as it is affectionately known, has an atomizer and a cartridge filled with a liquid nicotine solution. When the smoker inhales, a switch is activated that signals the atomizer and it quickly heats up and vaporizes the liquid nicotine into a fine mist that duplicates the look and feel of smoke. It’s supposed to smell and taste great and give you the full effect of smoking real tobacco without all that harsh smoke that can be so annoying. Really, isn’t that the most annoying part of smoking?

Assemblywoman Connie Wagner (D-Bergen) is concerned that children might be drawn to these e-cigs because of the variety of available flavors like chocolate, banana, strawberry which could end up being a gateway to real cigarettes. Come on, how often do you get a chance to smoke such fun flavors? Then again, now often do you get the chance to smoke such carcinogens and toxic chemicals as diethylene glycol which is an ingredient in antifreeze? That’s what the FDA, who has not approved the product, discovered were in those liquid nicotine cartridges. You’re probably better off with a real cigarette.

Meanwhile, down under, in Sydney, Australia, police have charged two stars of a British reality TV show with animal cruelty. The show is called called “I’m A Celebrity…Get Me Out Of Here” and it pits contestants against each other in a series of scary and stomach turning tasks in a remote setting. The incident in question that got the RSPCA all ruffled up occurred when a rat was killed and cooked with the intent to eat. “The killing of a rat for a performance is not acceptable,” David O’Shannessy told the BBC of the New South Wales RSPCA. He went on to say, “The concern is this was done purely for the cameras.” I might be wrong, but I think the bigger concern would be the cooking and eating the thing. Italian chef Gino D’Acampo (who was the winner of the latest season) and British actor Stuart Manning were charged in this heinous act and are scheduled to appear in court on February 3.

I had more to tell you, but frankly, I’m too grossed out to continue.

See you tomorrow!

PS. In answer to Melissa’s question about why the top tube of a woman’s bicycle frame (known as a step-through frame) is lower than that of the design for a man’s bike, is that it allowed for a more dignified way of mounting and dismounting the vehicle while wearing a skirt or a dress. The top tube is up so high on a man’s bike to teach the boys how to keep their balance on their seats.

A new study published in the American Journal of Medicine looking at some of the America’s “most wired” hospital facilities found that computerization hasn’t saved hospitals money or improved administrative efficiency.

The study evaluated data from approximately 4,000 American hospitals over a four-year period and found that the high cost of installing and maintaining hospital computerization systems is greater then any anticipated cost savings. Moreover, most of the software written for use in hospitals is intended for administrative, not medical purposes.

The report concludes that while hospital computing might “modestly improve process measures of quality,” they do not reduce administrative or over-all costs.

Here are some clues to the importance of water.  The earth’s surface is over 70% water.  Most of the human body is water.  Drinking water delivers nutrients, removes toxins, regulates body temperature, cushions organs and joints, and according to the Harvard Medical School, it lowers the risk of bladder cancer and kidney stones.  Are you feeling me yet?

And lack of water leads to dehydration.  My body lets me know when it is dehydrated by sapping my energy and giving me a throbbing headache.  The worst is trying something “bouncy” while dehydrated like jumping jacks or running.  That demonstrates pretty quickly how important water is to your system. 

Just like everything in medicine, exactly how much you need to drink each day is a matter of disagreement.  The most honest scientific answer we can give you is:  it depends.  But the rule heard most often is 8 eight-ounce glasses a day (8×8) for the average adult.  This comes from the idea that we need about liter of water per 1,000 calories burned.  You’ll need more if you exercise a lot, burn a lot of calories, or live where it is hot and dry.  Not all fluid needed by the body must be from beverages as there is also water in foods (such as fruits).  And if you are taking our fruit challenge, you are eating plenty of those!  You might get about 20% of your daily water needs through foods and the rest through beverages.

At Fantasy Healthball, we stick by the 8 eight-ounce glasses a day as a general rule of thumb.  An easy way to do this is to carry a liter of water with you and make sure you fill it up twice throughout the day.  It is part of our culture nowadays to see everyone walking around with their liter of water.  Water bottles are now a big business.  My personal favorite is this one but you are bound to find one you love.

If you still have questions, you can check out what the Mayo Clinic has to say or talk to your doctor.  Most people can use the 8×8 as a rule of thumb and then adjust based on your body size, lifestyle, climate, and if you happen to be running a marathon that day or not!  Choose fresh, clean, filtered water and choose it again and again!  Select our water challenge if you have trouble fitting water into your daily life.  You should drink more water than any other beverage with its 0 calorie goodness!  -  Jim Ballard

It seems these days that America’s symbol has changed from “mom and apple pie” to “work and coffee.”  Cities are no longer measured in population, but rather in numbers of Starbucks.  Coffee is everywhere.  In 2008, Starbucks alone has about nearly 17,000 stores in 49 countries.  If your vacation plans take you to South Korea, Kuwait, Turkey, or Malaysia, never fear, a Starbucks is near.  We can increasingly also find it along our waistline due to the array of specialty coffees available. 

A typical cup of black coffee may only have a few calories.  Interested in the grande Caramel Chocolate Frappuccino Blended Coffee?  That will be 400 calories.  How about just the grande Caffe Mocha with whole milk and whipped cream?  412 calories.  Why not add in the peppermint brownie?  440 calories more.  Crumble berry coffee cake?  Oh, no, you didn’t!  

If you can skip the specialties and the treats, coffee isn’t all bad.  To be fair, the tall basic coffee at Starbucks has 9 calories.  Also, caffeine may have some health benefits such as improving memory and decreasing fatigue and even helping to prevent some diseases.  However, there are some significant downsides such as high blood pressure, speeding the heart rate, dehydration, and making you feel jumpy and restless. 

The word on coffee from Harvard Medical School, and the Mayo Clinic, and also your grandmother, is “moderation.”  At Fantasy Healthball, we have a challenge for those of you who drink too much coffee.  If you are a heavy coffee/caffeine drinker, we suggest limiting it to 2 servings or less per day on our Daily Challenge Team Roster Scorecard.    And for heaven’s sake, just get the coffee and not the chocolatecaramelwhippedchemicalsyrupcrazedsugarfunbatch (a gazillion calories) and that little innocent looking Caramel Pecan Sticky Roll (730 calories – that’s more than a Big Mac!).  They may just have to sticky roll you out the door. 

Of course, caffeine isn’t just found in coffee.  It is also in chocolate, tea, some diet pills, some sodas, and many energy drinks.  Oh, and also in some alcoholic beverages which the FDA is now threatening to pull from the shelves.  So think about how much coffee you drink, the caffeine, what else is in the coffee, and your own health goals.  Also, check out our diet and nutrition info. and our exercise info. and get in our game!  — Jim Ballard

Newsflash: An ‘F’ is really, really bad.

But that’s exactly the grade that the dean of one of our nation’s premier medical schools just assigned to ObamaCare.

Dr. Flier points out that the 2,074 page bill isn’t just bad; it is fundamentally dishonest.

Only a true fool and ideologue would support the takeover of our life-and-death health care system and 1/6th of our economy through a bill that literally gets a failing grade.

NOVEMBER 17, 2009, 6:59 P.M. ET

Health ‘Reform’ Gets a Failing Grade
The changes proposed by Congress will require more draconian measures down the road. Just look at Massachusetts.

By JEFFREY S. FLIER

As the dean of Harvard Medical School I am frequently asked to comment on the health-reform debate. I’d give it a failing grade.

Instead of forthrightly dealing with the fundamental problems, discussion is dominated by rival factions struggling to enact or defeat President Barack Obama’s agenda. The rhetoric on both sides is exaggerated and often deceptive. Those of us for whom the central issue is health—not politics—have been left in the lurch. And as controversy heads toward a conclusion in Washington, it appears that the people who favor the legislation are engaged in collective denial.

Our health-care system suffers from problems of cost, access and quality, and needs major reform. Tax policy drives employment-based insurance; this begets overinsurance and drives costs upward while creating inequities for the unemployed and self-employed. A regulatory morass limits innovation. And deep flaws in Medicare and Medicaid drive spending without optimizing care.

Speeches and news reports can lead you to believe that proposed congressional legislation would tackle the problems of cost, access and quality. But that’s not true. The various bills do deal with access by expanding Medicaid and mandating subsidized insurance at substantial cost—and thus addresses an important social goal. However, there are no provisions to substantively control the growth of costs or raise the quality of care. So the overall effort will fail to qualify as reform.

In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care’s dysfunctional delivery system. The system we have now promotes fragmented care and makes it more difficult than it should be to assess outcomes and patient satisfaction. The true costs of health care are disguised, competition based on price and quality are almost impossible, and patients lose their ability to be the ultimate judges of value.

Worse, currently proposed federal legislation would undermine any potential for real innovation in insurance and the provision of care. It would do so by overregulating the health-care system in the service of special interests such as insurance companies, hospitals, professional organizations and pharmaceutical companies, rather than the patients who should be our primary concern.

In effect, while the legislation would enhance access to insurance, the trade-off would be an accelerated crisis of health-care costs and perpetuation of the current dysfunctional system—now with many more participants. This will make an eventual solution even more difficult. Ultimately, our capacity to innovate and develop new therapies would suffer most of all.

There are important lessons to be learned from recent experience with reform in Massachusetts. Here, insurance mandates similar to those proposed in the federal legislation succeeded in expanding coverage but—despite initial predictions—increased total spending.

A “Special Commission on the Health Care Payment System” recently declared that the Massachusetts health-care payment system must be changed over the next five years, most likely to one involving “capitated” payments instead of the traditional fee-for-service system. Capitation means that newly created organizations of physicians and other health-care providers will be given limited dollars per patient for all of their care, allowing for shared savings if spending is below the targets. Unfortunately, the details of this massive change—necessitated by skyrocketing costs and a desire to improve quality—are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required.

Yet it’s entirely unclear how such unspecified changes would impact physician practices and compensation, hospital organizations and their capacity to invest, and the ability of patients to receive the kind and quality of care they desire. Similar challenges would eventually confront the entire country on a more explosive scale if the current legislation becomes law.

Selling an uncertain and potentially unwelcome outcome such as this to the public would be a challenging task. It is easier to assert, confidently but disingenuously, that decreased costs and enhanced quality would result from the current legislation.

So the majority of our representatives may congratulate themselves on reducing the number of uninsured, while quietly understanding this can only be the first step of a multiyear process to more drastically change the organization and funding of health care in America. I have met many people for whom this strategy is conscious and explicit.

We should not be making public policy in such a crucial area by keeping the electorate ignorant of the actual road ahead.

Dr. Flier is dean of the Harvard Medical School.

I’d like to thank Dr. Flier for his courageous stand.  You’ve GOTTA know that the man is taking a lot of heat for it by the hard-core Massachusetts and Harvard liberal ideologue establishment.  Dr. Flier clearly isn’t taking this position on the Democrats’ health agenda for his own health, as it were.

Capitation would merely be the most obvious way that the government would place doctors in a morally/ethically untenable position: they would literally be paid more to give their patients less treatment, and paid less to give their patients more treatment.

Another means of accomplishing the same result would be to have – oh, I don’t know, say 111 federal bureaucracies – which would force doctors to consider their regulations more than considering the needs of their patients.

It is evil.  And Democrats are evil for foisting this abomination upon us.

by Dick Morris and Eileen McGann at Townhall.com

…More

Φήμες θέλουν την πρωταγωνίστρια του Heroes, Hayden Panettiere να παίρνει θέση πίσω από τις κάμερες στην παραγωγή του HMS, μία καινούργια ιατρική σειρά, που αφορά μια ομάδα μαθητών του Harvard Medical School. Τι ελπίδες έχουν άραγε μπροστά στον κολοσσό που λέγεται Grey’s Anatomy ?

A Harvard Medical School research team estimates 2,266 U.S. military veterans under the age of 65 died last year because they lacked health insurance and had reduced access to care.

That’s more than 14 times the number of deaths suffered by U.S. troops in Afghanistan the same year.

Source:
http://www.motherjones.com/mojo/2009/11/veterans-die-lack-health-insurance

A Harvard Medical School research team estimates 2,266 U.S. military veterans under the age of 65 died last year because they lacked health insurance and had reduced access to care.

That’s more than 14 times the number of deaths suffered by U.S. troops in Afghanistan the same year.

Source:
http://www.motherjones.com/mojo/2009/11/veterans-die-lack-health-insurance

(by Kathryn Giardi, LEED AP)

A few weeks ago I went to the 62nd meeting at 641-643 Huntington Avenue in Boston’s Longwood Medical Area to attend the weekly meeting for the Harvard Medical School’s newest LEED™ Gold office renovation project. I walked in the front door and was greeted by a woman in dress pants and a nice blouse. She asked me who I was there to see and all of a sudden it hit me, this building was no longer ours. The Principal-in-Charge, Brian and I had spent every Tuesday morning each week for over a year walking through the building in its many stages of construction, surrounded by subcontractors that had been asking us questions, and now all of a sudden we were guests. It was an uneasy feeling.

Layers of Existing Structure

I had been through the many stages of design and construction with these two attached masonry buildings, both built in the late 19th century. Almost two years ago I had spent each day for roughly three weeks surveying the existing conditions with a colleague, getting to know each and every nook and cranny of this congested, mazelike 26,000 SF office building. I was warned of the “haunted staircase” and learned how to travel down one flight of stairs in one building, over to the other building, and then up another flight of stairs just to pass between the two on certain floors. After that experience, the design process held a whole other meaning to me. We worked with the clients to help design the space, in the hopes that some of the character of the building could remain and be juxtaposed against modern curved glass walls. Although the budget did not allow for all of our modern accents, a handful of the original fire places were restored to retain the personality of the original building.

From existing masonry and wood frames to final design.

Once the Construction Documents were finalized (in 4 weeks!), and the bidding process was complete, construction began last summer. We had an idea of the surprises that might be uncovered when demolition began but no one was prepared for the structural redesign that was required. Many of the masonry bearing walls were to remain per the drawings but their poor condition was not always suitable for reuse. As entire staircases that cut through all levels of the building were removed, we would stand along side holes that cut the building in section, revealing the many layers of structure and the old craftsmanship that had pieced the building together. That real life section is something that we recreate all the time on 3D computer programs like Revit and it really solidified the connection between design and construction for me.

Huntington Teaming Room

One of the biggest challenges that ensued concerned fitting the mechanical, electrical, plumbing, and fire protection piping, ductwork, and equipment in an incredibly small space above the ceiling. Amazingly it was achieved but at the expense of the ceiling layout. Questions were answered in the field and during the week in the office. The Construction Administration on this renovation was practically a full time job. Not to mention the fact that this project is targeted for LEED Gold certification. That aspect brought a whole other dynamic to the design and construction process (that’s a story for another blog)!

Huntington Reception Desk

On one of our final walkthroughs, people were moving into their new offices and Harvard higher-ups were walking through the space complimenting our firm on the design. It felt great to hear the praises and when I looked around the space I agreed. But it was hard to watch everyone taking over the space, the building that we had painstakingly helped to design and build over the last two years. But in the end, this is the nature of our business, our designs are created for other people to enjoy – for our clients to do their business better. So we accepted our praises and said our goodbyes, and looked forward to handing off the building to be cared for by its happy occupants.

Huntington Facade

Do you take dietary supplements? Maybe vitamin C or a multivitamin? According to Harvard Medical School, that may not be the best idea. Many college students, including myself, believe that because we may not be getting all the calcium, iron, and vitamins we need during our college years, we can get them from taking dietary supplements. Well, according to Harvard Medical School, it’s better to try your best to increase your fruits and vegetables rather than take a supplement. Learn more about this issue by reading the full article.

Almost all of us have been to the doctor at some point or the other in our lives. One of the common things you would have noted in your meetings with your doctor is him scribbling down notes. But, have you wondered what he writes in such notes? Do you think you should be allowed to see those notes? And, are you prepared to see what your doctor might have written about your meeting and your physiological and psychological conditions?

A lot of what’s in that note is objective stuff about your blood pressure, weight and blood count. But often your doctor puts down subjective impressions.

Did you seem down? Anxious? Angry? Drinking too much? Not so mentally sharp? Physicians also may speculate about a tentative diagnosis – maybe a scary one – they haven’t shared with you.

What do you think doctors would feel about letting patients see their notes? As you would guess, there are mixed opinions. Some feel comfortable while others don’t. It ranges from ‘Well, transparency is here, this will be good for patients, they’ll be more actively involved in their care, this is a terrific idea,‘ to ‘This is the worst thing I’ve ever heard of.‘

Doctors’ notes are not really secret anyway. Other doctors see them. Insurance companies and lawyers do. And under a 1996 federal law called the Health Insurance Portability and Accountability Act, or HIPAA, patients have every right to see their complete medical records. But as Dr. Tom Delbanco of Harvard Medical School (HMS) puts it, “You can get it but we do everything in the world to make sure you don’t get it. The medical record has traditionally been viewed by the medical establishment as something that they own. They think: ‘It’s my private notes. This is my stuff.’”

Check out below for some other kinds of opinions that different doctors share:

• “Information should be accessible, but that will mean more work for doctors who may need to explain their notes to patients.”
• “My hope is that it will be a method of communicating with patients, so patients can see what we’re thinking, where our head is, what our plans are, why we’re suggesting what we do.”
• “We may be less candid. We may not as accurately describe the mood of the patient, the tenor of the encounter, for fear that we may get someone perhaps already a little angry during the encounter – more so after they log on and read the note that I just finished.”
• “Physicians are scared of this kind of thing. But the big, broad directions are clear. Which is: Patients have to be at the center of their care more and more. That doesn’t mean patients call the shots. But patients really have to be a team member. To be a team member, they’ve got to see the playbook. And doctors will have to learn to be respectful in the way they write their notes in some situation.”
• “If there’s some delicate problem, doctors shouldn’t dodge that topic, and patients should be prepared to see some things which may be a little painful for them to confront too.”

Your doctor’s reservations to this idea are understandable:

• It will be more work for them, because patients will call up wanting to know what something means, or demanding corrections.
• It might lead to more lawsuits.
• It might scare the hell out of patients.

Source: Adapted from the NPR story – “Doctors Don’t Agree On Letting Patients See Notes” by Richard Knox

For affordable and quality medical care in the United States, check out domestic medical tourism. For surgery abroad, check out medical tourism.

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• Metformin is more effective than chemotherapy alone
• Study supports cancer stem cells hypothesis
• Laboratory study focused on breast cancer cells

PHILADELPHIA, Sept. 14, 2009 – In a one-two punch, a familiar diabetes drug reduced tumors faster and prolonged remission in mice longer than chemotherapy alone by targeting cancer stem cells, Harvard Medical School researchers reported in the September 14 online first edition of Cancer Research, a journal of the American Association for Cancer Research.

“We have found a compound selective for cancer stem cells,” said lead researcher Kevin Struhl, Ph.D., the David Wesley Gaiser professor of biological chemistry and molecular pharmacology at Harvard Medical School. “What’s different is that ours is a first-line diabetes drug.”

These findings add to a growing body of preliminary evidence in cells, mice and people that metformin may improve breast cancer outcomes in people. In this study, the diabetes drug seemed to work independently of its ability to improve insulin sensitivity and lower blood sugar and insulin levels, all of which are also associated with better breast cancer outcomes.

The results fit within the cancer stem cell hypothesis, an intensely studied idea that small subsets of cancer cells have a special power to initiate tumors, fuel tumor growth and promote recurrence of cancer. Cancer stem cells appear to resist conventional chemotherapies, which kill the bulk of the tumor.

“There is a big desire to find drugs specific to cancer stem cells,” said Struhl. “The cancer stem cell hypothesis says you cannot cure cancer unless you also get rid of the cancer stem cells. From a purely practical point of view, this could be tested in humans. It’s already [in use as] a first-line diabetes drug.”

The possible usefulness of a diabetes drug against cancer lends credence to an emerging idea that, in the vast and complex alphabet soup of molecular interactions within cells, a relatively few biological pathways will turn out to be most important for many different diseases, Struhl suggested.

In experiments led by postdoctoral fellows Heather Hirsch, Ph.D., and Dimitrios Iliopoulos, Ph.D., the combination of metformin and the cancer drug doxorubicin killed human cancer stem cells and non-stem cancer cells in culture. The researchers used four genetically distinct breast cancer cell lines.

In mice, pretreatment with metformin prevented the otherwise dramatic ability of human breast cancer stem cells to form tumors. In other mice where tumors took hold for 10 days, the combination therapy also reduced tumor mass more quickly and prevented relapse for longer than doxorubicin alone. In the two months between the end of treatment and the end of the experiment, tumors regrew in the mice treated with chemotherapy alone, but not in those who received both drugs. Metformin was ineffective in treating tumors when used alone.

“This is an exciting study,” said Jennifer Ligibel, M.D., a medical oncologist at the Dana-Farber Cancer Institute and a Harvard Medical School instructor in medicine. Ligibel and colleagues at the National Cancer Institute of Canada Clinical Trials Group are developing a large-scale phase II trial and will study its metformin’s impact on recurrence in women treated for early stage breast cancer.

“There is a lot of interest in studying metformin in breast cancer, but so far we do not have direct evidence that metformin will improve outcomes in patients,” said Ligibel, who was not involved in the current study “That’s what this trial is for.”

So far, observational studies have suggested a lower risk of cancers, including breast cancer, and better response to chemotherapy in patients with diabetes who are treated with metformin, she said. Results of basic science studies have also suggested plausible biological mechanisms. The study from the Struhl lab suggests a potential new pathway through which metformin could have an effect on breast cancer cells, according to Ligibel.

In their search for compounds that selectively destroy cancer stem cells, researchers hope to improve cancer outcomes. But the story is never as simple in human cancers, according to Kornelia Polyak, M.D., Ph.D., a breast cancer researcher at the Dana-Farber Cancer Institute and an associate professor of medicine at Harvard Medical School.

Cancer stem cells are a shifty target, said Polyak, who was not involved in the current study. For example, any cancer cell can acquire the properties of a cancer stem cell, and cancer stem cells can change into non-stem cancer cells, which can be just as deadly. Clinical trials in people are needed to test these ideas, according to Polyak.

The study by Struhl and colleagues is an offshoot of a larger project in his lab to systematically track how gene activity changes when cells transform into cancer. These changes were remarkably similar to gene dynamics in diabetes and other inflammatory conditions.

The researchers reasoned that if a common genetic pathway underlies different diseases, drugs that work against one disease might work against another. In a screen, the most effective drug inhibiting the transformation of cells into cancer was metformin, which led to the experiments in this study. They were further encouraged by the low dose of metformin needed for the effect in the laboratory, compared to the amount needed for analogous molecular experiments in basic diabetes research. The relative dosage for treating or preventing cancer is unknown and untested in people.

Struhl and Harvard Medical School have applied for a patent for a combined therapy of metformin and a lower dose of chemotherapy, which is being tested in animals. The National Institutes of Health and the American Cancer Society funded this research.

The American Association for Cancer Research hosted a news briefing about the results of this study on Monday, Sept. 14, 2009.

Listen to a recording of the teleconference

Download* the mp3 of the press briefing (8.74 MB, 38 minutes and 11 seconds)

*On a PC, right mouse click on the “Download” link and select “Save link as…” in Firefox or “Save Target as…” in Internet Explorer.

Panelists:

Moderator – Frank Rauscher, III, Ph.D.
Editor in Chief, Cancer Research
Professor, Gene Expression and Regulation Program
The Wistar Institute

Kevin Struhl, Ph.D.
David Wesley Gaiser Professor of Biological Chemistry and Molecular Pharmacology
Harvard Medical School

George Prendergast, Ph.D.
President, CEO and Professor
Lankenau Institute for Medical Research

Jennifer Ligibel, M.D.
Medical Oncologist
Dana-Farber Cancer Institute
Download panelist photos through the following links

Frank Rauscher, III, Ph.D.

Kevin Struhl, Ph.D.

George Prendergast, Ph.D.

Jennifer Ligibel, M.D.

Read the full Cancer Research study here.

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Media Contacts:
Jeremy Moore
(267) 646-0557
jeremy.moore@aacr.org

Harvard Medical School
Carol Cruzan Morton
(617) 432-0442
communications@hms.harvard.edu

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The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world’s oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 28,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and nearly 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.