"Chronic inflammation is uniformly damaging and is absolutely causal"
April 26, 2019 1:51 PM Subscribe
In 2017, two cardiologists at Brigham and Women’s Hospital in Boston, who suspected such a link, published the results of a human clinical trial that will forever change the way people think about inflammation. The trial, which involved more than 10,000 patients in 39 countries, was primarily designed to determine whether an anti-inflammatory drug, by itself, could lower rates of cardiovascular disease in a large population, without simultaneously lowering levels of cholesterol, as statin drugs do. The answer was yes. (Jonathan Shaw, Harvard Magazine)
But the researchers went a step further, building into the trial additional tests seeking to clarify what effect the same anti-inflammatory drug, canakinumab, might have on illnesses seemingly unrelated to cardiovascular disease: arthritis, gout, and cancer. Only the researchers themselves, and their scientific colleagues, were unsurprised by the outcome. Lung cancer mortality dropped by as much as 77 percent. Reports of arthritis and gout also fell significantly.
But the researchers went a step further, building into the trial additional tests seeking to clarify what effect the same anti-inflammatory drug, canakinumab, might have on illnesses seemingly unrelated to cardiovascular disease: arthritis, gout, and cancer. Only the researchers themselves, and their scientific colleagues, were unsurprised by the outcome. Lung cancer mortality dropped by as much as 77 percent. Reports of arthritis and gout also fell significantly.
In the article they talk about how they found that regular exercise also significantly reduced inflammation, which might be one of the reasons exercise has always been recommended for a healthy lifestyle. I think i'll stick to that over a new pill. Fascinating article tho.
posted by Homo neanderthalensis at 2:19 PM on April 26, 2019 [10 favorites]
posted by Homo neanderthalensis at 2:19 PM on April 26, 2019 [10 favorites]
Saith Wikipedia about Canakinumab: One 150 mg subcutaneous injection ... costs over $16,700. ... Those treated in CANTOS had a 15% reduction in deaths from heart attacks, stroke and cardiovascular disease combined. However, there were serious side-effects, and no statistically significant overall survival benefit.
I skimmed over the Harvard Magazine article - it does mention alternatives to canakinumab.
posted by King Sky Prawn at 2:20 PM on April 26, 2019 [10 favorites]
I skimmed over the Harvard Magazine article - it does mention alternatives to canakinumab.
posted by King Sky Prawn at 2:20 PM on April 26, 2019 [10 favorites]
And then there's this, from October, 2018:
In a major setback, Novartis used its quarterly earnings report to flag an FDA slapdown on their application to market canakinumab for cardio risk reduction...
Based on the correspondence from the FDA, the CANTOS data would not support labeling for the use of canakinumab as a targeted therapy for those patients with cardiovascular disease who achieved a reduction of hsCRP below the 2 mg/L target. At this time, we are evaluating the feedback provided and plans further discussions with the FDA.1
That said, we are continuing to study canakinumab to treat non-small cell lung cancer in several Phase 3 studies, with the first trial completion expected in 2022.
Unless I missed it, I saw no mention of this in the Harvard Magazine article. Did something change from then to now?
posted by SteveInMaine at 2:42 PM on April 26, 2019 [6 favorites]
In a major setback, Novartis used its quarterly earnings report to flag an FDA slapdown on their application to market canakinumab for cardio risk reduction...
Based on the correspondence from the FDA, the CANTOS data would not support labeling for the use of canakinumab as a targeted therapy for those patients with cardiovascular disease who achieved a reduction of hsCRP below the 2 mg/L target. At this time, we are evaluating the feedback provided and plans further discussions with the FDA.1
That said, we are continuing to study canakinumab to treat non-small cell lung cancer in several Phase 3 studies, with the first trial completion expected in 2022.
Unless I missed it, I saw no mention of this in the Harvard Magazine article. Did something change from then to now?
posted by SteveInMaine at 2:42 PM on April 26, 2019 [6 favorites]
How about turmeric?
posted by bz at 2:54 PM on April 26, 2019 [10 favorites]
posted by bz at 2:54 PM on April 26, 2019 [10 favorites]
This is really exciting if true. Because guess what has really good anti-inflammatory properties
posted by weed donkey at 2:55 PM on April 26, 2019 [24 favorites]
posted by weed donkey at 2:55 PM on April 26, 2019 [24 favorites]
This is really exciting if true. Because guess what has really good anti-inflammatory properties
posted by weed donkey at 2:55 PM on April 26
is it... is it.. *clicks link* eponysterical dude.
posted by Homo neanderthalensis at 2:56 PM on April 26, 2019 [67 favorites]
posted by weed donkey at 2:55 PM on April 26
is it... is it.. *clicks link* eponysterical dude.
posted by Homo neanderthalensis at 2:56 PM on April 26, 2019 [67 favorites]
"One 150 mg subcutaneous injection, usually needed every two weeks, costs over $16,700; discounts are sometimes available."
Well, there you go. Guess I'll be sticking to turmeric and weed.
posted by irisclara at 3:06 PM on April 26, 2019 [18 favorites]
Well, there you go. Guess I'll be sticking to turmeric and weed.
posted by irisclara at 3:06 PM on April 26, 2019 [18 favorites]
According to Wikipedia, you need one of these $17k injections every two weeks, which means your immune system keeps making the interleukin it blocks.
But if it runs true to form your immune system probably ramps up production of the problematic interleukin in response to the canakinumab, which might mean that if you run out of money or coverage and stop taking this stuff, you then suffer an overwhelming intensification of the illness it's treating, which I think raises questions about prescribing it in the first place.
posted by jamjam at 3:13 PM on April 26, 2019 [11 favorites]
But if it runs true to form your immune system probably ramps up production of the problematic interleukin in response to the canakinumab, which might mean that if you run out of money or coverage and stop taking this stuff, you then suffer an overwhelming intensification of the illness it's treating, which I think raises questions about prescribing it in the first place.
posted by jamjam at 3:13 PM on April 26, 2019 [11 favorites]
Weed Donkey, does that that make 'chronic inflammation' an oxymoron?
posted by chromecow at 3:19 PM on April 26, 2019 [55 favorites]
posted by chromecow at 3:19 PM on April 26, 2019 [55 favorites]
Man, this goes great with the earlier assumption that stuff like surgical mesh is totally fine and even if it does cause some inflammation, then that's probably not anything to be worried about...
NARRATOR: IT DID NOT TURN OUT TO BE FINE
posted by danhon at 3:22 PM on April 26, 2019 [8 favorites]
NARRATOR: IT DID NOT TURN OUT TO BE FINE
posted by danhon at 3:22 PM on April 26, 2019 [8 favorites]
Weed Donkey, does that that make 'chronic inflammation' an oxymoron?
*airhorns blare*
posted by Homo neanderthalensis at 3:35 PM on April 26, 2019 [21 favorites]
*airhorns blare*
posted by Homo neanderthalensis at 3:35 PM on April 26, 2019 [21 favorites]
Are non-steroidal anti-inflammatory drugs like ibuprofen as effective as the gajillion dollar drug? Or is it just that they haven't been studied in this context? I did a quick ctrl-F of the Harvard article and saw only passing mention of ibuprofen and no mention of NSAIDs in general. Which seems a bit odd to me -- if you're claiming that inflammation is the root problem, yet you're trying to sell a brand new drug, it seems you might also want to address why existing anti-inflammatory solutions aren't sufficient.
posted by treepour at 3:51 PM on April 26, 2019 [9 favorites]
posted by treepour at 3:51 PM on April 26, 2019 [9 favorites]
Long term use of NSAIDs is already known to not be great for your kidneys or heart, so that's probably why they didn't look into therm.
posted by Anonymous at 3:56 PM on April 26, 2019
posted by Anonymous at 3:56 PM on April 26, 2019
Aspirin is a anti-inflammatory, and long-term use of it is considered to be fine. I wonder how much those baby aspirins regimens actually rely on that instead of anti-clotting for their benefits?
posted by tavella at 4:18 PM on April 26, 2019 [9 favorites]
posted by tavella at 4:18 PM on April 26, 2019 [9 favorites]
posted by benzenedream at 4:42 PM on April 26, 2019 [8 favorites]
does that that make 'chronic inflammation' an oxymoron?
Oh my God
posted by saladin at 4:57 PM on April 26, 2019 [6 favorites]
Oh my God
posted by saladin at 4:57 PM on April 26, 2019 [6 favorites]
Aspirin is a anti-inflammatory, and long-term use of it is considered to be fine.
Long-term aspirin use can have serious side-effects which have to be weighed against the benefits.
posted by clawsoon at 4:58 PM on April 26, 2019 [10 favorites]
Long-term aspirin use can have serious side-effects which have to be weighed against the benefits.
posted by clawsoon at 4:58 PM on April 26, 2019 [10 favorites]
If anyone's interested, here's the record for this study on ClinicalTrials.gov, which should have lots of useful detail.
posted by Making You Bored For Science at 5:15 PM on April 26, 2019 [3 favorites]
posted by Making You Bored For Science at 5:15 PM on April 26, 2019 [3 favorites]
Artificially, chemically monkeying around with our bodies' inflammatory responses will always have side effects, which are often worse than the problems we're trying to fend off. As noted above, aspirin, ibuprofen and other NSAIDs cause havoc in the intestinal system. Statins have lots of side effects, too. For people who have or are at high risk of specific, acute problems (cardiac, IBD/Crohn's, cancer, etc.) chemical therapy can be literally life-saving. For everyone else, if you want to reduce inflammation and its increasingly understood negative effects, eat better and get more exercise. There are no magic bullets. [/doctor only on tv]
posted by PhineasGage at 5:26 PM on April 26, 2019 [15 favorites]
posted by PhineasGage at 5:26 PM on April 26, 2019 [15 favorites]
Do my homework for me: If eating frequently is all that bad for you, there's a natural experiment from the people who are into exercise/bodybuilding, some of whom do six meals a day and some of whom do intermittent fasting. I realize there are a bunch of confounding factors, but I would expect some effect to show up in their inflammation levels.
There's also Ramadan, though that might be affected by not drinking as well as not eating during the fasting period. On the other hand, we didn't evolve with constant access to water, so who knows?
posted by Nancy Lebovitz at 5:27 PM on April 26, 2019 [1 favorite]
There's also Ramadan, though that might be affected by not drinking as well as not eating during the fasting period. On the other hand, we didn't evolve with constant access to water, so who knows?
posted by Nancy Lebovitz at 5:27 PM on April 26, 2019 [1 favorite]
From the second linked article:
Think about how over-the-counter anti-inflammatories such as ibuprofen and acetaminophen work. They block a particular signal. But Serhan discovered that aspirin works differently (and in a multi-faceted way): rather than blocking inflammatory signals, it attenuates them. In addition, it has mild anti-coagulant properties that are beneficial in atherosclerosis. And perhaps most importantly, aspirin stimulates the production of at least two classes of health-promoting SPMs. In work published as this magazine went to press, Serhan and colleagues showed that aspirin stimulates the production of a distinct type of SPM that fights cancer tumors in mice, and another SPM that inhibits cancer tumor formation in the first place.posted by Kirth Gerson at 5:56 PM on April 26, 2019 [3 favorites]
Can I just whine here? God, I want to believe. I'm in so much pain everyday, and I'm only 33. My doctor told me to stop taking so much ibuprofen, but I don't know how I'm supposed to work without some kind of painkiller. Naproxen makes my stomach bleed, paracetamol does nothing, aspirin does nothing. It's finally spring so I can ride my bike to work again, but I could also, like, die from being hit by a car, so there's that to consider. I'm walking more than 10k steps every day-- does that not count as exercise, or something? Why's it gotta be like this, maaaan?
I get annoyed when people act like I'm just not doing it right or I'd be feeling and looking better, but I kinda wish they were right. At least then there'd be something I could do.
posted by the liquid oxygen at 6:07 PM on April 26, 2019 [30 favorites]
I get annoyed when people act like I'm just not doing it right or I'd be feeling and looking better, but I kinda wish they were right. At least then there'd be something I could do.
posted by the liquid oxygen at 6:07 PM on April 26, 2019 [30 favorites]
N..nnoooo NSAIDs are not ok to take in quantity long term. They cause a lot of issues with the GI system, to the point where you can develop severe nutrient absorption issues and food intolerances. For short term pain management they're fine. But taking loading dosage (1000 mg every 6 hours) has serious health effects.
posted by ananci at 6:25 PM on April 26, 2019 [2 favorites]
posted by ananci at 6:25 PM on April 26, 2019 [2 favorites]
This is very weird because almost everything I have read about athletic training has said that inflammation and the body's response to it is an important of muscular development. To the extent that taking anti-inflammatories can retard your progress.
There was also recent evidence that running's impact reducing colon cancer is due to exercise induced inflammation.
posted by srboisvert at 6:31 PM on April 26, 2019 [2 favorites]
There was also recent evidence that running's impact reducing colon cancer is due to exercise induced inflammation.
posted by srboisvert at 6:31 PM on April 26, 2019 [2 favorites]
Inflammation is a broad and imprecise term, arguably to the point of being kind of useless. There are a multitude of pathways and processes which fall under this label and they do not necessarily act in concert. NSAIDs, corticosteroids, DMARDs, and antirheumatic biologicals like canakinumab all have anti-inflammatory properties, but work very differently and hence have different indications and risk/benefit profiles.
Canakinumab is a monoclonal antibody, which tend to be exceptionally precise in their proximal effects but are expensive to manufacture; that’s part of the reason for the high cost. Biologicals also come with significantly more complications than oral meds and thus it’s kind of doubtful they’ll ever achieve widespread adoption; that’s another reason.
posted by dephlogisticated at 6:32 PM on April 26, 2019 [25 favorites]
Canakinumab is a monoclonal antibody, which tend to be exceptionally precise in their proximal effects but are expensive to manufacture; that’s part of the reason for the high cost. Biologicals also come with significantly more complications than oral meds and thus it’s kind of doubtful they’ll ever achieve widespread adoption; that’s another reason.
posted by dephlogisticated at 6:32 PM on April 26, 2019 [25 favorites]
Here is my $.50.
When you get a glucose a-1c test it checks your blood sugar levels over 6 weeks. How, by checking how much crystallized sugar is coating your red blood cells. Yes the inflammation from sugar coated red blood cells is what damages kidneys, retinas, the linings of blood vessels causing possibly atherosclerosis. High blood pressure plays into this by constriction of the blood vessels causing even more damage. (This is an aside, honey producers remark that sage honey does not crystallize. Read up on sage.)
Exercise reduces inflammation in the sense it lowers blood pressure, and if while exercising and living, you take in enough water, exercise lowers blood sugar by using it up. Higher blood sugar is inflammatory.
Certain infections such as chlamydia pneumoniae cause inflammation of the blood vessels and heart and are causitive in heart attack. See Brent Muhlstein's research at LDS Hospital in SLC. A high percentage of elderly heart attack victims were ill with this as a lung infection.
An infection, mycoplasma genetalium has been found in joints of people diagnosed with rheumatiod arthritis, people with Parkinsons, and possibly other diseases of inflammation.
There are many sources for inflammation, it pays to find the cause, so you can get an appropriate cure.
I recently came to the realization I have spent a lot of my life dehydrated. This is devastating to many organ systems. This is a major cause of inflammation. Most of the receptor sites in our bodies are a water based enterprise, everything is more difficult if you are in a constant state of personal drought.
Let us not continue to make these cloying motherfuckers rich. Make medicine fess up and get at the minimum it takes to run a healthy physical body.
posted by Oyéah at 7:35 PM on April 26, 2019 [17 favorites]
When you get a glucose a-1c test it checks your blood sugar levels over 6 weeks. How, by checking how much crystallized sugar is coating your red blood cells. Yes the inflammation from sugar coated red blood cells is what damages kidneys, retinas, the linings of blood vessels causing possibly atherosclerosis. High blood pressure plays into this by constriction of the blood vessels causing even more damage. (This is an aside, honey producers remark that sage honey does not crystallize. Read up on sage.)
Exercise reduces inflammation in the sense it lowers blood pressure, and if while exercising and living, you take in enough water, exercise lowers blood sugar by using it up. Higher blood sugar is inflammatory.
Certain infections such as chlamydia pneumoniae cause inflammation of the blood vessels and heart and are causitive in heart attack. See Brent Muhlstein's research at LDS Hospital in SLC. A high percentage of elderly heart attack victims were ill with this as a lung infection.
An infection, mycoplasma genetalium has been found in joints of people diagnosed with rheumatiod arthritis, people with Parkinsons, and possibly other diseases of inflammation.
There are many sources for inflammation, it pays to find the cause, so you can get an appropriate cure.
I recently came to the realization I have spent a lot of my life dehydrated. This is devastating to many organ systems. This is a major cause of inflammation. Most of the receptor sites in our bodies are a water based enterprise, everything is more difficult if you are in a constant state of personal drought.
Let us not continue to make these cloying motherfuckers rich. Make medicine fess up and get at the minimum it takes to run a healthy physical body.
posted by Oyéah at 7:35 PM on April 26, 2019 [17 favorites]
Oh you know who else has been dealing with inflammation and pain once a month throughout history...
posted by fluttering hellfire at 7:53 PM on April 26, 2019 [11 favorites]
posted by fluttering hellfire at 7:53 PM on April 26, 2019 [11 favorites]
NSAIDs also cause rebound pain in many people. I became largely incapacitated with joint pain two years ago. It was about 8 months of visits to a variety of specialists. Cutting out a lot of detail: I stopped taking all NSAIDs and started drinking 1/4 tsp baking soda in water every four hours. Good ol sodium bicarbonate triggers the spleen to put the body back into a “de-inflame” state. 10 days of that, all of my joint pain disappeared, with the exception of one damaged shoulder. I encourage everyone to do their own research on long-term NSAID use and joint pain.
posted by Silvery Fish at 8:15 PM on April 26, 2019 [10 favorites]
posted by Silvery Fish at 8:15 PM on April 26, 2019 [10 favorites]
Inflammation is a broad and imprecise term, arguably to the point of being kind of useless.
Can I get this on a t-shirt, please?
posted by grumpybear69 at 8:15 PM on April 26, 2019 [6 favorites]
Can I get this on a t-shirt, please?
posted by grumpybear69 at 8:15 PM on April 26, 2019 [6 favorites]
Addendum:
http://www.jimmunol.org/content/early/2018/04/14/jimmunol.1701605
https://www.nhs.uk/news/medication/baking-soda-for-kidney-patients/
This topic really matters to me. Inflammation is indicated in everything from heart disease to depression.
posted by Silvery Fish at 8:22 PM on April 26, 2019 [8 favorites]
http://www.jimmunol.org/content/early/2018/04/14/jimmunol.1701605
https://www.nhs.uk/news/medication/baking-soda-for-kidney-patients/
This topic really matters to me. Inflammation is indicated in everything from heart disease to depression.
posted by Silvery Fish at 8:22 PM on April 26, 2019 [8 favorites]
Honey producers remark that sage honey does not crystallize. Read up on sage
Particular honey crystallisations are driven primarily by varying ratios of glucose, fructose, and water. Repeated cycles of enzymatic digestion by the bees combined with forced heating convert the nectar into a supercooled liquid of suspended glucose nucleation sites floating within a fructose-water matrix. Below the honey's melting point (and above its freezing point), a higher glucose concentration or a large seed crystal will drive crystallisation. Dextrin will retard it. It has nothing to do with "inflammation".
posted by meehawl at 8:55 PM on April 26, 2019 [12 favorites]
Particular honey crystallisations are driven primarily by varying ratios of glucose, fructose, and water. Repeated cycles of enzymatic digestion by the bees combined with forced heating convert the nectar into a supercooled liquid of suspended glucose nucleation sites floating within a fructose-water matrix. Below the honey's melting point (and above its freezing point), a higher glucose concentration or a large seed crystal will drive crystallisation. Dextrin will retard it. It has nothing to do with "inflammation".
posted by meehawl at 8:55 PM on April 26, 2019 [12 favorites]
Are non-steroidal anti-inflammatory drugs like ibuprofen as effective as the gajillion dollar drug?
This has been studied and unequivocally the answer is no, as far as preventing cardiovascular disease. Even excluding long term side effects from NSAIDs such as kidney disease, bleeding, and elevations in blood pressure.
posted by Slarty Bartfast at 10:04 PM on April 26, 2019 [2 favorites]
This has been studied and unequivocally the answer is no, as far as preventing cardiovascular disease. Even excluding long term side effects from NSAIDs such as kidney disease, bleeding, and elevations in blood pressure.
posted by Slarty Bartfast at 10:04 PM on April 26, 2019 [2 favorites]
IANAD, but in terms of magic pills, I’ve read that a significant proportion of people are magnesium deficient. It’s not as abundant in our food and drink as it used to be. The effects of deficiency run the gamut from physical to mental, including inflammation-related issues. Even constipation. You’re not going to hear about it in a TV commercial because no one’s getting rich off magnesium supplements. But look it up and see if the symptoms ring true.
posted by mantecol at 10:33 PM on April 26, 2019 [5 favorites]
posted by mantecol at 10:33 PM on April 26, 2019 [5 favorites]
That info on sodium bicarbonate and kidney disease is fascinating. I've never heard of that, but I do love to drink weird eastern european waters that have really high bicarbonate levels, and they all claim to be "good for health". Borjomi from Georgia is one of my favorites, and I try to do the Essentuki's every so often.
On the honey thing (maybe slight derail)
Repeated cycles of enzymatic digestion by the bees combined with forced heating convert the nectar into a supercooled liquid of suspended glucose nucleation sites floating within a fructose-water matrix.
In other words, it's a super-saturated solution. All supersaturated / supercooled liquids are prone to crystallization, and sage honey is no different - it will crystallize. But it has a higher fructose to glucose ratio than other honeys, which slows this process down. Honey - like weed, and also high-mineral-content water - is one of the things I dork out on.
Also, sage honey is delicious when mixed with cannabis extract. Sorry, sorry, I'll get off my high horse now. heh
posted by weed donkey at 10:39 PM on April 26, 2019 [6 favorites]
On the honey thing (maybe slight derail)
Repeated cycles of enzymatic digestion by the bees combined with forced heating convert the nectar into a supercooled liquid of suspended glucose nucleation sites floating within a fructose-water matrix.
In other words, it's a super-saturated solution. All supersaturated / supercooled liquids are prone to crystallization, and sage honey is no different - it will crystallize. But it has a higher fructose to glucose ratio than other honeys, which slows this process down. Honey - like weed, and also high-mineral-content water - is one of the things I dork out on.
Also, sage honey is delicious when mixed with cannabis extract. Sorry, sorry, I'll get off my high horse now. heh
posted by weed donkey at 10:39 PM on April 26, 2019 [6 favorites]
Sorry, sorry, I'll get off my high horse now. heh
BOOOO
yay
posted by Homo neanderthalensis at 10:51 PM on April 26, 2019 [13 favorites]
BOOOO
yay
posted by Homo neanderthalensis at 10:51 PM on April 26, 2019 [13 favorites]
IANAD, but in terms of magic pills, I’ve read that a significant proportion of people are magnesium deficient.
Magnesium, and probably boron. (Pubmed link; has info on hypomagnesemia, too: Magnesium also plays an important role in carbohydrate metabolism; its deficiency provokes and worsens insulin resistance.)
posted by Iris Gambol at 11:20 PM on April 26, 2019 [2 favorites]
Magnesium, and probably boron. (Pubmed link; has info on hypomagnesemia, too: Magnesium also plays an important role in carbohydrate metabolism; its deficiency provokes and worsens insulin resistance.)
posted by Iris Gambol at 11:20 PM on April 26, 2019 [2 favorites]
N..nnoooo NSAIDs are not ok to take in quantity long term. They cause a lot of issues with the GI system
This is not true of all NSAIDs, which can be very roughly split into two categories: COX-1 inhibitors and COX-2 inhibitors.
The COX-1 variety come with greater risk of GI issues because they indirectly tell the parietal cells in your stomach to go ahead and make acid, when they'd otherwise listen to signals telling them to stop. The drugs are also acidic themselves, but it is mostly inhibiting the normal behavior of your stomach that causes issues. Common COX-1 inhibitors include the well-known ibuprofen and naproxen (Advil and Aleve) and salicylic acid (aspirin).
The COX-2 inhibitors target a different signaling pathway to reduce inflammation that does not involve these cells and so cause fewer stomach problems. A common COX-2 inhibitor is celecoxib (Celebrex), and perhaps the lesser-known diclofenac (Voltaren). A more notorious example is rofecoxib (Vioxx).
Usage of this class of drugs carries increased risks of kidney damage, heart attack, and stroke — Vioxx caused a number of deaths and had to be pulled from the market, as a result.
It was later found out that the FDA had given approval to Merck to sell this drug, despite data showing safety issues. I'd be wary of any industry-funded drug research that says its products were not only safe but also beneficial to health.
posted by They sucked his brains out! at 11:26 PM on April 26, 2019 [1 favorite]
This is not true of all NSAIDs, which can be very roughly split into two categories: COX-1 inhibitors and COX-2 inhibitors.
The COX-1 variety come with greater risk of GI issues because they indirectly tell the parietal cells in your stomach to go ahead and make acid, when they'd otherwise listen to signals telling them to stop. The drugs are also acidic themselves, but it is mostly inhibiting the normal behavior of your stomach that causes issues. Common COX-1 inhibitors include the well-known ibuprofen and naproxen (Advil and Aleve) and salicylic acid (aspirin).
The COX-2 inhibitors target a different signaling pathway to reduce inflammation that does not involve these cells and so cause fewer stomach problems. A common COX-2 inhibitor is celecoxib (Celebrex), and perhaps the lesser-known diclofenac (Voltaren). A more notorious example is rofecoxib (Vioxx).
Usage of this class of drugs carries increased risks of kidney damage, heart attack, and stroke — Vioxx caused a number of deaths and had to be pulled from the market, as a result.
It was later found out that the FDA had given approval to Merck to sell this drug, despite data showing safety issues. I'd be wary of any industry-funded drug research that says its products were not only safe but also beneficial to health.
posted by They sucked his brains out! at 11:26 PM on April 26, 2019 [1 favorite]
I was going to chime in earlier, but there are people way smarter than me who have a much deeper understanding of things like honey.
I just want to second jamjam's comment:
But if it runs true to form your immune system probably ramps up production of the problematic interleukin in response to the canakinumab, which might mean that if you run out of money or coverage and stop taking this stuff, you then suffer an overwhelming intensification of the illness it's treating, which I think raises questions about prescribing it in the first place.
Um yeah, haven't we learned this over and over again by now? The homeostatic/feedback systems in your body will up or down regulate endogenous production of all sorts of enzymes and hormones. Trying to tweak things so far downstream is going to result in all sort of issues with both production and reception depending on what systems we're talking about. Take exogenous testosterone and your body's own natural production will shut down down. Take SSRIs for too long and your serotonin receptors might desensitize etc. That's one of the reasons we're not all getting leptin injections for weight loss. Chances are they're already elevated. (For people who really know this stuff, it won't hurt my feelings if you want to contradict me.)
I see how this can be a godsend for people with severe disorders who just need something that helps. Unfortunately, I fear that vampires like Peter Thiel are going to be mainlining this while they sit on their blood thrones receiving continuous transfusions of youthful fluids from their vassals.
posted by Telf at 1:42 AM on April 27, 2019 [3 favorites]
I just want to second jamjam's comment:
But if it runs true to form your immune system probably ramps up production of the problematic interleukin in response to the canakinumab, which might mean that if you run out of money or coverage and stop taking this stuff, you then suffer an overwhelming intensification of the illness it's treating, which I think raises questions about prescribing it in the first place.
Um yeah, haven't we learned this over and over again by now? The homeostatic/feedback systems in your body will up or down regulate endogenous production of all sorts of enzymes and hormones. Trying to tweak things so far downstream is going to result in all sort of issues with both production and reception depending on what systems we're talking about. Take exogenous testosterone and your body's own natural production will shut down down. Take SSRIs for too long and your serotonin receptors might desensitize etc. That's one of the reasons we're not all getting leptin injections for weight loss. Chances are they're already elevated. (For people who really know this stuff, it won't hurt my feelings if you want to contradict me.)
I see how this can be a godsend for people with severe disorders who just need something that helps. Unfortunately, I fear that vampires like Peter Thiel are going to be mainlining this while they sit on their blood thrones receiving continuous transfusions of youthful fluids from their vassals.
posted by Telf at 1:42 AM on April 27, 2019 [3 favorites]
Since my divorce, I no longer have to hang out with alternative health enthusiasts who'll collectively take apart the Harvard article and jam in herbs or extracts that answer to everything mentioned....and in the next breath, broadly demonize the entire modern medical establishmnent. Time spent sitting through these conversations is time I wish I could have back.
posted by bonobothegreat at 4:54 AM on April 27, 2019 [17 favorites]
posted by bonobothegreat at 4:54 AM on April 27, 2019 [17 favorites]
When we assume that inflammation is bad, to me this is like saying that a fever is bad. The fever is the body responding to something it's dealing with. The bodies processes trying to handle an issue of damage can cause secondary problems, however they might also be in the process of healing something that's wrong in the body. The assumption that inflammation just appears for no reason and needs to be disappeared with a pill is ignoring all the good things the body does that require inflammation to attend to an issue.
Harmful conditions, lack of exercises, socially or physically abusive circumstances, trauma, lack of sunlight, and ON AND ON are all things associated with creation inflammatory processes in the body.
What's almost maddeningly frustrating is that if you spend hours upon hours reading all this research being done and then you see the simplistic way our culture is STILL looking to "find a pill" without educated either patients OR EVEN DOCTORS on how to educate their patients about this stuff, it's just mind boggling. It's not surprising, I completely understand why we want pills because any of the doctors who have become knowledgeable about lifestyle changes and the reality of social inequality that is blocking that for many people who WANT changes but are being chronically harmed by their environment and poverty- reaching for the pill is the easiest hope.
We need to actually apply all the health research we have to creating a healthy culture and society that supports human needs. And our culture at present just utterly fails to engage with the research being done in that way. We either pick "give people a pill" or "hammer people over the head with the idea they are at fault for all the harms we've put them through and need to fix it all by themselves with lifestyle changes" which is honestly equally ridiculous and harmful.
posted by xarnop at 6:16 AM on April 27, 2019 [11 favorites]
Harmful conditions, lack of exercises, socially or physically abusive circumstances, trauma, lack of sunlight, and ON AND ON are all things associated with creation inflammatory processes in the body.
What's almost maddeningly frustrating is that if you spend hours upon hours reading all this research being done and then you see the simplistic way our culture is STILL looking to "find a pill" without educated either patients OR EVEN DOCTORS on how to educate their patients about this stuff, it's just mind boggling. It's not surprising, I completely understand why we want pills because any of the doctors who have become knowledgeable about lifestyle changes and the reality of social inequality that is blocking that for many people who WANT changes but are being chronically harmed by their environment and poverty- reaching for the pill is the easiest hope.
We need to actually apply all the health research we have to creating a healthy culture and society that supports human needs. And our culture at present just utterly fails to engage with the research being done in that way. We either pick "give people a pill" or "hammer people over the head with the idea they are at fault for all the harms we've put them through and need to fix it all by themselves with lifestyle changes" which is honestly equally ridiculous and harmful.
posted by xarnop at 6:16 AM on April 27, 2019 [11 favorites]
When we assume that inflammation is bad, to me this is like saying that a fever is bad.
Nobody is saying inflammation is universally bad. This is about chronic inflammation.
It’s not surprising to me they’re looking into this. People with psoriasis and psoriatic arthritis are at higher risk of cardiovascular issues, probably because of chronic inflammation (I haven’t looked up the extent to which the connection has been established recently), and the biologic drugs used to treat severe cases have been shown to protect against them. The association between rheumatoid arthritis and cardiovascular issues is even greater.
And while a decent amount of skepticism about the pharmaceutical industry is healthy, the industry is also doing amazing things. The biologic drugs for psoriatic and rheumatoid arthritis are no-shit life changing for a lot of people.
posted by asterix at 7:42 AM on April 27, 2019 [5 favorites]
Nobody is saying inflammation is universally bad. This is about chronic inflammation.
It’s not surprising to me they’re looking into this. People with psoriasis and psoriatic arthritis are at higher risk of cardiovascular issues, probably because of chronic inflammation (I haven’t looked up the extent to which the connection has been established recently), and the biologic drugs used to treat severe cases have been shown to protect against them. The association between rheumatoid arthritis and cardiovascular issues is even greater.
And while a decent amount of skepticism about the pharmaceutical industry is healthy, the industry is also doing amazing things. The biologic drugs for psoriatic and rheumatoid arthritis are no-shit life changing for a lot of people.
posted by asterix at 7:42 AM on April 27, 2019 [5 favorites]
IANAD, but in terms of magic pills, I’ve read that a significant proportion of people are magnesium deficient.
FWIW, I don't know about reducing inflammation, but for me, taking a calcium/magnesium supplement with my dinner or an evening snack does wonders for my sleep quality. Makes me wonder if inflammatory issues are behind some chronic insomnia issues? Exercising during the afternoon also helps me sleep better...
posted by Rosie M. Banks at 8:07 AM on April 27, 2019
FWIW, I don't know about reducing inflammation, but for me, taking a calcium/magnesium supplement with my dinner or an evening snack does wonders for my sleep quality. Makes me wonder if inflammatory issues are behind some chronic insomnia issues? Exercising during the afternoon also helps me sleep better...
posted by Rosie M. Banks at 8:07 AM on April 27, 2019
I'm heading to bed. But my visceral reaction is that chronic illness is another topic that metafilter doesn't do well. So many platitudes and inaccurate comments (diclofenac is known for it's severe GI complications) and suggestions for, lack of a better term, homeopathic treatments (turmeric, seriously?). Yes, a good lifestyle helps. But that assumes your disease agrees.
I haven't done research into the specific biologic referenced in this study. But I have extended experience both as someone supporting trials in, and as a patient dependent on them for the last 20+ years.
The US system is fucked up. I receive infusions every six weeks with another biologic which probably runs $60-$80k a year. I don't know for certain, because it costs me nothing. I never see an invoice. Never asked for an insurance policy. If NSAids were the same or better, I'm pretty sure I wouldn't know my nurses so well, and the government wouldn't be paying for it.
I do know that inflammation is reeking havoc with my body and mind and I have been fighting an intense battle particularly over the last couple of years. Anything that can moderate an otherwise unmanageable immune system is another tool for a ton of us just trying to function.
Assuming the study is valid and continues forward to specific indications, for single payor systems the next question will be around pharmacoeconomics. Does the cost of treatment warrant the benefit to society or humanitarian needs. For the US, it will be whether your insurance will cover it, if you have it.
posted by michswiss at 8:34 AM on April 27, 2019 [12 favorites]
I haven't done research into the specific biologic referenced in this study. But I have extended experience both as someone supporting trials in, and as a patient dependent on them for the last 20+ years.
The US system is fucked up. I receive infusions every six weeks with another biologic which probably runs $60-$80k a year. I don't know for certain, because it costs me nothing. I never see an invoice. Never asked for an insurance policy. If NSAids were the same or better, I'm pretty sure I wouldn't know my nurses so well, and the government wouldn't be paying for it.
I do know that inflammation is reeking havoc with my body and mind and I have been fighting an intense battle particularly over the last couple of years. Anything that can moderate an otherwise unmanageable immune system is another tool for a ton of us just trying to function.
Assuming the study is valid and continues forward to specific indications, for single payor systems the next question will be around pharmacoeconomics. Does the cost of treatment warrant the benefit to society or humanitarian needs. For the US, it will be whether your insurance will cover it, if you have it.
posted by michswiss at 8:34 AM on April 27, 2019 [12 favorites]
I want to head off the tumeric thing. Yes, it has some anti-inflammatory properties. Glucosamine has also been shown in studies to help with osteoarthritis. I think both are valid supplements in early or non-severe case. But there are a lot of us with severe disease that are tired of hearing these suggestions.
posted by michswiss at 8:46 AM on April 27, 2019 [13 favorites]
posted by michswiss at 8:46 AM on April 27, 2019 [13 favorites]
Oh yeah, and about this
which might mean that if you run out of money or coverage and stop taking this stuff, you then suffer an overwhelming intensification of the illness it's treating, which I think raises questions about prescribing it in the first place.
Yes, those are concerns when going off these medications. But the underlying conditions are debilitating or worse if not treated. Suggesting that people suffering from them not get treatment because they might get worse if they have to stop treatment completely fails to reckon with the reality of living with these issues.
posted by asterix at 8:53 AM on April 27, 2019 [5 favorites]
which might mean that if you run out of money or coverage and stop taking this stuff, you then suffer an overwhelming intensification of the illness it's treating, which I think raises questions about prescribing it in the first place.
Yes, those are concerns when going off these medications. But the underlying conditions are debilitating or worse if not treated. Suggesting that people suffering from them not get treatment because they might get worse if they have to stop treatment completely fails to reckon with the reality of living with these issues.
posted by asterix at 8:53 AM on April 27, 2019 [5 favorites]
And medical treatment often involves these sorts of trade offs. Chemo drugs can themselves cause cancer, but that in and of itself isn’t a reason to not use them. Sometimes you’re stuck trading a potential bad outcome in the future for a worse one now.
posted by asterix at 9:02 AM on April 27, 2019 [2 favorites]
posted by asterix at 9:02 AM on April 27, 2019 [2 favorites]
Thanks for the link and tasty followups. As someone with chronic eczema who is now on Dupixent I'm grateful that messing with my interleukin pathways has brought relief, but I do worry about those pesky longer term effects. Especially if I need to start paying for the full cost of this medication - that's when I will choose to go without.
posted by heidiola at 10:55 AM on April 27, 2019
posted by heidiola at 10:55 AM on April 27, 2019
Re. statins (which I'm on), my understanding is that they're indicated only when there are cardiac risk factors present. In my case, I have slight coronary artery occlusion in addition to high cholesterol. My cardiologist said statins also stabilize plaque deposits, making them less likely to rupture and cause a clot. Does that align with what you've seen, kalessin?
posted by Johnny Wallflower at 8:45 PM on April 27, 2019
posted by Johnny Wallflower at 8:45 PM on April 27, 2019
Thanks, random dude!
posted by Johnny Wallflower at 10:07 PM on April 27, 2019
posted by Johnny Wallflower at 10:07 PM on April 27, 2019
Stuff and nonsense! Johnny, in MetaFilter's heart of hearts, you'll always be the ideal average.
posted by Iris Gambol at 11:20 PM on April 27, 2019 [1 favorite]
posted by Iris Gambol at 11:20 PM on April 27, 2019 [1 favorite]
Artificially, chemically monkeying around with our bodies' inflammatory responses will always have side effects
It seems to me that between diet and medication you have the choice of monkeying with small nudges to a large number of factors in a complex system or monkeying with larger effects on a smaller (but still larger than you'd want for a true "magic bullet") number of factors in a complex system. Both of these approaches have their advantages and disadvantages.
Trying to tweak things so far downstream is going to result in all sort of issues with both production and reception depending on what systems we're talking about.
I mean, downregulation and tolerance effects exist, yes, but that doesn't mean drugs inevitably stop working altogether.
posted by atoxyl at 2:11 AM on April 28, 2019
It seems to me that between diet and medication you have the choice of monkeying with small nudges to a large number of factors in a complex system or monkeying with larger effects on a smaller (but still larger than you'd want for a true "magic bullet") number of factors in a complex system. Both of these approaches have their advantages and disadvantages.
Trying to tweak things so far downstream is going to result in all sort of issues with both production and reception depending on what systems we're talking about.
I mean, downregulation and tolerance effects exist, yes, but that doesn't mean drugs inevitably stop working altogether.
posted by atoxyl at 2:11 AM on April 28, 2019
I mean, downregulation and tolerance effects exist, yes, but that doesn't mean drugs inevitably stop working altogether.
Sure, I mean drugs work. Some are miraculously effective. I'm totally pro pharmaceutical research even though the current American system has some perverse incentives that create ethical concerns.
*On preview: This is the context I was thinking about when I made the above comment, I realize that not all of it was conveyed.
My comment above was concerned about:
1. Trying to apply one chemical to a multifactorial/complex problem will create additional effects that will need to be considered down the road, even it's just dose adjustment. (Nothing groundbreaking there.) We're always going to have unintended consequences when we start poking around complex systems, but that's life and hopefully we continue to get better at this over time.
1a. RCTs are great and key part of figuring out how the world works, but they do have their own shortcomings. It's a real 'the medium is the message' sort of problem that will favor pharmaceutical intervention over more complex, systemic changes. (Again, with immediate diseases, it's understandable that we want to find something the works ASAP and that is wonderful.)
2. The magnitude of effect of some drugs over placebo is so narrow, that tolerance may eventually negate the clinical benefits. (Thinking about some SSRIs etc.) This is clearly not the case for people who debilitating diseases where any relief is welcome. (That includes issues that are helped by SSRIs, not dismissing depressive or other mental issues.)
2a. We should be worried about pharmaceutical companies running over powered trials that eke out tiny statistical differences that might not benefit people on an individual level. (That's not the case in this example.) Reporting bias is still a problem so it would be nice to see the trials that don't pan out. Cherry Picking is an issue that has probably snuck a few drugs past the FDA that have negligible benefits over previous treatments or placebos and have severe side effects.
3. We often see a big difference between the clinical efficacy of an intervention and the real life effectiveness of that intervention when we try to use it on populations. We could probably do a better job of looking at practice based evidence in addition to evidence based practice.
4. A lot of our medical advice is conducted at a population level and then applied to individuals and we're not quite at the point where reporting of data is good enough at teasing out the variance of individual differences. Luckily journals are getting better and better at this. Reporting standards have improved so much over the last 15 years.
All that being said, I think we should investigate any avenue of treatment that can help people who are suffering. Just because a treatment is being pushed by a large pharmaceutical company obviously does not mean its automatically bad.
posted by Telf at 3:29 AM on April 28, 2019 [2 favorites]
Sure, I mean drugs work. Some are miraculously effective. I'm totally pro pharmaceutical research even though the current American system has some perverse incentives that create ethical concerns.
*On preview: This is the context I was thinking about when I made the above comment, I realize that not all of it was conveyed.
My comment above was concerned about:
1. Trying to apply one chemical to a multifactorial/complex problem will create additional effects that will need to be considered down the road, even it's just dose adjustment. (Nothing groundbreaking there.) We're always going to have unintended consequences when we start poking around complex systems, but that's life and hopefully we continue to get better at this over time.
1a. RCTs are great and key part of figuring out how the world works, but they do have their own shortcomings. It's a real 'the medium is the message' sort of problem that will favor pharmaceutical intervention over more complex, systemic changes. (Again, with immediate diseases, it's understandable that we want to find something the works ASAP and that is wonderful.)
2. The magnitude of effect of some drugs over placebo is so narrow, that tolerance may eventually negate the clinical benefits. (Thinking about some SSRIs etc.) This is clearly not the case for people who debilitating diseases where any relief is welcome. (That includes issues that are helped by SSRIs, not dismissing depressive or other mental issues.)
2a. We should be worried about pharmaceutical companies running over powered trials that eke out tiny statistical differences that might not benefit people on an individual level. (That's not the case in this example.) Reporting bias is still a problem so it would be nice to see the trials that don't pan out. Cherry Picking is an issue that has probably snuck a few drugs past the FDA that have negligible benefits over previous treatments or placebos and have severe side effects.
3. We often see a big difference between the clinical efficacy of an intervention and the real life effectiveness of that intervention when we try to use it on populations. We could probably do a better job of looking at practice based evidence in addition to evidence based practice.
4. A lot of our medical advice is conducted at a population level and then applied to individuals and we're not quite at the point where reporting of data is good enough at teasing out the variance of individual differences. Luckily journals are getting better and better at this. Reporting standards have improved so much over the last 15 years.
All that being said, I think we should investigate any avenue of treatment that can help people who are suffering. Just because a treatment is being pushed by a large pharmaceutical company obviously does not mean its automatically bad.
posted by Telf at 3:29 AM on April 28, 2019 [2 favorites]
"turmeric, seriously?"
Seriously. I have suffered from a herniated disk for two decades and the only thing that has brought me sustained relief is 1500MG of turmeric daily. Could be a coincidence or a placebo effect but, if it is either, the effects are potent for, within a few weeks of starting it, the discomfort diminished profoundly and has remained so for nearly three years. Yes, my right foot still tingles much of the time but the formerly constant pain, leaning-to-one-side walking and inability to sit for more than a few minutes have just about disappeared.
posted by bz at 11:15 AM on April 28, 2019 [1 favorite]
Seriously. I have suffered from a herniated disk for two decades and the only thing that has brought me sustained relief is 1500MG of turmeric daily. Could be a coincidence or a placebo effect but, if it is either, the effects are potent for, within a few weeks of starting it, the discomfort diminished profoundly and has remained so for nearly three years. Yes, my right foot still tingles much of the time but the formerly constant pain, leaning-to-one-side walking and inability to sit for more than a few minutes have just about disappeared.
posted by bz at 11:15 AM on April 28, 2019 [1 favorite]
For-profit organizations are going to maximize profit above all else, and the history of making the research fit the product has to be considered. Also, doctors get swamped with so much info from for profit companies, and they prescribe. People should have healthy skepticism. There's great work being done, but a lot of people can't afford the office visits, testing, and specialists, to say nothing of the drugs. For-profit health care is not working in the US for a lot of us.
Thanks for the info on boron, bicarb., sunshine, and other science. There is so much crap out there that it's difficult to use the Internet to research health issues unless your question is fairly specific. I changed my diet, increasing nuts and dried fruit, specifically for magnesium, because I had muscle cramps. Pretty sure that covers the boron, as well.
I wouldn't equate turmeric with homeopathy; it has some benefit. But, yeah, the alternative health crowd loves to recommend a mildly beneficial spice/ acupuncture/ meditation/ crystals to people with serious medical conditions.
Chocolate and coffee have some health benefits, so I cite that when people give me a hard time for my reliance on coffee. People can be puritanical about all sorts of stuff.
posted by theora55 at 11:22 AM on April 28, 2019
Thanks for the info on boron, bicarb., sunshine, and other science. There is so much crap out there that it's difficult to use the Internet to research health issues unless your question is fairly specific. I changed my diet, increasing nuts and dried fruit, specifically for magnesium, because I had muscle cramps. Pretty sure that covers the boron, as well.
I wouldn't equate turmeric with homeopathy; it has some benefit. But, yeah, the alternative health crowd loves to recommend a mildly beneficial spice/ acupuncture/ meditation/ crystals to people with serious medical conditions.
Chocolate and coffee have some health benefits, so I cite that when people give me a hard time for my reliance on coffee. People can be puritanical about all sorts of stuff.
posted by theora55 at 11:22 AM on April 28, 2019
If you want the unbiased, expert consensus on preventing and treating heart disease, see the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. It's published by a joint task force of the American College of Cardiology and American Heart Association. They update it every few years. It's extremely dry reading, meant for clinicians, but it's about the best advice you're going to get. The recommendations come from exhaustive reviews of the literature and are coded based on strength and level of evidence. Guidelines like these are what physicians follow when treating patients.
Statins save lives, full stop. Not everyone needs to be on a statin, but a lot of people do. They're one of the best tools we have for preventing deaths from heart disease. The ASCVD risk estimator, which takes into account several different factors, is commonly used to determine who is likely to benefit from therapy. Older adults at intermediate or high risk, especially those with diabetes, have been shown to benefit significantly in terms of morbidity and mortality.
posted by dephlogisticated at 2:07 PM on April 28, 2019 [2 favorites]
Statins save lives, full stop. Not everyone needs to be on a statin, but a lot of people do. They're one of the best tools we have for preventing deaths from heart disease. The ASCVD risk estimator, which takes into account several different factors, is commonly used to determine who is likely to benefit from therapy. Older adults at intermediate or high risk, especially those with diabetes, have been shown to benefit significantly in terms of morbidity and mortality.
posted by dephlogisticated at 2:07 PM on April 28, 2019 [2 favorites]
Someone with a 5 - 7.4% ASCVD risk would be classified as borderline. The guidelines recommend considering additional risk factors to guide treatment decisions, including possibly getting coronary artery calcium measured, but does not specifically recommend statin therapy for this subgroup, because, as you stated, the benefit from doing so is relatively small, and the evidence is weaker; the majority of studies have been performed in patients with more advanced heart disease.
The guidelines are just that: guidelines. They're intended to provide treatment recommendations based on the best available evidence for the average patient meeting certain criteria. They are not one-size-fits-all, and whether one chooses to follow those recommendations is entirely up to them. My comment was intended to point people in the thread towards a trustworthy source of information, and to emphasize the absolutely vital role that statins have in the treatment of heart disease, because the amount of [citation needed] in this thread is frankly alarming. It was not directly specifically at you.
posted by dephlogisticated at 3:44 PM on April 28, 2019 [1 favorite]
The guidelines are just that: guidelines. They're intended to provide treatment recommendations based on the best available evidence for the average patient meeting certain criteria. They are not one-size-fits-all, and whether one chooses to follow those recommendations is entirely up to them. My comment was intended to point people in the thread towards a trustworthy source of information, and to emphasize the absolutely vital role that statins have in the treatment of heart disease, because the amount of [citation needed] in this thread is frankly alarming. It was not directly specifically at you.
posted by dephlogisticated at 3:44 PM on April 28, 2019 [1 favorite]
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Oof. Obviously this does not mean their results are not correct, but it's certainly a blow to their credibility considering prior scandals in medical research funded by or beneficial pharmaceutical companies. I hope they will make their anonymized data public. Their sample size is certainly large enough to produce some pretty great results if they're doing their analysis with care. I also don't see any peer reviewed publications on canakinumab's effects on the non-cardiovascular diseases of interest. But either way it will be interesting to see where this goes!
posted by WidgetAlley at 2:15 PM on April 26, 2019 [27 favorites]