What about this new blood test for cancer?

An FDA advisory panel recently recommended approval of the Galleri blood test that uses DNA technology to look for evidence of over 50 cancers in people without symptoms. The idea, like all “screening” tests, is to find cancers before they cause symptoms and when they are easier to treat.

While it has not yet received FDA approval, I expect this to follow.

How good is this test and should you get tested?

Blood tests have been used before to look for asymptomatic cancer. The grand daddy is the PSA (prostate specific antigen) test that has been used for almost 40 years to look for early prostate cancer. (Its value is still controversial after all this time.)

Other cancer markers have proven to only detect advanced cancer and are used to monitor patients with known cancers, but are not recommended for screening. Examples would be the CEA test, elevated in colon, pancreas, breast, ovarian and other cancers and CA125, elevated in ovarian and other cancers.

Two DNA tests are now approved to look for asymptomatic colon cancer: Shield and SimpleScreen. These very similar tests have the common problem of being very good at detecting advanced cancer but not very good at detecting precancerous polyps or small stage 1 cancers. They are recommended for screening only in people who refuse colonoscopy.

What about Galleri?

Large trials have shown that about 1% of people over 50 with no symptoms to suggest cancer will have a positive test. About half of those with a positive test do have cancer. The test is also able to identify the origin of the cancer in most cases.

The problem? The test is much better at detecting advanced cancers than stage 1 cancers. The trial failed its goal of reducing the numbers of stage 3 and 4 cancers in those tested compared to those not tested.

Should you ask for the test? You can get it now with a doctor’s prescription but must pay for it yourself, at a cost of $800-$950. Once it has FDA approval, many insurance companies will pay for the test but are not required to do so.

Until a better test is available that reliably picks up very early cancers, I do not plan to have one of these tests done. You may feel differently. It is a personal decision.

Whether you do or do not, it is crucial that you get regular mammograms and colonoscopies, which have been shown to detect cancers early, when the results are best. Galleri is not a substitute for these proven screening tests.


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I am feeling dizzy. Should I take Antivert?

Many of us get dizzy occasionally. “Dizzy” means different things to different people. It may be weakness or lightheadedness at times. Most often, it is vertigo: a sense that the room is spinning or that you are spinning.

Historically, doctors have prescribed meclizine (brand name Antivert), a sedating antihistamine, to treat vertigo. While it is FDA-approved for this purpose, it is not always a good choice.

The commonest cause of vertigo is a shift of tiny stones in the middle ear (“otoliths”) into the wrong position. This causes BPV: benign positional vertigo. It typically comes on with a change of position. You feel as if you just got off a merry-go-round when all you did is get out of bed or lie down. [Note – the vertigo can come with any change in position – lying down or turning to one side may trigger it as well as getting up.]

Weakness or wooziness without the sense of spinning when getting up is NOT BPV, but more likely a drop in blood pressure resulting in less blood getting to the brain.

The treatment of BPV is a maneuver that moves the head to get the otoliths back into the right place. It can be done by a physician, nurse or physical therapist who know how, and usually cures the problem. Pills, with their side effects, have no place in treating this condition.

Meniere’s disease is a recurrent vertigo, usually accompanied by hearing loss and/or ringing in the ears that comes for no reason. Here meclizine may be helpful, but should only be used for the acute attacks, not on a prolonged basis.

Acute labyrinthitis comes on suddenly and can be severely disabling, making walking almost impossible. It is due to inflammation of the nerve to the inner ear. It can be accompanied by hearing loss, and if it is, is an emergency, requiring steroids to prevent permanent deafness. Sometimes the vertigo is so severe that the hearing loss is overlooked.

Meclizine can be used for a few days to help the troubling dizziness of labrynthitis, with the understanding that it is treating symptoms that are going to pass on their own. It is not curing the condition.

Why not use meclizine more freely?

A recent study looked at people who had been diagnosed with vertigo who were or were not prescribed meclizine. Those prescribed meclizine had almost three times as many falls resulting in emergency department visits as those who were not.

Add that to the concern that sedating antihistamines contribute to confusion, and it is clear. Meclizine may help with troubling vertigo, but it should be used in as low a dose and for as short a time as possible.

Finally – a warning. The new onset of vertigo that lasts for more than half an hour can be a stroke, and demands immediate evaluation.

What shots should I get this fall?

Ah, fall. Children go back to school, leaves turn color and it is time to think about your immunization against winter viruses.

What, if any shots should you get?

Influenza is not “just a bad cold.” Influenza lays you out with hacking cough, fever and muscle aches. While it rarely kills healthy young adults, it can, and it certainly kills frail elders and small children. Even young healthy people can be laid up for a week or more.

We never know how bad a flu season iwill be until it is upon us, and everyone should get an annual flu shot, which you can get at your doctor’s office, many pharmacies and local town-run clinics. The standard shot is fine for most. People over 65 or those with weakened immune systems should get either the “high dose” formulation or the new mRNA shot (which may not be as readily available this season).

What is most exciting about the mRNA flu vaccine is that in future years, it will allow the virus to be targeted much more accurately. The way flu shots are now made requires the manufacturers to commit to a flu virus target well in advance of the season. Sometimes the experts nail it while other times the shot is not a great match for the circulating strain. The new technology will shorten development from 6 months to six weeks, allowing manufacturers to adjust the shot if the virus mutates.

COVID is still with us, and yes, you should get a booster. The current shot is quite different from the original one, though not very different from last fall’s.

The FDA prioritizes those over 65, but there is no reason why anyone except perhaps young healthy men should not get one. (For reasons not fully understood, adolescent and young adult males are most prone to serious side effects such as inflammation of the heart, though even in that group, the heart damage is self-limited and benefits outweigh risks.)

While the COVID shot is only modestly effective at preventing infection and mild illness, it is very effective at preventing serious illness and death.

If you are over 75 and/or have bad lungs, get a one-time RSV (respiratory syncytial virus) shot. If you have had one, you do not need to repeat it.

Women in late pregnancy during the fall and winter should get immunized to protect their infants; RSV is a major illness for newborns. If the mother is not immunized, infants can be protected by a shot of monoclonal antibodies.


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Is the new cholesterol pill for me?

On July 16, the FDA approved enlicitide (brand name Lipfendra) to lower LDL cholesterol in people with high cholesterol. For people with very high cholesterol, this is a big deal.

We have known since the late 1950’s that elevated cholesterol was associated with an increased risk of heart attack, but the drugs then available to lower cholesterol were not very effective and had very annoying side-effects.

The first statin, lovastatin, was approved by the FDA in 1987 and it was a real “game changer.” There was finally a class of medicines that were well-tolerated by most people and very effective at lowering cholesterol. In 2026, seven statins are commercially available, most now available generically and thus reasonably priced. The evidence that these drugs not only reduce cholesterol but also reduce heart attack risk is overwhelming.

A minority of patients at risk from high cholesterol cannot take statins, usually because of an allergy that leads to liver damage. Some people take them safely but do not get adequate cholesterol lowering, even at high doses. The non-statin cholesterol-lowering drugs (ezetimibe, bempedoic acid) are not nearly as effective as statins and are usually added to a statin rather than used alone.

A true breakthrough was the development of what are called PCSK9 inhibitors, a totally new class of drugs that are very powerful at lowering cholesterol and which have now also been shown to reduce heart attack risk. These can be safely used in people who cannot take statins, though they are most often used as add-ons to statins in patients who have not reached desired cholesterol levels on the statin.

The two big downsides to PCSK9 inhibitors are that they are VERY expensive (list price around $6000/year) and that they must be given by injection.

The new drug enlicitide also works by inhibiting PCSK9 but comes in pill form, taken once daily. It will not be cheap; estimated list price is $3800/year.

Who should consider taking this new drug? If you cannot take a statin and you need to get your cholesterol down, or if you are on a full dose of a statin but you have not reached the cholesterol goal you set with your doctor, you are a candidate for a PCSK9 drug. If you would rather take a daily pill than an injection, enlicitide may be the answer.

Since safe, effective and cheap statins are the right choice for most people with high cholesterol, expect your insurance company to balk at paying for a much more expensive drug. If you need one, your doctor will have to convince them that you do.


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Cyclosporiasis - what you need to know

The outbreak of diarrheal illness caused by the parasite cyclospora is still making headlines. What do you need to know?

Many organisms can cause acute diarrhea, including viruses such as the norovirus, bacteria such as salmonella, and parasites. Viruses have no specific treatment while bacteria and parasites have specific treatments available.

The current culprit, cyclospora, is a microscopic parasite that can contaminate fresh food or water, and typically leads to severe watery diarrhea, along with bloating, loss of appetite and fatigue. Untreated, the diarrhea can last for many weeks to a few months. Treatment with the antibiotic trimethoprim-sulfa for a week relieves the symptoms within a few days.

There are outbreaks of cyclosporiasis in the US every summer, but rarely on the scale of the current outbreak. The worst hit have been the upper mid-west states, with Michigan the epicenter, but 45 states have reported at least some cases. As of July 31, 20,374 cases have been reported to the CDC. More than 10,000 of these cases have been in Michigan. The real number of cases is almost certainly much higher, with many not reported.

The source of the current outbreak seems to be contaminated lettuce from Mexico. Prior outbreaks have been linked to snap peas, raspberries and fresh herbs, as well as romaine lettuce.

Avoidance is better than treatment! Know where your produce comes from. This may be a good time to buy your produce from local farmers’ markets. I’d avoid packaged “pre-washed” lettuce. Remove the outer leaves and carefully wash all produce. Cooking kills the parasite and is the safest way to get your veggies.

Should you develop diarrhea that last more than a day or two, get medical help. The diagnosis can be made from a stool sample, and treatment clearly helps.

p.s. - Remind your senators and reps that public health should never be a partisan issue - red or blue, we are all at the same risks from such outbreaks!


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Why do women live longer than men?

As of 2024, while the average life expectancy in the U.S. climbed to 79, there was a striking and persistent gap between men and women. Women lived an average of 81.4 years, men 76.5. This five-year difference has been consistent over recent decades.

Why do women live so much longer than men?

Some of the difference is biologic and not anything men can change. Women have two X chromosomes, men one. This means that women have “backup” for loss of X chromosome gene deletions or losses. There is some animal data suggesting that the male Y chromosome has deleterious effects.

Women have stronger immune responses, letting them better fight off infections (but also making them more prone to auto-immune diseases like lupus).

Women have much more circulating estrogen than men, which seems to delay the onset of coronary disease, though women “catch up” after menopause when their estrogen levels drop.

There are many factors over which men do have control. Men are more likely than women to smoke and drink heavily, both negative factors for longevity.

Men are more likely to work in hazardous occupations (construction, fishing , forestry, police and fire, etc.) than women. Men also engage in more risky behaviors such as speeding in cars, fighting and extreme sports.

Women are much better than men at looking after their health – getting regular checkups, seeing a doctor if something seems wrong. Men tend to avoid doctors until forced to.

Women generally have much better social networks, a consistent factor promoting longevity. Men’s friendships tend to be less intense and less personal.

So, while we cannot (yet) engraft a second X chromosome into men, there are a lot of things men can do to emulate women and hopefully add a few years to their lives.


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TrumpRx - what is it good for?

In February, with much fanfare, TrumpRx was launched, claiming the ability to save US residents money on prescription drugs. Does it do so? Are there better ways to save money?

If you go to trumprx.gov, you are greeted by a glossy picture and a claim that “TrumpRx is rewriting the script, bringing major savings on essential medications to all Americans.”

Reality is less impressive than the rhetoric.

The site does not sell medications. Rather it directs you to manufacturers’ websites where you can (with a prescription) buy the medications directly from the companies, for cash – no insurance accepted. The list price is contrasted with the lower “TrumpRX” price.

43 medications are listed. All are brand name drugs. At least 18 are old-timers with much cheaper generic versions available at your local drug store, not only far cheaper than the list price but even cheaper than the discounted price offered.

An example: Protonix, an acid-suppressing medication, is shown with “an original price” of $497.28 for 30 tablets and a TrumpRx price of $200. Sounds good, no? Almost 60% off. It sounds good until you go to Amazon and see you can get the generic version, 30 tablets for $11.60.

Even for drugs where there is no generic yet available, you may well pay less at your pharmacy than the supposed savings offered via TrumpRx. Moreover, at the pharmacy you can use your health insurance, while using TrumpRx does not allow any insurance.

So, can you really save money on prescriptions? Yes, by following some commonsense rules.

First, always ask your prescriber if a generic is available for your condition. There are a few illnesses for which only one or a limited number of branded products will work, but such conditions are rare. For common conditions there are usually generic versions that are similarly effective.

Beware of manufacturer coupons that claim to let you pay little or nothing for a new branded drug – these have a limited lifetime, and when the promotion runs out you will be on an expensive medication for a long time.

Check the Mark Cuban Cost-plus Pharmacy (costplusdrugs.com). This has a large and growing number of medications at very reasonable prices.

Look for savings coupons on GoodRx.com.

If you have a condition for which only a very expensive drug will work, and your share will be financially stressful even using your insurance, call the manufacturer directly. Many have patient assistance programs that will lower your cost.

For a few items, including fertility drugs and weight loss drugs, TrumpRx may save you money – it does not take much time to look.


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