Reversing Type 2 diabetes Hello and happy Saturday! Here's this week's roundup of eclectic and under-the-radar health and medical science news. If you haven't subscribed yet, you can do so here.
Increasingly, research is showing that Type 2 diabetes can be put into long-term remission.
"It's taken years to accumulate this evidence," said Dr. Hertzel Gerstein, diabetes expert at McMaster University. "Ten years ago people would have been very skeptical that it's even possible."
Type 2 diabetes affects one in 10 Canadians. It is a serious metabolic disorder that can result in stroke, kidney failure, blindness, amputations and premature death. Right now doctors try to manage the disease using drugs to control a patient's blood glucose levels. Some of those drugs have serious side-effects.
"If you're on drugs it's not really remission, it's just controlling the disease," Gerstein said.
We reached him in Lisbon, where he's attending an international diabetes conference. At that meeting, a U.K. group presented research showing that Type 2 diabetes remission can be sustained for up to 10 years through weight loss.
Gerstein's own group is conducting a series of trials studying ways to reverse the condition using a combination of diet, exercise, counselling and short-term drug therapy.
Still, the goal of remission is not routinely being offered to patients right now.
"If you ask more experts at this meeting they'd say, 'Great idea,' but they'd have huge arguments about what to do and how to do it," Gerstein said. "The only way to resolve these arguments is to do the research."
Also this week, a group of U.K. researchers argued in the BMJ that doctors should be recording instances where the disease has been successfully reversed. And they say patients should be officially reclassified as "non-diabetic" when they achieve remission.
(Remission is defined as a return to normal blood sugar levels for one year without drugs.)
Gerstein cautions that remission won't always work for everybody. But he imagines a new era of diabetes treatment.
"I would love to look forward to an era where a large percentage of our patients who have been diagnosed with diabetes in the past are just being followed to make sure they're not relapsing, as opposed to lifelong drugs that are ever more complex, expensive and inconvenient."
How much does it cost to develop a drug?
Drugs are developed behind a curtain of corporate secrecy. But one group has been permitted to peek inside and see the data.
And for decades, those controversial estimates from the Tufts University Centre for the Study of Drug Development have been cited to show how much industry spends to develop a new drug.
In 2003, it was $800 million US for a new pill. Today, the estimate has grown to $2.6 billion US.
But the Tufts researchers have never named the companies or the drugs they studied.
The black box of corporate confidentiality makes it impossible for independent researchers to check those numbers, but the Tufts' estimate is often used to justify why new drug prices are so high.
So when two oncologists published an analysis this week setting the development costs for new cancer drugs at a fraction of the Tufts' estimate, it sparked controversy.
"I did not set out to create this ruckus," said Dr. Sham Mailankody from the Memorial Sloan Kettering Cancer Center. "I was surprised at how much attention it got, both positive and negative."
'There's room here to lower cancer drug prices.'- Dr. Sham Mailankody, study author
The new analysis used publicly reported data from 10 companies that developed new cancer drugs (including one non-cancer drug Soliris, dubbed "the world's most expensive drug.")
The conclusion: the median cost to develop a cancer drug is $648 million, about a quarter of the Tufts' estimate.
"There is room here to lower cancer drug prices, such that we continue to maintain reasonable margins for profits, but at the same time make these drugs widely available for patients," Mailankody said.
Canadian health economist Steve Morgan waded into the controversy by tweeting that the cost of research and development shouldn't dictate the final price.
"You don't pay firms for the cost of bringing something to market. You pay them for the value of what they brought to market," he told us.
At UBC, Morgan has studied drug development costs, and said most estimates don't include public investment, the millions of government dollars that subsidize new drugs through basic research and tax subsidies.
"It's a healthy debate," Morgan said. But he understands why the new analysis touched a nerve.
"Probably because this is getting close to the truth, and the truth may be dangerous for these firms that have used this narrative in the past."