When drugs beat surgery

When a kid gets appendicitis, surgery is the obvious solution; appendectomies are a dime a dozen. (Well, not here. In the US, while being incredibly common, they’re “one of the costliest surgical procedures performed during hospital stays.”)

They’re so expensive that surgeons, led by a team at Nationwide Children’s Hospital, looked into whether IV antibiotics are a way for parents to save money on their kids’ care.

And yep, publishing in the Journal of the American College of Surgeons (!), they concluded that it’s more cost effective to use drugs than to use surgery.

“This cost analysis demonstrates that nonoperative management for pediatric uncomplicated acute appendicitis is the most cost-effective management strategy over one year, compared to upfront surgery.”

Side note: Appendectomies cost almost three times as much here as in the UK or Switzerland, so an overseas vacation could be a cost-saving option, too.

Pleasure-free opioids

The problem with opioids is that they have a way of combining pleasure and pain relief, and the result (as we know) is addiction.

What if you could keep opioids’ pain-killing effect, but block its pleasure effect? That’s exactly what a couple of researchers in New York say they’ve done by combining opioids with a drug called an MAGL inhibitor, “which increases the level of an endocannabinoid, known as 2-AG, in the brain.”

Conventional wisdom said that endocannabinoids would increase the opioids’ pleasurable effect, but that turns out not to be the case. Instead, the MAGL inhibitor blocks the release of dopamine, thus removing the pleasure (other than the pleasure of not being in pain).

So far it’s only been tested — successfully — in mice, but if it works in humans it “[has] the potential to meaningfully change pain medicine.”

A better asthma treatment

For a flare-up of asthma or COPD, five days of prednisolone is the standard treatment. But British researchers have found a better option: a single, higher dose injection of benralizumab.

Typically, low-dose benralizumab is used for longer-term treatment, but when given in a higher dose during an asthma or COPD flare-up, it worked better and longer at keeping symptoms at bay.

After 28 days, respiratory symptoms of coughing, wheezing, breathlessness, and sputum were found to be better in those on benralizumab, whether or not they were also on steroids. After 90 days, there were four times fewer people in the benralizumab group who failed treatment compared with those receiving steroids.

They also found that the benralizumab injection’s effect lasted longer, meaning fewer trips to the doctor or hospital. And, of course, it also avoids the side effects associated with steroids.

Bonus: Yes, they do call it a “game-changer.”

Why GLP-1s fail

As many as 20% of people taking GLP-1 agonists don’t respond (or don’t respond well) to the drugs, but the drug makers claimed the number was only 10–15%. What happened?

Sure, the companies exaggerated the effect — they did the same when it came to hyping the amount of weight that’s typically lost. But that’s only part of the issue. A British physiologist explains all the other factors that didn’t appear in the clinical trials, from genetics to simple lack of formal support.