Episode #0029, part 1

Schmalfeldt: From the National Institutes of Health in Bethesda, Maryland. this is NIH Research Radio.

(THEME MUSIC) Schmalfeldt: Welcome to episode twenty-nine of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Bill Schmalfeldt. Coming up on this edition, Wally Akinso has a story about how MRI is being used to diagnose early disease in the opposite breasts of women diagnosed with breast cancer. I'll sit down with Dr. Griffin Rodgers, acting director of the National Institute of Diabetes and Digestive and Kidney Diseases to talk about what that institute has in mind for National Minority Health Month. A survey funded by the National Institute on Drug Abuse shows that fewer than 10 percent of drug-abusing offenders are getting the kind of treatment they need. And I'll tell you about my recent visit to an NIH-funded clinical research center at Vanderbilt University in Nashville where I'm taking part in a clinical trial. But first, Wally tells us about a national study on addiction to prescription painkillers. That's next on NIH Research Radio. (PUBLIC SERVICE ANNOUNCEMENT) NIDA Launches National Study on Addiction to Prescription Painkillers Schmalfeldt: It's a nationwide study to look for solutions to a nationwide problem—prescription drug abuse. Wally Akinso has the details.

Akinso: In response to the growing national problem of prescription drug abuse, the National Institute on Drug Abuse has launched a national study evaluating a treatment for addiction to painkillers. Dr. Nora Volkow, NIDA's Director, discussed the problem. Volkow: It's an addiction that has significantly increased over the past 5 years. It's actually the number one addiction; the number of new people becoming addicted to it. Last year in fact, it surpassed the number of new initiates to marijuana. It has surpassed the number of treatment admissions for addiction to that very much covered by heroin.

Akinso: The study will test the effectiveness of buprenophine in combination with naloxone tablets, along with different models of drug counseling in patients addicted to prescription painkillers. Buphrenorphine works by acting on the brain's own opiate receptors-targets heroin, morphine, and prescription painkillers-relieving drug cravings without prompting the same intense high or dangerous side effects. Dr. Volkow said when combined with naloxone, buprenorphine's abuse potential is further limited, since those who try to inject it to get high experience severe withdrawal symptoms, while no adverse effects occur when it is taken orally, as prescribed. She added that researchers must recognize the risk of addiction to pain medications and treatment for those who become addicted to them. This is Wally Akinso at the National Institutes of Health Bethesda Maryland.

(TRANSITIONAL MUSIC) Interview with Dr. Griffin Rodgers Schmalfeldt: This week on NIH Research Radio , we've taken the traveling microphone to the office of Dr. Griffin Rodgers, acting director of the National Institute of Diabetes and Digestive and Kidney Diseases. Thanks for taking some time to be with us today.

Rodgers: Pleasure to be here.

Schmalfeldt: So here we are in April—April is National Minority Health Month and I understand NIDDK, along with the National Diabetes Education Program is getting involved with a bunch of different outreach programs to sort of spread the word to the minority community about diabetes and other related disorders. What sort of things are you guys up to?

Rodgers: Certain ethic groups, such as African Americans, Hispanic, American Indians, Alaska Natives, Asian Americans and Pacific Islanders have an increased risk for developing both pre-diabetes and Type 2 diabetes. Current figures suggest that 54 million people over the age of 20 have pre-diabetes, a condition which increases the risk of developing diabetes.

Schmalfeldt: That's a lot of people. Rodgers: It is. But not only that, but heart disease and stroke. People who have pre-diabetes, they have blood glucose levels that are higher than normal but they're not high enough yet to be considered frank diabetes. Schmalfeldt: And a lot of these folks wouldn't even know they had this condition unless they actually went and got themselves checked. Rodgers: It's estimated that perhaps up to one-third of people are unaware that they have diabetes and of course the number would be even higher than that for pre-diabetes. The National Diabetes Education Program promotes the finding of a major NIH study—that is, the Diabetes Prevention Program or DPP—which is that modest weight loss reduces the risk of these patients that have pre-diabetes to go on to develop diabetes.

Schmalfeldt: By modest weight loss, we're talking 10 percent? Rodgers: Five to seven percent.

Schmalfeldt: That's even better than I thought. Rodgers: .for someone that's 200 pounds, that would be 10 to 14 pounds. And these findings are true for all ethnic groups, including the ones that I just mentioned.

Schmalfeldt: What are some of the risk factors for diabetes? I don't think we can ever really talk about that enough. It's a message that I really do think we need to drill into people. Rodgers: Absolutely. Well it turns out that the risk factors for diabetes are the same as those for pre-diabetes: a background of African American, Hispanic or Latino, American Indian or Alaska Native, or Asian or Pacific Islander. You're at increased risk for developing pre-diabetes or Type 2 diabetes. Being overweight or having what's defined as a body mass index—or BMI—greater than 25. Now, BMI is just a mathematical relationship between your weight and your height. Asian Americans actually develop a risk at a lower BMI—greater than 23. And if you're a Pacific Islander, it's around greater than 26. People over the age of 45 or people who have a family history of diabetes are at increased risk. And so if you fall into one of these categories, we are strongly urging the listeners—or if they have friends or relatives that fall into those categories.

Schmalfeldt: Everybody probably knows somebody who is in this category.

Rodgers: Absolutely. We encourage them to see their health care providers to be checked out. If you're a Medicare recipient, Medicare now covers tests to check for diabetes up to twice a year. And, in fact, if you develop diabetes, Medicare helps to pay for diabetes equipment, supplies, covers diabetes self management, training, medical nutrition therapy service, and other diabetes-related services.

Schmalfeldt: Now, NIDDK is doing more than just talking about this. There's a wealth of resources available to our listeners, both online and by calling a toll-free number. What are some of those resources?

Rodgers: The National Diabetes Education Program or NDEP—which is a partnership between the NIH and the CDC, and it also involves over 200 private and public partners offers free diabetes prevention resources that are tailored to specific ethnic groups through its "Small Steps, Big Rewards: Prevent Type 2 Diabetes" campaign. One example is the "More Than 50 Ways to Prevent Diabetes", coined after an old Simon and Garfunkel. "50 Ways to Lose Your Lover". Schmalfeldt: Right. That's the first thing that comes to mind. Rodgers: Exactly. Kind of humorous messages there, like "Snack on a Veggie, Reggie. Or, "Dance it Away, Faye" for example, to motivate people to take small steps to reduce their risk for diabetes. For the Hispanic and Latino population, we have the "Paso a Paso" tip sheet, available in English and in Spanish to help encourage Hispanics and Latinos to learn to reduce their risk for pre-diabetes. We have a "Power to Prevent Diabetes" tip sheet tailored to American Indians and Alaska Natives. You know, actually we have these materials in many, many different languages from Spanish to Samoan—over 15 languages that this information is provided. And the information is provided and tailored both at the level of the patients, the general public as well as providers. And if I can, if I could just give you some contact information.

Schmalfeldt: Sure!

Rodgers: For people interested in obtaining this information and more tips on how to lose weight and lower your risk for diabetes, you can call a toll free number—800-438-5383. Or you can visit us online at www.ndep.nih.gov.

Schmalfeldt: Excellent. And even though April is National Minority Health Month, we should be thinking about this all 12 months of the year.

Rodgers: We just want to highlight it this month, but you're absolutely right. This is something that is an ongoing effort.

Schmalfeldt: Dr. Griffin Rodgers, acting director of the NIDDK, thanks again for sitting in with us on NIH Research Radio .

Rodgers: It's been a pleasure. Thank you. (Transitional Music) Schmalfeldt: When we come back, Wally tells us how doctors are using a state-of-the-art imaging technique to check for cancer in the opposite breast of women diagnosed with breast cancer. That's next on NIH Research Radio . (PSA) MRI Detects Cancers in the Opposite Breast of Women Newly Diagnosed with Breast Cancer Schmalfeldt: As is true with all forms of cancer, the earlier breast cancer is discovered, the better the chances for a good outcome. Wally Akinso tells us how MRI is being used to look for cancer where it might not have been noticed before. AKINSO: MRI can be used to detect cancers in the opposite breast of women newly diagnosed with breast cancer, according to a study funded by the National Cancer Institute. MRI scans of women who were diagnosed with cancer in one breast detected over 90 percent of cancers in the other breast that were missed by mammography and clinical breast exam at initial diagnosis. Dr. Constance Lehman, the principal investigator of the study, said given the established success rates of mammography and clinical breast exams for detecting cancer in the opposite breast, adding an MRI scan to the diagnostic evaluation effectively doubled the number of cancers immediately found in these women.

Lehman: We know that women who have a diagnosis of breast cancer in one breast are at risk for developing cancer in the other breast. We then learned that many of these cancers are actually in the breast right at the time of that initial cancer diagnosis. And if we use MRI added to mammography we can find many more of these cancers than we could before MRI.

Akinso: Researchers hope that with breast MRI's strong ability to predict the absence of a tumor, they could provide women with more reassurance that the breast is disease free. Dr. Lehman is optimistic that there may be a long-term savings to patients and to the health care system due to MRI's ability to detect cancer in both breasts prior to beginning therapy. Lehman: I think this is important information to women and their doctors. Women when told that they have a breast cancer diagnosis have many difficult decisions to face. This study provides information they didn't have before to better guide those decisions. We want our patients to be able to make informed decisions and it's through these clinical research trials that we can provide the information so that they can make those informed decisions. Akinso: For more information on this study, log on to www.cancer.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.

(TRANSITIONAL MUSIC) NIDA Survey Shows Lack of Substance Abuse Treatment Options for Offenders Schmalfeldt: Studies show that drug abuse treatment cuts drug abuse in half, drastically decreases criminal activity and significantly reduces arrests. Yet a recent survey funded by the National Institute on Drug Abuse shows that fewer than ten percent of drug-abusing offenders are getting the kind of treatment they need.

Bennett: I think that's exactly where you would want them to be available. That ten percent refers to people who are in community corrections, which includes parole, probation, community supervision. And those are the people who are at very high risk when they go back into the community from incarceration of using drugs again.

Schmalfeldt: That was Dr. Fletcher Bennett, the NIDA Science Officer on the National Criminal Justice Treatment Practices Survey, which provides a picture of existing treatment programs across all correctional settings—including jails, prisons, probation and parole offices, and local community correction agencies for juvenile and adult offenders. He said that the survey shows there are far too few programs and services in a correctional setting, and the ones that do exist are only offered to a handful of offenders.

Bennett: There are probably various reasons, the biggest one may be just simply resources. Often there's an assumption drug abuse treatment is available in the community when in fact it is not. It's under-funded and under-supported. Schmalfeldt: In a published statement, NIDA Director Dr. Nora J. Volkow said that since offenders are four times as likely as the general population to have a substance abuse disorder, treating the offender population could measurably lower the demand for drugs in our society and reduce the crime rate. Dr. Bennett said NIDA is looking for ways to increase drug abuse treatment access for offenders.

Bennett: At this point we're simply trying to find the best way to integrate drug abuse treatment into correctional settings, including community corrections settings as well as jails and prisons. And so we're trying to find more effective ways of doing that so that the individual can have better outcomes when they go back into the community. Schmalfeldt: The survey findings were published in a special issue of the Journal of Substance Abuse Treatment .

(TRANSITIONAL MUSIC) Schmalfeldt: When we come back, I'll tell you about my recent visit to an NIH-funded clinical research center in Nashville as I continue to be screened for participation in a clinical trial for a new use of deep brain stimulation in Parkinson's Disease. That's next on NIH Research Radio .