Mark Pine

Yesterday officials of three federal public health agencies that oversee the safety of food met in Washington to discuss better ways of reducing the risk of microbial diseases due to food contamination. They discussed promising ideas for gathering information, identifying organisms and sources of contamination, and monitoring food suppliers, processors and retailers.

The safety of the food supply has made front page news. This month, the FDA recalled thousands of food products made with vegetable protein contaminated with Salmonella, a cause of gastroenteritis. Food poisoning incidents in recent years have involved ground beef , spinach and many other foods .

In response, one year ago the president established the Food Safety Working group. Yesterday, officials from the participating agencies—FDA, CDC and the Department of Agriculture’s Food Safety and Inspection Service (FSIS)—discussed methods of identifying food contamination risks, measuring progress in risk reduction, and tracking the effectiveness of efforts to reduce foodborne illness.

Malcolm Bertoni, an assistant commissioner at the FDA, spoke about metrics for monitoring the progress of his agency’s work. The agency would track such data as the percent of food facility inspections occurring as frequently as required and obtaining requisite data, and the time taken to recall food from stores and determine the contaminating pathogens.

Carol Maczka of the FSIS described her agency’s work to track the number of occurrences of illness. FSIS would set goals such as achieving a 10% reduction in frequency of Salmonella-related illness by 2011. Christopher Braden, acting director of the CDC division handling foodborne disease, tied measures of his agency’s progress to its work in tracking outbreaks, such as the speed of identification of cases and obtaining the DNA profiles of the causative organisms.

It was evident at the meeting that officials of the three agencies are thinking hard and carefully about how to reduce the incidence of food contamination and food-related illness, and they are planning to measure the progress of the effort. But it also seemed that the work is still in the planning stages.

I came away from the meeting surprised that such tracking and assessment measures hadn’t been put in place years ago, and to be frank, I wasn’t convinced that real progress would result from the discussions.

The officials of each agency described their efforts to improve and expand their traditional roles in preventing foodborne disease: The FDA participants talked about inspecting food establishments, those from D of A discussed identifying contaminated foods, and the representatives of the CDC spoke about tracking the epidemiology of outbreaks. But I did not hear much talk at the meeting about intra-agency communication and coordination.

The meeting reminded me of the “stovepiping” problems that national security agencies have in communicating and coordinating their work of tracking terrorists and preventing attacks. Last Christmas, the sabotage attempt on an airplane raised concerns once again about their ability to communicate between the agencies and combine their information.

In preventing terrorist attacks and those of food pathogens, collecting information at each separate agency, even if it is done well, is not enough. There must be good communication among them, and someone must take charge of “connecting the dots” and coordinating the work. I wonder whether same sort of problems as have come up among national security agencies will plague the public health agencies’ efforts to reduce foodborne diseases.

A commentary last month in JAMA, the journal of the AMA, urged the NIH to require reporting of more results of clinical trials of medications on its website, clinicaltrials.gov. The author of the opinion piece is James Dabney Miller, a scholar at the Johns Hopkins Bloomberg School of Public Health. He wrote that the sponsors of clinical trials are not required to report results of the trials at the present time. However, as mandated by Congress in a 2007 law, NIH will require that the sponsors post some results of their investigations on the clinical trial website starting this September.

Miller also said that NIH should insist that sponsors of clinical trials report results of trials of drugs not yet approved by the FDA—including trials of drugs already approved for another medical condition but not for the one that is the focus of the trials.

In recent weeks, I’ve put up several posts on this subject, including the last two. In this post, I want to consider some issues related to Miller’s position, which shed light on a problem for implementation of evidence-based medical treatment. Additionally, I want to discuss some reasons to move forward on Miller’s recommendation.

Most research on new drugs and other new medical treatments is sponsored and performed, directly or through hired researchers, by companies such as pharmaceutical manufacturers with a financial interest in profiting from a successful outcome of the research. Consequently, up to the present time, the sponsors often fail to publish findings that are negative on effectiveness or show harmful adverse effects.

A case in point is rosaglitazone, which I wrote about Friday. It causes serious adverse effects on the heart, which prompted the FDA to require a warning. Evidence of the problem was the subject of a study in the New England Journal of Medicine by Nissen and Wolski of the Cleveland Clinic. Nissen, a cardiologist, and his co-author obtained and reanalyzed publicly available data from 42 trials by the drug’s sponsor, GlaxoSmithKline (GSK). The data included summaries of adverse events but not the patient-level source data. Nevertheless, the authors were able to conclude that “…compared with placebo or with other antidiabetic regimens, treatment with rosiglitazone was associated with a significant increase in the risk of myocardial infarction and with an increase in the risk of death from cardiovascular causes…”

The fact that these medical experts not associated with GSK were able independently to examine summary data and demonstrate a serious problem with the drug shows the need for posting clinical trial results on a public website. The company did not come forward with a similar analysis and conclusion. The rosiglitazone case was a fortunate one, in that the problem could be discerned by independent experts from available summary information. But most often that would not be possible. Thus, a main reason for publicly posting source data would be so such experts could check and reanalyze it to verify—or dispute—the sponsor’s claims.

Moreover, as Miller advised, NIH should also require posting of results of trials of already-approved and marketed drugs that are being investigated for new indications. The reason is that sponsors have no interest in publishing research that fails to demonstrate effectiveness or shows harmful adverse effects associated with an unapproved indication of a drug already on the market. This is because physicians have the right to prescribe such a drug even for an unapproved use. Oftentimes, a drug has acquired a reputation for effectiveness for an unapproved indication on the basis of a few suggestive but inconclusive studies or case reports. In such situations, company sales people may promote a drug for the unapproved indication, even though doing so is improper, and the company may benefit from increased sales of the drug whether or not clinical trials support the use.

As a result, if a company is profiting from such “off-label” sales of a drug, its most advantageous and least costly course of action may be to hold back information and trial results that do not support the use. In that situation, only outside experts analyzing publicly available source data would be able to determine whether the use is effective and safe, or otherwise.

Radiologists are touting the benefits of virtual colonoscopies, which are CT x–ray scans of the colon. Most colonoscopies, however, are done by gastroenterologists with a fiber-optical scope. In both cases, the procedures are used to screen for and diagnose colon diseases, including cancer.

An article last week in ScienceDaily declared that because it can display tissue outside the colon, virtual colonoscopies have the benefit of detecting some non-colon tumors, as well as those within the colon. A study in the current issue of Radiology, the journal of the Radiology Society of North America, found that virtual colonoscopies detected an unsuspected extra-colonic cancer in one of every 300 people undergoing the test. The research was performed by radiologists at the University of Wisconsin in Madison and at the Naval and Uniformed Services medical institutions in Bethesda, Md.

The ScienceDaily piece claims other advantages for the virtual procedure, including “no risk of bleeding or of perforating the colon … no need for intravenous sedation, and the procedure is less costly.”

A story suggesting a different view of virtual colonoscopy appears this morning in the NY Times. Harris reports that physicians at the FDA warned managers at the agency that use of CT colonoscopies might result in “increased radiation exposure to the population [that] could be substantial and would raise a serious public health/public policy issue.”

Since radiation exposure is known to be associated with an increased cancer risk, the FDA scientists are worried, in essence, that colon CT scans, which are used to most often to screen for colon malignancies, might actually contribute to its occurrence. The FDA is considering approval of a CT scanner for colonoscopy following an application from General Electric, the manufacturer of the device.

The Times article asserts that

The agency has done little to assess whether the rapid proliferation of scans is in the best interests of patients, and whether the machines themselves properly protect patients [i.e., from unnecessary radiation] or are beneficial for all of their now-routine uses.

It is unfortunately true that many research reports in the medical literature advance the agendas of doctors and companies with financial interests in the treatments studied. The articles in ScienceDaily and Radiology reported research by radiologists, who do virtual colonoscopies. In contrast, as the Times’ Harris notes, gastroenterologists, through their organizations and medical journals, have taken a position in favor of optical colonoscopies, which is the procedure they perform.

Last Friday, I posted on a related issue: Evidence-based medicine and comparative effectiveness research. In the post, I cited an article in the BMJ, which documented the significant amount of financial conflicts of interest in medical research.

Regarding the choice of optical or virtual colonoscopy, as a physician, I do not see a good reason to choose the virtual procedure. It is the difference between temporary discomfort and the short-term increased risk surgical complications versus less initial discomfort and the long-term increased risk of colon cancer. For me, the choice is not hard to make.

The healthcare reform law enacted this week creates a new Patient-Centered Outcomes Research Institute to fund comparisons of medical treatments, Science magazine reports today. The initiative builds on $1 billion provided for comparative effectiveness research in the stimulus bill passed last year. The new independent, non-profit institute will set priorities for research and provide funds amounting to $150 million per year beginning in 2012.

The need for such research is clear. Consider that there are more than a dozen antidepressants on the market and almost that many drugs for elevated cholesterol and stomach acid-related problems. It’s not clear which drugs work best and for which patients they should be used. Moreover, pharmaceutical companies must pay for costly research, advertising and marketing expenses for each drug. This drives up the total cost of the nation’s medication.

Up till now, research on medical treatments has been funded almost completely by the companies that manufacture and market the drugs. This arrangement has led to the situation today with extremely high drug prices and duplicative and probably redundant treatments. Furthermore, in consequence of the obvious conflicts of interest of companies testing the benefits and risks of their own products, the results of research may be suspect and the marketing claims for the drugs may be poorly substantiated.

Two other articles this month illustrate the nature of the problem. The BMJ (British Medical Journal) published research by doctors at the Mayo Clinic on the diabetes drug rosiglitazone (Avandia, GSK), for which the FDA issued a warning that the drug may cause heart failure and reductions of blood flow to the heart. The authors surveyed 202 articles on rosiglitazone in the medical literature looking for potential conflicts of interest in which the authors had received income from GSK or other pharmaceutical companies.

They found that 94% of authors of articles favorable to the drug had financial conflicts concerning drug companies, and 87% had such a conflict with GSK, the manufacturer of the drug. In addition, “Authors who had favourable views on the safety of rosiglitazone were more than three times more likely to have a financial conflict of interest with a pharmaceutical company than were authors who had unfavourable views.”

In a similar vein, a story last week in the Milwaukee Journal-Sentinel highlights more direct efforts by GSK and other drug companies to influencing prescribing: Paying physicians to speak at medical meetings about the benefits of their drugs. The story reported that GSK paid one doctor $45,000 in 2009. Merck, Lilly and Cephalon are other drug companies that made similar payments that year, according to the article.

Fortunately, the new healthcare law will expose this problem more fully, the Science article reports. Beginning in 2013, a Physician Payments Sunshine act will require that medical product companies file reports with the government on payments to physicians amounting to more than $100 per year.

I hope that the era is not far off when physicians will choose medical treatments based mainly on evidence from unbiased, well-designed research funded by independent sources rather than studies funded by companies that have a vested interest in the outcome.

Several years ago, I would occasionally please myself by imagining the biological individuality that I and all other human beings possess through our unique set of genes. I would think of meiosis, the process of generating gametes. With twenty to thirty thousand genes, each with several possible alleles, reshuffling and then rejoining to create each of us, the combinatorial odds of another someone exactly like me or anyone else was practically zero. It turns out my thinking was off. Everyone is even more singular than I guessed by orders of magnitude.

Although our biological inheritance lies in our DNA, our DNA is much more than our genes. Last week articles in two journals reported that greater variation between individuals and species is found in the non-coding regions of the genome, which comprise 98% of the DNA, than in the genes, which encode proteins.

Researchers at Yale, Stanford, and in Germany and the UK sequenced binding sites for two transcription factors in several humans. They discovered base-pair differences among 7.5% of the sequences for one binding site and 25% of them for the other. In contrast, the protein-coding sequences of the human genome show inter-individual variability of only 0.025%. The same scientists also reported similar findings for yeast. And comparing the human DNA with that of a chimp, they found that non-coding DNA may include most of the variability between the two species.

The findings suggest that the greater variability of non-coding DNA may be the case for all forms of life.

Transcription factors are proteins, which are specified by genes and which bind to segments of DNA (“binding sites”) that do not code for proteins. The binding of transcription factors to their binding sites regulates the transcription and translation of genes into their corresponding proteins. Transcription factors determine whether a gene actually gets translated into a protein, i.e., whether the gene is active or repressed, and if active, how active it is.

Because of variation in the sequence of base-pairs, differences in binding sites can affect how well the corresponding transcription factors will bind to them. By affecting gene expression quantitatively in this way, transcription factors and their binding sites may exert huge influences on the phenotypic results of gene expression. In other words, they may determine many of the differences among individuals.

Last month, I posted about the relationship of non-coding DNA to diseases. Scientists at Lawrence-Berkeley National Laboratory had discovered that a mutation in one non-coding region of DNA is associated with atherosclerosis, the most common form of heart and vascular disease. I wrote that many genetic diseases might actually be associated with variations in non-coding regions of DNA rather than genes.

Scientists have discovered in recent years that non-coding regions of DNA—what used to be called “junk DNA”—actually contain important sequences that serve vital biological functions. Thus, it’s possible that our biological individuality and destiny may be determined as much or more by non-gene DNA as genes. The discoveries also suggest that people now rushing to get their genomes sequenced in hope of learning about their biological characteristics and risks for diseases may be jumping the gun.

USA Today reports this morning that more Americans favor the healthcare reform legislation than oppose it. The article cites results of the latest USA Today/Gallup poll, which shows:

By 49%-40%, those polled say it was “a good thing” rather than a bad one that Congress passed the bill. Half describe their reaction in positive terms — as “enthusiastic” or “pleased” — while about four in 10 describe it in negative ways, as “disappointed” or “angry.”

The poll was taken Monday, the day after the House of Representatives passed the Senate version of the healthcare reform bill, a decision that enacted most of the provisions of the Democrats’ legislation. Just two weeks earlier, the Gallup organization found a plurality of Americans opposing the bill. Asked their preference regarding their Congress member’s vote on the bill, 45% wanted a vote in favor and 48% against.

Why the sudden change? Perhaps some of the opposition shown by the earlier poll came from liberal Democrats who were keeping up the pressure for a public option. After passage, these folks folded and joined those openly happy at the passage the landmark reform.

But I suspect something more fundamental is being registered in the sizeable shift in opinion. If I’m right, the Republicans may have much to fear for having embedded indelibly in the public mind the unforgettable impression of their intractable, unanimous, strident resistance—which continues today on the Senate floor.

The American public may be like the stock market when it comes to healthcare reform. That wouldn’t be surprising, since healthcare reform affects the personal pocketbook, as well as personal health. In that case, the nation may have reacted to the huge uncertainties surrounding the outcome of the legislative struggle as the market does when it faces uncertainty. It tanks.

Passage of the bill on Sunday evening may have had the result of eliminating much of the ambiguity, following which many Americans breathed a sigh of relief that it was over. The rise of the favorability rating may simply reflect an assessment that things won’t turn out so bad and may even improve. The stock of healthcare reform may rise slowly in the coming months, just as the stock market seems to be doing lately. If so, most people may end up unfavorably impressed by the GOP strategy.

Perhaps, some Republicans are sensing this possibility. The Wall Street reports today that some of them are starting to rethink their strategy and may join Democrats in upcoming legislation on education and financial regulation. Moreover, the article says. “Following the enactment of the health-care revamp, some Republicans have said the party should have sought to negotiate, instead of offering blanket opposition, to win concessions.”

Education in this underprivileged, multiethnic Paris class is an emotional battle of wits—a duel of words and attitudes. The teacher, François, a man of convictions and good intentions, parries the constant disputatiousness and doubt of his mostly African-origin students. He struggles almost to trick them into learning—to teach them in spite of themselves. The students, in reaction, subvert his effort. It’s not that they don’t want to learn or don’t try to learn—they mostly do. But their object, it seems, is to learn while yet reducing François to a sense of his own irrelevancy and failure.

We, the audience, are stunned at the ceaseless conflict in its intensity and pointlessness and cannot help but wonder why it goes on. We understand the plight of alienated, disadvantaged minority youth, how they sense the rejection of the culture of the majority, the closure of the doors of opportunity against them. This Parisian classroom is not very different from many inner-city classrooms in America or other advanced nations, where the students see no point in the mastering the curriculum. The futility they feel is the very feeling they fight to infuse into their teacher.

Inevitably, François blunders. Frustrated and worn down, he blurts a slur at two girls. The consequences of the faux pas form the climax of the movie. One wonders how often François, the minority-school teacher, really tripped over his intensions and words and said such things, because in this film he essentially plays himself, as do the students. The actors are the actual people who lived in the situation portrayed.

Most fundamentally, I think, the circumstances of the story of the little classroom reflect the profound dislocations and discontinuities of the whole present world. Everything is changing. People are displaced from their countries of origin, ancient ways are falling by the wayside, divergent cultures clash in contact, technology transforms schools and places of work. Neither the teachers nor the taught know that the curriculum remains relevant. No one rests sure how to behave or what will be required.

It all waits for the complications of modern life to play out and settle down.

The Class (Fr.: Entre les Murs, 2008): The movie won numerous awards for its graphic portrayal of school life in an ethnic-minority Parisian school, including the Academy Award for Best Foreign Language Film (2009), and the Golden Palm (Cannes Film Festival, 2008).

“We are still a people capable of doing big things and tackling our biggest challenges,” President Obama said last night.

That is what I had come to doubt. As recently as Saturday, I wouldn’t have bet that reform of health care could be accomplished. Intermittently since last summer and as recently as two weeks ago, I believed the health care bill dead. Obama and the Democrats proved me wrong. How very thankful I am to have been mistaken!

Tempted to look back and believe this was the president’s strategy all along, I know this isn’t so. Obama—the community organizer—is inclined to hold back until contending factions have wrestled themselves to the ground and then to move in, lift them up, and bring compromise. I think that may be what he tried to do with health care reform.

But as things turned out, by not leading forcefully from the beginning, he prolonged the struggle, enervated the Congress, and anguished the electorate. In consequence, voters in Massachusetts (of all places) elected anti-reform Republican Scott Brown.

After the Brown victory, Obama finally took the reigns. He drove forward, first with a command performance at the health care summit, then with strong speeches across the country. Democrats in Congress followed his lead. They passed most transformational social legislation since the Great Society.

Health care reform is far from complete. The most important change—the sine qua non of ultimate success—is not yet accomplished. The system of paying for care must change. Doctors and other providers cannot continue to receive compensation for treating disease. That creates the perverse incentive that more illness earns more money. Providers should be paid for keeping people well and returning them to health. That would create the beneficial incentive to prevent illness and choose the best and most cost-effective treatments.

In the end, health care in America should be nationally integrated. Standards for insurance, best medical practices, cost-conscious pharmacopoeias should be established. It is a sector of the economy where the free-market freedom and local control bring not the best outcomes but inefficiency and poor choices.

ScienceNow reports that whole-genome sequencing is “how medical geneticists will routinely diagnosis patients in a few years.” Perhaps so, but one important question is will the tests benefit anyone but the testers?

The reporter made the claim in an article on genes associated with the rare neurological disorder, Charcot-Marie-Tooth disease, in the DNA of a geneticist at Baylor College of Medicine and his family members. Previous testing of their DNA of had failed to find a genetic basis for their disease. The genome-wide tests, which cost $50,000 each, found mutations in both copies of SH3TC2 in all affected family members but not in the others. The gene was already known to be associated with CMT, but the mutation found in the family had not before been identified.

The Baylor work was reported in the New England Journal of Medicine last week. However, the NEJM authors were more circumspect about the prospects of the testing:

Whole-genome sequencing may revolutionize medical diagnostics through rapid identification of alleles that cause disease. However, even in cases with simple patterns of inheritance and unambiguous diagnoses, the relationship between disease phenotypes and their corresponding genetic changes can be complicated. Comprehensive diagnostic assays must therefore identify all possible DNA changes in each haplotype and determine which are responsible for the underlying disorder. The high number of rare, heterogeneous mutations present in all humans and the paucity of known functional variants in more than 90% of annotated genes make this challenge particularly difficult. Thus, the identification of the molecular basis of a genetic disease by means of whole-genome sequencing has remained elusive.

Even if it becomes much less expensive in the future, will genome-wide testing be useful in diagnosing common diseases and be of benefit to most people? Other recent work suggests that the research still has a way to go.

Medical scientists at Brigham and Women’s Hospital in Boston published results last month of an assessment of 101 genetic variants associated with cardiovascular disease. Each single-nucleotide mutation was associated with CVD at the highly significant level of p < 10^-7. Yet among 19,000 healthy white women followed for 12 years, a genetic risk score based on these variants showed no better than a 4% correlation with the occurrence of CV events.

Similarly, this week, a group of breast cancer researchers led by the NIH, reported the results of adding 10 gene variants associated with breast cancer to a risk model based on traditional risk factors (e.g., family history). In this meta-analysis of 5600 women with cancer and 5900 controls from five studies, a random classification of cases and controls would have scored 50% and a perfect one 100%. Adding 4 of 10 gene variants to the model resulted in a score of 58% and adding 10 improved that to 62%. The classification of 33% of the women was better using the model but for 20% it was worse, and for most (47%), it was unchanged. The authors wrote, “inclusion of newly discovered genetic factors modestly improved the performance of risk models for breast cancer. The level of predicted breast-cancer risk among most women changed little after the addition of currently available genetic information.”

At present, it seems that genetic tests for disease may improve the diagnosis of rare disorders related to one or two variants. But it remains to be demonstrated that such testing would be useful for common diseases with many contributory genes. Until that happens, it would seem difficult to justify the general and routine use of whole-genome sequencing tests.

Perhaps gene tests might find routine clinical utility in another way—making decisions about treatments rather than diagnoses.

Breast cancer investigators at the Virginia G. Piper Cancer Center in Scottsdale, AZ, have initiated a trial of genetically based treatment among patients with advanced cancers and those refractory to standard therapy. They intend to do a pilot study analyzing biopsy specimens for abnormal genes and other characteristics and testing the malignancies for responsiveness to non-standard drugs.

As reported this week in ScienceDaily, the principle investigator, Gail Jameson, explained, “We may discover that a tumor has a gene mutation that responds to a drug not typically used in a ‘one-size-fits-all’ approach.” Previous small trials of this approach have shown promise in extending survival times.

In the future, genome-wide investigations will continue to be important in medical research. But I would guess that genetic tests will become routinely helpful to doctors choosing among drugs or other kinds of treatments long before they become very useful in assessing the risks of common illnesses. For making treatment decisions, however, it’s should not be necessary to do whole-genome sequencing.

Heart disease, stroke, diabetes—in recent decades the most widespread of Americans’ chronic diseases—appear to be linked to inflammation and the accumulation of body fat. Several news articles this month reinforce this conclusion by pointing to a common physiologic mechanism connecting these conditions.

Eating too much food, especially the high-fat-high-carb kind overwhelms the body’s ability to store fat, which spills over into other types of cells and brings on the metabolic syndrome of obesity, elevated blood sugar and LDL cholesterol, hypertension, and high risk of cardiovascular disease. The inactivity of modern life makes things worse by making it easier to consume more calories than necessary.

Doctors at UT Southwestern Medical Center have proposed this unified theory of the most prevalent modern diseases. Quoted in ScienceDaily, one of the doctors, Roger Unger, commented:

If one imagines the USA population to be unwitting volunteers in the largest (300 million subjects) and longest (50 years) clinical research project in history, the specific aim of which was to determine if the deleterious effects of sustained caloric surplus in rodents also can occur in humans, the outcome of the project becomes clear — after 50 years of exposure to an inexpensive calorie-dense diet high in fat and carbohydrates, 200 million subjects are overweight and >50 million have metabolic syndrome.

The metabolic syndrome develops because the cells that take up the excess fat—muscle, liver and macrophages, a type of immune cell—aren’t adapted to storing it and in reaction secrete inflammatory chemicals into the blood. The fat cells, in contrast, serve the storage function well, at least until they reach overcapacity. Thus, the accumulation of body fat actually protects against the metabolic syndrome and the chronic diseases.

A recent article in USA Today reports other research that supports the theory. Medical scientists at UCSF found that macrophages exposed to a lot of saturated fat become inflamed, but if the cells are genetically modified to hold more fat, this doesn’t happen. Another scientist at Columbia University found that macrophages make up only 5% of the cells in the body fat of lean people, but they may comprise 50% of these cells in the fat of obese people.

Another article by the AP reported that a doctor at Albert Einstein College of Medicine gave healthy but overweight volunteers intravenous fatty acids, as might happen when excess fat spills out from fat cells. She found that the subjects became resistant to the action of insulin, the characteristic of the metabolic syndrome that causes elevated blood sugar.

If the theory is correct, the best treatment for diabetes and cardiovascular disease may be to reduce daily calorie intake to match daily calorie need, and to do so by eating less high-fat-high-carb food. That, of course, would be no surprise. But Americans are having a hard time changing their food preferences and adjusting their energy requirements. So if all those excess calories are causing inflammation, which in turn is causing the diseases, why not test the effect of an anti-inflammatory drug?

Researchers at NIH are doing just that, according to the AP report. They will try the anti-inflammatory drug salsalate in several hundred people with type 2 diabetes, as an addition to their usual medication. The drug is related to aspirin but is less harmful to the GI system. Earlier research suggested that salsalate helped lower blood sugar.

Inflammation appears increasingly to play a central role in all the chronic diseases of modern life. It now appears that overeating may be one of the reasons for it.