In this section:
Researchers at Washington State University show how fatty acids can fight prostate cancer.
By Eric Sorensen
New findings from Washington State University, which are at odds with a 2013 study asserting that omega-3s increase the risk of prostate cancer, point the way to more effective anti-cancer drugs.
Washington State University researchers have found a mechanism by which omega-3 fatty acids inhibit the growth and spread of prostate cancer cells. The findings, which are at odds with a 2013 study asserting that omega-3s increase the risk of prostate cancer, point the way to more effective anti-cancer drugs.
Scientists have long known that omega 3s reduce inflammation and have anti-diabetic effects, and some recently discovered how this happens.
“But we’re the first to show that they work this way in cancer,” said Dr. Kathryn Meier, professor and associate dean for graduate education at the WSU College of Pharmacy. “The attention has mostly been on inflammation and diabetes but there has always been an interest in cancer, and we were the first to show this mechanism in any cancer cell at all. And we’re using prostate cancer, which is the most controversial subject in omega 3s.”
A 2013 study in the Journal of the National Cancer Institute found that men with higher levels of omega-3 fatty acids in their blood had a greater risk of developing prostate cancer. It was not clear if the fatty acids came from food—certain fish, seeds and nuts are high in omega 3s—or supplements like fish oil.
Working with prostate cell cultures, Meier and two students, Ze Liu and Mandi Hopkins, found the fatty acids bind to a receptor called FFA4, for “free fatty acid receptor 4.” Rather than stimulating cancer cells, the receptor acts as a signal to inhibit growth factors, suppressing proliferation of the cancer cells.
“This kind of knowledge could lead us to better treat or prevent cancer because now we know how it works.”—Dr. Kathryn Meier
“This kind of knowledge could lead us to better treat or prevent cancer because now we know how it works,” Meier said. The study also found that a drug mimicking the action of omega 3s can work as well or better than fatty acids in suppressing the cancer cells. The study appears in the Journal of Pharmacology and Experimental Therapeutics.
Meier said it is still unclear if the effect can be obtained by taking dietary supplements like fish oil. Some people don’t tolerate fish oil very well, she said. Moreover, the effect of fish oil could fade as it is digested, while data from this study suggest that an omega-3 drug needs to be in a cancer cell all the time to have an effect.
“It’s very difficult in dietary studies to tell how much to take or what form to take,” Meier said. “Should you be eating fish? Should you be taking pills? But now we have a potential drug. Once you have a drug you can test very precisely whether it works or not in a certain disease and you would know exactly how much to give people.”
Eric Sorensen is a science writer for Washington State University.
Data from the study suggests an omega-3 drug needs to be in a cancer cell all the time, in order to have an effect. “But now we have a potential drug,” Meier adds. “Once you have a drug you can test very precisely whether it works or not.”
A team from the University of California, san Diego gives patients with type 2 diabetes a healthcare "tune-up."
By Heather Buschman
Dr. Candis Morello reveals to a happy patient the progress he’s made after visiting the clinic. Within six months of attendance, the patient had reversed the damage caused by stage 2 chronic kidney disease by gaining control of his blood glucose levels. Photo credit: University of California, San Diego
Healthcare providers are facing increasing pressure to achieve better patient outcomes, faster. With that in mind, Dr. Candis Morello and her team of UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences students set up a diabetes intensive medical management “tune-up” clinic for complex type 2 diabetes patients at the Veterans Affairs San Diego Healthcare System. The clinic, unique for its management by a pharmacist, pharmacy students and endocrinologist, provides personalized clinical care and real-time, patient-specific diabetes education in hour-long visits.
“We developed the clinic to empower patients through very patient-specific clinical care, as well as very specific education to help them reach their goals,” said Morello, who serves as professor of clinical pharmacy and associate dean for student affairs. “There was a need at the medical center to help our patients achieve better glycemic control, to help the medical center achieve better target markers, and to help the primary care provider meet their patients’ targets.”
But is the diabetes tune-up clinic any better at achieving patient outcomes than regular visits to a primary care provider? A new paper Morello and team published in the Annals of Pharmacotherapy says yes.
In the study, the team compared A1C, a measure of blood sugar levels, between two groups of patients—99 who attended the clinic for three one-hour visits over six months, and 56 who saw their primary care physicians at least two times in six months. The clinic group experienced significantly greater improvements at six months: compared to an average A1C reduction of just 0.8 percent in the primary care group, the tune-up clinic patients reduced their A1C by an average of 2.4 percent, and three-quarters reached their target goals.
“This personalized approach to diabetes management is pushing the boundaries of pharmacy and healthcare,” Morello explained. “We’re teaching lifelong skills in just six months—that’s a very short time to achieve chronic long-term goals. And preliminary data shows the benefits are maintained even 12 months after a patient leaves our tune-up clinic.”
“This personalized approach to diabetes management is pushing the boundaries of pharmacy and healthcare.”—Dr. Candis Morello
Furthermore, the diabetes clinic patients experienced a few other clinically significant improvements—they didn’t gain weight and didn’t experience any low blood sugar incidents.
This collaborative tune-up model was likely so successful in part, Morello said, because many of the patients have several other health issues that also need to be discussed at regular physician visits, leaving little time to talk about diet, exercise and managing blood sugar levels. The diabetes clinic dedicates time specifically to those matters, freeing up primary care providers to address a patient’s other conditions.
This pharmacist-led clinic exemplifies the changing landscape in pharmacy. California recently expanded pharmacists’ scope of practice, allowing them to initiate and monitor a patient’s drug therapy, rather than simply fulfill a doctor’s prescription. “The clinic is positive, interactive, engaging and educating, which really demonstrates the pharmacist in action. Hopefully, with the dissemination of this model, it would be adopted and duplicated in other health systems.”
Heather Buschman, Ph.D., is senior manager of communications and media relations at the University of California, San Diego Health.
‘Pharmacy of the future’ redefines the relationship between the patient and pharmacist.
By Athena Ponushis
Northeast Ohio Medical University and Ritzman Pharmacy are bridging the chasm between higher education and pharmacy practice, to create a “pharmacy of the future.”
Set in a healthcare ecosystem on the NEOMED campus, next to a medical fitness facility and primary care physician office, the pharmacy will use technology to engage the tech savvy—individuals wearing Fitbits or smartwatches, using social media or apps to track their fitness—and the use of these digital tools will open up time for pharmacists to cultivate relationships and engage with patients who are fond of vintage-inspired, face-to-face care.
“One of the hardest parts is figuring out how you engage someone,” said Dr. Charles Taylor, dean of the NEOMED College of Pharmacy and president of Pharmacy Innovations, an affiliate of the university.
“I, just like anyone else, can read the statistics indicating how many people don’t take their prescriptions the way they should, or how individuals could benefit from advanced services like medication management or transitions of care. The harsh reality is this: look across the country, we’re not delivering that service as well as I think we can, but we will be in the future.”
This visionary pharmacy, expected to open in early 2016, will include a station much like an Apple store “genius bar,” where a patient may use an iPad or smart device to download an app or watch a video about a medication or condition, then pose questions to a pharmacist.
There will also be private rooms, where a patient can talk one-on-one with a pharmacist, as well as a larger room, where support groups may gather. Technology will enable pharmacists, students and faculty to transcend the walls of the pharmacy, too.
“We want to work with health plans and local health systems to improve the medication reconciliation experience and we are doing that through a telepresence component.
We’ll be able to connect a pharmacist with other health professionals if they have questions about a medication, and be broadcast into small primary care clinics, talk one-on-one with patients or perhaps with other pharmacists to create a network of practitioners who are delivering more advanced patient care,” Taylor said.
Telepresence technology will allow the pharmacy to help with medication adherence or medication management, whether it’s on campus or in someone’s home.
Such automation will also allow the university to leverage its faculty, connecting an expert with advanced credentials in psychiatric medication, for example, to a mental health patient or provider in a more rural, underserved part of the state.
“What a better way than through an academic institution to set up a model and measure outcomes.”—George Glatcz, COO Ritzman Pharmacy
When people hear “pharmacy of the future,” they think “Star Wars,” said George Glatcz, chief operating officer of Ritzman Pharmacy, which has 25 locations in northeast Ohio. But at the heart of this innovative practice model rests small-town, vintage care.
If you look back 30 or 40 years, he said, the pharmacist was one of the most respected members of the community. Everyone knew their pharmacist and they were integral to patients’ care.
“I think we lost our way in pharmacy for awhile and became solely focused on the production of the prescription,” Glatcz said. “What we’re trying to do is bring that philosophy back into the present,” making the pharmacist a leader in the community, “and we call that pioneering vintage care.”
This innovative pharmacy will be using novel technologies to alleviate administrative burdens behind the counter, bringing the pharmacist back in front of the community.
When Ritzman asked its customers what they wanted from their pharmacy experience, no one could really articulate it. There was no expectation of care.
“Patients thought, ‘I’ll just pick up my prescription and go, there’s no need to have a conversation with my pharmacist.’” Glatcz said. “Hearing those sentiments took away what the practice of pharmacy is all about—patient care.”
It’s the patient experience that will make this pharmacy different, Glatcz added, who likens the current pharmacy experience to buying a cup of coffee years ago when you would run into a convenient store, grab a cup and run out. It better be hot and fast.
Glatcz believes the same thing has happened in community pharmacy. Patients think ‘My prescription better be ready so I can run in and run out,’ but he believes this too can be revolutionized, just like the coffee house experience.
This state-of-the-art facility will change the patient experience—come in, workout, see your primary care doctor, spend hours on your laptop at a pharmacy—but it will change the student experience, too.
When Taylor held listening sessions with faculty about the future of NEOMED, they consistently voiced a desire for innovation and the creation a model to build the next generation of innovators.
“It became apparent that we needed to be the model,” Taylor said. “And we need to use it as a case example with our students to inspire them. It has to be more than just words, more than curriculum; we needed a comprehensive approach, aligned with real, authentic opportunities.”
Now, NEOMED students will be immersed in a true pharmacy practice from day one. The rigor of it will grow, the complexities of patients and practices will elevate, and they will be able to see what pharmacy practice can be, and what it should be, Taylor said.
Glatcz feels the best part of this collaboration with NEOMED will be measuring outcomes to add to the momentum of pharmacy’s evolution.
“What a better way than through an academic institution to set up a model and measure outcomes,” Glatcz said, which ensures the future of pharmacy circles back to its original mission: building relationships with patients.
These renderings showcase Northeast Ohio Medical University and Ritzman Pharmacy’s “pharmacy of the future,” designed around digital health technology to engage patients with their pharmacist.
Athena Ponushis is a freelance writer based in Ft. Lauderdale, Florida.
Last updated on: 12/22/2015 4:57 PM