Outlook: Stroke

Stroke is the second most common cause of death worldwide, yet it can often be prevented. Each year, some 17 million people worldwide will have a stroke and almost 6 million of them will die. Research seeks to guide rehabilitation, to help maintain brain function after a stroke, and to develop treatments to repair the physical damage caused by the condition. Read more in this Nature Outlook I edited.

Infants May Benefit From Advanced Cochlear Implants

Young children need more detailed sound information, new study finds.

Cochlear implants are powerful tools for people with hearing loss. Using electrodes implanted in the ear that transmit sound directly to the brain, they can give even the profoundly deaf a sense of sound.

But their success often depends on how early the implants are placed. People who are born deaf and receive implants as adults have worse outcomes than those who are fitted with the implants as children, said Andrea Warner-Czyz, an audiologist at the University of Texas at Dallas who studies development in children with hearing loss. Read more in Inside Science.

Colleges set guidelines for marijuana

Physicians need to ensure conventional therapies are exhausted before prescribing medical marijuana, say many provincial colleges.

The seven provincial colleges of physicians that have issued guidelines are urging their members to take a cautious approach to prescribing medical marijuana.

The uncertainty over the risks and benefits of the drug and the lack of reliable data on its clinical effects are underlying caveats in guidelines from the colleges. The colleges advise physicians to take great care when deciding whether to prescribe cannabis to patients and to first ensure that conventional therapies have been exhausted. Read more in CMAJ.

Quebec doctors aim to fill marijuana knowledge gaps

Doctors in Quebec who prescribe medical marijuana will automatically take part in a province-wide research project to assess the risks and benefits of the drug.

Health Canada recently shifted responsibility for deciding who should have access to the drug onto the shoulders of individual doctors, raising concerns among physician groups, including the Canadian Medical Association, about the lack of robust data on the safety and effectiveness of marijuana used for medical purposes. Read more in CMAJ.

Be wary of “prescribing” medical marijuana, CMA warns

Canadian physicians should be wary of “prescribing” medical marijuana under new regulations that come into effect on Apr. 1, 2014, says the president of the Canadian Medical Association.

“For the CMA, nothing has really changed,” says Dr. Hugo Francescutti. “Our stand has always been that there is insufficient scientific evidence to support the use of marijuana for clinical purposes.”

In addition, he says, the regulatory colleges have indicated that they have concerns about patient safety and will be keeping a close eye on doctors who do “prescribe” the drug. “They are telling us to tread very gently. So if you are about to authorize access to marijuana you better really have the evidence that shows that it has some beneficial impact for your patient, because if something untoward happens you will be held to quite a high standard.” Read more in CMAJ.

With pot now legal, therapies sought to blunt high of marijuana

Marijuana is going mainstream in the US. On 1 January, Colorado became the first state in the country to allow recreational use of the drug. Washington is set to do the same within the next few months, and many others are considering similar measures.

Critics of these moves say that legalizing marijuana will increase consumption, leading to an uptick in substance use problems. And with more than 4 million Americans already dependent on or abusing marijuana—making cannabis the number 3 recreational drug after alcohol and tobacco—scientists and public health officials are increasingly fretting over the dearth of available pharmacologic treatments for marijuana addiction. “Every day we are growing more concerned about the number of people seeking treatment,” says Ivan Montoya, a psychiatrist and epidemiologist who serves as deputy director in the division of pharmacotherapies at the US National Institute on Drug Abuse (NIDA) in Bethesda, Maryland. Read more in Nature Medicine.

New Brunswick drug plan hopes to avoid pitfalls of other provinces

New Brunswick waited a long time for a prescription drug plan but it may now have the best one in Canada, according to Steve Morgan, who studies pharmaceutical policy at the University of British Columbia in Vancouver.

“New Brunswick learned not to make the mistake of the western provinces, which only cover prescription drugs costs once they exceed about 3% of income,” says Morgan. “It goes a lot further than the catastrophic drug plans in other provinces.” Read more in CMAJ.

Kinesin inhibitor marches toward first-in-class pivotal trial

The key to treating cancer is to put a stop to the out-of-control cell growth that leads to tumor formation. One way to do this is to go after the microtubules that help coordinate this rampant cell division. Yet because microtubules function in both dividing and non-dividing cells—for example, in non-dividing neurons they’re involved in intracellular transport—drugs that target microtubules directly tend to cause nerve pain and other side effects. That’s why researchers have been on the lookout for more specific targets in the microtubule machinery—ones that are only active in rapidly growing cells during mitosis.

The kinesin spindle protein (KSP), a molecular motor that crawls along the microtubules to help the cells divide, provides one such candidate target. To date, drugs designed to block this protein (which is also known as Eg5) have failed to live up to their potential, with something of a KSP inhibitor graveyard littered with failed and abandoned products from companies including Cytokinetics, AstraZeneca, Eli Lilly and others. Read more in Nature Medicine.

US conflict-of-interest case draws attention across continent

A conflict-of-interest case in Oregon is gaining attention across the United States and Canada for the precedent it may set regarding how much physicians should disclose to patients about their financial ties to medical companies.

Two physicians in Salem, Dr. Matthew Fedor and Dr. Kyong Turk, were charged under Oregon’s Unlawful Trade Practices Act. The doctors implanted defibrillators and pacemakers without disclosing to patients that they had been paid by the devices’ manufacturer, Biotronik, to train sales representatives from the company. Read more in CMAJ.