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Five-Cent Diabetes Pill From 1958 May Be New Cancer Drug (bloomberg.com)
40 points by tshtf 969 days ago | 46 comments



Cool. I'm on metformin (the drug from the article) and Actos for my American Diabetes[1]. Maybe metformin's anti-cancer properties will counter Actos' known pro-cancer properties! :-)

[1] By American Diabetes I mean diabetes due to being overweight. A few years ago, I changed my eating habits, got down to merely chubby, and all traces of diabetes went away. Eventually, changes in work threw my schedule into disarray, I stopped making time to go home and cook and reverted to too much fast food, much of the weight came back, and so did the diabetes.

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Subway salads & In&Out protein style or McDonalds burgers & milkshakes style fast food?

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A mix, although shakes are rare. It's the tempting add-ons (e.g., cookies at Subway) and the late night "I didn't stock any good snacks at home to avoid temptation, and so I end up going to the convenience store" runs that are the killers.

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Stock better snacks, double your orders of healthier food?

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Ok, now to protect my health I should be taking this drug (Metformin?), taking aspirin, drinking a glass of wine, eating blueberries... what have I missed? Maybe a pill that combines all that? There's an actionable startup idea!

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Gullibitor, for people who don't question all those newspaper headlines about the latest wonder drug breakthrough. Though I will admit blueberry wine sounds like a good idea.

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You're only going to take metformin if you have risk factors and/or metabolic syndrome/diabetes. Metformin has side effects. It's not as simple as aspirin.

(I'm not on it, but my wife was after our first kid was born and there was a concern about gestational diabetes).

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I might be wrong, but my understanding is that metformin is remarkably safe. I know you shouldn't take it if you have kidney or liver disease, and you mentioned the risk for women who are or might become pregnant, but except in those cases, I think gastrointestinal upset is about the only side-effect.

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The gastrointestinal upset is very prevalent, especially when people start taking it. It is also a good idea to avoid alcohol completely while on metformin. Metformin isn't a miracle cure - it helps reduce sugar absorption and generation by a (little) bit. Good old fashioned diet and exercise are far better, with metformin just taking the edge off. The best way of affecting long term public health is to address diet and exercise rather than giving everyone 5c pills.

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Also not mentioned is that metformin can severely reduce B12 uptake. Lack of B12 can result in nervous system issues, and is very similar to neuropathy.

You have a store of several years of B12 so it can take quite a while before depletion sets in.

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FWIW, the dreams of the 'end-all pill' fall short for a wide variety of reasons - one of the major ones being volume of ingredients necessary. For many recommended doses of vitamins / minerals, you simply need more than the total weight of those ingredients than can fit into a pill. The magnitude of this depends upon which supplementation schools of thought you believe in, but there is a limit to how much you can cram into a pill you can swallow.

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  Fry: I can't swallow that.
  Prof. Farnsworth: Good news! It's a suppository!

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Remember the aspirin has to be low-dose...

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It's not a good idea to take it preemptively. Only take low-dose aspirin if you've been diagnosed with heart problems or likely to have problems in the future.

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But the Internet told me it was a good idea!

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Are they saying that controlling blood sugar reduces cancer, or that metformin controls blood sugar -and- reduces cancer through some other mechanism?

There is enormous evidence of health problems caused by high blood sugar. If this applies to cancer too, the actionable plan is to start measuring one's own blood sugar (either daily or with an implant which can do it continuously), and learn to control it. I'm ready to try this myself.

Nothing beats direct measurement / "what gets measures gets fixed".

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I've been taking this on and off before meals as an anti-aging drug. Glad it's getting some mainstream coverage. It's quite possible just about everyone should be taking it, certainly everyone on a typical American high-carb diet.

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It's quite possible just about everyone should be taking it

Statements like this instantly set off my alarm bells. A drug that everybody should be routinely taking? Call me skeptical.

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I didn't really mean that; I meant something more like "every person that is unusually obsessive about their health and willing to regularly take diagnostic testing that is considered conventionally bad Bayesian medicine at a population level should try Metformin".

So really I meant that everyone should have health care in the top .1% of healthcare available on the planet, but that's a utopia, not reality.

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We all take powerful drugs every day: it's just that we mostly get them from food. (Example: Vitamin C and scurvy.)

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By that argument, glucose is also a drug.

There's a key difference between drugs and foods. For example, Vitamin C is required for synthesis, metabolism, and enzyme operation [1]. Caffeine simply enhances alertness. Your body will cease to function correctly without Vitamin C; not so without Caffeine (unless you are fostering a dependance)

[1]: http://en.wikipedia.org/wiki/Vitamin_C#Physiological_functio...

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Sure, glucose is a drug. There's a lot of overlap between foods, supplements, and drugs, and for the most part the distinction is created by bureaucrats at the FDA.

My favorite example of something that is simultaneously a food, drug, and supplement is the Seville orange. http://en.wikipedia.org/wiki/Bitter_orange

The bitter orange is delicious with stronger orange flavor than a normal orange, particularly in the peel. Most commercially used "natural orange flavor" is derived from bitter orange peels. The bitter orange contains a powerful set of ephedra-like substances, which are quite powerfully mind altering. A single bitter orange is actually uncomfortably stimulating for most people, in the sense that people have enough of a sense for this kind of thing that they stop eating before they consume an entire orange.

But even though sour orange extract is regulated as a supplement, it works as a powerful drug, and an unusually dangerous one at that. It still grows on trees and is very delicious and perhaps available blended in a $15 cocktail near you. Most bartenders don't realize they are adding a stimulant to a drink when they add Seville orange.

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Well, that settles it, clearly if every food is also a drug, that means any drug is safe to take in large quantities on a regular basis.

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All he's saying is that the line's blurry. If you drink 50 gallons of water in a day, you will overdose -- everything is harmful in some quantity, food or otherwise.

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That's fascinating. How is it supposed to slow aging? Have you noticed anything to indicate it's working for you? Are there any side effects?

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I've noticed no side effects in low dosages and my A1C has improved but hard to seperate that from other confounding factors. http://www.lef.org/featured-articles/metformin_dosage.html This is at very low dosage, 500mg once per day, but again, on and off, I mostly forgot to take it.

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How does this drug work? Does it reduce your blood sugar somehow? Would it be useful for weight loss?

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Hmm. So the way I read this:

We have an old drug that helps diabetes to treat cancer.. The drug costs $.05/pill, for diabetes.

It will be called "Nocan", and feature a $24/pill cost, due to a new patent being granted. *

*Just like Eli Lilly with PMS-PMDD and name change of Prozac to Sarafem. All you need do is bribe FDA for new "disease" name, and you have another 17 yr patent.

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Orphan Drug Law. If you want someone to do all the work to actually prove it works, which is incredibly expensive, they must be compensated in some way.

There are certainly other ways to compensate people who do this research, but this way maps pretty well to our current laws.

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Some drugs are very expensive, but most orphan drugs aren't. Average costs are between $25-60 million per drug.

http://www.palgrave-journals.com/biosoc/journal/v6/n1/full/b...

http://www.cptech.org/ip/health/rnd/evidenceregardingrnd.pdf

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A somewhat similar corollary - 'Lovaza', sold by GSK. It contains Omega-3-acid ethyl esters.

Also widely known as fish oil, and is prescribed for the same reasons fish oil is recommended in supplementation. Only difference is fish oil is marginally less concentrated, much cheaper, doesn't have the 'pharma' tag and isn't prescribed.

In the industry it's known as one of the biggest cash cows for GSK - it's earned them many billions.

http://www.omegavia.com/lovaza-vs-fish-oil/

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They might as well have called the drug "snake oil". It would have made more sense :-)

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Patents are the foundation for knowledge trickle-down-theory.

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Huh? How do you patent metformin? It's an extremely widely prescribed drug.

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You don't. You patent "Nocan", a drug with an extremely similar (most would say "identical") chemical structure. Metformin is a diabetes medication, while Nocan will be a cancer drug, so they're totally different. The diseases aren't even handled by the same medical specialists. ;)

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If metformin works for cancer the way aspirin does for heart disease, with an overall long-term prophylactic effect, people will just take metformin. It is very easy to get metformin.

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I was going to say that your doctor won't be allowed to prescribe metformin, but I checked and the FDA is fine with your doc independently prescribing drugs for off-label use. The manufacturer of metformin isn't allowed to market it as an anti-cancer drug, but what doctor won't be aware of this?

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at least it is a new indication, see the Makena Pricing Controversy to learn about what the Orphan Drug Law allows https://en.wikipedia.org/wiki/KV_Pharmaceutical#Makena_prici...

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It's possible to receive a patent for applying a known drug to a new area.

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First of all, are you sure about that?

Second of all, how does that even work? Metformin is very very widely prescribed.

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It's called a "use" patent.

There are many different ways to patent a drug. Composition patents, formulation patents, use patents, etc.

The problem is that if you get a "use" patent, it only stops other company from promoting the drug for the use you patented. In the case of metformin, it's already available as a cheap generic.

So if a company were to conduct studies proving that it reduced the risk of cancer and got a patent on it, there is nothing to stop a doctor from prescribing the generic version.

So unless a company can find a way to recoup their R&D costs associated with running the trials, they won't bother.

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I wasn't aware of use patents. Informative post, thank you.

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So who would break patent law in the case that a doctor prescribes the $0.05 diabetes pills to a cancer patient?

The doctor? He doesn't really make a profit of this and at least over here in Austria, a doctor may prescribe any substance he wants as long as he can argue that it is for the well-being of his patient.

The producer of the diabetes drugs? They don't sell it as a cancer drug.

The apothecary? He's just following the doctor's orders.

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Nobody would be sued because nobody is breaking any patent laws.

That's why you rarely (never?) see a drug company take an old, off-patent drug and try and get a patent for it (in it's original form) on a new disease. Since there is no way to recoup any investment costs, they simply don't make the investment.

What does happen is that drug companies will take an old, off-patent drug and modify it somehow so that it can be patented. They can do that a number of different ways: create a unique formulation of the drug, create a drug-device combination product or try and create a slightly modified (and hopefully improved) version of the original drug.

Under the current system, unless you have a patent (or marketing exclusivity from the FDA) you have no opportunity to recoup any investment you made in the drug.

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The parent is saying you can patent "using Metformin to prevent Cancer" separately than "using Metformin to help with diabetes."

I'm not 100% sure of this, but I'm pretty sure that this is the way the FDA approval process for drugs work. You can't just 'decide' to prescribe Metformin for cancer one day.

A single drug has to go through the approval process N separate times for N separate applications/diseases.

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Yes, you can. Doctors prescribe drugs for off-label use all the time. The FDA approves the marketing of drugs for specific health problems, but nobody cares about marketing metformin.

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