Wednesday, May 31, 2017

Haiku Mid Spring

Day opening up
Cat slithers around the tree
Fly, robin, fly

Blooming cherry trees
Every year different
Spring to remember

Rain greying the air
Lonely under umbrella
But the happy frogs

Moon cleaning the sky
Of starry impurities
But then a white neck

Staring at the wall
It does not start to move
No, it does not move

Mellow, yellow light
Resting on the leaves of oaks
Wind reads old papers


High Hopes and Aspirations or how ASP015K / Peficitinib brings back the Small Molecule Hype

ASP015K, now called peficitinib is an oral Janus kinase (JAK) inhibitor with selectivity for JAK1/3, developed by Astellas Pharma for treatment of rheumatoid arthritis (RA) and other autoimmune diseases [1]. A year later, as the hype about JAK and small molecules were cooling down, I’ve written: “Could ASP015K keep up with its’ aspirations at the EULAR 2013 meeting?” And: “My positive impression dwindles considerably! I hope we’ll see results from a phase 2b study later this year.” [2] So we already had a Phase 2b study presented at the EULAR 2013 Meeting.

As tofacitinib and baricitinib are approved in the EU right now, hype and hopes in protein kinase inhibitors return. Last year I’ve speculated: “I guess that the pharmaceutical industry isn’t prudent enough not to overprice small molecules, so that our patient's needs are addressed.” [3] And I’ve proven right. [4]

Recently Gregory M. Weiss, M.D. has published an article [5]: “JAK Inhibitor Peficitinib Reduces RA Symptoms”. He refers to a phase 2b study. So, it seemed to me nothing new under the sun. I stumbled over the sentence: “The authors suggest that rheumatoid arthritis patients with elevated C-reactive protein levels may respond better to higher doses of peficitinib than those with elevated sedimentation rates.” Most of my patients, who have elevated sedimentation rates also have elevated C-reactive protein levels, and vice versa.

There is already a phase 3 study on Peficitinib under way [6]. I’ve checked the abstracts for the 2017 EULAR Meeting (still under embargo), but there isn’t any study mentioned, so that I expect news on this study could be published at the ACR 2017 Meeting later this year.

There will be an open extension phase 2b study on filgotinib being presented at the EULAR 2017 Meeting. No study on decernotinib expected at the EULAR 2017 Meeting.

The race for the high end price level small molecules is open again. Let’s hope that besides the hype there’ll be some benefit for our patients.



Tuesday, May 30, 2017

Junk Food de luxe oder die Mär von gesunden Fertiggerichten

Ich dachte gestern, ich höre nicht richtig, als es im Radio hieß, dass Bundeslandwirtschaftsminister Christian Schmidt (CSU) ein Strategiepapier vorlegt, dass Fertiggerichte mit weniger Salz, Zucker und Fett auskommen sollen. In "kleineren, kaum sensorisch bemerkbaren Reduktionen" sollen die Hersteller das bewerkstelligen, wobei sie sich erst bis Mitte 2018 freiwillig auf Zielwerte einigen sollen.
„Wegen ihres hohen Gehalts an Salz, Zucker oder Fett und dem häufigen Konsum stehen etwa Brot, Joghurtprodukte, Frühstücksflocken, gesüßte Erfrischungsgetränke sowie Tiefkühlpizzen im Fokus. Sanktionen gegen Hersteller sind vorerst nicht geplant.“ [1] Ich glaube nicht, dass dies passieren wird, das mit den Sanktionen.

Drücken wir es einmal anders aus: dieses Junk Food de luxe bleibt Junk Food. Wie kann man nur der Auffassung sein, dass man gesunde Fertiggerichte herstellen kann? Lesen Sie bitte einmal die Zutatenlisten. Wie viel Zucker, Salz und Fett man beifügt, damit der Dreck auch gegessen wird. Dazu noch Farben, Geschmacksstoffe, Emulgatoren, …

Bundeslandwirtschaftsminister Schmidt hält es „für möglich, künftig Werbung für Lebensmittel mit besonders viel Zucker, Fett oder Salz gesetzlich einzuschränken.“ [2] „Ich liebe es“.

Ich bin für die Einführung der Junk Food Maut. Lieber Bundeslandwirtschaftsminister Christian Schmidt, lassen Sie sich doch dazu von Ihrem Pateikollegen Verkehrsminister Alexander Dobrindt (CSU) beraten.

Wie könnte man es nun wirklich besser machen. Wieder anfangen, selbst zu kochen. Schon in den Kindergärten und dann in den Schulen beginnen, die nächste Generation zu einem besseren Umgang mit der Ernährung anzuleiten, z.B. dass es nur noch selbst gekochte Speisen und nicht in der Mikrowelle erhitzte Fabrikkost gibt.



Another Funeral Forest, the Trostwald

I have shown you a Begräbniswald, what then is a Trostwald? It is another natural burial site. Trost means comfort or consolation and Wald means forest.

Here I will show an example in Odenthal, which is only a 20 minute drive away from where I live; actually it’s quite near to the Begräbniswald in Hand. I took the pictures during May 2017.

This funeral forest really is a forest. Most of the trees are beech trees. There are some quite old ones. „The forest with its tall trees, the crowns shield us, the trunks we lean on to rest and the roots draw power from the earth to give support.” At the Trostinsel (Comfort Island) the ashes of children up to three years are buried for free. Prices vary in between 250-800 €. That is less than an anonymous urn burial on a cemetery. 

The crowns shield us, the trunks we lean on to rest - 
and a cross, a simple wooden cross

 A plan to find the right tree

Nameplates on the trees

Another cross and the young plant on the tree stump 
giving hope and consolation