News in brief: New drug target could lead to non-opioid treatments for neuropathic pain; Plea for neurologists from voluntary assisted dying board; Global medical journals unite to call for climate crisis action

9 Sep 2021

New drug target could lead to non-opioid treatments for neuropathic pain

A new drug target could lead to safe and effective non-opioid neuropathic pain treatments, according to Australian researchers.

Electrophysiology and preclinical pain models showed positive allosteric modulators (PAM) could bind the adenosine A1 receptor with higher selectivity and less side effects than previously investigated activators, Monash University researchers wrote in Nature.

PAMs bind to a different part of the A1 receptor than traditional drug hopefuls, the researchers found, with cryo electron microscopy allowing them to solve high resolution structures of the receptor bound to adenosine and an analgesic PAM.

The researchers’ discovery could help researchers develop non-opioid drugs that lack side effects such as respiratory depression and addiction.

Plea for neurologists from voluntary assisted dying board

A lack of specialist involvement is hampering the operations of Victoria’s assisted dying scheme for terminally ill people, according to the latest report from the independent Voluntary Assisted Dying Review Board.

While there are now 234 medical practitioners trained and registered to take part in the assisted dying scheme, most are GPs (137), the Board notes.

There are few medical practitioners in specialties such as medical oncology (41), neurology (11), haematology (6) and respiratory medicine (6), which means that patients and their carers face challenges in accessing voluntary assisted dying consultations in person with coordinating or consulting medical practitioners, the report authors say.

“Despite the 18% growth in medical practitioners actively participating over the past six months, the Board continues to encourage more medical practitioners to become involved in voluntary assisted dying,” their report recommended.

Of the 488 applicants for the scheme since July 2019, 83% had a malignant diagnosis and 17% had a non-malignant diagnosis. The most common underlying malignant illnesses were lung cancer (19.8%), breast cancer (9.6%), colorectal and pancreatic cancer (both 10.1%), while neurodegenerative disease accounted for almost half of the non-malignant disease applications.

Global medical journals unite to call for climate crisis action

More than 230 major health journals are standing together to demand urgent action on climate change, in a bid to prevent further catastrophic harm to health.

In an unprecedented move, the journals have simultaneously published a joint editorial calling on governments to halt the destruction of nature, protect health, and create “a sustainable, fairer, resilient, and healthier world,” ahead of this month’s UN General Assembly climate conference in Glasgow, UK.

The editorial, published in titles such as BMJ, The Lancet, the New England Journal of Medicine, and the Medical Journal of Australia, warns that the greatest threat to global public health is the failure of world leaders to take sustained and effective action to rein in global temperature rises.

Recent targets to reduce emissions and conserve nature are welcome but do not go far enough, and “are yet to be matched with credible short and longer term plans to accelerate cleaner technologies and transform societies”, it said.

Insufficient action means that temperature rises “well in excess” of 2°C are now likely, which would represent a “catastrophic outcome for health and environmental stability”.

Addressing the climate threat will require a similar level of funding as that made available by the government in the fight against COVID-19, the authors said. “Huge investment will be needed, beyond what is being considered or delivered anywhere in the world. But such investments will produce huge positive health and economic outcomes.”

Dr Fiona Godlee, Editor-in-Chief of the BMJ, and one of the co-authors of the editorial, said healthcare professionals who have been on the frontline of the COVID-19 crisis “are united in warning that going above 1.5C and allowing the continued destruction of nature will bring the next, far deadlier crisis”.

“2021 has to be the year the world changes course – our health depends on it.”

The editorial was coordinated by the UK Health Alliance on Climate Change.

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