Many patients are eager to discontinue Wegovy or Zepbound when their weight loss plateaus. But doctors say it’s difficult to go cold turkey.Susana Parks was delighted when she lost 40 pounds on Eli Lilly’s obesity drug, Zepbound. But now that she is at her goal weight, she has questions: Can she stop taking the drug? And if she does, how can she maintain her weight loss?“I can’t stop cold turkey or I will gain it back — that is clear,” said Ms. Parks, 60, of Bend, Ore. “Do I go to a lower dosage? Do I take it every two weeks instead of weekly? How do I maintain?”These questions are becoming common, obesity medicine specialists say, as more and more people lose weight with obesity drugs. Some struggle to pay for the medicine, have difficulty finding it to purchase or just don’t want to stay on a drug longer than they believe they need to.When doctors are confronted with these queries, here is what they advise — and what they can’t say.What will happen if I stop taking the new weight-loss drugs after losing weight?Dr. David Cummings, a weight-loss specialist at the University of Washington, has been asked this question by many patients. He explains that the makers of the drugs conducted large studies in which people took the drugs and then stopped.“On average, everyone’s weight rapidly returned,” Dr. Cummings said. And, he said, other medical conditions, like elevated blood sugar and lipid levels, return to their previous levels after improving.He also tells patients that while on average, weight is regained when the drugs are stopped, individuals vary in how much weight and how quickly it returns.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The estimate focused on five cancers for which there is medically recommended screening — breast, cervical, colorectal, lung and prostate — and found that colonoscopies accounted for most of the costs.The United States spent $43 billion annually on screening to prevent five cancers, according to one of the most comprehensive estimates of medically recommended cancer testing ever produced.The analysis, published on Monday in The Annals of Internal Medicine and based on data for the year 2021, shows that cancer screening makes up a substantial proportion of what is spent ever year on cancer in the United States, which most likely exceeds $250 billion. The researchers focused their estimate on breast, cervical, colorectal, lung and prostate cancers, and found that more than 88 percent of screening was paid for by private insurance and the rest mostly by government programs.Dr. Michael Halpern, the lead author of the estimate and a medical officer in the federally funded National Cancer Institute’s health care delivery research program, said his team was surprised by the high cost, and noted that it was likely to be an underestimate because of the limits of the analysis.For Karen E. Knudsen, the chief executive of the American Cancer Society, the value of screening for the cancers is clear. “We are talking about people’s lives,” she said. “Early detection allows a better chance of survival. Full stop. It’s the right thing to do for individuals.”“We screen for cancer because it works,” Dr. Knudsen added. “The cost is small compared to the cost of being diagnosed with late-stage disease.”Other researchers say the finding supports their contentions that screening is overused, adding that there is a weak link between early detection and cancer survival and that the money invested in cancer testing is not being well spent.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

While not a perfect alternative to colonoscopies or fecal tests, experts hope the test could lead to more people getting screened for colorectal cancers.The Food and Drug Administration on Monday approved a new screening test for colorectal cancer. It requires only a sample of blood and can find cancers when they are early stage and usually curable.For many people, a routine blood test is easier to get than a colonoscopy or a fecal sample test. But the blood test, made by Guardant Health of Palo Alto, Calif., comes with a limitation. Unlike other screening tests for colon and rectal cancers, it has a poor record of finding precancerous growths. Removal of those growths can prevent cancer.The test, named Shield, will be available within a week. Guardant will announce its list price at that time, said Matt Burns, a company spokesman. It is approved for people aged 45 and over who are at average risk for colon cancer.The hope is that the blood test, despite its limitation, can encourage more people to be screened for colorectal cancer, the second-most common cause of cancer-related deaths in the United States. As many as 53,000 Americans are expected to die from colorectal cancer this year.Regular screening can prevent as many as 73 percent of those deaths. But although current guidelines recommend screenings starting at age 45, as many as 25 to 50 percent of people who should be getting screened are not.The problem is convincing more people to be screened. That is where the new test comes in. It is simple for patients — the blood sample can be obtained at a doctor’s office as part of a routine physical exam, or at a commercial lab.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

In the era when people traveled by sailing ship and steamer, illnesses usually burned themselves out before boats reached shore, a new study finds.On Dec. 22, 1874, the H.M.S. Dido arrived in Fiji from Sydney, Australia, carrying about 200 people and an invisible payload. A king of Fiji and his son, who were on the ship, were infected with measles. When they debarked, they started an epidemic that killed 20,000 people in Fiji — up to one-fourth of the population — who had no immunity to the disease.But in those days, when people traveled by sail or steam, such events were the exception rather than the rule. A new report, published last week in The Proceedings of the National Academy of Sciences, uses mathematical models to show how viruses had to beat very long odds to be transmitted across the sea. Most often, the study found, infectious diseases burned themselves out on board before ships ever docked.In the contemporary world, it is expected that new diseases and older infectious menaces will spread almost instantly around the globe, as happened with Covid-19. But where was the inflection point? Elizabeth Blackmore, a doctoral student at Yale, and James O. Lloyd-Smith, an ecologist at the University of California, Los Angeles, set out to find the moment when viral transmission started to change.John McNeill, a historian at Georgetown University who was not involved in the study, said Ms. Blackburn’s use of sophisticated mathematical modeling “has achieved something here that no historian or anybody else has been able to do before — to quantify likelihoods of transmission.”Kyle Harper, a historian at the University of Oklahoma who was also not involved in the study, said the work “breaks new ground.”Ms. Blackmore said that she and Dr. Lloyd-Smith thought of the idea to look at shipping when she was working on her master’s degree. They learned that the first reports of smallpox outbreaks of smallpox in California were not until 1806 and 1838. And smallpox was first reported much later elsewhere in the Pacific.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A large study showed that for most patients, having both breasts removed after cancer was detected in one made no difference.For the more than 310,000 women diagnosed with breast cancer every year, no matter how well the treatment goes, there is always a lingering fear. Could the disease come back, even years later? And what if it comes back in the other breast? Could they protect themselves today by having a double mastectomy?A study has concluded that there is no survival advantage to having the other breast removed. Women who had a lumpectomy or a mastectomy and kept their other breast did just as well as women who had a double mastectomy, Dr. Steven Narod of Women’s College Hospital in Toronto and his colleagues reported, using U.S. data from more than 661,000 women with breast cancer on one side.In the study, published in JAMA Oncology on Thursday, the researchers added that most women did very well — the chance of cancer in the other breast was about 7 percent over 20 years.But the study’s results may not apply to women who have a gene variant, BRCA1 or BRCA2, which greatly increases their cancer risk. For the 1 in 500 American women with this variant, cancer researchers agree that it’s worth considering a double mastectomy.The finding that a double mastectomy is not protective against death for many breast cancers seems counterintuitive, Dr. Narod admitted. An accompanying editorial, by Dr. Seema Ahsan Khan, a breast cancer surgeon at Northwestern University, and Masha Kocherginsky, a biostatistician also at Northwestern, called it a conundrum.Previous smaller studies have come to the same conclusion. But, Dr. Narod said, some doctors have questioned the methods in earlier research. We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Progress in the quest to help progeria patients suggests that gene editing techniques may help treat other ultrarare conditions.A cure for an ultrarare disease, progeria, could be on the horizon. The disease speeds up aging in children and dramatically shortens their lives. But, until recently, there was no path toward a highly effective treatment.Now, a small group of academics and government scientists, including Dr. Francis Collins, the former director of the National Institutes of Health, is working with no expectation of financial gain to halt progeria in its tracks with an innovative gene editing technique.If gene editing is effective in slowing or halting progeria, researchers say, the method may also help to treat other rare genetic diseases that have no treatments or cures and, like progeria, have aroused little interest from drug companies.After a quarter-century of research, the group is approaching manufacturers and planning to seek approval from regulators for a clinical trial on progeria gene editing.The project “has merit, but also risk,” said Dr. Kiran Musunuru, a gene editing researcher at the University of Pennsylvania, who also advises a gene editing company. He cautioned that although the editing worked well in mice, there is no guarantee that it will work in human patients.Dr. Collins first became interested in progeria while he was training in medical genetics at Yale University in 1982, almost three decades before he was appointed to lead the N.I.H. One day, he saw a new patient, Meg Casey. She was less than four feet tall, hairless under her wig and wrinkled like an older woman. She was only in her 20s.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

As patients consider drugs like Wegovy, Ozempic, Zepbound and Mounjaro to treat obesity, experts say the choices are not so simple.People with obesity now have a choice between two powerful drugs to help them lose weight. One is semaglutide, sold by Novo Nordisk as Wegovy for obesity treatment and as Ozempic for diabetes. The second, tirzepatide, is sold by Eli Lilly as Zepbound for obesity and as Mounjaro for diabetes. Many with neither obesity or diabetes take the drugs to get thinner.A recent study suggested that people lost more weight taking Mounjaro than they did taking Ozempic, and it may leave you wondering: Which should I take? And if I’m already taking one of them, should I switch?The answers, obesity medicine experts say, are not so simple. Here are some factors that can help sort out hype from realistic hope.Is one weight loss drug really better than the other?For now, it’s hard to say. All of the information available comes from “highly flawed studies,” said Dr. Diana Thiara, medical director of the weight loss clinic at the University of California, San Francisco.That includes the recent study comparing Mounjaro and Ozempic. Using electronic health records, the researchers reported that those taking Mounjaro lost an average of 15.3 percent of their weight after a year. Those taking Ozempic lost an average of 8.3 percent.While that sounds impressive, Dr. Susan Z. Yanovski, co-director of the Office of Obesity Research at the National Institute of Diabetes and Digestive and Kidney Diseases, said, “I wouldn’t make any decisions on my medical care based solely on a study like this.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

‘Obesity first’ doctors say they start with one pill, to treat obesity, and often find other chronic diseases, like rheumatoid arthritis, simply vanishLesa Walton suffered for years with rheumatoid arthritis. “It was awful,” said Ms. Walton, 57, who lives in Wenatchee, Wash. “I kept getting sicker and sicker.”She also had high blood pressure, and she was obese. Doctors told her to diet and exercise, which she did, to no avail.Then she found a doctor who prescribed Wegovy, one of the new obesity drugs. Not only did she lose more than 50 pounds, she said; her arthritis cleared up, and she no longer needed pills to lower her blood pressure.Her new doctor, Dr. Stefie Deeds, an internist and obesity medicine specialist in private practice in Seattle, said that Ms. Walton exemplifies a growing movement in obesity medicine.Proponents call it “obesity first.” The idea is to treat obesity with medications approved for that use. As obesity comes under control, they note, the patient’s other chronic diseases tend to improve or go away.“We are treating the medical condition of obesity and its related complications at the same time,” Dr. Deeds said.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The Guardant Health Shield test, one committee member said, “is better than nothing for patients who are getting nothing, but it is not better than a colonoscopy.”A committee of experts that advises the Food and Drug Administration voted by large majorities on Thursday that a new blood test to screen people for colon and rectal cancers was safe and effective, and that its risks outweighed its benefits.But the group cautioned that the blood test had limitations and added that they were endorsing it with the hope that it would increase the abysmally low number of people who are regularly screened for this cancer.The F.D.A. usually follows the advice of its expert committees.In the United States, about 150,000 people are diagnosed with colon and rectal cancers annually, and about 53,000 are expected to die this year. Most who are screened for the disease receive a colonoscopy or a fecal test. The F.D.A. approved these methods long ago, and research has demonstrated that they are more accurate than the new blood test, Shield, made by Guardant Health of Palo Alto, Calif.But for people with average risk of the disease, a blood test would offer convenience — no difficult preparation, fasting or anesthesia needed as is the case for a colonoscopy, no ick factor of a self-administered fecal test. It still must be followed by a colonoscopy if cancers or pre-cancers are detected.The biggest issue with the blood tests is that, unlike colonoscopies, they miss most of the precancerous growths on the colon that, if detected and removed, would prevent a person from developing cancer. That, said Dr. Stephen M. Hewitt, a committee member from the National Cancer Institute, “really undermines the concept of cancer prevention.”The test, said Charity J. Morgan, a committee member who is a biostatistics professor at the University of Alabama, Birmingham, “is better than nothing for patients who are getting nothing, but it is not better than a colonoscopy.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A review of a limited number of cases of unresponsive patients with severe traumatic brain injuries raised questions about a custom of making a decision within 72 hours.When a patient with a severe traumatic brain injury is comatose, in intensive care, unresponsive and hooked up to a ventilator, but not brain-dead, when is the time to withdraw life support? A small study on the fates of people in such situations suggests that doctors and patients’ families may make better decisions if they wait even a few days longer than usual.Often, a doctor sits down with family members within 72 hours of the patient’s admission to intensive care to discuss the patient’s prognosis, and whether they want to keep their loved one alive, or to remove life support.Experts say that many doctors would describe the outlook as grim — most likely death or severe disability. Reported outcomes of patients who had severe traumatic brain injuries show that most times the decision is to remove life support. The patient dies.The researchers behind the new study say that their limited data suggests that doctors’ predictions so soon after the injury frequently are wrong.The study, published Monday in Journal of Neurotrauma, used a national database that included 1,392 traumatic brain injury patients.Sifting through the data, they ended up comparing 80 patients with severe injuries who died after life support was withdrawn, with 80 similar patients whose life support was not withdrawn.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.