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El Niño is Here. Are KZN Clinics Ready?

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By Christina Pitt for Spotlight

With El Niño conditions expected to bring a hotter, drier summer, Spotlight asks whether the KwaZulu-Natal government is ready to keep health services running and protect vulnerable communities during the extreme weather that may be on the way.

For Phumelele Shabalala, extreme weather has made an already difficult life harder.

The 46-year-old has lived in Vimbukhalo, a rural village near Bergville in KwaZulu-Natal’s Drakensberg foothills, for 24 years.

Shabalala grows vegetables to sell and help feed her four children. But during a dry spell in 2024, she says streams began drying up and her maize crops started dying.

Another resident in the area told Spotlight that they had lost cattle to dehydration and untreated wounds caused by sun exposure, threatening livelihoods dependent on farming.

In nearby Stulwane village, 28-year-old Nondumiso Nokwanda Sigubudu has experienced a different kind of devastation.

Heavy rainfall damaged her home in October 2025 and again in October this year, she says. Part of a wall remains open, exposing her family to the cold and leaving their home unsecured. Sigubudu believes the conditions have affected her two children’s health, saying they frequently suffer from colds and fevers.

Extreme weather can also make it difficult for residents to get medical care.

A mobile clinic visits Vimbukhalo once a month for check-ups and chronic medication refills. But Shabalala says it sometimes cannot reach the village when heavy rain makes roads impassable, leaving residents waiting for another visit or seeking alternative care.

Such disruptions are particularly concerning as El Niño, a natural climate pattern that can affect rainfall in southern Africa and increase the risk of drought, is forecast to strengthen towards the end of 2026.

KwaZulu-Natal has a long history of droughts and floods. According to a Council for Scientific and Industrial Research report, the province recorded 85 declared weather- and climate-related disasters between 2007 and 2021 — more than any other province.

For vulnerable communities in rural KwaZulu-Natal, this raises an urgent question: how prepared is the province to protect them and keep essential health services running when extreme weather strikes?

El Niño, KZN and what’s at stake

El Niño occurs when sea surface temperatures in the central and eastern tropical Pacific Ocean become unusually warm, disrupting atmospheric circulation and influencing weather patterns around the world.

South Africa’s seasonal outlook indicates an increased likelihood of below-normal rainfall across much of the country between December 2026 and February 2027, Dr Nosipho Zwane of the South African Weather Service said during a health department webinar in October.

But drought is not inevitable.

“El Niño is often associated with hotter and drier summer conditions. However, this does not happen exactly the same way every time,” Zwane said.

Speaking to Spotlight, University of Pretoria meteorology professor Willem Landman cautions that seasonal forecasts cannot predict individual storms or flash floods months ahead. Even a drier-than-average season can bring intense downpours and localised flooding.

Although El Niño is a natural phenomenon, its effects can be compounded by climate change. The World Meteorological Organization says there is no evidence that climate change is increasing the frequency or intensity of El Niño events, but a warmer atmosphere and ocean can amplify associated extremes, including heatwaves and heavy rainfall.

Hotter conditions increase the risks of heat exhaustion, heatstroke and worsening chronic illnesses, particularly among pregnant and postpartum women, young children, older people and outdoor workers, says public health specialist Celeste Madondo of the Foundation for Professional Development.

Research in rural KwaZulu-Natal has also linked heat exposure to adverse pregnancy outcomes. One study found a “clear relationship between maternal heat exposure during the month preceding conception and miscarriage”.

But the health risks of extreme heat are not always immediately apparent.

“The difficulty with heat is that you can’t see it. You can feel it, but you can’t necessarily see its effects,” Madondo says. “With droughts and floods, the damage is visible. You can see the flooding. You can see that your house is gone.”

Dam levels versus rural realities

While extreme heat poses health risks of its own, reduced rainfall can also threaten the water supplies and livelihoods that rural communities depend on.

South Africa’s major dams were 97.7% full on average in October, compared with 88.3% in KwaZulu-Natal. But Landman says these figures do not necessarily reflect water availability in rural communities dependent on streams, boreholes and rainfall.

For farming households, less water can mean fewer crops, livestock losses and reduced income. As Landman puts it: “If you don’t plant, you don’t have food.”

Drought can also make it harder for people to stay on HIV treatment. In KwaZulu-Natal, almost 1.6 million people were receiving antiretroviral treatment in 2025, according to Thembisa, the leading mathematical model of HIV in South Africa.

Research by the Africa Health Research Institute (AHRI) examined the impact of drought on HIV treatment in rural KwaZulu-Natal, analysing records from more than 40 000 people at 17 clinics between 2010 and 2018. The study found that drought was associated with fewer patients taking their medication as prescribed or staying in HIV care, with some recovery after the drought.

A related study, based on interviews with 27 people living with HIV in rural Hlabisa, in the uMkhanyakude district, explored how the 2015–2016 El Niño-related drought affected access to treatment.

Collins Iwuji, a professor of climate, environment and health at AHRI and co-author of both studies, says food insecurity was among the challenges patients faced.

“During the drought, the price of food was also going up and they didn’t want to take their pills on an empty stomach, because of the potential side effects,” Iwuji explains. “So what some of them did was they skipped the pill.”

Others missed clinic appointments while collecting water or lost contact with their usual clinics after moving with their livestock in search of water.

Iwuji cautions that their work could not prove that drought caused these treatment interruptions, although participants’ accounts suggested that drought-related hardship played a role.

Asked whether the province’s HIV services are now better prepared for climate-related disruptions, Iwuji says improvements have been “partial rather than systematic”.

Measures such as allowing people living with HIV to collect three to six months of medicines at a time and community medicine collection points can reduce the need for frequent clinic visits. But Iwuji says these services expanded significantly during the COVID-19 pandemic, rather than in response to climate-related emergencies.

Is KZN ready?

The question of preparedness extends beyond HIV services. The devastating floods of April and May 2022 exposed serious problems within the province’s preparedness for extreme weather.

The Presidential Climate Commission described the government’s response as largely reactive, identifying poor coordination between departments, inadequate preparation, and gaps in getting early warnings to vulnerable communities.

Problems were also evident within the health system. A 2026 study⁠ involving staff at a KwaZulu-Natal provincial tertiary hospital found that the facility lacked specific plans for weather-related emergencies when researchers collected data in 2023. Staff also reported shortages of personnel and resources, difficulties obtaining emergency supplies and poor communication.

In November 2023, the National Department of Health, working with the World Health Organization (WHO), began establishing a network of Public Health Emergency Operations Centres (PHEOCs) to strengthen preparedness and coordination.

Despite these efforts, a draft health-sector readiness assessment presented by the national health department’s Director of Epidemiology and Surveillance, Mbhekiseni Khumalo, at a webinar in October suggests significant gaps remain.

The country scored 61% across 11 areas of preparedness. Rapid response teams and communication with communities lagged at 45%, while coordination received just 28%. Health service delivery performed better at 82%. The assessment reflects preparedness nationally rather than in KwaZulu-Natal specifically. The findings are preliminary, with supporting evidence attached for only 10% of the indicators assessed.

In KwaZulu-Natal, the provincial health department says it has put measures in place to prepare for extreme weather emergencies.

“The department receives weather warnings through the Provincial Disaster Management Centre, the South African Weather Service application and the National PHEOC WhatsApp channel,” says provincial department spokesperson Ntokozo Maphisa.

This information is then shared with all district health emergency teams, which then put response measures into action.

Maphisa says the department has also developed backup plans for floods, heatwaves, fires and other emergencies, with instructions for healthcare workers. The department also works with other sectors to maintain essential health services, according to Maphisa.

From weather warnings to action

One challenge is ensuring that weather warnings reach healthcare facilities and communities in time for them to act.

A R46.5-million WEATHER project, involving the University of KwaZulu-Natal and international partners, aims to improve how flood notifications reach clinics and hospitals.

“Published research has already shown that official warnings did not reach some eThekwini community health centre managers in 2022. Closing that gap between warning and facility action is at the centre of the system we are designing,” says one of the project’s principal investigators, Professor Saloshni Naidoo.

The research also found that the centres’ emergency plans lacked clear instructions for responding to weather-related disruptions.

Naidoo explains that the proposed system would combine official weather warnings with practical advice for health workers, such as checking medicine supplies and contacting patients on chronic treatment. These aspects of the system still need to be developed with the provincial health department.

The system is being designed to reach rural communities with poor internet connectivity.

Maphisa confirms that senior provincial health managers are involved in the project, which is expected to be tested in early 2027 and evaluated later that year. It will therefore not be operational during the coming summer.

Can hospitals and clinics withstand the next disaster?

The condition of clinic and hospital buildings is another important part of preparing for extreme weather.

The provincial health department has been repairing facilities damaged by severe storms, including the 2022 floods.

Its Strategic Plan 2025/26–2029/30 lists 47 repair projects involving roofs, gutters and drainage systems. At the time of the plan, four were complete, 19 under construction, 18 at the tender stage and six still being planned.

But repairing damage does not necessarily make facilities more resilient to future extreme weather.

The Presidential Climate Commission has warned that rebuilding damaged infrastructure without making it better able to withstand extreme weather could leave it vulnerable to future disasters.

Iwuji says making healthcare facilities more resilient starts with assessing the risks each building faces.

He says the WHO has developed a framework for assessing facilities’ vulnerability to floods, storms, extreme heat and drought, as well as their capacity to cope with these threats. Such assessments can help determine what improvements each facility needs.

Extreme heat presents another challenge, particularly in ageing healthcare buildings.

“The buildings are old. The aircons don’t work. It’s not maintained,” Iwuji says. “Now if you have an overcrowded facility that’s hot, the healthcare workers are also experiencing the effects of the heat. But we expect them to ensure that they serve clients to the best of their ability under these conditions.”

The KwaZulu-Natal health department did not answer Spotlight’s questions about whether the repairs include measures to make healthcare facilities more resilient to future extreme weather.

Iwuji acknowledges that the province has made progress in improving coordination between departments since the 2022 floods, but questions how far these changes have translated into action. “There is movement towards creating some resilience. But in terms of practical implementation and what that means, that is what I haven’t seen yet,” he says.

*This article was first published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.

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FDA Requires New Warning on GLP-1 Drugs for Rare Vision-Loss Risk

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Labelling update will note potential association with NAION, a condition that can cause permanent monocular vision loss

Photo by Haberdoedas on Unsplash

The U.S. Food and Drug Administration is requiring manufacturers of all glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to add information about a potential increased risk of non-arteritic anterior ischaemic optic neuropathy (NAION) to the Warnings and Precautions section of product labelling.

NAION is a rare condition that can produce acute, painless vision loss in one eye, including permanent impairment, the agency said in a drug safety communication issued November 9, 2026. Cases have been reported with every currently marketed GLP-1 RA.

Key Takeaways

  • FDA is requiring a class-wide Warnings and Precautions labelling change for GLP-1 RAs to note a potential increased risk of NAION.
  • In an FDA meta-analysis of 126 randomised trials, the NAION incidence was 6.4 events per 100 000 person-years with GLP-1 RAs versus 3.8 with placebo or non-GLP-1 glucose-lowering drugs.
  • Clinicians should counsel patients to report sudden painless monocular vision changes immediately and refer suspected cases promptly to ophthalmology; discontinuation should be considered unless benefits clearly outweigh risks.

The agency is requiring application holders for all GLP-1 RA medications to add information to the Warnings and Precautions section of labelling about the potential increased risk of NAION associated with use of these medications,” the FDA stated. NAION results from reduced blood flow to the optic disc; its precise pathophysiology is incompletely understood. Established risk factors include smoking, diabetes, hypertension, sleep apnoea, anaemia, and kidney disease. Occurrence in one eye elevates the risk of involvement of the fellow eye.

Symptoms typically include sudden, painless vision loss in one eye (often noticed on waking), visual-field defects such as blind spots or tunnel vision, colour distortion, and reduced central acuity. Patients should seek medical attention immediately if these occur. Individuals with a prior NAION event should discuss with their clinician whether to continue or stop the GLP-1 RA.

This requirement comes after a wave of studies pointing to a possible association between GLP-1 drugs and NAION, including a 2024 observational study involving semaglutide.

The agency examined clinical-trial data, animal studies, postmarketing reports, and observational analyses. A meta-analysis of 126 trials encompassing 134 253 patients (78 217 treated with a GLP-1 RA) and nearly 289 000 person-years of exposure identified 15 probable NAION events – 10 among GLP-1 RA recipients and 5 among those receiving placebo (none among recipients of other non-GLP-1 glucose-lowering agents). This yielded the 6.4 versus 3.8 per 100 000 person-years rates noted above. Background incidence in adults older than 50 years is estimated at 2.3 to 10.2 cases per 100 000p-y.

Europe’s drug regulator warned about the risk 17 months ago.

A separate FDA retrospective cohort analysis in adults with type 2 diabetes found no statistically significant increase in NAION risk with GLP-1 RAs versus SGLT-2 inhibitors, but a higher risk versus DPP-4 inhibitors. Animal data did not reveal a clear mechanism. The absolute risk remains low, and the FDA characterised the finding as a potential association rather than a confirmed causal relationship.

GLP-1 RAs (including semaglutide, tirzepatide, liraglutide, dulaglutide, and others) are approved for type 2 diabetes, chronic weight management, and selected cardiovascular, renal, and other indications. The labelling change applies across the class, including dual GIP/GLP-1 agonists and the oral agent orforglipron.

NAION presents as acute, painless monocular vision loss, often noticed upon awakening, with an altitudinal or other visual-field defect and a relative afferent pupillary defect. Fundoscopy typically shows disc oedema in the acute phase, followed by pallor. There is no established acute treatment that restores vision; management focuses on secondary prevention (control of vascular risk factors, smoking cessation) and counselling about the roughly 15–25% risk of sequential involvement of the fellow eye over subsequent years. Prompt ophthalmology or neuro-ophthalmology referral is essential both to confirm the diagnosis and to exclude arteritic causes (giant-cell arteritis), which require urgent systemic corticosteroids. In the GLP-1 RA context, shared decision-making about drug continuation should weigh the substantial cardiometabolic benefits against the small absolute increment in this rare event, particularly in patients with preexisting optic-nerve risk factors.

Healthcare professionals are advised to instruct patients to report sudden monocular visual changes immediately, refer suspected cases urgently, and consider discontinuing the GLP-1 RA unless treatment benefits clearly outweigh the risk.

Read the FDA announcement here.

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Drug Combination Helps Extend Survival for Bladder Cancer Patients

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Photo by Ivan S

An international trial found that adding two medicines to treatment around bladder-removal surgery improved survival for people who could not receive, or chose not to have, cisplatin chemotherapy.

An estimated 78 in every 100 people receiving the drug combination were alive two years after joining the VOLGA trial, compared with 69 in every 100 in the comparison group who were offered surgery without the trial medicines. The findings could expand treatment options for people unable to receive cisplatin chemotherapy, potentially providing an option to receive less drug treatment after surgery than some other approaches.

The trial, led by Professor Thomas Powles, involved people whose cancer had grown into the bladder’s muscle wall. It tested two medicines: durvalumab, which helps the immune system respond to cancer, and enfortumab vedotin, which uses an antibody to deliver a cell-killing drug.

The findings were published in the New England Journal of Medicine and announced at ESMO 2026. The study was sponsored by AstraZeneca.

Why are more treatment options needed?

Cancer that has grown into the bladder’s muscle wall is called muscle-invasive bladder cancer. If it has not spread to distant organs, surgery or radiotherapy can be used to remove or destroy the cancer, potentially preventing it from returning.

Removing the bladder is one treatment option. But even after surgery, cancer can return if microscopic cancer cells remain elsewhere in the body. Chemotherapy containing cisplatin can improve survival when given before surgery. However, kidney problems, hearing loss or other health conditions can make it unsuitable for some people.

Recent trials have expanded the options for people with bladder cancer. For people who can receive cisplatin, adding durvalumab to chemotherapy before surgery, then continuing durvalumab afterwards, improves survival. NICE, which assesses treatments for NHS use, recommends this approach.

Another combination, pembrolizumab and enfortumab vedotin, has also improved survival in trials, including among people unable to receive cisplatin. In the KEYNOTE-905 trial involving these patients, both medicines were given before and after surgery. Enfortumab was given for nine treatment cycles: three before surgery and six afterwards.

VOLGA tested a different approach: giving just three cycles of enfortumab, all before surgery, with durvalumab before and afterwards. Researchers wanted to see whether this could improve survival while avoiding the need to give enfortumab during recovery from major surgery.

What did the treatment involve?

The trial involved 695 people across 25 countries who could not receive cisplatin or had chosen not to have it. They were assigned by chance to three groups.

One group was offered durvalumab and enfortumab before surgery, followed by durvalumab afterwards. A second was offered the same medicines plus another immunotherapy, tremelimumab. The comparison group was offered surgery without these trial medicines, but could receive other approved medicines afterwards.

What were the benefits and risks?

The survival improvement with durvalumab and enfortumab – 78 versus 69 people in every 100 alive at two years – was statistically significant. The combination also improved ‘event-free survival’, which measured how long people lived without their cancer progressing or returning. It also counted not undergoing planned bladder-removal surgery while cancer remained as an event, whether this was because of worsening health or a decision not to proceed. At two years, an estimated 64 in every 100 were alive without a recorded event, compared with 45 in every 100 in the comparison group.

The tremelimumab combination improved event-free survival, but did not show a statistically significant overall survival benefit at this analysis.

The survival benefit came with additional risks compared with surgery without the trial medicines. Health problems classified as severe or worse occurred in about 71 in every 100 receiving durvalumab and enfortumab, compared with 50 in every 100 in the comparison group. These included problems from any cause, not all of which were caused by the medicines. One death was considered treatment-related in the durvalumab–enfortumab group, and five in the group also receiving tremelimumab.

What happens next?

Researchers will continue following participants to understand how long the survival benefit lasts and assess longer-term effects of treatment.

VOLGA showed that durvalumab with enfortumab helped people live longer than those offered surgery without the trial medicines. However, it did not compare this combination directly with pembrolizumab and enfortumab, which improved survival in the recent KEYNOTE-905 trial. Therefore, the findings cannot tell doctors which approach offers the best balance of survival and side-effects for patients. Further trials could answer this question and establish who needs enfortumab after surgery and who could safely have less treatment.

Before the VOLGA combination can become a routine NHS option, it requires regulatory approval, which will consider the benefits and risks.

VOLGA adds to recent progress in bladder cancer treatment, providing evidence for another option for people who cannot receive cisplatin chemotherapy. This growing range of approaches gives researchers more opportunities to find treatments that help people live longer while limiting side effects and the demands of treatment.

Source: Queen Mary University of London

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Aspirin Fails to Prevent Recurrence in Colorectal Cancer Liver Metastases

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Photo by cottonbro studio

Previous research has raised hopes that aspirin might reduce the risk of colorectal cancer returning after treatment. However, a large randomised clinical trial has found no such benefit for patients who had surgery for colorectal cancer that had spread to the liver.

Colorectal cancer is one of the most common cancers in Norway, which also has one of the highest incidence rates in the world. Approximately 30% of patients with colorectal cancer develop liver metastases during the course of their disease. Once the disease has spread, it is much more difficult to treat than primary colorectal cancer confined to the bowel.

“Patients rarely die from the primary tumour itself. It is the metastatic disease that is usually life-threatening,” says Sheraz Yaqub, Professor at the University of Oslo and consultant hepatobiliary surgeon at Oslo University Hospital.

For many patients, surgery offers the best chance of a cure.

“But even when we remove the tumours surgically, the cancer returns in more than half of patients,” says Yaqub.

Previous studies have suggested a protective effect of aspirin

Previous observational studies have suggested that aspirin use after colorectal cancer treatment may be associated with a lower risk of recurrence and improved survival. More recent randomised trials have investigated whether aspirin can provide such benefits, particularly in patients with specific molecular alterations in their tumours.

Yaqub and his colleagues wanted to find out whether aspirin could have the same preventive effect in patients whose colorectal cancer had spread to the liver.

“We wanted to know whether we could prevent the cancer from returning by giving aspirin to these patients as well,” Yaqub says.

The study has now been published in The Lancet Gastroenterology & Hepatology.

An inexpensive and widely available medicine

Aspirin has long been used to treat pain, fever and inflammation.Its potential to prevent cancer recurrence has therefore attracted considerable interest.

“Aspirin is inexpensive, widely available and has been used for more than a century. Its effects and side effects are well known, which made it an attractive candidate for preventing cancer recurrence,” says Yaqub.

Could aspirin prevent recurrence after treatment for liver metastases?

The researchers conducted ASAC, a randomised, double-blind, placebo-controlled trial investigating whether aspirin could reduce the risk of recurrence after curative-intent treatment of colorectal cancer liver metastases.

A total of 466 patients were randomised at 14 hospitals in Norway, Sweden and Denmark. All had undergone treatment (surgery or local ablation) for colorectal cancer liver metastases.

The participants were randomly assigned to receive either aspirin 160mg daily or an identical placebo for up to three years.

“For most patients, the cancer returns within the first two years after surgery. That is why we followed participants for three years,” says Yaqub.

No reduction in recurrence with aspirin

The researchers found that aspirin did not reduce the risk of the cancer returning, compared with placebo. Patients who received aspirin also had a lower overall survival rate, but this finding should be interpreted with caution. Serious adverse events were more common in the aspirin group.

“We found no benefit from aspirin in preventing cancer recurrence in these patients. The finding of lower overall survival, together with higher frequency of serious adverse events also raise concerns,” says Yaqub.

“Our results show that aspirin should not be routinely recommended to prevent recurrence after curative-intent treatment of colorectal cancer liver metastases,” he adds.

Why randomised trials matter

In an earlier study, Yaqub and colleagues linked information from the Norwegian Cancer Registry and the Norwegian Prescription Database. That registry-based study suggested that patients with colorectal cancer who were taking aspirin lived longer than those who were not.

However, studies based on health registries cannot show with certainty whether a treatment was the reason for the difference.

“Registry studies can identify associations, but they cannot establish whether aspirin itself is responsible for improved survival. Randomised, placebo-controlled trials provide much stronger evidence about the effects of treatment,” he explains.

Why might aspirin benefit some patients but not others?

The reasons are not yet clear, but differences in disease stage and tumour biology may play a role.

The ASAC trial was conducted alongside the Scandinavian ALASCCA trial. Both studies examined molecular changes in tumour tissue.

The ALASCCA study found that aspirin reduced recurrence in some patients with localised colorectal cancer whose tumours carried specific alterations in the PI3K signalling pathway. In contrast, the ASAC trial found no benefit for patients who had been treated for colorectal cancer that had spread to the liver, including those with the molecular alterations examined in the study.

“What works for one group of patients does not necessarily work for another. We cannot simply transfer results from patients with primary colorectal cancer to patients who have been treated for liver metastases,” says Yaqub.

Patients should not stop taking aspirin without medical advice

The ASAC trial investigated the effect of starting aspirin after cancer treatment. Patients who were already taking aspirin were not eligible to take part.

The findings therefore do not mean that people who already take aspirin for other medical reasons should stop treatment.

“Patients who are already taking aspirin for cardiovascular disease or other medical indications should not stop treatment because of these findings. Any changes should be discussed with their treating physician,” Yaqub says.

Source: University of Oslo

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New Course of Treatment May Cure Hyperaldosteronism

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Pexels Photo by Thirdman

A study led by Queen Mary University of London has found that a new treatment could offer a lasting cure for some people with a common hormonal cause of high blood pressure, even after they stop taking medication.  The treatment, known as extended aldosterone synthase inhibition (EASI), involves taking a new class of drugs for 6-12 months to target excess production of the hormone aldosterone, a common cause of high blood pressure.

Unlike conventional treatments that control blood pressure, the EASI-treatment appears to reverse its underlying cause, removing the need for lifelong medication. Until now, cure has required surgery to remove an entire adrenal gland.

The study, published in the New England Journal of Medicine, followed 14 people treated at eight centres across the United States. Researchers found that the EASI-treatment led to sustained reversal of excess aldosterone production and partial or complete resolution of high blood pressure for up to two years after treatment ended. 

Hormone levels and blood pressure remained similar to, or lower than, those recorded during their EASI treatment, suggesting that the benefits could persist long after people stop taking the drug. The findings raise the possibility that, for some people, high blood pressure could be cured rather than managed with lifelong medication. 

Figure 1: The graphs compare blood pressure and hormone measurements before treatment with those at 6 months, 1 year and 2 years after stopping an extended course of aldosterone synthase inhibition. The large reduction in aldosterone-to-renin ratio is due to a fall in the adrenal gland hormone, aldosterone, and compensatory increase in the kidney hormone, renin. The third row shows apparent safety of the treatment, with only modest increases in blood potassium and creatinine – a marker of kidney function.

It is estimated that between 5–10% of hypertension cases are caused by primary aldosteronism, a condition in which benign nodules in the adrenal glands produce too much aldosterone. This causes the kidneys to retain excess salt, raising blood pressure. 

The scientific basis for EASI-treatment dates back to a 2005 experiment in mice, which showed that deleting the gene responsible for producing aldosterone synthase caused the cells that make aldosterone to disappear. Researchers at Queen Mary predicted that prolonged treatment with an aldosterone synthase inhibitor might have a similar effect in humans, potentially removing the underlying cause of their hypertension.  

The opportunity to investigate this came through the first study of this class of drugs in people with primary aldosteronism, reported last year in the New England Journal of Medicine, in a paper also led by Queen Mary. 

Researchers subsequently examined routine follow-up measurements of people’s blood pressure and hormone levels, comparing them with values recorded before EASI treatment. They found that the main marker of excess aldosterone production remained 99 per cent lower than before treatment, while blood pressure was, on average 25 points lower. Almost a quarter of those who participated had normal blood pressure without taking any other medication. 

Although aldosterone synthase inhibitors have previously been tested in larger studies of people with hypertension, these generally involved shorter treatment periods of 6–12 weeks, with outcomes measured during treatment. In contrast, the new Queen Mary-led study found that the benefits of 6–12 months of treatment persisted for up to two years after treatment had ended.

Morris Brown, lead author and Professor of Endocrine Hypertension at Queen Mary, said: “While duly cautious about our findings because of the pragmatic nature of the study, they were predicted by previous experiments, and longer follow-up may justify a claim that a finite course of medication leads to infinite cure.  

“EASI-treatment is unlikely to be the elixir for most patients with hypertension. But the possibility of tablets achieving a surgical cure has long been a holy grail for this common type of hypertension.” 

Mason Freeman, Professor of Medicine at Harvard Medical School and initiator of the original study while medical director at Cincor, said “This follow up study led by Dr Brown has generated some extraordinary and unexpected findings. The sustained remission in the biochemical markers of the hyperaldosterone state, combined with much improved blood pressure levels, offers the very exciting possibility that many patients with primary aldosteronism may be able to be treated with a once a day pill, perhaps for a limited period of time, and obtain similar benefits to what we now achieve only after invasive diagnostic testing and major adrenal surgery.”

Building on these findings, the researchers are now leading a larger prospective clinical trial called ELIXIR to investigate whether the EASI treatment can provide a lasting cure for people with primary aldosteronism. The trial will also use molecular imaging of the adrenal glands to investigate whether prolonged treatment causes aldosterone-producing cells to disappear. 

Source: Queen Mary University London

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Potassium Binder May Ease Potassium Restriction During Dialysis

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Anna Frodesiak, CC0, via Wikimedia Commons

Dietary potassium restriction is important for managing hyperkalaemia, or high blood potassium levels, in individuals on maintenance haemodialysis, but it imposes a substantial day-to-day burden. Results from a recent clinical trial indicate that adding the potassium binder sodium zirconium cyclosilicate (SZC) may help. The findings were published in BMC Nephrology and also presented at American Society of Nephrology (ASN) Kidney Week 2026 October 22–25.

In the multicentre, randomised, open-label, parallel-group trial, outpatients receiving thrice-weekly maintenance haemodialysis with pre-dialysis serum potassium of 5.5 to < 6.5 mEq/L were assigned to SZC plus standardised nutritional counselling or nutritional counselling alone for 8 weeks.

In the main analysis including 183 patients, those who received SZC plus standardised nutrition counselling had a greater improvement in quality of life related to dietary potassium restriction than those who received nutrition counselling alone. SZC also lowered pre-dialysis serum potassium more effectively. No patient in the SZC group needed rescue treatment during the 8-week study, compared with 25 of 92 patients in the control group. In exploratory analyses, the investigators also saw an increase in fruit intake without an increase in total dietary potassium intake, as well as improvements in several areas of kidney disease-related quality of life. There were no serious treatment-related adverse events or deaths.

“SZC may provide an important patient-centred benefit beyond lowering serum potassium. When added to standardised nutritional counselling and regular potassium monitoring, SZC reduced the day-to-day burden of dietary potassium restriction while also providing better potassium control,” said corresponding author Hiromichi Wakui, MD, PhD, of Yokohama City University Graduate School of Medicine. “Hyperkalaemia treatment should be judged not only by whether the potassium level falls, but also by whether treatment makes daily life less burdensome for patients.”

The investigators stressed that individualised dietary assessment, regular potassium monitoring, and attention to overall nutritional quality remain essential. When dietary restriction alone places a substantial burden on patients, potassium-binding therapy may support a safer and more patient-cantered management strategy.”

Source: American Society of Nephrology

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The Strongest Thing a Man Can Do is Book a Doctor’s Appointment

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By Dr Veronica Netangaheni, Founder, Dr Vee’s Health and Wellness

South African men are taught to provide, protect, lead and carry the weight of their families, often at the expense of their own wellbeing. From a young age, many are conditioned to believe that strength means enduring pain, suppressing emotions and solving problems without asking for help. Yet one of the most important responsibilities of being a man is rarely discussed: taking responsibility for his own health.

As a general practitioner, I see the consequences of this mindset in my consulting room. Men often seek medical attention only when symptoms become unbearable, when their bodies can no longer accommodate neglect or when a manageable condition has progressed into something far more serious. They will make time for their families, businesses and responsibilities, but postpone the one appointment that could protect their own lives.

We have created a culture where men are expected to look after everyone, yet rarely encouraged to look after themselves.

Men service their cars. Why do they neglect themselves?

A man will take his vehicle for servicing when a warning light appears on the dashboard, understanding that ignoring a mechanical problem could eventually cost him more. Yet when his own body sends warning signs, he often dismisses them, hoping the discomfort will disappear without medical intervention.

The consequences are reflected in South Africa’s mortality figures. Statistics South Africa’s 2024 mortality report recorded 11 334 male deaths attributed to diabetes and 10 322 to hypertensive diseases. These conditions can develop silently, often without obvious symptoms, while gradually damaging vital organs and increasing the risk of life-threatening complications.

A blood pressure check, blood glucose test and cholesterol screening may take only minutes, but they can reveal risks that would otherwise go undetected. Feeling strong, looking healthy and being able to perform daily responsibilities do not necessarily mean that the body is functioning as it should. A man should not have to reach a medical emergency before his health becomes a priority.

Your sexual health may be warning you about your heart

Erectile dysfunction is another health concern that men often struggle to discuss, sometimes turning to unregulated medication rather than seeking professional advice. However, difficulties with sexual performance can be more than an embarrassing bedroom problem; they may signal underlying conditions such as diabetes, hypertension and cardiovascular disease.

The blood vessels responsible for achieving an erection are also connected to the wider cardiovascular system. Damage caused by these conditions can affect sexual function and may provide an early indication of broader vascular problems. Men must therefore understand that discussing changes in their sexual health with a doctor is not an admission of weakness, but an opportunity to identify potentially serious health concerns before they become life-threatening.

Silence is not strength

The crisis extends beyond physical health. The Commission for Gender Equality highlighted in 2026 that approximately 80% of suicide deaths in South Africa are among men. This should force us to question the expectations we place on men and the limited space we give them to acknowledge emotional distress.

We expect men to carry financial pressure, unemployment, family responsibilities and relationship difficulties while maintaining the appearance that everything is under control. We discourage boys from crying, teach men to suppress vulnerability and then wonder why so many struggle to ask for help when life becomes overwhelming.

We cannot continue confusing emotional silence with resilience. A man who admits that he is struggling has not failed his family or his responsibilities. He is recognising that his wellbeing matters and that some challenges require support beyond what he can manage alone.

Medical progress means nothing if men stay away

South Africa has made significant progress in HIV prevention and treatment, with access to PrEP, PEP and newer prevention options such as twice-yearly injectable lenacapavir. Effective treatment also means that people living with HIV who maintain an undetectable viral load cannot sexually transmit the virus.

Yet medical progress means little if fear, stigma and outdated ideas about masculinity continue keeping men away from testing and treatment. Knowing your HIV status is not a sentence; it is an opportunity to make informed decisions, protect your health and take control of your future.

We must also recognise that raising healthy men starts with raising boys differently. Boys need mentors who teach them that accountability, compassion and emotional intelligence are essential parts of manhood, not qualities that diminish it.

It is time to make men’s health a priority

My message to men is simple: book the appointment before your body makes the decision for you. Check your blood pressure, blood sugar and cholesterol, get tested for HIV, discuss appropriate cancer screenings and seek professional support when your mental health begins to suffer.

Families, employers, healthcare professionals and communities also have a responsibility to create environments where men can seek help without ridicule or judgement.

For generations, we have told men to provide, protect and lead. But we cannot keep expecting them to fulfil these responsibilities while overlooking the importance of their own survival.

The strongest thing a man can do is not pretend he is invincible. It is recognise that his health matters, ask for help when necessary and take action before it is too late.

Dr Veronica Netangaheni is a general practitioner.

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Standard Kidney Function Tests Underestimate Chronic Kidney Disease in People with Cancer

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Chronic kidney disease (CKD). Credit: Scientific Animations CC4.0

New research indicates that commonly used measures of kidney function largely underestimate the prevalence of chronic kidney disease (CKD) in patients with cancer. The findings were presented at American Society of Nephrology (ASN) Kidney Week 2026 October 22–25.

In 1200 adults with solid tumours, investigators compared measured glomerular filtration rate (mGFR), which directly measures kidney filtration rate using a specialised clearance marker, with commonly used estimated GFR (eGFR) values based on the blood proteins cystatin C and creatinine.

CKD prevalence rates based on mGFR, eGFR based on creatinine, and eGFR based on both creatinine and cystatin C were 18.9%, 10.2%, and 15.7%, respectively. Among those with mGFR of 45–59 ml/min/1.73 m² (indicating mild to moderate CKD), 72.1% had creatinine-based eGFR >60, suggesting that they had normal kidney function. Among those with mGFR <45 (indicating more advanced CKD), 52.5% had creatinine-based eGFR >45. Adding cystatin C to creatinine improved GFR discrepancy, but concordance remained poor.

These thresholds are especially important for decisions about drug eligibility and dose adjustments, as drug clearance rates often drop as kidney function declines. “The results suggest that errors in GFR estimation may contribute to exceeding toxicity in patients with cancer receiving anticancer therapy,” said corresponding author Veronica Torres Costa e Silva, MD, PhD, of the University of São Paulo Medical School, in Brazil. “I’ll give the example of cisplatin. Most recommendations state that patients with GFR of 45–60 ml/min/1.73m² should have a dose reduction of 25–50%, and those with GFR below 45 ml/min/1.73m² should not be considered eligible. This means that our patients are receiving exceedingly higher doses and having a higher frequency of toxicity because we are not capable of accurately assessing GFR and making accurate dose adjustments.”

Study: “Discrepancy in Glomerular Filtration Rate in Patients with Cancer”

Source: American Society of Nephrology

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What is the Financial Impact of Participating in a Cancer Clinical Trial?

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Study reveals differences by income level, travel distance, and trial phase

Photo by Tima Miroshnichenko on Pexels

New research reveals that participating in cancer clinical trials can cause financial burdens that are shaped by both socioeconomic and logistical factors. The analysis published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, indicates the need for better reimbursement programs to improve equitable access to, and retention in, cancer clinical trials. 

For adults with cancer, participating in clinical trials can carry costs related to travel, lodging, meals, internet access, missed work, and greater need for childcare/eldercare. In the United States, federal legislation addressing financial support for clinical trial participants is currently under consideration. Recognising the need for financial support for participation in trials, the Lazarex Cancer Foundation reimbursed out-of-pocket non-medical costs from 2006–2024 for patients enrolled in therapeutic cancer clinical trials across multiple US sites. 

When investigators examined the types and amounts of expenses faced by trial participants, they found that among 2826 individuals who received at least one reimbursement, median total per-patient reimbursement was $2128, median trial participation duration was 4.3 months, and monthly reimbursed amounts declined substantially throughout trial participation (with monthly reimbursements falling to 60% of initial levels by 3 months into trial participation).  

Importantly, the program reimbursed expenses only if there were no other sources of financial support from the trial sponsor or site. 

Types of reimbursement varied by patient income: internet, ground transportation, and childcare/eldercare were more common at lower income levels, while lodging and airfare were more common for higher income. After adjustments, monthly reimbursed amount was greater among middle-tier household income quartiles, greater distance to trial site, and phase 1 trials. 

“When we consider the overall cost of running cancer clinical trials, covering patients’ travel, lodging, and other non-medical expenses represents a relatively small investment. Our findings suggest that these costs are modest compared with what sponsors already spend per participant and decline substantially over time,” said lead author Sukh Makhnoon, PhD, an assistant professor in the O’Donnell School of Public Health and Simmons Comprehensive Cancer Center at UT Southwestern Medical Center. “Reimbursing patients for these expenses could be a practical and relatively inexpensive way to reduce financial barriers and make cancer clinical trials more accessible.”  

Source: Wiley

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New Triple Agonist Yields Major Weight Loss and Knee-pain reduction in Trials

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Photo by Sweet Life on Unsplash

A pair of phase 3 trials of the investigational triple agonist retatrutide showed a mean weight loss of up to ~25% and clinically meaningful pain reduction versus placebo in people with obesity and osteoarthritis.

Compared to currently available GLP-1 (glucagon-like peptide-1) drugs like semaglutide or tirzepatide, which target one or two receptors and typically result in 10%-20% weight loss, retatrutide, a once-weekly injectable, targets three hormone receptors: GLP-1, GIP (glucose-dependent insulinotropic polypeptide), and glucagon (GIP/GLP-1/glucagon).

The two trials, TRIUMPH-4 and TRIUMPH-1-OA, found that the highest doses produced average body-weight reductions of 20–25%. In a pooled analysis, roughly two-thirds of retatrutide recipients achieved ≥ 50% reduction in pain scores, compared with 38% on placebo. Additional benefits included lower blood pressure, improved lipids, and reduced systemic inflammation. The results of the Northwestern University-led trials were published in the New England Journal of Medicine.

Current knee-OA options (intra-articular corticosteroids, physiotherapy, topical agents, NSAIDs, opioids) offer only limited or short-term relief. Modest (5–10%) weight loss via diet and exercise can help but is hard to sustain, particularly when pain limits activity. Retatrutide’s three-receptor mechanism produced greater weight loss than dual or single agonists typically achieve.

Dr Thomas Schnitzer, corresponding author at Northwestern, said: “Participants had remarkable responses. Many of the people in this study lost considerable amounts of weight, with a few losing up to a hundred pounds or more.”

People who need a knee replacement were excluded from the trial. The biggest unknown from the study, Schnitzer said, is whether retatrutide slows the progression of knee OA enough to reduce the need for total joint replacement. 

“That would be the goal here to say you can reduce people’s pain, and you can stop the progression of their osteoarthritis,” Schnitzer said. 

The other area of this research that needs further investigation is whether the drug can reduce painful knee OA in people who are not overweight, as they were not included in the study. 

“These drugs are believed to have significant anti-inflammatory activity, but the mechanism is not entirely known,” Schnitzer said. “Whether cutting down inflammation in the joint is also important in addition to reducing load needs more research, so this is still a first step, in my view. I’ve been working in the OA field for a long time, and I think this opens up opportunities to do a lot more studies to understand the condition better.”

Dr Philip Conaghan (University of Leeds) presented TRIUMPH-4 results at the American College of Rheumatology meeting.

Source: EurekAlert