Study links blood levels of inflammatory markers with different aspects of cancer-related fatigue.
Photo by Karolina Grabowska on Pexels
New research reveals that inflammatory responses may play a role in different types of fatigue experienced by many people with cancer. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
Cancer-related fatigue can be a distressing and persistent burden that causes patients to feel physical, emotional, and/or cognitive tiredness or exhaustion. Activation of inflammatory responses by the tumour itself and/or by cancer treatment is thought to be a key biological driver of this symptom, but inflammatory activity across the cancer continuum has not been thoroughly examined.
To investigate, researchers at the University of California, Los Angeles (UCLA) analysed protein markers of inflammation in 192 women with early-stage breast cancer who were examined before radiation or chemotherapy and throughout the 18 months after treatment. At each assessment, women reported on different dimensions of fatigue (general, physical, mental, and emotional) and provided blood that was tested for protein markers of inflammation. These included two pro-inflammatory cytokines (TNF-α and IL-6) and two downstream markers of their activity (sTNF-RII and CRP).
Higher levels of TNF-α, sTNF-RII, and IL-6 were linked with greater general fatigue, which involves feelings of tiredness and exhaustion. These effects remained even after accounting for age, race, education, body mass index, and cancer stage. Similarly, there was a positive association between physical fatigue, which involves feelings of physical weakness and heaviness, and TNF-α, sTNF-RII, and CRP. Conversely, higher levels of TNF-α and sTNF-RII were associated with lower levels of emotional fatigue. No significant associations between mental (or cognitive) fatigue and inflammatory markers were found.
“Our findings indicate that inflammation plays a role in some aspects of cancer-related fatigue, but not others, and that these effects persist well after treatment,” said lead author Julienne E. Bower, PhD, of UCLA. “This is critical for developing targeted treatments for this common and disabling symptom.”
Neurons in the brain of an Alzheimer’s patient, with plaques caused by tau proteins. Credit: NIH
It has been known that brain lithium (Li) levels are depleted in individuals with mild cognitive impairment, a precursor for Alzheimer’s disease. For years, there have been attempts to restore Li levels to prevent Alzheimer’s disease by administering lithium carbonate. But now, it has been shown that the Li from this compound has been sequestered and not actually restoring the endogenous Li levels. Now, scientists have tried using lithium oxide (LiO) salts instead – and the treatment appears to be effective in prevention and even reversal of a mouse model of Alzheimer’s.
Join our QuickNews podcast as the arguments for and against this lithium-based approach are unpacked and debated.
UCLA researchers have uncovered a link between “morning sickness” symptoms and the body’s natural, but complex, inflammatory response to biological and bodily changes during pregnancy.
According to the National Institutes of Health, up to 80% of early-stage pregnant mothers experience some nausea, vomiting and aversions to certain foods and smells. While uncomfortable, these symptoms are not typically a sign that anything is wrong with the health of the mother or the developing fetus, but rather an indication of a delicate balance unique to pregnant women.
“During pregnancy, a mother’s immune system faces a tricky challenge: it has to protect both her and the foetus from infection, but without accidentally attacking the foetus, whose genetic identity is half-foreign because it is half derived from the father. Normally, the immune system attacks anything that seems foreign, so in pregnancy, it has to carefully adjust to keep the foetus safe while still defending against infection,” said UCLA anthropology professor Molly Fox, corresponding author of the study published in Evolution, Medicine and Public Health.
The researchers believe that this delicate balance, which protects mother and foetus, is achieved by a unique mix of inflammatory responses. They function to prevent the mother’s body from rejecting the foetus, alongside adaptive behavioural mechanisms, like nausea, that encourage the mother to avoid foods that are potentially harmful, especially in the first and second trimesters when the foetus is most vulnerable.
“Nausea, vomiting or aversions to foods or smells are not indications that something is going wrong for the mother or the foetus. It’s likely an indication that everything is moving along normally, and a reflection of the body’s healthy and helpful immune response,” said UCLA anthropology professor and paper co-author Daniel Fessler.
Methodology and findings
For the study, the UCLA-led team of anthropologists and epidemiologists collected and analysed blood samples to measure immune system molecules called cytokines. Cytokines are proteins that send signals to help the body launch a quick defence against sickness and regulate inflammation. Participants also filled out questionnaires that asked about morning sickness-related symptoms and food and smell aversions during the early stages of pregnancy. The participants were 58 Latina women in Southern California who were followed beginning in early pregnancy through the postpartum.
Sixty-four percent of study participants experienced odour or food aversions, primarily to tobacco smoke and meat. Sixty-seven percent reported nausea and 66% experienced vomiting.
The study team measured pro-inflammatory cytokines as well as anti-inflammatory cytokines. They found that women who experienced an aversion to tobacco smoke showed a noticeable shift toward a more inflammatory response. Food aversions, nausea and vomiting were also associated with a more pro-inflammatory immune balance.
An evolutionary process?
The correlation is consistent with researchers’ theory that these symptoms may be part of an evolutionary adaptation that helps pregnant mothers’ bodies minimize exposure to harmful substances, though the study’s authors caution that the evidence is not definitive and more research is needed.
They emphasised that the study allowed the team to look at both human biological and behavioural responses during pregnancy.
“In many mammals, the foetal compartment has barriers separating it from the mother’s blood supply, where her immune cells are. But in humans, we have a unique setup – foetal cells are bathed in maternal blood. Humans have the most invasive of all placentas, burrowing deep into maternal tissue. So humans need unique strategies to prevent the mother’s immune system from attacking the foetus,” said Fox.
These immunological changes may induce nausea, which in turn encourages food avoidance that might act as an additional layer of protection, according to the researchers
“Nowadays, you will see labels on packages of ground beef or soft cheese that warn pregnant women to be cautious about these products because of the risks of foodborne illness during pregnancy. Aversions to certain odours and foods, and nausea and even vomiting, appear to be evolution’s way of achieving that same objective,” said Fessler.
Practical implications
The researchers, including first author Dayoon Kwon, who just completed her PhD in epidemiology at UCLA (and is now a postdoctoral fellow at Stanford), said that the study could help bolster recognition that nausea and vomiting are normal symptoms with biological underpinnings associated with healthy pregnancies. The study’s results could help in paving the way for common-sense workplace accommodations, such as more efficient deployment of health care benefits and other helpful resources to reduce stigma, excessive absences and lost productivity.
They also encourage other researchers to continue to look into the questions raised by the study, to not only explore the evolutionary questions, but to work toward providing clinicians with non- or low-invasive measures of prognoses.
Facing off a dual burden of high disease risk and low service access
Photo by Sydney Sims on Unsplash
CAPE TOWN, 08 OCTOBER 2025: South African and international leaders in public health will gather on Friday, 10 October 2025 at the University of Cape Town to convene an in-person scientific seminar: Agents of change and women who use drugs. Women who use drugs (WWUD) in South Africa face compounded health and social vulnerabilities that leave them disproportionately excluded from essential health services. Compared to men, women experience heightened stigma, intimate partner violence, reproductive health challenges, and structural barriers such as childcare responsibilities and lack of women-centred care.1,2 Scientific discussions among academics will focus on how women can be supported through access to harm reduction programming and drug policy reform.
Seminar: Agents of change and women who use drugs
· Date : 10 October 2025
· Time : 13:30 – 15:30 (SAST)
· Venue : Neurosciences Institute Auditorium, UCT/Groote Schuur Hospital, Cape Town
Recent evidence highlights both the scale of drug use and the urgent need for tailored harm reduction. National estimates suggest there are approximately 82 500 people who inject drugs (PWID) in South Africa, with women comprising between 16% and 27% of this population.3 Led by TB HIV Care, a 2023 bio-behavioural survey across four South African sites documented extremely high HIV prevalence among PWID: 72.1% in Tshwane, 49.3% in eThekwini, 45.4% in Mashishing, and 30.3% in Mbombela. Hepatitis C (HCV) prevalence was similarly alarming, reaching 89% in Tshwane and over 75% in multiple sites.3
“The evidence consistently shows that harm reduction works,” says Dr Andrew Scheibe, medical doctor and technical advisor with TB HIV Care in Cape Town, INHSU board member, and fellow co-convener of the upcoming INHSU 2025 conference. “Harm reduction reduces infections, prevents overdose, and connects people to healthcare, yet access across Africa remains the exception rather than the rule.”
Sex-based disparities are stark. While HIV prevalence among PWID overall has ranged from 14% to over 70%, women consistently show higher prevalence rates than men. One multi-city study found 18% HIV prevalence among female PWID, compared to 13% among males.4 More recent research in Durban confirmed that women face greater barriers to accessing sexual and reproductive health, harm reduction, and HIV services, often due to fear of arrest, intimate partner control, and lack of programming designed for women.5
“Everyone in our communities deserve health, dignity, and care,” says Mfezi Mcingana, Programme Director: Key Populations at TB HIV Care. “People who use drugs are part of our communities and supporting their access to healthcare, not punishment, builds a safer, healthier society for all”, Mcingana concludes.
Despite the magnitude of risk, women remain underrepresented in harm reduction programmes. In opioid agonist therapy (OAT), fewer than 10% of participants are women.6 Needle and syringe programmes (NSPs) and OAT are limited in coverage, mostly urban-based, and not designed with women’s needs in mind. The absence of services aimed at women perpetuates cycles of preventable morbidity, mortality, and infectious disease transmission.
“While the scale of the challenge is undeniable, pioneering efforts by a few African governments show what harm reduction leadership can look like,” says Angela McBride, Executive Director of the South African Network of People Who Use Drugs (SANPUD), INHSU board member, and co-convener of INHSU 2025. “Harm reduction means putting health and human rights before punishment, shifting away from criminalisation and towards evidence-based, rights-affirming policies.”
To address this gap, investment in women-centred harm reduction is essential. Priorities include scaling up OAT and NSPs with women-specific entry points, integrating sexual and reproductive health services into harm reduction sites, providing childcare support, and ensuring protection from intimate partner violence. Without these interventions, WWUD in South Africa will continue to be excluded from public health progress and national HIV/HCV response goals.
References:
Shirley-Beavan, S., Roig, A., Burke-Shyne, N., Daniels, C. and Csak, R. (2020). Women and barriers to harm reduction services: a literature review. Harm Reduction Journal, 17(74). Available here.
Harm Reduction International & South African Network of People Who Use Drugs (SANPUD) (2020). Barriers to harm reduction for women who use drugs in South Africa. London: Harm Reduction International. Available here.
SANPUD (2023). South African bio-behavioural survey and population size estimation among people who inject drugs. Johannesburg: South African Network of People Who Use Drugs. Available here.
Scheibe, A., Young, K., Moses, L., Basson, R., Versfeld, A., Spearman, C.W. and Sonderup, M.W. (2016). HIV prevalence and risk among people who inject drugs in South Africa. International Journal of Drug Policy, 30, pp.107–113. Available here.
Milford, C., Cavanagh, T., Bosman, S., Chetty, T. and Rambally, G. (2024). Access to and acceptability of sexual and reproductive health, harm reduction and other essential health services among people who inject drugs in Durban, South Africa. Harm Reduction Journal, 21(123). Available here.
INHSU (2021). Gender and opioid substitution therapy access in Tshwane, South Africa. International Network on Health and Hepatitis in Substance Users. Available here.
For over two decades, finasteride – a prescription drug taken by millions of men to treat hair loss – has carried troubling signals of deeper harm: depression, anxiety, and in some cases, suicide.
A new review by Prof Mayer Brezis of the Hebrew University of Jerusalem argues that the medical and regulatory community failed the public by repeatedly overlooking evidence of finasteride’s potentially psychiatric effects.
The review, published in The Journal of Clinical Psychiatry, compiles data from eight major studies conducted between 2017 and 2023, showing a consistent pattern: users of finasteride were significantly more likely to experience mood disorders and suicidal thoughts than those not taking the drug. Findings come from multiple countries and data systems, including the US FDA, as well as national health records in Sweden, Canada, and Israel.
“The evidence is no longer anecdotal,” said Prof. Brezis, professor emeritus of medicine and public health. “We now see consistent patterns across diverse populations. And the consequences may have been tragic.”
According to the paper, hundreds of thousands of people may have suffered from depression related to finasteride, and hundreds – possibly more – may have died by suicide.
A Delayed Response, With a High Cost
While the FDA acknowledged depression as a potential side effect in 2011 and added suicidality in 2022, concerns had already been raised as early as 2002. Internal FDA documents from 2010, cited in Prof Brezis’ paper, reveal large portions blacked out as “confidential” – including estimates of how many users could have been affected.
By 2011, the FDA had recorded just 18 suicides linked to finasteride. Based on global usage, he argues, the number should have been ranged in the thousands. “It wasn’t just underreporting,” he wrote. “It was a systemic failure of pharmacovigilance.”
Unlike weight-loss or psychiatric medications, which receive intense post-marketing scrutiny, finasteride’s “cosmetic” status may have shielded it from investigation. Notably, none of the studies cited in Brezis’ review were initiated by Merck, the original manufacturer, or requested by regulators.
A Cosmetic Drug With Life-Altering Risks
Finasteride works by blocking the conversion of testosterone into dihydrotestosterone (DHT). In the process, it may also disrupt neurosteroids like allopregnanolone, which are linked to mood regulation in the brain. Animal studies show long-term effects on neuroinflammation and even structural changes in the hippocampus.
For some patients, the harm does not end when the drug is stopped. Reports of “post-finasteride syndrome” describe lingering symptoms – insomnia, panic attacks, cognitive dysfunction, and suicidal thoughts – that persist months or years after discontinuation.
Regulatory Gaps and Corporate Silence
The report is particularly critical of the FDA and Merck. Despite having access to millions of patient records, neither acted in time. Brezis suggests that industry silence was strategic, motivated by market pressures and legal liability -echoing past controversies like Merck’s handling of Vioxx.
“Nothing is more important to Organon than the safety of our medicines,” the company recently stated. Yet none of the safety studies cited were initiated by the manufacturer.
The FDA, meanwhile, took five years to respond to a citizen petition calling for a black-box warning. Its final decision was to add suicidal ideation to the label – but not as a formal warning.
What Now?
Brezis is calling for immediate changes in how drugs like finasteride are approved, monitored, and prescribed. His recommendations include:
Suspending marketing of the drug for cosmetic purposes until safety is re-established.
Rquiring mandatory post-approval studies with strict enforcement.
Systematically recording drug histories in suicide investigations.
For many patients, those reforms will come too late.
The paper, “Failing Public Health Again? Analytical Review of Depression and Suicidality from Finasteride” was published in The Journal of Clinical Psychiatry and is available here.
