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Content 7


The Doctor and the Pharmacist

Radio Show Articles:
October 22, 2016

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Endocrine Disruptors Tied to $300 Billion in Annual U.S. Healthcare Cost
Androgen Deprivation Therapy for Prostate Cancer Tied to Dementia Risk
Half of Americans Stressed Out by Election
Could Placebo Be an Effective Therapy for Low Back Pain?
Pregnancy Within 2 Years after Bariatric Surgery tied to Perinatal Complications
Hospital Patients at Greater Risk for C. diff If Prior Bed Occupant Took Antibiotics
H. pylori Eradication Favors Bismuth Quadruple Therapy
Absence of a Parent in Early Childhood linked to Drinking and Smoking as Preteen
Olympic Committee Issues Statement on the Effects of Exercise during Pregnancy
WHO Pushes for Taxes on Sugary Beverages
KCl Price May Increase$$$ Here we go again!

Endocrine Disruptors Tied to $300 Billion in Annual U.S. Healthcare Cost
By Kelly Young, Edited by Lorenzo Di Francesco, MD, FACP, FHM
Exposure to endocrine-disrupting chemicals may cost the U.S. over 2% of its gross domestic product, suggests an analysis in the Lancet Diabetes & Endocrinology.
Researchers examined 15 established exposure-response relationships between endocrine-disrupting chemicals (such as organophosphate pesticides and flame retardants) and various disorders (e.g., loss of IQ, diabetes, autism). Using 2010 U.S. population and costs, they extrapolated that endocrine disruptors cost the U.S. a median of $340 billion annually. IQ points lost and intellectual disability related to in utero exposure to flame-retardant chemicals was responsible for most of the cost.
The authors write that these are likely underestimates of the financial burden given that only a subset of endocrine-disrupting chemicals and their effects were analyzed.
A commentator says that the research "provides a lesson on the lasting economic effects of harmful chemicals: whether banned long term, currently restricted, or being voluntarily phased out, the precautionary principle of proving chemicals are safe rather than proving their harm might be more financially beneficial."
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Androgen Deprivation Therapy for Prostate Cancer Tied to Dementia Risk
By Amy Orciari Herman, Edited by André Sofair, MD, MPH
Use of androgen deprivation therapy for prostate cancer is associated with increased risk for new-onset dementia, according to an observational study in JAMA Oncology.
Using electronic medical records from one medical center, researchers studied nearly 9300 men diagnosed with prostate cancer over a 20-year period; roughly 20% received androgen deprivation therapy. During a median follow-up of 3.4 years, 314 men developed dementia.
The estimated risk for dementia at 5 years was 7.9% among those who received androgen deprivation therapy versus 3.5% among those who did not. Use of androgen deprivation therapy for 12 months or longer was associated with the greatest risk.
The authors call for further research but point to several potential mechanisms underlying the association, including the role of androgens in neuron growth and health.
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Half of Americans Stressed Out by Election
By Amy Orciari Herman, Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
Some 52% of U.S. adults find the 2016 presidential election to be a "very or somewhat significant source of stress," according to an online survey conducted by the American Psychological Association (APA).
Over 3500 adults aged 18 and older completed the survey in August 2016. Among the other findings:

The APA offers these tips for coping:

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Could Placebo Be an Effective Therapy for Low Back Pain?
By Kelly Young, Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS
A placebo appears to alleviate low back pain even when people know they’re getting a placebo, according to a small, open-label study in Pain.
Nearly 100 adults in Portugal with chronic low back pain were randomized to receive treatment as usual with or without a daily placebo pill. Placebo recipients were told they were getting a pill filled with an inactive substance and no medication.
At 3 weeks, placebo recipients had 30% reductions in both maximal and usual pain scores, while usual treatment recipients had 16% and 9% reductions, respectively. Disability score reductions were also greater with placebo.
After 3 weeks, patients who didn’t receive the placebo were allowed to try it. Those who did reported greater pain reductions.
The authors conclude: "Our data suggest that harnessing placebo effects without deception is possible in the context of a plausible rationale. More research on this possibility is warranted in ... other conditions defined by self-appraisal."

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Pregnancy Within 2 Years After Bariatric Surgery Tied
to Perinatal Complications

By Amy Orciari Herman, Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM
Perinatal complications are more common among infants whose mothers have undergone bariatric surgery, especially if the surgery was within 2 years of the child’s birth, according to a retrospective cohort study in JAMA Surgery.
Using hospital and birth certificate data from Washington State, researchers studied roughly 1900 infants born to mothers who’d had bariatric surgery and 8400 population-based controls. Infants of bariatric surgery patients, compared with controls, were more likely to be born prematurely (14% vs. 9%), be admitted to the neonatal ICU (15% vs. 11%), be small-for-gestational age, and have Apgar scores of 8 or lower. Differences between groups were significant after adjustment for confounders, including maternal BMI.
Risks were highest for infants born within 2 years of their mother’s surgery. Infants born 2–4 years after surgery were no more likely to be born prematurely or admitted to the NICU than controls.
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Hospital Patients at Greater Risk for C. diff If Prior Bed Occupant
Took Antibiotics

By Kelly Young
Hospitalized patients may have elevated risk for Clostridium difficileinfection (CDI) if the patient who occupied the bed before them was taking antibiotics, suggests a retrospective study in JAMA Internal Medicine.
Using New York hospital records, researchers assessed 100,000 pairs of patients who sequentially occupied the same hospital bed. Patients in beds that had most recently been used by someone taking antibiotics (besides those used to treat C. difficile, such as oral vancomycin and metronidazole) had a higher incidence of CDI than those whose prior bed occupant hadn't taken antibiotics (0.72% vs. 0.43%). The association was still significant after excluding prior patients who had C. diff.
The authors conclude: "The increase in risk was small but is of potential importance given the frequency of use of antibiotics in the hospital. These data imply that patient-to-patient transmission of C. difficile or other bacteria that mediate susceptibility to CDI takes place in the nonoutbreak setting and in the face of a multifaceted effort seeking to prevent health care-associated CDI."
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H. pylori Eradication Favors Bismuth Quadruple Therapy
By Kelly Young, Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM
Bismuth-based quadruple therapy is more effective than standard triple therapy as a first-line treatment for Helicobacter pylori infection, suggests a Lancet trial.
Researchers in Taiwan randomized 1600 adults with confirmed H. pyloriinfection to one of the following regimens:

Clarithromycin resistance in this population was roughly 15%.
The H. pylori eradication rate was highest with bismuth quadruple therapy (90%). However, this treatment also had the highest adverse event rate (67%). Triple therapy plus metronidazole was not superior to triple therapy alone in H. pylori eradication (86% and 84%, respectively).
The authors conclude: "Bismuth quadruple therapy is preferable to 14-day triple therapy in the first-line treatment in the face of the rising prevalence of clarithromycin resistance."
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Absence of a Parent in Early Childhood linked to Drinking and
Smoking as Preteen

By Kelly Young
Children with an absent parent because of death or separation are at higher risk for drinking alcohol and smoking before adolescence, according to a study in Archives of Disease in Childhood.
Researchers periodically surveyed the families of nearly 11,000 children in the U.K. when the children were aged 9 months through 11 years.
After multivariable adjustment, parental absence before age 7 was associated with a 54% increased risk for smoking and a 27% increased risk for drinking alcohol by age 11. There was no difference in risky behaviors based on which parent was absent or the child’s age at absence.
The authors conclude: "Early life might be an important time to intervene in order to prevent the uptake of risky health behaviors. Health behaviors established earlier in life are known to track into adulthood. Thus the early uptake of risky health behaviors is a feasible mechanism through which disparities in disease outcomes might emerge."
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Olympic Committee Issues Statement on the Effects of Exercise
During Pregnancy

By Amy Orciari Herman, Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM
Exercise during pregnancy does not increase the risk for premature birth, induced labor, epidural anesthesia, or episiotomy or perineal tears, according to a consensus statement from the International Olympic Committee (IOC).
Among the group's other conclusions, based on a systematic literature review:

However, the IOC notes that intense exercise around the time of egg implantation and repetitive heavy lifting during the first trimester might increase the risk for miscarriage. Accordingly, the group says elite athletes "may consider" limiting such activity.
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WHO Pushes for Taxes on Sugary Beverages
By Kelly Young, Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
The World Health Organization is encouraging countries to start taxing sugar-sweetened drinks, like sodas, to reduce the risk for diabetes and obesity.
The organization says countries should aim to increase the sales price of such beverages by at least 20% to see a reduction in consumption. Low-income individuals, youth, and people who have a generally unhealthy diet would be most affected by price changes and could potentially benefit the most, the WHO report states.
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KCl Price May Increase$$$ Here we go again!
Generic drugmaker Virtus Pharmaceuticals recently petitioned the FDA to hold up on its plan to remove unapproved generic versions of potassium chloride from the market and has now filed a lawsuit demanding the FDA put on the brakes. Virtus alleges that if the FDA follows through, it will hand a monopoly on the generic drug to a couple of companies that is sure to lead to much higher prices for a treatment that has been sold for nearly 70 years and grandfathered in as a safe generic. The suit requests a declaratory judgment that FDA may not take enforcement action against Virtus' product without a formal and specific determination that the product is either unsafe or ineffective. 

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