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Content 7


The Doctor and the Pharmacist

Radio Show Articles:
September 22, 2012

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DEA Drug Take Back Day
83 New Alzheimer's Drugs in Research and Development
Half of All Prescribed Medicines in France are "Useless or Dangerous"
Which Is Worse, Hepatitis B or Hepatitis C?
Association Between High Urinary Bisphenol A Concentration and Obesity in Children
Can Anticipatory Guidance About Infant Diet Help Prevent Obesity?
Is Working Too Hard Really Bad for Your Heart?
Subclinical Thyroid Disease Increases Risk for heart Failure (HF) Events
Favorable Trends in Serum Lipid Levels in U.S. Children and Adolescents
Symptomatic Iron Deficiency Without Anemia

DEA Drug Take Back Day
On September 29th, from 10am to 2pm the DEA is sponsoring a Drug Take Back Day at Law Enforcement Agencies around the country. Local sites include police departments in Hoffman Estates, Elk Grove and Arlingtin Heights along with other suburban sites and a variety of Chicago Police locations.
Feel free to contact Mark Drugs for more information or for drug and sharps disposal sites near you or for more information or to find the site nearest you, the following website is available:
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MM: There is no question in anyone’s mind that Big Pharma needs to do research and develop new drugs. This is especially true when it comes to drugs that potentially treat conditions that are approaching epidemic status. Alzheimer’s Disease (AD) is one of these conditions. Big Pharma is willing to invest big because they see a big long term potential return. The massive number of baby boomers who are living longer and are statistically more likely to need these drugs are entering this very large potential market. Don’t be surprised to see 100 new drugs enter the research pipeline for this condition in the next few years. There is too much money to be made for Pharma to pass up this opportunity.
83 New Alzheimer's Drugs in Research and Development
There are 83 new drugs in research and development for Alzheimer's, 12 for cognition disorders and two for dementias, according to a new U.S. industry report. Between 1998 and 2011, 101 such treatments failed to reach patients, and only three medicines were approved to treat symptoms of the disease, representing a 34:1 ratio of setbacks, says the report, which is published by PhRMA.
"Setbacks in Alzheimer's research are disappointing to many, including the scientists carrying out the studies, but these unsuccessful attempts are critical stepping-stones to advancing our understanding of this extremely complex disease," commented John J Castellani, chief executive of PhRMA. 

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MM: This is an interesting statistic since France denies the public the easy use of both Vitamin D3 and Bio-identical Progesterone. Both of which are potentially life changing therapies for a variety of conditions
Half of All Prescribed Medicines in France are "Useless or Dangerous"
According to two medical specialists, half of all medicines being prescribed by doctors in France are either useless or potentially dangerous for patients. The blame is placed on the powerful pharmaceutical companies for keeping these drugs on sale at huge expense to the health system and the taxpayer.
The individuals say that removing what they describe as superfluous and hazardous drugs from the list of those paid for by the French health service would save up to save €10bn (£8bn) a year, prevent up to 20,000 deaths linked to the medication, and reduce hospital admissions by up to 100,000. The report states that the French consume medication worth around €36bn every year, around €532 for each citizen who has an average 47 boxes of medicine in cupboards every year. Also, the state covers 77% of the cost, amounting to 12% of GDP. 
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Clin Infect Dis 2012 Aug 15; 55:507
Which Is Worse, Hepatitis B or Hepatitis C?
Chronic hepatitis B infection was associated with higher liver-related mortality.
Chronic hepatitis B and chronic hepatitis C virus infections are both potentially fatal conditions, but few head-to-head comparisons of clinical outcomes have been attempted.
Among almost 7000 American men included in a large prospective database of men who have sex with men, about 5% of participants entered the study with each type of chronic hepatitis. After a median follow-up of almost 8 years, all-cause mortality was similar in both groups, but liver-related mortality was significantly higher for those with chronic hepatitis B infections. This finding held true for both HIV-negative and HIV-positive participants, including those who were severely immunocompromised.
Excluding the few men in the study who underwent treatment for hepatitis C infection did not change the pattern. However, liver-related mortality among participants who were coinfected with hepatitis B and HIV and who were enrolled after 2002 was markedly lower than among those who were enrolled earlier, possibly reflecting use of newer antiviral drugs that are active against both HIV and hepatitis B virus.
Comment: This study is the first in which the effects of hepatitis B and hepatitis C virus infections were compared in a relatively homogeneous population. Its results are worth noting because a surge of public health advertisements have brought hepatitis C screening and treatment into the public eye recently. Clinicians should remember that, despite vaccination, hepatitis B is still out there, and effective oral treatment can save lives.
— Abigail Zuger, MD Published in Journal Watch General Medicine September 20, 2012
Citation(s): Falade-Nwulia O et al. Comparative risk of liver-related mortality from chronic hepatitis B versus chronic hepatitis C virus infection.Clin Infect Dis 2012 Aug 15; 55:507.
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MM: We know that obesity has reached and surpassed epidemic proportions. I applaud the entire medical community to look for any “universal” causes for this disastrous situation. I just hope that things like High Fructose Corn Syrup (HFCS) and vitamin D deficiency/insufficiency will not be ignored because of various economic-political pressures and influences.
JAMA 2012 Sep 19; 308:1113
Association Between High Urinary Bisphenol A Concentration and Obesity in Children
Urinary BPA concentration was significantly associated with obesity in non-Hispanic white children, but other phenols were not.
Bisphenol A (BPA) is a well-established endocrine disrupter that has been associated with obesity and coronary artery disease in adults. Data from the 2003–2004 National Health and Nutrition Examination Survey (NHANES) indicates that about 93% of people older than 6 years of age have detectable urinary BPA levels. Investigators examined the association between urinary BPA concentration and body- mass index (BMI) in 2838 children (age range, 6–19 years) randomly selected from the 2003–2008 NHANES; 18% were obese (BMI z score >95th percentile) and 34% were overweight (BMI z score >85th percentile).
In analyses that controlled for potential confounders, the prevalence of obesity was significantly higher among children with BPA levels in the highest quartile compared with those in the lowest quartile (22% vs. 10%; odds ratio, 2.5). The association was significant only for non-Hispanic white children (OR, 6.0 for the highest quartile). No associations were found between urinary BPA levels and poverty, amount of exposure to television, or caloric intake. Urinary metabolites of other phenols and exposure to sunscreen were not associated with obesity.
Comment: This interesting study suggests another avenue for research in unraveling the epidemic of childhood obesity. In this study, urinary BPA concentration was associated with obesity in non-Hispanic white children. The authors do not exclude the possibility that obese children ingest more BPA-containing foods. Avoiding known environmental exposures to BPA continues to be a reasonable goal for children and adults.
— F. Bruder Stapleton, MD Published in Journal Watch Pediatrics and Adolescent Medicine September 19, 2012
Citation(s): Trasande L et al. Association between urinary bisphenol A concentration and obesity prevalence in children and adolescents. JAMA 2012 Sep 19; 308:1113.
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MM: In spite of the results in this study, I believe that education is an excellent starting point to correcting societal issues. It is cost effective in that it addresses a problem when it is of a size that it can still be addressed. Some of the most difficult lifestyle activities to change are the various habits and actions that are long ingrained. Also, when a problem grows beyond some point that it appears fruitless or impossible to address, then people tend to simply abandon looking at any options.
Pediatrics 2012 Sep; 130:e507
Can Anticipatory Guidance About Infant Diet Help Prevent Obesity?
Two interventions incorporated into well-child visits during the first year of life led to modest dietary changes.
Three primary care clinics in Ohio were randomized to pilot one of three brief anticipatory guidance interventions designed to reduce obesogenic infant feeding behaviors. The intervention was delivered at each well-child visit during the first year (at 2, 4, 6, 9, and 12 months). The clinics were located in geographic areas where 75% of adults were overweight or obese and 85% received Medicaid. One intervention was a maternal-focused intervention aimed at maternal eating habits. The second intervention was a detailed program focused on infant feeding (Ounce of Prevention). The control group received usual care based on the Bright Futures nutrition pocket guide (2002).
Among the 292 mother-child dyads, 25% and 36% were lost to follow-up at 6 and 12 months, respectively. At baseline, 62% of mothers were overweight or obese by self report. At 12 months, after adjusting for maternal education, race, marital status, having ever breast-fed the child, and snacking behavior while watching television, mothers in both the maternal-focused and infant-focused groups reported giving significantly less juice (mean, 9 ounces vs. 14 ounces) and more servings of fruit than mothers in the control group (mean, 1–1.5 vs. <1 servings). Mothers in the maternal-focused intervention group also served more vegetables to their children than the control group. At 12 months, infant weight did not differ significantly among the three groups.
Comment: These brief, relatively inexpensive interventions directed at either maternal eating habits or infant feeding practices to reduce obesity resulted in only modest improvements in diet. However, as we struggle to prevent obesity, this type of anticipatory guidance may be one of a number of prevention interventions needed to curb the epidemic of child obesity. The authors provide details and examples of the interventions in the original article.
— Louis M. Bell, MD Published in Journal Watch Pediatrics and Adolescent Medicine September 19, 2012
Citation(s): French GM et al. An evaluation of mother-centered anticipatory guidance to reduce obesogenic infant feeding behaviors.Pediatrics 2012 Sep; 130:e507.
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Lancet 2012 Sep 14
Is Working Too Hard Really Bad for Your Heart?
A collaborative meta-analysis suggests that the effect is real but smaller than previously thought.
In a recent meta-analysis of published cohort studies, job strain was associated with about a 40% increase in risk for coronary heart disease. However, these studies are susceptible to publication bias and limited by methodological idiosyncrasies. To minimize these shortcomings, investigators conducted a participant-level meta-analysis of 13 published and unpublished European studies including 197,473 individuals (mean age, 42; 49% women). The same validated model was used in all of the studies to assess baseline job strain.
Fifteen percent of the cohort reported job strain, defined as high demands and low control. Compared with participants without job strain, those with job strain had a significantly higher risk for incident myocardial infarction or death from coronary artery disease (hazard ratio, 1.23). In separate analyses of published and unpublished data, the effect was higher in published studies than in unpublished studies (HR, 1.43 and 1.16, respectively), but remained significant in both when adjusted for age, sex, and socioeconomic status. The association was also significant in an analysis excluding coronary events that occurred within 3 years after baseline (HR, 1.31).
Comment: These findings suggest that work stress is associated with a smaller increase in risk for coronary heart disease than has been previously reported. However, eliminating publication bias and possible reverse causality (by leaving out early events) strongly confirms the health risk of job strain. Stress management should continue to be an important element of comprehensive coronary artery disease prevention.
— Beat J. Meyer, MD Published in Journal Watch Cardiology September 19, 2012
Citation(s): Kivimäki M et al. Job strain as a risk factor for coronary heart disease: A collaborative meta-analysis of individual participant data. Lancet 2012 Sep 14; [e-pub ahead of print].
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Circulation 2012 Aug 28; 126:1040
Subclinical Thyroid Disease Increases Risk for heart Failure (HF) Events
The effect is significant at both very high and very low thyroid-stimulation hormone levels, but whether corrective treatment improves outcomes is unknown.
Current practice guidelines recommend routine screening for subclinical thyroid disease as a possible etiology of heart failure (HF). However, data supporting this recommendation are relatively sparse. To explore the association between subclinical thyroid abnormalities and HF events, investigators conducted a pooled analysis of prospective cohort studies published during the past 6 decades that included baseline measurement of thyroid-stimulating hormone (TSH) and free thyroxine levels; longitudinal follow-up with ascertainment of HF events; and a control euthyroid group. Studies confined to patients taking thyroid-replacement agents or to those with overt thyroid disease were excluded.
The analysis included six studies including 25,390 individuals. Euthyroidism was defined as a TSH of 0.45–4.49 mIU/L; by this criterion, 8.1% of the cohort had subclinical hypothyroidism and 2.6% had subclinical hyperthyroidism. Median follow-up exceeded 10 years. After adjustment for age and sex, subclinical hyper- and hypothyroidism were both associated with increased risk for HF events; the association was significant for hypothyroidism at TSH levels ≥10.0 mIU/L (hazard ratio, 1.86) and for hyperthyroidism at TSH levels <0.10 (HR, 1.94). These findings were consistent even after accounting for differences in other cardiovascular risk factors and excluding patients with preexisting HF or atrial fibrillation.
Comment: These data provide some support for the current guideline recommendations to screen patients with new-onset heart failure for subclinical thyroid dysfunction and incremental support for broader screening for thyroid disease in general. However, one cannot conclude that correcting the thyroid condition will reduce the risk for HF events. Decisions about treating subclinical thyroid dysfunction should continue to be driven by the established evidence base.
— Frederick A. Masoudi, MD, MSPH, FACC, FAHA Published in Journal Watch Cardiology September 19, 2012
Citation(s): Gencer B et al. Subclincial thyroid dysfunction and the risk of heart failure events: An individual participant data analysis from 6 prospective cohorts. Circulation 2012 Aug 28; 126:1040.
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JAMA 2012 Aug 8; 308:591
Favorable Trends in Serum Lipid Levels in U.S. Children and Adolescents
A surprising finding given the increasing prevalence of childhood obesity
Efforts to reduce cardiovascular risk factors include reducing serum cholesterol levels early in life. Investigators examined trends in serum lipid levels in 16,116 children (age range, 6–19 years) who participated in the National Health and Nutrition Examination Survey between 1988 and 2010.
Among all youths, the following changes were significant: mean total serum cholesterol levels declined (from 165 mg/dL to 160 mg/dL), the prevalence of elevated serum cholesterol declined (from 11% to 8%), mean high-density lipoprotein cholesterol (HDL-C) increased (from 50 to 52 mg/dL), and mean non-HDL-C declined (from 115 mg/dL to 107 mg/dL). Mean serum triglycerides and low-density lipoprotein cholesterol (LDL-C) levels were evaluated in adolescents only, and both declined significantly (by 9 mg/dL and 5 mg/dL, respectively). Most sex-, age-, and racial/ethnic-specific trends were similar to overall trends. Among obese youths, triglycerides, LDL-C, and non-HDL-C levels declined significantly, but changes in HDL-C levels were not significant. The overall prevalence of an adverse lipid concentration (HDL-C <40 mg/dL or non-HDL-C ≥145 mg/dL) also declined significantly.
Comment: The overall positive trends reflected in these data are encouraging and somewhat surprising given the increasing prevalence of childhood obesity during the same time period. Reasons for improvement in childhood lipid levels are likely multifactorial. Efforts to promote a healthy diet, exercise, and weight control in children must continue.
— F. Bruder Stapleton, MD Published in Journal Watch Pediatrics and Adolescent MedicineAugust 22, 2012
Citation(s): Kit BK et al. Trends in serum lipids among US youths aged 6 to 19 years, 1988-2010. JAMA 2012 Aug 8; 308:591.
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CMAJ 2012 Aug 7; 184:1247
Symptomatic Iron Deficiency Without Anemia
Oral iron improved fatigue symptoms in nonanemic menstruating women with low ferritin levels.
Does iron deficiency cause fatigue in the absence of anemia? If so, can oral iron therapy improve symptoms? To find out, Swiss researchers identified 198 menstruating women with fatigue who had normal hemoglobin levels (≥12.0 g/dL; mean, 13.5 g/dL), low or low-normal serum ferritin levels (<50 µg/L; mean, 23 µg/L), and no other obvious cause of fatigue. Participants were randomized to receive either daily ferrous sulfate (80-mg elemental iron) or placebo.
At baseline, the average score on a standardized fatigue index was 25 (maximum score, 40). At 12 weeks, mean decrease in fatigue score was significantly greater in the iron group than in the placebo group (–12.2 vs. –8.7). In the iron group, mean hemoglobin concentration increased by 0.3 g/dL and mean ferritin level increased by 12 µg/L. These changes, although modest, were statistically significant relative to the essentially unchanged levels in the placebo group.
Comment: In this study, low-dose iron improved fatigue in nonanemic, menstruating women whose iron stores were marginal (as assessed by serum ferritin levels). The findings suggest that clinicians should check both blood counts and serum ferritin levels when menstruating women present with fatigue. However, several caveats should be noted: The placebo effect was substantial, blinding might have been compromised (because iron can change stool color), we don't know whether the 4-point difference in fatigue scores is clinically important, and scores on several quality-of-life indicators were not significantly different between the iron and placebo groups.
— Allan S. Brett, MD Published in Journal Watch General Medicine August 23, 2012
Citation(s): Vaucher P et al. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: A randomized controlled trial. CMAJ 2012 Aug 7; 184:1247.

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