Wednesday, September 30, 2015

Wisdom Wednesday: Best Selling, Most Prescribed Branded Drugs

Through June of this year, the cholesterol-lowing drug rosuvastatin (Crestor, AstraZeneca) was the most prescribed branded drug in the United States, and the arthritis drug adalimumab (Humira, Abbott Laboratories) was the best-selling branded drug, according to the latest data from the research firm IMS Health.

Rosuvastatin had about 21 million prescriptions, followed by asthma medication fluticasone propionate/salmeterol (Advair Diskus, GlaxoSmithKline), at about 13.6 million prescriptions; the proton pump inhibitor esomeprazole (Nexium, AstraZeneca), at about 13.2 million prescriptions, the insulin glargine injection Lantus Solostar (sanofiaventis), at about 11.2 million, and the attention-deficit drug lisdexamfetamine dimesylate (Vyvanse, Shire), at about 10.6 million.

Rounding out the top 10 most prescribed drugs for the period (in order) were the antiepileptic drug pregabalin (Lyrica, Pfizer), the chronic obstructive pulmonary disease medication tiotropium bromide (Spiriva Handihaler, Boehringer ingelheim Pharmaceuticals), the diabetes drug sitagliptin (Januvia, Merck), the asthma/chronic obstructive pulmonary disease drug budesonide/formoteral (Symbicort, AstraZeneca), and the antipsychotic medication aripiprazole (Abilify, Otsuka Pharmaceutical).

The top seller, arthritis drug adalimumab (Humira, Abbott Laboratories), had sales of about $8.6 billion, followed by the antipsychotic Abilify, at $7.2 billion; the arthritis drug etanercept (Enbrel, Amgen), at roughly $6.1 billion; the cholesterol drug Crestor, at just under $6.1 billion; and the insulin glargine ingection Lantus Solostar (sanofi-aventis), at around $5 billion.

Monday, September 28, 2015

Antibacterial Soaps Fail to Beat Plain Soap

Lab tests conducted by a team of Korean researchers revealed that when bacteria are exposed to the standard over-the-counter antibacterial ingredient known as triclosan for hours at a time, the antiseptic formulation is a more potent killer than plain soap.

The problem: People wash their hands for a matter of seconds, not hours. And in real-world tests, the research team found no evidence to suggest that normal hand-washing with antibacterial soap does any more to clean the hands than plain soap.

“[The] antiseptic effect of triclosan depends on its exposure concentration and time,” explained study co-author Min Suk Rhee, a professor in the department of biotechnology and the department of food bioscience and technology at the College of Life Sciences and Biotechnology at Korea University in Seoul.

But most people who wash their hands with antibacterial soap do so for less than 30 seconds, Rhee noted, using formulations containing less than 0.3% triclosan – the maximum allowed by law. And that combination, he said, is “not adequate for having an antibacterial effect.”

Rhee and his colleagues outline their findings in the September 16 issue of the Journal of Antimicrobial Chemotherapy.

Triclosan is the antibacterial component of liquid soap. In bar formulation, it’s triclocarban, according the U.S. Food and Drug Administration. These ingredients have been somewhat controversial. Some contend there is no scientific evidence to back up claims that these products are more effective than regular soap. Others have argued that these ingredients aren’t safe.

Friday, September 25, 2015

Half of U.S. Adults Have Diabetes or High Risk of Getting It

Up to 14% of adults had diagnosed or undiagnosed type 2 diabetes in 2011-2012, and about 38% had diagnosed or undiagnosed prediabetes, the researchers reported. Prediabetes is defined as having elevated blood sugar levels that aren’t high enough to be called full-blown diabetes, the researchers explained.

“Prediabetes puts people at risk of diabetes in the future,” said lead researcher Catherine Cowie. She is program director of the U.S. National Institute of Diabetes and Digestive and Kidney Diseases’ division of diabetes, endocrinology and metabolic diseases.

About one-third of those Americans with type 2 diabetes don’t know they have it, and most of those with prediabetes are unaware of their condition, the study authors said. For these adults, the findings should be a wake-up call to get treatment and make lifestyle changes that include losing weight and being more active, Cowie said.

Although data from recent years suggests that the increase in the prevalence of diabetes may be leveling off, it’s still too high, Cowie added.

“Diabetes can be treated, but only if it is diagnosed,” she explained. “The medical community needs to be aware that there is a high rate of undiagnosed diabetes in the population."

Type 2 diabetes is caused by obesity, poor eating habits and lack of exercise. The new report was published September 8 in the Journal of the American Medical Association.

Wednesday, September 23, 2015

Wisdom Wednesday: Toxicity in Everyday Life

The liver is our major organ of detoxification. Eighty percent of the blood entering the liver comes directly from the digestive tract. So it’s not any surprise that that is where most of our toxins enter the body. Toxins can enter any orifice and through the skin, but the mouth is, by far the most common avenue.

Liver detoxification is divided into two phases. Everything that enters the liver goes through Phase I liver detox. Phase II liver detox is reserved for spent hormones (the ones made in our body) and alcohol only. At least that was the case until we started manufacturing chemicals in the 20th century.

Today a vast majority of manmade chemicals must go through both phases of liver detox to be rendered harmless and expelled from the body. This massive list includes most medications, the pesticides and hormones sprayed on our food, antibiotics in our drinking water and 800 plus bisphenols that are known estrogen disruptors.

This landslide of artificial chemicals overwhelms Phase II liver detox in each and every one of us. Its negative effects grow exponentially with each new generation. When my new patients complete a Symptom Survey, the liver invariably shows up as the organ responsible for the largest percentage of symptoms, regardless of their history.

Recently one of my patients asked me to write a blog about a specific form of air pollution. I suggested that a blog on how to minimize the effects of our toxic environment might be more aligned with the purpose of my blog.

Monday, September 21, 2015

Exercise May Be Good Medicine for Irregular Heartbeat

Exercise appears to help control an irregular heartbeat known as atrial fibrillation in obese people, a new study shows.

Australian researchers found that “cardiorespiratory fitness” reduced the risk that this potentially dangerous heartbeat will return by as much as 84% - even more than losing weight. Cardiorespiratory fitness refers to the ability of the heart and lungs to supply oxygen to the body during sustained physical activity.

“This study adds to a growing body of evidence that aggressive risk factor management with increased physical activity should be an integral component of management of atrial fibrillation,” said lead researcher Dr.

Prashanthan Sanders, director of the Center for Heart Rhythm Disorders at the University of Adelaide in Australia.

Atrial fibrillation, the most common abnormal heart rhythm, affects about 2.7 million Americans, according to the American Heart Association. Obesity and inactivity are risk factors for atrial fibrillation, which can lead to stroke, the researchers pointed out.

The report was published online August 24 in the Journal of the American College of Cardiology.
For the study, Sanders and colleagues assigned 308 patients with atrial fibrillation to one of three groups based on their level of fitness: low, adequate, or high fitness. All had a body mass index (BMI) of 27 or more, meaning they were overweight or obese.

The groups were followed for about four years to see how their level of fitness affected the recurrence of the abnormal heartbeat. Patients were also offered a doctor-led weight loss and exercise program.

Friday, September 18, 2015

Acupuncture Might Help Ease High Blood Pressure

Researchers found that blood pressure levels declined slightly in a small group of patients treated 30 minutes a week with “electroacupuncture” - where needles carry low-level electrical stimulation - at specific points of the body.

“Potentially, blood pressure can be kept low with a monthly follow-up treatment,” said study co-author Dr. John Longhurst, a cardiologist at the University of California, Irvine.

A estimated 70 million U.S. adults - one in 3 - have high blood pressure, according to the U.S. Centers for Disease Control and Prevention. It’s believed that only half have their condition under control. High blood pressure can lead to stroke and heart disease.

Blood pressure can often be lowered by becoming more fit, taking medications or both. But these approaches don’t work for everyone, and the medication can cause side effects, especially among the elderly.

Acupuncture, an ancient Chinese therapy, is increasingly viewed as a possible alternative, the researchers said in background notes with the study. Practitioners insert thin needles into key points on the body in an attempt to rebalance the flow of energy.

High blood pressure was defined as 140-180 mm Hg over 90-99 mm Hg. None of the participants was taking blood pressure medication.

Wednesday, September 16, 2015

Wisdom Wednesday: The Patient History

I was taught that “history is 75% of the diagnosis.” I often repeat that phrase adding “without a history I might as well be practicing as a veterinarian.” No offense to vets, but without some dialog, just where do you begin?

Patients often are not very detailed in the their history. I frequently get “back” listed as the chief complaint and only history on my entrance case history form. If the patient is feeling a little more expressive, he will write “low back.” These patients are not engaged in their health. I believe they learned this behavior from health care providers that also were not engaged.

A study by Beckman and Frankel showed that 75% of the time physicians interrupted their patients within 18 seconds of them beginning to express their complaints. Less than 2% of the time did the patient ever return to complete their concerns.

Most patients have more than one complaint on entry with an average of three concerns per visit. Furthermore, some experts note than contrary to common opinion, most patients do not express their primary complaint first. It is up to the physician to listen carefully and arrange the various complaints by priority.

The engaged patient will provide a detailed history. We e-mail our entrance forms to new patients well ahead of their appointment so they can fill them out completely. If the history is complex (I love a complex health history), they will attach several pages to the form. Too often these are patients that have never been provided an opportunity to relate their history and they are desperate for help.

Monday, September 14, 2015

Probiotics Don’t Keep Bad Bugs at Bay

Probiotics don’t protect the intestines of critically ill patients against antibiotic resistant bacteria, a new study indicates.

“With fewer therapies available to treat multidrug-resistant organisms, innovative methods to prevent or eliminate gastrointestinal colonization [by bacteria] are necessary,” said lead author Dr. Jennie Kwon, a clinical researcher in infectious disease at Washington University School of Medicine in St. Louis.

Colonization is the first step before a full-blown infection can develop, the study authors explained.

The current research included 70 patients in intensive care units who received either standard care or probiotics twice a day for up to two weeks.

Probiotics are live microorganisms - popularly called “good” bacteria. Probiotics are believed to boost a person’s resistance to harmful germs, the researchers said.

Antibiotic-resistant bacteria colonized the intestines of 10% of patients who received probiotics and 15% of those who got standard care. However, this difference was not statistically significant, the researchers noted.

The study was published August 27 in the journal Infection Control & Hospital Epidemiology.

Friday, September 11, 2015


Electronic (e)-cigarettes are about 95% less harmful to health than tobacco cigarettes, and they might be useful in helping people kick the smoking habit, according to a report commissioned by Public Health England (PHE)

The authors of the report also found that regular users of e-cigarettes are almost exclusively adults who are already smokers. In fact, the rate of youths and adults who smoke cigarettes has continued to decline in England, and there is no current evidence that e-cigarettes are “renormalizing smoking or increasing smoking uptake,” they write.

At first glance, the PHE report appears to be at odds with research that has drawn different conclusions on various issues related to e-cigarettes.

Given the growing popularity and increasing use of e-cigarettes, questions remain about their effects on teens and young adults. In fact, a study published at the same time as the PHE report arrived at a different conclusion about the gateway issue (JAMA. 2015;314:700-707).

In an editorial accompanying the JAMA study (2015;314.673-674), Nancy A. Rigotti, MD, from the Massachusetts General Hospital and Harvard Medical School in Boston, explains that the study provides “the strongest evidence to date that e-cigarettes might pose a health hazard by encouraging adolescents to start smoking conventional tobacco products.”

But Dr. McNeill takes issues with the conclusions reached in the JAMA study.

“One of the issues we raise in our report is that of measurement,” she told Medscape Medical News. “It is not the same to equate ‘ever use’ with use, as ever use can mean that someone had just tried an e-cigarette once.”

In the JAMA study, that was the measure of e-cigarette use and smoking. “Adolescence is a time of experimentation, so what we are really concerned with is any regular use of e-cigarettes and uptake of smoking,” Dr. McNeill explained.

Dr. Hajeck said he agrees that the JAMA study does not show that vaping leads to smoking. “It just shows that people who are attracted to e-cigarettes are the same people who are attracted to smoking,” he pointed out. “People who drink white wine are more likely to try red wine that people who do not drink alcohol.”

Wednesday, September 9, 2015

Wisdom Wednesday: How Reliable Are Medical Studies? Half of Findings Couldn’t Be Replicated

Independent researchers couldn’t reproduce the findings of more than half of 100 experiments previously published in three prominent psychology journals, a new review reports.

This review should fuel skepticism over scientific claims, particularly if those claims are based on shaky statistics, said one of the new study’s authors, Brian Nosek, a professor of psychology at the University of Virginia. Nosek is also executive director of the Center of Open Science, the non-profit group that coordinated the project.

Only 47% of the follow-up studies were able to reproduce the same effects of the original studies, the review found. The strength of findings found during original studies also appeared to diminish when successfully replicated, Nosek said.

The new review also calls into question the statistics used in the original studies. About 97% of the original studies showed a statistically significant result, but only 36% of the replication studies did the same.

“Reproducibility is a central feature of science,” Nosek said. “A scientific claim doesn’t become believable because of the status or authority of the person that generated it. Credibility of the claim depends in part on the repeatability of its supporting evidence.”

Monday, September 7, 2015

Steriod Injections Probably Won’t Help Your Low Back Pain

Steroid injections for low back pain may provide some relief for certain patients, but any benefits are temporary, a new study finds.

Low back pain related to herniated disk and, to a lesser degree, spinal stenosis (narrowing of the spinal canal), is often treated with epidural steroid injections, the researchers said. But after reviewing 38 previously published studies, the researchers found no strong evidence to support their use for these conditions.

“These injections may not be as effective as perceived, and decisions should be based on an informed discussion of risks, benefits, and potential options, including surgery, medications and non pharmacological options like exercise therapy,” said lead researcher Dr. Roger Chou, a professor of medicine at the Oregon Health & Science University.

Chou said lower back pain usually improves over time without treatment, but some patients may want relief sooner.

“Patients may have a perception that these injections reduce the need for surgery or result in long-term benefits,” Chou said. “It’s important for them to understand that benefits appear to he short-lived and to weigh these short-term benefits against potential complications of the injections, such as infection and nerve injury.”

Friday, September 4, 2015

Just 1 in 3 Seniors with Diabetes Has Disease Under Control

“This research gives us a good picture of diabetes control in older adults and gets us thinking about what it means that older Americans are not meting clinical targets and how we should address this from a public health perspective,” study leader Elizabeth Selvin, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said in a school news release.

The study included almost 1,600 diabetes patients, aged 65 and older, in Maryland, Minnesota, Mississippi and North Carolina.  The researchers looked at whether the participants met American Diabetes Association Guidelines for three key measures of good diabetes control: blood sugar, blood pressure and cholesterol levels.

The results showed that only one in three of the patients had diabetes controlled as defined by the ADA guidelines.  Some experts consider the ADA guidelines too demanding for seniors.  But even using less stringent measures, the researchers found that many of the patients did not have their diabetes under control.

The study appears in the July issues of the journal Diabetes Care.

One reason why seniors with diabetes may have more difficulty keeping their disease under control is that many of them have other health problems that may require more immediate attention from doctors, according to study co-author Chirstina Parrinello, who is also at the Johns Hopkins Bloomberg School of Public Health.

Wednesday, September 2, 2015

Wisdom Wednesday: Quercetin

Quercetin belongs to a group of plant pigments called flavonoids that give many fruits, flowers, and vegetables their color.

Flavonoids, such as quercitin, are antioxidants - they scavenge damaging particles in the body known as free radicals, which damage cell membranes, tamper with DNA, and even cause cell death. Antioxidants can neutralize free radicals and may reduce or even help prevent some the damage they cause. In test tubes, quercetin has strong antioxidant properties, but researchers aren’t sure aren’t sure whether taking quercetin (and many other antioxidants) has the same effects inside the body.

Quercetin acts like an antihistamine and an anti-inflammatory, and may help protect against heart disease and cancer. Quercetin can also help stabilize the cells that release histamine in the body and thereby have an anti-inflammatory effect.

In nature, quercetin is found as part of the vitamin C complex. Ascorbic acid encapsulates quercetin, taurine, and other flavonoids protecting them from oxidation.

In the liver, quercetin enhances aspects of phase II liver detoxification. Phase II is the route that hormones, alcohol, most drugs and artificial chemicals must follow to be removed from the body.