PRESCRIPTION DRUG ADS: AN ESCALATING PROBLEM

The problem is even worse than I thought! Just released by Kaiser Health News: Pharmaceutical company spending on direct-to-consumer advertising has grown 62% since 2012, even as ad spending for most other products has remained static. Pharmaceutical ads tracked by Kantar Media exceeded $6 billion in 2016, with most of that spent on television.

The American Medical Association (AMA) recently called for a ban on direct-to-consumer drug ads, arguing that such ads promote demand for potentially inappropriate use. Unfortunately, a ban is unlikely because of arguments by the drug industry around free speech (first amendment rights), and that the ads are providing “valuable” information to patients about treatment options. For more perspective, the United States is 1 of only 2 countries that allows drug ads; the other is New Zealand.

In 2016, the top 3 ads based on spending were Lyrica, Humira, and Eliquis.

Lyrica is used for various types of neurological pain caused by diabetes “fibromyalgia,” and others. Despite its high cost, its efficacy is marginal, especially when compared with ordinary inexpensive pain medications such as Advil.

Humira is a so-called “biologic” drug used for various types of arthritis, inflammatory bowel disorders, psoriasis (skin disorder) and others. In most instances, Humira (and others in the same class) should be reserved for cases that are severe and do not respond to cheaper, older alternatives.

Eliquis is an anti clotting agent that can be used for problems such as heart (atrial fibrillation) and vein disorders that predispose toward dangerous blood clotting. Again, cheaper, effective alternatives are available.

In all the examples cited above, as in the case of most other drugs promoted on TV, one ‘s own physician should be consulted—and not pressured—before a decision to embark on such therapy. Cheaper alternatives should always be considered.

WHAT SHOULD BE DONE ABOUT THIS PROBLEM

The AMA has called for a ban on direct-to-consumer marketing of prescription drugs and medical devices, a position adopted at the Interim Meeting in November, 2015. The physicians adopting the new policy pointed to excessive advertising budgets in the billions of dollars and the increasing unaffordability of prescription drugs as reasons why the ban is necessary. Excessive advertising is often causing patients to demand new, expensive drugs when older drugs are usually less costly, more effective, safer, and more appropriate for the patient’s specific situation.

AMA members who voted for the policy also cited consolidation in the pharmaceutical industry and anti-competitive practices among drug companies as creating an untenable situation that leads to artificially inflated drug prices. Sadly, drug companies devote approximately 30% of their costs to this purpose, in comparison with about 15% allotted toward research on new, potentially more important products.

“Today’s vote in support of an advertising ban reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices,” said AMA Board Chair-elect Patrice A. Harris in a press release. “Direct-to-consumer advertising also inflates demand for new and more expensive drugs, even when these drugs may not be appropriate.”

In addition to suggesting a marketing ban, the AMA announced it will step up efforts to monitor the pharmaceutical industry and advocate for federal regulators to take action when anti-competitive practices limit the availability of generic medications or manipulate the market to favor an expensive medication.

This is a welcome position by the AMA, and in my opinion, it is long overdue. For the benefit of all consumers, I hope it will eventually result in governmental legislative action! In the meantime, take all these ads with a healthy dose of skepticism!

 

 

 

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COULD POTASSIUM BE THE MISSING LINK?

We have long known that the mineral, potassium, is a healthy component of a normal diet and likely provides more benefit than does its counterpart, sodium. For instance, reducing sodium in the diet has been recommended to lower blood pressure and the risk of heart disease. However, in a new review article, University of Southern California researchers found that increasing dietary potassium is as important to improving the risk factors for cardiovascular and kidney disease as limiting dietary sodium.
The research team reviewed more than 70 studies related to dietary approaches to regulating high blood pressure and found that the interaction of sodium and potassium is integral to maintaining healthy blood pressure levels. The ratio of sodium to potassium excreted as urine is an indication of how much of these minerals is consumed. When dietary potassium intake is elevated, the kidneys – composed of millions of small tubes working together – shift fluid to the area near the end of the tubes where potassium secretes into the urine. This shift reduces the amount of sodium and water that’s reabsorbed into the body. In this way, high potassium diet signals the body to reduce the amount of sodium that is retained. This reciprocal pattern regulates the levels of both minerals in the body, which in turn helps lower blood pressure. Higher intake and excretion of potassium has also been found to slow the progression of kidney and heart disease.
In addition to analyzing data about the sodium–potassium ratio and its relationship to chronic disease, the research team explored strategies to educate the public about the importance of potassium for blood pressure control and heart health. Suggested policies include:

  • Requiring manufacturers to print potassium content on Nutrition Facts labels,

  • Promoting low–cost and easily available sources of potassium (milk, dried beans, potatoes, bananas, etc.)

  • Encouraging families to cook healthy, plant–based meals together.

“Consuming an abundance of potassium is a good strategy since our physiology evolved and was optimized to deal with high potassium low sodium intake, often referred to a Paleolithic diet,” wrote the research team. In other words, the human body functions best with a balance of the two nutrients.

So lets explore further some facts about potassium, which is also needed for normal muscle growth, and for nervous system and brain function. In addition to reducing blood pressure, potassium seems to work by protecting blood vessels from damage and excessive thickening. This mineral is found in many different foods, especially fruits and vegetables. Ironically, these are the same foods that are associated with better cardiovascular health, a fact that prompts the question: Could the contained potassium be the main component that accounts for such robust heart health attributed to these foods?Probably not, because there are additional components that could also contribute toward the same ends, but the question is intriguing!

HOW MUCH POTASSIUM IS GOOD?

Although there is some debate regarding the optimal amount of dietary potassium, most authorities recommend a daily intake of at least 4,700 milligrams. Most Americans consume only half that amount per day, which would make them deficient in regards to this particular recommendation. Likewise, in the European Union, insufficient potassium intake is common. In a large pooled analysis, Italian researchers reported in 2011 that by raising one’s daily intake of potassium by 1,640 milligram, you could expect a 21% lower risk of stroke. Even greater benefits can be achieved if we combine increased potassium with reduced intake of sodium.

In order to get 4,700 mg of potassium a day, try to get your intake from healthy eating unless your physician says otherwise. Dietary supplements containing potassium, while generally safe, can lead to excessive intake of this element that can be dangerous and, therefore, under most circumstances, are best avoided. Moreover, foods containing liberal amounts of potassium usually also possess other valuable nutrients that promote health in other ways. Several delicious foods can help you reach your potassium goal. Below is a list of great foods that can satisfy your needs as well as your eating pleasure.

1. Sweet potatoes: Surprisingly, this source outranks bananas on the list of foods that are high in potassium. One sweet potato packs a whopping 694 mg of potassium and only 131 calories, plus loads of fiber, beta-carotene (Vitamin A), and energizing carbohydrates. Baked, fried, grilled, mashed, or stuffed, sweet potatoes are one of the healthiest and most delicious foods you can eat. But be careful about what you put on them, avoiding large amounts of butter or trans fats.

2. Fresh tomatoes are great, but tomato paste and puree are even better sources of potassium. One quarter cup of tomato paste delivers 664 mg of this vital mineral, while one half cup of puree comes in at 549 mg. Tomato juice itself has just over 400 mg, but in general includes too much added sodium to be very beneficial. If you love cooking with tomatoes and want to get more potassium into your diet, make spaghetti sauce more often.

3. Those cooked, slightly bitter greens deserve a place at the table in part because they pack a whopping 644 mg of potassium per half cup. The beets themselves are also not only good for potassium (1 cup contains 440 mg) but they also provide generous amounts of folate (Vitamin B9), amounting to approximately 35% of daily adult requirements.

4. White beans are good providers of potassium, with half-a-cup delivering nearly 600 mg, but kidney and Lima beans, as well as lentils and split peas, are all respectable sources. All beans are good in general and appear prominently on any list of the best foods for fiber, so it’s smart to make beans a much bigger part of your diet.

5. Yogurt. Eight ounces of plain old non-fat yogurt contains 579 mg of potassium, while low-fat, whole milk, and cultured buttermilk—yogurt’s tangy cousin—have a little less. Delicious ways to use yogurt include mixing it with granola at breakfast, using it instead of mayonnaise on sandwiches and in salads, and swapping it for whipped cream on desserts. Bonus: Most yogurt products contain probiotics, natural bacteria that can aid digestion and keep your gut healthy.

6. Clams: Canned or fresh, 3 ounces of clams pack 534 mg of potassium and have the highest concentration of vitamin B12 of any food. Use them to make seafood pasta or traditional New England clam chowder.

7. Prunes: Juice from prunes is no joke when it comes to potassium, delivering 530 mg per 3/4 cup; half-a-cup of stewed prunes have nearly 400 mg. While you know prunes are good for regularity, you may not know that eating more of these dried plums can help keep your bones strong too. In one study, women who ate 10 prunes a day had significantly higher bone density than women who ate dried apples.

8. Carrots: The juicing trend means more people will be getting their potassium from carrot juice, which packs over 500 mg in one 3/4 cup. Besides their potassium benefits, carrots and other orange-colored fruits and vegetables are also great for your eyes and vision.

9. Molasses: Looking for a nutrient-packed alternative to sugar or honey? One tablespoon of blackstrap molasses (the thick, dark kind) has nearly 500 mg of potassium and a respectable amount of iron and calcium.

10. Fish: Meaty fish like halibut and tuna have nearly 500 mg of potassium per 3 ounce serving, but cod and even farm-raised rainbow trout have plenty of potassium too. But potassium isn’t the only reason to add more fish and seafood to your diet. Evidence is mounting that regularly eating fish, not taking fish supplements, can increase your lifespan, thanks in large part to the healthy fats in fresh fish; a high fish diet can even reduce your risk of death by heart disease by 35%, according to Harvard researchers.

11. Soy: Unprocessed soy products (think edamame, not soy powder) are a great source of

  1. protein. One half cup of cooked soybeans contains nearly 500 mg of potassium.

    12. Squash: Winter squash like spaghetti squash are a dieter’s dream: it contains less than 50 calories per serving, yet contains 448 mg of potassium per half cup. Also helpful is plenty of vitamin A and fiber.

    13. Bananas: Everyone thinks of bananas when they think of high-potassium foods, and one medium fruit does pack more than 400 mg of this mineral. But bananas are also the ultimate hunger buster, packed with healthy type of carbohydrate that is filling and tends to prevent subsequent hunger.

    14. Milk: This product is a surprising source of potassium, with 382 mg per cup for the non-fat or skim version (1% and whole milk contains a little less).

    15. Orange juice: One of the healthiest additions to your breakfast table is 3/4 of a cup of orange juice, which delivers 355 mg of potassium. Orange juice, especially the fresh-squeezed variety, is also a good source of calcium, folate, and several B vitamins.

So this list above can give you an idea of what foods to select with potassium in mind. But there are many more, too numerous to detail here. So keep your eyes on food labels—hopefully more listings will be coming soon—and you can make these judgments for yourself!

 

 

 

 

 

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KALE AND ITS RELATIVES: GREAT NUTRITION!

Kale has long been known for its outstanding nutritious content. But now it’s becoming increasingly evident that its relatives, bok choy, broccoli, brussels sprouts, and even cauliflower, deserve to share in the limelight as well. Before you suffer from a fit of distaste and stop reading, this family of vegetables, called crucifers, deserves serious consideration. They contain not only liberal quantities of vitamins and minerals, but also possess unique disease-fighting compounds, as described below.

These vegetables are the most common dietary source of glucosinolates, which are natural chemicals that break down into cancer-protecting compounds. A recent study in the medical journal, Annals of Oncology, disclosed that just one weekly serving of any of them over a two-year period lowered the risk of breast, colon, and oral cancer by 17%, esophageal cancer by 28%, and kidney cancer by 32%. It’s uncertain which of these veggies contains the greatest anticancer properties, so it’s best to eat a variety.

As an added dividend, this vegetable family possesses a rich source of vision-protecting carotenoids as well as fiber, folate, potassium, and vitamins C, E, and K. Any of these latter ingredients may contribute to that cancer-fighting ability, but they may also seem to fight inflammation and protect against cardiovascular disease as well. This latter property was suggested by an analysis of 134,796 people in China, disclosing that those who ate about 6 ounces per day, reduced their risk of heart disease by about 20% compared with those who ate less.

SOME SUGGESTIONS FOR CONSUMPTION OF THIS GROUP

Steaming or stir-frying of any will preserve the glucosinolates, but avoid over cooking, for this will diminish these nutrients.

Brussels sprout chips can be made tasty by removing the leaves from the base and tossing them with olive oil and then baking then at 350o / F for about 20 minutes, turning frequently until they become crispy.

Broccoli stalks can be sliced into coins for use in pasta dishes or as a dipper for hummus.

Watercress can be mixed with milder greens like baby spinach and toned down with other flavors like lemon juice, avocado, and apple slices.

Raw cauliflower that’s been grated to resemble rice is a good low-calorie substitute for pasta, potatoes, and rice. It can microwaved and sauteed.

Additional ideas are subject to imagination!

So try to stop gagging and give as at least some of them a try. It could even save your life!

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THE ANTIOXIDANT MYTH–Poster Child: “Pom Wonderful”

Anyone watching TV these days is aware of the huge hype surrounding the product Pom Wonderful, which is based upon the flawed concept that pomegranate juice possesses some supernatural quality to make you “crazy healthy” by fighting off those nasty “free radicles” with antioxidants, presenting an unlikely combination of a raucous Samari Warrior with muted culinary pleasure. “POM Wonderful” is a brand of pomegranate juice that is manufactured by a company owned by Linda and Stewart Resnick, California billionaires, who pretty much single-handedly created a multi-million dollar market for pomegranate juice where none existed before. Or, as LA Times reported:

It has long been clear that the most wonderful thing about Pom Wonderful pomegranate juice is the spectacular marketing skill that persuades consumers to fork over their hard-earned cash for a liquid that sells for five to six times the price of, oh, cranberry juice. A daily 8 oz. dose of POM Wonderful juice costs about $780 annually according to a recent Federal Trade Commission case, which we explain below.

In 2010, the Federal Trade Commission (FTC) filed a complaint against the Resnicks, one of their business partners, and two of their companies (which I’ll refer to collectively as “POM”), alleging unfair and deceptive trade practices. POM, according to the FTC complaint, made false and misleading claims that its POM products treat, prevent, and reduce the risk of heart disease, prostate cancer and erectile dysfunction.

An Administrative Law Judge (ALJ) agreed with the FTC and on May 17, 2012, issued a 335-page decision and cease and desist order, ruling POM lacked competent and reliable scientific evidence that drinking 8 ounces of POM Wonderful Juice daily, or taking one POMx pill, or one teaspoon of POMx liquid, treats, prevents or reduces the risk of heart disease, prostate cancer, or erectile dysfunction. In the Matter of POM Wonderful, LLC, et al., F.T.C. No. 9344 (May 17, 2012). Nevertheless, outrageous claims about this product persist to this day.

The idea that free radicals are dangerous and could be countered by antioxidants stems originally from test-tube experiments that have not extended to living organisms. Although many fruits and vegetables possess antioxidant properties, their benefits are likely due to other features (such as potassium content) exerted by the plants themselves. This idea is supported by the fact that antioxidant supplements such as vitamins C and E, carotenes, lycopene, and selenium have not been shown in themselves to exhibit any salutary properties Thus scientists are beginning to debunk myths surrounding antioxidant pills, juicing, and other dietary fads.

Researchers analyzed nutrition studies in a new review published in the Journal of the American College of Cardiology, which begins to cut through the confusion about the best dietary patterns to reduce heart disease. The review concludes that—with or without antioxidant properties—current evidence strongly supports eating plenty of fruits, vegetables, whole grains, legumes, and nuts in moderation. Heart–healthy diets may also include liberal amounts of fish and some chicken, with lesser quantities of lean meat and low–fat and nonfat dairy products, and liquid vegetable oils.
The review examined several dietary patterns as well as “hypes and controversies” surrounding nutrition to provide information to aid both physicians and the population in considering which dietary habits to adopt.
They concluded that there is a growing consensus that a predominantly plant–based diet that emphasizes green, leafy vegetables, whole grains, legumes and fruit were the best improvements thus far seen in heart health,

Other nutrition topics covered in the review include:

  • Eggs and cholesterol. Although a government report issued in 2015 dropped specific recommendations about upper limits for cholesterol consumption, the review concluded that it remains prudent to advise patients to significantly limit intake of dietary cholesterol in the form of eggs or any high cholesterol foods to “as little as possible.”
  • Vegetable oils. Coconut oil and palm oil should be discouraged due to limited data supporting routine use. The most heart–healthy oil is olive oil, though perhaps in moderation as it is still higher calorie, research suggests.
  • Berries of various types. Fruits and vegetables are the healthiest and most beneficial means to reduce heart disease risk, although, as noted, these benefits probably do not result from antioxidant activity. There is no compelling evidence that adding high–dose antioxidant dietary supplements benefits heart health.
  • Nuts. Nuts can be part of a heart–healthy diet. But beware of consuming too many, because nuts are high in calories.
  • Juicing. While the fruits and vegetables contained in juices are heart–healthy, the process of juicing concentrates calories, which makes it is much easier to ingest too many. Eating whole fruits and vegetables is preferred, with juicing primarily reserved for situations when daily intake of vegetables and fruits is inadequate. If you do juice, avoid adding extra sugar or honey, to minimize calories.
  • Gluten. People who have celiac disease or other gluten sensitivity must avoid gluten—wheat, barley and rye. For patients who don’t have any gluten sensitivities, many of the claims for health benefits of a gluten–free diet are unsubstantiated, the researchers conclude.
  • The authors also addressed why there can be confusion surrounding nutrition studies, because many of these studies are funded and/or influenced by the food industry and may have some bias.

Furthermore, it’s very hard to separate the effects of specific nutrients in a food. For example, an apple contains many components including proteins, vitamins and fiber. Also, many people who eat a healthy diet also follow other healthy lifestyle behaviors, such as regular physical activity, getting enough sleep, and not smoking, and it can be hard to pinpoint the diet’s effect separate from these other behaviors. Confounding matters even more, some nutrition studies tend to be based on surveys that rely on people’s memories of what they ate, which isn’t always reliable.
The founder of modern medicine, Hippocrates, said, ‘Let food be thy medicine.” If we can get everyone to understand the value of nutrition in prevention—in comparison to treatment—we can have a profound impact on reducing heart disease, and it is certainly far more cost–effective—especially if one avoids Pom Wonderful!

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WHEN SCIENCE LOSES, WE ALL SUFFER

             

Obviously, the victories of science are evident all around us, notably in human health! The many successes include the extension of useful life and vitality to an average of about 80 years, the total elimination of deadly diseases such as smallpox and poliomyelitis, and the list goes on and on. Undoubtedly, we can expect to achieve additional major advances—provided of course—that science encounters no major roadblocks.

But now, and for the first time in memory, political interference is threatening disrupt this progress! According to the editors of—surprisingly—a major British medical journal, Donald Trump’s presidency has “raised worrying questions about its likely impact on science and health policy”. This article goes on to state “The administration seems to place little value on facts or analysis, and may not be considering the consequences of its pronouncements and policies on biomedical research and the health of Americans and citizens around the world. We are particularly concerned that Trump’s administration is acting in ways that will suppress research and limit communication on scientific topics that it deems politically inconvenient,” Moreover, these authors state “scientific communications at the Environmental Protection Agency were being vetted by political appointees before public presentation, and communications with the public had been restricted for employees at various agencies, including the departments of Agriculture, Interior, and Health and Human Services. Federal websites are being scrubbed of scientific information, adding that a reversal of the Affordable Care Act could damage health, and that new immigration policies could harm recruitment and training of doctors and scientists and worsen physician shortages.”. Weighing in further, Michael Halpern, deputy director of the Center for Science and Democracy at the Union of Concerned Scientists, a nonprofit advocacy organization in Washington, DC, states “You have a President who isn’t afraid to attack individuals who he deems enemies, and it’s not out of the realm of possibility that a scientist who published information he didn’t like could become subject to his wrath.” He said reports of a “gag order” on communications at various federal agencies has led to anxiety and uncertainty — in part because the administration has created confusion by not specifically stating its communications policies in writing.

Officials at various federal agencies have told reporters there is no such “gag order.” When contacted by Medscape Medical News, representatives from the National Institutes of Health said, “The US Department of Health and Human Services and its agencies continue to communicate fully about its work through all of its regular communication channels with the public, the media and other relevant audiences. There is no directive to do otherwise.” But various other federal scientists that have been contacted have indicated otherwise, and this is leading to self-censoring. One stated “In an uncertain time, people tend to keep their heads down so they don’t get chopped off.”

Other scientific organizations have also been registering alarm about the Trump administration. In November 2016, more than 2000 scientists signed a letter to Trump and Congress, asking them to “adhere to high standards of scientific integrity and independence in responding to current and emerging public health and environmental threats”.

A Call to Action

The British editors said their aim was to “reaffirm our commitment to fostering and applying the best evidence for policy and practice, to be an open forum for rigorous debate that challenges the status quo and holds us all to account, to speak truth to power and support others who do the same, and to actively campaign for a better world, based on our values of transparency, independence, and scientific and journalistic integrity.”

Other organizations have also urged scientists to stand up and speak out. “Taking action is the best course when science is threatened or when science can illuminate public issues,” wrote Rush Holt, PhD, Chief Executive Officer of the American Association for the Advancement of Science (AAAS), in an editorial in Science in early February. Scientists should not remain silent, Dr Holt said. They should avoid politicizing science, but, also shouldn’t be lulled into thinking that the facts will speak for themselves. “One need not avoid — indeed, should not avoid — applying relevant science in political or societal situations where it can help address problems,” he wrote.

In a separate editorial in Science, AAAS President Barbara Schaal, PhD, called on the administration to include credible scientists as advisers, “not individuals who reject proven science on issues of critical public importance such as vaccines or climate change.” Dr Schaal, dean of the Faculty of Arts and Sciences at Washington University, St Louis, wrote, “Science cannot thrive when policy-makers — regardless of political party affiliation — use disagreements as an opportunity to attack scientific conclusions that counter a political agenda.”

But political interference goes one step further, for government representatives are even espousing antiscience by attempting to deny the advantages of immunization, an issue that has been critically and objectively settled in past years, ad nauseum. Robert F. Kennedy Jr believes—without credible evidence—the vaccine preservative thimerosal has led to an uptick in neurodevelopmental and other disorders in children. The Trump administration allegedly plans to assemble a vaccine safety commission to explore potential links between vaccinations and a host of disorders, including autism—long ago debunked. Kennedy, chairman of the World Mercury Project, a nonprofit group whose partners include groups that espouse a vaccine-autism link, told reporters attending a Washington, DC, press briefing that he is still in discussion with the administration regarding the assembling of a vaccine commission.

More recently, President Trump said he “knew that the pharmaceutical industry was going to cause an uproar about this,” but he promised he would not back down. “We need a debate on this,” said Kennedy, who has campaigned against mercury in vaccines for at least a decade. “I don’t see how anyone has a legitimate objection to having another set of eyes on the vaccine program,” he said.

In early February, however, more than 350 medical organizations wrote a letter to Trump, which included a long list of studies demonstrating the safety of vaccines, to express their “unequivocal support” for the safety of these products.

CONCLUSION

The current administration now appears to be challenging what they already have dubbed “fake news,” but they now seem to be training their sights on what they are likely to call “fake science.” If they continue along this path, they are doing so at their own risk, as well as the risk of the entire population’s health! Although remaining above the fray for decades, it’s now high time for scientists to move into the political arena!

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