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!

 

 

 

Facebooklinkedinmail
linkedin

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!

 

 

 

 

 

Facebooklinkedinmail
linkedin

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!

Facebooklinkedinmail
linkedin

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!

Facebooklinkedinmail
linkedin

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!

Facebooklinkedinmail
linkedin

DAIRY MILK VERSUS NUT MILK (SOY, ALMOND and OTHERS): WHAT’S THE REAL SCOOP?

Nut milks are made from ground nuts and water. They’re lower in calories than even nonfat cow’s milk, but have the same amount of fat (about 2 grams per cup) as 1 percent milk. Most of the fat in nut milk is the healthier monounsaturated kind, though, while the fat in cow’s milk is mostly saturated fat. And you’ll get plenty of calcium and vitamin D from most nut milks because they are usually fortified.

Almond milk and other nut milks do have some nutritional shortfalls. For example, a cup of 1 percent fat cow’s milk contains 8 grams of protein, but hazelnut milk has only 2 grams, and cashew and almond milk might contain 1 gram or less. By comparison, low-fat plain soy milk, contains 4 to 6 grams of protein. Another potential downside is added sugar. Certain sweetened cashew and almond milks contain almost 2 teaspoons of added sweeteners per cup. Thus unsweetened nut milks are a healthier choice.

Coconut milk is slightly different. Not to be confused with the thicker, fattier stuff in cans, coconut milk is watered down to match cow’s milk consistency and fat content. It is usually fortified with calcium and vitamin D, but it has zero protein and 4 to 5 grams of mostly saturated fat, so it’s best avoided.

The biggest difference between nut-based milk and dairy milk is that the former doesn’t naturally contain the high amount of calcium found in dairy milk. So if you’re after calcium, look for brands fortified with calcium. The other big difference is the protein content: about 8 grams per one-cup serving of dairy milk vs. less in the nut varieties, except, as noted, soy milk. Nut milk might contain some vitamins and other nutrients not found in regular milk, such as fiber and vitamin E.

Getting enough vitamin D from your diet can be a challenge if you’re not much of a milk drinker or don’t spend much time in the sun. That’s because dairy milk, which is usually fortified with the bone-friendly nutrient, is one of the few foods that contain D in abundant amounts. But the nut milks may be a good option for getting vitamin D, especially now, since many milk alternatives are fortified with vitamin D, containing almost as much as cow’s milk. And since the Food and Drug Administration has recently increased the amount of vitamin D that can be added to both dairy milk and milk alternatives, you can now get up to 205 international units (IU) of D in an 8-ounce glass of your favorite dairy substitute. That’s almost twice as much as a milk drink could contain before the rule change. The recommended target is 600 IU per day for adults up to age 70 and 800 IU per day after that.

Another problem avoided by nut milks is that of lactose intolerance, often a cause of abdominal cramping and diarrhea. In contrast to dairy milk, none of these products contains lactose and thus anyone with this disorder may ingest them at will, including in cooking, etc.

CONCLUSION

The nut milks in general offer an excellent alternative to cow’s milk. But to get all the benefits, you must check the labels. Make sure you are getting adequate amounts of calcium and vitamin D. Avoid added sugar. Also check the protein content; if in doubt, soy milk is the best option.

The rest is up to your taste!

Facebooklinkedinmail
linkedin

LOSE OBAMACARE AND WE ALL SUFFER

Although Trump’s food policy agenda is unclear, his anti-regularity, anti-science leanings in general should be a major cause of concern to all of us.

If the Affordable Care Act (“Obamacare”) is repealed, not only could 22 million Americans face the devastating prospect of losing their health insurance, but all of us would lose several other health benefits as well.

First we would lose the opportunity to see how many calories are in thousands of foods, for, starting May 1st, 2017, we could lose the ACA rule that requires the listing of calories on menu boards of chain restaurants, movie theaters, supermarkets, delis, and convenience stores. The new administration could scrap the whole effort—as some in the food industry have urged. Moreover, the Federal Drug Administration (FDA) has told companies to disclose added sugars on Nutrition Facts labels by 2018. Since the new administration will likely sack the current physician FDA leader (Robert Califf, MD) in favor of a politically motivated layman, this regulation also could well be eliminated or delayed for years.

Second, the Obama administration proposed voluntary targets for cutting sodium (salt) in foods, which, as I have explained, would save tens of thousands of lives every year (http://www.mortontavel.com/2014/10/06/). Again, the present administration could scrap the whole effort—as some in the food industry have urged.

With regard to our children, two members of the Trump campaign’s agriculture advisory committee have worked to roll back the progress we’ve made in improving school lunches and removing junk foods from school vending machines. Can anyone doubt the potential damage of this measure?

The new administration may be inclined to grant the food industry’s request to continue to use heart-damaging trans fat (http://www.mortontavel.com/2014/) in many processed foods.

What about safe food protections? Who knows what to expect from a president whose campaign accused the “food police”—the FDA—of inspection “overkill.”

All these threats, as noted above, serve as a potential detriment—if not an outright danger—to the health of the general population. We should all follow these issues closely and become engaged, whenever possible, in the political process itself.

Facebooklinkedinmail
linkedin

EDUCATION SECRETARY NOMINEE LINKED TO BLATANT QUACKERY

The nomination of Betsy DeVos for U.S. Secretary of Education has led several major press outlets to investigate Neurocore Brain Performance Centers, a clinic chain in which she and her husband are the principal investors. Neurocore’s Web site states that its primary approach—which it calls neurofeedback, EEG biofeedback, and/or quantitative EEG (qEEG)—is effective against attention deficit hyperactivity disorder (ADHD), anxiety, autism, depression, memory disorders, migraines, sleep disorders, and stress. The main treatment consists of hooking up patients to a device that records their brain wave patterns, showing movies to to them, and interrupting them when they become distracted. Neurocore asserts that this process “retrains” brains. In a video interview, Neurocore’s CEO asserted—without providing evidence—that (a) medication can be helpful but is only a short-term fix that masks symptoms, (b) cognitive behavioral therapy (AKA psychotherapy) can help in some cases but just gives compensating behaviors, and (c) unlike these, Neurocore’s neurofeedback deals with the “root causes” of these disorders. In interviews, former employees expressed skepticism. Child psychiatrists and psychologists with expertise in autism and ADHD debunked Neurocore’s claims, and questioned its advertising and methods (New York Times, Jan 30, 2017). Another press report noted that Michigan’s Department of Insurance and Financial Services recently denied a claim for Neurocore’s services for treating migraine. DeVos, who is a billionaire, is also the daughter of one of Amway’s founders. None of these “brain claims” noted above possess any biologic validity, nor have they appeared in any acceptable scientific peer review publications—the usual destination for valid scientific advances.

Betsy DeVos is not just unqualified, she’s dangerous! Does anyone in his/her right mind believe such a person should occupy a cabinet position?

Facebooklinkedinmail
linkedin

TERROR THREATS: SOME SIMPLE MATH

       

Why are you standing here on this street corner?

Wildly waving your hands and shouting?

I’m keeping away the elephants”

But there aren’t any elephants here.

You bet: that’s because I’m here.”

Traditional Tale

In the wake of Trump’s recent executive order to shut down travelers from 7 predominately Muslim countries, one is reminded of the old adage conveyed above.

First, the actual number of terrorist deaths caused by immigrants in past years from these 7 banned countries is ZERO! Although we obviously can’t lower that number to below zero, even if there were a minuscule chance that we could be subjected to acts of terror from incoming travelers from one of these countries, how would that compare with a variety of threats already facing our population? Excluding the multiple deaths in NYC on 9/11/2001, all terrorism incidents inside the United States between 2001 and 2014 averaged 14 per year, mostly from home-grown gunmen.

Our population’s chance of dying as a result of firearm violence amounts to approximately 33,000 yearly, which is over 2,000 times greater than each individual’s chance of dying as a result of domestic terrorism. The chance of dying from an automobile accident is similar to this figure, approximately 33,000 yearly (1.13 fatalities per 100 million vehicle miles traveled), and this renders such travel statistically riskier per unit mile than commercial air travel, which carries a mortality rate that is approximately 60 times lower than that resulting from motor vehicles.

So the risk presented by travelers from the seven countries referred to above is even less than the minimal risk presented to an occupant in the commercial flight going to or from any of these countries!

Compare this with the number of American deaths caused by travelers from Saudi Arabia, which exceeded 3,000 in a single year – 2001. Yet immigration from Saudi Arabia is not restricted by the Trump ban. Could this major discrepancy be explained by the fact that Saudi Arabia is a country in which Trump has extensive business investments? Or does the ban result from Trump’s ignorance of basic math itself? Or could it be simply explained by the fact that Trump is in bed with the NRA?

Take your choice!


Facebooklinkedinmail
linkedin

DOES WEATHER PLAY ANY ROLE IN PAIN PRODUCTION?

DOES WEATHER PLAY ANY ROLE IN PAIN PRODUCTION?

Perhaps the most common fantasy (old wives tale?) is the idea that changes in the weather, including temperature, humidity, air pressure, wind direction and precipitation, can bring on aches and pains, especially those related to joint (arthritis) and back pains. Although there is no biologic reason to believe such a theory, little research has been devoted to this subject in the past.

Now research from The George Institute for Global Health has revealed the weather plays no part in the symptoms associated with either back pain or osteoarthritis.

Professor Chris Maher, of The George Institute for Global Health, said: “The belief that pain and inclement weather are linked dates back to Roman times. But our research suggests this belief may be based on the fact that people recall events that confirm their preexisting views.

“Human beings are very susceptible so it’s easy to see why we might only take note of pain on the days when it’s cold and rainy outside, but discount the days when they have symptoms but the weather is mild and sunny.”

Almost 1000 people with lower back pain, and around 350 with knee osteoarthritis were recruited for the Australian–based studies. Weather data from the Australian Bureau of Meteorology were sourced for the duration of the study period. Researchers compared the weather at the time patients first noticed pain with weather conditions one week and one month before the onset of pain as a control measure.

Results showed no association between back pain and temperature, humidity, air pressure, wind direction or precipitation. However, higher temperatures did slightly increase the chances of lower back pain, but the amount of the increase was not clinically important.

The findings reinforce earlier research on back pain and inclement weather from The George Institute which received widespread criticism from the public on social media.

Professor Maher, who led the back pain study, added: “People were adamant that adverse weather conditions worsened their symptoms so we decided to go ahead with a new study based on data from new patients with both lower back pain and osteoarthritis. The results though were almost exactly the same – there is absolutely no link between pain and the weather in these conditions.”

Back pain affects up to a third of the world’s population at any one time, while almost 10 percent of men and 18 percent of women over the age of 60 have osteoarthritis.

Associate Professor Manuela Ferreira, who led the osteoarthritis research at The George Institute, said: “People who suffer from either of these conditions should not focus on the weather as it does not have an important influence on your symptoms and it is outside your control.”

A/Prof Ferreira, Senior Research Fellow at The George Institute and at the Institute of Bone and Joint Research, added: “What’s more important is to focus on things you can control in regards to managing pain and prevention.”

The back pain study was published in the journal Pain Medicine, and the study on osteoarthritis, in the journal Osteoarthritis and Cartilage.

Facebooklinkedinmail
linkedin

High Prices for Drugs With Generic Alternatives: The Case of Duexis and Others

 

    A recent article appeared in the AMA journal noted why certain drug prices, especially generics, are outrageously high. As I explained in a previous post, (http://www.mortontavel.com/2017/01/06/), some drug makers employ legal “scams” to achieve such astronomical results. Below we describe a more subtle means they achieve the same results of bilking the public.

To begin, approximately 13% of health care expenditures in the United States are for prescription drug spending, nearly $420 billion in 2015. High-priced pharmaceuticals, therapies that cost more than $600 per month, are projected to eclipse 50% of total drug spending by 2018. Price increases for these therapies have been persistent, with unit costs increasing 164% between 2008 and 2015.

Pharmacy benefit managers are third-party administrators that process and pay prescription drug claims and negotiate drug prices with manufacturers. These managers are ostensibly charged with the responsibility of mitigating cost increases through such means as controlling increased co-payment requirements for patients, and exclusion of some expensive medications from health plan formularies. Below we use the illustrative example of Duexis, a single-tablet, fixed-dose combination of the nonsteroidal anti-inflammatory (NSAID) ibuprofen and the common antacid, famotidine (PepcidR), marketed by Horizon Pharma (Dublin, Ireland). This is how the pharmaceutical companies have sought to circumvent such restrictions and maintain high prices for drugs with generic alternatives.

Duexis was approved by the US Food and Drug Administration (FDA) in 2011 to relieve symptoms of arthritis and to decrease the risk of developing peptic ulcers in patients at risk for such problems. After approval, Duexis was first marketed at an average wholesale price, used for pricing and reimbursement of prescription drugs, of $158.40 per month. The drug is a combination of 2 over-the-counter medications that are sold as generics and would cost approximately $16 per month if purchased separately at the same doses. Since 2012, Duexis has had 11 price increases. As of August 12, 2016, the monthly wholesale price was $2061, representing a 1131% aggregate increase. In 2015, nearly $200 million was spent on Duexis in the US, with estimated cumulative revenue over 5 years of more than $600 million since FDA approval.

To circumvent co-payment requirements imposed by pharmacy benefit managers on patients to reduce use of high-priced drugs, pharmaceutical companies frequently offer co-pay assistance, also known as drug coupons; coupons cover direct costs to patients but not the amounts that insurers pay the manufacturer. In 2015, pharmaceutical manufacturers spent more than $7 billion on co-pay assistance. Horizon reports that 98% of patients prescribed Duexis have co-payments of no more than $10. Thus, patient out-of-pocket costs for Duexis are less than for ibuprofen and famotidine purchased separately. Federal programs, such as Medicare, do not permit manufacturers to provide co-pay assistance, because such assistance is considered an illegal inducement to encourage use of the drugs. Pharmaceutical companies, however, can work around this federal policy by providing financial assistance to patients through “independent” charities. The Patient Access Network Foundation, a large co-pay charity, provides financial assistance to patients prescribed Duexis and others.

Pharmacy benefit managers can also limit use of high-priced drugs by excluding them from health insurance formularies. When 2 large pharmacy benefit managers, Express Scripts and Caremark, excluded Duexis in 2015, Horizon provided Duexis without charge to patients covered by plans using these benefit managers. This response ensured that patients who received Duexis at no cost and the physicians who prescribed it remained aware of the brand, while the company collected revenue from other payers that continued to reimburse the drug. Pharmaceutical companies also ensure that their expensive therapies remain on formularies by providing rebates to pharmacy benefit managers, calculated as a percentage of the dollar value of a dispensed drug. As the result of an increased rebate offer from Horizon, Caremark removed Duexis from its exclusion list for 2017. Pharmacy benefit managers may provide some of the rebate savings to their customers, but typically much of the rebate is kept by the benefit manager as additional revenue, clearly an ethical violation.

In 2015, Horizon’s CEO was among 5 industry leaders elected to the board of directors of the Pharmaceutical Research and Manufacturers of America. Such tactics have been used to increase sales for other expensive drugs with effective, lower-priced, generic alternatives. Examples include Horizon’s Vimovo (naproxen/esomeprazole), Novum’s Alcortin A (hydrocortisone/iodoquinol) topical gel, Valeant’s Zyclara (imiquimod) topical cream, Mallinckrodt’s Acthar gel (Corticotropin injection), and Insys Therapeutics’ Subsys (fentanyl) sublingual spray.

The US experience with Duexis illustrates the problem of self-serving interests in health care. Companies charge what the market will bear and use available strategies to circumvent price constraints. Insurance plans and pharmacy benefit managers generally avoid the negative publicity that accompanies restrictive drug formularies and pass along the associated increases in costs through higher premiums. Patients, noting that they have paid for health insurance coverage, request what they believe to be the best and most convenient therapies, regardless of the price or generic alternatives. Physicians, perceiving that they are acting in the best interests of the individual patient and seeking to avoid disagreements and insurance hassles, are often unwilling to advocate for clinically equivalent but less costly therapies.

REMEDY FOR THIS PROBLEM

There should be greater scrutiny of the medical value of expensive drugs, especially those with inexpensive generic alternatives. The states and the federal government should ban all third parties from being involved in prior authorization. This is the responsibility of the physician who prescribes the medication. Additionally, states should restrict the use of co-pay assistance programs, particularly since the majority of drug coupons are for brand-name medications for which lower-cost therapeutics are available. Finally, better federal regulation of “charitable” organizations that provide financial assistance to patients is needed. For example, contributions to such organizations from manufacturers should not be allowed for diseases treated by a single drug, because manufacturers can effectively ensure that donations will be spent only on co-pay assistance for their products. To preserve the long-term financial stability of the health care system, the use of medications that provide clearly established benefit to patients should be the first priority, although they have their own challenges. High-priced drugs with generic alternatives should be, as described above, carefully controlled by governmental action

Facebooklinkedinmail
linkedin

PHYSICIANS IN GOVERNMENT: USUALLY GOOD, BUT SOMETIMES NOT

    This is a summary of an article appearing in the New England Journal of Medicine (Jan 12, 2017)§ With regard to the department of health and human services (HHS), only two previous secretaries have been physicians. For the most part, all of us physicians work to defend not only our own patients, but society at large against dangers to health, and in the process, usually eschew venal and self serving goals. That is why most of us chose this respected profession of care-giving in the first place.

Let us begin by describing the good doctors: Otis Bowen, our former Indiana Governor, was Ronald Reagan’s second HHS secretary, and he engineered the first major expansion of Medicare, championed comparative effectiveness research and, together with Surgeon General C. Everett Koop, another exemplary physician, led the fight against HIV-AIDS. Louis Sullivan, HHS secretary under President George H.W. Bush, focused his attention on care for vulnerable populations, campaigned against tobacco use, led the development of federally sponsored clinical guidelines, and introduced President Bush’s health insurance plan, which incorporated income-related tax credits and a system of risk adjustment. All these aforementioned physicians, serving in GOP administrations, drew on a long tradition of physicians as advocates for the most vulnerable, were defenders of public health, and enthusiastic proponents of scientific approaches to clinical care.

Now comes the bad: In sharp contrast with these previous examples, Tom Price, Trump’s pick for secretary of HHS, shows a record that demonstrates less concern for the sick, the poor, and the health of the public, in favor of greater concern for the economic well-being of the rich and the care-givers themselves.

To exemplify this point, let’s enumerate his previous positions.

  1. Price has sponsored legislation opposing regulations on cigars and has voted against regulating tobacco as a drug, in reality, this product is actually far worse than most drugs!
  2. In 2007, during the presidency of George W. Bush, he was one of only 47 representatives to vote against the Domenici-Wellstone Mental Health Parity and Addiction Equity Act, which improved coverage for mental health in private insurance plans.
  3. He voted against funding for combating AIDS, malaria, and TB, and against expansion of the State Children’s Health Insurance Program, and in favor of allowing hospitals to turn away Medicaid and Medicare patients seeking nonemergency care if they could not afford copayments.
  4. He favors converting Medicare to a premium-support system.
  5. He opposed reauthorization of the Violence Against Women Act, and has voted against legislation prohibiting job discrimination against LGBT people and against enforcement of laws against anti-LGBT hate crimes.
  6. He favors amending the Constitution to outlaw same-sex marriage.
  7. He opposes stem-cell research and voted against expanding the NIH budget and against the recently enacted 21st Century Cures Act, showing particular animus toward the Cancer Moonshot. Would he continue this stance if he were afflicted with cancer himself?
  8. He is a leader of the repeal of the ACA (“Obamacare”) in favor of a regressive “plan” which, without going into details, will offer much greater subsidies relative to income for purchasers with high incomes and more meager subsidies for those with low incomes. In effect, Price’s replacement proposal would make it much more difficult for low-income Americans to afford health insurance, diverting federal tax dollars to people who can already afford it, and also substantially reducing protections for those with preexisting conditions. The end result would be a shaky market dominated by health plans that offer limited coverage and high cost-sharing.
  9. Strongly anti-abortion and advocating the defunding of Planned Parenthood, Price has accepted the validity of the fraudulently modified videotapes used against this organization—despite their many pro-health programs for the poor.

CONCLUSION

   The HHS Department oversees a broad set of health programs that touch about half of all Americans. Over five decades covering nine presidential tenures of both parties, secretaries have used these programs to protect the most vulnerable Americans. The proposed nomination of Tom Price to HHS highlights a sharp contrast between this tradition of compassionate leadership and the priorities of the incoming administration.

I am not at all proud of this “fellow” physician!

  • Glied SA and Frank RG, Care for the Vulnerable vas Cash for the Powerful—Trump’s Pick for HHS. N.Engl J. Med. 376;2. 2017: 103-105.
Facebooklinkedinmail
linkedin