Does Advil Cause Heart Attacks?

Maybe. But Maybe not. In a highly publicized study from the British Medical Journal (BMJ 2017;357:j1909) researchers from McGill University (my medical school) did a retrospective statistical analysis of several studies. Using data from other publications where heart attacks were reported, they looked to see if NSAIDs (like advil, aleve, etc) were more likely to have been taken in the month prior to the heart attack in those patients versus the control population.

They found that there was a 20-50% increased probability of the use of these drugs in the week or month before the heart attack.

So what does this mean? I interpreted the results to mean that many patients mistook their chest pain for muscular and took readily available advil or aleve. Or does it mean that those people who had major blockages made it worse by taking these? Surely taking Advil for a week in a normal person would not cause a heart attack!

So no, I don't trust this entirely - even though it was done at McGill. But as usual moderation is the key. And if you don't know what is causing that chest discomfort don't assume its muscular!

Interesting Articles on Vitamin D

An Interesting Article on Vitamin D

https://www.nytimes.com/…/vitamin-d-deficiency-supplements.…

Those Baby Blues - Can Diet be Effective?

Postpartum blues occur in about 75% of women, typically peaking on postpartum day 5 and usually disappearing by day 10. Women who experience severe postpartum blues are more likely to develop postpartum depression, which develops in about 13% of all women. Immediately following childbirth, a woman's hormones levels change dramatically and this is thought to be the cause.

Researchers created a dietary supplement (consisting of tryptophan, tyrosine, and blueberry juice) to counter the effects of certain postpartum hormonal changes. (Proc Natl Acad Sci U S A 2017 Mar 28; 114:3509)

In this very small study (42 women) they found this supplement significantly decreased depression indexes.

A larger study should be underway, and hopefully we will find a simple treatment to those baby blues!

Keeping our Children Healthier - Juice and Cold Medications to be avoided

Both should be avoided at certain ages.

The American Academy of Pediatrics has expanded its recommendation against offering juice to all infants 12 months and under because it offers no nutritional benefit. Previously, the group advised against juice consumption in infants 6 months and younger.

Among the group's other recommendations, published in Pediatrics:

• When a pediatrician deems juice to be medically necessary in infants older than 6 months, it should be given in a cup, not a bottle.

• For toddlers, 100% juice (4 oz. or less) may be offered as part of a snack or meal.

• For children aged 4 through 6 years, consumption should be limited to 6 ounces a day; for those 7 to 18 years, the recommended daily limit is 8 ounces.

• For children with chronic diarrhea, abdominal pain, excessive flatulence, and bloating, clinicians should inquire about juice consumption.

• For children with poor or excessive weight gain, clinicians should recommend cutting all juice from the diet

Over the counter cough and cold medications have never been shown to have any efficacy in children. The common cold in children is generally a self-limited illness that requires nothing more than hydration, rest, and sometimes fever treatment.

On the other hand they can be dangerous. To assess the rate of pediatric adverse events associated with over-the-counter (OTC) cough and cold medications in the U.S., investigators analyzed data from the Pediatric Cough and Cold Safety Surveillance System for patients <12 years of age reported to have at least one adverse event associated with any of the following pharmaceuticals: brompheniramine, chlorpheniramine, dextromethorphan, diphenhydramine, doxylamine, guaifenesin, pseudoephedrine, and phenylephrine.

They found over 3,000 adverse events from 2009-2014, often from accidental ingestion and overdose. These included rapid heart rate, agitation, hallucinations, and two deaths. (Green JL et al. Pediatrics 2017 Jun).

With no known benefit and such severe possible risk, these should be avoided in all children especially those under 4.

Cancer Checkpoint Therapy - Move Towards a Cure (slowly)

When cancer forms, the cells have many mutations which would make them appear foreign to our body's immune system and should trigger an immune response which destroys them.

One of the reasons this does not happen in many cancers is that they also produce a a "checkpoint" molecule that tells the body's defense cells to desist.

Researchers have produced a drug that can block this checkpoint molecule therefore leaving the cancer cell vulnerable to the body's defense system. After checkpoint-inhibitor treatment with pembrolizumab (Keytruda), some responses were seen in 53% of patients, and complete responses were seen in 21% in 12 different types of cancer including metastatic cancers previously thought incurable. Treatment generally was tolerated well, although there is some concern about the possibility of attacks on normal tissues.

Currently about 60,000 patients a year could fall into the response group. We will have to see if relapse or resistance becomes a problem.

Measles - why are we talking about it?

Largest measles outbreak in Minnesota in decades sickens children, leads to hospitalizations. And another outbreak in Portugal led to the death of a 17-year-old girl. Wouldn’t it be great if we had a simple, effective way of preventing measles? Oh, wait.

https://www.nytimes.com/…/…/measles-minnesota-vaccines.html…

http://www.euronews.com/…/death-of-portuguese-girl-proves-m…

Scamming The Medical System and Increasing Costs - Drug and Insurance Companies

The recent unsuccessful attempt to repeal Obamacare (probably due to having no viable alternative) has once again put some focus on medical costs.

Two recent reports show how easy it has been to squeeze more money out of an already bloated system.

In the first, the New York Times reported how UnitedHealth Group and other insurance companies stand accused of "systematically bilking" Medicare Advantage of billions of dollars annually. The accusation comes from a whistle-blower, a former finance director at UnitedHealth. He told the Times that the company uses data-mining to find ways to increase the apparent seriousness of patients' illnesses — and thus Medicare's payments to the insurer. UnitedHealth denies the allegation.

Medicare pays these insurance companies a fixed amount every month to take care of patients; but the amount varies depending on how sick the patient is.

https://www.nytimes.com/2017/05/15/business/dealbook/a-whistle-blower-tells-of-health-insurers-bilking-medicare.html?_r=0

I can tell you that when I worked with the HMOs in Florida, they did not hide the fact that they wanted me to use certain codes; and indeed would send a representative periodically to try and get me to up-code my patients. My only reward was that I was less likely to be dropped from their panel - which, under current laws they can do for no reason.

Drug Prices

As the use of generic drugs has grown substantially to >85% of dispensed U.S. prescriptions, prices of some commonly prescribed generic drugs have also risen dramatically, such as the Epi-Pen! Researchers found increases in generic drug prices were inversely proportional to competition level: 64% for low-competition drugs, 44% for medium-competition drugs, and 10% for high-competition drugs. Some low-competition drugs rose in price by >1000% in <6 years!! (Ann Intern Med 2017 Jul 4)

Regulatory policies that encourage competition or limit monopoly manufacturers of generic drugs may be necessary — and vital — to achieve reasonable drug costs.

The insurance companies and drug manufacturers have had a free ride under to current system. This needs to be addressed!

More Dangers of Artificial Sweeteners - Weight Gain, Diabetes, Strokes and Dementia

In the past I have reported that artificial sweeteners; or non-nutritive sweeteners such as stevia, sweet 'n low, aspartame, etc do not seem to help weight loss and may even cause increase appetite.

In a recent study (CMAJ July 17, 2017 vol. 189 no. 28 doi: 10.1503/cmaj.161390), researchers examined 37 studies that looked at the effects of artificial sweeteners in 400,000 people over age 12. They found that for outcomes like weight, metabolic syndrome, and type 2 diabetes, there was higher risk with increased intake of artificial sweeteners.

Dr. Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, comments: "This study raises the concerning possibility that not only have these sweeteners not helped people manage their weight, but may have actually jeopardized their cardiometabolic health. The evidence base is far too weak to make definitive conclusions, but the urgent need for more information about these common ingredients is obvious."

In a second study, Stroke. 2017;STROKEAHA.116.016027, over 10 years' follow-up, recent and cumulative intake of artificially sweetened soft drinks was associated with increased risks for stroke, all-cause dementia, and Alzheimer dementia. Sugar-sweetened soft drinks did not pose increased risk.

Often people at high risk or obese start drinking diet sodas, etc, as a way to loose weight and lower risk. It seems clear the opposite occurs.

In my opinion artificial sweeteners have no place in our diet. And high sugar sodas, which can contain 16 packets of sugar per glass also are very bad for us. Dietary change to healthier food is the only answer; there are no shortcuts!