It’s finally here! The snow in the Northeast is finally coming to an end! Happy Spring to all my BreakFree friends!
The end of March signals it’s time for our monthly geek-out!
I’ve compiled all of this month’s top headlines in health, wellness, nutrition, nutrigenomics, functional and naturopathic medicine, and pharmacology for your reading or skimming pleasure. As usual, I’ve highlighted the most pertinent points and left the full source references for those hungry for more brain food.
Here’s a taste of what’s in store for your inquiring minds:
1. Vegetarians versus Paleos- a new study scores a point for the major plant (and fish) consumers
I’m thinking that maybe we should all just JERF (just-eat-real-food) and see what happens. You?
2. How gluten led to suing the FDA!
3. The J-shapped vitamin D curve-too much of a good thing?
4. Vaccine Wars-both sides up in arms
Ok, let’s dive in!
NUTRIGENOMICS
No Grains: Is This Bad, A Fad, Or Just Makin’ Ya’ Mad!?
The Pro Side Of Grains
1. Cereal Fiber & Decreased Risk of Death
The results from a correlational study with 367,442 participants from the prospective NIH-AARP Diet and Health Study (enrolled in 1995 and followed through 2009) reported that, “Consumption of whole grains and cereal fiber was inversely associated with reduced total and cause-specific mortality. Our data suggest cereal fiber is one potentially protective component.”
Strengths and limitations of the study: The authors acknowledged that reverse causality might effect the association results they reported. This means that people with chronic disease may modify their overall eating habits and lifestyle to be more healthy in general, “… both whole grains and cereal fiber were correlated with high levels of physical activity and better health status, as well as with low BMI, low levels of smoking, and low intakes of alcohol and red meat.”
Huang T, Xu M, Lee A, Cho S, Qi L. Consumption of whole grains and cereal fiber and total and cause-specific mortality: prospective analysis of 367,442 individuals. BMC Medical. March 23, 2015. http://www.biomedcentral.com/1741-7015/13/59
2. Vegetarians Found to Have Lower Risk of Colon Cancer
Wait, no so fast! To the paleo lovers’ relief, the lowest risk was among “vegetarians” that also ate fish.
In the study, dietary exposure was measured by a food frequency questionnaire based on a large, prospective, North American cohort (The Adventist Health Study 2). The participants included 77, 659 Seventh-Day Adventist men and women (after exclusions) who were recruited between January 1, 2002, and December 31, 2007.
Conclusions and Relevance Vegetarian diets are associated with an overall lower incidence of colorectal cancers. Pescovegetarians in particular have a much lower risk compared with nonvegetarians. If such associations are causal, they may be important for primary prevention of colorectal cancers.
Orlich MJ, Singh PN, Sabate J, Fan J, Sveen L, Bennett H, Knustan SF, Beeson WL, Jaceldo-Sigel K, Butler TL, Herring P, Fraser GE. Vegetarian Dietary Patterns and the Risk of Colorectal Cancers. JAMA Intern Med. Published online March 09, 2015. doi:10.1001/jamainternmed.2015.59
The Con Side of Grains
1. Gluten Sensitivity Found In Trial
A recent study reported results that just one week of gluten ingestion caused an increase of symptoms in those who were suspected to have gluten sensitivity. Therefore, the fiber lovers may have other symptoms, although their risk for colorectal cancer was reduced.
The authors summarize the gluten-no-gluten debate as follows, “There is debate over the existence of nonceliac gluten sensitivity (NCGS) -intestinal and extra-intestinal symptoms in response to ingestion of gluten-containing foods by people without celiac disease or wheat allergy. We performed a randomized, double-blind, placebo-controlled, cross-over trial to determine the effects of administration of low doses of gluten to subjects with suspected NCGS.”
Di Sabatino A, Volta U, Salvatore C1, Biancheri P, Caio G, De Giorgio R, Di Stefano M1 Corazza GR. Small Amounts of Gluten in Subjects with Suspected Nonceliac Gluten Sensitivity: a Randomized, Double-Blind, Placebo-Controlled, Cross-Over Trial. Clin Gastroenterol Hepatol. 2015 Feb 19. pii: S1542-3565(15)00153-6. doi: 10.1016/j.cgh.2015.01.029.
2.The Literal Gluten Trial
FDA Sued For Gluten in Medications
According to the Wallstreet Journal, “After taking a generic drug seven years ago and developing side effects consistent with ingesting gluten, Weber petitioned the FDA to either eliminate wheat gluten in medicines or require new labeling on drugs containing the protein. The agency response has been slow. In 2011, the FDA sought public comments about the issue, but otherwise has not taken action. So Weber has now filed a lawsuit to demand the FDA do something.”
Sullivan E. FDA is Sued for Failing to Regulate the Use of Glutens in Medicines. WSJ. March 17, 2015.
Can’t We Just All Get Along?
Could it be the fiber that feeds our bugs?
Fiber feeds those critters that we all love that line our belly. Its consumption may be why paleo lovers that include copious veggies and vegetarians could both reap benefits from their diets.
For example, another recent randomized study that included 240 adults with metabolic syndrome found that just adding fiber to the diet resulted in weight loss after 12 months. However, less weight was lost compared to those who followed the much harder American Heart Association (AHA) dietary guidelines.
Ma YA, Oldenzki B, Wang J, Persuitte GM, Li W, Merriam P, Wedick N, et al. Single-Component Versus Multicomponent Dietary Goals for the Metabolic Syndrome: A Randomized Trial. Ann Intern Med. 2015;162(4):248-257. doi:10.7326/M14-0611.
Quick as a Wink Updates:
A Mushroom Compound Shows Promise Against Ebola
The researchers said the compound, called tetrandrine, blocked infection of human white blood cells in lab dishes and prevented Ebola virus disease in lab mice. More research is needed, including monkey studies, before it can be tested in people, they added.
Dunham W. Compound from Chinese medicinal herb shows promise for Ebola. Reuters. February 26, 2015.
Stroke Risk Decreases with Folic Acid
The China Stroke Primary Prevention Trial, a randomized, double-blind clinical trial conducted from May 19, 2008, to August 24, 2013 with 20, 702 hypertensive adults, tested the primary hypothesis that therapy with enalapril and folic acid is more effective in reducing first stroke than enalapril alone. Eligible participants were stratified by MTHFR C677T genotypes (CC, CT, and TT). The authors concluded, “Among adults with hypertension in China without a history of stroke or MI, the combined use of enalapril and folic acid, compared with enalapril alone, significantly reduced the risk of first stroke. These findings are consistent with benefits from folate use among adults with hypertension and low baseline folate levels.”
Huo Y, Li J, Qin X, Huang Y, Wang X, Gottesman RF, et al. Efficacy of Folic Acid Therapy in Primary Prevention of Stroke Among Adults With Hypertension in China: The CSPPT Randomized Clinical Trial. JAMA. 2015 Mar 15. doi: 10.1001/jama.2015.2274.
Blood Pressure (BP) Aside-Shake It On or Keep That Salt Shaker Off the Table?
Recent pre-clinical and clinical data support that even in the absence of an increase in BP, excess dietary sodium can adversely affect target organs, including the blood vessels, heart, kidneys, and brain. In this review, the investigators review these issues and the epidemiological research relating dietary sodium to BP and cardiovascular health outcomes, addressing recent controversies.
William B. Farquhar, David G. Edwards, Claudine T. Jurkovitz, William S. Weintraub. Dietary Sodium and Health. Journal of the American College of Cardiology, 2015; 65 (10): 1042 DOI: 10.1016/j.jacc.2014.12.039
Too Much Of A Good Thing for Vitamin D?
The authors of recent study in The Journal of Clinical Endocrinology & Metabolism reported to Science Daily, “We have studied the level of vitamin D in 247,574 Danes, and so far, it constitutes the world’s largest basis for this type of study. We have also analysed their mortality rate over a seven-year period after taking the initial blood sample, and in that time 16,645 patients had died. Furthermore, we have looked at the connection between their deaths and their levels of vitamin D,” Professor at the Department of Clinical Medicine, Peter Schwarz explains.
The conclusion is clear: the study confirms that there is indeed a correlation between mortality rates and too low levels of vitamin D, but the new thing is that the level of vitamin D can also be too high.
University of Copenhagen – The Faculty of Health and Medical Sciences. High levels of vitamin D is suspected of increasing mortality rates. ScienceDaily. March 10, 2015. www.sciencedaily.com/releases/2015/03/150310105222.htm.
Darshana Durup, Henrik Løvendahl Jørgensen, Jane Christensen, Anne Tjønneland, Anja Olsen, Jytte Halkjær, Bent Lind, Anne-Marie Heegaard, Peter Schwarz. A reverse J-shaped association between serum 25-hydroxyvitamin D and cardiovascular disease mortality – the CopD-study. The Journal of Clinical Endocrinology & Metabolism. 2015; jc.2014-4551 DOI: 10.1210/jc.2014-4551
International Agency for Research on Cancer (IARC) Experts Assess Pesticides Link to Cancer
In March, 2015, 17 experts from 11 countries met at the International Agency for Research on Cancer (IARC; Lyon, France) to assess the carcinogenicity of the organophosphate pesticides tetrachlorvinphos, parathion, malathion, diazinon, and glyphosate (table). These assessments will be published as volume 112 of the IARC Monographs.1
Guyton KZ, Loomis D, Grosse Y, Benbrahim-Tallaa L, Guha N, Scoccianti C, Mattock H, Straif K. (IARC Monograph Working Group, France). Carcinogenicity of tetrachlorvinphos, parathion, malathion, diazinon, and glyphosate. Lancet Oncology. March 20, 2015. http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2815%2970134-8/fulltext
Praise for Peanuts & Mortality Risk in Study
Three large cohort studies were evaluated to determine the link between nut consumption and mortality. One cohort included 71,764 US residents of African and European descent and the other 2 cohorts included 134,265 participants in the Shanghai Women’s Health Study (SWHS).
The authors reported, “Nut consumption was associated with decreased overall and cardiovascular disease mortality across different ethnic groups and among individuals from low SES groups. Consumption of nuts, particularly peanuts given their general affordability, may be considered a cost-effective measure to improve cardiovascular health.”
Luu HN, Blot WJ, Xiang Y-B, et al. Prospective evaluation of the association of nut/peanut consumption with total and cause-specific mortality. JAMA Intern Med 2015; DOI:10.1001/JAMAINTERNMED.2014.8347.
Oral Tolerance To Peanuts Show Benefits in Trial
A randomized trial of 640 infants between 4-11 months who had severe eczema, egg allergy, or both compared outcomes based on consumption or avoidance of peanuts until 60 months of age. They were assigned to separate study cohorts on the basis of preexisting sensitivity to peanut extract which was determined with the use of a skin-prick test. The authors concluded, “The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts.”
George Du Toit, Graham Roberts, Peter H. Sayre, Henry T. Bahnson, Suzana Radulovic, Alexandra F. Santos, et al. Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy. New England Journal of Medicine. 2015; 150223141105002. DOI: 10.1056/NEJMoa1414850
McDonald’s To Phase Out Chicken with Antibiotics
Fast food giant McDonald’s announced Wednesday it will begin sourcing chickens raised without antibiotics. Over the next two years, the chain says its U.S. restaurants — which number around 14,000 — will transition to the new antibiotics policy, which prohibits suppliers from using antibiotics critical to treating human illness.
Aubrey A, Barclay E. McDonald’s Says It Won’t Be Serving Chicken Raised On Antibiotics. NPR. March 04, 2015. http://www.npr.org/blogs/thesalt/2015/03/04/390701295/mcdonalds-says-it-wont-be-serving-chicken-raised-on-antibiotics
HEALTH
Green Space and Health
In a study with 250782 people, it was demonstrated “that the percentage of green space in people’s living environment has a positive association with the perceived general health of residents. Green space seems to be more than just a luxury and consequently the development of green space should be allocated a more central position in spatial planning policy.”
Maas J, Verheij RA, Groenewegen PP, de Vries S, Spreeuwenberg P. Green space, urbanity, and health: how strong is the relation? Journal of Epidemiology and Community Health. 2006;60(7):587-592. doi:10.1136/jech.2005.043125.
Purpose in Life & Stroke Risk (Microinfarcts)
Participants came from the Rush Memory and Aging Project. Each participant completed a standard measure of purpose in life. Uniform neuropathologic examination identified macroscopic infarcts and microinfarcts, blinded to clinical information. Association of purpose in life with cerebral infarcts was examined in ordinal logistic regression models using a semiquantitative outcome…Purpose in life may affect risk for cerebral infarcts, specifically macroscopic lacunar infarct
Yu L, Boyle PA, Wilson RS, Levine SR, Schneider JA., Bennett DA. Purpose in Life and Cerebral Infarcts in Community-Dwelling Older People. Stroke. Doi: 10.1161/STROKEAHA.114.008010
Drowning in Plastic
A Canine Technology To Revolutionize Thyroid Cancer Screening?
Frankie, a German Shepherd mix, had 90 percent accuracy at spotting tumor traces in urine samples…A team at the University of Arkansas in Little Rock said that Frankie can accurately sniff out cases of thyroid cancer when presented with patients’ urine samples.
Mozes, A. Specially Trained Pooch Sniffs Out Thyroid Cancer. Health Day News. March 7, 2015. http://consumer.healthday.com/cancer-information-5/thyroid-cancer-news-727/specially-trained-pooch-sniffs-out-thyroid-cancer-697131.html
Less Mammograms With More Information?
A random cohort of women in a community-based, parallel-group, randomized controlled trial that included 409 women in the intervention group and 408 controls analyzed if education on overdetection of breast cancer information would impact decision to choose mammography screening. The authors concluded, “Information on overdetection of breast cancer provided within a decision aid increased the number of women making an informed choice about breast screening. Becoming better informed might mean women are less likely to choose screening.”
Jolyn Hersch, Alexandra Barratt, Jesse Jansen, Les Irwig, Kevin McGeechan, Gemma Jacklyn, Hazel Thornton, Haryana Dhillon, Nehmat Houssami, Kirsten McCaffery. Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial. The Lancet. 2015; DOI: 10.1016/S0140-6736(15)60123-4Bottom of Form
Perfect Storm of Stress & Depression Means More Risk On Heart
In a prospective cohort study of 4487 adults with coronary heart disease from the Reasons for Geographic and Racial Differences in Stroke study found that in the first 2.5 years of follow-up, participants with concurrent high stress and high depressive symptoms had increased risk for myocardial infarction or death relative to those with low stress and low depressive symptoms.
Alcantara, C, Muntner P, Edmondson D, Safford MM, Redmond N, Colantonio LD, Davidson KW. Concurrent Stress and Depressive Symptoms Increase Risk of Myocardial Infarction or Death. Circulation. March 10, 2015, doi: 10.1161/CIRCOUTCOMES.114.001180
Motivational Talk and Performance Outcomes
Motivational self-talk (M-ST) was found helpful for male cyclists as evidenced by improved endurance performance and a higher power output. The VO2 response matched the increase in power output, yet rating of perceived endurance was unchanged, “thereby inferring a perceptual benefit through M-ST.”
Improvement of 10-km Time-Trial Cycling With Motivational Self-Talk Compared With Neutral Self-Talk. IJSPP, March 2015, 10(2): 166 – 171. http://dx.doi.org/10.1123/ijspp.2014-0059.
The Healing Power Of Saunas
Researchers assessed cardiovascular and all-cause mortality in relationship to sauna usage among 2,315 men aged 42-60 from eastern Finland. The average follow-up was 21 years. 2-3 saunas a week provided benefit; however, “Men who had 4-7 sauna sessions benefited even more; they were at 63% lower risk of sudden cardiac death, 48% lower risk of CHD death, 50% lower risk of CVD death and were 40% less likely to die from all causes, compared with those who had one sauna session a week. “
Whitman, H. Men who sauna are ‘at lower risk of cardiac death’. Medical News Today. February 24, 2015. http://www.medicalnewstoday.com/articles/289833.php
Original Source: Association Between Sauna Bathing and Fatal Cardiovascular and All-Cause Mortality Events. JAMA Intern Med. Published online February 23, 2015. doi:10.1001/jamainternmed.2014.8187
Air Pollution & Stroke Risk
People living in areas with more air pollution face a greater risk of carotid artery stenosis, a narrowing of the arteries that supply blood to the brain, according to research scheduled for presentation at the American College of Cardiology’s 64th Annual Scientific Session in San Diego.
American Cardiology Association. Air Pollution Connected with Narrowing of the Arteries. March 4, 2015. http://www.acc.org/about-acc/press-releases/2015/03/04/16/58/air-pollution-connected-with-narrowing-of-the-arteries?w_nav=S
What If HPV Didn’t Cause Cervical Cancer?
According to this paper neither genetic predisposition nor HPV infections are necessary for the development of cervical cancer. All cervical cancer cells investigated during the course of this study contained new abnormal karyotypes. The clonality (genetic makeup) of these new abnormal karyotypes indicates the cervical cancers originated with these karyotypes – NOT from a virus.
Erickson N, Duesberg P. What If HPV Does Not Cause Cervical Cancer? Green Med Info. February 21, 2015. http://www.greenmedinfo.com/blog/what-if-hpv-does-not-cause-cervical-cancer?page=2
Bad Science, Is Policy Out of Sight, Out of Mind? FDA Inspection Results
Fifty-seven published clinical trials were identified for which an FDA inspection of a trial site had found significant evidence of 1 or more of the following problems: falsification or submission of false information, 22 trials (39%); problems with adverse events reporting, 14 trials (25%); protocol violations, 42 trials (74%); inadequate or inaccurate recordkeeping, 35 trials (61%); failure to protect the safety of patients and/or issues with oversight or informed consent, 30 trials (53%); and violations not otherwise categorized, 20 trials (35%). Only 3 of the 78 publications (4%) that resulted from trials in which the FDA found significant violations mentioned the objectionable conditions or practices found during the inspection. No corrections, retractions, expressions of concern, or other comments acknowledging the key issues identified by the inspection were subsequently published.
Seife C. Research Misconduct Identified by the US Food and Drug Administration: Out of Sight, Out of Mind, Out of the Peer-Reviewed Literature. JAMA Intern Med. 2015 Feb 9. doi: 10.1001/jamainternmed.2014.7774.
Cardiovascular and Nervous System Changes During Meditation
A recent study examined inter-individual variations to meditation through monitoring of EEG, blood pressure, heart rate, and heart rate variability (HRV) in 20 novice and 20 experienced meditators during a week-long wellness retreat.
Meditation produced variable but characteristic EEG changes, significantly different from baseline, even among novice meditators on the first day. In addition, although participants were predominately normotensive, the mean arterial blood pressure fell a small (2-3 mmHg) but significant (p<0.0001) amount during meditation. The effect of meditation on HRV was less clear and influenced by calculation technique and respiration. No clear relationship between EEG changes, HRV alterations or mean blood pressure during meditation was found.
Steinhubl SR, Wineinger NE, Patel S, Boeldt DL, Mackellar G, Porter V, Redmond J, Muse ED, Nicholson L, Chopra D and Topol EJ (2015). Cardiovascular and nervous system changes during meditation. Front. Hum. Neurosci. 9:145. doi: 10.3389/fnhum.2015.00145
AHA New Issue With Focus On Women
The latest gender-specific research on heart disease continues to show differences between women and men, yet gaps remain in how to best diagnose, treat and prevent this number one killer of women, according to studies published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.
AHA. Women’s heart disease should be a research priority. American Heart Association Rapid Access Journal Report. February 24, 2015. http://newsroom.heart.org/news/womens-heart-disease-should-be-a-research-priority
Women, Insulin, Obesity, & PTEN
Women have higher adiposity but maintain better insulin sensitivity compared to men. New research suggests this may be due to down regulation and inactivation of the phosphatase and tensin (PTEN) gene. PTEN is a gene which inhibits insulin signaling. These conclusions were based on a cross-sectional study from participants in the Molecular Study of Health and Risk in Ethnic Groups (Mol-SHARE).
Constantine Samaan, Sonia S. Anand, Arya M. Sharma, Imtiaz A. Samjoo, Mark A. Tarnopolsky. Sex differences in skeletal muscle Phosphatase and tensin homolog deleted on chromosome 10 (PTEN) levels: A cross-sectional study. Scientific Reports, 2015; 5: 9154 DOI: 10.1038/srep09154
McMaster University. Women retain insulin sensitivity better than men. ScienceDaily. March 17, 2015. www.sciencedaily.com/releases/2015/03/150317134509.htm
Breastfeeding Linked To Intelligence
Prolonged breast-feeding is associated with higher intelligence in adulthood, longer schooling, and higher adult income, according to a study published March 17 in the Lancet Global Health.
Brown, T. Prolonged Breast-feeding Linked to Higher Adult IQ. Medscape Medical News. March 18, 2015. http://www.medscape.com/viewarticle/841668?src=wnl_edit_medn_wir&uac=146852BY&spon=34
Accumulating Toxins May Mess Up Your Blood Sugar
Within the Coronary Artery Risk Development in Young Adults study researchers compared measurements of POPs (persistent organic pollutants) in serum obtained from 90 non-diabetic controls and 90 cases who were diabetes-free at year 2 but became diabetic by year 20.
They concluded, “Glucose homeostasis may worsen after decades of exposure to PCBs and OCPs at background environmental levels, independent of BMI and after participants reached the 5th decade of life.”
Suarez-Lopez JR1, Lee DH2, Porta M3, Steffes MW4, Jacobs DR Jr5. Persistent organic pollutants in young adults and changes in glucose related metabolism over a 23-year follow-up. Environ Res. 2015 Feb 20;137C:485-494. doi: 10.1016/j.envres.2014.11.001. [Epub ahead of print]
Oxygen Treatment for Cancer
According to a study in Science Translational Medicine, “Antitumor T cells either avoid or are inhibited in hypoxic and extracellular adenosine-rich tumor microenvironments (TMEs) by A2A adenosine receptors.”
The researchers reported on various mechanisms that supported the use of oxygen therapy to modulate immune response and decrease this “hypoxia-adenosingeric immunosuppression.”
M. Hatfield, J. Kjaergaard, D. Lukashev, T. H. Schreiber, B. Belikoff, R. Abbott, S. Sethumadhavan, P. Philbrook, K. Ko, R. Cannici, M. Thayer, S. Rodig, J. L. Kutok, E. K. Jackson, B. Karger, E. R. Podack, A. Ohta, M. V. Sitkovsky, Immunological mechanisms of the antitumor effects of supplemental oxygenation. Sci. Transl. Med. 7, 277ra30 (2015).
The Power Of Belief in Back Pain Relief with Acupuncture
A total of 485 patients were recruited from 83 acupuncturists before commencing acupuncture for back pain. Questionnaires measured variables from 4 theories (fear-avoidance model, common-sense model, expectancy theory, social-cognitive theory), clinical and sociodemographic characteristics, and disability.
…Illness perceptions and, to a lesser extent, self-efficacy and expectancies can usefully supplement variables from the fear-avoidance model in theorizing pain-related disability. Positive changes in patients’ beliefs about back pain might underpin the large nonspecific effects of acupuncture seen in trials and could be targeted clinically.
Bishop F, Yardley L, Prescott P, Cooper C, Little P, Lewith GT. Covariates of Longitudinal Changes in Back-related Disability in Patients Undergoing Acupuncture. Clinical Journal of Pain. March 2015; 31(3): 254–264. doi: 10.1097/AJP.0000000000000108
Linking BPA To Autism
To determine whether there was a relationship between BPA (Bisphenol-A) exposure and ASD, urine specimens were collected from 46 children with ASD and 52 controls. Free and total BPA concentrations were determined by mass spectrometry. The fraction glucuronidated was calculated from the difference…The results suggest there is an association between BPA and ASD.
Stein, T. P., Schluter, M. D., Steer, R. A., Guo, L. and Ming, X. (2015), Bisphenol A Exposure in Children With Autism Spectrum Disorders. Autism Res. doi: 10.1002/aur.1444
Yay Or Nay for Shoulder Surgery?
A pragmatic, multicenter, parallel-group, randomized clinical trial, the Proximal Fracture of the Humerus Evaluation by Randomization (PROFHER) trial, recruited 250 patients aged 16 years or older…who presented at the orthopedic departments of 32 acute UK National Health Service hospitals between September 2008 and April 2011 within 3 weeks after sustaining a displaced fracture of the proximal humerus involving the surgical neck.
Among patients with displaced proximal humeral fractures involving the surgical neck, there was no significant difference between surgical treatment compared with nonsurgical treatment in patient-reported clinical outcomes over 2 years following fracture occurrence. These results do not support the trend of increased surgery for patients with displaced fractures of the proximal humerus.
Rangan A, Handolll H, Brealey S, Jefferson L, Keding A, Martin BC, Goodchild L, Chuang L-H, Hewitt C, Torgerson D. Surgical vs Nonsurgical Treatment of Adults With Displaced Fractures of the Proximal Humerus: The PROFHER Randomized Clinical Trial. JAMA. March 2015;313(10):1037-1047. doi:10.1001/jama.2015.1629.
Microbiome Recap:
https://youtube.com/watch?v=lKKZQfwzWAM%3Ffeature%3Dplayer_detailpageframeborder%3D0allowfullscreen
DRUG UPDATES
The Heat Is On -Vaccines
The controversy or pro-vaccines and pro-choice is hot and heated.
The two sides hit headlines since the measles outbreak in Disney, California. Here’s a little bit of a lengthily summary from the CDC:
CDC’s Morbidity and Mortality Weekly Report (MMWR)- February 20, 2015
As of February 11, a total of 125 measles cases with rash occurring during December 28, 2014–February 8, 2015, had been confirmed in U.S. residents connected with this outbreak. Of these, 110 patients were California residents. Thirty-nine (35%) of the California patients visited one or both of the two Disney theme parks during December 17–20, where they are thought to have been exposed to measles, 37 have an unknown exposure source (34%), and 34 (31%) are secondary cases. Among the 34 secondary cases, 26 were household or close contacts, and eight were exposed in a community setting. Five (5%) of the California patients reported being in one or both of the two Disney theme parks during their exposure period outside of December 17–20, but their source of infection is unknown. In addition, 15 cases linked to the two Disney theme parks have been reported in seven other states: Arizona (seven), Colorado (one), Nebraska (one), Oregon (one), Utah (three), and Washington (two), as well as linked cases reported in two neighboring countries, Mexico (one) and Canada (10).
Among the 110 California patients, 49 (45%) were unvaccinated; five (5%) had 1 dose of measles-containing vaccine, seven (6%) had 2 doses, one (1%) had 3 doses, 47 (43%) had unknown or undocumented vaccination status, and one (1%) had immunoglobulin G seropositivity documented, which indicates prior vaccination or measles infection at an undetermined time. Twelve of the unvaccinated patients were infants too young to be vaccinated. Among the 37 remaining vaccine-eligible patients, 28 (67%) were intentionally unvaccinated because of personal beliefs, and one was on an alternative plan for vaccination. Among the 28 intentionally unvaccinated patients, 18 were children (aged <18 years), and 10 were adults. Patients range in age from 6 weeks to 70 years; the median age is 22 years. Among the 84 patients with known hospitalization status, 17 (20%) were hospitalized.
CDC. Measles Outbreak — California, December 2014–February 2015. Morbidity and Mortality Weekly Report (MMWR). February 20, 2015. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm?s_cid=mm6406a5_w
“I don’t think we have heard the end of the public discussion about measles and measles vaccination the United States. In fact, I have quite honestly been surprised at the backlash directed at parents who choose not to vaccinate and practices that support delayed vaccinations. Although it is overdue that vaccine proponents are as vocal in the public discourse as are vaccine objectors, it is unfortunate that it required children contracting measles to get us to this point.”
Basco WT. Measles: A One-Stop Shop of Resources for Pediatric PCPs. Medscape Pediatrics-Viewpoints. February 23, 2015
Two Major Releases On Vaccine Efficacy:
RED BOOK RELEASED: http://redbook.solutions.aap.org/DocumentLibrary/2015RedBookMeasles.pdf
THE FILM, BOUGHT, RELEASED: http://boughtmovie.net/free-viewing/
Influenza Vaccine 18% Effective, Even Lower Than Predicted
The influenza vaccine this season has had little to no efficacy, in particular against the predominant A strains that have been circulating, said researchers from the Centers for Disease Control and Prevention (CDC) today. They presented new data to the CDC’s Advisory Committee on Immunization Practices (ACIP) that suggested the vaccine was only 18% effective for all ages.
Other Vaccine News Updates
- …the ACIP panel declined to recommend universal vaccination. Instead, it voted to recommend use of the vaccine in about 300,000 to 350,000 individuals aged over 10 years considered at high risk for serogroup B, including: patients with persistent complement component deficiencies; those with functional or anatomic asplenia, including sickle cell disease; microbiologists who work with meningitides; and people at risk because of outbreaks. The CDC told the ACIP that such outbreaks — often on college campuses — are rare, though there have been two at universities in 2015 already.
- Yellow Fever Boosters recommended for travelers every 10 years
- Gardasil Vaccine Backed
Ault, A. CDC Says Influenza Vaccine Only 18% Effective This Year. Medscape Medical News. February 26, 2015. http://www.medscape.com/viewarticle/840557?src=wnl_edit_medn_wir&uac=146852BY&spon=34
New Flu Strains for 2015-2016
A panel of US Food and Drug Administration (FDA) advisers has recommended all new components for the influenza vaccine for the 2015-16 season. The influenza vaccine has included the exact same strains for the last two flu seasons, but data indicate that this year’s vaccine was largely ineffective and that those strains are no longer circulating.
Ault, A. FDA Advisers Recommend Total Overhaul of 2015 Flu Vaccine. Medscape Medical News. March 5, 2015.
NSAIDs Increase Bleeding Risk In Those On Antithrombotic Medications
… Danish researchers analyzed the association between the concomitant use of NSAIDs and various antithrombotic medications, including aspirin, clopidogrel, and oral anticoagulant therapy, and adverse cardiovascular outcomes and bleeding risks in 61 971 patients admitted with a first-time MI between 2002 and 2011. The median follow-up was 3.5 years…
After adjustment for multiple baseline variables, the overall risk of bleeding was more than twofold higher among post-MI patients who were concomitantly taking an NSAID compared with those who were not (hazard ratio [HR] 2.02; 95% CI 1.81–2.26).
O’Riordan M. NSAIDs Up Bleeding/CV Risks in Post-MI Patients Treated With Antithrombotic Medication. Heartwire. February 24, 2015. http://www.medscape.com/viewarticle/840282?src=wnl_edit_medn_wir&uac=146852BY&spon=34#vp_3
Motelukast’s Neurobehavioral Risks In Pediatric Patients
The US Food and Drug Administration (FDA) first alerted healthcare professionals (HCPs) about a possible association between the use of leukotriene inhibitors and neuropsychiatric events in 2008 and added information to product labels in 2009…Continued concerns about suicidality and neuropsychiatric events with montelukast were again raised at a recent FDA Pediatric Advisory Committee (PAC) meeting in September 2014.
Scudder L, Seymour S, Torjusen E. Montelukast’s Underrecognized Adverse Drug Events. FDA on Medscape > FDA Expert Interview. March 2, 2015.
The Potential Over-treatment of Diabetes
In a cross-sectional analysis of data from 2001-2010 on 1288 older adults (?65 years) with diabetes who were involved in the National Health and Nutrition Examination Survey (NHANES), the study’s authors concluded, “Although the harms of intensive treatment likely exceed the benefits for older patients with complex/intermediate or very complex/poor health status, most of these adults reached tight glycemic targets between 2001 and 2010. Most of them were treated with insulin or sulfonylureas, which may lead to severe hypoglycemia. Our findings suggest that a substantial proportion of older adults with diabetes were potentially overtreated.”
Lipska K, Ross JS, Miao Y, Shah ND, Lee SJ, Steinman MA. Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control. JAMA Intern Med. 2015;175(3):356-362. doi:10.1001/jamainternmed.2014.7345.
Chantix & Alcohol May Mean Seizures
The US Food and Drug Administration (FDA) has changed the labeling on the smoking cessation drug varenicline (Chantix, Pfizer Inc) to reflect concerns that the drug may lower tolerance to alcohol and is linked to a rare risk for seizures.
Cassels C. Chantix May Lower Alcohol Tolerance, Up Seizure Risk: FDA. News Alerts > Medscape Medical News. March 9, 2015.
Are Psychedelics the Safer Drug Option?
A recent large population study of 130,000 adults in the United States failed to find evidence for a link between psychedelic use (lysergic acid diethylamide, psilocybin or mescaline) and mental health problems.
Johansen P-O, Krebs T-S. Psychedelics not linked to mental health problems or suicidal behavior: A population study. J Psychopharmacol. March 5, 2015doi: 10.1177/0269881114568039
The Non-Scary News on Testosterone
Two new studies muddy the waters on the potential cardiovascular risks previously linked to testosterone-replacement therapy in men, with both studies suggesting the therapy might not be causing the cardiovascular harm suggested in previous analyses[1,2]. Both are scheduled for the presentation later this week at the American College of Cardiology (ACC) 2015 Scientific Sessions.
O’Riordan M. Two Studies Suggest Testosterone Might Not Increase Risks of Cardiovascular Events. Heartwire from Medscape. March 09, 2015. http://www.medscape.com/viewarticle/841098?src=wnl_edit_medn_wir&uac=146852BY&spon=34
Inflammatory Drugs, Arthritis, & the Heart
A literature review reported that, “tumour necrosis factor inhibitors and methotrexate are associated with a decreased risk of all CVEs while corticosteroids and NSAIDs are associated with an increased risk. Targeting inflammation with tumour necrosis factor inhibitors or methotrexate may have positive cardiovascular effects in RA.”
Note: Several drug companies were associated with the authors, CVE=cardiovascular events
Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Fleming P, et al. The Effects of Tumour Necrosis Factor Inhibitors, Methotrexate, Non-steroidal Anti-inflammatory Drugs and Corticosteroids on Cardiovascular Events in Rheumatoid Arthritis, Psoriasis and Psoriatic Arthritis: A Systematic Review and Meta-Analysis. Annals of the Rheumatic Diseases. Ann Rheum Dis. 2015;74(3):480-489. Disclosures
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