Friday, January 20, 2017

Chain restaurants broke pledge to improve kids' menus

In 2011, national restaurant chains, under the aegis of the National Restaurant Assn's Kids LiveWell program, promised to cut calories, saturated fat, and sodium in so-called kids' meals.

By 2015, the restaurants numbered 150 chains in 42,000 locations.

Some major chains did take soda off as the beverage and add yogurt or fruit as side, but according to a study done at Harvard, more changes are needed (Am J of Preventive Medicine).

The researchers said they saw very little meaningful progress in the nutritional quality.

For one thing, the soda has often been replaced by other sugar-sweetened bevs. Sugar-sweetened drinks are still 80% of the options.

Those apple slices? That yogurt? Apparently not the whole answer. The kids will still be offered fried nuggets and cheese, burgers, and other "kid" tasty items.

But what is the answer? Not all kids will chow down on a salad.

It guess it's back to the parents. How about splitting an adult fish meal between two kids. Or choosing the roasted chicken sandwich instead of the fried? Insist on milk or water? Veggies with a dip?

Got any other suggestions?

Thursday, January 19, 2017

Third of asthma patients may not have it

According to a study of 613 randomly selected Canadian asthma patients (JAMA), 33% of them were being treated but did not have asthma. This meant they were needlessly taking strong medications.

Half had not been properly tested. In other words, the doctor listened to a report of trouble breathing and handed over an inhaler--without doing a spirometry test, which tells how well the lungs are working.

In some cases, the patients might have had asthma but it had become inactive--although they kept taking the meds.

Both Canadian and American guideliness recommend doctors reassess asthma patients every so often. If the symptoms are under control, treatment could be tapered down.

But most doctors, the researchers said, do not do this.

Taking the steroids in the medicines can have bad effects over time.

In this study, a third of patients had nothing wrong at all. Two had heart disease, and 65% had minor conditions like allergies.

I was told once I had late-onset asthma--but it was a medication reaction. I kept saying I don't have asthma--and 9 months after stopping the med, I was back to normal...not a wheeze since.

Wednesday, January 18, 2017

Berating your child's doctor can be very bad

Does he look like he's getting
over it?
I know this sounds like a given, but remember, when someone is sick, emotions run high.

Parents, especially, can get desperate, feel out of  the loop, outmatched by the knowledge of those around their child, and can get upset.

A University of Florida management professor and a doctoral student have found that "rudeness" can have a "devastating effect on medical performance."

Lack of sleep on the part of doctors, they found, can account for 10%-20% of medical errors--but rudeness and (I guess) hurt feelings on the part of the doctor account for 40%.

Rudeness from the patient or loved ones changes the doctor's cognition--doctors don't "understand" or "just get over" certain behavior.

The studies--done in Israel--involved neonatal teams challenged by parents played by actors. The teams that had been berated performed badly in all 11 measures of performance.

The negative effects lasted all day--meaning they could have affected other patients, too.

The researchers also tested pre-test "interventions," such as a computer game to raise the threshold of sensitivity to anger. There was also a post-test intervention--writing about the experience from the mother's perspective.

These worked! The teams were "immunized" from the effects of rudeness.

OK...but what about the doctor's rudeness toward the family and even the patient. I had one of my mother's doctors say old people smelled bad...referring to my mother. I answered back. Did she get worse treatment for that? Who knows. Maybe.

I guess this "fraught" stuff goes both ways.

Tuesday, January 17, 2017

Hot to live longer?

Researchers at the Larner College of Medicine at the University of Vermont found that eating hot red chili peppers is associated with a 13% reduction in mortality.

You have to be careful of the word "associated" and this means untimely mortality (obviously, all of life is 100% terminal).

The study, published in PLoS ONE, used our favorite dataset--the National Health and Nutritional Examination Survey (NHANES). This involves 16,000 Americans followed for up to 23 years.

In the study, the baseline of chili pepper eaters were younger, male, white, Mexican-American, married, smokers, drinkers, and big veggie and meat eaters. They also had lower HDL (good) cholesterol, income, and education.

With these variables, eating chili peppers seemed to help stave of death by 13%.

Why? Well, the capsaicin, the hot stuff, is believed to play a role in cellular mechanisms preventing obesity and modulating blood flow and also to possess antimicrobial properties which alter the biology of the gut.

The researchers say recommending eating hot peppers or hot food in general might become a recommendation.

In the meantime, no one is stopping you from eating some hot sauce or peppers whenever you want.

Monday, January 16, 2017

Interesting book on the pharmaceutical industry

First, a disclaimer. I have not read the whole book--and am excerpting from a story on it.

Second, I am using this because the new president is already lining the industry up in his Twitter crosshairs. So this industry will come up again, I bet. Maybe a little background will provide context.

The book is Prescription for Change by Michael Kinch, director of the Center for Research Innovation in Biotechnology at Washington University in St Louis.

The book starts with early research--primitive then--just to determine that a drug was not a poison. One early antibiotic was mixed with antifreeze--106 children died.

Then began the struggle between innovation and regulation--and the world of patent extensions, me-too drugs, generics, pay-for-delay, orphan drugs, and compendum expansion.

For example, companies gamed the system by gaining FDA approval for an orphan drug (to treat a rare condition) and then did a small clinical trial, leading to its being approved for a larger population (market)--this is call compendium expansion.

Still, Kinch contends this is not dark--that the high cost of bringing a new drug to maker--$2.6 billion--is to make sure the drug is safe.

But these high costs led to companies buying each other and dismantling their own research, Instead they get new drugs from the biotech sector--where 2/3 of the drugs have originated in the last decade.

Now, those biotech companies are failing.,

At the same time, three crises are looming:

--Antibiotic resistance. If one drug stops "working," and there is no other, then what.

--Resistance to AIDS drugs. One in five patients on the drug cocktail keeping them alive has a virus resistant to one of the five drugs in the cocktail. Even of the 10 drug companies doing this research have stopped.

--Alzheimer's. Fully 99.6% of drugs to treat this failed clinical trials. Many companies have pulled back on this research.

So now what? We need to look at all aspects of how drugs are created. One idea is to eliminate costly Phase III clinical trials. Bad idea? Worth the risk? What IS the risk? And toxicity is only one aspect--what about effectiveness?

I would add--would the new president's vow to negotiate lower prices with these companies under some new health scheme he has play into this mix--which many in the industry call "The Valley of Death"?

Still, I see more research into individualized treatment keyed to genetics, new methods of  pain control. We cannot give up, that's for sure.