Category Archives: General Health

Prevalence of Anxiety, Depression, and Conduct Disorders

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For any physician, it is easy to think that the entire world is sick since that is what we see all day long.  In a pediatric GI office, there are high rates of anxiety and depression. A recent study (RM Ghandour et al. J Pediatr 2019; 206: 256-67) shows that not everyone is afflicted.  Using data from the 2016 National Survey of Children’s Health (children 3-17 years), which relies on self-administered surveys, the authors found the following:

  • 7.1% had current anxiety problems
  • 7.4% had a current behavioral problem
  • 3.2% had current depression.
  • Nearly 3 of 4 children with depression had concurrent anxiety, whereas 1 in 3 children with anxiety had concurrent depression.

The study includes detailed tables examining age, gender, ethnicity, region of country, rural/urban, insurance status, financial status, educational attainment, and health status. While this study relies on parent/caregiver reports, the authors note that  “research has shown good agreement between parental report and clinical records.”

My take: Problems with anxiety, depression, and behavioral problems are common but not universal.

Related blog posts:

 

Grapefruit Frequently Affects Medication Levels

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A recent NT Times article: Can Grapefruit Juice Affect My Thyroid Medicine?

Link: list of medications affected by grapefruit/grapefruit juice

An excerpt:

“You don’t have to drink liters and liters of the stuff to have an effect,” Dr. Bailey said. For example, he said, “if you take simvastatin and drink a single glass of grapefruit juice, it’s like taking three times the dose,” though the impact can be much more or much less, since individual susceptibilities vary widely….Other citrus fruits like Seville oranges, limes and pomelos can also produce a similar effect.

Genetically-Modified Gut Bacteria

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A recent NPR story (A Gulp Of Genetically Modified Bacteria Might Someday Treat A Range Of Illnesses) explored new research regarding ingestion of genetically modified gut bacteria for medical purposes.

Two of the examples that were highlighted included phenylketonuria (PKU) and cirrhosis.  For each disorder, the researchers are modifying E coli. For PKU, this may allow individuals to consume foods like milk and meat that usually would make them sick because individuals with PKU develop toxicity in response to phenylalanine in their diet.  For cirrhosis, the genetically modified E coli help eliminate the elevation of ammonia which is due in part to gut bacteria and in part due to liver dysfunction.  The report notes that the application of this science is likely to impact many other disorders including ulcerative colitis.

These efforts represent an exponential change to modifying the gut microbiome to enhance health.

Related blog posts:

NY Times:Supplements Don’t Help Dementia

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It is tiresome how many products are marketed with baseless claims of preventing dementia.  Some pushback:

NY Times: Supplements Won’t Prevent Dementia. But These Steps Might.

An excerpt:

The Food and Drug Administration estimates that 80 percent of older adults rely on dietary supplements, many purporting to prevent or treat Alzheimer’s and other forms of dementia…

Vitamins, various antioxidants, concoctions derived from animals and plants — “we see plenty of ads on TV, but we have no evidence that any of these things are preventive,” said Dr. Steven DeKosky, a neurologist and deputy director of the McKnight Brain Institute at the University of Florida.

Dr. DeKosky led a federally supported study of Ginkgo biloba extract, for instance, following more than 3,000 people for seven years to see if it reduced dementia. It didn’t.

Some of the steps that may help according to article:

  • Increased physical activity;

  • Blood pressure management for people with hypertension, particularly in midlife;

  • And cognitive training.

Tackling High Drug Costs -Lessons from Australia and Brazil

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In two related commentaries referenced below, the authors detail how Australia and Brazil managed to provide a blockbuster hepatitis C virus (HCV) medication without following the going-broke example of Blockbuster video stores.

  • Australia: S Moon et al. NEJM 2019; 380: 607-9
  • Brazil: EM da Fonseca et al. NEJM 2019; 605-6.

Australia provided a lump-sum payment of approximately 770 million dollars (in U.S.) over 5 years in exchange for an unlimited volume of direct-acting antivirals (DAAs). As a result of this approach, Australia managed to treat many more patients at a much lower cost.  “The government would have to spend …U.S. $4.92 billion more to treat the same number or it could treat 93,000 fewer patients with a fixed budget” of approximately U.S. $766 million.

With the Australian approach, the authors note that it is analogous to a patent buyout and works if the ongoing drug manufacturing cost is low and the manufacturer is able to meet growing volume demand.

Brazil’s approaches for DAAs relied on either threatening loss of patent protections and/or enabling local generic production of sofosbuvir.  This resulted in ~90% price discount. Patent protection in Brazil is granted only if a medication is approved by both INPI (Instituto Nacional da Propriedade Industrial) and ANVISA (Brazilian Health Regulatory Agency).

My take: Given the rising costs of medicines, examining how other countries surmount these financial barriers is important.  In my view, the often arbitrary and exorbitant pricing by pharmaceutical companies will erode the support of protective policies in the U.S. which thus far has helped produce many advances.

Skull Rock, Joshua Tree National Park

 

Telemedicine -Still Not Popular

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Several recent reports indicate that telemedicine is being adopted at a slow pace  –thanks to Ben Gold for these references.

AP: Telemedecine’s Challenge: Getting Patients to Click the App

An excerpt:

Widespread smartphone use, looser regulations and employer enthusiasm are helping to expand access to telemedicine, where patients interact with doctors and nurses from afar, often through a secure video connection…

Doctors have used telemedicine for years to monitor patients or reach those in remote locations. Now more employers are encouraging people covered under their health plans to seek care virtually for several reasons…

Telemedicine can reduce time spent away from the job, and it also can cost half the price of a doctor’s visit, which might top $100 for someone with a high-deductible plan…

Research firm IHS Markit estimates that telemedicine visits in the U.S. will soar from 23 million in 2017 to 105 million by 2022. But even then, they will probably amount to only about one out of every 10 doctor visits.

My take: Telemedicine can overcome geographical barriers. However, I worry about the person-to-person connection as this is hard even with face-to-face visits.

An unrelated article using telemedicine: IBD News Today: Remote Monitoring Offers Little Benefit to IBD Patient, Study Finds In this randomized study with 348 adult patients wtih IBD, telemedicine (in addition to clinic visits) did not improve patient confidence or management more than the control populaiton. 

Joshua Tree National Park