Newsletter 07/27/18 – Paper or Plastic?

To my Patients and Friends,

Here are this week’s medical highlights… enjoy!

Big-box prescriptions

According to a report just published in the Annals of Internal Medicine, bypassing Medicare’s prescription co-pays for common generic drugs and paying out-of-pocket at Walmart can save you money.  As it turns out, Walmart’s $4 per-month program is cheaper about 21% of the time.  The cost difference was found to be particularly relevant for Medicare Advantage plan participants.  So before ordering that next prescription refill, call Walmart to ask about their $4 per-month generic discount program to see if you are eligible for a lower-cost alternative.

Postpartum depression is non-discriminatory

Postpartum depression is a a mood disorder that affects some women after childbirth. Symptoms of postpartum depression include feelings of extreme sadness, anxiety, and fatigue that may make it difficult to perform daily activities, including caring for a newborn.  Postpartum depression has traditionally been viewed as a problem among women.  However, new fathers are almost as likely as their female counterparts to show signs of depression in the postpartum period, according to a study recently published in JAMA Pediatrics.  The researchers found a 4.4% prevalence of depression among screened new fathers, which is not much less than the 5% prevalence found among new mothers.  According to recommendations from the American Academy of Pediatrics, physicians should ask both mothers and fathers about feelings of depression around the time pregnancy and newborn delivery.

Food additives and child health

Environmental chemicals are known to have significant negative impacts on health.  Children are especially vulnerable, because they are growing and are therefore more apt to incorporate environmental chemicals into their systems.  Additionally, because they need to fuel their growth and development, kids ingest more food (pound-for-pound) than adults, and therefore are at higher risk for exposure.  The American Academy of Pediatrics recently released a statement indicating that numerous food-related chemicals and additives may negatively impact our children’s health.  Some of these chemicals include:

  • Bisphenols like BPA: found in plastics and the lining of cans. They mimic estrogen in the body, impacting puberty, fertility, body fat and the nervous and immune systems.
  • Phthalates: found in plastics and vinyl tubes used in industrial food production. They can impede the normal development of male genitalia and increase the risk of childhood obesity and heart disease.
  • Perfluoroalkyl chemicals (PFCs): used in the production of oil-resistant food packaging. They may inhibit immunity, lead to lower birth weight and fertility, and can impact the thyroid gland.
  • Percholate: added to food packaging to limit static electricity. It is known to affect the thyroid gland and impacts early brain development.
  • Styrene: used extensively in the manufacturing of plastics, rubber, and resins. With high levels of exposure, it can cause headache, fatigue, dizziness, confusion, drowsiness and poor concentration.
  • Artificial food coloring: these have been shown to exacerbate attention deficit hyperactivity disorder (ADHD).
  • Nitrates and nitrites: preservatives found in cured and processed meats. These can interfere with thyroid function and have been linked with cancers of the GI tract and the nervous system.

There are a lot of things we can do to minimize these exposures.  In the household, we ought to do our best to serve children primarily fresh or frozen produce (versus canned foods), and avoid storing or heating foods in plastic containers (glass is better).  Additionally, it would be wise to avoid eating processed meats; this is especially true for women during pregnancy.  Use of plastics with recycling codes 3 (phthalates), 6 (styrene) and 7 (bisphenols) should generally be avoided.  On a societal level, we should strive for reasonably stringent food safety regulations (a political hot potato these days, although most health advocates agree).

More on blood pressure and the brain

According to research just presented at the Alzheimer’s Association International Conference in Chicago, intensive control of blood pressure in older adults can help to decrease the likelihood of  the developing mild cognitive impairment (MCI), which can often be a precursor to Alzheimer’s disease (or other forms of dementia).  According to this research, adhering to the recently-updated blood pressure guidelines from the American Heart Association and the American College of Cardiology can go a long way toward keeping MCI (along with other known BP-related conditions such as heart disease, stroke and kidney disease) at bay.  I encourage regular monitoring of blood pressure for all patients, and especially for those with a history of elevated BP or those taking BP medications.  Stay in touch with your doctor!

Unnecessary prescriptions

For many patient who don’t have a regular primary care physician, urgent care centers can provide an accessible alternative when they become ill.  And as a result of of the current shortage of primary care physicians in the U.S., the urgent care industry is booming.  The dilemma: the success of the urgent care business model relies on large volumes of brief visits and on providing what may be perceived by their clientele as the “quick fix.”  So the patient who shows up with a cold frequently expects to leave with a prescription in hand.  Admittedly, the problem of over-prescribing of antibiotics is not limited to urgent care centers.  However, a recent study of insurance claims data by the Centers for Disease Control (CDC), found that patient were unnecessarily treated with an antibiotic for a viral cold about twice as often in urgent care centers than in emergency clinics or medical offices, a prescribing pattern that was described by one reviewer as “alarmingly liberal.”  Given all that we know about the dangers of unnecessary antibiotic use (including “superinfections” such as colitis, MRSA, and other antibiotic resistance phenomena), the onus is on all doctors to communicate effectively with their patients about the judicious prescribing of these important medications.

New cancer treatments on the horizon

Normally, cancer cells produce unique proteins that, in theory, should be recognized by the immune system as foreign (and therefore fall under attack).  However, that usually doesn’t happen.  In an exciting case report recently published in the Journal Nature, researchers at the National Cancer Institute describe a new treatment for breast cancer that has the potential to revolutionize oncology practice.  The case involved a 49-year-old woman suffering from metastatic chemotherapy-resistant breast cancer.  The researchers treated the patient with a novel approach using contemporary genomic techniques which enabled them to target, harvest and reinfuse large numbers of her own white blood cells so that the cancer cells were effectively infiltrated and destroyed by her immune system.  Over the course of 42 weeks, the patient’s metastases vanished.

Although this is just one case (and these treatments are not risk-free), research in immunotherapy is ongoing, and we can expect further efforts aimed at developing similar treatments… very encouraging news, indeed.

New (and not-so-new) drivers and risky behaviors

Interestingly, this report appeared around the time my teenage daughter received her driver’s license: researchers at the National Institutes of Health have found that the rate of crashes or near-crashes among teen drivers rose 8-fold during the 3-month span after finishing the learning period and beginning to driving independently.  So if we happen to run into each other and I look like I haven’t slept, you’ll know why.

On a related note, a report recently published in the Journal of Pediatrics reveals that about half of parents talk on the cell phone- and about a third engage in texting- while driving.  The impetus is on us all to set the best examples we can for our kids… the “do-as-I-say-and-not-as-I-do” approach probably won’t work.

That’s all for this week… have a nice weekend.