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12/26/19
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12:37 ,
How much you enjoy the new Star Wars movie will depend a lot on your expectations going in, a new study suggests. Researchers surveyed 441 people before and after they saw the last episode in the popular franchise, Star Wars VIII: The Last Jedi, released in 2017. They wanted to see how audiences' expectations affected their actual enjoyment of the movie.

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12:37 ,
Researchers have come one step closer toward understanding how the part of our brain that is central for decision-making and the development of addiction is organized on a molecular level. In mouse models and with methods used for mapping cell types and brain tissue, the researchers were able to visualize the organization of different opioid-islands in striatum. Their spatiomolecular map may further our understanding of the brain's reward-system.

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12:37 ,
Scientists revealed that ATAD5 actively deals with replication stress, in addition to its known function to prevent such stressful situations. Though ATAD5 has been known as a tumor suppressor by maintaining genomic stability and suppressing tumorigenesis, it has been unclear whether the replication regulatory protein is also involved in the replication stress response.

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11:37 ,
The VISION study looked at whether levels of a cardiac blood test, NT-proBNP, measured before surgery can predict cardiac and vascular complications. Higher levels of NT-proBNP, which can be caused by various anomalies in the cardiac muscle, such as stress, inflammation or overstretch, can help identify which patients are at greatest risk of cardiac complications after surgery. The study included 10,402 patients aged 45 years or older having non-cardiac surgery with overnight stay from 16 hospitals in nine countries.

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11:07 ,
The study modeled the harms and benefits of introducing four-yearly PSA screening for all men aged 55 to 69 versus more targeted checks for those at higher risk of the disease. The researchers concluded that the best approach would be to screen men at a slightly higher genetic risk - nearly half of men in that age group -- as this would have the biggest health benefit, preventing deaths from prostate cancer while minimizing unnecessary treatments for harmless tumors.

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11:07 ,
Researchers have developed a new 'tumor-on-a-chip' device that can better mimic the environment inside the body, paving the way for improved screening of potential cancer fighting drugs. The device, has a 1 mm well at the center flanked by a series of 'microposts'. The culture is placed in the middle well, and cells that construct blood vessels are places along the microposts. Over a few days the vessels grow and attaches to the culture.

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In the early 1990s, doctors began describing a new condition affecting the esophagus of patients who were predisposed to allergies including food allergy, asthma, and eczema, and who were having trouble swallowing. Today, we call this condition eosinophilic esophagitis (EoE).

What is EoE?

EoE is an allergic inflammation of the esophagus that causes a range of symptoms. Adolescents and adults most often experience it as difficulty swallowing, sometimes feeling like food moves too slowly through the esophagus and into the stomach. In some cases, food actually gets stuck (and may require urgent removal). Children and some adults primarily experience reflux symptoms and abdominal pain rather than difficulty swallowing.

In most cases, EoE develops as an allergic response to certain foods including wheat, milk, egg, soy, nuts, and seafood. If it is not properly diagnosed and treated, EoE may lead to permanent scarring or strictures (narrowing of the esophagus).

How is EoE diagnosed?

When EoE is suspected, generally the first test is an upper endoscopy, in which a flexible tube with a small camera and a light on one end is used examine the esophagus. The endoscopy usually reveals characteristic features of EoE, such as concentric rings and linear furrows or vertical lines, as well as small white spots or plaques.

The diagnosis is confirmed if biopsies from the esophagus reveal the hallmark increase in eosinophils. Eosinophils are a relatively rare type of immune cell that play a prominent role in allergic disorders including EoE and asthma.

How common is EoE?

EoE can affect both men and woman of any age, but it appears to be most common in men in their 30s and 40s. It is currently estimated that EoE may affect up to one in 2,000 adults in the US, and evidence suggests that the numbers have been growing. A recent review of nearly 30 studies in Europe and North America found that there has been a progressive increase in the number of new EoE cases, especially since the early 2000s.

The rise in EoE cases may be partly due to greater awareness of the condition and more widespread use of endoscopy. But a number of studies have confirmed a true rise in the incidence of the disease.

Why might EoE be on the rise?

The exact reasons for the rise of EoE are unknown, and it is especially puzzling that in many cases EoE results from an allergic sensitivity to a food that has been well tolerated up to that point.

There are several hypotheses about why EoE is increasing. Many of them relate back to the idea that EoE, and other allergic and autoimmune diseases, seem to correlate with decreased exposure to microbes and infections. Possible explanations that have been explored include:

  • The hygiene hypothesis: do fewer childhood infections equal more allergic diseases?
  • Microbial dysbiosis: has the modern/Western diet and lifestyle changed our microbiome?
  • Environmental factors: might changes in food production, genetic modification of crops, chemical additives, food processing, and pollutants play a role?
  • Declining frequency of H. pylori infection: might this common stomach bacteria (a common cause of peptic ulcers) be protective against some allergic diseases?
  • Increasing frequency of gastroesophageal reflux disease (GERD): could acid reflux break the barrier of the esophagus and allow food allergens to stimulate the immune system?
  • Increasing use of acid-suppressing medications: does the use of antacids, especially early in life, change the microbes in the esophagus or somehow otherwise alter the risk of later food allergy?

How is EoE treated?

There are currently no FDA-approved treatments for EoE. Most people are initially treated with a proton-pump inhibitor (PPI) antacid, which resolves EoE in up to half of cases. If this does not work, either a mild topical steroid or identification and elimination of specific dietary triggers is attempted.

When steroids are used to treat EoE, these are generally in a liquid formulation that is swallowed, rather than inhaled as they would be for asthma. Swallowed steroids act locally on the esophagus and are minimally absorbed through the gastrointestinal tract. Although steroids for EoE are generally safe and effective, they do not lead to a long-term cure because the disease tends to come back as long as patients continue to eat foods that trigger the underlying allergic response.

Patients may also opt to identify their food trigger and eliminate it from the diet, and this represents a more definitive treatment approach. Unfortunately, currently available allergy testing does not accurately predict the foods that cause EoE. Trigger foods generally need to be identified using a process of food elimination and reintroduction. Wheat and dairy are the two most common triggers for EoE, and patients will often start by eliminating these two foods for about eight weeks. At that point, their symptoms are reassessed, and they also undergo a repeat endoscopy with biopsies to determine if the eosinophils have disappeared in response to the dietary changes.

Several medication therapies are on the horizon. These include better formulations of steroids and biologic medications that reduce the activity of eosinophils.

Summary

If you are having trouble swallowing or have experienced episodes of food getting stuck in the esophagus, particularly if you have other allergic conditions, discuss your symptoms with your doctor. Unrecognized or untreated EoE can lead to permanent damage to your esophagus.

For more information or to learn about strategies for living with EoE, visit the American Partnership for Eosinophilic Disorders.

The post Eosinophilic esophagitis: A new food-related allergic condition on the rise? appeared first on Harvard Health Blog.



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00:24 , ,

It is estimated that 7.1% of the adult population in the U.S. experienced at least one major depressive episode in 2017. The highest rates are among those ages 18 to 25 years. Many people believe depression is caused by a chemical imbalance in the brain. This is a theory that has been widely promoted by drug companies and psychiatrists, to the point it is now accepted as fact.

However, this is just a theory and, worse, it's a theory that has been largely discredited. The idea spread quickly after it was proposed in the 1960s when it appeared antidepressant drugs altered brain chemicals. In the 1980s, Prozac (fluoxetine) was released by Eli Lilly and heavily promoted to balance brain chemicals and affect depression.

Prozac had fewer side effects than some of the earlier antidepressants and soon became the poster child for selective serotonin reuptake inhibitor (SSRI) class of antidepressants. However, while heavily prescribed, data repeatedly showed SSRIs worked no better than placebos for those experiencing mild to moderate depression.

Although antidepressants don't effectively treat depression, they do double the risk of harm from suicide and violence in healthy adults and increase aggression in children and adolescents.

Researchers also suggest major depression could be vastly overdiagnosed and overtreated with antidepressants. The majority who are prescribed these drugs end up staying on them long-term, which may compromise their health.

More Studies Link Depression to Inflammation

Researchers have found yet another link between inflammation and depression. In one study1 published in the Journal of Neurology, Neurosurgery & Psychiatry, researchers systematically reviewed the safety and effectiveness of anti-inflammatory agents in people suffering with major depression.

The literature review included results from 30 randomized control trials with a 1,610 participants. In an overall analysis of 26 studies, the researchers found anti-inflammatory agents reduced depressive disorder when compared with placebo. They found no differences in quality of life analysis but did find gastrointestinal event differences between the treatment periods.

A subanalysis of the data demonstrated an adjunctive treatment with antidepressants with nonsteroidal anti-inflammatory drugs, statins, omega-3 FAs and minocycline significantly reduced depressive symptoms.2

Results from another large metanalysis3 carried out by researchers from Aarhus University Hospital in Denmark revealed similar findings, showing anti-inflammatories may be effective in the treatment of depression. One researcher explains the study showed the combination of anti-inflammatory drugs along with antidepressants have beneficial effects.

The results also showed the effect against depression was present when the anti-inflammatory medication was used alone, compared against a placebo. The scientists analyzed 36 international studies of participants who suffered from depression or who had symptoms of depression. One of the researchers, Dr. Ole Köhler-Forsberg, commented on the results of the study:4

"This definitely bolsters our chances of being able to provide personalised treatment for individual patients in the longer term. Of course we always have to weigh the effects against the potential side-effects of the anti-inflammatory drugs.

We still need to clarify which patients will benefit from the medicine and the size of the doses they will require. The findings are interesting, but patients should consult their doctor before initiating additional treatment."

Yet in another recently published study in Molecular Psychiatry5 scientists found patients treated with immunotherapeutics for inflammatory disorders, who also presented with depression or depressive symptoms, experienced symptomatic relief. The team found the reduction in depressive symptoms was not associated with any treatment-related changes in their physical health.

Immune Dysregulation May Trigger Allergic-Type Reaction

There has been an increasing number of studies in which depression is reported to be linked to immune dysregulation and inflammation, mimicking an allergic reaction.6 Your body uses inflammation as a defense mechanism to an attack.

A localized, infected wound demonstrates an isolated inflammatory response as it turns red and sore. Inflammation is also triggered by stress and physical trauma; inflammation in turn triggers depression. This is related to response to the release of cytokines, which are small protein cells the body uses to help with the response.

This information may ultimately influence emotions and how you feel. By affecting the quality of your sleep, metabolism and stress responses, inflammation may create a biological environment triggering depressive symptoms.

The findings from these studies have contributed to a mounting body of evidence that inflammation may be a biochemical route of mental health symptoms. Thus, it may provide another nonpharmacological route for treating those who suffer with depression. Köhler-Forsberg and colleagues are interested in a pharmacological response, and he points out:7

"Some studies suggest that the choice of antidepressant can be decided by a blood sample that measures whether there is an inflammatory condition in the body. Other studies show that the same blood sample can be used as a guideline for whether a depressive patient can be treated with anti-inflammatory medicine that has a better effect when there is inflammation present at the same time as the depression.

However, we need to verify these findings and examine which patients can benefit from this before it can be implemented in everyday clinical practice."

Mental Health Screening May Overlook Contributing Factors

Physicians commonly use mental health screening tests to determine how best to treat depressive symptoms. The use of these screening tests is only as good as the physician administering them to analyze the data and how you feel when you enter the doctor's office.

In one 2013 study, an evaluation of 5,639 participants identified by their clinician as suffering with depression, researchers found only 38.4% met the DSM-4 criteria for a major depressive episode. In speaking to The New York Times, one of the researchers pointed out that not only are physicians prescribing more medications, but patients are demanding more as well.

He points out Americans have become used to using drugs to address the stresses of daily life that may trigger short-term situational sadness. Mental health screening tests do not often consider vitamin deficiencies, lack of exercise, poor nutrition, lack of sleep or inflammation.

Antidepressant Use Doubled in Seniors

In the 2013 study evaluating participants who were prescribed antidepressants by their physician, a mere 14.3% of those over age 65 met the DSM-4 criteria for a major depressive episode. To investigate whether the number of antidepressant drugs prescribed to seniors had risen, another team of researchers looked at data from 1991 to 1993.

They compared this against data gathered from studies occurring from 2008 to 2011. During the early period, 4.2% of adults were taking antidepressants. This number more than doubled to 10.7% during the later period. The rate of antidepressant use in older adults living in care homes in the English population cohort studies also rose, from 7.4% to 29.2%.

A study published in 2017 reviewed data from 1990 to 2015 gathered from Australia, Canada, England and the U.S. In this report it was noted that the prevalence of disorders and symptoms had not decreased despite an increase in the prescription of antidepressants.

In seniors, depression is associated with cognitive decline, dementia and poor medical outcomes. Those with depression also experience higher rates of suicide and mortality. Guidelines from the American Psychiatric Association suggest antidepressant medication with psychotherapy in the elderly. But, despite the increased risks with antidepressants, most seniors receive only medication.

Treatment with antidepressant drugs in seniors increases the risk of Type 2 diabetes, which increases the risk of other comorbid health conditions including heart disease and stroke. The drugs are also linked to the development of thicker arteries and dementia.

In addition, depending on the classification of drug, they are known to reduce several nutrients, including coenzyme Q10, vitamin B12, calcium and folate. Of concern in the elderly is the risk of osteoporosis and fractures associated with antidepressant medications.

One 2015 study compared women treated with indigestion drugs against those treated with SSRIs and found a 76% increased rate of fracture in the first year in those taking antidepressants. When these risks are combined with the knowledge the drugs work no better than placebo for mild to moderate depression, seniors may experience greater risk than any benefit they receive.

Consider Nonpharmacological Options to Reduce Depression

Reducing the inflammatory response in your body is crucial as it is a root cause of many chronic conditions, including depression. In addition to strategies to reduce inflammation, there are other approaches with a history of improving symptoms.

As you consider the following nonpharmacological suggestions, remember you don't have to do them all at once, and you can accomplish them no matter your age or current physical abilities. Begin the journey to better health taking small, permanent steps.

• Exercise — Exercise normalizes your insulin and leptin sensitivity and has a significant effect on kynurenine, a neurotoxic stress chemical produced from the amino acid tryptophan; brain-derived neurotrophic factor (BDNF), a growth factor regulating neuroplasticity and new growth of neurons and your endocannabinoid system, all of which

• Nutrition — There are several nutritional factors that affect your mood and emotions, not the least of which is eating too much sugar. Excessive amounts of sugar disrupt your leptin and insulin sensitivity, affect dopamine levels and damage your mitochondria, all of which affect your mood.

Nutrients such as omega-3 fats, magnesium, vitamin D and the B vitamins each influence your mood and brain health. You may experience the beneficial effects of boosting these nutrients to optimal levels in as little as two weeks.

• Light therapy — Light therapy is an effective treatment for seasonal affective disorder, and researchers8 find it is also effective against moderate to severe depression. Participants simply used a white light box for 30 minutes each day as soon as possible after waking up.

• Mindful meditation or Emotional Freedom Techniques (EFT) — In a study9 of 30 moderately to severely depressed college students, the depressed students were given four 90-minute EFT sessions. Students who received EFT showed significantly less depression than the control group when evaluated three weeks later.



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00:24 , ,

One of the primary roles of the U.S. Food and Drug Administration is to review the safety and efficacy of drugs before they are sold on the U.S. market. In 2016, The BMJ1 suggested a strong conflict of interest when they wrote about a revolving door existing between the FDA and the pharmaceutical industry. In pursuit of monetary gain, this relationship places the health of Americans at risk.

Although these ties have been revealed in the past, two researchers from Oregon Health and Science University suggested many of the medical reviewers at the FDA go on to work for drug companies.2

They found that of the 55 who had worked as hematology oncology medical reviewers for the FDA from 2001 to 2010, 15 had gone on to work with or consult in the pharmaceutical industry. In addition to the pharmaceutical industry’s influence in the FDA, one agency reports3 that in 2018 alone, $9.35 billion was spent on educating and entertaining doctors — that’s more than double the 2013 figure of $4.34 billion.

Big Pharma also keeps a hand in research to ensure their drugs are approved. For instance, when there are significant or severe forms of clinical trial violations in research using human participants, these are classified as an official action indicated, or OAI. In a review4 of FDA inspection reports from 1998 to 2013, researchers found 60 clinical trials classified as OAI used for data in 78 published articles.

Of those, only three mentioned violations found by the FDA including fraud, incompetence and misconduct. In other words, anyone using medical journal data to make decisions may find those decisions are based on fraudulent or heavily flawed published studies.

BMJ Calls for Accurate Research to Back Medical Practice

The BMJ launched a global initiative calling for a reduction in the commercial influence in health care moving toward transparency. In a press release published at the same time as the first article in the collection,5 BMJ’s editor-in-chief, Dr. Fiona Godlee, said:6

“Patients and the public deserve to have evidence they can trust. Commercial influence has no place in scientific research, nor in the education and guidance of clinicians, nor in decisions about diagnosis and treatment. We hope that people around the world support our call for fundamental reforms.”

The journal plans to add more content to the collection to further understanding of the conflict of interest between commercial Industries and medical decisions.7 They brought together experts from eight nations in medicine, law and philosophy to propose fundamental cultural changes with the intention of moving away from commercial influence and closer toward independence.

In trying to balance overtesting, overdiagnosis and overtreatment against necessary procedures for diagnosis, the experts want to ensure dissemination of valid evidence “conducted as independently as possible from industries profiting from their use.” They go on to say:8

“Some see transparency as the best strategy, while others regard it as necessary but insufficient. We argue that endemic financial entanglement is distorting the production and use of healthcare evidence, causing harm to individuals and waste for health systems.”

As such, the group is calling for governments to pass legislation requiring disclosure when medical reviewers are paid by the manufacturers. In addition, they bring attention to countries like Norway that have moved away from acknowledging physicians’ attendance at industry-sponsored events, when it comes to earning continuing educational credits.

Case in Point: Johnson & Johnson Liable for Damages

The idea that industry-funded studies affect medical decisions is not news.9 The number of clinical studies supported by companies that make a profit from the results is only growing. One example is Johnson & Johnson, the company that sold pelvic mesh to thousands of Australian women while knowing it could be harmful and without warning the women or physicians of the risks.

More than 1,350 women from Australia won a class action suit in November 2019 against Johnson & Johnson for misleading information about the risks of the pelvic mesh implants. The implants were sold by a subsidiary, Ethicon, which is charged with being negligent.

In addition to the Australian suit, Johnson & Johnson agreed to a $117 million settlement to resolve lawsuits about the pelvic mesh implants in 41 U.S. states. The same company was ordered to pay Oklahoma in a judgment in which the state argued Johnson & Johnson was a “kingpin” in the opioid crisis.

Oklahoma Attorney General Mike Hunter specifically identified two subsidiaries of Johnson & Johnson that provided the majority of the raw opium used by Johnson & Johnson and other manufacturers to produce the drugs for the past two decades.10

The women who had the pelvic mesh implanted for treatment of urinary incontinence testified to chronic pain, severe discomfort and bleeding during sex after having the implant. In the ruling against Johnson & Johnson in Australia, judge Anna Katzmann said:11

“The question is whether this conduct considered as a whole was misleading or likely to mislead. I believe it was. The post-market evaluation of all the Ethicon devices was deficient. It fell well below the level of care required of a reasonably prudent manufacturer. The risks were known, not insignificant and on Ethicon’s own admission, serious harm could ensue if they eventuated."

Big Pharma Identified a Path to Profits

The history of the relationship between physicians and pharmaceutical companies began in the early 1900s when the Carnegie Foundation contributed to the suppression of homeopathic practitioners.

The infamous Flexner Report gave homeopathic colleges a poor rating based in part on the school offering courses in pharmacology, which the American Medical Association did not consider worthwhile at the time.

Over time, the AMA and Big Pharma came to an understanding and relationship that has linked them ever since. While it may have seemed a logical step in the beginning, it has proven to be disastrous for health.

For instance,12 from 2011 to 2015, the pharmaceutical industry dropped more than $286 million on events attended by Australian clinicians. Some received free travel and lodging for overseas conferences.

This increases the likelihood a practitioner will prescribe the company's drugs. Although doctors have disputed this, a ProPublica analysis13 found doctors prescribed more drugs after receiving payments. The analysis shows an association and confirms the prevailing perception of a relationship between financial gifts and brand-name prescriptions.

In the wake of a call for transparency and independence from industry-funded research from the BMJ, Dr. Chris Moy, chair of the Australian Medical Association ethics and medico-legal committee voiced concern this may lead to a lack of funding.14

"Who is going to fund all this? Is the government going to fund it? Money makes the world go round, in simple terms. Research will not happen unless there is funding. Medicine is always going to need pharma companies. We cannot be too brutal on them.”

The Tale of Two Journals: NEJM Partners With Big Pharma

As The BMJ fights for transparency to protect consumer health, the New England Journal of Medicine (NEJM) appears to have taken the opposite tack. In 2015, there appeared three articles written by the same author, Dr. Lisa Rosenbaum,15,16,17 in which the journal appeared to shift its support in favor of closer ties between the pharmaceutical industry and the field of medicine.

February 7, 2019, the journal published two industry-funded studies examining omadacycline as an antibiotic for treatment in community-acquired pneumonia18 or soft tissue infection.19 In a description of the methods and analysis in the study on soft tissue infection, the authors wrote of Paratek, manufacturer of omadacycline:20

“Paratek Pharmaceuticals designed and conducted the trial and prepared the statistical analysis plan. Analyses were performed and data interpreted by Paratek Pharmaceuticals in conjunction with the authors.”

The study used a noninferiority trial design21 in which an experimental treatment is tested against an active control and approved treatment in use. Noninferiority trials are used when assigning patients to a placebo is unethical. One analysis of the studies came to this conclusion:22

“It is fairly evident that this article was not intended to further scientific progress, but rather to sell a shiny new product … And while by all accounts this novel antimicrobial appears to be non-inferior and likely equivalent to moxiflaxacin, it is the intention and the methodology which we should call into question.”

Further analysis of two more studies published on the same date revealed more holes in the studies, bending the results toward prescribing medications that were likely as effective as those currently being sold. The analysis finished with this conclusion:23

“While each of these articles offer their own distinct set of insults against empiricism, they do so in close temporal and spatial proximity, all published in the NEJM on the same day.”

Reduce Your Use of Big Pharma Products

Pharmaceutical companies have a history of altering information to perpetuate their own financial gain. Purdue Pharmaceutical’s Project Tango is only one example of a company that sought to take advantage of an epidemic they helped create by promoting a program to provide an addictive opioid and then the cure, essentially becoming an “end-to-end” provider.

The industry produces 55% more air pollution than the auto industry, despite being 28% smaller. Massive amounts of waste are also entering waterways near manufacturing plants, contributing to the growth of antibiotic-resistant bacteria.

Seek to make lifestyle choices that will reduce your dependence on drugs. Consider the information in the following articles to help guide your choices for nutrition, exercise and sleep, three foundational pillars to good health.



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