Drugs and Supplements
Consumers are barraged by ads for prescription drugs on television and in print. Twenty years ago, people who knew the names of the drugs available for their health conditions, and knew to ask for new drugs by name, were few and far between. But today, direct-to-consumer ads encourage patients to ask their doctors for new (and often pricey) medications. While it isn’t bad to inform people about new and potentially better medications, this tidal wave of advertising has a downside. Potential side effects and risks are not always completely and plainly explained and the cost of these drugs is often not made clear. While it is fine to ask your doctor about a drug you’ve seen on TV or elsewhere, be aware that a new medicine is not necessarily a better medicine — or the right one for you.
Women of all ages have questions and concerns about their sex lives. These issues often come up after having a baby, during perimenopause, and well into later life, too. Women’s sexuality is very complex. Brain chemistry, mood, hormones, and the nature of a woman’s relationship with her sexual partner are all important influences. This week, the FDA approved the drug flibanserin for treatment of low sex drive in premenopausal women. This drug is no “pink Viagra,” and its effect on women’s sexual function may be small, but it may be a step in the right direction simply because it draws attention to the value of a satisfying sex life for women and acknowledges it as a legitimate health concern.
Vitamin D holds promise for many things, like building bone, preventing heart attacks and strokes, reducing cancer risk, and more. But that promise isn’t fully backed by science. For example, a controlled clinical trial published this week in JAMA Internal Medicine found that a vitamin D supplements didn’t build bone in postmenopausal women with blood levels of vitamin D below the threshold generally considered necessary for good health. Many researchers are looking ahead to results from an ongoing trial called VITAL, which aims to gather the kind of solid evidence that will let us know for sure whether taking relatively high doses of vitamin D can ward off heart attack, stroke, or cancer. The results are expected by the end of 2017. It’s also possible to get vitamin D the old-fashioned way: go out in the sun between 10 a.m. and 3 p.m. with at least 10% of your skin exposed. Stay out long enough to absorb the sun but not long enough to be burned.
The latest guidelines used to determine who should take a cholesterol-lowering statin to prevent heart disease appear to be more accurate and cost-efficient than the previous guidelines. That’s according to two studies led by Harvard researchers, both published in this week’s Journal of the American Medical Association. The new guidelines, published in 2013 by the American College of Cardiology and the American Heart Association, recommend a statin for men and women between the ages of 40 and 75 who have a 7.5% or higher risk of having a heart attack or stroke over the next 10 years. The JAMA studies show that the new guidelines provide a more accurate assessment of who would benefit from a statin and who wouldn’t, and are more cost-effective than the older guidelines. Statins aren’t a cure-all. Eating a healthier diet, exercising often, and not smoking will go a long way to preventing heart attack and stroke.
High cholesterol is a key culprit in the development of cardiovascular disease, the leading cause of death in the United States and many other developed countries. We know that lowering cholesterol helps prevent heart attacks and strokes. But an unanswered question remains: how low should you go? New research published online today in The New England Journal of Medicine suggests that lower is better. In a large clinical trial, participants who took a cholesterol-lowering statin plus ezetimibe, a different type of cholesterol-lowering drug, had lower levels of harmful LDL cholesterol and experienced fewer heart attacks and strokes than participants taking a statin alone. The new findings provide a strong rationale for using ezetimibe when a statin alone isn’t enough.
When appendicitis strikes, an operation to remove the appendix has long been the route to recovery. But a new strategy called “antibiotics first” could help some people avoid surgery for appendicitis. A clinical practice article in today’s New England Journal of Medicine explores the idea of antibiotics first for appendicitis. The main advantage is that it could eliminate the need for surgery in some people with appendicitis. The drawbacks are that it leaves open the possibility of repeat bouts of appendicitis, with an appendectomy still down the road. It could also lead to lingering symptoms and a sense of uncertainty that could affect quality of life. Although immediate surgery is the standard of care for appendicitis, an antibiotics first approach could be appropriate now for individuals who prefer not to have surgery, aren’t healthy enough for surgery, or aren’t near a medical center that routinely does laparoscopic appendectomy.
Each year, several million people with neck or back pain get injections of anti-inflammatory steroid medications. When they work (they don’t always), such injections can bring profound relief. But injecting these medications into the spine can cause partial or total paralysis, brain damage, stroke, and even death. Case reports beginning in 2002 highlighted serious problems linked to spinal steroid injections. In 2014, the FDA started requiring a warning on the labels of injectable steroids. A Viewpoint article in this week’s Journal of the American Medical Association spotlights new safety recommendations to help prevent these rare but real problems. The new recommendations are part of the FDA’s Safe Use Initiative.
Each year, an alarming number of babies born in the United States spend their first few days withdrawing from drugs, often prescription painkillers their mothers took during their pregnancies. This problem, called neonatal abstinence syndrome (NAS), has increased fourfold since 2004, according to a report published online yesterday in The New England Journal of Medicine. NAS occurs in many babies whose mothers took a type of medication called an opioid during pregnancy. (Two commonly used opioids are OxyContin and Vicodin.) These drugs easily pass from the mother’s bloodstream to the baby’s. In effect, NAS is a baby’s withdrawal from opioids. With medication and time, babies with NAS get better, but they have to spend time in the hospital. In short, they get a rough start on life that can set them back and possibly have long-term repercussions. With so many safe options for pain control, women who are pregnant should use opioids only if these medications are absolutely necessary.
If you’re among the one in three American adults with high blood pressure, be sure you’re getting plenty of the B vitamin known as folate. Doing so may lower your odds of having a stroke, an often disabling or deadly event linked to high blood pressure. That’s the conclusion of a large trial conducted in China, where many people don’t get enough folate. Most Americans get plenty of folate or its synthetic version, folic acid. That’s largely because grain folic acid is added to most grain products, including wheat flour, cornmeal, pasta, and rice. It’s a good idea for everyone to do a diet check to make sure it delivers enough folate. Good sources include green leafy vegetables, beans, and citrus fruits.
Every so often, a medical advance comes along that rewrites the script for treating a disease or condition. After today’s announcement of impressive results of a new type of cholesterol-lowering drug, that scenario just might happen in the next few years. The results of three clinical trials presented today at the annual meeting of the American College of Cardiology, and simultaneously published in the New England Journal of Medicine, suggest that a class of new drugs called PCSK9 inhibitors can dramatically reduce the amount of harmful LDL cholesterol circulating in the bloodstream and prevent heart attacks, strokes, and other problems related to cholesterol-clogged arteries. The drawbacks are that PCSK9 inhibitors must be given by injection every 2 to 4 weeks, may cause mental confusion or trouble paying attention, and, if approved, will likely be expensive.