Annals Internal Medicine, Author Interviews, Diabetes, Pediatrics / 15.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46950" align="alignleft" width="100"]Juliana CN Chan MD Chair Professor of Medicine and Therapeutics Head, Division of Clinical Pharmacology, Department of Medicine and Therapeutics Director, Hong Kong Institute of Diabetes and Obesity Director, Clinical Research Management Office Faculty of Medicine The Chinese University of Hong Kong Dr. Chan[/caption] Juliana CN Chan MD Chair Professor of Medicine and Therapeutics Head, Division of Clinical Pharmacology, Department of Medicine and Therapeutics Director, Hong Kong Institute of Diabetes and Obesity Director, Clinical Research Management Office Faculty of Medicine The Chinese University of Hong Kong MedicalResearch.com: What is the background for this study? What are the main findings? Response: The prevalence of young onset diabetes (YOD) is increasing world-wide with doubling of its prevalence in the last 10 years in many developed nations. Using the Hong Kong Diabetes Register established since 1995, we first reported that 1 in 5 Chinese adults with diabetes were diagnosed before the age of 40 years. These young patients had poor control of multiple risk factors with 1.5 fold higher risk of premature death and cardiovascular-renal complications compared to patients with usual onset of diabetes after the age of 40 (Chan JC et al AJM 2014, Luk A et al Diabetes Care 2014). Due to the multisystem nature of diabetes, we asked the question whether these young patients might have recurrent hospitalizations during their 3-4 decades of complex clinical course. Using a territory-wide diabetes database involving 0.42 million people followed up between 2002 and 2014, we compared the hospitalization rates accrued till the age of 75 years and found that patients with young onset diabetes had the highest hospitalization rates by attained age. Compared to patients with usual onset of diabetes, patients with YOD had 1.8- 6.7 higher risk of hospitalizations due to all-causes, notably renal disease compared to those with usual onset of disease. Amongst patients with young onset diabetes, over one-third of the bed-days were due to mental illness before the age of 40 years. We used mathematical modeling and estimated that intensified risk factor control in YOD can reduce the cumulative bed-days by 30% which can be further reduced by delaying the onset of diabetes. These original data is a wakening call to the community regarding the complex nature of YOD involving interactions amongst environment, lifestyles and personal factors (e.g. genetics, education and socioeconomic status) and the biomedical-psychological-behavioral needs of these high risk population, which if undiagnosed, untreated or suboptimally managed, can have huge economic impacts on health care system and loss of societal productivity, leaving personal suffering aside.
Addiction, Author Interviews, JAMA, UCLA / 15.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46947" align="alignleft" width="200"]Dr-John W. Ayers Dr. Ayers[/caption] John W. Ayers, PhD MA Division of Infectious Diseases and Global Public Health Department of Medicine, University of California San Diego, La Jolla MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The Substance Abuse and Mental Health Services Administration national helpline (1-800-662-HELP) is the only free, federally managed and endorsed US drug treatment referral service, helping callers find the best local services that match their needs. Are millions suffering simply because they are not aware that lifesaving help is a phone call away? In our new study, published in JAMA Internal Medicine, Mark Dredze, Alicia Nobles and I delved into Americans’ engagement with 1-800-662-HELP following singer Demi Lovato’s July 24, 2018 hospitalization for a reported overdose that on-the-scene investigators originally linked to heroin. Lovato has since recovered.
Aging, Author Interviews, Geriatrics, Lancet, Nutrition, UC Davis, Weight Research / 15.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46867" align="alignleft" width="183"]Valter Longo, PhD Edna M. Jones Professor of Gerontology  Professor of Biological Sciences Leonard Davis School of Gerontology Director of the USC Longevity Institute USC Dr. Longo[/caption] Valter Longo, PhD Edna M. Jones Professor of Gerontology Professor of Biological Sciences Leonard Davis School of Gerontology Director of the USC Longevity Institute USC MedicalResearch.com: What is the background for this study? What are the main findings? Response: The use of a low calorie diet that mimics fasting for 4 days twice a month starting at middle age can extend lifespan and rejuvenate mice. In humans a similar diet once a month causes improvements in cholesterol, blood pressure , inflammation, fasting glucose etc consistent with rejuvenation
Author Interviews, Depression, JAMA, Surgical Research, Urology / 14.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46921" align="alignleft" width="114"]Blayne Welk MD, MSc, FRCSC Associate Professor of Surgery St. Joseph's Hospital Western University Dr. Welk[/caption] Blayne Welk MD, MSc, FRCSC Associate Professor of Surgery St. Joseph's Hospital Western University MedicalResearch.com: What is the background for this study? What are the main findings? Response: I found that when I was referred women with midurethral sling complications, they were often quite emotional and described a significant period of time when they struggled with the complications before they were referred to someone to assess them. The study looked at the rate of depression and self-harm behavior of women who had surgery for midurethral sling complications compared to women who did not have midurethral sling complications. I found that there was an increased risk of both of these outcomes among women who had surgery for complications, however this risk was primarily present in younger women.
Author Interviews, Heart Disease, JACC, Sleep Disorders / 14.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46941" align="alignleft" width="133"]José M. Ordovás, PhD Director Nutrition and Genomics Professor Nutrition and Genetics            JM-USDA-HNRCA at Tufts University Boston, MA 02111 Dr. Ordovás[/caption] José M. Ordovás, PhD Director Nutrition and Genomics Professor Nutrition and Genetics JM-USDA-HNRCA at Tufts University Boston, MA 02111 MedicalResearch.com: What is the background for this study? Response: The current knowledge supports the notion that poor sleep is associated with cardiovascular risk factors such as obesity, hypertension, and diabetes. Besides, there is some proof that poor sleep might be related to the development of atherosclerosis; however, this evidence has been provided by studies including few participants and, in general, with sleep disorders, such as sleep apnea. Our research has used state-of-the-art imaging technology to measure plaque buildup in the arteries, and objective measures of sleep quantity and quality in about 4000 participants of the PESA CNIC- Santander Study. Moreover, this is the first study to look at the multiterritory development of plaques versus other studies that looked exclusively at the coronary arteries. Therefore, this combination provides stronger evidence than previous studies about the risk of poor sleep on the development of atherosclerosis.
Author Interviews, Diabetes, JAMA, Ophthalmology / 13.01.2019

MedicalResearch.com Interview with: [caption id="attachment_38910" align="alignleft" width="300"]Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. Illustration depicting diabetic retinopathy Illustration depicting diabetic retinopathy[/caption] Eugene Yu-Chuan Kang, MD. House Staff, Department of Ophthalmology Chang Gung Memorial Hospital Chang Gung University, School of Medicine MedicalResearch.com: What is the background for this study?   Response: More and more patients suffered from diabetes mellitus (DM) around the world, as well diabetic complications such as diabetic retinopathy (DR). DR is one of the major causes of blindness in working-age adults. In addition to the cost of treatment for patients with advanced DR, loss of visual function also yields a great burden to the family and society. For advanced DR, surgical interventions such as retinal laser, intravitreal injection, and vitrectomy are needed. However, those surgical interventions for severe DR can only retard or stop disease progression. If DR can be prevented or slowed by medical treatments, the burden of medical costs for treating severe DR may be decreased. Statin, an HMG-CoA reductase inhibitor, was discussed frequently in the recent years. Multiple functions of statins besides their lipid lowering effect were discovered. Previous investigations have reported that statin therapy could reduce mortality rate and decrease risk of cardiovascular diseases. In our study, we wanted to figure out if statin therapy may have any association between diabetic retinopathy. 
Alzheimer's - Dementia, Author Interviews, Science, Sleep Disorders / 13.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46932" align="alignleft" width="137"]Brendan P. Lucey, MD, MSCI Assistant Professor of Neurology Director, Sleep Medicine Section Washington University School of Medicine Saint Louis, Missouri 63110 Dr. Lucey[/caption] Brendan P. Lucey, MD, MSCI Assistant Professor of Neurology Director, Sleep Medicine Section Washington University School of Medicine Saint Louis, Missouri 63110 MedicalResearch.com: What is the background for this study? Response: Alzheimer’s disease and sleep are currently thought to have a two-way or bidirectional relationship. First, sleep disturbances may increase the risk of developing AD. Second, changes in sleep-wake activity may be due to Alzheimer’s disease pathology and our paper was primarily focused on this aspect of the relationship.    If sleep changes were a marker for AD changes in the brain, then this would be very helpful in future clinical trials and possibly screening in the clinic.
Author Interviews, Dermatology, Education / 13.01.2019

MedicalResearch.com Interview with: Yssra-SolimanYssra S. Soliman, BA Division of Dermatology, Department of Internal Medicine Albert Einstein College of Medicine Bronx, New York MedicalResearch.com: What is the background for this study? What are the main findings?  Response: As the population of the United States becomes increasingly diverse, certain fields within medicine have not followed this trend. Dermatology is the least diverse field after orthopedics. We wanted to understand what barriers prevent medical students from applying to dermatology and whether these barriers differed based on students' racial, ethnic or socioeconomic backgrounds. The main findings of this study are that certain groups are more likely to cite specific barriers than non-minority students. These barriers are significant deterrents to applying to dermatology and include the lack of diversity in dermatology, negative perceptions of minority students by residency programs, socioeconomic barriers such as lack of loan forgiveness and poor accessibility to mentors. 
Author Interviews, JACC, Karolinski Institute, OBGYNE, Pediatrics, Weight Research / 12.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46817" align="alignleft" width="137"]Martina Persson, M.D, PhD Karolinska Institutet Dr. Persson[/caption] Martina Persson, M.D, PhD Karolinska Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is well known that maternal obesity increases risks of adverse fetal outcomes, including congenital malformations of the heart. However, it is unclear if maternal overweight and obesity associate with risks of specific and more complex congenital heart defects. We conducted a population-based cohort study in Sweden using data from several health registries. The study included more than 2 million live, singletons born between 1992-2012. Risks (prevalence rate ratios) of complex heart defects (Tetralogy of Fallot, transposition of the great arteries (TGA), atrial septal defects (ASD), aortic arch defects, and single ventricle heart) and several specific heart defects were estimated in infants to mothers with overweight and increasing degree of obesity. We found that risks of aortic arch defects, ASD and patent ductus arteriosus (in term infants) increased with maternal obesity severity. On the other hand, we found no clear associations between maternal BMI and risks of several other complex and specific heart defects. 
Author Interviews, Global Health, Pediatrics, Pulmonary Disease, Weight Research / 12.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46917" align="alignleft" width="200"]Judith Garcia Aymerich Head of the Non-Communicable Diseases and Environment Programme ISGlobal  Dr. Garcia-Aymerich[/caption] Judith Garcia Aymerich Head of the Non-Communicable Diseases and Environment Programme ISGlobal  MedicalResearch.com: What is the background for this study? Response: Several studies have assessed the associations of overweight and obesity with lung function in children and adolescents, but they have found contradictory results. An important limitation of these studies is that most of them considered only overall body weight and did not take into account for the different contribution of lean body mass and fat mass, and their relative proportions that vary by age and sex.
Author Interviews, Chemotherapy, Colon Cancer / 12.01.2019

MedicalResearch.com interview with: [caption id="attachment_46915" align="alignleft" width="133"]Anders Rabbe CEO of Isofol Medical Anders Rabbe[/caption] Anders Rabbe CEO of Isofol Medical MedicalResearch.com: What is the background for this study? How common is colorectal cancer?  Response: Colorectal cancer (CRC) is one of the most common forms of cancer with more than 1.8 million new cases identified globally every year. Due to a lack of new therapeutic options and a high mortality rate, colorectal cancer is a disease with a significant unmet need for effective new treatments. Isofol is developing arfolitixorin (Modufolin®) to improve the efficacy of standard of care chemotherapy for advanced colorectal cancer. Arfolitixorin is the company’s proprietary drug candidate currently being studied in a global Phase 3 AGENT study (ISO-CC-007) as a first-line treatment for patients with metastatic colorectal cancer (mCRC), which just enrolled its first patient in December of 2018.
Author Interviews, CDC, Global Health, Infections, Vaccine Studies / 11.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46907" align="alignleft" width="200"]Kevin Chatham-Stephens, MD, MPH, FAAP CDR U.S. Public Health Service Dr. Chatham-Stephens[/caption] Kevin Chatham-Stephens, MD, MPH, FAAP CDR U.S. Public Health Service MedicalResearch.com: What is the background for this study? Response: Typhoid fever is a life-threatening disease caused by Salmonella Typhi bacteria. It spreads when someone consumes food or water that has been contaminated with feces (poop) from someone carrying the bacteria. About 12–27 million cases of typhoid fever occur worldwide every year. About 350 culture-confirmed cases of typhoid fever in the United States are reported to CDC each year. Most of these cases occur among international travelers. Symptoms of typhoid fever often include high fever, weakness, stomach pain, cough, and loss of appetite. Some people have diarrhea or constipation. Typhoid fever can be prevented through vaccination and safe food and water practices. Typhoid fever is treated with antibiotics, although most infections diagnosed in the United States cannot be successfully treated with the class of antibiotics called fluoroquinolones.
Author Interviews / 11.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46896" align="alignleft" width="185"]Gurit E. Birnbaum, Ph.D. Associate Professor Baruch Ivcher School of Psychology Interdisciplinary Center (IDC) Herzliya Herzliya, Israel Dr. Birnbaum[/caption] Gurit E. Birnbaum, Ph.D. Associate Professor Baruch Ivcher School of Psychology Interdisciplinary Center (IDC) Herzliya Herzliya, Israel  MedicalResearch.com: What is the background for this study? Response: Sexual desire evolved to serve as a powerful motivational force that brings potential romantic partners together initially and thereby helps to facilitate sexual intercourse and pregnancy. As such, sexual acts may be devoid of affectional bonding, as in the case of one night stands. And yet, sexual desire may play a major role not only in attracting potential partners to each other, but also in encouraging the formation of an attachment between them. Nevertheless, thus far it has been unclear whether desire motivates merely reproductive acts, with attachment between partners developing independently, or whether desire directly contributes to the building of an emotional bond between newly acquainted partners. Indeed, although sexual urges and emotional attachments are not necessarily connected with each other, evolutionary and social processes may have rendered humans particularly likely to become romantically attached to partners to whom they are sexually attracted. The present research sought to provide support for the latter option.
Author Interviews, BMJ, Endocrinology, Heart Disease, Hormone Therapy, Menopause, Thromboembolism / 11.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46894" align="alignleft" width="120"]Yana Vinogradova, PhD Research Fellow Department of Primary Care School of Medicine University of Nottingham University Park, Nottingham Dr. Vinogradova[/caption] Yana Vinogradova, PhD Research Fellow Department of Primary Care School of Medicine University of Nottingham University Park, Nottingham MedicalResearch.com: What is the background for this study?   Response: The study targeted middle age women going through menopause.  This is the stage of life when women naturally reach the end of their reproductive life and their hormones gradually decrease.  Some women experience unpleasant effects such as hot flushes, night sweats, mood swings, memory and concentration loss, headaches.  Quality of life may be severely affected.  Hormone replacement therapy uses a class of drugs, which, like all drugs, have side effects.   VTE is a serious side effect which can have a lethal outcome. There are different preparations of hormones available for such women.  Some of them were extensively studied in a large American Trial Women’s Health Initiative and showed the risk of VTE to be twice as high for women who took them.  However, these well-studied drugs are mostly prescribed in America.  The more popular drugs in Europe and the UK have been much less studied, so it was unclear how they compared. 
Author Interviews, Cancer Research, Esophageal, NEJM, Surgical Research / 11.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46825" align="alignleft" width="130"]Guillaume Piessen, MD, PhD University Hospital Centre Lille, France Prof. Piessen[/caption] Guillaume Piessen, MD, PhD University Hospital Centre Lille, Franc MedicalResearch.com: What is the background for this study? Response: Patients requiring surgery for esophageal cancer fare better after undergoing a hybrid minimally invasive esophagectomy (HMIE) with a combined laparoscopy+thoracotomy procedure compared to an open esophagectomy (OE), according to results of the MIRO trial published in the last issue of the New England Journal Of Medicine (link article). This French prospective multi-center randomized controlled study was funded by the French National Cancer Institute (Grant n° 1907). The study was conducted by Pr Mariette who sadely passed away in 2017 and Pr Piessen (Department of Digestive and Oncological Surgery, CHU Lille), under the hauspice of FRENCH (Fédération de Recherche EN Chirurgie) and FREGAT (French Eso-Gastric Tumors) working group (https://www.fregat-database.org/fr/). Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer. Hybrid minimally invasive esophagectomy (HMIE) combines a laparoscopic abdominal phase with an open thoracotomy, which may have specific advantages including lower rate of pulmonary complications, without laparoscopic tumor dissection limiting potential tumor spillage and easier reproducibility of the technique [12]. Postoperative morbidity, especially pulmonary complications, affects more than half of patients after open esophagectomy for esophageal cancer. Hybrid minimally invasive esophagectomy (HMIE) combines a laparoscopic abdominal phase with an open thoracotomy, which may have specific advantages including lower rate of pulmonary complications, without laparoscopic tumor dissection limiting potential tumor spillage and easier reproducibility of the technique [12].
Author Interviews, JAMA, Smoking, Social Issues, Tobacco Research, UCSD / 11.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46797" align="alignleft" width="128"]Eric Leas PhD, MPH Stanford Prevention Research Center University of California, San Diego Dr. Leas[/caption] Eric Leas PhD, MPH Stanford Prevention Research Center University of California, San Diego MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recent research has demonstrated the importance that neighborhood context has on life opportunity, health and well-being that can perpetuate across generations. A strongly defining factor that leads to differences in health outcomes across neighborhoods, such as differences in chronic disease, is the concurrent-uneven distribution of modifiable risk factors for chronic disease. The main goal of our study was to characterize inequities in smoking, the leading risk factor for chronic disease, between neighborhoods in America's 500 largest cities. To accomplish this aim we used first-of-its-kind data generated from the 500 Cities Project—a collaboration between Robert Wood Johnson Foundation and the US Centers for Disease Control and Prevention—representing the largest effort to provide small-area estimates of modifiable risk factors for chronic disease. We found that inequities in smoking prevalence are greater within cities than between cities, are highest in the nation’s capital, and are linked to inequities in chronic disease outcomes. We also found that inequities in smoking were associated to inequities in neighborhood characteristics, including race, median household income and the number of tobacco retailers. 
Author Interviews, Gastrointestinal Disease, Microbiome, Nature / 11.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46889" align="alignleft" width="132"]Dr. Venkatakrishna R Jala, PhD Assistant Professor James Graham Brown Cancer Center Department of Microbiology and Immunology University of Louisville Dr. Jala[/caption] Dr. Venkatakrishna R Jala, PhD Assistant Professor James Graham Brown Cancer Center Department of Microbiology and Immunology University of Louisville MedicalResearch.com: What is the background for this study? What are the main findings? Response: Humans evolved along with their gut microbiota and adapted their physiological activities to help each other. Along with consumption of healthy diets, humans must harbor the appropriate microbiota to convert the foods into available components called metabolites. These microbial metabolites play a critical role in preserving homeostasis, the development of immune systems and preventing adverse events both systemically and locally. Despite the availability of large metagenomics (bacterial sequence) data, and its associations with disease conditions, the functional dynamics of microbiota (good vs bad) in human health or diseases are yet to be defined. The host’s indigenous gut microbiota and its metabolites have emerged as key factors that greatly influence human health and disease, including inflammatory bowel diseases (IBD). IBD patients suffer from leaky gut and increased inflammation. The current study demonstrates that a microbial metabolite derived from ellagitannin/ellagic acid rich diets (e.g., pomegranate, berries) called ‘urolithin A’ and its synthetic analogue significantly enhance gut barrier function in addition to blocking the unwarranted inflammation in IBD animal models. 
Author Interviews, Microbiome, Surgical Research, Weight Research / 11.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46883" align="alignleft" width="147"]Casey Morrow, Ph.D. Leader of the research team and professor emeritus Department of Cell, Developmental and Integrative Biology University of Alabama at Birmingham Dr. Morrow[/caption] Casey Morrow, Ph.D. Leader of the research team and professor emeritus Department of Cell, Developmental and Integrative Biology University of Alabama at Birmingham MedicalResearch.com: What is the background for this study? Response: The human gastrointestinal tract (GIT) contains several distinct physical environments within the stomach, small intestine (duodenum, jejunum, ileum) and colon that harbor complex microbial communities. Changes in the fecal microbe composition have been described for Roux-en-Y gastric bypass (RYGB), the most effective and durable treatment for morbid obesity, and sleeve gastrectomy (SG).
Author Interviews, Pediatrics / 10.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46852" align="alignleft" width="144"]PHILIPPE P. HUJOEL PhD, DDS, MSD, MS Professor, Oral Health Sciences Adjunct Professor, Epidemiology Adjunct Professor, Periodontics Dental Public Health Sciences, School of Dentistry University of Washington Dr. Hujoel[/caption] PHILIPPE P. HUJOEL PhD, DDS, MSD, MS Professor, Oral Health Sciences Adjunct Professor, Epidemiology Adjunct Professor, Periodontics Dental Public Health Sciences, School of Dentistry University of Washington MedicalResearch.com: What is the background for this study? Response: In 2012, an economist, Kevin Denny, identified an association between breastfeeding and handedness.  The newly published study attempted to refute this association in a larger population, and with more control for potential confounding variables.
Author Interviews, JAMA, Primary Care / 10.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46878" align="alignleft" width="142"]Ying Xue, DNSc, RN Associate Professor University of Rochester School of Nursing Rochester NY 14642 Dr. Ying Xue[/caption] Ying Xue, DNSc, RN Associate Professor University of Rochester School of Nursing Rochester NY 14642 MedicalResearch.com: What is the background for this study? Response: Shortages of primary care physicians have been a national concern, and forecasts project worsening trends in the future.1 The shortfall of primary care physicians is particularly severe in rural and other underserved communities, and some evidence indicates that the shortage of primary care physicians is due to maldistribution rather than insufficient supply.2 Nurse practitioners (NPs) constitute the largest and fastest growing group of non-physician primary care providers. The Health Resources and Services Administration (HRSA) estimated that the number of primary care NPs will grow 93% from 2013 to 2025, and a projected shortage of 23,640 full-time equivalent primary care physicians in 2025 could be effectively mitigated with better utilization of NPs and physician assistants.1 As the primary care physician shortage persists, examination of trends in the distribution of primary care NP supply, particularly in relation to populations most in need, will inform strategies to strengthen primary care capacity. However, such evidence is limited, particularly in combination with physician workforce trends. We thus characterized the temporal trends in the distribution of primary care NPs in low-income and rural areas compared with the distribution of primary care physicians.
Author Interviews, Cost of Health Care, Dartmouth, JAMA, Pharmaceutical Companies / 09.01.2019

MedicalResearch.com Interview with: Steven Woloshin, MD, MS Professor Co-director of the Center for Medicine and Media The Dartmouth InstituteSteven Woloshin, MD, MS Professor Co-director of the Center for Medicine and Media The Dartmouth Institute MedicalResearch.com: What is the background for this study? What are the main findings? What influence does medical marketing have on medical care and drug prices? Response: There are published studies looking at promotional spending mostly for drugs (DTC and professional).  This paper is unique because it is such a broad look including not just drugs but also marketing of disease (in "awareness campaigns"), health services and laboratory tests. What is new here is the size and scope of marketing.  For context, $29.9 billion spent on promoting prescription drugs, disease awareness campaigns, health services, and laboratory tests corresponds approximately to $1000 per American.    For context, FDA's total budget is around $5 billion – and NIH's total budget is about $30 billion. This figure is up from $17.7 billion in 1997, with the most rapid increase in DTC promotion of prescription drugs and health services.   Pharmaceutical marketing to professionals (detailing visits and samples) accounted for most spending and remained high despite policies to limit industry influence. $30 billion is of an underestimate (egg, we did not include monies spent on professional marketing (detailing) of laboratory tests, health services or devices, the value of drug coupons/discounts/rebates, company marketing budgets, lobbying or campaign contributions). Further it is just the tip of the iceberg – marketing works so promotional spending is an important driver of why medical care is so expensive:  it leads to more – and more expensive - tests and treatments.
Alcohol, Author Interviews, Depression, JAMA / 09.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46863" align="alignleft" width="200"]Dr. Ingunn Olea Lund, PhD The Norwegian Institute of Public Health Oslo, Norway Dr. Ingunn Olea Lund[/caption] Dr. Ingunn Olea Lund, PhD The Norwegian Institute of Public Health Oslo, Norway MedicalResearch.com: What is the background for this study? Response: There are significant amounts of research on children of parents with alcohol use disorders – where the children are shown to be at risk of several adverse outcomes, including mental disorders, substance use disorders, suicide, impaired school performance, and employment problems. There is very little previous research on how other, more normal levels of parental drinking may influence child outcomes, such as mental health. This is a grave oversight, as there are vastly more parents with normal drinking patterns than there are parents who suffer from an alcohol use disorder. This means that there are potentially a lot more cases of adverse effect for children, and the number of children at risk may be higher than previously assumed. In addition to parents' alcohol use, several other risk factors in the family that may affect child mental health outcomes, such as parents' mental health and socio-economic status. Researchers have tended to look at these risk factors separately, but as these risks tend to co-occur, it may be more informative to consider them together. To our knowledge, this is the first study that examines possible harm from normal levels of parental drinking, alone or in combination with other parental risk factors, on children’s anxiety and depression. The sample consists of more than 8700 triads: children and both their parents. We combined information from three health registries with survey data where both adolescents and their parents provided information about health and social conditions. The health registers include information about the children 's actual contact with the health care system; we used information about whether children received diagnoses and/or treatment for anxiety and/or depression.
Author Interviews, C. difficile, Microbiome, Pain Research / 09.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46859" align="alignleft" width="133"]MedicalResearch.com Interview with: David M. Aronoff, MD, FIDSA, FAAM Professor & Addison B. Scoville Jr. Chair in Medicine Director, Division of Infectious Diseases Department of Medicine Vanderbilt University Medical Center MedicalResearch.com: What is the background for this study? Response: Clostridium difficile infection (CDI) is a major cause of antibiotic-associated colitis and diarrhea and a leading cause of hospital-acquired infection. It is caused by the toxin-producing, anaerobic, spore-forming bacterium Clostridium difficile. Antibiotic use is a major risk factor for CDI but epidemiological studies suggest that other factors, some modifiable, some not, can also increase the risk for CDI. Older age is an example of a non-modifiable risk factor for CDI. Some epidemiological studies suggested that taking the prostaglandin synthesis inhibiting drugs called non-steroidal anti-inflammatory drugs (NSAIDs) might also increase the risk for CDI. NSAIDs include medications such as ibuprofen, naproxen, indomethacin, and others. Because NSAID use is so common, if it is a risk factor for the acquisition of, or severity of, CDI, that would be important because that would be a modifiable risk factor. We therefore sought to determine the impact of NSAID exposure on CDI severity in a mouse model of antibiotic-associated CDI. We also sought evidence for possible mechanisms whereby NSAIDs might increase the risk for CDI. MedicalResearch.com: What are the main findings? Response: Exposure of mice to indomethacin (an NSAID) for two days prior to infection with Clostridium difficile in antibiotic-exposed mice increased the severity of disease and this was associated with severe inflammation, changes to the bacterial populations in the colon and increased damage to the protective epithelial lining of the colon. MedicalResearch.com: What should readers take away from your report? Response: Our studies provide evidence in a mouse model of CDI that support human epidemiological studies linking NSAID use with CDI. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Studies in humans are needed to see if NSAID use is indeed a causal risk factor for CDI acquisition or severity. MedicalResearch.com: Is there anything else you would like to add? Response: This work was funded by the National Institutes of Health and the Crohn’s and Colitis Foundation of America. Dr. Aronoff has served as Consultant for Synthetic Biologics, Inc, Biocidium, NAEJA-RGM and BLC-USA on projects unrelated to this study. He also has research funding from Pfizer unrelated to this study. Citation: Damian Maseda, Joseph P. Zackular, Bruno Trindade, Leslie Kirk, Jennifer Lising Roxas, Lisa M. Rogers, Mary K. Washington, Liping Du, Tatsuki Koyama, V. K. Viswanathan, Gayatri Vedantam, Patrick D. Schloss, Leslie J. Crofford, Eric P. Skaar, David M. Aronoff. Nonsteroidal Anti-inflammatory Drugs Alter the Microbiota and Exacerbate Clostridium difficile Colitis while Dysregulating the Inflammatory Response. mBio, 2019; 10 (1) DOI: 10.1128/mBio.02282-18 [wysija_form id="3"] [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. Dr. Aronoff[/caption]David M. Aronoff, MD, FIDSA, FAAM Professor & Addison B. Scoville Jr. Chair in Medicine Director, Division of Infectious Diseases Department of Medicine Vanderbilt University Medical Center MedicalResearch.com: What is the background for this study? Response: Clostridium difficile infection (CDI) is a major cause of antibiotic-associated colitis and diarrhea and a leading cause of hospital-acquired infection. It is caused by the toxin-producing, anaerobic, spore-forming bacterium Clostridium difficile. Antibiotic use is a major risk factor for CDI but epidemiological studies suggest that other factors, some modifiable, some not, can also increase the risk for CDI. Older age is an example of a non-modifiable risk factor for CDI. Some epidemiological studies suggested that taking the prostaglandin synthesis inhibiting drugs called non-steroidal anti-inflammatory drugs (NSAIDs) might also increase the risk for CDI. NSAIDs include medications such as ibuprofen, naproxen, indomethacin, and others. Because NSAID use is so common, if it is a risk factor for the acquisition of, or severity of, CDI, that would be important because that would be a modifiable risk factor. We therefore sought to determine the impact of NSAID exposure on CDI severity in a mouse model of antibiotic-associated CDI. We also sought evidence for possible mechanisms whereby NSAIDs might increase the risk for CDI.
Author Interviews, JAMA, Orthopedics, Pain Research, University of Pittsburgh / 09.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46849" align="alignleft" width="200"]Dr. Michael Schneider DC, PhD Associate Professor School of Health and Rehabilitation Sciences  University of Pittsburgh Dr. Schneider[/caption] Dr. Michael Schneider DC, PhD Associate Professor School of Health and Rehabilitation Sciences University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: Lumbar spinal stenosis (LSS) is one of the fastest growing problems in the country due to its aging population. One third of Medicare users have the condition, and it is the number one reason for spine surgery in this population. Existing research evaluates the benefits of nonsurgical treatment options compared to surgery, but there was no existing research that compared the available nonsurgical options to each other to determine the best course of treatment for each patient. We studied three nonsurgical treatments for LSS: medical management with medications and/or epidural injections, individualized care with a physical therapist or chiropractor, and group exercise. We assessed each of these treatment methods with a questionnaire, a walking distance test, and a physical activity monitor. 
Author Interviews, Cancer Research, Cost of Health Care, JAMA / 08.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46845" align="alignleft" width="200"]Kiu Tay-Teo, PhD World Health Organization Geneva, Switzerland Dr. Kiu Tay-Teo[/caption] Kiu Tay-Teo, PhD World Health Organization Geneva, Switzerland MedicalResearch.com: What are the main findings? Response: High costs and high risks of R&D for drugs have been presented to justify high drug prices, especially for cancer drugs. However, it is unclear whether prices are in fact justifiable compared to the overall return on R&D investment. In this paper, we systematically compared incomes from the sales of cancer drugs with the R&D costs. We quantified the incomes generated from the sales of 99 cancer drugs approved by FDA from 1989–2017. This was based on sales figures reported in the originator companies’ annual financial reports, and where necessary, estimates deduced from the reported figures. The sales incomes were net of rebates and discounts, but without accounting for expenses and taxes. For the R&D costs of bringing one new cancer drug to the market, the literature reported a typical costs of between $219 million and $2.9 billion, after accounting for the costs of failed products that were investigated but not marketed and the opportunity costs. For the main analysis, we used a median cost of $794 million, as reported in the literature. To be clear, this analysis did not estimate profit return because we do not have information about the costs and year-to-year variations in costs (i.e. expenses and taxes) specific to cancer drugs.
Author Interviews, Columbia, Depression, Hearing Loss, JAMA / 08.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46841" align="alignleft" width="147"]Justin S. Golub, MD, MS Assistant Professor Otology, Neurotology, and Skull Base Surgery Department of Otolaryngology-Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons NewYork-Presbyterian/Columbia University Irving Medical Center Dr. Golub[/caption] Justin S. Golub, MD, MS Assistant Professor Otology, Neurotology, and Skull Base Surgery Department of Otolaryngology-Head and Neck Surgery Columbia University Vagelos College of Physicians and Surgeons NewYork-Presbyterian/Columbia University Irving Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Age-related hearing loss is extremely common, yet few people do anything about it. We studied a population of over 5,000 individuals and found that hearing loss was related to feelings of depression. The worse the hearing loss, the worse the symptoms of depression. Even people with just mild hearing loss had nearly two times the odds of depressive symptoms compared to normal hearing people. Among people with moderate hearing loss, the odds of depressive symptoms were four times as high. These statistics take into account various factors that can cause both hearing loss and depression, such as age and demographic background. 
Author Interviews, Cost of Health Care, University of Pittsburgh / 08.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46836" align="alignleft" width="132"]MedicalResearch.com Interview with: Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy Dr. Hernandez[/caption] Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy MedicalResearch.com: What is the background for this study? What are the main findings? Response: The objective of our study was to answer a research question of high policy relevance: to what extent are rising drug costs due to inflation in the prices of existing products versus the market entry of new, more expensive drugs. We found that rising prices of brand-name drugs are largely driven by manufacturers increasing prices of medications that are already in the market rather than to the entry of new products. In contrast, increases in costs of specialty and generic drugs were driven by the entry of new drugs.
ALS, Author Interviews, Brigham & Women's - Harvard, Cognitive Issues, JAMA, Multiple Sclerosis / 08.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46832" align="alignleft" width="200"]Michael Fralick, MD, FRCPC, SM, PhD (Cand) Clinical Associate, General Internal Medicine, St Michael’s Hospital Phillipson Scholar, Clinician Scientist Program, University of Toronto  PhD Candidate, IHPME, University of Toronto Affiliated Faculty, Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital, Harvard University Dr. Fralick[/caption] Michael Fralick, MD, FRCPC, SM, PhD (Cand) Clinical Associate, General Internal Medicine St Michael’s Hospital Phillipson Scholar, Clinician Scientist Program, University of Toronto PhD Candidate, IHPME, University of Toronto Affiliated Faculty, Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital, Harvard University MedicalResearch.com: What is the background for this study? What are the main findings? Response: This medication is a pill that combines two ingredients: dextromethorphan (the active ingredient in cough syrup) and quinidine (used to increase the concentration of dextromethorphan). The medication was primarily studied and evaluated in patients with amyotrophic lateral sclerosis (ALS)   or (multiple sclerosis) MS, but anecdotal evidence suggested it was being prescribed to patients with dementia. We used data from two nationwide healthcare databases to understand how the medication was being used in routine care.
Author Interviews, JAMA, Pediatrics, Smoking, Tobacco, Tobacco Research / 07.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46793" align="alignleft" width="165"]Dr. Hongying Dai, PhD Associate Professor at the College of Public Health University of Nebraska Medical Center. Dr. Dai[/caption] Dr. Hongying Dai, PhD Associate Professor at the College of Public Health University of Nebraska Medical Center. MedicalResearch.com: What is the background for this study? Response: The 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) banned cigarettes with characterizing flavors (e.g., candy, fruit, clove) except menthol. However, there are no restrictions on the marketing and sales of flavored non-cigarette tobacco products. This has led to a proliferation of flavored tobacco products in the marketplace. Flavoring has become one of the leading reasons for current tobacco use among youth. It is reported that 81% of e-cigarette users, 79% of hookah users, 74% of cigar users, 69% of smokeless tobacco users, and 67% of snus users attributed the availability of appealing flavors for their tobacco use in 2013–2014 among teenagers aged 12 to 17 years. In November 2018, the FDA proposed new restrictions on flavored tobacco products.
Author Interviews, CMAJ, Heart Disease, Occupational Health, Social Issues, Stroke / 07.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46787" align="alignleft" width="150"]Allan Garland, MD,  MA  Professor of Medicine & Community Health Sciences Co-Head, Section of Critical Care Medicine University of Manitoba Dr. Garland[/caption] Allan Garland, MD,  MA  Professor of Medicine & Community Health Sciences Co-Head, Section of Critical Care Medicine University of Manitoba MedicalResearch.com: What is the background for this study? Response: Heart attacks, strokes and cardiac arrest are common acute health events.  Most studies of serious acute health events look at outcomes such as death and how long is spent in the hospital.  But for working age people, the ability to work and earn income are very important outcomes that have rarely been studied. We set out to carefully measure, across Canada, how much heart attacks, strokes and cardiac arrests affect the ability of working age people to work and earn.