A Trip to the Pharmacy

Since I was running some errands today, my husband asked me to pick up an over the counter medicine that was on sale at the local pharmacy. The several hundred prescriptions per week that I write are sent electronically so I have very little actual contact with the retail stores other than an occasional chat with a pharmacist clarifying directions. It had been a very long time since I was last in a store. I could not have been more dismayed at the apparent state of retail pharmacies.

First all, calling the operation a pharmacy is disingenuous at best. There is a prescription dispensing area at the back of the store, past the aisles of shampoos, Halloween and Christmas decorations, socks and electronics. The queue to attract a pharmacy technician was quite long; there was plenty of time to read the posters for flu shots, glucose meters and frequent buyer clubs. The perimeter of the store held refrigerator and freezer cases with an assortment of beverages (milk, juices, soda) and frozen dinners. There was a dazzling display of potato chips and other snack foods and the assortment of Halloween candy and Xmas wrapping paper was impressive.

The shampoo aisle ran the length of the store; the “professional” section had products for all types of hair all labeled “to be sold in professional salons only.” Nice selection of batteries and lots of laundry supplies as well. The school supply section was cleaned out.

I had plenty of time to observe the other customers since there was only one checkout person for the fifteen people in line. No one seemed too happy, but no one seemed to be sick. The candy display under the checkout counter had plenty of offers: buy 2 get one for a penny, 4 for $5, buy 10 and get a $2 credit to use next time. Maybe the ad for glucose meters should be moved from the back to the front?

Beer Here

The NFL is doing its best to play football and part of the fun of watching the game is having a beer or two. Moderate consumption of any alcoholic beverage is associated with lower rates of cardiovascular disease From a nutritional standpoint, beer contains more protein and B vitamins than wine. The antioxidant content of beer is equivalent to that of wine, but the specific antioxidants are different because the barley and hops used in the production of beer contain flavonoids different from those in the grapes used in the production of wine.

Where we run into problems is that there are a lot of games on Sunday and a couple of beers per game soon adds up. Binge drinking is defined as drinking five or more drinks on an occasion. Beer accounted for two thirds of all alcohol consumed by binge drinkers and accounted for most alcohol consumed by those at greatest risk of causing or incurring alcohol-related harm.

Overall, 74.4% of binge drinkers consumed beer exclusively or predominantly, and those who consumed at least some beer accounted for 80.5% of all binge alcohol consumption. By beverage type, beer accounted for 67.1%, liquor for 21.9%, and wine accounted for 10.9% of binge drinks consumed. Beer also accounted for most of the alcohol consumed by those at highest risk of causing or incurring alcohol-related harm, including people aged 18-20 years (67.0% of drinks were beer); those with three or more binge episodes per month (70.7%); those drinking eight or more drinks per binge episode (69.9%); those binging in public places (64.4%); and those who drove during or within 2 hours of binge drinking (67.1%).

Don’t forget that many beers have a lot of calories. There are plenty of lighter options – and watch out for the snacks! 

Influenza 2012-2013

As soon as school starts in the fall, it’s time to start thinking about flu shots.

Each year experts from the FDA, the World Health Organization, the Centers for Disease Control and Prevention (CDC), and other public health experts study influenza virus samples and global disease patterns to identify virus strains likely to cause the most illness during the upcoming flu season.

Based on that information and the recommendations of the FDA’s Vaccines and Related Biological Products Advisory Committee, the strains selected for inclusion in the 2012-2013 flu vaccines are:

•   A/California/7/2009 (H1N1)-like virus

•   A/Victoria/361/2011 (H3N2)-like virus

•   B/Wisconsin/1/2010-like virus.

While the H1N1 virus is the same as what was included in the 2011-2012 influenza vaccines, this year’s influenza H3N2 and B viruses differ from those in the 2011-2012 influenza vaccines. There is always a possibility of a less than optimal match between the virus strains predicted to circulate and the virus strains that end up causing the most illness. However, even if the vaccine and the circulating strains are not an exact match, the vaccine may reduce the severity of the illness or may help prevent influenza-related complications.

For more information: flu.gov

Is the Clock Ticking?

It’s common wisdom that it’s harder for a woman to get pregnant as she gets older. Women are most likely to easily get pregnant between the ages of 19 and 26 and the rate of conception steadily ebbs thereafter. There is a significant decline starting at age 31 and there is a big drop off in fertility at age 37. The subfertility in older (!) women is due to the poor quality of aging eggs, fewer eggs in reserve and changing hormones. Additionally, as time passes women have more opportunity to acquire medical and surgical conditions.

Now it appears that what’s sauce for the goose is sauce for the gander. Multiple studies haves shown that advancing age is a serious reproductive factor for men as well as for women. Animal studies show that older sperm contributors have lower fertilization rates, poorer embryo quality, increased miscarriages and smaller fetuses. Since sperm cells undergo many more replications there is more chance for mistakes to occur. Older fathers pass along many more genetic mutations than do younger men.

Observational data indicate that increasing weight in men leads to decreased fertility; observing a crowd of 35 year old men would indicate that they weigh more than when they were college seniors.

Men face the same time pressures as women. In the world of reproductive medicine, delayed childbearing is defined as older than age 30 for both men and women. Women have long heard the tick of their biologic clocks – perhaps it’s time for men to listen as well. 

School Lunch

Lunch is an important part of the school day – almost as important as recess! Many children brown bag their lunches, but many more depend on the school lunch (and breakfast) for a substantial portion of their daily nutrition.

In the past, school lunch programs have depended upon contributions of excess food from USDA programs – the idea was that farmers would have a ready market for their wares and that school children would benefit eating farm-fresh products. Well, we all know how that turned out! For the first time in fifteen years the USDA has raised the standards of the school lunch program. This will have a direct impact on the thirty-two million children who participate in the school meals program every day.

The final standards make the same kinds of practical changes that many parents are already encouraging at home, including offering students both fruits and vegetables every day of the week, substantially increasing offerings of whole grain-rich foods, offering only fat-free or low-fat milk varieties, and increasing the focus on reducing the amounts of saturated fat, trans fats and sodium.

For the first time, calories are limited based on the age of the children. Under the old plan, the regulations stated a minimum number of calories; faced with increasing obesity we need to reeducate ourselves about proper portion size. It’s challenging for adults to regulate intake. It’s unreasonable for beginning readers to scan a nutrition label to see that a granola bar is actually two portions or for a thirsty adolescent to know that a bottle of juice drink is four servings.

Parents play an important role in supporting the school lunch program. Don’t sabotage the healthy meal initiatives by criticizing the food. If you are not satisfied, contact the school and offer help. Don’t allow children to have additional sweets or beverages other than water. Contact the school if your child is truly hungry after finishing the school breakfast or lunch.

Bon appetit.

 Nutrition Standards for School Meals

The Nocebo Effect

Just knowing that a drug can have side effects may increase your risk of suffering them. This is the nocebo effect: the patient’s expectation that a drug will do harm. An excellent summary of this appears in the New York Times review pages.

Side effects from medications are real and can be harmful. Even so, the benefits may still outweigh the potential risks. A recent study confirmed that certain cholesterol medications might lead to diabetes in susceptible patients. However, the reduction in cardiovascular disease with lowering the blood cholesterol is real – and even more important in patients with diabetes. Certain patients (and we have a good idea who they might be) can have terrible effects from osteoporosis medications. This doesn’t mean that other patients at high risk for hip and vertebral fractures shouldn’t take them.

I believe that direct to consumer pharmaceutical advertisements do greater harm than good. Mind you, only expensive medications have the budgets needed to buy television commercials. The ads rarely get down and dirty to discuss the actual disease but show idyllic vacations scenes or silly cartoons, ending with a sonorous litany of terrible outcomes (rash, headache, liver failure, depression and/or death).

Starting a medication should be a shared decision. Usually the physician is more knowledgeable party but the patient is the one that actually decides whether to take the medicine. No decision is written in stone – treatment plans can be (and often are) revised. These discussions are best done face to face; the discussions are of a higher quality when the patient is prepared with questions and concerns. 

Dementia

As people age, there is some decline is short-term memory. However, when memory becomes so poor that there is an impact on the activities of daily living, it is no longer simple forgetfulness but may be dementia. The most common causes of dementia are cerebrovascular disease and Alzheimer’s disease. In Alzheimer disease, build-up of abnormal proteins damages brain cells. In cerebrovascular disease, low blood flow to the brain damages brain cells. While there is no cure for dementia, there are several medications that may be helpful in slowing the progression of disease.

The medications that are currently approved for dementia have shown small improvements in measurements of memory and thinking, but there is no data that show important improvement in behavior and quality of life.

Patients with dementia are less able to make clinical decisions and are less able to cooperate with treatment plans; caregivers play a large role in determining plans of care. Behavioral disturbances (delusions, aggression, depression) can have a profound effect on those around the patient. Inadequate nutrition is common. Exercise program and occupational therapy have been shown to improve everyday life without the side effects seen with many medications.

Caregivers of patients with dementia can suffer significant stress, particularly as cognitive function declines. Respite care and support groups are available in most areas, often through the local agency on aging.

For more information:

Alzheimer's Association at 1-800-272-3900 or on-line.