FDA approves long-acting injectable schizophrenia treatment

“This is the kind of news that makes you want to stand up and dance when you read it. I am eager to learn more about the details of Aristada. Imagine the future mental health management with injectable long-lasting psychosis medications.” Bill Chesnut, MD

 FDA approves long-acting injectable schizophrenia treatment

 The Wall Street Journal (10/6, Armental, Subscription Publication) reports that the Food and Drug Administration approved Aristada (aripiprazole lauroxil), Alkermes PLC’s drug to treat schizophrenia.

Bloomberg News (10/6, Chen) reports that Aristada is “a long-acting injectable medicine with options to be taken once monthly or every six weeks,” and is “intended as an alternative to oral anti-psychotic medications taken daily.”

AMA newsletter October, 2015.


CDC urges people at high risk of HIV infection to use PrEP

“This is a wonderful medical advance. I hope Truvada can be disseminated throughout the poorest countries who are most ravaged by HIV.” Bill Chesnut, MD

CDC urges people at high risk of HIV infection to use PrEP

The Washington Post (11/25, Cha) reports that the Centers for Disease Control and Prevention is making a “big push” to get more people at “substantial” risk of getting HIV to start on pre-exposure prophylaxis (PrEP). The therapy “involves taking a daily pill – Truvada [tenofovir/emtricitabine] – that makes it more difficult for the virus to establish a permanent infection when a person is exposed to” the virus “through sexual contact or injectable drug use.” Research has shown that the therapy can reduce risk of infection “by 70 to more than 90 percent.”

USA Today (11/24, Szabo) reports that a national survey not yet published shows that though the “Food and Drug Administration approved Truvada in 2012, one-third of primary care doctors have never heard of PrEP.” The drug, manufactured by Gilead Sciences Inc., “costs about $10,000 a year, according to the CDC.” However, according to Carlos del Rio, co-director of the Emory Center for AIDS Research in Atlanta, many insurance plans cover the drug and those who are uninsured can get Truvada for free through Gilead’s patient assistance program.

Vox (11/24, Lopez) says the CDC report suggests PrEP is crucial for individuals who engage in risky behavior, such “sex with an HIV-positive partner, sex with multiple partners, anal sex without a condom, and sharing needles to inject drugs.”


Up to two-thirds of new cancer drugs lack evidence they extend the patient’s life, study finds

“This is important information for cancer patients and their family caregivers. Often the hard questions of how much longer life will be prolonged are not asked. More often the questions are about the chance of cure if thermotherapy is used. Ask your physician to explain the prognosis  of this treatment as the five-year survival rate. That statistic is known for almost all cancer treatments.” Bill Chesnut, MD

Up to two-thirds of new cancer drugs lack evidence they extend the patient’s life, study finds

The Milwaukee Journal Sentinel (10/20, Fauber) reports that a study published in JAMA Internal Medicine found that of the 54 new cancer drugs approved over the past five years, 36 of them were approved based upon so-called surrogate measures, rather than evidence that the drugs actually extended or improved the patient’s life. In addition, the study found that of those 36 drugs, many still had not demonstrated that they help patients live longer, even after being on the market for up to four years.

AMA Wire newsletter, November 2015.

Caffeinated products may not cause heart palpitations, research suggests

This is important information because of the longstanding conventional knowledge that caffeine is forbidden for patients with atrial fibrillation and such.” Bill Chesnut, MD

Caffeinated products may not cause heart palpitations, research suggests

On its website, NBC News (1/26, Fox) reports that research published in the Journal of the American Heart Association suggests “drinking coffee, tea or chocolate does not appear to cause heart palpitations, heart fluttering and other out-of-sync heartbeat patterns.”

HealthDay (1/26, Preidt) reports that the research “included nearly 1,400 healthy people whose coffee, tea and chocolate consumption was assessed.” Participants “wore a portable device that continuously monitored their heart rhythm for 24 hours.” Investigators found that participants “who consumed higher amounts of the products didn’t have extra heartbeats.”

AMA Journal 1.27.16


Researchers develop blood test to detect concussions in children

“This development of a blood test for concussion needs wider dissemination as a part of our cultural discussion about head impact sports.” Bill Chesnut, MD

Researchers develop blood test to detect concussions in children

CBS News (11/11, Welch) website reports that “a simple blood test can accurately detect concussions in children, a new study finds, and researchers hope one day it could be used on the field to help coaches, trainers and parents develop a plan of action on the spot.” The test “accurately identified the presence of brain injuries 94 percent of the time.” Lead study author Dr. Linda Papa, an emergency medicine physician said in a statement that this blood test “could ultimately change the way we diagnose concussions, not only in children, but in anyone who sustains a head injury.” The study was published in the journal Academic Emergency Medicine.

HealthDay (11/11, Reinberg) reports that the blood test measures levels of glial fibrillary acidic protein (GFAP), which is “found in cells that surround neurons in the brain,” and is released into the bloodstream when the brain is injured.

JAMA 11.11.15

Adults with who take hypertension medications at bedtime may be less likely to develop Type 2 diabetes

“Hypertension is serious, complicated and there is a lot to know. I posted elsewhere on this site a video of how to take your blood pressure correctly. I recommend reviewing that. This article associates type 2 diabetes with your control of hypertension. This finding is an important finding and needs wider dissemination than I have seen in my reading.” Bill Chesnut, MD

Adults with who take hypertension medications at bedtime may be less likely to develop Type 2 diabetes

The Los Angeles Times (9/24, Healy) “Science Now” reports that research published in Diabetologia suggests that “adults with high blood pressure who take all of their hypertension medications before they go to bed, rather than in the morning, are less likely to develop Type 2 diabetes.” Another study, “also published in Diabetologia” yesterday “and conducted by the same…researchers, found that subjects whose blood pressure did not dip, and those whose readings dipped more briefly or shallowly, were more likely to develop Type 2 diabetes than those whose sleep-time blood pressure saw a deep and sustained drop from daytime levels.”

AMA Wire 9.26.15

Association of Bullying Behavior at 8 Years of Age and Use of Specialized Services for Psychiatric Disorders by 29 Years of Age

“This is a pressing report of 5,034 children. The authors address childhood experiences that are associated with mental and behavioral health problems as your adults. Exposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services.  This deserves wide dissemination.” Bill Chesnut, MD

 Association of Bullying Behavior at 8 Years of Age and Use of Specialized Services for Psychiatric Disorders by 29 Years of Age

Andre Sourander, MD, PhD1,2; David Gyllenberg, MD, PhD1; Anat Brunstein Klomek, PhD3,4; Lauri Sillanmäki, Stud SocSc1; Anna-Marja Ilola, MD1; Kirsti Kumpulainen, MD, PhD5

JAMA Psychiatry. 2016;73(2):159-165. doi:10.1001/jamapsychiatry.2015.2419.

 Importance. Bullying and being exposed to bullying among children is prevalent, especially among children with psychiatric symptoms, and constitutes a major concern worldwide. Whether childhood bullying or exposure to bullying in the absence of childhood psychiatric symptoms is associated with psychiatric outcomes in adulthood remains unclear.

Objective.  To study the associations between bullying behavior at 8 years of age and adult psychiatric outcomes by 29 years of age.

Design, Setting, and Participants.  Nationwide birth cohort study of 5034 Finnish children with complete information about childhood bullying behavior was followed up from 8 to 29 years of age. Follow-up was completed on December 31, 2009, and data were analyzed from January 15, 2013, to February 15, 2015.

Main Outcomes and Measures.  Information about bullying, exposure to bullying, and psychiatric symptoms were obtained from parents, teachers, and child self-reports when children were 8 years of age. Use of specialized services for psychiatric disorders from 16 to 29 years of age was obtained from a nationwide hospital register, including outpatient and inpatient treatment.

Results.  Among the 5034 study participants, 4540 (90.2%) did not engage in bullying behavior; of these, 520 (11.5%) had received a psychiatric diagnosis at follow-up; 33 of 166 (19.9%) who engaged in frequent bullying, 58 of 251 (23.1%) frequently exposed to bullying, and 24 of 77 (31.2%) who both frequently engaged in and were frequently exposed to bullying had received psychiatric diagnoses at follow-up. When analyses were adjusted by sex, family factors, and child psychiatric symptoms at 8 years of age, we found independent associations of treatment of any psychiatric disorder with frequent exposure to bullying (hazard ratio [HR], 1.9; 95% CI, 1.4-2.5) and being a bully and exposed to bullying (HR, 2.1; 95% CI, 1.3-3.4). Exposure to bullying was specifically associated with depression (HR, 1.9; 95% CI, 1.2-2.9). Bullying was associated with psychiatric outcomes only in the presence of psychiatric problems at 8 years of age. Participants who were bullies and exposed to bullying at 8 years of age had a high risk for several psychiatric disorders requiring treatment in adulthood. However, the associations with specific psychiatric disorders did not remain significant after controlling for concurrent psychiatric symptoms.

Conclusions and RelevanceExposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services. Early intervention among those involved in bullying can prevent long-term consequences.


Obese kids who cut back on sugar intake may see health improvements after just 10 days

“This report from the AMA newsletter is important. These children were massively obese, with BMI > 50.” Bill Chesnut, MD

 Obese kids who cut back on sugar intake may see health improvements after just 10 days

The Wall Street Journal (10/27, A6, McKay, Esterl, Subscription Publication) reports that a study published online Oct. 26 in the journal Obesity adds to the evidence associating the consumption of sugar with metabolic syndrome in youngsters.

The Washington Post (10/27, Cha) reports in “To Your Health” that 44 youngsters ranging in age from nine to 18 took part in the study during which all participants followed a low-sugar diet.

The New York Times (10/27, O’Connor) “Well” blog reported that the study found that “obese children who cut back on their sugar intake see improvements in their blood pressure, cholesterol readings and other markers of health after just 10 days.” The study’s findings indicate that calories “from sugar are especially likely to contribute to type 2 diabetes and other metabolic diseases, which are on the rise in children, said the study’s lead author.”

AMA 10.28.15

How to take your blood pressure correctly!

“How to take your blood pressure correctly, from the AMA newsletter.” Bill Chesnut, MD

The one video you need for accurate blood pressure readings

Verify that you’re getting the most accurate blood pressure readings from your patients by using this quick video.

Share the video on Facebook or Twitter with your practice team and patients so they understand how seemingly minor factors can affect their blood pressure measurements.

Here are some additional resources to help you improve your practice’s hypertension management:

Why you should take action

The number of hypertension-related deaths in the United States increased by 66 percent over the past decade, according to data from the Centers for Disease Control and Prevention. To put that in perspective, the number of deaths from all other causes combined increased only 3.5 percent during that period.

The AMA’s Improving Health Outcomes initiative is taking steps to reverse this trend. Through this initiative, the AMA and participating physicians and care teams are working with researchers at the Johns Hopkins Armstrong Institute for Patient Safety and Quality and the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities to develop and test evidence-based blood pressure recommendations and provide practical tools for physician practices.


Brain scans to catch depression before it starts.

“This brief article is about the neuroimaging research at the McGovern Institute for Brain Research at M.I.T. Functional MRI shows the patterns of activity in the brain. It is revealing differences in brain patterns that are predictive. This link is the research at McGovern; the whole area is astonishing.” Bill Chesnut, MD   http://mcgovern.mit.edu/brain-disorders/psychiatric

Brain scans to catch depression before it starts

By Ben Gruber, 2.4.16.

CAMBRIDGE, MASS. (Reuters) – Researchers at MIT’s McGovern Institute are using the latest advances in brain imaging to identify children at high risk of depression before the debilitating and sometimes deadly disorder sets in.

According to the World Health Organization an estimated 350 million people of all ages suffer from depression. It’s a serious mental disorder that affects every aspect of a person’s life and in severe cases could lead to suicide.

The study involved two groups of children, one at high risk of depression due to family history and a control group with kids at low risk.

Kids from both groups were scanned to map the network pathways in their brains. The question was if the researchers could find differences in brain activity that would be an indicator for a higher risk of depression.

“They answer is there are very great differences. We saw differences that were striking in a number of circuits including those that change in depression, including those involved in feelings, other parts that are involved in thinking. The additional thing besides seeing these differences were that the differences were so strong child by child that that we were very close to perfect with being able to categorize from a brain scan itself whether a child was at risk or not,” said John Gabrieli, a professor of Brain and Cognitive Sciences at MIT.

The goal going forward is to follow these children and see who among the high risk group goes on to develop depression, tracking changes in their brain function along the way .

“Obviously the children that go on to depression the more we can identify them well the more we are hopeful that we can get preventive treatments going. Not waiting for them to be suffering but helping them beforehand,” said Gabrieli

“So we want to learn both to identify early children who are at true risk, help them before they struggle and learn from those that are resilient what is different about them because that might be a hint about how to help the children that are not resilient,” he added.

The researchers say a better understanding of how depression affects the brain will ultimately lead to better treatment options for those that are most at risk.

Here is the McGovern Institute for Brain Research at MIT: http://mcgovern.mit.edu/

This is some of the brain research they do: http://mcgovern.mit.edu/research

Association of Seafood Consumption, Brain Mercury Level, and APOE ε4 Status With Brain Neuropathology in Older Adults

“About the safety of eating seafood: Seafood consumption has been a concern because of the increased levels of mercury in fish. This study shows that moderate intake of seafood may produce a decreased chance of developing Alzheimer’s disease.” 

The best way to absorb the several findings of this critical study is this YouTube video by one of the authors at Rush Medical Center in Chicago and published in the Journal of the American Medical Association Network. First rate research.  https://www.youtube.com/watch?v=m9MncHHHXpA  .” Bill Chesnut, MD


Martha Clare Morris, ScD1; John Brockman, PhD2; Julie A. Schneider, MD, MPH3,4,5; Yamin Wang, PhD1; David A. Bennett, MD3,4; Christy C. Tangney, PhD6; Ondine van de Rest, PhD7

JAMA. 2016;315(5):489-497. doi:10.1001/jama.2015.19451.

Importance  Seafood consumption is promoted for its many health benefits even though its contamination by mercury, a known neurotoxin, is a growing concern.

Objective  To determine whether seafood consumption is correlated with increased brain mercury levels and also whether seafood consumption or brain mercury levels are correlated with brain neuropathologies.

Design, Setting, and Participants  Cross-sectional analyses of deceased participants in the Memory and Aging Project clinical neuropathological cohort study, 2004-2013. Participants resided in Chicago retirement communities and subsidized housing. The study included 286 autopsied brains of 554 deceased participants (51.6%). The mean (SD) age at death was 89.9 (6.1) years, 67% (193) were women, and the mean (SD) educational attainment was 14.6 (2.7) years.

Exposures  Seafood intake was first measured by a food frequency questionnaire at a mean of 4.5 years before death.

Main Outcomes and Measures  Dementia-related pathologies assessed were Alzheimer disease, Lewy bodies, and the number of macroinfarcts and microinfarcts. Dietary consumption of seafood and n-3 fatty acids was annually assessed by a food frequency questionnaire in the years before death. Tissue concentrations of mercury and selenium were measured using instrumental neutron activation analyses.

Results  Among the 286 autopsied brains of 544 participants, brain mercury levels were positively correlated with the number of seafood meals consumed per week (ρ = 0.16; P = .02). In models adjusted for age, sex, education, and total energy intake, seafood consumption (≥ 1 meal[s]/week) was significantly correlated with less Alzheimer disease pathology including lower density of neuritic plaques (β = −0.69 score units [95% CI, −1.34 to −0.04]), less severe and widespread neurofibrillary tangles (β = −0.77 score units [95% CI, −1.52 to −0.02]), and lower neuropathologically defined Alzheimer disease (β = −0.53 score units [95% CI, −0.96 to −0.10]) but only among apolipoprotein E (APOE ε4) carriers. Higher intake levels of α-linolenic acid (18:3 n-3) were correlated with lower odds of cerebral macroinfarctions (odds ratio for tertiles 3 vs 1, 0.51 [95% CI, 0.27 to 0.94]). Fish oil supplementation had no statistically significant correlation with any neuropathologic marker. Higher brain concentrations of mercury were not significantly correlated with increased levels of brain neuropathology.

Conclusions and Relevance  In cross-sectional analyses, moderate seafood consumption was correlated with lesser Alzheimer disease neuropathology. Although seafood consumption was also correlated with higher brain levels of mercury, these levels were not correlated with brain neuropathology.