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This week’s topics include asthma and under the tongue immunotherapy, reducing C. dif infections, safety of smoking cessation drugs, and antibiotic stewardship.

Program notes:

0:39 Safety of smoking cessation medicines
1:40 None increased risk of psychiatric problems
2:40 How about combinations?
3:07 Sublingual immunotherapy
4:08 In people with moderate to severe asthma
5:09 Limited FDA approval
5:44 Antibiotic stewardship
6:44 Identified top 20% of overprescribers
7:45 Nobody mandating change
8:00 Reducing C.dif infections in hospital
9:00 Estimated to save quite a lot
10:30 End

Related blog: https://podblog.blogs.hopkinsmedicine.org/2016/04/28/allergy-meds-under-the-tongue/

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Anchor lead:  Geography significantly impacts longevity, Elizabeth Tracey reports

Wealth matters when it comes to longevity, a recent study looking at national data shows, but where you live is also very important.  Mike Klag, dean of the Johns Hopkins Bloomberg School of Public Health, describes the findings.

Klag: At the bottom of the income distribution life expectancy would vary by five, six, years.  This work builds on work that was published recently about decreasing life expectancy in middle aged persons in the US.  These are dry numbers but what they translate into people’s everyday experience is seeing their life expectancy go down, their opportunities go down, and that’s what’s driving I think some of the political discussion in this country.  The good thing is by strengthening communities, we can ameliorate and change, reverse some of these trends.   :31

Klag says the income and geography variation remained even when access to healthcare was not a factor, indicating that lifestyle choices such as smoking, diet, and physical activity are very powerful when it comes to longevity, so helping people make better choices is key.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: There’s plenty of evidence that those who live longest are also the wealthiest, Elizabeth Tracey reports

Take US tax records for over a decade and correlate them with medical and death records, and what emerges is a huge amount of data showing that people who are well off live longest, and that the gap between those at the top of the income curve compared to those at the bottom is several years of life.  Mike Klag, dean of the Johns Hopkins Bloomberg School of Public Health, looks at the data.

Klag: What this analysis found was that life expectancy went up continuously with household income, and if you compare the bottom 1% to the top 1%, we’ve heard a lot about the top 1%, there was a 15 year age gap.  People in the top 1% men in the top 1%, lived 15 years longer than the those in the lowest 1%, where women it was a ten year gap.  That’s a huge gap, that’s the difference in life expectancy between a smoker and a nonsmoker.   :26

Klag says these numbers point to clear action points with regard to policy and education, helping people to make better choices to promote health.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Even slightly overweight people are at increased risk for cardiovascular disease, Elizabeth Tracey reports

A very large study following young men for almost two decades shows that even when people are at the high end of normal weights, they’re at increased risk for cardiovascular disease, including sudden cardiac death and strokes.  Mike Klag, dean of the Johns Hopkins Bloomberg School of Public Health, says even at a body mass index of 22, well within normal limits, risk was apparent.

Klag: That’s where there started to be an increase in risk of these cardiovascular disease outcomes. Incredibly powerful study and it raises great concerns because of the increasing weight we’re seeing in adolescents around the world. So even in kids who have a very desirable BMI, young men, there was an increased risk.  Just another sign that we need to take the epidemic of obesity seriously.  Of course those at the upper end of the range, those who were obese, they saw the highest risk of these cardiovascular disease outcomes.     :29

Klag says he’d like to see longer follow up from this study as well as correlation with other risk factors such as smoking, but says the very large numbers of participants provide persuasive evidence.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead:  Married people with cancer do better than those who are not, Elizabeth Tracey reports

Those who are married and develop cancer survive longer than those who are unmarried, a recent study found. And while there’s been a lot of data on the so-called ‘marriage benefit’ in lots of studies, this one doesn’t really give any insight into why.  William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, muses on the possibilities.

Nelson: One is socioeconomic status.  If you’re better off, cancer provides significant financial and social challenges, and so one question of course is is this a question of financial security, in other words are you better off if you’re married, and that’s the reason for the survival.  In this study it seemed to cross the socioeconomic states, having said that the folks who did the study were left with the social support notion that there may just be more social support.   :26

Nelson says everyone withstands treatment better with emotional support, and that friends and family are often glad to be present for a loved one’s treatment.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Better measures are needed to assess patient safety, Elizabeth Tracey reports

Patient safety could get a huge boost with better tools to measure it.  That’s according to Peter Pronovost, a patient safety expert at Johns Hopkins and author of a recent paper on the need for better measurement in the Journal of the American Medical Association.

Pronovost: In one hand we say well we have too many measures and on the other hand we say we have too few measures.  How might we explore that? Well, we know for example the top five or ten reasons patients die needlessly in this country.  They’re infections and blood clots, and sadly, that outside of infections we don’t have a valid way to measure those major causes of death, and we should and we could. If we were to charge CDC, which has developed valid ways of measuring infections, with developing ways of measuring these other causes of harm.   :32

Pronovost is hopeful such measurement tools will soon be available and help provide real data on risks and efficacy of strategies to avert them for patients. At Johns Hopkins, I’m Elizabeth Tracey.

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Pulse: May 2016

April 28, 2016

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Program notes:

0:23 Choosing Wisely
1:23 Bring down cost of care while providing good care
2:23 Most of what is being implemented has already been tested
3:23 There is a needed variation in medicine
4:24 Payers need to look closely
5:23 Very well informed patient knows
6:10 End

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