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Program notes:

0:35 Jeremy Greene and state and federal advocacy

1:35 Focus on the patient in front of me

2:32 Became brand name only

3:22 Sherita Golden

4:22 Didn't real know how to treat

5:22 As front line clinicians we can share challenges

5:56 Lee Biddison

6:50 Feels unjust

7:50 Industrialized medicine

8:50 Start to move the needle on drug prices

9:50 Continue to speak about things that are problematic

11:08 End

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Anchor lead: If you don’t drink alcohol and you’re worried about Alzheimer’s disease, what should you do? Elizabeth Tracey reports

People who drink alcohol moderately in middle age seem to develop Alzheimer’s disease less often than those who don’t drink at all or who drink heavily. If you’re a teetotaler, does this mean you should start quaffing alcohol? Sevil Yasar, a neurologist at Johns Hopkins who wrote the editorial accompanying the study in the British Medical Journal says, not so fast.

Yasar: Definitely if you drink a lot, cut down. If you are an abstainer I would not recommend to my patients that you should start now to drink you know one glass of wine. I need more answers before I can do that. This is a population, they were in London, they were government employees so I’m sure they were better socioeconomics, maybe better social habits. How can I generalize it to everyone? The one and the best answer is doing a clinical trial.  :26

Yasar points out that such a trial should be free of any bias as a result of funding by the alcoholic beverage industry, and would need to follow a large number of participants over a long period of time. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Why does moderate alcohol consumption seem to protect against Alzheimer’s disease? Elizabeth Tracey reports

People who drink alcohol in moderation – one to two drinks per day from midlife on – appear to have a lower risk of Alzheimer’s disease than those who drink more than that, but also, and surprisingly, those who drink little or no alcohol. That’s according to a study published recently in the British Medical Journal. Sevil Yasar, a neurologist at Johns Hopkins who wrote the accompanying editorial, says one possible mechanism is known.

Yasar: Alcohol has a protective effect actually on cardiovascular disease. It can reduce your risk, of course again when you consume a small or moderate amount. And this study showed that partially what we found the protective effect of when you consume between 7 or up to 14 units per week when you consume it it’s partially due to you have reduced risk for new heart attack, new stroke, and also diabetes.  :26

Yasar says more studies like this one are needed before alcohol consumption should be recommended. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Quantity and timing of alcohol consumption may affect Alzheimer’s development, Elizabeth Tracey reports

Drinking moderately in your middle years may protect you against Alzheimer’s disease later, a recent study in the British Medical Journal found. Sevil Yasar, whose editorial accompanied the publication and a neurologist at Johns Hopkins, describes the study.

Yasar: It basically looked at people in their thirties and forties and followed them for 23 years, and looked at how their reported alcohol consumption in midlife can affect their risk for dementia in their later life. When you consume a larger amount, anything over 14 units, that’s like five glasses or ten glasses of wine a week, then you had a higher risk of dementia. When you abstain, less than one unit or you’re complete abstainer, then your risk for dementia in late life also increased, and by quite substantially,  by more than 40%. :33

Yasar says the study can’t identify why someone who abstains is at higher risk, but one hypothesis is that moderate alcohol intake may act as an anti-inflammatory, an idea she hopes will be tested further. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Having an acidic environment inside some cells in the brain may be a factor in Alzheimer’s disease, Elizabeth Tracey reports

Cells in your body have a variety of compartments within them, one of which is called an endosome. Rajini Rao and colleagues at Johns Hopkins, have furthered research based on an observation about endosomes in people with Alzheimer’s.

Rao: Endosomes, which are these small, cargo carrying compartments in the cell, were larger and more numerous in the cells of patients with Alzheimer’s disease compared to the age-matched control people.   :14

Turns out that a gene defect renders the endosome too acidic, and therefore unable to do its job that helps remove amyloid in the brain, and this may be important in Alzheimer’s. Rao says a known class of drugs called histone acetylase inhbitors may help.

Rao: It opens up the potential to use these histone acetylase inhibitors, which are FDA approved to treat certain kinds of blood cancers, so it’s possible we could repurpose them to treat Alzheimer’s.   :14

Rao notes that barriers to using these drugs remain, but she’s hopeful newer drug delivery technologies may help. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Social isolation may have much to do will poor health in older people, Elizabeth Tracey reports

Having few social interactions is increasingly associated with poor health outcomes, many studies are reporting, and the problem is especially acute for older people. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says there are many factors that explain why.

Davidson: Aging is isolating, particularly if you don’t have strong social support and economic resources. Venturing out of your home, people are frightened of potential violence, the traffic is daunting, many older people can’t afford  a car or have their license taken for a range of issues. As we get older friends disappear. So for many people particularly in their eighties and nineties, their whole social network has disappeared.  :28

Davidson notes that it’s a healthcare success story that we now have so many people aged 80 and older, but the system must turn its attention to mitigating loneliness for this population. She says loneliness is well-known, for example, to increase mortality following a heart attack so addressing this problem is another part of providing good care. At Johns Hopkins, I’m Elizabeth Tracey.

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Program notes:

0:30 State of telemedicine at Johns Hopkins

1:30 Lost mobility and can't come to clinic

2:30 Highly technical treatment for stroke

3:30 Johns Hopkins Community Physicians using

4:26 Serve patients in rural areas

5:30 23 States recognize licensure

6:32 Economy no longer bound by state lines

7:15 Does offer more convenience

8:04 End

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