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Anchor lead: Identifying thyroid disease may need to change as people age, Elizabeth Tracey reports

Thyroid diseases are common as people age, especially an underactive thyroid gland known as hypothyroidism. Now a new study by thyroid expert Jenna Mammen at Johns Hopkins and colleagues has shown that as people age, making the diagnosis correctly may require more than just testing thyroid stimulating hormone, or TSH, as is commonly done.

Mammen: What these findings mean is that in addition to checking TSH we probably should be looking at thyroid hormone directly in our people in their 70s and 80s. In younger people including people in their fifties and sixties, the vast majority of changes that we see are changes driven by primary thyroid dysfunction and the TSH remains a reliable indicator of thyroid function.  :25

Mammen says older folks may want to ask their physician to test thyroid hormone directly as well as TSH if thyroid disease is suspected. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Should we add lithium to drinking water to reduce the incidence of dementia? Elizabeth Tracey reports

The drug lithium is used to treat some mental illnesses. Now a recent study reports that it may reduce the incidence of Alzheimer’s disease. Constantine Lyketsos, an Alzheimer’s expert at Johns Hopkins, says it does impact on two important substances known to be involved in the disease, amyloid and tau.

Lyketsos: For a while now people have been reporting out of laboratories that lithium impacts the development of amyloid and even phosphorylation of tau.  :09

The study looked at lithium in drinking water.

Lyketsos: Very creative Finnish investigators realized that if you measured lithium in drinking water in Finland at least there’s a range in the amount of lithium that naturally exists in the drinking water. In situations where drinking water had more lithium there seemed to be less dementia.  :18

Lyketsos says he’s not ready to advocate for adding lithium to drinking water but would follow up this study with one looking at blood levels of lithium and Alzheimer’s risk. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Should the US follow the lead of other countries in destigmatizing drug use? Elizabeth Tracey reports

Portugal is being put forward as a model for decreasing opioid addiction and overdose death, where destigmatization is the linchpin along with community health worker outreach to those who use drugs. Yet Eric Strain, a drug abuse expert at Johns Hopkins, says such a strategy may not help.

Strain: Stigma and drug use is a complicated concept. Because we want to destigmatize getting into treatment for drug use, but we don’t want to destigmatize drug use itself. If we do that we run the risk of more young adults using drugs because it’s been destigmatized. So we need to sort of thread that needle between having drug use be something we don’t want people to do but if you do run into a problem then we welcome you coming into treatment and getting that addressed.  :30

Strain says using community health workers to identify those who use drugs and bring them into treatment could help stem the tide of use and overdose deaths while not endorsing use. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What would be helpful about declaring opioid overdoses a national emergency?

64,000 people dead from opioid overdoses last year. Those are the dire statistics, and Eric Strain, a drug abuse expert at Johns Hopkins, says their impact is clear.

Strain: We’ve seen the changes in life expectancy for middle aged men in this country, which is related to opiate overdoses, really is a wake up call. Prescription opioids certainly play a key role in that.  :12

Strain says declaring our opioid epidemic a state of emergency would help.

Strain: At a federal level there is some things that can be done like emergency funds, reallocation of funds, that can help address the opioid crisis. So there are advantages there, but I think that also it helps to crystalize, in both clinicians minds as well as in the public’s mind, that we need to do something different from what we’ve been doing in the past. :21

Strain says robust treatment programs, not just naloxone reversal, are needed, as well as effective constraints on supply chains.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Helping manage health care costs is something called ‘high value care,’ Elizabeth Tracey reports

Health care costs too much. That’s an inescapable fact, and one that may be helped by an approach called ‘high value care.’ Paul Rothman, dean and CEO of Johns Hopkins Medicine, describes the strategy.

Rothman: When we talk about value we talk about things we can do to restrain our expenditures on health care but either maintain the quality or improve the quality of care that we’re providing, so the old adage of doing more with less. That is the basis of what we call value in health care.  :18

At Johns Hopkins an integrated approach to care called ‘inHealth’ is leading the way.

Rothman: Precision medicine, which is our InHealth initiative here at Johns Hopkins, seeks to see if we can more precisely define subsets of disease, therefore better directing therapies to the patients who will really benefit from those specific therapies.  :18

Rothman notes that inHealth also helps people avoid treatments that won’t be beneficial but always come with side effects. At Johns Hopkins, I’m Elizabeth Tracey.

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036507010-vaccineThis week’s topics include Medicare spending on frail elderly, resorbable stents, men with HPV, and procalcitonin to assess antibiotic need.
Program notes:
0:41 Looking at procalcitonin to determine antibiotic use
1:42 Improve or worsen survival
2:40 Point of care testing
2:54 Stents that resorb
3:52 First approved in Europe in 2011
4:50 Post marketing surveillance helpful
5:16 Men infected with HPV
6:17 Infection rate 11.5% in men
7:17 Should men self-identify?
7:35 Preventable spending in the Medicare population
8:35 Account for 50% of preventable cost
9:34 Things can be managed as outpatient
10:51 End
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Anchor lead: There is a role for opioid medications in managing some chronic pain, Elizabeth Tracey reports

Now that federal authorities are so focused on curtailing the opioid epidemic, does that mean that there’s no place for these medicines in the treatment of chronic pain? Not at all, says Michael Clark, a pain expert who spoke at a recent Johns Hopkins symposium on chronic pain management.

Clark: These are substances with abuse potential. Some set percentage of people will develop an addiction, we don’t really know how to predict that. All we can really say is that we have to be clear about our outcomes for the patient so that if I give you opioids and you become more functional, your symptoms improve, your approach to living your life is better, any of those things that we would put under a functional, satisfying life, then it would be hard to argue with giving you opioids.   :31

Clark is in favor of short courses of the drugs as part of a comprehensive pain management strategy with an eye toward eliminating opioids if possible. At Johns Hopkins, I’m Elizabeth Tracey.

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