Drug companies pay doctors over A$11 million a year for travel and education. Here’s which specialties received the most
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Drug companies are paying Australian doctors millions of dollars a year to fly to overseas conferences and meetings, give talks to other doctors, and to serve on advisory boards, our research shows.
Our team analysed reports from major drug companies, in the first comprehensive analysis of its kind. We found drug companies paid more than A$33 million to doctors in the three years from late 2019 to late 2022 for these consultancies and expenses.
We know this underestimates how much drug companies pay doctors as it leaves out the most common gift – food and drink – which drug companies in Australia do not declare.
Due to COVID restrictions, the timescale we looked at included periods where doctors were likely to be travelling less and attending fewer in-person medical conferences. So we suspect current levels of drug company funding to be even higher, especially for travel.
What we did and what we found
Since 2019, Medicines Australia, the trade association of the brand-name pharmaceutical industry, has published a centralised database of payments made to individual health professionals. This is the first comprehensive analysis of this database.
We downloaded the data and matched doctors’ names with listings with the Australian Health Practitioner Regulation Agency (Ahpra). We then looked at how many doctors per medical specialty received industry payments and how much companies paid to each specialty.
We found more than two-thirds of rheumatologists received industry payments. Rheumatologists often prescribe expensive new biologic drugs that suppress the immune system. These drugs are responsible for a substantial proportion of drug costs on the Pharmaceutical Benefits Scheme (PBS).
The specialists who received the most funding as a group were cancer doctors (oncology/haematology specialists). They received over $6 million in payments.
This is unsurprising given recently approved, expensive new cancer drugs. Some of these drugs are wonderful treatment advances; others offer minimal improvement in survival or quality of life.
A 2023 study found doctors receiving industry payments were more likely to prescribe cancer treatments of low clinical value.
Our analysis found some doctors with many small payments of a few hundred dollars. There were also instances of large individual payments.
Why does all this matter?
Doctors usually believe drug company promotion does not affect them. But research tells a different story. Industry payments can affect both doctors’ own prescribing decisions and those of their colleagues.
A US study of meals provided to doctors – on average costing less than US$20 – found the more meals a doctor received, the more of the promoted drug they prescribed.
Another study found the more meals a doctor received from manufacturers of opioids (a class of strong painkillers), the more opioids they prescribed. Overprescribing played a key role in the opioid crisis in North America.
Overall, a substantial body of research shows industry funding affects prescribing, including for drugs that are not a first choice because of poor effectiveness, safety or cost-effectiveness.
Then there are doctors who act as “key opinion leaders” for companies. These include paid consultants who give talks to other doctors. An ex-industry employee who recruited doctors for such roles said:
Key opinion leaders were salespeople for us, and we would routinely measure the return on our investment, by tracking prescriptions before and after their presentations […] If that speaker didn’t make the impact the company was looking for, then you wouldn’t invite them back.
We know about payments to US doctors
The best available evidence on the effects of pharmaceutical industry funding on prescribing comes from the US government-run program called Open Payments.
Since 2013, all drug and device companies must report all payments over US$10 in value in any single year. Payment reports are linked to the promoted products, which allows researchers to compare doctors’ payments with their prescribing patterns.
Analysis of this data, which involves hundreds of thousands of doctors, has indisputably shown promotional payments affect prescribing.
US research also shows that doctors who had studied at medical schools that banned students receiving payments and gifts from drug companies were less likely to prescribe newer and more expensive drugs with limited evidence of benefit over existing drugs.
In general, Australian medical faculties have weak or no restrictions on medical students seeing pharmaceutical sales representatives, receiving gifts, or attending industry-sponsored events during their clinical training. They also have no restrictions on academic staff holding consultancies with manufacturers whose products they feature in their teaching.
So a first step to prevent undue pharmaceutical industry influence on prescribing decisions is to shelter medical students from this influence by having stronger conflict-of-interest policies, such as those mentioned above.
A second is better guidance for individual doctors from professional organisations and regulators on the types of funding that is and is not acceptable. We believe no doctor actively involved in patient care should accept payments from a drug company for talks, international travel or consultancies.
Third, if Medicines Australia is serious about transparency, it should require companies to list all payments – including those for food and drink – and to link health professionals’ names to their Ahpra registration numbers. This is similar to the reporting standard pharmaceutical companies follow in the US and would allow a more complete and clearer picture of what’s happening in Australia.
Patients trust doctors to choose the best available treatments to meet their health needs, based on scientific evidence of safety and effectiveness. They don’t expect marketing to influence that choice.
Barbara Mintzes, Professor, School of Pharmacy and Charles Perkins Centre, University of Sydney and Malcolm Forbes, Consultant psychiatrist and PhD candidate, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Top 8 Fruits That Prevent & Kill Cancer
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Dr. Amy Dee, pharmacist and cancer survivor herself, lays out the best options for anticancer fruits:
The fruits
Without further ado, they are:
- Kiwi: promotes cancer cell death while sparing healthy cells
- Plums & peaches: an interesting choice to list these similar fruits together as one item, but they both also induce cell death in cancer cells while sparing healthy ones
- Dragon fruit: this does the same, while also inhibiting cancer cell growth
- Figs: these have antitumor effects specifically, while removing carcinogens too, and additionally sensitizing cancer cells to light therapy
- Cranberries: disrupt cancer cell adhesion, breaking down tumors, while protecting non-cancerous cells against DNA damage
- Citrus fruits: inhibit tumor growth and kill cancer cells; regular consumption is also associated with a lower cancer risk (be warned though, grapefruit interacts with some medications)
- Cherries: induce cancer cell death; protect healthy cells against DNA damage
- Tomatoes: don’t often make it into lists of fruits, but lycopene reduces cancer risk, and slows the growth of cancer cells (10almonds note: watermelon has more lycopene than tomatoes, and is more traditionally considered a fruit in all respects, so could have taken the spot here).
We would also argue that apricots could have had a spot on the list, both for their lycopene content (comparable to tomatoes) and their botanical (and thus phytochemical) similarities to peaches and plums.
For more information on each of these (she also talks about the different polyphenols and other nutrients that constitute the active compounds delivering these anticancer effects), enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Food Choice & Cancer Risk: Eat To Beat Cancer
- Beat Cancer Kitchen: Deliciously Simple Plant-Based Anticancer Recipes (book)
Take care!
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Valentine’s Day & Your Heart
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We’re not talking metaphorically; this is about your “beating wet pumpy thing” as a friend of this writer once put it!
Heart to heart
A dietician calls for us to take care of our hearts this Valentine’s Day, with ideas such as:
- Teamwork makes the dream work: support your partner’s health objectives by choosing gifts or activities that align with their goals, such as opting for new running shoes instead of candy if they aim to exercise more.
- Split up… Dinner: instead of consuming large portions individually, consider sharing a decadent meal to reduce metabolic load while still enjoying the experience together.
- A moving experience: plan active dates like hiking, dancing, or taking a walk, which promote both bonding and cardiovascular health. And if you can think of other perhaps “vigorous activities” you might enjoy doing together on Valentine’s Day, then that’s great for your heart too!
- Be aware of mutual health influences: recognize that partners can impact each other’s health behaviors and risks; making healthy choices together can strengthen both the relationship and individual well-being.
- No date, no problem: if you’re single this Valentine’s Day, consider connecting with friends, of if that’s not for you, perhaps treating yourself to a “self-care day” at home.
Read in full: Celebrate Valentine’s Day with actual hearts in mind, says dietitian
Related: Only One Kind Of Relationship Promotes Longevity This Much!
Playing the hand you’re dealt
We can make many choices in life that affect our health one way or the other, but there are some things we can’t control, and that includes a family history of some disease or other. In the case of a family history of heart conditions, all is not lost, and you can still play the odds:
- Diet: rich in fiber, especially fresh fruits and vegetables, legumes, and whole grains. Go easy on sugary, salty, and/or processed foods. Yes, sugary too! Sugary foods can increase blood pressure in the same way that salt does, by forcing the same homeostatic response.
- Exercise: prioritize movement, as in those “active minutes” that your smartwatch tracks. That famous “150 minutes per week” is great; more is better.
- Sleep: get up regularly around the same time each morning, preferably early. You should get to the point whereby you wake up shortly before the time your alarm would go off, each morning.
- Avoid: smoking and alcohol. They are both terrible for heart health.
- Teamwork: work with healthcare professionals to manage your heart health; a personalized plan is best, and they are there to help.
Remember, genes predispose; they don’t predetermine:
Read in full: Expert explains how to improve heart health, even if your family has history of heart conditions
Related: The Whole Heart Solution: Halt Heart Disease Now With the Best Alternatives and Traditional Medicine
Not so sweet?
Chocolate is famously high in antioxidants, but that must be weighed against other factors, if for example you’re eating a product that, when all’s said and done and the ingredients list is read, is mostly sugar.
That can be avoided, though! If you do like chocolate, we recommend getting dark chocolate with a high percentage of cocoa; 90% is great if you can find it!
Even so, the saturated fat content means you still might want to make it a moment for intentional “mindful eating” of a square or two, before setting it aside for another day:
Read in full: Valentine’s Day and chocolate are a perfect match, but is it a healthy relationship?
Related: 10 “Healthy” Foods That Are Often Worse Than You Think
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Can a drug like Ozempic help treat addictions to alcohol, opioids or other substances?
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Semaglutide (sold as Ozempic, Wegovy and Rybelsus) was initially developed to treat diabetes. It works by stimulating the production of insulin to keep blood sugar levels in check.
This type of drug is increasingly being prescribed for weight loss, despite the fact it was initially approved for another purpose. Recently, there has been growing interest in another possible use: to treat addiction.
Anecdotal reports from patients taking semaglutide for weight loss suggest it reduces their appetite and craving for food, but surprisingly, it also may reduce their desire to drink alcohol, smoke cigarettes or take other drugs.
But does the research evidence back this up?
Animal studies show positive results
Semaglutide works on glucagon-like peptide-1 receptors and is known as a “GLP-1 agonist”.
Animal studies in rodents and monkeys have been overwhelmingly positive. Studies suggest GLP-1 agonists can reduce drug consumption and the rewarding value of drugs, including alcohol, nicotine, cocaine and opioids.
Out team has reviewed the evidence and found more than 30 different pre-clinical studies have been conducted. The majority show positive results in reducing drug and alcohol consumption or cravings. More than half of these studies focus specifically on alcohol use.
However, translating research evidence from animal models to people living with addiction is challenging. Although these results are promising, it’s still too early to tell if it will be safe and effective in humans with alcohol use disorder, nicotine addiction or another drug dependence.
What about research in humans?
Research findings are mixed in human studies.
Only one large randomised controlled trial has been conducted so far on alcohol. This study of 127 people found no difference between exenatide (a GLP-1 agonist) and placebo (a sham treatment) in reducing alcohol use or heavy drinking over 26 weeks.
In fact, everyone in the study reduced their drinking, both people on active medication and in the placebo group.
However, the authors conducted further analyses to examine changes in drinking in relation to weight. They found there was a reduction in drinking for people who had both alcohol use problems and obesity.
For people who started at a normal weight (BMI less than 30), despite initial reductions in drinking, they observed a rebound increase in levels of heavy drinking after four weeks of medication, with an overall increase in heavy drinking days relative to those who took the placebo.
There were no differences between groups for other measures of drinking, such as cravings.
Some studies show a rebound increase in levels of heavy drinking. Deman/Shutterstock In another 12-week trial, researchers found the GLP-1 agonist dulaglutide did not help to reduce smoking.
However, people receiving GLP-1 agonist dulaglutide drank 29% less alcohol than those on the placebo. Over 90% of people in this study also had obesity.
Smaller studies have looked at GLP-1 agonists short-term for cocaine and opioids, with mixed results.
There are currently many other clinical studies of GLP-1 agonists and alcohol and other addictive disorders underway.
While we await findings from bigger studies, it’s difficult to interpret the conflicting results. These differences in treatment response may come from individual differences that affect addiction, including physical and mental health problems.
Larger studies in broader populations of people will tell us more about whether GLP-1 agonists will work for addiction, and if so, for whom.
How might these drugs work for addiction?
The exact way GLP-1 agonists act are not yet well understood, however in addition to reducing consumption (of food or drugs), they also may reduce cravings.
Animal studies show GLP-1 agonists reduce craving for cocaine and opioids.
This may involve a key are of the brain reward circuit, the ventral striatum, with experimenters showing if they directly administer GLP-1 agonists into this region, rats show reduced “craving” for oxycodone or cocaine, possibly through reducing drug-induced dopamine release.
Using human brain imaging, experimenters can elicit craving by showing images (cues) associated with alcohol. The GLP-1 agonist exenatide reduced brain activity in response to an alcohol cue. Researchers saw reduced brain activity in the ventral striatum and septal areas of the brain, which connect to regions that regulate emotion, like the amygdala.
In studies in humans, it remains unclear whether GLP-1 agonists act directly to reduce cravings for alcohol or other drugs. This needs to be directly assessed in future research, alongside any reductions in use.
Are these drugs safe to use for addiction?
Overall, GLP-1 agonists have been shown to be relatively safe in healthy adults, and in people with diabetes or obesity. However side effects do include nausea, digestive troubles and headaches.
And while some people are OK with losing weight as a side effect, others aren’t. If someone is already underweight, for example, this drug might not be suitable for them.
In addition, very few studies have been conducted in people with addictive disorders. Yet some side effects may be more of an issue in people with addiction. Recent research, for instance, points to a rare risk of pancreatitis associated with GLP-1 agonists, and people with alcohol use problems already have a higher risk of this disorder.
Other drugs treatments are currently available
Although emerging research on GLP-1 agonists for addiction is an exciting development, much more research needs to be done to know the risks and benefits of these GLP-1 agonists for people living with addiction.
In the meantime, existing effective medications for addiction remain under-prescribed. Only about 3% of Australians with alcohol dependence, for example, are prescribed medication treatments such as like naltrexone, acamprosate or disulfiram. We need to ensure current medication treatments are accessible and health providers know how to prescribe them.
Continued innovation in addiction treatment is also essential. Our team is leading research towards other individualised and effective medications for alcohol dependence, while others are investigating treatments for nicotine addiction and other drug dependence.
Read the other articles in The Conversation’s Ozempic series here.
Shalini Arunogiri, Addiction Psychiatrist, Associate Professor, Monash University; Leigh Walker, , Florey Institute of Neuroscience and Mental Health, and Roberta Anversa, , The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The push for Medicare to cover weight-loss drugs: An explainer
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The largest U.S. insurer, Medicare, does not cover weight-loss drugs, making it tougher for older people to get access to promising new medications.
If you cover stories about drug costs in the U.S., it’s important to understand why Medicare’s Part D pharmacy program, which covers people aged 65 and older and people with certain disabilities, doesn’t cover weight-loss drugs today. It’s also important to consider what would happen if Medicare did start covering weight loss drugs. This explainer will give you a brief overview of the issues and then summarize some recent publications the benefits and costs of drugs like semaglutide and tirzepatide.
First, what are these new and newsy weight loss drugs?
Semaglutide is a medication used for both the treatment of type 2 diabetes and for long-term weight management in adults with obesity. It debuted in the United States in 2017 as an injectable diabetes drug called Ozempic, manufactured by Novo Nordisk. It’s part of a class of drugs that mimics the action of glucagon, a substance that the human body makes to aid digestion.
Glucagon-like peptide-1 (GLP-1) drugs like semaglutide help prompt the body to release insulin. But they also cause a minor delay in the pace of digestion, helping people feel sated after eating.
That second effect turned Ozempic into a widely used weight-loss drug, even before the Food and Drug Administration (FDA) gave its okay for this use. Doctors in the United States can prescribe medicines for uses beyond those approved by the FDA. This is known as off-label use.
In writing about her own experience in using the medicine to help her shed 40 pounds, Washington Post columnist Ruth Marcus in June noted that Novo Nordisk mentioned the potential for weight loss in its “ubiquitous cable ads (‘Oh-oh-oh, Ozempic!’)”
The American Society of Health-System Pharmacists has reported shortages of semaglutide due to demand, leaving some people with diabetes struggling to find supply of the medicine.
Novo Nordisk won Food and Drug Administration (FDA) approval in 2021 to market semaglutide as an injectable weight loss drug under the name Wegovy, but with a different dosing regimen than Ozempic. Rival Eli Lilly first won FDA approval of its similar GLP-1 diabetes drug, tirzepatide, in the United States in 2022 and sells it under the brand name Mounjaro.
In November of 2023, Eli Lilly won FDA approval to sell tirzepatide as a weight-loss drug, soon-to-be marketed under the brand name Zepbound. The company said it will set a monthly list price for a month’s supply of the drug at $1,059.87, which the company described as 20% discount to the cost of rival Novo Nordisk’s Wegovy. Wegovy has a list price of $1,349.02, according to the Novo Nordisk website.
Even when their insurance plans officially cover costs for weight loss drugs, consumers may face barriers in seeking that coverage for these drugs. Commercial health plans have in place prior authorization requirements to try to limit coverage of new weight-loss shots to those who qualify for these treatments. The Wegovy shot, for example, is intended for people whose weight reaches a certain benchmark for obesity or who are overweight and have a condition related to excess weight, such as diabetes, high blood pressure or high cholesterol.
State Medicaid programs, meanwhile, have taken approaches that vary by state. For example, the most populous U.S. state, California, provides some coverage to new weight-loss injections through its Medicaid program, but many others, including Texas, the No. 2 state in terms of population, do not, according to an online tool that Novo Nordisk created to help people check on coverage.
Medicare does cover semaglutide for treatment of diabetes, and the insurer reported $3 billion in 2021 spending on the drug under Medicare Part D. Congress last year gave Medicare new tools that might help it try to lower the cost of semaglutide.
Medicare is in the midst of implementing new authority it gained through the Inflation Reduction Act (IRA) of 2022 to negotiate with companies about the cost of certain medicines.
This legislation gave Medicare, for the first time, tools to directly negotiate with pharmaceutical companies on the cost of some medicines. Congress tailored this program to spare drug makers from negotiations for the first few years they put new medicines on the market, allowing them to recoup investment in these products.
Why doesn’t Medicare cover weight-loss drugs?
Congress created the Medicare Part D pharmacy program in 2003 to address a gap in coverage that had existed since the creation of Medicare in 1965. The program long covered the costs of drugs administered by doctors and those given in hospitals, but not the kinds of medicines people took on their own, like Wegovy shots.
In 2003, there seemed to be good reasons to leave weight-loss drugs out of the benefit, write Inmaculada Hernandez of the University of California, San Diego, and coauthors in their September 2023 editorial in the Journal of General Internal Medicine, “Medicare Part D Coverage of Anti-obesity Medications: a Call for Forward-Looking Policy Reform.”
When members of Congress worked on the Part D benefit, the drugs available on the market were known to have limited effectiveness and unpleasant side effects. And those members of Congress were aware of how a drug combination called fen-phen, once touted as a weight-loss miracle medicine, turned out in rare cases to cause fatal heart valve damage. In 1997, American Home Products, which later became Wyeth, took its fen-phen product off the market.
But today GLP-1 drugs like semaglutide appear to offer significant benefits, with far less risk and milder side effects, write Hernandez and coauthors.
“Other than budget impact, it is hard to find a reason to justify the historical statutory exclusion of weight loss drugs from coverage other than the stigma of the condition itself,” they write.
What’s happening today that could lead Medicare to start covering weight loss drugs?
Novo Nordisk and Eli Lilly both have hired lobbyists to try to persuade lawmakers to reverse this stance, according to Senate records. Pro tip: You can use the Senate’s lobbying disclosure database to track this and other issues. Type in the name of the company of interest and then read through the forms.
Some members of Congress already have been trying for years to strike the Medicare Part D restriction on weight-loss drugs. Over the past decade, senators Tom Carper (D-DE) and Bill Cassidy, MD, (R-LA) have repeatedly introduced bills that would do that. They introduced the current version, the Treat and Reduce Obesity Act of 2023, in July. It has the support of 10 other Republican senators and seven Democratic ones, as of Dec. 19. The companion House measure has the support of 41 Democrats and 23 Republicans in that chamber, which has 435 seats.
The influential nonprofit Institute for Clinical and Economic Review conducts in-depth analyses of drugs and medical treatments in the United States. ICER last year recommended passage of a law allowing Medicare Part D to cover weight-loss medications. ICER also called for broader coverage of weight-loss medications in state Medicaid programs. Insurers, including Medicare, consider ICER’s analyses in deciding whether to cover treatments.
While offering these calls for broader coverage as part of a broad assessment of obesity management, ICER also urged companies to reduce the costs of weight-loss medicines.
Most people with obesity can’t achieve sustained weight loss through diet and exercise alone, said David Rind, ICER’s chief medical officer in an August 2022 statement. The development of newer obesity treatments represents the achievement of a long-standing goal of medical research, but prices of these new products must be reasonable to allow broad access to them, he noted.
After an extensive process of reviewing studies, engaging in public debate and processing feedback, ICER concluded that semaglutide for weight loss should have an annual cost of $7,500 to $9,800, based on its potential benefits.
What does academic research say about the benefits and the potential costs of new obesity drugs?
Here are a couple of studies to consider when covering the ongoing story of weight-loss drug costs:
Medicare Part D Coverage of Antiobesity Medications — Challenges and Uncertainty Ahead
Khrysta Baig, Stacie B. Dusetzina, David D. Kim and Ashley A. Leech. New England Journal of Medicine, March 2023In this Perspective piece, researchers at Vanderbilt University create a series of estimates about how much Medicare may have to spend annually on weight-loss drugs if the program eventually covers these drugs.
These include a high estimate — $268 billion — based on an extreme calculation, one reflecting the potential cost if virtually all people on Medicare who have obesity used semaglutide. In an announcement of the study on the Vanderbilt website, lead author Khrysta Baig described this as a “purely hypothetical scenario,” but one that “ underscores that at current prices, these medications cannot be the only way – or even the main way – we address obesity as a society.”
In a more conservative estimate, Bhaig and coauthors consider a case where only about 10% of those eligible for obesity treatment opted for semaglutide, which would result in $27 billion in new costs.
(To put these numbers in context, consider that the federal government now spends about $145 billion a year on the entire Part D program.)
It’s likely that all people enrolled in Part D would have to pay higher monthly premiums if Medicare were to cover weight-loss injections, Baig and coauthors write.
Baig and coauthors note that the recent ICER review of weight-loss drugs focused on patients younger than the Medicare population. The balance of benefits and risks associated with weight-loss drugs may be less favorable for older people than the younger ones, making it necessary to study further how these drugs work for people aged 65 and older, they write. For example, research has shown older adults with a high blood sugar level called prediabetes are less likely to develop diabetes than younger adults with this condition.
SELECTing Treatments for Cardiovascular Disease — Obesity in the Spotlight
Amit Khera and Tiffany M. Powell-Wiley. New England Journal of Medicine, Dec. 14, 2023
Semaglutide and Cardiovascular Outcomes in Patients Without Diabetes
A Michael Lincoff, et. al. New England Journal of Medicine, Dec. 14, 2023.An editorial accompanies the publication of a semaglutide study that drew a lot of coverage in the media. The Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT) study was a randomized controlled trial, conducted by Novo Nordisk, which looked at rates of cardiovascular events in people who already had known heart risk and were overweight, but not diabetic. Patients were randomly assigned to receive a once-weekly dose of semaglutide (Wegovy) or a placebo.
In the study, the authors report that of the 8,803 patients who took Wegovy in the trial, 569 (6.5%)
The study also reports a mean 9.4% reduction in body weight among patients taking Wegovy, while those on placebo had a mean loss of 0.88%.
The findings suggest Wegovy may be a welcome new treatment option for many people who have coronary disease and are overweight, but are not diabetic, write Khera and Powell-Wiley in their editorial.
But the duo, both of whom focus on disease prevention in their research, also call for more focus on the prevention and root causes of obesity and on the use of proven treatment approaches other than medication.
“Socioeconomic, environmental, and psychosocial factors contribute to incident obesity, and therefore equity-focused obesity prevention and treatment efforts must target multiple levels,” they write. “For instance, public policy targeting built environment features that limit healthy behaviors can be coupled with clinical care interventions that provide for social needs and access to treatments like semaglutide.”
Additional information:
The nonprofit KFF, formerly known as the Kaiser Family Foundation, has done recent reports looking at the potential for expanded coverage of semaglutide:
Medicaid Utilization and Spending on New Drugs Used for Weight Loss, Sept. 8, 2023
What Could New Anti-Obesity Drugs Mean for Medicare? May 18, 2023
And KFF held an Aug. 4 webinar, New Weight Loss Drugs Raise Issues of Coverage, Cost, Access and Equity, for which the recording is posted here.
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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Make Your Vegetables Work Better Nutritionally
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Most people know that boiling vegetables to death is generally not best for them, but raw isn’t always best either, and if we want to not sabotage our food, then there’s more to bear in mind than “just steam them, then”.
So, what should we keep in mind?
Water solubility
Many nutrients are water-soluble, including vitamin C, vitamin B-complex (as in, the collection of B-vitamins), and flavonoids, as well as many other polyphenols.
This means that if you cook your vegetables (which includes beans, lentils, etc) in water, a lot of the nutrients will go into the water, and be lost if you then drain that.
There are, thus, options;
- Steaming, yes
- Use just enough water to slow-cook or pressure-cook things that are suitable for slow-cooking, or pressure-cooking such as those beans and lentils. That way, when it’s done, there’s no excess water to drain, and all the nutrients are still in situ.
- Use as much water as you like, but then keep the excess water to make a soup, sauce, or broth.
- Use a cooking method other than water, where appropriate. For example, roasting peppers is a much better idea than roasting dried pulses.
- Consume raw, where appropriate.
Fat solubility
Many nutrients are fat-soluble, including vitamins A, D, E, and K, as well as a lot of carotenoids (including heavy-hitters lycopene and β-carotene) and many other polyphenols.
We’re now going to offer almost the opposite advice to that we had about water solubility. This is because unless they are dried, vegetables already contain water, whereas many contain only trace amounts of fat. Consequently, the advice this time is to add fat.
There are options:
- Cook with a modest amount of your favorite healthy cooking oil (our general go-to is extra-virgin olive oil, but avocado oil is great especially for higher temperature cooking, and an argument can be made for coconut oil sometimes)
- Remember that this goes for roasting, too. Brush those vegetables with a touch of olive oil, and not only will they be delicious, they’ll be more nutritious, too.
- Drizzle some the the above, if you’re serving things raw and it’s appropriate. This goes also for things like salads, so dress them!
- Enjoy your vegetables alongside healthy fatty foods such as nuts and seeds (or fatty animal products, if you eat those; fatty fish is a fine option here, in moderation, as are eggs, or fermented dairy products).
For a deeper understanding: Can Saturated Fats Be Healthy?
Do not, however, deep-fry your foods unless it’s really necessary and then only for an occasional indulgence that you simply accept will be unhealthy. Not only is deep-frying terrible for the health in a host of ways (ranging from an excess of oil in the resultant food, to acrylamide, to creating Advanced Glycation End-products*), but also those fat-soluble nutrients? Guess where they’ll go. And unlike with the excess vegetable-cooking water that you can turn into soup or whatever, we obviously can’t recommend doing that with deep-fryer oil.
*see also: Are You Eating AGEs?
Temperature sensitivity
Many nutrients are sensitive to temperature, including vitamin C (breaks down when exposed to high temperatures) and carotenoids (are released when exposed to higher temperatures). Another special case is ergothioneine, “the longevity vitamin” that’s not a vitamin, found in mushrooms, which is also much more bioavailable when cooked.
So, if you’re eating something for vitamin C, then raw is best if that’s a reasonable option.
And if it’s not a reasonable option? Well, then you can either a) just cope with the fact it’s going to have less vitamin C in it, or b) cook it as gently and briefly as reasonably possible.
On the other hand, if you’re eating something for carotenoids (especially including lycopene and β-carotene), or ergothioneine, then cooked is best.
Additionally, if your food is high in oxalates (such as spinach), and you don’t want it to be (for example because you have kidney problems, which oxalates can exacerbate, or would like to get more calcium out of the spinach and into your body, which which oxalic acid would inhibit), then cooked is best, as it breaks down the oxalates.
Same goes for phytates, another “anti-nutrient” found in some whole grains (such as rice and wheat); cooking breaks it down, therefore cooked is best.
This latter is not, however, applicable in the case of brown rice protein powder, for those who enjoy that—because phytates aren’t found in the part of the rice that’s extracted to make that.
And as for brown rice itself? Does contain phytates… Which can be reduced by soaking and heating, preferably both, to the point that the nutritional value is better than it would have been had there not been phytic acid present in the first place; in other words: cooked is best.
You may be wondering: “who is eating rice raw?” and the answer is: people using rice flour.
See: Brown Rice Protein: Strengths & Weaknesses
Want to know more?
Here’s a great rundown from Dr. Rosalind Gibson, Dr. Leah Perlas, and Dr. Christine Hotz:
Improving the bioavailability of nutrients in plant foods at the household level
Enjoy!
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There are ‘forever chemicals’ in our drinking water. Should standards change to protect our health?
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Today’s news coverage reports potentially unsafe levels of “forever chemicals” detected in drinking water supplies around Australia. These include human-made chemicals: perfluorooctane sulfonate (known as PFOS) and perflurooctanic acid (PFOA). They are classed under the broader category of per- and polyfluoroalkyl substances or PFAS chemicals.
The contaminants found in our drinking water are the same ones United States authorities warn can cause cancer over a long period of time, with reports warning there is “no safe level of exposure”.
In April, the US Environmental Protection Agency (USEPA) sent shock waves through the water industry around the world when it announced stricter advice on safe levels of PFOS/PFOA in drinking water. This reduced limits considered safe in supplies to zero and gave the water industry five years to meet legally enforceable limits of 4 parts per trillion.
So, should the same limits be enforced here in Australia? And how worried should we be that the drinking in many parts of Australia would fail the new US standards?
What are the health risks?
Medical knowledge about the human health effects of PFOS/PFOA is still emerging. An important factor is the bioaccumulation of these chemicals in different organs in the body over time.
Increased exposure of people to these chemicals has been associated with several adverse health effects. These include higher cholesterol, lower birth weights, modified immune responses, kidney and testicular cancer.
It has been very difficult to accurately track and measure effects of different levels of PFAS exposure on people. People may be exposed to PFAS chemicals in their everyday life through waterproofing of clothes, non-stick cookware coatings or through food and drinking water. PFAS can also be in pesticides, paints and cosmetics.
The International Agency for Research on Cancer (on behalf of the World Health Organization) regards PFOA as being carcinogenic to humans and PFOS as possibly carcinogenic to humans.
Is our drinking water safe? What about long-term risks? Volodymyr TVERDOKHLIB/Shutterstock Our guidelines
Australian drinking water supplies are assessed against national water quality standards. These Australian Drinking Water Guidelines are continuously reviewed by industry and health experts that scan the international literature and update them accordingly.
All city and town water supplies across Australia are subject to a wide range of physical and chemical water tests. The results are compared to Australian water guidelines.
Some tests relate to human health considerations, such as levels of lead or bacteria. Others relate to “aesthetic” considerations, such as the appearance or taste of water. Most water authorities across Australia make water quality information and compliance with Australian guidelines freely available.
What about Australian PFOS and PFOA standards?
These chemicals can enter our drinking water system from many potential sources, such as via their use in fire-fighting foams or pesticides.
According to the Australian Drinking Water Guidelines, PFOS should not exceed 0.07 micrograms per litre in drinking water. And PFOA should not exceed 0.56 micrograms per litre. One microgram is equivalent to one part per billion.
The concentration of these chemicals in water is incredibly small. And much of the advice on their concentration is provided in different units. Sometimes in micrograms or nannograms. The USEPA uses parts per trillion.
In parts per trillion (ppt) the Australian Guidelines for PFOS is 70 ppt and PFOA is 560 ppt. The USEPA’s new maximum contaminant levels (enforceable levels) are 4 ppt for both PFOS and also PFOA. Previous news reports have pointed out Australian guidelines for these chemicals in drinking water are up to 140 times higher than the USEPA permits.
Yikes! That seems like a lot
Today’s news report cites PFOS and PFOA water tests done at many different water supplies across Australia. Some water samples did not detect either chemicals. But most did, with the highest PFOS concentration 15.1–15.6 parts per trillion from Glenunga, South Australia. The highest PFOA concentration was reported from a small water supply in western Sydney, where it was detected at 5.17–9.66 parts per trillion.
Australia and the US are not alone. This is an enormous global problem.
One of the obvious challenges for the Australian water industry is that current water treatment processes may not be effective at removing PFOS or PFOA. The Australian Drinking Water Guidelines provide this advice:
Standard water treatment technologies including coagulation followed by physical separation, aeration, chemical oxidation, UV irradiation, and disinfection have little or no effect on PFOS or PFOA concentrations.
Filtering with activated carbon and reverse osmosis may remove many PFAS chemicals. But no treatment systems appear to be completely effective at their removal.
Removing these contaminants might be particularly difficult for small regional water supplies already struggling to maintain their water infrastructure. The NSW Auditor General criticised the planning for, and funding of, town water infrastructure in regional NSW back in 2020.
Where to from here?
The Australian water industry likely has little choice but to follow the US lead and address PFOS/PFAS contamination in drinking water. Along with lower thresholds, the US committed US$1 billion to water infrastructure to improve detection and water treatment. They will also now require:
Public water systems must monitor for these PFAS and have three years to complete initial monitoring (by 2027) […]
As today’s report notes, it is very difficult to find any recent data on PFOS and PFOA in Australian drinking water supplies. Australian regulators should also require ongoing and widespread monitoring of our major city and regional water supplies for these “forever chemicals”.
The bottom line for drinking tap water is to keep watching this space. Buying bottled water might not be effective (2021 US research detected PFAS in 39 out of 100 bottled waters). The USEPA suggests people can reduce PFAS exposure with measures including avoiding fish from contaminated waters and considering home filtration systems.
Correction: this article previously listed the maximum Australian Drinking Water Guidelines PFOA level as 0.056 micrograms per litre. The figure has been updated to show the correct level of 0.56 micrograms per litre.
Ian A. Wright, Associate Professor in Environmental Science, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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