Big pharma partnering with influencers to sell drugs, medical devices

The latest Instagram influencer frontier? Medical promotions

Abstracts

“By enlisting influencers to market their health care products amid a stream of Facetuned photos, pharmaceutical and biotechnology companies co-opt narratives that give social media users a sense of how healthy they can be, if only they had this product.”

“Social media enables its users to connect over shared interests, locations, and even illnesses. Using this formula, health care companies locate potential influencers who can use these commonalities to reach and build trust with an audience.”

“One wonders why a company would assume the risk of misinformed patients, as they are responsible for what their paid endorsers say. The reason is simple: One in three consumers in the US consult social media for health-related matters. “

Read The latest Instagram influencer frontier? Medical promotions, on vox, Feb 15, 2019.

Air pollution exposed children with mental health problems

Association between neighbourhood air pollution concentrations and dispensed medication for psychiatric disorders in a large longitudinal cohort of Swedish children and adolescents

Abstract

Objective
To investigate associations between exposure to air pollution and child and adolescent mental health.

Design
Observational study.

Setting
Swedish National Register data on dispensed medications for a broad range of psychiatric disorders, including sedative medications, sleeping pills and antipsychotic medications, together with socioeconomic and demographic data and a national land use regression model for air pollution concentrations for NO2, PM10 and PM2.5.

Participants
The entire population under 18 years of age in 4 major counties. We excluded cohort members whose parents had dispensed a medication in the same medication group since the start date of the register. The cohort size was 552 221.

Main outcome measures
Cox proportional hazards models to estimate HRs and their 95% CIs for the outcomes, adjusted for individual-level and group-level characteristics.

Results
The average length of follow-up was 3.5 years, with an average number of events per 1000 cohort members of ∼21. The mean annual level of NO2 was 9.8 µg/m3. Children and adolescents living in areas with higher air pollution concentrations were more likely to have a dispensed medication for a psychiatric disorder during follow-up (HR=1.09, 95% CI 1.06 to 1.12, associated with a 10 µg/m3 increase in NO2). The association with NO2 was clearly present in 3 out of 4 counties in the study area; however, no statistically significant heterogeneity was detected.

Conclusion
There may be a link between exposure to air pollution and dispensed medications for certain psychiatric disorders in children and adolescents even at the relatively low levels of air pollution in the study regions. The findings should be corroborated by others.

Reference.

The Guardian press releases : here, here, here, here, here, here.

Toxiques légaux, d’Henri Boullier

Comment les firmes chimiques ont mis la main sur le contrôle de leurs produits

Depuis les années 1960, d’ambitieux dispositifs réglementaires promettent de contrôler les produits chimiques auxquels nous sommes exposés quotidiennement. Pourtant, les rares « interdictions » prononcées sont systématiquement assorties de dérogations permettant de continuer à les utiliser. Pourquoi les États semblent-ils incapables de prononcer des décisions fermes ? Comment la commercialisation de substances toxiques est-elle devenue « légale » ?

Ce livre montre comment les grandes entreprises chimiques ont inscrit dans le droit l’impossibilité d’interdire leurs molécules, si toxiques soient-elles. Depuis 2006, le règlement REACH encadre leur commercialisation en Europe. Ce texte promettait de résoudre la méconnaissance des effets de dizaines de milliers de substances présentes sur le marché et d’améliorer leur contrôle. Finalement, les entreprises sont au cœur de la fabrique de l’expertise et les agences publiques se retrouvent à évaluer les risques de produits pour lesquels elles n’ont aucune donnée solide. En suivant la trajectoire de trois molécules dangereuses – un sel métallique, un solvant et un plastifiant –, l’enquête de l’auteur montre comment REACH organise leur maintien sur le marché.

L’histoire retracée dans ce livre est caractéristique de la manière dont certaines grandes réformes contemporaines masquent en fait un désengagement de l’État sans précédent. L’expertise est externalisée, les données fournies sont insuffisantes, les procédures dérogatoires multiples. Les firmes maîtrisent, plus que jamais, les ressorts de cette bureaucratie industrielle.

Référence.

Air pollution linked to higher risk of miscarriage

Acute effects of air pollutants on spontaneous pregnancy loss: a case-crossover study

2019 Study Abstract

Objective
To investigate the relationship between acute exposure to air pollutants and spontaneous pregnancy loss.

Design
Case-crossover study from 2007 to 2015.

Setting
An academic emergency department in the Wasatch Front area of Utah.

Patient(s)
A total of 1,398 women who experienced spontaneous pregnancy loss events.

Intervention(s)
None.

Main Outcome Measure(s)
Odds of spontaneous pregnancy loss.

Result(s)
We found that a 10-ppb increase in 7-day average levels of nitrogen dioxide was associated with a 16% increase in the odds of spontaneous pregnancy loss (odds ratio [OR] = 1.16; 95% confidence interval [CI] 1.01–1.33; P=.04). A 10-μg/m3 increase in 3-day and 7-day averages of fine particulate matter were associated with increased risk of spontaneous pregnancy loss, but the associations did not reach statistical significance (OR3-day average = 1.09; 95% CI 0.99–1.20; P=.05) (OR7-day average = 1.11; 95% CI 0.99–1.24; P=.06). We found no evidence of increased risk for any other metrics of nitrogen dioxide or fine particulate matter or any metric for ozone.

Conclusions
We found that short-term exposure to elevated levels of air pollutants was associated with higher risk for spontaneous pregnancy loss.

Why nobody knows what’s really going into your food

Massive legal loophole means companies can add new ingredients to foods with no government safety review

The industry can declare on their own that added ingredients are safe without ever consulting the Food and Drug Administration about potential health risks.

References : publicintegrity and belowthesaltnews, 2015.

Air pollution exposed adolescents with mental health problems

Exploration of NO2 and PM2.5 air pollution and mental health problems using high-resolution data in London-based children from a UK longitudinal cohort study

In the first analysis of how common air pollutants affect teenage mental health, researchers found young people were three to four times more likely to have depression at 18 if they had been exposed to dirtier air at age 12. Comparison with earlier work indicates that air pollution is a greater risk factor than physical abuse in raising the risk of teenage depression.

Study Highlights

    • High-resolution pollution estimates were successfully combined with cohort data.
    • Age-12 pollution exposure was not associated with age-12 mental health problems.
    • But age-12 pollution exposure was significantly associated with age-18 depression.
    • Associations with depression held even after controlling for common risk factors.
    • Elevated odds of age-18 conduct disorder among children exposed to air pollution.

Abstract, Feb 2019

Air pollution is a worldwide environmental health issue. Increasingly, reports suggest that poor air quality may be associated with mental health problems, but these studies often use global measures and rarely focus on early development when psychopathology commonly emerges. To address this, we combined high-resolution air pollution exposure estimates and prospectively-collected phenotypic data to explore concurrent and longitudinal associations between air pollutants of major concern in urban areas and mental health problems in childhood and adolescence. Exploratory analyses were conducted on 284 London-based children from the Environmental Risk (E-Risk) Longitudinal Twin Study. Exposure to annualized PM2.5 and NO2 concentrations was estimated at address-level when children were aged 12. Symptoms of anxiety, depression, conduct disorder, and attention-deficit hyperactivity disorder were assessed at ages 12 and 18. Psychiatric diagnoses were ascertained from interviews with the participants at age 18. We found no associations between age-12 pollution exposure and concurrent mental health problems. However, age-12 pollution estimates were significantly associated with increased odds of major depressive disorder at age 18, even after controlling for common risk factors. This study demonstrates the potential utility of incorporating high-resolution pollution estimates into large epidemiological cohorts to robustly investigate associations between air pollution and youth mental health.

Reference.

The Guardian press releases : here, here, here, here, here, here.

Impact of upstream oil extraction and environmental public health : A review of the evidence

There are approximately 40,000 oil fields globally and 6 million people that live or work nearby

Highlights

  • Identifies 63 studies on the exposure and health risks related to oil extraction
  • Examines the human health effects of oil drilling
  • Discusses potential exposure pathways via include air, soil, water and waste fluids

Abstract

Upstream oil extraction, which includes exploration and operation to bring crude oil to the surface, frequently occurs near human populations. There are approximately 40,000 oil fields globally and 6 million people that live or work nearby. Oil extraction can impact local soil, water, and air, which in turn can influence community health. As oil resources are increasingly being extracted near human populations, we highlight the current scope of scientific knowledge regarding potential community health impacts with the aim to help identify scientific gaps and inform policy discussions surrounding oil drilling operations.

In this review, we assess the wide range of both direct and indirect impacts that oil drilling operations can have on human health, with specific emphasis on understanding the body of scientific literature to assess potential environmental and health risks to residents living near active onshore oil extraction sites. From an initial literature search capturing 2236 studies, we identified 22 human studies, including 5 occupational studies, 5 animal studies, 6 experimental studies and 31 oil drilling-related exposure studies relevant to the scope of this review.

The current evidence suggests potential health impacts due to exposure to upstream oil extraction, such as cancer, liver damage, immunodeficiency, and neurological symptoms. Adverse impacts to soil, air, and water quality in oil drilling regions were also identified. Improved characterization of exposures by community health studies and further study of the chemical mixtures associated with oil extraction will be critical to determining the full range of health risks to communities living near oil extraction.

Exposure to Glyphosate-Based Herbicides and Risk for Non-Hodgkin Lymphoma

A Meta-Analysis and Supporting Evidence, Mutation Research/Reviews, February 2019

Abstract

Glyphosate is the most widely used broad-spectrum systemic herbicide in the world. Recent evaluations of the carcinogenic potential of glyphosate-based herbicides (GBHs) by various regional, national, and international agencies have engendered controversy.

We investigated whether there was an association between high cumulative exposures to GBHs and increased risk of non-Hodgkin lymphoma (NHL) in humans. We conducted a new meta-analysis that included the most recent update of the Agricultural Health Study (AHS) cohort published in 2018 along with five case-control studies.

Using the highest exposure groups when available in each study, we report the overall meta-relative risk (meta-RR) of NHL in GBH-exposed individuals was increased by 41% (meta-RR = 1.41, 95% CI, confidence interval: 1.13–1.75). For comparison, we also performed a secondary meta-analysis using high-exposure groups with the earlier AHS (2005), and we determined a meta-RR for NHL of 1.45 (95% CI: 1.11–1.91), which was higher than the meta-RRs reported previously. Multiple sensitivity tests conducted to assess the validity of our findings did not reveal meaningful differences from our primary estimated meta-RR. To contextualize our findings of an increased NHL risk in individuals with high GBH exposure, we reviewed available animal and mechanistic studies, which provided supporting evidence for the carcinogenic potential of GBH. We documented further support from studies of malignant lymphoma incidence in mice treated with pure glyphosate, as well as potential links between GBH exposure and immunosuppression, endocrine disruption, and genetic alterations that are commonly associated with NHL.

Overall, in accordance with evidence from experimental animal and mechanistic studies, our current meta-analysis of human epidemiological studies suggests a compelling link between exposures to GBHs and increased risk for NHL.

 

Reference. Image credit gmwatch.

Major US funders ($$ billions) are pushing for greater clinical trials transparency

Noncommercial US Funders’ Policies on Trial Registration, Access to Summary Results, and Individual Patient Data Availability

2019 Study Key Points

  • Question
    What are the current policies for clinical trial registration, summary results sharing, and individual patient data sharing among the top 10 noncommercial US health research funders?
  • Findings
    In this review study, 6 of 9 (67%) of the top US funders have a publicly available written policy addressing all 3 major trial transparency domains. However, fewer US funders require specific transparency actions in these domains (11%-56%) or monitor compliance with their policies (56%-67%).
  • Meaning
    More work remains to be done to ensure timely implementation and enforcement of clinical trial transparency initiatives to reduce waste and realize public value from clinical research investments.

Abstract

Importance
Incomplete information about existing research is an underlying cause of research waste. National and international initiatives and requirements have been launched to address this issue.

Objectives
To characterize current clinical trial transparency policies among the largest noncommercial US funders and examine whether the policies are concordant with international funders.

Design, Setting, and Participants
This retrospective review of public information used methods developed for documenting funder policies internationally; 2 researchers searched each funder’s website and Google between May and November 2018 to locate trial transparency policies for 10 top US funders. Key informants at each funding organization were contacted by email and given 3 or more weeks to review and confirm or correct the findings. Nonresponders were contacted 2 or more additional times. Descriptive statistics were calculated to summarize the findings. The study was conducted using publicly available policy information with findings confirmed by funder representatives where possible. Participants included top 10 noncommercial US health research funders with the highest reported investment in health research (2013 dollars) who fund clinical trials. Data analysis was conducted from November 6, 2018, to November 23, 2018.

Exposures
Availability of policies addressing each of the 3 key trial transparency domains as specified by the World Health Organization in 2017.

Main Outcomes and Measures
Independent assessment by 2 investigators of availability (yes or no) of a policy addressing registration for trials, sharing of summary results, and individual participant data sharing activities; requirements (yes, no, or supportive statement) of these policies in terms of completeness, timeliness, public access, and provision of additional technical or financial support to meet data sharing requirements; description (yes or no) of internal monitoring for policy adherence.

Results
All 10 funders acknowledged the outreach. One funder who indicated that less than 1% of their research funding goes to clinical trials was removed. Six (67%) of the remaining 9 top US funders have a publicly available written policy for all 3 major trial transparency domains. The most comprehensive trial transparency practice among US funders addresses summary results sharing as follows: 8 of 9 US funders (89%) have a policy, 5 of 9 US funders (56%) require reporting of summary results within 1 year, and 6 of 9 US funders (67%) monitor compliance with their summary results sharing policy. For clinical trial registration, 7 of 9 US funders (78%) have a policy and 5 of 9 US funders (56%) require registration and monitor trial registration to measure adherence to the policy.

Conclusions and Relevance
In this study, overall the proportion of US funders with policies and practices to support trial transparency in this sample was similar or compared favorably with the larger international sample of noncommercial funders recently reported.

 

Les dépenses de santé, l’accès aux soins et la politique des rustines

L’inégalité d’accès aux soins n’est plus ce qu’elle était, Luc Perino, 2018

Publié par Luc Perino, médecin généraliste, humeur du 20/09/2018

Dans les années 1960, vingt ans après la création de la sécurité sociale, les dépenses de santé ont augmenté de façon vertigineuse jusqu’à créer d’intolérables déficits. Qui fallait-il accuser ?

  • Les mandarins qui ont dépensé sans compter pour le prestige de nos CHU.
  • Les assurés qui ont tiré à hue et à dia sur le système jusqu’à devenir les plus gros consommateurs de médicaments et d’arrêt-maladie.
  • Les médecins et professionnels de santé qui ont multiplié les actes inutiles.
  • Les industriels qui ont médicalisé la société pour vendre de plus en plus d’imagerie, de biologie et de pharmacologie.
  • Les mutuelles privées qui ont brandi de futiles spectres pour avoir leur part du profit de la peur.

Contrairement à un réflexe bien républicain, je n’inclus pas les gouvernements dans cette liste des responsabilités. Certes, ils n’ont fait que poser des « rustines » ayant la discrétion qui convient – on ne touche pas impunément au sujet sensible de la santé –, mais bon an mal an, entre des déficits faramineux approchant 25 milliards d’euros et des années presque à l’équilibre, le système a survécu déjà plus de 70 ans. Saluons donc nos dirigeants qui ont établi le record mondial de longévité d’un système national de protection.

Or voilà que le nouveau défi n’est plus celui du budget, mais celui de l’inégalité de l’accès au soin : celle-là même que souhaitait abolir la sécurité sociale. Qui doit-on accuser de ce retour à la case départ ?

  • Les mandarins à la solde des laboratoires qui délaissent les vrais malades pour mieux façonner l’opinion sur les risques des bien-portants.
  • Les assurés nantis qui exigent le droit à l’immortalité sans contrainte.
  • Les médecins et professionnels de santé qui font désormais passer leur qualité de vie avant le sacerdoce et la fonction.
  • Les industriels qui falsifient impunément la recherche clinique.
  • Les mutuelles qui, devenues financières, ont déjà choisi leur camp avant l’implosion du système.

Cette nouvelle inégalité de l’accès aux soins est très différente de celle qui avait prévalu à la création de la sécurité sociale. Elle ne se résume pas à de triviales inégalités sociales, elle résulte aussi d’un remaniement profond de la pensée médicale, d’un bouleversement du mode de vie des acteurs du soin et de la financiarisation de tous les marchés de la santé.

Saluons encore les tentatives du gouvernement actuel, bien qu’il ne puisse plus ignorer que la politique des rustines est définitivement inadaptée à ces nouveaux contextes.

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