Significant decrease in testosterone therapy since 2013

Testosterone Prescribing in the United States, 2002-2016

Testosterone use in the United States tripled from 2001 through 2011, mostly in men without a clear indication.

In late 2013 and early 2014, two studies reported increased myocardial infarction and stroke associated with testosterone use.

The US Food and Drug Administration (FDA) issued a safety bulletin on January 31, 2014.

After a decade of growth, the percentage of US men receiving testosterone prescriptions decreased from 2013,  falling to less than 2% of men by 2016.

This prescribing trends study was published July 10, 2018.

Pesticides, le Poison de la Terre

Les produits phytosanitaires sont pointés du doigt – Aude Rouaux, 2016

En Gironde ou en Charente, à proximité des vignes ou travaillant dans le milieu agricole, des ruraux auraient été touchés par l’usage des pesticides dans leur environnement immédiat.

  • Pourquoi les riverains de Birac, petite commune charentaise, développent-ils un nombre surprenant de cancers des ganglions ?
  • Comment expliquer que les enfants du village de Preignac en Gironde sont-ils plus touchés par les leucémies ?

Aujourd’hui, les familles dénoncent le silence des autorités. La réalisatrice Aude Rouaux leur donne la parole afin de mener l’enquête sur un sujet qui demeure encore en 2016 un tabou, dans le monde agricole.

Valérie Murat et Marie-Lys Bibeyran, deux personnes très impliquées dans le combat contre l’utilisation des pesticides en Gironde, sont interviewées.

Transgenerational effects of chemotherapy

Both male and female children born to women exposed to chemotherapy have fewer children

2018 Study Highlights

  • Cancer survival rates have been improving.
  • Little is known about the generational effects of chemotherapy-exposure.
  • The children of chemotherapy-exposed women have fewer live births compared to matched controls.
  • Further research needs to validate these findings.

Abstract

Background
There is little known about the transgenerational effect of chemotherapy. For example, chemotherapy is known to decrease fecundity in women. But if women are able to have offspring after chemotherapy exposure, do these children also have decreased fecundity?

Methods
This study is a retrospective cohort study utilizing the Utah Population Database (UPDB), a comprehensive resource that links birth, medical, death and cancer records for individuals in the state of Utah. The male and female children (F1 generation) of chemotherapy-exposed women (F0 generation) were identified. The number of live births (F2 generation) to this F1 generation was compared to two sets of chemotherapy-unexposed, matched controls using conditional Poisson regression models (regression coefficient, 95% confidence interval, P-value). The first unexposed was established using the general population and the second unexposed was established using first cousins to the F1 generation.

Results
The exposed F1 individuals had 77.2% fewer children (−1.48; −2.51 to −0.70; p = 0.001) relative to the unexposed general population. F1 males had 86.9% fewer children (−2.03; −4.91 to −0.51; p = 0.005) and F1 females had 70.5% fewer children (−1.22; −2.40 to −0.36; p = 0.016). When comparing to their unexposed cousins, the F1 generation (both sexes combined) had 74.3% (−1.36; −2.82 to −0.29; p = 0.029) fewer children.

Conclusion
The sons and daughters (F1 generation) of chemotherapy-exposed women have fewer live births when compared to both matched, unexposed general population and cousin controls. Chemotherapy may have a transgenerational effect in exposed women which needs further investigation.

Ce que les soignants doivent savoir du marketing pharmaceutique dans l’Union Européenne

Information ou influence ? Traduit en français par la Troupe du RIRE

Les professionnels de santé sont fortement exposés aux activités marketing de l’industrie pharmaceutique. Plusieurs études montrent que l’exposition à l’information provenant des laboratoires pharmaceutiques ne conduit pas à une amélioration de la prescription. Au contraire, cela peut nuire à l’objectivité de la prescription et au professionnalisme des prescripteurs.

Fait ou fiction? Ce que les professionnels de la santé doivent savoir sur le marketing pharmaceutique dans l’Union européenne

Avec un accent particulier sur la promotion pharmaceutique dans l’Union européenne, ce nouveau guide de Health Action International enseigne aux étudiants à identifier et évaluer les méthodes utilisées dans les activités de promotion pharmaceutique, ainsi que leur impact sur la pratique clinique et la santé publique. Ils développent également la capacité d’évaluer de manière critique les activités de promotion pharmaceutique d’une manière qui préserve l’accès aux médicaments.

Comprendre et répondre à la promotion pharmaceutique: un guide pratique

Publié en collaboration avec l’Organisation mondiale de la santé en 2010, ce livre enseigne aux étudiants les techniques de marketing utilisées par l’industrie pharmaceutique. Il leur donne également les compétences nécessaires pour analyser de manière critique le marketing pharmaceutique et accéder à une information de meilleure qualité, impartiale et indépendante sur les médicaments.

Le guide est largement utilisé dans le monde entier par les facultés de médecine, de dentisterie, de pharmacie, de sciences pharmaceutiques et de santé publique en tant que complément du Guide de l’OMS pour une bonne prescription.

What Healthcare Professionals Need to Know about Pharmaceutical Marketing in the European Union

Fact or Fiction ?

85.2% of medical students recently surveyed in France (n=2,101) reported feeling inadequately educated about conlicts of interest arising from interactions with the pharmaceutical industry

Healthcare professionals are highly exposed to pharmaceutical marketing activities. Evidence shows that exposure to information from pharmaceutical companies does not lead to net improvements in prescribing, but can negatively affect prescribing and professional behaviour.

This guide and its workshop series build on the publication, Understanding and Responding to Pharmaceutical Promotion: A Practical Guide, produced by Health Action International, in collaboration with the World Health Organization, in 2009, as a companion to the WHO’s Guide to Good Prescribing.

Interview du gynécologue Anne Cabau sur le distilbene

Archives Antenne 2 Midi, 16 février 1983

Anne Cabau a été une lanceuse d’alerte à une époque où ce terme n’existait pas. Sans ses travaux, l’affaire du Distilbène n’aurait jamais éclaté.

Anne Cabau, médecin gynécologue à la MGEN, qui avait contribué à faire éclater le scandale du Distilbène en 1983, est décédée dimanche 01 juillet 2018 à Paris à l’âge de 81 ans, a annoncé lundi le Réseau DES France, association des victimes de ce médicament.

Le Distilbène DES, en savoir plus

Understanding and Responding to Pharmaceutical Promotion

A Practical Guide, 2010

Patients place great trust in doctors and pharmacists to properly prescribe and dispense medicines. But health professionals receive little to no instruction on how to critically assess pharmaceutical marketing. Many of them underestimate the influence that industry marketing has on their prescribing and dispensing practices.

Published in collaboration with the World Health Organization in 2010, this book teaches students about the marketing techniques used by the pharmaceutical industry. It also equips them with skills to critically analyse pharmaceutical marketing and access better-quality, unbiased and independent information on medicines.

Understanding and Responding to Pharmaceutical Promotion: A Practical Guide is used widely around the world by faculties of medicine, dentistry, pharmacy, pharmaceutical sciences and public health as a companion to the WHO’s Guide to Good Prescribing.

Guide to Good Prescribing – A Practical Manual

A World Health Organization resource, 1994

Abstract

Pharmacology training for most medical students concentrates more on theory than on practice. The material is often drug centred and focuses on indications and side effects of different drugs. But in clinical practice the reverse approach has to be taken, from the diagnosis to the drug. Moreover patients vary in age, gender, size and sociocultural characteristics, all of which may affect treatment choices. Patients also have their own perception of appropriate treatment and should be fully informed partners in therapy. All this is not always taught in medical schools, where the number of hours spent on therapeutics may be low compared to traditional pharmacology teaching. As a result although pharmacological knowledge is acquired, practical skills remain weak.

This training manual meets that need. It provides step by step guidance to rational prescribing and teaches skills that are not time limited but which remain valid throughout a clinical career. It demonstrates that prescribing a drug is part of a process that includes many other components. The manual explains the principles of drug selection and how to develop and become familiar with a set of drugs for regular use in practice, called P(personal)-drugs. Practical examples illustrate how to select, prescribe and monitor treatment, and how to communicate effectively with patients. The advantages and disadvantages of different sources of drug information are also described. The manual can be used for self-study or as part of a formal training programme.

Although intended primarily for undergraduate medical students who are about to enter the clinical phase of their studies, postgraduate students and practising doctors may also find it a source of new ideas and perhaps an incentive for change.

Endocrine Disrupting Chemicals and Behavior

Special issue of Hormones and Behavior, Volume 101, Pages 1-148, May 2018

The peer-reviewed journal Hormones and Behavior, Volume 101, Pages 1-148 (May 2018), raises concern about how many of the 90,000+ chemicals in use today may disrupt our most basic endocrine systems with significant consequences for neurodevelopment, neurophysiology, healthy brain aging, and behavior.

Several articles address bisphenol A :

About PDBEs, triclosan, and other replacement chemicals :

Other studies included in this special issue address behavioral effects of voluntary taken pharmaceuticals, including birth control pills, and pain medications.

About DES and the BRAIN :

Prenatal exposure to several replacement chemicals linked to hyperactivity, problem behaviors in children

Exposure to perfluoroalkyl substances during pregnancy and child behaviour at 5 to 9 years of age

2018 Study Highlights

  • Serum levels of perfluoroalkyl substances were measured in 1023 pregnant women.
  • Child behaviour was assessed by use of the Strength and Difficulties Questionnaire
  • Prenatal perfluorohexane sulfonic acid (PFHxS) was associated with problem behaviour
  • Prenatal perfluorononanoic acid (PFNA) was associated with hyperactive behaviour
  • Prenatal perfluorodecanic acid (PFDA) was associated with hyperactive behaviour.

Abstract

We examined associations between prenatal exposure to perfluorohexane sulfonic acid (PFHxS), perfluoroheptanoic acid (PFHpA), perfluorononanoic acid (PFNA), and perfluorodecanic acid (PFDA) – and child behaviour (SDQ-total) and hyperactivity (sub-scale) at 5–9 years of age in birth cohorts from Greenland and Ukraine.

Pregnancy serum samples (N = 1023) were analysed for perfluoroalkyl substances (PFASs) and categorised into tertiles and also used as continuous exposure variables. Problem behaviour and hyperactivity were assessed, using the Strength and Difficulties Questionnaire (SDQ) and categorised as normal/borderline and abnormal. Associations were analysed using multiple logistic and linear regression.

High compared to low prenatal PFHxS exposure was associated with 1.16 (95% confidence interval (CI): 0.08; 2.25) point higher SDQ-total (more problem behaviour) in Greenland and 0.80 (CI: 0.06; 1.54) point higher SDQ-total in the combined analyses, whereas no association was present in Ukraine alone. One natural log-unit increase in prenatal PFNA exposure was associated with 0.90 (CI: 0.10; 1.71) points higher SDQ-total in Greenland and 0.72 (CI: 0.13; 1.31) points higher in the combined analysis and no association in Ukraine. Prenatal PFAS exposure was unrelated to problem behaviour (abnormal SDQ-total). In the combined analysis, odds ratio (OR) (CI) for hyperactivity was 1.8 (1.0; 3.2) for one natural log-unit increase in prenatal PFNA and 1.7 (1.0; 3.1) for one natural log-unit increase in prenatal PFDA exposure.

Findings are compatible with weak effects on child behaviour of prenatal exposure to some PFASs although spurious results are not entirely unlikely. The associations were strongest in Greenland.