Based on a Danish study of 70,000 using databases. Of course, this wasn’t a double-blinded, randomized trial—who would agree to drink this amount or less or more each week consistently for many years! So,bar this is not the final word but very interesting. Alcohol has been shown, just as moderate coffee drinking to have bad and good effects.
CURING APPENDICITIS WITHOUT SURGERY
There was a meta-analysis (a study combining other studies to have large numbers and more firm conclusions) that showed that for those whose appendix had not burst, that antibiotics were not a bad idea. There is no firm conclusion as to which patients should be treated with antibiotics and observation vs. surgery. Keep in mind that when an instrument touches your intestine, it can become sticky and stick to other parts which can cause suffering and more surgery in the future.
STOPPING ANTIBIOTICS WHEN BETTER OR CONTINUE TILL BOTTLE EMPTY?
There is no evidence that many infections need a certain amount of days on antibiotics; this has not been studied. We did study Strep throat and the evidence for 10 days of therapy is not bad. For skin infections, I tell the patient to take the antibiotics for a day after the infection reaches a certain stage and then stop, even though there are pills left in the bottle. If you take an antibiotic longer than needed or when not needed (for a viral cold or flu) then you are setting yourself and others up for resistance problems in the future.
CIGARETTES ARE COSTLY, AND SOON TO BE WEAKER
Many of my patients have quit smoking or want to quit, due to the new high price. News articles show a marked drop in sales. Now the FDA is pursuing lowering the nicotine levels in cigarettes to non-addictive levels. This will mean that more people won’t smoke because they have to or they will experience withdrawal (headaches, irritability, anxiety).
Remember: we don’t know which causes the complications of smoking: nicotine or the tar or both. We don’t have 20 years of people smoking the nicotine without the tar; I’m talking about vaping.
3 RECENT REPORTS OF HIV REMISSION
A child in South Africa, treated from birth for a year, had remission for 8 years, and then had to restart as did a San Francisco man treated days after he suspected he caught HIV (and did) was in remission 7.4 months after treatment was stopped. A Thai man has been in remission for 10 years. These cases are being studied to understand what happened.
LONG ACTING MED PREVENTS HIV IN MEN AND WOMEN = PrEP
Cabotegravir was given as a large injection in both buttocks every 3 months, but the first month they also took it by mouth to get the levels up quickly. Of course, they were vulnerable to other STIs.
ONCE-A-DAY ISENTRESS APPROVED
A breakthrough, years ago, was the approval of Isentress® (raltegravir®) as the first integrase inhibitor with less drug interactions and great power in treating HIV. Other drugs have been approved in this class, such as Tivicay®. In fact I hve been substituting Tivicay® for my Isentress® patients who prefer once daily dosing; a few were not tolerant to the change. Now we can change those who are happy with the 400mg Isentress® twice a day with 2, 600mg pills of Isentress HD® (high def?) once a day and the tolerance is almost guaranteed.
GENERIC TRUVADA® APPROVED
This will bring down the cost of antivirals. Since Truvada’s® replacement, Descovy®, was released, then maybe we should use it for those with pre-existing kidney disease and those whose kidney function worsens. In addition, Descovy® may be helpful for those with osteoporosis (weak bones). The Descovy® is in the new Complera® (Odefsy®) and the new Stribild® (Genvoya®). Some wonder if Gilead postponed the release of Descovy® to have patients on their medications rather than generics more years. Will some health plans make restrictions on the Descovy® and make a Complera® patient take the generic Truvada® with the other pill? Will PrEP efforts only use the generic Truvada? There may be much money to be saved for other health care needs, like paying sky-high prices for orphan drugs that investors bought in order to make a lot of money by raising prices.
I had a patient recently discharged and the pharmacy and health plan found a way around this price that got jacked up as mentioned above. The price of the work-around was much, much lower. How many of you would say yes to the idea of buying a pill that no one else makes so that you can jack the price up beyond reason and make the health plans pay so that you would be super rich? This barrier has caused some to go without medicines and there is no data yet on how many have suffered and how much. Any barrier to good treatment causes some to not get the treatment.
Daniel Pearce, D.O., FACOI, AAHIVS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine HIV Specialist, Assistant TB Physician, Riverside University Healthcare System, Public Health (Department) Member, Coachella Valley Clinical Research Initiative