Latest / Morning Medical with Dr. Chow / Oral Wegovy Approval, Air Pollution & Mental Health, and Flu Season Insights

Transcript

Oral Wegovy Approval, Air Pollution & Mental Health, and Flu Season Insights · Morning Medical with Dr. Chow

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  Good morning, and welcome to Morning Medical with Dr.
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  Chow.
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  I'm Dr.
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  Chi-Ming Chow, and today we're diving into some of the latest developments in the world of
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  health and medicine.
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  From groundbreaking approvals in weight loss medications to the impact of air pollution on
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  mental health, we'll cover it all.
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  Let's start with a significant update from the United States about a new weight loss
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  medication.
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  The United States Food and Drug Administration has approved a new pill version of the popular
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  weight loss medication, Wegovy.
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  This marks the first daily oral medication approved to treat obesity, a move that's
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  expected to significantly impact the obesity treatment landscape.
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  Novo Nordisk, the pharmaceutical company behind Wegovy, now has a competitive edge over its
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  rival Eli Lilly, whose own oral obesity drug is still under review.
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  Both Wegovy and Eli Lilly's drug are glucagon-like peptide-1, or GLP-1, medications.
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  They work by mimicking a natural hormone in the body that helps control appetite and feelings
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  of fullness.
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  Previously, these treatments were primarily available as injectables, but the introduction
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  of a pill form could make the medication more accessible and potentially more affordable for
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  many.
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  In clinical trials, participants who took the oral form of Wegovy lost an average of 13.6
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  percent of their total body weight over about 15 months.
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  This is quite comparable to the weight loss seen with the injectable form.
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  The availability of a pill form is expected to broaden access to obesity treatments,
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  especially for those who are needle-averse.
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  The approval of the Wegovy pill is a significant step in the ongoing effort to
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  address obesity, a chronic condition affecting over 100 million people in the United States
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  alone.
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  Experts believe that having an oral option will not only expand the market but also reduce
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  costs, making it easier for patients to access this treatment.
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  Novo Nordisk plans to make the Wegovy pills available within weeks.
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  The pricing is expected to be more competitive compared to the injectable versions, with the
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  starting dose available for approximately one hundred forty-nine dollars per month through
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  certain providers.
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  This could be a game changer for many patients struggling with the high costs of injectable
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  treatments.
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  It's important to note that all GLP-1 drugs, whether they're taken as a pill or injected,
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  have similar side effects, including nausea and diarrhea.
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  However, the convenience of a daily pill versus a weekly injection might sway some patients'
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  preferences.
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  The development of oral medications for obesity treatment is a promising advancement in making
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  weight loss therapies more accessible and affordable.
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  It's a step forward in addressing the growing obesity epidemic with innovative solutions that
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  meet more patients' needs.
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  Today, I want to share a deeply personal and urgent perspective from Zoe Weissman, a student
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  at Brown University, who has survived not one, but two school shootings.
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  Zoe's story is both harrowing and inspiring, and it serves as a powerful call to action for
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  all of us in the healthcare community to advocate for gun violence prevention.
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  Zoe recounts her experience of surviving a recent shooting at Brown University, which
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  tragically claimed the lives of two students and injured nine others.
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  This was not her first encounter with such a horrific event.
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  In 2018, she witnessed the Marjory Stoneman Douglas High School shooting in Parkland,
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  Florida, from an adjacent middle school.
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  These experiences have left an indelible mark on her, shaping her future aspirations in
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  medicine and advocacy.
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  As a future physician enrolled in Brown's Program in Liberal Medical Education, Zoe is
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  determined to use her medical career not only to treat illnesses but also to champion
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  preventive measures that safeguard the health and well-being of children and communities.
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  She emphasizes that healthcare professionals have a duty to speak up and take action against
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  gun violence, which has become the leading cause of death for children and adolescents in
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  the United States since 2020.
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  Zoe argues that addressing gun violence requires a multifaceted approach involving both
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  medical professionals and policymakers.
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  She believes that clinicians must advocate for commonsense policies like mandated safe firearm
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  storage, extreme risk protection orders, and universal background checks.
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  Additionally, she stresses the importance of increased funding for mental health treatment
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  and community violence intervention programs.
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  In a nation where guns are often seen as symbols of liberty, Zoe calls on everyone,
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  including physicians, to raise awareness about the devastating impact of firearms on public
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  health.
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  She dreams of a future where gun violence is no longer a threat that healthcare providers must
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  warn their patients about and where political leaders prioritize prevention efforts before
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  their communities are affected by such tragedies.
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  Zoe's story is a poignant reminder of the urgent need for action to prevent gun violence,
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  and it challenges us all to consider our role in advocating for policies that protect our
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  communities.
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  As healthcare providers, we have the opportunity and responsibility to contribute to
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  this critical public health issue.
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  Let's join Zoe in her fight against gun violence and work towards a safer future for
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  everyone.
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  Today, we're turning our attention to a concerning link between air pollution and
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  mental health.
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  A recent study from the United States has found that long-term exposure to pollution from fine
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  particulate matter is associated with a higher risk of depression among older adults.
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  This study, which focused on Medicare patients, highlights the potential mental health impacts
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  of air pollution that is small enough to penetrate deep into the lungs and bloodstream.
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  The researchers discovered that each quartile increase in exposure to particulate matter with
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  a diameter of two point five micrometers or smaller, known as PM2.5, correlated with a
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  seven percent higher risk of developing depression.
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  This data was averaged over five years and measured in the participants' ZIP code of
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  residence.
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  The study found that the most significant contributors to this increased risk were
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  pollutants such as soil dust, sulfate, and elemental carbon.
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  These findings were reported by Yang Liu, Doctor of Philosophy, and colleagues from Emory
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  University in Atlanta, and published in JAMA Network Open.
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  The study is particularly noteworthy because while previous research has linked such
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  pollution to depression, most of those studies were conducted outside the United States, often
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  in areas with higher concentrations of airborne pollutants.
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  The study calls for stricter regulation of fine particulate emissions, especially those from
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  fossil fuel combustion and traffic sources.
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  The researchers noted that sulfate, primarily from fossil fuel combustion, might contribute
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  to depression by causing mitochondrial dysfunction and oxidative stress, which can
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  affect the central nervous system.
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  Soil dust, which is rich in silica and metals, can accumulate in the body, potentially
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  damaging the nervous system.
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  Silica has been shown to induce oxidative stress and systemic inflammation, both of which
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  have been associated with an increased risk of depression.
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  Elemental carbon, another pollutant from traffic sources, is small enough to cross the
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  blood-brain barrier and may be neurotoxic.
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  The study analyzed Medicare data from nearly twenty-four million beneficiaries aged
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  sixty-five and older, covering the period from January 2000 to December 2018.
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  Among the cohort, over fifty-five percent were women, and nearly eighty-nine percent were
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  white.
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  Of the five and a half million who developed depression, a substantial majority had at least
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  one comorbidity, such as hypertension, during the follow-up period.
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  The researchers also found that the associations between pollution and depression
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  were stronger among individuals with comorbidities, particularly those with
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  hypertension and cardiovascular, neurodegenerative, and respiratory diseases.
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  This suggests that comorbidities might interact with PM2.5 exposure to accelerate the
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  development of depression, possibly due to complex medication regimens, weaker social
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  engagement, and unhealthy lifestyles.
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  While the study provides important insights, the researchers acknowledge limitations, such
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  as potential confounding factors like physical exercise, smoking, and alcohol use that weren't
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  fully accounted for.
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  Nonetheless, it underscores the pressing need for public health interventions to reduce
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  pollution and protect vulnerable populations from its wide-ranging health impacts, including
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  mental health.
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  Today, we're discussing a recent study from Taiwan that has raised concerns about the use
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  of benzodiazepines during pregnancy.
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  This study, published in JAMA Internal Medicine, suggests that these medications, when
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  used during pregnancy, particularly in the second trimester, are linked to several adverse
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  outcomes.
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  These include an increased risk of abortion, preterm birth, and babies being small for their
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  gestational age.
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  Benzodiazepines are commonly prescribed for conditions such as anxiety, insomnia, and
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  certain neurological disorders.
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  Despite their therapeutic benefits, about two percent of pregnant women take these
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  medications, which has prompted healthcare providers to consider the potential risks
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  involved.
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  The Taiwanese cohort study analyzed data from over four hundred fifty-four thousand
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  pregnancies.
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  Researchers found that benzodiazepine use was associated with an increased risk of both
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  spontaneous and elective abortions.
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  Specifically, the absolute risk of abortion among benzodiazepine users was 0.83 events per
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  one hundred pregnancies, compared to 0.52 events per one hundred in nonusers.
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  Furthermore, the study indicated a link between benzodiazepine use and preterm birth, as well
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  as small for gestational age outcomes, with the effects being more pronounced during the second
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  trimester.
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  The researchers suggest that these trimester-specific findings might be due to
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  biological mechanisms, as benzodiazepines could impair progesterone synthesis, a hormone
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  crucial for maintaining pregnancy and supporting fetal growth.
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  Interestingly, the study did not find a significant association between benzodiazepine
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  use and stillbirth.
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  However, the increased risks of abortion and preterm birth highlight the need for careful
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  consideration when prescribing these medications to pregnant women.
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  In an editorial accompanying the study, experts from Duke University emphasized the importance
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  of weighing these risks against the benefits of benzodiazepines.
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  They noted that while avoiding benzodiazepines during pregnancy is often advisable, abrupt
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  discontinuation can lead to withdrawal symptoms and seizures, especially in patients who have
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  been on long-term treatment.
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  The editorial also pointed out that more research is needed to explore whether the risks
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  associated with benzodiazepine use differ by type, dosage, and duration of treatment.
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  Such insights could help clinicians make more informed decisions when managing the health of
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  pregnant patients who require these medications.
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  This study utilized data from Taiwan's National Health Insurance Research Database and the
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  National Birth Certificate Application database, covering a period from January 2011
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  to December 2021.
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  The research team emulated a series of open-label, randomized trials, stratifying the
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  data by trimester to gain a clearer understanding of how benzodiazepine use affects
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  pregnancy outcomes.
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  While the study provides valuable evidence, the authors acknowledge limitations, such as
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  potential residual confounding and the possibility of unrecorded abortions.
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  Despite these limitations, the findings underscore the need for heightened awareness
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  and cautious prescribing practices regarding benzodiazepine use in pregnancy, especially
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  considering the rising prevalence of anxiety and insomnia during this critical period.
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  As we conclude today's episode, we turn our focus to a pressing health issue affecting
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  Quebec, Canada, where emergency rooms are experiencing unprecedented overcrowding even
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  before the peak of the flu season.
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  This situation is particularly acute in regions like the greater Montreal area,
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  Centre-du-Québec, and the Capitale-Nationale.
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  According to Dr.
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  Antonio D’Angelo, chief medical officer of the emergency pediatrics department at CHU
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  Sainte-Justine in Montreal, the number of flu cases is expected to peak around December 25th
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  or 26th.
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  This timing coincides with a period when fewer healthcare professionals are available,
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  exacerbating the stress on the healthcare system.
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  Dr.
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  Gilbert Boucher, president of the Association des spécialistes en médecine d'urgence du
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  Québec, reports that nearly one in five patients visiting the emergency room leaves
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  without seeing a doctor.
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  This situation underscores the dire need for strategic measures to manage patient flow and
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  ensure that those in critical need receive care.
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  Last week, Quebec’s Laboratoire de santé publique du Québec recorded approximately 3,500
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  cases of influenza.
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  Significantly, 26 percent of tests for the influenza A (H3N2 strain) returned positive
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  results.
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  The flu is notably spreading among children aged five to 17, with many parents opting to
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  visit emergency rooms rather than consulting a primary care physician or allowing their
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  children to rest at home.
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  Dr.
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  Judy Morris, outgoing president of the Association des médecins d’urgence du Québec,
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  highlights that the additional burden this year is compounded by many parents also falling ill.
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  She advises against visiting emergency rooms unless absolutely necessary, particularly for
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  children who do not require urgent care.
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  The flu has severely impacted older adults, with nearly half of the patients showing up at
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  hospitals with high fevers and flu symptoms.
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  Dr.
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  Élyse Berger Pelletier, an emergency physician at Hôtel-Dieu de Lévis, points out that elderly
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  patients often have no choice but to seek hospital care due to severe symptoms.
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  Public health authorities are urging the public to monitor symptoms closely, especially before
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  attending large gatherings during the holiday season.
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  They recommend utilizing clinics or calling 811 for medical advice, and stress the continued
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  importance of wearing masks when symptomatic.
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  Nationwide, the flu positivity rate is nearing its highest level in three seasons, with
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  concerns about low vaccination coverage in several provinces.
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  Despite this year's vaccine being less effective, experts emphasize its role in
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  preventing complications among high-risk populations.
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  As we wrap up today's episode, it's clear that the healthcare systems in Quebec and across
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  Canada are under significant pressure due to the early onset of the flu season.
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  It's crucial for the public to heed the advice of health professionals and take preventive
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  measures seriously.
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  Thank you for joining me today on Morning Medical with Dr.
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  Chow.
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  Stay informed, stay healthy, and until next time, take care.