Is Amphetamine Truly the Solution For Managing Rambunctious Children?

 

https://www.additudemag.com/misunderstood-adhd-in-the-classroom/

Imagine yourself as a parent, receiving a call from school because your child keeps interrupting class and will not sit still. You think to yourself, “But aren’t kids always bursting with energy?” The teacher urges you to put your child on medication to calm him or her down. You are not sure, but you decide to accept. Everything will go back to normal with a handful of pills, no? Or is the problem something deeper?

All About ADHD

Attention Deficient Hyperactive Disorder, shortened to ADHD, is a neurodevelopmental disorder that impairs the brain’s executive functions. Organization, planning, time management, and paying attention becomes extremely difficult for those with ADHD. You may know a friend or parent with an ADHD kid. ADHD is a relatively common disorder, affecting 11% of children and 5% of adults (1). Even I have ADHD and can relate to all these symptoms. I best described my struggles to a friend as, “Having a hundred computer tabs open and rattling around in your head but you can’t close any of them”. Not only does the condition impact your personal or social life, it can detrimentally affect your work or schooling. Being forced to sit still in class while a teacher is lecturing about some uninteresting topic is agony. Back in the early 20^th century, unruly students would be kicked out of class or smacked with rulers, but there is a modern solution: Medication.

Prescription Problems

There are many different types of ADHD medication. Some act instantly and allow for powering through a morning test and some are slow acting and facilitate survival of the school day. The most commonly used drug are stimulants which increase the neurotransmitters dopamine and norepinephrine in the central nervous system. Because dopamine is in short supply in those with ADHD, they struggle with mood and concentration (6). In the United States, 8.5% of children, about 1 in 12 children, are on some form of medication to treat ADHD (1). And with the whirlwind of COVID causing kids to be cooped indoors, ADHD prescriptions are at an all-time high (7). These medications are not without their problems. As some medications use amphetamines, they are tightly regulated, punishing the absentminded for forgetting their refills. Medications are also expensive and difficult to force children to take. Finding the correct type of prescription is an added challenge. Not enough dosage and the children are bouncing off the walls, too much dosage and the children are mindless drones. It is a nightmare for everyone involved. Maybe ADHD is not the fault of the children, but of the school system.

https://www.additudemag.com/slideshows/how-can-we-improve-education-for-students-with-adhd/

Schooling Situation

Public or private, children are in school for eight hours a day. They have many classes, but not a lot of free time. According to the National Association of Early Childhood Specialists, 40% of schools have removed or are considering removing recess. Removing a well needed break for children is problematic. Stewart Trost, a kinesiologist, believes kids who have recess have improvements in staying on task, are less fidgety in the classroom, and are more well behaved (3). Participating in sports have the same beneficial effects. Physical exercise raises those needed dopamine levels and clears the mind to improve students’ social skills and focus in the classroom (2, 5). There are many more ways the United States’ school system could be improved. ADDitude, a magazine devoted to understanding and triumphing over ADHD, provides solutions. Teachers should be trained in recognizing ADHD symptoms instead of considering it as unruly behavior. Class lessons could be more interactive which decrease the amount of time required for students to sit quietly at a desk. Recess breaks should be non-negotiable (4). So the next time little Timmy is squirming in his seat, don’t throw pills at the problem, let him be a kid! Exercise and fresh air are far less expensive.

By Carmen Harper, a Master's of Medical Science student at the University of Kentucky

References:

ADDitude Editors. “What Is ADHD? Attention Deficit Hyperactivity Disorder in Children and Adults”. ADDitude. 2019. https://www.additudemag.com/what-is-adhd-symptoms-causes-treatments/

ADDitude Editors. “Exercise and the ADHD Brain: The Neuroscience of Movement”. ADDitude. 2022. https://www.additudemag.com/exercise-and-the-adhd-brain/

Silver, Larry. “No Recess for Recess”. ADDitude. 2017. https://www.additudemag.com/benefits-of-recess-for-adhd/

ADDitude Editors. “10 Ways We Would Fix the U.S. School System”. ADDitude. 2021. https://www.additudemag.com/slideshows/how-can-we-improve-education-for-students-with-adhd

Stewart, Kristen. “How Exercise Works Like A Drug for ADHD”. Everyday Health. 2013. https://www.everydayhealth.com/add-adhd/can-you-exercise-away-adhd-symptoms.aspx

Cochrane, Zara. “ADHD Medications List”. Healthline. 2023. https://www.healthline.com/health/adhd/medication-list

Kritz, Fran. “The Adderall Shortage: Why It’s Still Happening and What to Do if You Can’t Get Your Meds”. Everyday Health. 2023. https://www.everydayhealth.com/adhd/the-adderall-shortage-why-its-still-happening-and-what-to-do/

 

To Live or to Die by BMI Anti-Black Racism and the Black Community’s Struggle with Obesity

 Let’s Have an Uncomfortable Conversation

There is no debate that obesity is a serious condition that disproportionately impacts the Black community in America. In 2018, Black Americans were found to be 1.3 times more likely to experience obesity and 20 percent less likely to participate in consistent exercise compared to white people.¹ Black women are 50 percent more likely to experience obesity compared to their white counterparts. However, the tools we use to classify obesity are a little out of date.

What is BMI?

Body Mass Index is the measurement of weight (kg) divided by the square of height (m).² BMI is a tool that is used to detect possible risks associated with high body fat and to categorize patients by weight. BMI is used by life insurance companies, electronic health records, and healthcare providers to quantify disease risk.³

Let’s Take a Closer Look at the Origins of BMI

Adolphe Quetelet was a mathematician from Belgium who became very interested in using statistics to define the “average man,” an idealized concept of physicality.⁴ Quetelet found that using a ratio of weight and squared height was the best way to quantify body size and growth. This number was named the Quetelet Index in 1832. Weight tables came into the picture as a result of observations by life insurance companies in the early 20th century. Louis Dublin, vice president of Metropolitan Life Insurance Company, noticed an increase in deaths of policyholders who were obese. He collected data on the matter and found that people of the same height and sex exhibited a vast range of weights. To account for this, he took that range of weights and divided them into small, medium, and large. Insurance companies then decided what weight category was “desirable” and used this number to inform their policies and payouts. The topic of obesity was of growing concern, and by the time of World War II, medical professionals needed a reliable index of weight for clinical and epidemiological studies. In 1972, Ancel Keys, an American physiologist, performed a study that compared the different weight indexes available to clinicians and decided that the Quetelet Index was the most accurate. He then renamed that index to the Body Mass Index, and this ratio was then adopted by medicine.

One of the main criticisms of the Body Mass Index at the time was its ability to be generalized to other populations.⁴ Studies on BMI relied on data from white populations, therefore it did not account for any physical differences in frame and weight distribution for other ethnic groups.

This shortcoming has several serious implications, especially for Black Americans.^3,4

 BMI, Eugenics, and Racism

Discrimination against Black people for their body size originated during chattel slavery when Europeans “observed” enslaved Africans and presumed that they were more sensuous and that they ate too much.⁵ Sabrina Strings, author of Fearing the Black Body: The Racial Origins of Fat Phobia, is an expert on the topic of obesity science and anti-Blackness. In an interview with NPR, Dr. Strings discusses how slave owners differentiated between the enslaved and the free.
After centuries of slavery, it became difficult to tell who was enslaved just by their skin tone, so “they decided to articulate new aspects of racial identity.” Dr. Strings elaborates that appetite and size were two key indicators of a person undeserving of freedom.

 BMI and racism were brought together by Francis Galton, known as the Father of Eugenics.⁶ Galton used the Quetelet Index as the basis for his theories about eugenicist breeding practices - he was concerned with turning Quetelet’s “average man” into an extraordinary one, and this vision did not include people of color or obese bodies.

 Charles Davenport came shortly after Galton and was convinced that there was some racial component to obesity.^6,7 His research conflated a “healthy” body with an attractive body, thus promoting the concept that Black people are “unhealthy” and therefore undesirable. A key component of eugenics is associating physicality with moral value, demoralizing bodies that do not fit within the established aesthetic.

From Strings, S. (2023a, July 1)7

BMI is not a one-size-fits-all solution

The problem with BMI lies within its ability to serve as a “catchall proxy for body fat, nutritional status, and health risk.”8 Relying too much on BMI may unfairly inform diagnoses and exacerbate pre-existing stigma and distrust between Black Americans and the medical community.
 
Given how deeply ingrained BMI is within our healthcare system, it might not be realistic to just do away with it altogether, but adjusting the cut points for ethnicity and educating providers on diagnosing and treating obesity in the Black community is a good start. Dr. Fatima Stanford, an obesity medicine physician-scientist at Harvard Medical School, proposed new BMI cut points that are adjusted for both ethnicity and gender.⁹ These new BMI thresholds are a better predictor of future morbidity and mortality associated with obesity because they are “based on association with metabolic disease” relative to each subgroup, allowing for a more personalized assessment of risk.

 

Obesity in the Black community is a sensitive, nuanced topic that requires special attention from healthcare providers to ensure that Black patients are being treated holistically. BMI may be a useful tool for assessing populations and providing a metric that predicts health risks and disease, but we must all be careful to only see BMI as a part of the picture.

 

By Alexis Jackson, A Master’s of Medical Science student at the University of Kentucky

Sources

1.     Department of Health and Human Services. (2022). Obesity and African Americans. Office of Minority Health. https://minorityhealth.hhs.gov/obesity-and-african-americans

2.     Centers for Disease Control and Prevention. (2022, June 3). About adult BMI. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

3.     Centers for Disease Control and Prevention. (2022, June 3). About adult BMI. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html\

4.     Eknoyan, G. (2007). Adolphe Quetelet (1796 1874) the average man and indices of obesity. Nephrology Dialysis Transplantation, 23(1), 47–51. https://doi.org/10.1093/ndt/gfm517

5.     NPR. (2020, July 21). Fat phobia and its racist past and present. NPR. https://www.npr.org/transcripts/893006538

6.     Farber, S. A. (2008). U.S. Scientists' Role in the Eugenics Movement (1907–1939): A Contemporary Biologist's Perspective. Zebrafish, 5(4), 243-245. https://doi.org/10.1089/zeb.2008.0576

7.     Strings, S. (2023a, July 1). How the use of BMI fetishizes white embodiment and racializes fat phobia. Journal of Ethics | American Medical Association. https://journalofethics.ama-assn.org/article/how-use-bmi-fetishizes-white-embodiment-an d-racializes-fat-phobia/2023-07

8.     Stern, C. (2021, May 8). Why BMI is a flawed health standard, especially for people of color. The Washington Post.https://www.washingtonpost.com/lifestyle/wellness/healthy-bmi-obesity-race-/2021/05/0 4/655390f0-ad0d-11eb-acd3-24b44a57093a_story.html

9.     Race, ethnicity, sex, and obesity: Is it time to personalize the scale? (n.d.). https://www.mayoclinicproceedings.org/article/S0025-6196(18)30807-3/pdf

DRUG, DUPE! SAVE YOUR MONEY AND GO WITH GENERIC

     What do the words generic and ineffective have in common? Absolutely nothing! It is a common misconception that generic brands are less effective than name brand products, due to the gain of negative connotation surrounding the terms in society. The brand effect is studied by large pharmaceutical companies to understand what convinces consumers to buy their drug products and how that can be incorporated into gaining business and recurring sales. The difference in advertising and drug packaging from company to company can be enough to persuade consumers into purchasing their products. Society tends to be easily influenced in today's market, especially with the growth of social media presence amongst the general population. The strategic advertising that name brand companies put out onto online platforms is meant to introduce and familiarize us with their products hoping to make consumers more susceptible to purchasing their products. When describing drugs, patients tend to associate price with efficiency, meaning the more expensive the drug the better it will work. I mean, who doesn’t want to feel better, faster? The name on the box does not have any correlation as to how well a drug works, nor does the price tag! Next time you find yourself in the drugstore medicine aisle, look at the similarities between name brand products and generic products. Being an educated and informed consumer is important and will save you time and money, especially when you reach for the generic brands.   

https://soieric.com/generic-vs-branded-medicines-in-india-a-quick-differentiation/

WHAT IS THE DIFFERENCE?

    According to the Food and Drug Administration, “generic medicines work in the same way and provide the same clinical benefits and risks as their brand-name counterparts. A generic medicine must be the same as a brand-name medicine in dosage, safety, effectiveness, strength, stability, and quality, and in the way it is taken. Generic medicines also have the same risks and benefits as their brand-name counterparts.” (5) These generic medicines are required to go through the same strict pre-approval process that name brand products do. This protects the consumer from purchasing a less effective drug due to reasons including financial restrictions, limited access to health care or knowledge.   

https://www.ideagen.com/thought-leadership/blog

SAVE OR SPLURGE?

    What makes generic brands more affordable? The lower cost is attributed to not having to repeat animal and clinical studies required of the brand-name medicines to demonstrate safety and effectiveness. (4) Research can be costly and is not always guaranteed a successful outcome. The ability to skip the research portion of drug development saves cost and time. The estimated cost of research and development can range from $1-2 billion per drug. (4) The amount of time these medications also take to develop is also considered when determining a price point in drug stores. The development process can take on average 10+ years and the pharmaceutical company does not receive a financial return on its investment. (4) Generic medicines cannot get final FDA approval until protective patents of name brand drugs have expired. (1) This causes a delay in the timing of distribution to drug stores; however, these generic drugs applications are typically approved within 6 months of submission to the FDA. (3) The time and money saved by companies producing these generic drugs is a direct reflection into how they price their products and can sell to a wide demographic of customers. These drugs provide a more affordable option for patients who may have limited resources giving them access to pharmaceutical care.  

https://www.vecteezy.com/vector-art/340554-piggy-bank

SHOW ME THE STUDIES

    Multiple studies have been conducted to evaluate the influence branding and marketing have on consumers, specifically related to drug products. Authorized generic (AG) drugs, name brand drugs that are marketed as generic drugs, were used as an experimental control group, and name brand drugs of identical composition were compared to observe the bias consumers have towards favoring brand name drugs versus generic drugs to treat chronic diseases. “After analyzing data from more than 3.5 million patients, the authors (of the research study) observed that use of generics provided comparable clinical outcomes to those of the brand-name products for chronic conditions including diabetes (glipizide), hypertension (amlodipine, amlodipine-benazepril, and quinapril), osteoporosis (alendronate and calcitonin salmon), and depression and anxiety (escitalopram and sertraline).” (2) Another study was conducted to measure the effectiveness of antiepileptic drug (AED) therapy in terms of persistence and rate of seizures in epileptic patients, comparing generic versus name brand drug therapies. The results showed that 31 patients on the generic AEDs had hospitalizations and ER visits while there were 47 incidents recorded of patients that were on the brand name AEDs. The gap rate of which patients experienced seizure-like symptoms was an average of 124.2 days (about 4 months) for patients on the name brand AED, while the average gap rate for patients on the generic brand AED was 137.9 days 

(about 4 and a half months). In other words, the generic brand medication outperformed the name brand medication, as it resulted in less hospitalizations and provided patients with relief from symptoms for a longer time. (1) Both studies present compelling data that supports the idea that generic drugs do not necessarily mean less effective. In fact, certain experimental data results favor the generic brand in terms of efficacy. Looking at the research, we should not write off generic brands!  

https://www.scripthero.com/articles/brand-vs-generic-prescriptions

WHAT SHOULD YOU DO?

    Educating yourself about branding, marketing, and taking the time to read the labels can save you money and change your perspective on purchasing drugs in the future. Consulting with a pharmacist may also be helpful, as they provide insightful information regarding questions you may have about different branded medications. Although brand name drugs seem to appeal to consumers more than the generic brand, make the choice and switch to generic. The higher price does not constitute for the quality and efficacy of the medication. You are spending your extra money on the name, the packaging costs, and the developmental debt of the pharmaceutical company. Generic brands are equally as effective and cost less, so why wouldn’t they be the better choice? Physicians can do their part to encourage patients to do their own research to make informed and educated decisions. Educated consumers should feel confident about the quality and efficiency of the products that you are using. So read the labels, do your research, save your money, and reach for the bottom shelf generics.  

REFERENCES

1. Gagne JJ, Kesselheim AS, Choudhry NK, et al. Comparative effectiveness of generic versus brand-name antiepileptic medications. Epilepsy Behav. 2015;52(Pt A):14-18.

doi:10.1016/j.yebeh.2015.08.014

2. Desai RJ, Sarpatwari A, Dejene S, et al. Comparative effectiveness of generic and brand-name medication use: A database study of US health insurance claims. PLoS Med.

2019;16(3):e1002763. Published 2019 Mar 13. doi:10.1371/journal.pmed.1002763

3. Ted Sherwood, The generic drug approval process, Food and drug administration website, https://www.fda.gov/drugs/news-events4.

4.     David Austin and Tamara Hayford prepared the report with guidance from Joseph Kile, Lyle Nelson, and Julie Topoleski, Research and development in the pharmaceutical industry, Congress budget office website, https://www.cbo.gov/publication/57025, April 2021, accessed on October 26th, 2023.

5. Generic drug facts, Food and drug administration website, https://www.fda.gov/drugs/generic-drugs/generic-drug-facts, updated on November 11th, 2021, accessed on October 23rd, 2023.

-human-drugs/generic-drug-approval-process, updated March 17th, 2022, accessed on October 26th, 2023.

By Karly Brungs 

A Master's of Medical Sciences Student at the University of Kentucky

HDL Cholesterol: Is it the hero or the villain?

 

Every great story needs a great hero and a terrific villain. With his evil actions, the villain represents the opposite of the hero, driving him to act and save the day, allowing him to shine. The High-Density Lipoproteins (HDL) play the hero role, and Low-Density Lipoproteins (LDL) play the story's villain. This, however, might not always be the case. It has always been assumed that high LDL levels, known as the "bad" cholesterol, increase a person's heart attack and stroke risk. And, high HDL, or the so called "Good" cholesterol, can help reduce cholesterol levels. As a result, several publications and articles are currently pushing and instructing people on increasing their HDL levels (1). However, we should keep HDL levels within a normal range because sometimes having too much of a good thing might be harmful; it can hurt our bodies and raise the risk of cardiovascular and other diseases rather than improving it, as studies suggest.

From: https://stock.adobe.com/images/cartoon-cholesterol-hdl-and-ldl-components-are-good-fats-and-bad-fats-from-food/289846779

What is HDL?

Before understanding the role of HDL, we need to know what cholesterol is. Cholesterol is a fat-like substance found in all the cells in our body. Our body makes cholesterol, which is required to make hormones, vitamin D, and other essential substances in food digestion. But too much cholesterol is harmful, as it can combine with other substances and stick to the artery wall, forming plaque; the buildup of this plaque is called atherosclerosis. The buildup of plaque is a significant cause of coronary artery disease (CAD), where the coronary artery becomes narrowed or blocked. Cholesterol travels throughout our body via lipoproteins. These lipoproteins are the combination of fat and proteins, HDL, and LDL. The latter is called the "bad" cholesterol, as high plasma levels are responsible for plaque formation. HDL is known as the "good" cholesterol as it carries the "bad" cholesterol back to the liver, where it is broken down and removed from our body. We should maintain both levels within the normal range, even though many people think that the more HDL we have, the better our health outcome. (2)

Why are HDL levels a problem?

HDL is a healthy cholesterol with a favorable purpose in our bodies. This fact, however, has led to various misconceptions: some people believe that the greater the HDL number, the lower the risk of developing cardiovascular disease; others overlook the importance of HDL levels and instead prioritize LDL. The typical range values of HDL lie between 40 mg/dl and 80 mg/dl, not too low to a level that cannot effectively lower the LDL and not too high to increase the risk of heart disease. Moreover, a study of 400,000 people of the general population in the U.K. suggests that men with HDL levels lower than 40 mg/dl or higher than 80 mg/dl and women above 100 mg/dl are at a greater risk of both mortality from all causes, cardiovascular disease in particular. Similar findings were made in people who already had certain risky conditions. Another study of more than 11,000 people with hypertension found a higher risk of cardiovascular events in patients with HDL levels below 40 mg/dl and above 80 mg/dl.(3, 4) To maintain optimal cardiovascular health, HDL levels should fall between 40 mg/dl to 80 mg/dl. Individuals with HDL levels outside this range are at a greater risk of mortality from all causes, particularly cardiovascular disease.

Elevated levels of HDL are also associated with other health issues. A study of more than 16,000 Australians over 70 found that those with the highest HDL levels were at 33% higher risk of bone fractures than those with lower levels, indicating that higher-than-normal HDL levels adversely affect bone density. Observational and genetic studies suggested that high HDL levels are a potential risk factor for Age-related Macular degeneration (AMD: an eye condition that can blur central vision). Some genetic studies found and supported an inverse relationship between HDL levels and infectious diseases. Other studies indicate a possible relationship between HDL levels, dementia, and type 2 diabetes, with the need for further investigations. (5, 6)  In summary, maintaining HDL levels between 40 mg/dl and 80 mg/dl is crucial for reducing the risk of developing cardiovascular disease and mortality from all causes.

From: https://www.everydayhealth.com/high-cholesterol/can-you-improve-your-cholesterol-and-triglyceride-levels/

What can be done?

         In conclusion, people exhibiting low HDL levels may need to increase it, as HDL protects our body from heart diseases. Many recent articles and papers are now being published, guiding and urging people to boost their HDL levels and providing ways to achieve higher HDL levels. Adopting a healthy lifestyle, including regular exercise, a balanced diet, and avoiding smoking, are some of the most beneficial that can help boost HDL levels. However, it is crucial that people with high HDL levels, higher than 80 mg/dl, should seek ways to reduce it. Changing the patient’s medication may be beneficial if the patient uses a statin or another prescription that boosts HDL levels. It is also essential to consult a doctor or a healthcare professional if there are any concerns about HDL or cholesterol levels. By focusing on maintaining overall health and well-being through healthy habits and regular check-ups, we can do our best to maintain a healthy cholesterol profile and reduce the risk of heart disease and other health problems. (7).

By Mahdi Barakat, A Master's of Medical Science Student at the University of Kentucky 

References:

1.           Rondanelli M, Giacosa A, Morazzoni P, Guido D, Grassi M, Morandi G, et al. MediterrAsian Diet Products That Could Raise HDL-Cholesterol: A Systematic Review. Biomed Res Int. 2016;2016:2025687.

            2.           Medicine NLo. Cholesterol December 10, 2020 [Available from: https://medlineplus.gov/cholesterol.html#cat_51.

            3.           Liu C, Dhindsa D, Almuwaqqat Z, Sun YV, Quyyumi AA. Very High High-Density Lipoprotein Cholesterol Levels and Cardiovascular Mortality. The American Journal of Cardiology. 2022;167:43-53.

            4.           Trimarco V, Izzo R, Morisco C, Mone P, Virginia Manzi M, Falco A, et al. High HDL (High-Density Lipoprotein) Cholesterol Increases Cardiovascular Risk in Hypertensive Patients. Hypertension. 2022;79(10):2355-63.

            5.           Hussain SM, Ebeling PR, Barker AL, Beilin LJ, Tonkin AM, McNeil JJ. Association of Plasma High-Density Lipoprotein Cholesterol Level With Risk of Fractures in Healthy Older Adults. JAMA Cardiology. 2023;8(3):268-72.

            6.           Kjeldsen EW, Nordestgaard LT, Frikke-Schmidt R. HDL Cholesterol and Non-Cardiovascular Disease: A Narrative Review. Int J Mol Sci. 2021;22(9).

            7.           Clinic M. HDL cholesterol: How to boost your 'good' cholesterol Nov 3, 2022 [Available from: https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/hdl-cholesterol/art-20046388.

 

*Cough**Cough* Oh no! Where Are the Antibiotics?! Stop! …Resist That Urge!

 

“If we use antibiotics when not needed, we may not have them when they are most needed (1).” This is a quote from Tom Friedman, the director for the CDC (center for disease control) from the year 2009 to 2017. There are many people who think that they need antibiotics every time they get sick or begin to feel a little “under the weather”. Antibiotics are likely the comfortable choice of treatment given that they are safe (when used correctly) leading patients to be more agreeable to take a prescribed antibiotic rather than an unfamiliar therapeutic. Although antibiotics are viewed by many as the automatic, first line of treatment whenever they become ill, this is not always the best option. Taking antibiotics unnecessarily contributes to our rising antibiotic resistance crisis. Ceasing the overuse and misuse of antibiotics is paramount in fighting this crisis.

 What are antibiotics?

             Antibiotics are a type of medication that should be taken when a patient has a bacterial infection. Some examples of bacterial infections include strep throat and urinary tract infections (commonly referred to as “UTI’s”). They function by either killing the bacteria or by making it really difficult for bacteria to grow and reproduce. This medication can be given orally (in the form of a pill, capsule, or liquid), through injection via an IV (intravenously), or as a cream, spray, or ointment (2).

From: https://www.cell.com/trends/biotechnology/fulltext/S0167-7799%2819%2930249-5

What’s the big deal?

             When antibiotics are taken incorrectly several problems can occur.  Contrary to common belief, an antibiotic will not treat an illness caused by a virus or fungus. This means that taking an antibiotic, when you have an illness caused by a virus or fungus, is completely unnecessary and it will not treat that illness. Whenever someone takes an antibiotic unnecessarily, they are contributing to the possibility of creating antibiotic resistant bacteria within their body. Another problem that occurs when using antibiotics incorrectly or unnecessarily is that of a person taking too low of a dose. This often contributes to bacterial resistance to said antibiotic in the bacteria that are not killed because the dose was insufficient.  Antibiotic resistance is also an outcome that occurs naturally (without misuse of antibiotics) in bacteria, and other microorganisms such as parasites, viruses, and fungi. The natural process of antibiotic resistance can occur when bacteria experience genetic changes and therefore are no longer affected by the presence of certain (or sometimes all) antibiotics (1).

 Using the previous example to illustrate, when bacteria are exposed to an antibiotic in a low enough dose that not all the bacteria will be killed, the bacteria who survive build-up an “immunity” to that medication in the similar way that people develop an immunity to diseases when they are exposed. These bacteria who gained “immunity” or resistance against the antibiotic they were exposed to go on to reproduce and create more bacteria that are resistant to that same antibiotic (1).  Whenever there are bacteria that are produced that are resistant to all of the known antibiotics, they can then be classified as a superbug (which are extremely difficult to treat given that they do not respond to the regular antibiotics; (1). 

From: https://www.downtoearth.org.in/cartoon/simply-put-antibiotic-resistance-69030

What can you do?

             In the fight against antibiotic resistance, it is very important that everybody does their part. This may look different depending on who you are and what you do for a living, but every little bit counts. One of the most necessary modes of action everyone can enforce is to finish the entire round of antibiotics that your provider has prescribed to you. This means that you cannot stop taking your medication simply because you “feel better”, which is a common mistake that people make. It is also important to only take antibiotics that are prescribed for your specific case. For example, not all antibiotics are created equally, some may not be strong enough for one type of bacterial infection however, another antibiotic may be too strong for your specific bacterial infection, and this could result in the death of healthy bacteria. If too many healthy bacteria are killed, a patient can experience a second infection with a bacteria known as C. diff (Clostridioides difficle), which causes extreme diarrhea and colon damage that can result in death if left untreated (2). So, the next time you feel the urge to not finish your antibiotic prescription or to take some antibiotics that you had “leftover,” consult a medical professional to ensure you have accurate and sufficient treatment. 

From: https://unfoundation.org/blog/post/what-is-antimicrobial-resistance-and-what-can-you-do-to-stop-it/

By Holly Christian, a Master's of Medical Sciences student at the University of Kentucky

References

(1) Gautam, A. (2022, February 15). Antimicrobial resistance: The next probable pandemic. JNMA; journal of the Nepal Medical Association.  https://pubmed.ncbi.nlm.nih.gov/35210634/.

(2) U.S. National Library of Medicine. (n.d.). Antibiotics. Medline Plus

Why It’s Important to Know All the Facts: Hormonal Birth Control

 What is Birth Control?

Hormonal Contraception, also known as birth control, is a drug therapy used to prevent pregnancies in women at childbearing age. Hormonal contraception can come in the form of pills, patches, Intrauterine devices, shots, and injections. While birth control is primarily used to prevent pregnancy, it may have other uses such as to regulate periods and to help with endometriosis pain. Women that suffer from PCOS may also take birth control to reduce some of the symptoms they experience and keep their monthly cycles.

 

What Can Happen with Prolonged Use of Birth Control?

 While many women stay on birth control for years at a time, it may be beneficial to take breaks periodically over the years to prevent increased risk of cancer. It has been argued that there is an increased risk of breast cancer, ovarian cancer, and cervical cancer with prolonged use of birth control. However, this does not mean that birth control is a damaging medication, but there are warnings with all medication taken. Scientists are still trying to distinguish exactly how much influence hormonal contraception may have on risk of cancer in patients overall.

https://www.womanlog.com/sex/hormonal-birth-control

According to an article by the National Cancer Institute, “Oral Contraceptives and Cancer Risk”, women that use oral contraceptives are at a greater risk of developing cervical cancer after 5-9 years of consistent birth control pills use. The risk was doubled with 10 years or more consistent use. In a similar situation, when looking at breast cancer studies in an article titled “ Oral Contraceptive Use and Breast Cancer : A Prospective Study of Young Women”, the amount of estrogen component called levonorgestrel and ingredient formulation may account for an increased risk of developing breast cancer in comparison to other manufactured brands.

 It is important to notice however that cervical cancer was noticed to have an increase in patients that have a history of HPV. While there is noticed increase in cervical cancer with prolonged use of oral contraception, it is also important to consider that HPV may develop into cervical cancer on its own regardless of integration of other medications according to Dr. Natasha Rafter, a public health professor at Auckland University.

 On the contrary, other cancer risk may decline with longer contraceptive use. The effects of birth control may have long term effects on the body that prevent endometrial cancer from forming in patients that have endometriosis. It is also mentioned in “Oral Contraceptives and Cancer Risk” that “risk is reduced by at least 30%, with a greater risk reduction the longer oral contraceptives were used”.

 The Bottom Line

 Although there have been many studies on hormonal contraception and cancer risk, it is not conclusive whether or not birth control has substantial effect on developing carcinogenic effects. All this is to say that there is much more information to consider when talking about the link of birth control to cancer. One specific type of birth control may not be ideal for a patient based on their medical history, family history, and estrogen content. The truth is scientists are still trying to learn more everyday about the cause of cancer. It is important to discuss concerns with your doctor and decide what exactly may be the most beneficial means of contraception, whether that is a low dose estrogen birth control, progesterone only option, or abstinence until further research.

  By SaBrea Cowan, An Undergraduate Biology Student at the University of Kentucky

Resources

 Hunter, Colditz, G. A., Hankinson, S. E., Malspeis, S., Spiegelman, D., Chen, W., Stampfer, M. J., & Willett, W. C. (2010). Oral contraceptive use and breast cancer: A prospective study of young women. Cancer Epidemiology, Biomarkers & Prevention, 19(10), 2496–2502. https://doi.org/10.1158/1055-9965.EPI-10-0747

 MEDSAFE. Oral Contraceptives, HPV and Risk of Cervical Cancer. (n.d.). Retrieved October 20, 2022, from https://medsafe.govt.nz/profs/PUarticles/OCHPV.htm

 Mørch, Lina S et al. “Contemporary Hormonal Contraception and the Risk of Breast Cancer.” The New England journal of medicine 377.23 (2017): 2228–2239. Web.

 Oral contraceptives (birth control pills) and cancer risk. National Cancer Institute. (n.d.). Retrieved October 19, 2022, from https://www.cancer.gov/about-cancer/causes- prevention/risk/hormones/oral-contraceptives-fact- sheet#:~:text=The%20longer%20a%20woman%20uses,years%20of%20use%20(9).