I am writing this on a flight home to LA from New York. I went to the very cold east coast for a Save the Children board meeting and Gala. I participated in three days of nonstop discussions (and celebration) of the humanitarian efforts of this amazing NGO (non governmental organization) for which I have had the honor of serving as a trustee. I did not read any medical journals…so I thought I would share some of the tough challenges that we discussed that threaten children in our current crisis filled world. To do so, I am quoting some of the facts presented to our board at dinner Tuesday night…

2013 was the first time since World War II when more than 50 million people were displaced from their homes as a result of war and violence. Over 15 million refugees fled to developing countries which themselves have significant needs. The drivers of this humanitarian crises are likely to continue and include climate change, population growth with a “youth budge”, urbanization, migration, political instability, religious fundamentalism, intolerance and hate. (The last are my words.) 200 million people have been affected by natural disasters and there are 100 violent conflicts a year. The most vulnerable are children. Child protection, their health, nutrition and education needs are among the most underfunded components of responses by the international community.

Here is where I can proudly report on what Save the Children is doing: During 2014 Save the Children has responded to 90 humanitarian emergencies in 53 countries reaching 8 million people. These include building Ebola treatment centers in West Africa, community education and outreach programs to educate on risk avoidance, diagnosis facilities and programs to care for children orphaned by Ebola. Save the Children’s global outreach concentrates on child protection, health, nutrition and education in countries that few of us will ever visit and may have trouble finding on a map…South Sudan, CAR, Somalia, Sudan, Mali, Ethiopia, Mozambique (I have reported on schools The LA Associates of Save the Children have built in the last two countries), Iraq, Yemen, Syria, Philippines, Pakistan, and India as well as Laos, Myanmar, DRC and Nicaragua (to name a few).

Yes, these are statistics and names of far off countries, and as we read them they may not register on an emotional level. But the story of one child with a name who may die before the age of 5, or may never have a home or family because of conflict and disease, or if that child is a girl and has a greater chance of dying in childbirth than learning to read…when we know that child’s name we begin to care. I have had the opportunity to meet some of these children and their families … I am proud to be a small part of an organization that strives to value their future.

I hope you will decide to learn more by going to savethechildren.org.

Next week, I will resume my usual women’s health update articles.

Smoking is the number one cause of lung cancer and lung cancer is the leading cause of cancer related deaths in the United States. (More than breast, colorectal and prostate cancer combined!) A proper medical history should always include a smoking history and medical care should include therapies (and ongoing encouragement) to stop if a patient is still smoking. But what about screening and follow up? Despite advances in diagnosis, staging and treatment, only 18% of patients with lung cancer are still alive five years after diagnosis.There is an understandable goal by all of us to do better…

An article published in the November 6 issue of the New England Journal of Medicine has provided data that helps improve smoking mortality statistics; it demonstrates the efficacy of screening with low-dose CT scans of the lungs. The National Lung Screening Trial (NLST), enrolled more than 50,000 persons at 33 US centers. They included individuals who were 55 to 74 years of age with a smoking history of at least 30 pack years. (That means that they smoked one pack for 30 years or two packs for 15 years or, and I am not sure how one does this…3 packs for 10 years.) They included both current smokers and former smokers who had quit within the previous 15 years.

The findings were very significant. There was a 20% reduction in lung cancer mortality with low-dose CT scan diagnosis and treatment versus those who were diagnosed with lung cancer by simple chest x-ray. In absolute terms, this translated to approximately three fewer deaths from lung cancer per 1000 high risk persons who underwent low-dose CT scanning.This is as great a benefit as that reported for breast cancer mortality with annual mammography screening among women 50 to 59 years of age.

There were false positives…(The scan can pick up abnormalities that are not cancer). To decrease the false positive results and unnecessary biopsies and/or surgery, participants found to have a nodule were followed with additional CT screening and only when a lesion got bigger or more worrisome was a biopsy performed. In the end, relatively few of the surgeries (24%) were performed in patients who had benign nodules.

What also got my attention was the fact that screening with low-dose CT was much more cost-effective among women then among men. Scanning was also more likely to have a mortality impact in the groups with the highest risk of lung cancer such as those who were still smoking and those who were older.

And now a very recent headline: Medicare just announced that they “will cover annual screenings for lung cancer for older Americans with a long history of heavy smoking”. They “will extend coverage for CT scans to Medicare beneficiaries who smoked at least a pack a day for 30 years or the equivalent, even if they quit as long as 15 years ago”. According to their announcement the scans will be free for recipients and “the coverage would apply to beneficiaries through age 74.”

Bottom line: If you are a former smoker of the equivalent of one pack of cigarettes a day for 30 years or, heaven forbid, you are a current smoker and you’re over the age of 55, talk to your physician about getting a low dose CT scan of your lungs. Based on the recent studies and the fact that Medicare has announced that they will pay, this should be affordable (if you are not yet on Medicare) or free if you are 65 or older. Too bad the cost of future CT scans are not charged to tobacco companies every time they sell a pack of their poison!

We all know what comes with our 50th birthday… The advice by your physician to get colon cancer screening. And then comes the yuck factor; discussion of the ways to do a colon cleanse in order to be able to view the interior aspects of this very long digestive conduit with either a “true” or virtual colonoscopy. (I discuss both in previous websites.) Although I know that the best way to detect precancerous polyps and/or early cancer is with colonoscopy, I am willing to discuss alternatives such as the virtual “look see” and now a new stool test. It is aptly named Cologuard.

Remember, when found early colorectal cancer is highly treatable.The five-year survival for early-stage cancer is greater than 90%. And if a pre-cancerous polyp is found and removed the cancer can be prevented! However, 23 million Americans between 50 and 75 are not getting screened as recommended, and as a result, colorectal cancer remains the second leading cancer killer in the United States.

According to the manufactures of this new test, “it offers people 50 years and older who are at average risk for colorectal cancer an easy to use screening test which they can do in the privacy of their own home.” Normally I don’t use my website to talk about new products but I was impressed by the fact that the FDA has approved Cologuard and that Medicare now pays for it.

This is a test in which a small sample of stool is tested for cancer associated DNA markers as well as the presence of occult hemoglobin (blood). When you have a bowel movement, your stool picks up cells that are shed from the colon lining. If any cells have abnormal DNA or there is a minute amount of blood, the test is meant to detect this. If it’s positive it may indicate the presence of colorectal cancer or advanced adenoma (precancerous polyp). Colorguard was studied in a large clinical trial which included more than 10,000 patients at 90 sites in the US and Canada. The participants in the study completed Cologuard as well as a fecal chemical test for occult blood before having a standard colonoscopy. They wanted to see how well Cologuard detected cancer and pre-cancer compared to a colonoscopy. What they found was that Cologuard found 92% of colon cancers and 42% of pre-cancers. When the Cologuard test was negative it was accurate 87% of the time.

These are pretty good statistics…certainly not perfect. But for those who put off screening, don’t have access to a facility that can perform colonoscopy or can’t afford payment, this test may increase early diagnosis and “rule in” those individuals who absolutely need referrals for colonoscopy and biopsy.

The test requires a special collection kit which has to be ordered by your physician. It can’t be purchased over-the-counter. Once you get it there are directions that are fairly easy to follow as to how to collect (a weird word in this context) the stool sample. The kit has prepaid UPS labels so it can be sent to the laboratory that does the testing. The results will then go to your physician.

Or you can do the colon cleanse and bypass this…it is worth a discussion.

After the report that came out in 2002 from the Women’s Health Initiative (WHI) almost 80% of women who had been on Premarin and Provera stopped taking it. But as more and more women went through the menopausal change, had significant symptoms and the results of the WHI underwent interpretation and reanalysis, women and their physicians sought forms of hormone therapy (HT) that would potentially be safer and “cure” symptoms. In many instances, this involved the use of estradiol instead of Premarin (a type of estrogen that is “conjugated” and made from the urine of pregnant mares). The “new” estrogen that was often preferred was estradiol (the active estrogen that is produced by the ovary and works on the estrogen receptors in our body). It also was more acceptable, especially to vegetarians, because it is manufactured from a vegetable source. Estradiol is currently available as a pill, patch, cream or vaginal ring. And rather than use synthetic Provera, many physicians have switched to a natural progesterone which they prescribe with estrogen in order to protect the lining of the uterus in women who have not undergone hysterectomy. Has this change made a huge difference on the impact of hormone therapy on coronary heart disease mortality?

An attempt to answer this question was addressed in a recent article published in the Journal Obstetrics and Gynecology by the Department of Obstetrics and Gynecology at Helsinki University Hospital in Finland and the Nordic School of Public Health. The risk of coronary heart disease death in hormone therapy users in age-matched women were compared between the pre (1995-2001) and post ( 2002-2009) women’s WHI eras. They used a nationwide register on 290,272 women age 40 years or older who took hormone therapy. (I love the way Scandinavian countries have kept registers and medical data on their population.) The post-WHI group was given estrogen in the form of estradiol and when needed natural progesterone.

The researchers expected to find a higher coronary heart disease death risk in hormone therapy users during the pre-WHI era. But instead, the use of HT was accompanied by significant reductions in the risk of death resulting from coronary heart disease in both groups. They found that exposure to HT for one year or less was accompanied by a 29% reduction and an exposure of 1 to 8 years with the 43% reduction in the risk of coronary heart disease and death in the pre-WHI era. In the post-WHI era HT use of one year or less was associated with an 18% and an exposure of 1 to 8 years with a 54% reduction in coronary heart disease mortality. The differences are not significant. Discontinuation of HT was associated with an increased risk of cardiac death of 42% in the pre-women’s health initiative era and 31% in the post women’s health initiative era during the first post treatment year. This risk apparently vanished in further follow-up during both eras

Their conclusion was that the changes in HT use after the WHI when they were almost exclusively using estradiol and natural progesterone failed to affect coronary heart disease mortality in HT users in their nationwide study. Does this mean all women should consider hormone therapy for prevention of coronary heart disease mortality no matter what? And does the type of hormone make a difference? No … other studies have shown that hormone therapy is helpful in women who are not older than 60 and that estrogen is beneficial if a woman has healthy coronary arteries but it is probably not affective in she has atherosclerotic plaque which is far more likely to be present in the arteries of women older than 60.

So once more decision to use HT is not simple… Should we take hormones for our hearts at least initially and what it does HT do to our risk of breast cancer? (The answer is that long-term use does increase breast cancer risk). And what are the benefits of estradiol and natural progesterone versus previously prescribed forms of HT? Should hormones be taken orally or through patches, creams or vaginal inserts? How long is it safe and have positive impacts? At what age should we stop? There is no question that estrogen it is the out effective therapy for severe menopausal symptoms but it is contraindicated for some women going through the menopausal transition. All this has to be discussed with a physician who has thorough knowledge about the pros and cons of HT. There is now one more study to put into the discussion.

Many of us have now assumed certain grandparenting duties with joy and pleasure, especially if we do can them without the duress of becoming the primary care giver … Apparently there have been very few studies on what this role does to our cognitive health. So I read with great interest the article that appeared in this month’s journal of the North American Menopause Society (aptly named Menopause).

The title of the article is “Role of grandparenting in postmenopausal women’s cognitive health: results from the Women’s Healthy Aging Project”. The participants included 186 Australian women from a larger prospective aging study. This portion of the study was meant to examine the disuse hypothesis, also known as ” the use it or lose it” hypothesis that proposes that decreases in activity with age results in the disuse of cognitive mechanisms, which then cause a decline in cognitive abilities. We know that as we get older, large social networks or high levels of social activities can improve cognitive function, help diminish cognitive decline and even lower the risk of developing dementia. So does grandparenting fulfill this function?

A questionnaire was administered to the participants in 2004. They were asked whether they had grandchildren, if they were currently minding their grandchildren, and, if so, how much time they spent minding their grandchildren. Participants were also asked if they felt that their children have been particularly demanding of them in the past 12 month. Cognitive tests were later administered (I won’t bore you with the types and the questions) and their verbal memory and executive function were assessed. There were 131 grandmothers in the sample and those who spent time minding grandchildren (111) were more likely to be employed than those who did not. There was no significant difference in age, number of grandchildren or education between the participants. No significant differences in performance in any of the tests were observed between grandmothers and non-grandmothers; there were also no significant differences between participants who were minding grandchildren and those who were not. The only differences that were found were that participants who spent one day a week minding their grandchildren had the highest cognitive performance in all the tests and those who did so for five days or more per week had the lowest test scores. Frequent grandparenting apparently predicted lower processing speed and working memory performance. Moreover, those who had to perform this “task” almost daily reported more feelings of resentment.

Does this mean that too much of a grandparenting role may not be good for our cognitive health? Although this article was published in a peer reviewed journal, I feel the study is too small to make that assumption. There’s no question that if one has to take care for grandchildren without a respite it can be tiring both physically and mentally. Those in the study who “minded” their grandchildren five days a week or more may have had no choice and indeed minded. Their mood and perhaps fatigue may have adversely impacted their cognitive test results.

I have to stop now and take my granddaughter to her dance class. The drive might be mind numbing but watching her perform is not. This is not a daily “task”, so I assume my cognitive abilities will remain intact.

I didn’t have a chance to discuss this in my last website and even though I’m a week late I wanted to belatedly acknowledge the International Day of the Girl which was celebrated on October 11. In honor of that day, the CDC sent an email with information that they hoped would raise awareness about the health issues that impact young girls worldwide. They chose seven topics (none, thank goodness about Ebola) that should be addressed in order to promote the health and safety of girls. I thought I would outline them this week:

Binge Drinking
The CDC noted that “alcohol is the most commonly used and abused drug among youth in the United States.” According to their statistics one in five high school girls binge drink and half of high school girls who drink alcohol report binge drinking. That means that they’re consuming four or more drinks on a single occasion. This increases their risk of behavior problems, injuries, sexually transmitted infections, unintended pregnancy and also impacts their risk of becoming addicted to alcohol and future health problems.

Human Papilloma Virus (HPV)
This type of virus causes most cases of cervical cancer as well as vaginal and anal cancer. It’s now calculated that 14 million people including teens become infected with HPV every year! But here’s the good news… We now have an HPV vaccine that protects against the HPV types that most often cause anal, cervical, vaginal, vulvar and mouth/throat cancers in women. I’ve talked to most of my patients who are mothers, as well as my younger patients, about the importance of getting this vaccine and indeed have written several articles on my website. Here is a reminder: The HPV vaccine is recommended for girls and boys when they are 11 or 12 years old. It can lower HPV infection rate for teen girls by half. Unfortunately, only 57% of girls and 35% the boys have started the HPV vaccine series. We have to do better…

Indoor Tanning
As I hope we all know, this significantly increases skin cancer risk. The risk is highest among those who start tanning at a younger age. Nearly 33% of white high school girls have tanned indoors and some start doing this as early as age 14 or younger. Indoor tanning causes melanoma which is the deadliest type of cancer. It also contributes to premature aging. We do have laws that prevent young teens from using indoor tanning salons in California but I’m not sure that they are well followed. Somehow we have to promote the slogan that untanned skin is beautiful (and will stay beautiful longer). So many of us wish we had known this years ago.

Sexually Transmitted Infections (STI’s)
Teens and young adults between the ages of 15 and 24 account for half of all new STI’s. Clearly this is where choice of partner and condoms come into play or should I say foreplay…

Sexual Violence
The CDC reports that studies indicate that 36% to 62% of reported sexual assaults are committed against girls age 15 and younger around the world. In the United States, 40.4% of female rape victims where first raped before age 18.

Suicide
Among 15 to 24-year-olds, suicide accounts for 11% of all deaths annually!

Teen Pregnancy
In 2012, more than 86,000 teens in The United States ages 15 to 17 gave birth. As the CDC points out, this increases their medical risks and results in huge emotional, social and financial costs to the mother and her children. Becoming a teen mom affects whether the mother finishes high school, goes to college, and the type of job she will get.

I listed these alarming stats because I (and the CDC) think we should be aware of the major issues that impact the teen girls in our lives. Ignoring them will not help us address their problems. Yes, we should be celebrating the day of the young girl, but to do so, we need to make sure she stays safe and healthy.

This has been a fabulous week for me. On Monday, I was honored by the National Breast Cancer Coalition event titled “Les Girls”. Unlike most “disease dinners” this was a cabaret style stage show with television actors singing, dancing and providing fabulous entertainment to a few hundred guests who were there to raise money and awareness for this amazing organization. What made the evening so touching and rewarding for me was the fact that family, friends and patients came…

Now on to a new medical article… The Obstetrics and Gynecology Journal published an article this month on titled “Exposure to selective serotonin reuptake inhibitor’s (antidepressants) in early pregnancy and the risk of miscarriage.” This is very relevant because up to 15% of all women are affected with depressive symptoms during pregnancy. Untreated depression has been associated with preeclampsia, preterm delivery, low birth weight, and miscarriage. The question the researchers posed and sought to answer is whether SSRIs increase miscarriage rates.

In Denmark, where the study was carried out, the number of women being treated with an SSRI during pregnancy has apparently increased 16 fold from 1997 to 2010. In the United States, up to 13% of pregnant women are treated with an SSRI in the first trimester of pregnancy. Denmark, like the other Scandinavian countries, maintains amazingly detailed medical records on their entire population and these of course include statistics on pregnancy, miscarriage, procedures and prescriptions. The researchers identified 1,279,840 registered pregnancies between 1997 and 2010. Of these 71.2% ended up in live births, 17.7% in induced abortions and 11.1% in miscarriages. They also found that 1.8% of women were exposed to an SSRI during the first 35 days of pregnancy. Women exposed to an SSRI were more likely to be older, have a lower educational length, lower income and experienced more previous miscarriages compared with unexposed women. The statisticians calculated that the hazard rate of having a miscarriage in pregnancies exposed to an SSRI compared to those of unexposed women was 1.27. That means that those exposed had a 27% increase risk of miscarriage. But they also identified 1.8% of women who discontinued SSRI treatment 3 to 12 months before conception and of whom 13.8% experienced a miscarriage prepared with the 11.1% among the unexposed women. So their hazard rate for miscarriage after discontinuing treatment before conception was 1.24. In other, more understandable words, they had the same risk of miscarriage as women who continued taking SSRIs

Bottom line: It’s not the SSRI that increases risk of miscarriage but probably lifestyle factors associated with depression such as alcohol use, smoking or poor compliance for folic acid supplementation during pregnancy. Because the risk of miscarriage is elevated in both women who take an SSRI and those who stopped a few months before getting pregnant, there’s likely no benefit discontinuing the medication that helps alleviate symptoms of depression.

In a week in which we’re supposed to get ready to ask to be written during Yom Kippur “in the book of life” there’s been a lot of news about death, especially Ebola….All the medical journals are now publishing articles about this devastating disease. As a trustee on the board of Save The Children, I’ve been appraised almost daily about the epidemic in the three countries in West Africa where we already have significant programs. Caroline Miles, our CEO has traveled to Liberia where Save the Children and other NGOs are establishing Ebola diagnostic centers, isolation centers and Ebola treatment centers. The consequences of not becoming involved in attempts to treat, contain and hopefully prevent further spread of this disease will have devastating country-wide and global consequences.

But I’m not going to report on Ebola or other diseases in this week’s website. The media is finally doing a good job (especially the New York Times) and so I looked for some novel, not completely medical news to report. I found it in good old JAMA.

In the past, physicians have tended to be Republican. I assume this was for mostly for monetary reasons. (I would try to avoid political discussions with many of my colleagues because I knew we disagreed, especially about their economic woes, which are perhaps currently more valid.) My good news is that the growing ranks of women in the medical profession are shifting political allegiances toward the left.

Women now account for roughly 1/3 of the US physician workforce and happily that proportion is growing. A new study analyzed donations from physicians to national political campaigns between the 1991-1992 election cycle through the 2011-2013 election cycle. Physician campaign contributions increased during this time. But those made to Republicans declined between the mid-1990s and 2012. It was reported that the majority of male physician contributors still backed Republicans but only 31% of female physician contributors supported that party. My take is that this is due to the lack of the official Republican Party’s support of women’s reproductive rights, immigration reform, and funding for causes so many women, especially those involved in health care, care about.

Finally some news that made me smile…May the Jewish New Year bring improved health, governance and stability to all of us.

The incidence of BRCA1 and BRCA2 mutations is higher in the Ashkenazi Jewish population and hence studies on population screening have initially been done in Israel. This week we celebrate the Jewish New Year…and the latest JAMA article on population based screening for these mutations was most timely.

The article published in the September 17 JAMA is based on the 2014 Lasker Award. This award in medical science was presented to Dr. Mary-Clair King to recognize and honor her “for bold and imaginative contributions to medical science and society – exemplified by her discovery of a single gene BRCA1 that causes a… form of hereditary breast cancer…” The article both describes the application of this discovery and suggests that population-based screening of women for BRCA1 and BRCA2 should become a routine part of clinical practice.

Just to remind you: BRCA1 mutation carriers have a combined risk of developing either breast or ovarian cancer of 60% by age 60 and 83% by age 80. For BRCA2 mutation carriers, risk is 33% by age 60 and 76% by age 80.

A recent study in Israel recruited more than 8000 healthy Ashkenazi Jewish men. The men were tested as a gateway to families for breast and ovarian cancer. (The men were unaffected by breast-cancer themselves but if they were positive, it would enable researchers to identify female mutation carriers, not based on their personal or family history of cancer.) 175 men were identified as carriers of the mutation and genetic testing was offered to all of their female relatives. Surprisingly, 50% of families found to harbor BRCA1 or BRCA2 mutation had no history of breast or or ovarian cancer that would have triggered clinical attention. However, female mutation carriers from these theoretically low-cancer- incidence families had similar cancer risks to female carriers from families with high cancer incidence. Low-cancer-incidence families were simply smaller with fewer females and hence were less likely to exhibit a significant breast or ovarian cancer history.

The authors of the article point out that without population-wide screening, women with BRCA1 or BRCA2 mutation from such families would not have been identified until they developed cancer; a failure of cancer prevention. This study has significant implications for preventive care in Israel which has a large population of Ashkenazi Jews. But in another study, it was found that only 35% of families with high incidence of breast or ovarian cancer had even previously been referred for genetic counseling, despite common knowledge of the increased risk due to BRCA1 and BRCA2 in the Ashkenazi Jewish population and the availability in that country of free testing and counseling.

In the United States, the number of carriers of mutations in the BRCA1 and BRCA2 genes is estimated to be between 1 in 300 and 500 women or between 250,000 and 450,000 adult women for whom breast and ovarian cancer is both highly likely and potentially preventable. Wide scale population genetic counseling and screening should go on our medical wish list. But at present, the US Preventive Services Task Force (USPSTF) supports BRCA1 and BRCA2 testing based on family history and ancestry, but not for the entire female population. Unfortunately only 19% of US primary care physicians accurately assess family history for BRCA1/BRCA2 testing. This is clearly unacceptable.

The author states at the end of the article that “population wide screening will require significant efforts to educate the public and to develop new counseling strategies, but this investment will both save women’s lives and provide a model for other public health programs in genomic medicine…. Women should have the choice to learn if they carry an actionable mutation in BRCA1 or BRCA2.” We have much to learn and do…

Since I tend to report on aspects of my personal life, I want to announce some personally exciting news: My daughter and her two small children moved to LA for a year. Not only are they living three minutes away…the children are in my temple school. I am delighted!

I have also become involved with a terrific organization, the National Breast Cancer Coalition (NBCC) which sponsors and supports the research that will help us prevent, diagnosis and effectively treat breast cancer. They are holding their annual event in LA on October 6. It will be a phenomenal French style review of dancing and singing titled “Les Girls” with performances by many of your favorite TV and theater stars and will be hosted by Allison Janney (who, I might add just won two Tonys). I am somewhat embarrassed to add that the NBCC board decided to present me with an award that evening and I am truly honored.

So if you think you would like to come to a fun evening and contribute to an important cause you can download details HERE.

Now onto the medical subject of this week’s website….Weight Loss

The September 3 issue of JAMA was dedicated to this weighty subject. As you know, one third of Americans are overweight or obese. It truly is an American epidemic. (And by the way, risk for a majority of cancers is significantly increased or just plain caused by obesity.) Multi billions of dollars are spent on branded weight loss programs, foods, diets, lifestyle recommendations and “come-on books” that suggest a secret way to lose pounds quickly, now and forever… A meta-analysis of 48 unique, randomized trials was published in that issue of JAMA and after many tables and graphs concluded that both low-carbohydrate and low-fat diets were associated with more weight loss than no dietary intervention over a 12-month period and that behavior support and exercise enhanced weight loss. (So far, I think we all knew this.) What made this article unique and caused it to create a stir was the fact that the statisticians found that weight loss differences between individual diets were small and likely of little importance. Their suggestion: if you want to lose weight adhere to any diet that you can stay on be it low-carb or low-fat.

The last article in the JAMA issue discussed two drugs, now on the market, that may aid and albeit weight loss: lorcaserin (Belviq) and Qsymia (Vivus). These new products are FDA approved for use in obese patients with body mass index (BMI) equal to or greater than 30 or overweight patients (BMI over 27) who also have at least one weight- related risk factor such as hypertension, abnormal lipids or type 2 diabetes.

In short: Belviq activates a serotonin receptor (type 2C to be exact) and is thought to suppress appetite. It can, however, cause headache, nausea and dizziness and in trials was discontinued 36 to 50% of the time. In the first year of one major trial, patients lost somewhat more that 5 % of their body weight but regained a quarter of it back during the second year of therapy. Qsymia combines phentermine and Topamax, a drug used for epilepsy. ( In the past phentermine was combined with fenfluramine (“phe-fen”) and caused heart valve problems…hence it was discontinued and now a new combination has been formulated, and felt to be heart valve safe.) Weight loss of 5% or more in the first year occurred in 45 to 70 % of patients depending on the dose and those who continued the medication for two years had an average weight loss of 10% compared to 1.8% in those on placebo. Side effects that occurred in more than 5% of patients included dry mouth, constipation, numbness and in the higher doses, insomnia. There were also reports of difficulties in concentration and memory.

In conclusion, the article states that either drug, taken as an addition to diet and exercise “may be affective in increasing weight loss in the first year of use, but much less so in the second year. Qsymia appears to be more effective than lovaserin, but may cause more troublesome adverse effects.”

A lot of information…I (or your other physicians) will be happy to discuss all of this in your next visit.

And I hope to see some of you (not in the office) October 6….

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