Published October 7, 2023

Morning Report — Not Your Typical Medical Newsletter

We get it, you see a lot of medical newsletters, so hear us out. Once a month, we’ll highlight important medical news sprinkled with witty commentary, fun facts, giveaways, and more… because learning should be fun! Subscribe to receive the Morning Report directly.

Good morning and happy fall! Is your city home to a pro sports team—with a large stadium or arena? Having this totem of hometown pride may be an assault on your city’s public health, suggests a recent article (shared by Debbie Downer). US cities that acquired a new pro team between 1962 and 2016 saw a swelling of influenza cases and related mortality relative to their pre–pro-team numbers. A new MLB, NFL, NBA, or NHL team could drive influenza mortality up 4% to 24%. The concern peaks when a pro hockey team skates into town: (1) the junction of a packed indoor arena, (2) the heart of influenza season, and (3) predominantly cold-weather cities seemingly emboldens the virus.

No word yet on virus transmission rate hikes likely to occur when Travis Kelce’s Chiefs plus a swarm of Swifties descend on your city.

The Cold Truth About Phenylephrine as a Decongestant 

PRODUCT PONDERINGS

“If you have a stuffy nose and you take this medicine, you will still have a stuffy nose.” That’s pharmacist-turned-whistleblower Leslie Hendeles’ bleak assessment of phenylephrine, the “decongestant” that headlines the ingredients list of cold n’ flu heavyweights like Tylenol, NyQuil, and Benadryl. He and colleagues first declared the futility of phenylephrine in 2007, and now an FDA advisory panel concurs—handing the FDA an onerous decision to make.

A cold medicine shake-up

The FDA advisory panel unanimously proclaimed phenylephrine—in oral formulations—useless as a decongestant after reviewing several studies in which the over-the-counter drug appeared no more effective at relieving cold symptoms than placebo (or a mother’s kiss). The drug seems to lose its effectiveness following enteral absorption, possibly explaining why the intranasal formulation may still work. In the coming months, the FDA will likely decide whether to ban the ingredient from store shelves, a move that could leave the cold-relief aisle as sparse as the card section on Mother’s Day. The ingredient is a mainstay of more than 250 products. If the FDA does block phenylephrine—a safe bet given the agency’s history of adhering to counsel—the decision could hobble the industry as it scrambles to reformulate popular products.

Key takeaways 

The FDA panel ruled that taking phenylephrine poses no harm but may “delay [a patient’s] journey to a useful remedy.” However, banning these OTC products could drive innumerable cold sufferers to your office door and overload the healthcare system, says the Consumer Healthcare Products Association. Nevertheless, FDA panel chairwoman Maria Coyle stands by the ruling, “I think we clearly have better options in the over-the-counter space … and the studies do not support that [phenylephrine] is an effective drug.” Those alternatives include intranasal formulations of phenylephrine and products with pseudoephedrine. If purchasing the latter, patients should be aware that pharmacies secure the products and cap the number of tablets sold, given the drug’s association with Breaking Bad-type meth lab endeavors.

Guideline Updates …

• CDC recommends updated Covid shot for everyone ages 6 months and up
• USPSTF recommends PrEP for prevention of HIV in individuals at increased risk
• USPSTF recommends continuing to screen for hypertension in pregnancy

Spicy Showdown in Dyspepsia Treatment

GI GIST

Let’s time travel back 5,000 years and visit Southeast Asia. If someone of that era were sidelined with dyspepsia, they undoubtedly reached for a spoonful of turmeric and waited for the spice to work its anti-inflammatory magic. But if we Marty McFly back to 2023, when we have access to abundant pharmacologic choices, should we now relegate turmeric to curry dishes?

In a randomized, double-blind controlled trial of >200 patients with functional dyspepsia in Thailand, investigators pitted turmeric—or more accurately, curcumin, the active compound in turmeric—against a conventional pharmacologic, the proton-pump inhibitor omeprazole. At 28 and 56 days, researchers found significant but similar reductions in symptom severity and no difference in adverse effects across the following three groups: curcumin (two 250-mg curcumin pills four times daily, plus one placebo pill), omeprazole (one 20-mg omeprazole pill daily, plus two placebo pills four times daily), and curcumin-plus-omeprazole (two 250-mg curcumin pills four times daily, plus one 20-mg omeprazole pill once daily).

Key takeaways 

In the first study of its kind, a natural compound matched the efficacy of omeprazole in reducing excess stomach acid. “The new findings from our study may justify considering curcumin in clinical practice,” the authors conclude. But before you tell patients to promote turmeric from the spice rack to the medicine cabinet, consider that this single study has limitations: small sample size, small curcumin doses compared to typical supplements, etc. And while generally safe, turmeric can pose allergy and bleeding risks as well as liver injury. This study simply adds flavor to the conversation about digestive health and offers a nonpharmacologic option that may work for some patients. As gastroenterologist Dr. Yuying Luo put it, “If it is helpful, that’s wonderful. If not, that’s the tough part of treating disorders … not all patients are the same and have the same response to medication.” Variety is the spice of clinical practice.

Time to Rethink Dialysis in Some Patients with AKI?

NEPH NEWS

Piggybacking on that last point, not all patients with renal impairment are the same either, yet many tread a similar burdensome dialysis path. A recent study of nearly 2,000 patients with acute kidney injury (AKI) showed that the initial dialysis prescriptions matched those of patients with end-stage renal disease, despite distinct treatment objectives. And a corresponding article illustrates the heavy toll many patients pay for this one-size-fits-all approach …

Poster patient for precision care

In her late 30s, Melissa Lawson of California overcame acute myeloid leukemia (during a pandemic) only to suffer the acute shutdown of her kidneys—the why is still a mystery. As a result, she nearly died and then faced a new “normal”: infections, life without an appendix and bowel segments, and dialysis for her AKI three times a week. The dialysis treatments dropped an anvil on her life, leaving her nauseated, prone to vomiting, feeling cold, suffering from headaches, and overwhelmed with anxiety and depression.

A fateful move to the UCSF Medical Center connected Melissa with Dr. Chi-yuan Hsu, who tapped her for the abovementioned study aimed at validating his theory that many patients with AKI could taper off dialysis. She safely completed one glorious week without dialysis. But the unavailability of close monitoring at her subsequent rehab center landed Melissa back in the dialysis chair. A series of setbacks plagued her until pre-op tests for fistula surgery (to help her better tolerate dialysis) showed restored renal functioning. Melissa canceled the surgery and has since enjoyed six months of a life unplugged. The anvil has been lifted.

Key takeaways 

Melissa’s story is not a one-off. In Dr. Hsu and colleagues’ study, 40% of the patients with AKI regained their renal function, yet only 27% of them were weaned off dialysis. And more than two-thirds of the 40% who recovered their kidney function later discontinued dialysis abruptly, indicating that earlier treatment reductions may have worked. While this type of care typically falls to your friendly nephrologist, the study reminds PCPs to empower patients to advocate for more frequent kidney function testing. Per Dr. Hsu, “I think there are people we could take off [dialysis] if we invested the time. For these people, it’s an enormous improvement in life.”

FDA Approves …

• Generic estradiol gel for vasomotor symptoms due to menopause
• Ryzumvi for treatment of pharmacologically induced mydriasis
• Ilaris for the treatment of gout flares in adults
• Vyvanse generics for ADHD, binge-eating disorder
• New COVID-19 vaccines

A Tale of Two Antibiotics for Acute Sinusitis

INFECTIOUS FINDINGS

Twenty-plus years ago, two small studies concluded that amoxicillin and amoxicillin-clavulanate cleared acute sinusitis in children at equally high rates. But the world has changed since then: the Red Sox lifted their curse, your phone became a computer, and bacteria evolved into new species. So, researchers initiated a long-overdue rematch of the two antibiotics—but on a much larger scale.  

A cohort study compared the outcomes of >300,000 children and adolescents with acute sinusitis who were taking either amoxicillin or amoxicillin-clavulanate. Once again, both antibiotics demonstrated equivalent efficacy, with almost no treatment failures. However, amoxicillin-clavulanate carried a modestly heightened risk of adverse events, registering at 2.3% vs amoxicillin’s 2.0%. Most notably, individuals on amoxicillin-clavulanate faced a 15% greater likelihood of experiencing gastrointestinal problems and a 33% higher risk of yeast infections than those prescribed amoxicillin.

Key takeaways

Fortunately, 98% of patients in the study successfully resolved their acute sinusitis regardless of which antibiotic they took, so clinicians can’t really go wrong. But the superior safety profile coupled with the narrower antibiotic spectrum of amoxicillin seemingly gives it an edge. Lead author Timothy Savage, MD, MPH, MSc, says, “Based on these data, physicians should seriously consider prescribing amoxicillin as a first line of defense against acute sinusitis.” 

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

• Low-dose aspirin cuts type 2 diabetes risk in over-65s
• Health claims and doses of fish oil supplements in the US
• An antibiotic from an uncultured bacterium binds to an immutable target
• Scientists reveal new findings about older adults who take vitamin D
• A potential blood test for Parkinson’s disease
• Increasing lifestyle walking by 3000 steps per day reduces blood pressure in sedentary older adults with hypertension: Results from an e-health pilot study
• Long Covid is real. Now the evidence is piling up.

Morning Report is written by:

• Alissa Scott, Lead Author
• Emily Ruge, Author, Editor
• Aylin Madore, MD, MEd, Editor
• Ariel Reinish, MD, MEd, Editor

Would you like to share your feedback with Morning Report? Drop us an email at morningreport@pri-med.com to let us know how we’re doing.

Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.

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