162. Movies, Pregnancy Pills, 2020 National Asthma Education

What you see is what you get- no more clearly seen then in
This paper titled

Nutritional Analysis of Foods and Beverages Depicted in Top-Grossing US Movies, 1994-2018

In JAMA internal medicine which looked at the nutritional quality of foods and beverages depicted in
the 250 top-grossing US movies from 1994 to 2018
these 250 movies sold 10 billion box office tickets and grossed $164 billion in theaters
worldwide. These are popular movies we all watch or are aware of
and what they put on the screen as a societal “norm”
in this study-
Two trained researchers viewed movies in their entirety and listed all
foods and beverages depicted in each scene.
they used the Nutrient Profile Index (NPI) to classify foods and beverages as healthy or not
penalizes components that should be limited like
sugar, sodium, and saturated fat and rewards fiber, protein, and fruit and vegetable
Now I understand this is not a one size fits all and the authors admit there is not portion control
on this so if the movie had a thimble full of high sugar intense soda and a whole garden of
lettuce the were considered “equal”
The results showed that-
nutrition ratings showed that 72.7% received a less healthy food nutrition score and 90.2%
received a less healthy beverage nutrition score.
But did it get better with time, I mean people use to smoke and now they don’t-
“We found no evidence of improvement over time in sugar, saturated fat, total fat, or sodium
content of foods or in sugar content of beverages”
part of the reason I bring up this article is because There were many disturbing findings like
G-rated movies, nearly 1 in 5 beverages (23 of 127 [18.1%]) were alcoholic beverage and 50%
of the time it was an alcoholic beverage in rated R movies!
the beverage sugar content was higher in movies targeting younger audiences --- on
average movies depicted 121 g (95% CI, 116-125 g) of total sugar per 2000 kcal, which is
higher than the total sugar content in 3 cans of Coca-Cola.
in summary- what you see is what you get and if you see your favorite actors eating junk food it
makes it ok to also eat junk food. . we already live in an obese society and any opportunity we
can to prvent or promote healthy eating should be done, even if that means during a movie
while you stuff your face with a 120oz coke and 620ounces of buttery popcorn.

But speakig of movies what do yu think of when you think of tom cruise or maybe I should say if
someone says the move “Jerry maguire” what do you think of?

I think “show me the money” which is a perfect segway to this paper in annals of IM titlted

https://www.acpjournals.org/doi/10.7326/M20-5665
Are Financial Payments From the
Pharmaceutical Industry Associated With
Physician Prescribing?
A Systematic Review
This was a systematic review to look to see if
payments from the drug industry is associated with physician prescribing practices.
The results were obvious, if you got money then you prescribed the drug companies drug more
often, and this was also associated with increase prescribing cost… the total cost and rates of
prescribing varied BUT NONE
And I repeat NONE OF THE identified studies had all null findings.
The easy answer is Receiving payments from a drug company may lead a physician to
prescribe more of that company's drug in the future.
Or you can sit back and question medicine and look at it from a different perspective--
prescribing may cause payments:
Drug companies may target payments to physicians who are already high prescribers of their
drugs. Both mechanisms are plausible.
The studies the look at temporal prescribing found substantial increases in prescribing immediately
after receipt of each industry payment.
Industry spending on drug promotion disproportionately targets drugs that are less effective or
offer little therapeutic advancement BECAUSE physicians want to use effective drugs
REGARDLESS OF THE PROMOTION!!! whereas marginally effective drugs require more
intensive promotion to increase prescribing!!
ASA after a stroke- we know it works, you odnt need to sell it to me
Statins after and MI- we know it works
Metformin for type 2 diabetes- we know it works

No need to show up at my door. I think the pharmacuetical industry is like the necessary evil, we
need them, they do great things and have the money to do fantastic trials because they have
the money to chase people down to get the outcome data we need but taking money from them
tugs on our need to prescribe their medications EVEN when our patients may benefit from
another or different or cheaper drug and if you think well this doesn’t apply to mean I want to
repeat what I said earlier
NONE OF THE identified studies had all null findings.
So unless you think you are magically different than every other provider that has ever been
studied then yes, even you are affected by drug money money and meals. Money talks so if you
cant stand the heat get out of the kitchen and speaking of heat
This next article titled
Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and
stillbirths: systematic review and meta-analysis
Found a small but very real and consistent association between exposure to high enviromental
temperatures and pregnancy outcomes,
odds of a preterm birth rose 1.05-fold (95% confidence interval 1.03 to 1.07) per 1°C increase in
temperature and 1.16-fold (1.10 to 1.23) during heatwaves which were defined as two or more
days with temperatures above a predefined threshold.

This gives me two pieces of informtion which is those individuals who workout a lot should
probably avoid the hot yoga during pregnancy, stick to the regular yoga for 9 months and those
individuals with low economic status and no access to air conditioning will suffer and on a grand
scale will see higher rates of preterm delivery. This is sad and if a real finding it is one we will
never see on microscopic data remember it is only a 5% increase risk with the 95% confidence
interval going all the way down to 1.03% we are not good enough to pick up such small
differences in our day to day clinical practice but with macroscopic data. It becomes clear, I am
eager for more information on this in the future.

Remember when I said last year that according to me and now according to ACOG for almost
10 plus years we should let women get birth control over the counter!! When I told you that this
is insane that we has providers think we are so special they must come to us to get
contraception?? Well we are one step closer in this paper titled
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31785-
2/fulltext?utm_source=The+Scope&utm_campaign=f2254e45a6-
Weekly_Scope_Jan_12_2018_COPY_01&utm_medium=email&utm_term=0_809ad7d22b-
f2254e45a6-180869057

“Use of effective contraception following provision of the progestogen-only pill for women
presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic
cluster-randomised crossover trial”

pragmatic cluster-randomised crossover trial of almost 600 women receiving emergency
contraception in a pharmacy were randomized to either an intervention group or a control group.
In intervention group, women received a 3-month supply of the progestogen-only pill (75 μg
desogestrel) plus a rapid access card to a participating sexual and reproductive health clinic. In
the control group, pharmacists advised women to attend their usual contraceptive provider
The primary outcome was the use of effective contraception (hormonal or intrauterine) at 4
months.

Although there was a significant amount of people lost to follow up, almost 40% which was
higher than the expected 25% lost to follow up expected by the authors, however at 4 months
The proportion of women using effective contraception was 20·1% greater in the intervention
group, than in the control group. (mean 40·5%, 29·7–51·3 [adjusted for recruitment period,
treatment group, and centre]; p=0·011).

But taking birthcontrol or on BC is a surrogate outcomes so lets look at the secondary outcome-
--
Secondary outcomes were incidence of abortion in the 12 months following recruitment and an
economic evaluation of the intervention.
Sadly this study would have needed about 2000 patients to clearly tell a difference in
unexpected pregancy or abortion.
I guess the summary is that if you want women to be on birth control you have to make it easier
for them to acccess it and whatever format that is then fine, let them access it. Their risk of
children far exceeds your need for another easy RVU patient.

https://www.nejm.org/doi/full/10.1056/NEJMc2031173?utm_source=The+Scope&utm_campaign
=f2254e45a6-
Weekly_Scope_Jan_12_2018_COPY_01&utm_medium=email&utm_term=0_809ad7d22b-
f2254e45a6-180869057

https://www.nejm.org/doi/suppl/10.1056/NEJMc2031173/suppl_file/nejmc2031173_appendix.pdf



https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020.283
4?guestAccessKey=4474ae2b-f5ad-45c1-a5b9-
4735927592c1&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-

But the next article is breath-taking

Titled- Managing Asthma in Adolescents and Adults2020 Asthma Guideline Update From the National
Asthma Education and Prevention Program

The important thing to know is
Those with mild persistent asthma should use either regular daily ICS with an as-needed
inhaled (SABA), or to use both ICS and SABA on an as-needed basis.
Those with moderate persistent asthma should use ICS and formoterol daily with additional
doses of the ICS/formoterol as needed
Some will say this is different than the gina guidelines which say ICS/formoterol right from the
start. I will say you are right this is different than the global initiative for asthma guidelines. And
you may be asking, well then what is the right thing to do and my answer is---
The only correct answer is not what you should be doing but what you should not be doing and
that means those individuals coming in with mild persistent asthma, the newly diagnosed
asthma patient really should no longer be on just prn albuterol. Those days are done, the data
and the guidelines agree. ----