Using antibiotics without a prescription is a prevalent public health problem

1. Using antibiotics without a prescription is a prevalent public health problem

People report obtaining antibiotics without a prescription in the United States from flea markets, pet stores, health food stores, or online.

Non-prescription antibiotic use was reported in all socioeconomic and demographic groups studied to date.

Abstract: http://annals.org/aim/article/doi/10.7326/M19-0505
URLs go live when the embargo lifts

People using antibiotics without a prescription seems to be a prevalent public health problem. Antibiotics were obtained through various means, including saving leftover prescriptions for later use, getting them from friends and family, or obtaining them from local markets "under the counter." Findings from a scoping review are published in Annals of Internal Medicine.

When people take antibiotics without a prescription, they often take unnecessary medication or choose an inappropriate drug or dose. This practice is associated with avoidable adverse events and may also increase the risk for inducing antibiotic resistance. It is important to understand how prevalent nonprescription antibiotic use is and the factors that contribute to the issue.

Researchers from Baylor College of Medicine and the Center for Innovations in Quality, Effectiveness, and Safety reviewed 31 published studies to determine the prevalence of nonprescription antibiotic use in the U.S. and to examine the factors that influence that use. The prevalence of nonprescription antibiotic use varied from 1 percent among people visiting a clinic to 66 percent among Latino migrant workers. Storage of antibiotics for future use varied from 14 percent to 48 percent and a quarter of the people in one study reported intention to use antibiotics without a prescription. Factors that contribute to nonprescription use include lack of insurance or health care access, cost of a physician visit or prescription, embarrassment about seeking care for a sexually transmitted infection, not being able to get time off of work to visit a clinic or physician's office, and several other reasons. According to the researchers, more studies are needed to quantitate nonprescription antibiotic use and explore potentially modifiable factors that contribute to unsafe practices.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with authors, Larissa Grigoryan, MD, PhD or Barbara W. Trautner, MD, PhD, please contact Dipali Pathak at pathak@bcm.edu or Carol Swartsfager at Carol.Swartsfager@va.gov.

2. Aspirin use is widespread despite few benefits, high risks

More than 6 million Americans take aspirin daily without their physician's recommendation

Abstract: http://annals.org/aim/article/doi/10.7326/M19-0953
URLs go live when the embargo lifts

Despite recommendations, aspirin use in the U.S. is widespread among groups at risk for harm, including older adults with prior peptic ulcer disease. As such, there is a tremendous need for health care practitioners to inquire about ongoing aspirin use and to counsel patients about the balance of benefits and harms. Findings from a brief research report are published in Annals of Internal Medicine.

Physicians and medical professional societies have widely supported aspirin use for primary prevention of cardiovascular disease (CVD) in persons at increased risk. However, current evidence-based guidelines from the American Heart Association and the American College of Cardiology (AHA/ACC) recommend against routine aspirin use in persons older than 70 years and those with increased bleeding risk. However, the extent to which these populations take aspirin for primary prevention in the U.S. is unknown.

Researchers from Beth Israel Deaconess Medical Center and Harvard Medical School used data from the Sample Adult component of the 2017 National Health Interview Survey (NHIS), a nationally representative in-person household survey of health and disability among U.S. adults, to characterize aspirin use for primary prevention of CVD. They found that among adults aged 40 years or older without CVD, 23.4 percent (approximately 29 million persons) reported taking daily aspirin for prevention. Of these, 22.8 percent (6.6 million persons) did so without a physician's recommendation. Nearly half of adults aged 70 years or older without CVD reported aspirin use. After adjustment, older age, male sex, and cardiovascular risk factors (hypertension, hyperlipidemia, diabetes, and smoking) were statistically significantly associated with aspirin use. The authors noted that a history of peptic ulcer disease was not significantly associated with lower aspirin use. According to the authors, these findings show a tremendous need for health care practitioners to talk to their patients about aspirin use.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Christina Wee, MD, MPH, please contact Jennifer Kritz at jkritz@bidmc.harvard.edu.

3. Data suggests that Medicare for all is unlikely to cause a surge in hospital use

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2806
URLs go live when the embargo lifts

Data suggests that universal health care coverage is unlikely to cause a surge in hospital use if growth in hospital capacity is carefully constrained. Reducing coverage may just shift care toward wealthier and healthier persons. Findings from nationally representative surveys are published in Annals of Internal Medicine.

Gaining health insurance improves access to outpatient care, which may prevent hospitalization. However, analysts generally assume that expanding coverage will increase society-wide use of inpatient services. Understanding the implications of universal health care coverage on hospital use is an important aspect for consideration.

Researchers from the Cambridge Health Alliance and Harvard Medical School studied data from the National Health Interview Survey (1962 to 1970) and Medical Expenditure Panel Survey (2008 to 2015) to determine how the implementations of Medicare and Medicaid (1966) and the Patient Protection and Affordable Care Act (ACA) (2014) affected hospital use. The data showed that in the wake of the two largest coverage expansions in U.S. history, neither hospital dischargers nor hospital stays increased society-wide, at least not initially. While some populations did increase their use of hospital care, the increases were offset by reductions among others. For example, after the introduction of Medicare and Medicaid, hospital use increased among elderly and low-income persons but decreased among younger and higher-income persons. According to the researchers, these findings suggest that major coverage expansions are associated with redistributions, rather than increases, in hospital use.

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Adam Gaffney, MD, please contact Clare Fauke at clare@pnhp.org.

4. Researchers call HHS policy to end fetal tissue research a tragic misstep

Abstract: http://annals.org/aim/article/doi/10.7326/M19-2061
URLs go live when the embargo lifts

The authors of a commentary from Research! America say that the recently announced U.S. Department of Health and Human Services (HHS) policy to end fetal tissue research is a tragic misstep that will do harm without doing any good. Their editorial is published in Annals of Internal Medicine.

The new HHS policy prohibits the procurement of new fetal tissue for intramural research at the National Institutes of Health (NIH), circumscribing this research and precluding any future projects at the Institutes, regardless of potential. The authors warn that choking off an avenue of research that has already helped change HIV/AIDS from a certain death sentence into an illness that can be avoided with a single daily pill, among so many other advances, will have consequences for both patients and researchers working on their behalf.

The authors provide dozens of examples of vaccines and medications that were only made possible through the availability of fetal tissue for research. They say that even if a resource similar to fetal tissue could be identified for other types of studies, fetal tissue research is foundational to the study of early human development. This and other areas of research

Notes and media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Mary Woolley, MA, please contact Robert Shalett at rshalett@researchamerica.org.

Also new in this issue:

Methods for Development of the European Commission Initiative on Breast Cancer Guidelines: Recommendations in the Era of Guideline Transparency

Holger J. Schu¨ nemann, MD, PhD, MSc; Donata Lerda, PhD; Nadya Dimitrova, PhD; Pablo Alonso-Coello, MD, PhD; Axel Gra¨ wingholt, MD; Cecily Quinn, MD; Markus Follmann, MD, MPH, MSc; Robert Mansel, MD; Francesco Sardanelli, MD; Paolo Giorgi Rossi, PhD; Annette Lebeau, MD; Lennarth Nystro¨m, PhD; Mireille Broeders, PhD; Lydia Ioannidou-Mouzaka, MD; Stephen W. Duffy, BSc, MSc, CStat,; Bettina Borisch, MD; Patricia Fitzpatrick, MD; Solveig Hofvind, PhD; Xavier Castells, MD, PhD; Livia Giordano, MD; Sue Warman, MEd; and Zuleika Saz-Parkinson, PhD; for the European Commission Initiative on Breast Cancer contributor group'*

Research and Reporting Methods

Abstract: http://annals.org/aim/article/doi/10.7326/M18-3445

State Health Care Reform: Waivers, Single-Payer, and the Need for Alternative Pathways

James Maroulis, JD, MAS, and Tim Ken Mackey, MAS, PhD

Ideas and Opinions

Abstract: http://annals.org/aim/article/doi/10.7326/M19-0509

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