TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.
This week's topics include mortality rates in Anglophone countries, computer interfaces for communication in people with amyotrophic lateral sclerosis (ALS), plant and animal fat and mortality, and skin reactions to antibiotics.
Program notes:
0:41 Two reports on brain-computer interface
1:41 Implant just below the skull
2:32 Mortality in the U.S. in comparison with other Anglophone countries
3:31 Between ages of 45 and 84
4:31 Lower deaths prior to 45
5:31 Females don't fare as well regardless
5:45 Oral antibiotics and skin reactions
6:45 Three times higher for sulfonamides
7:45 Older age associated with polypharmacy
8:15 Plant and animal fat intake and mortality
9:15 Animal fat conferred increased risk
10:15 Biological plausibility
11:15 Beans and legumes
12:37 End
Transcript:
Elizabeth: How does the U.S. compare to other English-speaking countries in terms of mortality?
Rick: Using brain-computer interfaces to communicate.
Elizabeth: What's the impact of plant and animal fat on mortality?
Rick: And oral antibiotics and the risk of serious skin reactions.
Elizabeth: That's what we're talking about this week on TTHealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I'm Elizabeth Tracey, a Baltimore-based medical journalist.
Rick: And I'm Rick Lange, president of Texas Tech University Health Sciences Center in El Paso, where I'm also dean of the Paul L. Foster School of Medicine.
Elizabeth: Rick, I'm going to turn the ball to you. What would you like to start with?
Rick: Let's start in the New England Journal of Medicine with two reports of something I teed up as brain-computer interfaces. These were two individuals -- the 45-year-old gentleman that had been diagnosed with ALS 5 years previously underwent a procedure where they surgically implanted microelectrode arrays into the area of the brain that communicates.
On the first day that they trained this brain-computer interface -- and this occurred by the way about a month after the electrodes were implanted -- they were able to achieve about a 50-word vocabulary with about a 99.6% accuracy. If he could think about the words, it would translate it into words on the computer and directly into speech. After a period of about 8 months, they evaluated how well it was performing at 97.5% accuracy, and they were able to achieve about 32 words per minute.
The second patient also had microelectrodes implanted, but instead of implanting them directly into the brain they implanted them just below the skull, so they were on the surface of the brain. They were able to show that, again, in an individual with ALS with otherwise limited speech is that it did improve speech, but after about 7 years it was no longer useful. But what happened was there was progression of the ALS so that it no longer communicated with the computer in a way that allowed the person to speak.
Elizabeth: Clearly, this technology is something that is being employed in areas other than folks with ALS who have speech issues.
Rick: The success of this sounds really good, an accuracy of over 90% with 125,000-word vocabularies, but not all neurologic patients are the same. If the person has progressive neurologic deterioration, is it suddenly not quite as effective? There is still a lot to learn, but nevertheless, it's still pretty encouraging.
Elizabeth: It's very encouraging because that's, of course, one of the most troubling disabilities for folks with ALS. Hopeful news.
Moving, then, to something that's a little less hopeful, let's turn to the BMJ: mortality in the United States in comparison with 6 other, what they call, anglophone -- and I disparage that as obfuscation -- English-speaking countries with high income levels: the U.S., the U.K., Canada, Australia, Ireland, and New Zealand. They were looking at life expectancy at birth and at age 65. They also looked at age and cause-of-death contributions to life expectancy differences between countries, and something that they call the "index of dissimilarity" for within-country geographic variations in mortality.
Australia was hands down the best performer in life expectancy at birth, leading everyone else among these English-speaking countries by 1 to almost 4 years of age for women and 1 to 5 years of age for men. These Australians experience this lower mortality predominantly between the ages of 45 and 84, which is kind of interesting because clearly that's when the chronic disease starts to become a really big problem.
They also experienced the lowest levels of inequality, while Ireland, New Zealand, and the U.S. had the highest levels of inequality. Clearly, the things that are important here are what they call "mortality from external causes" such as drug and alcohol-related deaths, screenable/treatable cancers, cardiovascular disease, and respiratory diseases -- especially influenza and pneumonia -- points to the notion that there is a lot of disparities among all of these countries in access to the healthcare system, even when you have access to the types of services that are received and how they impact on your long-term health.
Rick: Australia's healthcare system really outperforms that in the U.S. as well as the United Kingdom, New Zealand, and Canada. Australia has lower deaths prior to age 45 due to firearm mortality, motor vehicle accidents, and drug overdoses than in the U.S. Regarding mortality later, the smoking rate prevalence is less in Australia than it is in the U.S.A. and the United Kingdom.
Australia has also done some innovative things with regard to mental health, Elizabeth. About 20 years ago, Australia implemented an innovative national network for youth mental health care. Finally, Australia looks like they have better cancer screening. Many of the cancers are preventable to screen: colorectal cancer, breast cancer, and cervical cancer. It looks like we've got a lot to learn from our friends across the Pacific.
Elizabeth: I agree and also they did look at data from 14 additional countries that are not predominantly English-speaking. They produced a statement that I think is pretty disheartening. It says anglophone countries never rank among the top performers in female life expectancy over this period and so don't enjoy that same boost in life expectancy in Australia even as the men do. I think that clearly points to a place where intervention is needed.
Rick: Lastly, one thing you didn't mention is there is inequality among these countries, but even within the countries.
Elizabeth: Some lessons here, I think.
Rick: Speaking of lessons, let's talk about oral antibiotics and the adverse reactions associated with them, specifically skin reactions. This is an article that's in JAMA. We have known for a long time that there are individuals that are allergic to certain antibiotics and those allergies oftentimes manifest as skin reactions. There are more serious skin reactions that can prompt hospitalization and sometimes even in an ICU setting with a high mortality.
These investigators looked at the risk of serious cutaneous adverse drug reactions associated with commonly prescribed oral antibiotics. They used a population-based administrative database among adults aged 66 years or older who received at least one oral antibiotic between 2002 and 2022 in Ontario, Canada. There were over 20,000 individuals who had been in the emergency room or hospitalized for skin reactions following antibiotic use.
Individuals that received sulfonamides had the highest risk of skin reactions and compared to the lowest risk -- that is macrolides -- about 3 times higher with sulfonamides. Other antibiotics were also associated with serious drug reactions. Penicillin is about 40% higher than macrolides and fluoroquinolones about 30%. The highest risk of ED visits for hospitalization was associated with cephalosporins. That's about 5 times higher than with macrolides. It happens in about 2 out of 1,000 individuals that receive antibiotics; about 20% of those end up in the hospital and those that have the most severe skin reactions, called Stevens-Johnson or toxic epidermal necrolysis, their mortality is 20% to 40%.
Elizabeth: Okay. What are the alternatives and are these associated with previous use of these specific agents?
Rick: They didn't have that information and that's a good question. If someone has an allergic reaction, you want to avoid them.
Elizabeth: We have decision support tools that are employed clinically. Is there such an animal for this?
Rick: No, this is actually the largest study and the best one to identify the risk.
Elizabeth: I am wondering if these adverse cutaneous reactions are disproportionately associated with aging. Does that tell us something that's critical about aging populations?
Rick: We do know that older age is associated with polypharmacy -- not only are they taking antibiotics, but other drugs which could interact -- and also comorbidities that can actually increase the risk of serious adverse drug reactions. Things like kidney insufficiency or liver disease, and even malignancy.
Elizabeth: It's sounding like to me that -- once again, back to this idea of a decision support tool -- that it would also integrate all of that into it.
Rick: These are all things that should be considered.
Elizabeth: Okay. Let's turn to JAMA Internal Medicine, "Plant and Animal Fat Intake and Overall and Cardiovascular Disease Mortality." Maybe you should take a guess, Rick. How many times have we discussed this issue in 20 years of podcasting?
Rick: Too numerous to count, Elizabeth.
Elizabeth: It's right up there with PSA. In this case, what did they do? They looked at this large prospective cohort study in the U.S. called the NIH-AARP Diet & Health Study and this took place between 1995 and 2019. In this analysis, 407,000+ men and women, mean age 61. They were looking at the death data and they were also looking at their food consumption.
What they basically found was that a greater intake of plant fat, particularly fat from grains and vegetable oils, was associated with a lower risk of overall and cardiovascular disease mortality. Of course, our friend, animal fat, was associated with an increased risk of both overall and cardiovascular disease mortality. They also broke out dairy fat and egg fat -- also still associated with a modestly increased risk.
They conclude that replacement of 5% of energy from animal fat with 5% energy from plant fat, especially those from grains or vegetable oils, would reduce mortality by 4% to 24% and 5% to 30% for cardiovascular disease mortality. We have also discussed before lots of benefits of dairy in terms of overall mortality, so it was interesting to see that broken out as a part of the animal fat group and fingered as increasing risk.
Rick: We are changing our diet in a way that's healthy. What I'm going to say is there was a pretty significant benefit with really no downside at all. Now, whenever I see a study like that where they are doing surveys and they are trying to do an association because it doesn't prove causality, you look to say, "Is there some biologic or physiologic explanation of why this could be?"
Ingestion of plant oils is associated with reduced production of lipids, reduced inflammation, a decrease in cholesterol uptake in the intestine, and it actually makes the blood vessels work better. It enhances what's called endothelial function. There are a lot of benefits that could explain the reduction in mortality and cardiovascular mortality. Having said that, you said we have talked about this too-numerous-to-count times, so why did you pick this particular study this time?
Elizabeth: I think I'm always kind of looking for the last word on it. Maybe that's my hope, that at some point we're going to be able to say, "This is definitive and we don't need to talk about this anymore."
Let me just go back to the study for a second. They did also assert that a higher intake of fat from beans and legumes was not associated with any other mortality outcomes, which was a little bit disconcerting to me. Because I mean as part of that whole strategy for, "Hey, what's the best diet?" beans and legumes, of course, are really important. Then, let's just explain that that variation in the benefit is relative to the quintiles that they divided the data into. I felt like at the end of this it was kind of a little wishy-washy honestly.
Rick: The strengths of this particular study, you were looking for the final word -- over 400,000 men and women, that's a large population; over 8.1 million person-years of follow-up, that's a long follow-up; and then there were enough deaths in that group to actually look at some of these specifics. I hope this is the final word and I hope that our listeners take this to heart.
Elizabeth: Let's just also note that, speaking of heart, in this 24 years of observation they noted 185,000+ deaths, almost 60,000 of them from cardiovascular disease. It still remains the #1 cause of death and something that everybody needs to consider in their choices.
Rick: These dietary changes can actually reduce the risk of cardiovascular death.
Elizabeth: On that note, that's a look at this week's medical headlines from Texas Tech. I'm Elizabeth Tracey.
Rick: And I'm Rick Lange. Y'all listen up and make healthy choices.