Newsbriefs: Older Pedestrians & Traffic Fatalities; Medication Prescribing; Testosterone Therapy
Older Pedestrians at Greater Risk of Traffic Fatalities
In its 2016 report, Dangerous by Design, the nonprofit agency Smart Growth America examined the most dangerous U.S. metro areas, and the populations at greatest risk for being struck while walking on roadways. According to the report, between 2005 and 2014 a total of 46,149 people were struck and killed by cars while walking. In 2014, an average of 13 people were killed daily and of those, two were people over the age of 65. Overall, the report notes that people of color and older adults were found to be disproportionately at greater risk, with older adults being 50 percent more then younger people to be struck and killed by a vehicle. Not surprisingly, many fatalities occur on roads with fast-moving cars and little or no sidewalks. The report includes a “Pedestrian Danger Index,” which ranks 104 of the largest U.S. metro areas. Florida, by far, has the most dangerous metro areas for walking. Vermont has the safest. The nonprofit’s programs and goals include advocating for better street design. For the complete report, go to SmartGrowthAmerica.org. To stay safer while walking, avoid talking on the phone, texting, or wearing headphones. Wear brightly-colored reflective clothing, and use lights at dusk and dawn.
How Conflict of Interest Policies Affect Medication Prescribing
It is common for pharmaceutical companies to promote medications to physicians during sales visits and events that may involve gifts such as meals and free samples, a practice called “detailing.” In recent years, some academic medical centers in the United States have instituted policies restricting detailing, but little is known about what effect, if any, such policies have had on prescribing practices by physicians. Ian Larkin, PhD, at UCLA, and George Lowenstein, PhD, at Carnegie Mellon University, Pittsburgh, led a multicenter team of researchers who studied the effects of policies designed to limit pharmaceutical representative detailing. The team looked at prescribing by physicians affiliated with 19 academic medical centers in five states. These states—California, Illinois, Massachusetts, New York, and Pennsylvania—have the largest numbers of academic medical center-affiliated physicians and in 2015 accounted for nearly 35 percent of all U.S. prescriptions. When policy changes restricted marketing activities at the medical centers, researchers found that physicians prescribed fewer of the promoted drugs, and more non-promoted drugs in the same drug classes. The analysis included 16.1 million prescriptions; while the decline observed was modest in terms of percentage, proportionally small changes can represent thousands of prescriptions. The study was supported in part by a contract from the National Institute of Mental Health, part of the National Institutes of Health. The report appeared in the May 2 issue of JAMA.
Mixed Results for Testosterone Therapy in Older Men
In older men with low testosterone, one year of testosterone treatment improved bone density and corrected anemia, but also increased the volume of coronary artery plaque, according to results reported from the Testosterone Trials (T Trials). Testosterone treatment had no effect on memory or other cognitive function. The T Trials were conducted at 12 sites across the country in 790 men age 65 and older with low levels of testosterone and symptoms to which low testosterone might contribute. The studies were funded primarily by the National Institute on Aging (NIA). Additional funding, and the study drug and placebo, were provided by AbbVie Pharmaceuticals. “Many older men have testosterone levels below those found in healthy younger men,” says NIA Director Richard J. Hodes, MD. “In most cases, these low levels are not due to diseases known to affect testosterone levels. Many of these men also have problems that could be related to low testosterone, including impaired cognition, anemia, cardiovascular disease, diminished sexual function, decreased mobility, and fatigue. The T Trials were designed to determine if testosterone treatment might help alleviate these symptoms and conditions while monitoring for adverse effects.” While there were benefits to the treatment, researchers state that the diverse outcomes indicate the trade-offs between benefits and risks of testosterone treatment in older men, and that treatment should be individualized for each patient.
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