Go Lean…Caribbean

 Go Lean Commentary:

The below news article relates to our most vulnerable victims in society, our children under age 2. The article helps us to appreciate that they need to be protected.

This report was published by a recognized technocratic institution, the Children’s Hospital of Philadelphia (CHOP), a previously referenced source for the publishers of the book Go Lean…Caribbean. Many of the research of CHOP have relevance for Caribbean life and the Go Lean elevation effort.

The CHOP research is published as follows:

Title: Antibiotic Use by Age 2 Associated With Obesity Risk

Repeated exposure to broad-spectrum antibiotics in the first two years of life is associated with early childhood obesity, say researchers from The Children’s Hospital of Philadelphia in a retrospective study based on data from electronic health records from the extensive CHOP Care Network.

Studying early life events that may affect how the body regulates weight

The researchers found that children with four or more exposures to broad spectrum antibiotics during infancy were particularly more likely to be at risk for obesity. The study, published online September 29, 2014 in JAMA Pediatrics, did not directly examine cause and effect, said Charles Bailey, MD, PhD, (See Photo) lead author of the study, but he added, “as pediatricians, we’re interested in whether events that happen early in life might reset the baseline and have a long-term effect on how the body regulates weight.”

The researchers were intrigued by the emerging idea that the microbial population that begins to colonize in infants’ intestines shortly after birth, known as the microbiome, plays an important role in establishing energy metabolism. Previous studies have shown that antibiotic exposure influences the microbiome’s diversity and composition. “The thought is that the microbiome may be critically dependent on what is going on during infancy,” Bailey added.

The study team analyzed electronic health records from 2001 to 2013 of 64,580 children with annual visits at ages 0 to 23 months, as well as one or more visits at ages 24 to 59 months within the CHOP Care Network. They assessed the relationships between antibiotic prescription and related diagnoses before age 24 months and the development of obesity in the following three years.

Broad-spectrum drugs associated with obesity but not narrow-spectrum drugs

The investigators saw the association with broad-spectrum drugs, but they reported no significant association between obesity and narrow-spectrum drugs. For this study, they classified first-line therapy for common pediatric infections, such as penicillin and amoxicillin, as narrow-spectrum. They considered broad-spectrum antibiotics to include those recommended in current guidelines as second-line therapy.

“Treating obesity is going to be a matter of finding the collection of things that together have a major effect, even though each alone has only a small effect,” said Patricia DeRusso, MD, director of the Healthy Weight Program and vice president of Medical Staff Affairs at Children’s Hospital who was the senior author of the study. “Part of what we are exploring in this study is one of those factors that we can possibly modify in the way we take care of kids and make it better.”

Future investigations are needed involving multiple large pediatric health systems that will take a broader look at several populations and how adopting guidelines that accentuate the use of narrow-spectrum antibiotics might affect patients’ risk of obesity, Dr. Bailey said. In addition to supporting this type of research locally, CHOP is also a key contributor to networks such as PEDSnet that link many children’s hospitals to make more effective clinical research possible. Researchers also are looking at ways the microbial communities living in infants’ intestines are swayed by dietary and environmental factors.

Early intervention is key

Childhood obesity has more than doubled in children over the past 30 years, according to the Centers for Disease Control and Prevention. Many will remain obese into adulthood and be susceptible to heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. Medical researchers at CHOP want to identify ways to intervene as early as possible, in order to avert the lifetime of medical, developmental, and social problems associated with obesity.

More information

“Association of Antibiotics in Infancy With Early Childhood Obesity” JAMA Pediatrics, published online on September 29, 2014 doi:10.1001/jamapediatrics.2014.1539

Dr. Bailey’s coauthors were Christopher Forrest, MD, PhD; Peixin Zhang, PhD; Thomas M. Richards, MS; Alice Livshits, BS; and Patricia A. DeRusso, MD, MS.

This research project was funded by an unrestricted donation to The Children’s Hospital of Philadelphia’s Healthy Weight Program from the American Beverage Foundation for a Healthy America.

Contact: Joey McCool, The Children’s Hospital of Philadelphia, 267-426-6070 or McCool@email.chop.edu
Children’s Hospital of Philadelphia Web Site – Posted 9-30-2014
http://www.chop.edu/news/antibiotic-use-by-age-2-associated-with-obesity-risk.html

Referenced Video: https://www.youtube.com/watch?v=HF3zTp5YQSg

Why is antibiotics misuse so high in American society*?

One theory is that Big Pharma, the Pharmaceutical industry, dictates standards of care in the field of medicine, more so than may be a best-practice. (Picture the scene of a Pharmaceutical Salesperson slipping in the backdoor to visit a doctor and showcase latest product lines).

This subject of damaging health effects deriving from capitalistic practices in medicine aligns with Go Lean … Caribbean (Page 157), as it posits that Cancer treatment (in the US) has been driven by the profit motive, more so than a quest for wellness and/or a cure.

This is not the model we want to effect the well-being of our young children.

The Go Lean roadmap specifies where we are as a region (minimal advanced medicine options), where we want to go (elevation of Caribbean society in the homeland for all citizens to optimize wellness) and how we plan to get there – confederating as a Single Market entity. While the Go Lean book strategizes a roadmap for economic empowerment, it clearly relates that healthcare, and pharmaceutical acquisitions are important in the quest to make the Caribbean a better place to live, work and play. At the outset of the Go Lean book, in the Declaration of Interdependence (Page 11), these points are pronounced:

viii.  Whereas the population size is too small to foster good negotiations for products and commodities from international vendors, the Federation must allow the unification of the region as one purchasing agent, thereby garnering better terms and discounts.

ix.     Whereas the realities of healthcare and an aging population cannot be ignored and cannot be afforded without some advanced mitigation, the Federation must arrange for health plans to consolidate premiums of both healthy and sickly people across the wider base of the entire Caribbean population. The mitigation should extend further to disease management, wellness, obesity and smoking cessation programs.

The Go Lean book is not a medical reference or science book, but it does touch on medical issues, especially as they relate to community economics. The publishers of the book are not trying to dictate policies for medical practice; that would be out-of-scope for Go Lean, which serves as a roadmap for the implementation and introduction of the technocratic Caribbean Union Trade Federation (CU). The CU‘s prime directives are identified with the following 3 statements:

• Optimization of the economic engines in order to grow the regional economy to $800 Billion & create 2.2 million new jobs.
• Establishment of a security apparatus to protect the resultant economic engines.
• Improve Caribbean governance to support these engines.

Previous blog/commentaries addressed similar issues as the foregoing article. The following sample applies:

The Caribbean Union Trade Federation has the prime directive of optimizing the economic, security and governing engines of the region. The foregoing article/VIDEO depicts that research is very important to identify and qualify best-practices in health management for the public. Obviously the scourge of obesity is unwelcomed. Nutrition education is a key mitigation, but the foregoing article/VIDEO proclaims another driver that is outside of the control of the afflicted, or their families. This is the manifestation and benefits of Research & Development (R&D). The roadmap describes this focus as a community ethos. Then it goes on to stress that the CU must promote the community ethos that R&D is valuable and must be incentivized for adoption. The following list details additional ethos, strategies, tactics, implementations and advocacies to optimize the region’s health deliveries:

The foregoing news/VIDEO story depicted analysis administered by the Children’s Hospital of Philadelphia, a teaching and research facility for the care of children.  There is a need for more such R&D on obesity causes and drivers. In the Caribbean, Cuba currently performs a lot of R&D into cancer, diabetes and other ailments. The Go Lean roadmap posits that more innovations will emerge in the region as a direct result of the CU prioritization on science, technology, engineering and medical (STEM) activities on Caribbean R&D campuses and educational institutions.

The Go Lean roadmap does not purport to be an authority on medical best-practices. The CU economic-security-governance empowerment plan should not direct the course of direction for obesity research and treatment. Neither should pharmaceutical salesmen. Their motive is strictly profit …

The CU motive, to impact the Greater Good, mandates monitoring progress in obesity research, the causes and effects. The hope is to minimize the affliction. This is the heavy-lifting the Caribbean region needs. This means life-or-death for some. All of the Caribbean is hereby urged to lean-in to this roadmap for Caribbean elevation.

Download the book Go Lean … Caribbean – now!

————–

* Appendix – Antibiotics Misuse – (http://en.wikipedia.org/wiki/Antibiotics)

“The first rule of antibiotics is try not to use them, and the second rule is try not to use too many of them.” – The ICU Book ^[70]

Inappropriate antibiotic treatment and overuse of antibiotics have contributed to the emergence of antibiotic-resistant bacteria. Self prescription of antibiotics is an example of misuse.^[71] Many antibiotics are frequently prescribed to treat symptoms or diseases that do not respond to antibiotics or that are likely to resolve without treatment. Also incorrect or suboptimal antibiotics are prescribed for certain bacterial infections.^[41][71] The overuse of antibiotics, like penicillin and erythromycin, have been associated with emerging antibiotic resistance since the 1950s.^[56][72] Widespread usage of antibiotics in hospitals has also been associated with increases in bacterial strains and species that no longer respond to treatment with the most common antibiotics.^[72]

Common forms of antibiotic misuse include excessive use of prophylactic antibiotics in travelers and failure of medical professionals to prescribe the correct dosage of antibiotics on the basis of the patient’s weight and history of prior use. Other forms of misuse include failure to take the entire prescribed course of the antibiotic, incorrect dosage and administration, or failure to rest for sufficient recovery. Inappropriate antibiotic treatment, for example, is their prescription to treat viral infections such as the common cold. One study on respiratory tract infections found “physicians were more likely to prescribe antibiotics to patients who appeared to expect them”.^[73] Multifactorial interventions aimed at both physicians and patients can reduce inappropriate prescription of antibiotics.^[74]

Referenced Sources:

41. Slama TG, Amin A, Brunton SA, et al. (July 2005). “A clinician’s guide to the appropriate and accurate use of antibiotics: the Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria”. Am. J. Med. 118 Suppl 7A (7): 1S–6S. doi:10.1016/j.amjmed.2005.05.007

56. Pearson, Carol (28 February 2007). “Antibiotic Resistance Fast-Growing Problem Worldwide”. Voice Of America. Archived from the original on 2 December 2008. Retrieved 29 December 2008.

70. Marino PL (2007). “Antimicrobial therapy”. The ICU book. Hagerstown, MD: Lippincott Williams & Wilkins. p. 817. ISBN 978-0-7817-4802-5.

71. Larson E (2007). “Community factors in the development of antibiotic resistance”. Annu Rev Public Health 28: 435–447. doi:10.1146/annurev.publhealth.28.021406.144020. PMID 17094768.

72. Hawkey PM (September 2008). “The growing burden of antimicrobial resistance”. J. Antimicrob. Chemother. 62 Suppl 1: i1–9. doi:10.1093/jac/dkn241. PMID 18684701.

73. Ong S, Nakase J, Moran GJ, Karras DJ, Kuehnert MJ, Talan DA (2007). “Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction”. Annals of Emergency Medicine 50 (3): 213–20. doi:10.1016/j.annemergmed.2007.03.026. PMID 17467120.

74. Metlay JP, Camargo CA, MacKenzie T, et al. (2007). “Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments”. Annals of Emergency Medicine 50 (3): 221–30. doi:10.1016/j.annemergmed.2007.03.022. PMID 17509729