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What you see is what you get- no more clearly seen then inThis 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 inthe 250 top-grossing US movies from 1994 to 2018these 250 movies sold 10 billion box office tickets and grossed $164 billion in theatersworldwide. These are popular movies we all watch or are aware ofand what they put on the screen as a societal “norm”in this study-Two trained researchers viewed movies in their entirety and listed allfoods and beverages depicted in each scene.they used the Nutrient Profile Index (NPI) to classify foods and beverages as healthy or notpenalizes components that should be limited likesugar, sodium, and saturated fat and rewards fiber, protein, and fruit and vegetableNow I understand this is not a one size fits all and the authors admit there is not portion controlon this so if the movie had a thimble full of high sugar intense soda and a whole garden oflettuce 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 sodiumcontent of foods or in sugar content of beverages”part of the reason I bring up this article is because There were many disturbing findings likeG-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 --- onaverage movies depicted 121 g (95% CI, 116-125 g) of total sugar per 2000 kcal, which ishigher 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 itmakes it ok to also eat junk food. . we already live in an obese society and any opportunity wecan to prvent or promote healthy eating should be done, even if that means during a moviewhile 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 ifsomeone 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/M20-5665Are Financial Payments From thePharmaceutical Industry Associated WithPhysician Prescribing?A Systematic ReviewThis was a systematic review to look to see ifpayments 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 moreoften, and this was also associated with increase prescribing cost… the total cost and rates ofprescribing varied BUT NONEAnd 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 toprescribe 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 theirdrugs. Both mechanisms are plausible.The studies the look at temporal prescribing found substantial increases in prescribing immediatelyafter receipt of each industry payment.Industry spending on drug promotion disproportionately targets drugs that are less effective oroffer little therapeutic advancement BECAUSE physicians want to use effective drugsREGARDLESS OF THE PROMOTION!!! whereas marginally effective drugs require moreintensive promotion to increase prescribing!!ASA after a stroke- we know it works, you odnt need to sell it to meStatins after and MI- we know it worksMetformin 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, weneed them, they do great things and have the money to do fantastic trials because they havethe money to chase people down to get the outcome data we need but taking money from themtugs on our need to prescribe their medications EVEN when our patients may benefit fromanother or different or cheaper drug and if you think well this doesn’t apply to mean I want torepeat what I said earlierNONE OF THE identified studies had all null findings.So unless you think you are magically different than every other provider that has ever beenstudied then yes, even you are affected by drug money money and meals. Money talks so if youcant stand the heat get out of the kitchen and speaking of heatThis next article titledAssociations between high temperatures in pregnancy and risk of preterm birth, low birth weight, andstillbirths: systematic review and meta-analysisFound a small but very real and consistent association between exposure to high enviromentaltemperatures and pregnancy outcomes,odds of a preterm birth rose 1.05-fold (95% confidence interval 1.03 to 1.07) per 1°C increase intemperature and 1.16-fold (1.10 to 1.23) during heatwaves which were defined as two or moredays with temperatures above a predefined threshold. This gives me two pieces of informtion which is those individuals who workout a lot shouldprobably avoid the hot yoga during pregnancy, stick to the regular yoga for 9 months and thoseindividuals with low economic status and no access to air conditioning will suffer and on a grandscale will see higher rates of preterm delivery. This is sad and if a real finding it is one we willnever see on microscopic data remember it is only a 5% increase risk with the 95% confidenceinterval going all the way down to 1.03% we are not good enough to pick up such smalldifferences in our day to day clinical practice but with macroscopic data. It becomes clear, I ameager for more information on this in the future. Remember when I said last year that according to me and now according to ACOG for almost10 plus years we should let women get birth control over the counter!! When I told you that thisis insane that we has providers think we are so special they must come to us to getcontraception?? Well we are one step closer in this paper titledhttps://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 womenpresenting to community pharmacies for emergency contraception (Bridge-It): a pragmaticcluster-randomised crossover trial” pragmatic cluster-randomised crossover trial of almost 600 women receiving emergencycontraception 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 μgdesogestrel) plus a rapid access card to a participating sexual and reproductive health clinic. Inthe control group, pharmacists advised women to attend their usual contraceptive providerThe primary outcome was the use of effective contraception (hormonal or intrauterine) at 4months. Although there was a significant amount of people lost to follow up, almost 40% which washigher than the expected 25% lost to follow up expected by the authors, however at 4 monthsThe proportion of women using effective contraception was 20·1% greater in the interventiongroup, 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 aneconomic evaluation of the intervention.Sadly this study would have needed about 2000 patients to clearly tell a difference inunexpected pregancy or abortion.I guess the summary is that if you want women to be on birth control you have to make it easierfor them to acccess it and whatever format that is then fine, let them access it. Their risk ofchildren 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.2020.2834?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 NationalAsthma Education and Prevention Program The important thing to know isThose with mild persistent asthma should use either regular daily ICS with an as-neededinhaled (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 additionaldoses of the ICS/formoterol as neededSome will say this is different than the gina guidelines which say ICS/formoterol right from thestart. I will say you are right this is different than the global initiative for asthma guidelines. Andyou 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 andthat means those individuals coming in with mild persistent asthma, the newly diagnosedasthma patient really should no longer be on just prn albuterol. Those days are done, the dataand the guidelines agree. ----