Annals
Established in 1927 by the American College of Physicians

FOR THE PRESS

12 May 2015 Annals of Internal Medicine Tip Sheet

Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.

1. ACP officially supports transgender rights and same-sex marriage, opposes “conversion” therapy in new policy position paper

Free content: www.annals.org/article.aspx?doi=10.7326/M14-2482

A new policy position paper from the American College of Physicians (ACP) offers recommendations on how to achieve health care equality for lesbian, gay, bisexual, and transgender (LGBT) patients. Among its recommendations, ACP calls for comprehensive transgender health care services included in health benefits plans and civil marriage rights for same-sex couples. Lesbian, Gay, Bisexual, and Transgender Health Disparities: A Policy Position Paper from the American College of Physicians is published in Annals of Internal Medicine.

Evidence suggests that LGBT persons face a common set of challenges within the health care system. These challenges range from access to health care coverage and culturally competent care to state and federal policies that reinforce social stigma, marginalization, or discrimination. These policies often keep LGBT persons from accessing health care and are also associated with increased rates of anxiety, suicide, and substance or alcohol abuse. ACP is committed to improving the health of all Americans and opposes any form of discrimination in the delivery of health care services. ACP’s policy position paper aims to eliminate disparities in the quality of or access to health care for members of the LGBT community.

ACP’s Health and Public Policy Committee reviewed published studies, reports, and surveys on LGBT health care and related health policy to inform its recommendations. The full recommendations can be accessed for free in Annals of Internal Medicine. In brief, some of ACP’s key statements and recommendations include the following:

2. Young lesbians less likely than heterosexuals to be vaccinated for HPV

Free abstract: www.annals.org/article.aspx?doi=10.7326/M14-2108

Adolescent and young adult lesbians may be less likely to initiate vaccination for the human papillomavirus, or HPV, according to a study published in Annals of Internal Medicine. Prevalent misconceptions about risk seem to dissuade women and health care providers from initiating the vaccine.

Nearly all cases of cervical cancer are caused by HPV, so it is recommended that all U.S. women and girls between the ages of 11 and 26 years receive the HPV vaccine, regardless of sexual identity or behavior. Lesbians may be at greater risk for cervical cancer than most heterosexual women for several reasons, including limited knowledge of female-to-female HPV transmission, a higher prevalence of smoking, and greater obesity rates. For this reason, vaccination against

HPV may be even more critical in this population.

Researchers used data from the National Survey of Family Growth to examine the association between sexual orientation identity and HPV vaccination among U.S. women and girls. They found that females who self-identified as lesbian were significantly less likely than their heterosexual counterparts to initiate HPV vaccination. The researchers suggest that targeted efforts may be needed to educate lesbians and health care providers about HPV and the importance of vaccination in preventing cervical cancer.

3. Vehicle for aggregate harm or the lesser of two evils? Experts offer opposing viewpoints on e-cigarette use

Free abstracts: www.annals.org/article.aspx?doi=10.7326/M15-0450 and www.annals.org/article.aspx?doi=10.7326/M15-0361

Electronic cigarettes are a new and divisive force in the struggle against tobacco-related morbidity and mortality. Two commentaries published in Annals of Internal Medicine offer opposing views on their use.

Thaddeus Bartter, MD, of the University of Arkansas for Medical Sciences suggests that a lack of regulation and oversight in e-cigarette marketing means that young people may be tempted by the glamorous images portrayed in e-cigarette advertisements. The aggregate harm is that e-cigarette exposure increases the desire to smoke cigarettes, which could lead to a lifetime of addiction for susceptible young people. Dr. Bartter warns that e-cigarettes have the capacity to disrupt a 50-year fight against smoking.

M. Bradley Drummond, MD, MHS, of Johns Hopkins Asthma & Allergy Center argues that e-cigarettes may be beneficial as a tool for helping smokers reduce their use of combustible cigarettes. Dr. Drummond suggests that the all-or-nothing approach to smoking cessation where complete abstinence is the goal may seem insurmountable to some smokers. E-cigarettes offer these smokers a way to reduce the harms of smoking by giving them a less toxic alternative. He argues that there is a tremendous amount of uncertainty about the harms of e-cigarettes, but the probability of harm from combustible cigarettes is certain.

4. Unlabeled stimulant BMPEA in sports supplement combined with exercise could have caused stroke

Free abstract: www.annals.org/article.aspx?doi=10.7326/L15-0106

β-Methylphenylethylamine (BMPEA), an amphetamine-like stimulant that has been found in dietary supplements marketed to improve athletic performance and weight loss, could be to blame for hemorrhagic stroke in a patient who took the supplement before completing a vigorous workout. The case report, published in Annals of Internal Medicine, is the first to suggest a connection between BMPEA and exercise-induced stroke.

The female patient, who was previously healthy and in good physical condition, reported sudden onset of numbness and clumsiness in her left hand that started 45 minutes after beginning her regular, vigorous workout routine. The patient reported taking the supplement, Jacked Power, as directed on the label shortly before exercising. The researchers analyzed the patient’s supplement in the lab and found it contained a high dose of the stimulant, BMPEA, which was not listed in the product ingredients.

The U.S. Food and Drug Administration warned consumers that BMPEA, a synthetic compound with unknown health effects in humans, is sometimes sold as if it were a natural compound found in the shrub Acacia rigidula. In this case, neither BMPEA nor Acacia rigidula was listed on the supplement label.

The report’s lead author, Pieter Cohen, MD, Assistant Professor of Medicine, Harvard Medical School and a practicing general internist at Cambridge Health Alliance, says that consumers and physicians should be on high alert.

“Dietary supplements can legally be sold to improve work-outs even when there is zero evidence that they actually work in humans,” said Dr. Cohen. “This creates a perverse incentive for manufacturers to introduce untested drugs into sports supplements to achieve the advertised effect. Tragically, untested stimulants can pose serious health risks to unsuspecting consumers.”

Dr. Cohen suggests that physicians report any suspected adverse events from sports supplements to the FDA at www.safetyreporting.hhs.gov.