WWL>Topics>>2-27-14 1:10pm Angela: on drug testing

2-27-14 1:10pm Angela: on drug testing

Feb 27, 2014|

Angela talks with Dr. Pramilla Subramaniam of the LSU Health Sciences Center about the revolutionary development in medical testing: testing drugs on women as well as men.

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Automatically Generated Transcript (may not be 100% accurate)

News of the sun would come out it is absolutely gorgeous and it's going to be cold beautiful night for parades tonight. A little different than yesterday it was about as great as -- -- But we also have a new day of programs and so our first one is going to be you got to listen to this. I'm gonna get back to it but our second program I think you might have a -- that we had done. General honoree on earlier this week and you're talking about his life today and among the many things he's doing. Is he has created. A fabulous program at Southern University. Which is where he graduated. And it's helping young African American men. Get on track and we're gonna do a whole hour we're gonna meet a couple of the young men involved and it's a real positive. As we look for answers to the crises were facing. This is one of them. And then our third hour is going to be. What more and more of us are not only talking about the doing and that's putting up crime -- or security cameras. By our homes and we're gonna talk to a man who is put together the network of 600. Cameras. That are outside just your neighbor as yourself home and it's a nonprofit. And it's going to be looking at the impact those cameras are now having. On our fight against crime and but we begin with. The medical industry is having an aha moment with the realization. That you can't give men and women. The same doses of medicine's. And you must apply medical testing to the sexes equally. They now understand. Sex specific research is amongst. It all started with the realization. That prescription doses of Ambien had a greater impact on women than men. But that isn't the only -- If you're female and take any prescription drugs this is important. And if you're a man who loves a woman who takes prescription drugs it's equally important. Here to talk about the need for sex specific research. Is doctor from -- super money them. A cardiologist. And professor of medicine at the L issue Health Science Center school of medicine. Thank you thank you thank you for taking -- analysts welcome this is important it's very important. And I think our eyes as -- people were opened with a sixty minute piece that ran on Ambien it was like oh my gosh. Oh my gosh. Can you kind of tell us what was. Well enough from there at the sixty minute. -- it was clear that Ambien. The doses that is normally prescribed. Kostis greater problems in the morning after commonly used with women compared to -- Meaning that -- -- had a higher dosage in this system even Philip. Dosage ten milligrams was used which has pretty much a standard for both men and women. So did they metabolize. Drugs differently was that actually quote an overdose in women with a standard dosage that was supposed to be prescribed. Public men and women. So that led to the FDA's elect saying that women should be started with a much Lola -- and maybe attack happened -- And that not when he extended to Ambien but the he sold one wonders if this is just Andean. Is at all. Drugs that I used to -- -- meat is at all other drugs at the use in. Clinical arena what about a high blood pressure medications got a cardiac drugs that I used. Should we be thinking more in -- my using the right dole lose. For a woman and I'm treating compared to a -- I think what was equally startling was the fact that. All of the studies we hear about the effort that gets on medication out of the market I mean it's such a long process. How women have been minimized. In that research. Absolutely but you know you have to understand and that they need to trials a posting you want to do is when he -- patients -- and BC the after they've been studied. Many times the first phase one tie is on helped the individuals to see is this drug safe. Then they go to faced who trounced -- say that drug does this. Does it do that in does group of patients and it's a small. It is -- -- people doesn't do what it's intended to do. And again is it safe. And finally even begin that phase three trials is when we have patients that disease he and the question that is and asked is. Does this drug have a beneficial effect for disease me at this game I'm also looking at safety profile. So if you had the phase one trials majority of that studies are done on helped the Indians lead to a them college students looking -- extra money and it basically looking to -- is this safe. Now Paula can you get a woman. Those of child bearing age. To participate. That is -- -- and that's that's something to think about. Does the presence of hormones. In women changed them metabolism of the drugs on the safety profile. The efficacy as he called -- the effect that she want is it changed. So it it becomes very difficult to include women in the -- trials summit that at -- -- a done predominately in helping me. Isn't it true though that during media related tragic time. And sixties -- seventies when women had done. Severely. Now. That -- -- him I'd guess that the Milton -- babies. That that was a turning point on not many well absolutely -- when they gave thalidomide to pregnant women. And if Condit that was so much of our nominees in their babies in basically shut down including women in -- -- -- using drugs. And that was -- the biggest problem that he had so doing that time no amendment included. And therefore no 18 the -- -- include women in policy as slowly as. Drugs came on board cardiovascular disease became very important in females. Then the question is how but women what is -- disease affected -- amendment at the heart disease and amendment was one of the biggest theme that came out. Looking at trials including women in the -- DC's arena -- I was reading an article found it fascinating. But in the early -- search. Four out of five mice -- -- that is correct I I I thought that very interesting because actress on the -- in. That issue on sixty minutes I if the question yourself. Is that we treat patients and eat -- patience pioli on guidelines -- what is the best by the patient within a given disease. Do we'd be -- look at the patient and say wow this is a female therefore I should do this. -- -- -- is a man out there I should do that and I personally haven't done in the past except. But it's specifically involves heart disease I know what is different between women and men site it Yeremiah and it -- clinical. At testing according to that but I don't necessarily think I do that with a suspected drugs on the list as proven drug. Safety features in -- compare men. So it's ideal thing for you on opening for a I it's a big eye -- from off. Yes OK stay with this everyone and if you've ever had an issue if your woman you've ever had an issue about. A reaction that was not expected. With a drug that you know maybe they're looking at now because your female give us a call 2601870. In will be right back. Will there are definitely differences between men and women. Good differences but differences and I think were all looking at now. On how men and women are treated on both with medication and -- now on talking even diagnosis. Medically and this was really based on the need for or the question sex specific research for search done for medications. Using primarily meant so now we're finding the differences Ambien being the most the most talked about. Difference in dosages. For men and women. And we have doctor Camilla. Who brought money home with this from L issue Health Science Center -- -- a cardiologist. And fascinating subject because I think one and hearing from you is that you all in the medical community are now seeing this more clearly. It isn't that women are smaller than men in this its size its that would cause the difference in dosage as much as. Our metabolism. Our hormones. That kind of thing. As this recent studies especially -- drug showing ms. difference in body fat. So the distribution of the drug in the body fat may make a difference in its efficacy in the treatment of diseases. In comes off Bob metabolism that's important. It until we -- that is important that also means study showing -- and genetic variations in women. That'd be able to metabolize something more because -- -- genetic make. So we should be be having genetic studies done for each of the drugs -- -- coming up to see how well he metabolize. The classic drug intent to genetic studies is Plavix. Look at world could be used a lot of off. For vascular disease as -- some failures and Plavix and some of the study shows that there is genetic variations in the metabolism. That. And that is not specific of females but the same system that works in that drug also works in other drugs in females as well. So there's a lot of things he and then the question is -- -- so what is the impact of hormones and you know if you think about -- applause. Not everybody reaches menopause at the same page. So what is the difference in the hormones and obeyed the intact but then drugs. In females unity disparity forty of fifty. Depending upon them on applause comes. So I think as is that a lot of affects different things at work on women in times of drug metabolism and I don't think anybody knows exactly. Which one is most important and ask what may seem simple question. A husband wife go to use they both have our problems. They both would require the same medication. Would you give them the same dosage. Prior to all this discussion absolutely I think what I usually do in my own practices I'll be stocked low. And then looked myself up but I never I don't think I would have sat and thought and said. Does as a cardiac drug let me choose a different dosage -- my female patient rather than her husband. I think I've gone with the guidelines that -- this drug works by this disease so let's start off slow and work is self opted a maximum Billiton was beneficial in the trap. And I think now that we have seen this with ambient. I think we need to step back and say are we doing the right being in for a all our female patients with all the different drugs -- B dual use. And maybe it might be a practice that we should do that didn't females maybe start -- low -- And then goal and a bit higher than spotted the same dose I'm not and now it is it. It is confusion and I think a lot of the physicians are going to be confused as to what did do. Except it all patients but there it is the female demand even the elderly acting the best. Thing to do it always be start off with the lowest dose possible they showed that they don't have any side effects and then work yourself up on new dosages. A person having a woman having too much it's something. Can cause issues are absent some of the drugs that caused -- on creation of the QPSP Condit -- at a party and that makes them. More risk far. They bad dad dad leaving quickly in the music and -- back. So lot of side effects from a lot of drugs at the party used. Some of the side effects are not necessarily -- specific it is just the drug itself. For example of that common blood pressure medication used some patients it causes a cost some patients it doesn't cost a cough. Now can be figured out which patient is more prone to a coffin the simple blood pressure medication beyond not abating for the symptoms could be. Stated to us and become my office is it but people are doing just fine but why is that you know now. And I don't think that is necessarily specific machine and it's of a woman -- man -- been used as class specific problem that drug. But that if you were mentioning the diagnosed at age is almost a bias and you would treat someone. Forty vs eighty absolutely acting in heart disease acting the most important thing to realize that in women heart disease out colors much me. Symptoms of a heart attack but because angina actress -- means. Even though it is not the same and -- -- discuss that later on if you wish. Usually symptoms on -- and about ten years later than a male counterpart and heart attacks used 820 years. Later than a meal -- part zones. Don't know done that some of it could be the protective effect of the estrogens and that would cause catastrophic -- if you look at the cholesterol makeup. The women -- protected doing GAAP pre menopausal period because that would estrogens in navy -- good cholesterol. So even if you have a risk of having a heart attack the good cholesterol helps you out. But once you reach menopause and estrogen -- goes down. The good cholesterol goes down the bad cholesterol stays up so I -- much higher risk of heart disease at that time. So I can even talk about heart disease heart disease and the disease of the of the eighty team the -- age group as in them elitist more for middle aged. A disease problem so I mean look at that the treatment strategy changes a little bit if I have a forty year old -- that comes to Meehan has classic history out. Heart disease I'm aggressive I wanna make sure that nothing happens to that person. If you have an 8085 year old female that may have similar symptoms he may wanna step back in saint. What other problems that she'd have east and being that they need to do with besides medical treatment. Should I need to go and take care of these aggressively. Complications from out of these test the new procedures that we do. So -- ten to step back and being a little -- and I think that is good. Because you don't wanna do things to an elderly person that in -- -- -- this is absolutely -- let's talk about diet B I'm gonna go back to the park if we're gonna talk a lot about them the next half hour but. Diabetes it's just a common issue in our area. Could this be relevant to what were talking about oh absolutely because diabetes is a big risk factor for heart disease. And at diabetic if you look at that diabetic females in the diabetic males that diabetic -- man has a much higher incidence of heart disease than the same diabetic me. So the impact of diabetes and females as much higher then than it is on the -- -- part. Don't know why. The are -- O'Connor -- of women are much smaller so if you have some plaque buildup in the arteries designate. Party smaller than what it usually is an apple creates more problems cannot -- I can that. Guarantee that. Women tend to have more diffuse disease then it's a single blockages in certain areas. Don't know why that is as in big a study that was done in May amend that and it's kind of women's initiative. Looking predominantly at women. They'd found that the disease in women have more diffuse. That hot bodies react a little bit if they tried to give drugs to cause the bodies to get data on its small. The army so women behave differently than the arteries of men they tend to have more issues with spasm. Than men do so that there are differences in -- women that differences in the risk factors in how the effect that -- Hypertension for example high blood pressure. The impact of high blood pressure and -- is much higher than the impact of hypertension in -- -- why that is so I'm not very clear. So the biggest difference actually in heart disease in women is not when these high blood pressure and diabetes. But also the cholesterol level before Mann applause and after menopause. You would mentioned about -- of the protective. Estrogen is protective two women and then postman upon us it's. Is that a reason to take estrogen after men on -- you know when I was training dad cool enough that game was yes once they have the -- reached menopause. We should protect them by giving them the post menopausal hormone therapy and even institute. But that was several beautiful study showed that estrogen -- prevention of heart disease is actually detriment. It actually increases they increase upon attacks it increased incidence of strokes it actually increased also the incidents of breast cancer. So com on that -- should not be taken to protect yourself from having heart disease. If you Gilani used hormone therapy use it right now -- for the post menopausal symptoms you have. And that -- -- promised date the lowest -- for the benefit and for the shortest duration. Lots to learn. Stay with this were talking about the difference between men and women and -- any comments and Mike you're on the -- stay with this we're gonna take a break going to the newsroom. And Jim -- Should women and men be taking the same dosage of medication for a similar. But situation and the answer we're learning is no. More and more we're learning and thank Kevin we have doctor Camilla -- money and who was with the LSU -- Health Science Center is a cardiologist. Helping us clarify things. Let's go to our caller Mike in Covington thank you for holding. An idea. Our arms this in this city and indigestion there. East on sixty minutes and you're not such an aware of the problem at all -- all these drug from the market. They always have in included in -- But it women and -- separated if you remember the East Asia it didn't come out they just didn't address that issue. Should be let go back now regrets that issue earlier albeit different era so if that question not coordinate shot up like this -- -- new discoveries that. That would be an important if we treat -- but that was well he's done second of Walt Whitman and all react in different. Are all heading and enlightening and reacts and different hockey -- -- -- maybe not. Somebody else to swell papers it was due to drop. So I mean we we we -- -- accurate that you start -- in the market and they tell you that can work. About 2% of the -- their best to design to be okay is not designed to help everybody because doctors are not treaty patience. Individually. Yet treat a patient and pick up clinics now for men that treat erectile dysfunction because the fact that she hosted by record that -- -- people. -- -- make a point about that at -- audience that you know all list. And medical. A class -- -- report it would this discussion I get to the point. It is epic back the patient management studies. Can't address the situation and that doctors on the backside after patients like all among women as you'll probable can -- years ago now. Troubles studies that pocket -- hormone that. And then elect right not treating them individually back given their or lecture them like pets and now we're finding out. They don't have all these adverse reactions to that in charge -- early treated differently but what. Part of that so that's all Wednesday -- you know all of -- -- it's it's really not about. This spring -- fought that women are different than men that -- -- So are you a physician. OK you don't -- just a subject that sent pitcher button huh. It public because I'm 66 and you know there's a lot I'd like Jake. Testosterone for example -- my doctor treats me equally blood tests all right your fanatic about you studied that it structural bad for you because. If it's not -- correct it was certainly it is to. Not -- correct and I think the public talking about mostly across the charters dubbed the portrait console. You know there's there's there's there's something that. You know if it is it's real simple you just addressed the patient had an individual and everything else take care of itself we all this technology how to. Research in and and and bring things to market bill has been money. The other market the match and sales quickly and so I have to beat let's spend money let's say it's Ellis got worked for so. You know expect kind of bug me but that's just -- -- I think I. Doctor Simonyi wants to say something why not specifically with respect to the post menopausal hormone therapy. That -- study showing that about hormone therapy may have been -- Haitian women and prevent heart disease. In addition there was study showing that actually had beneficial effects on cholesterol. So I think at that time of the adversary chairman of the of the using hormones are managing postmenopausal. Females. Beat clearly believed that it had a protective effect on females because that's all the studies be tracked. -- last time rent and more and more studies done that -- study showing. That clearly hormone therapy benefits cholesterol that the question however as does. Having benefit and cholesterol. Lead to benefit in preventing heart disease era and that's when the other studies came and said no just because -- cholesterol got -- Didn't mean that that heart disease got -- I understand your point yeah I would put out -- is. Is that during that term there were there were scrapped restructure these women are my white streak in notre update so my point that they -- not -- Treatment studies or blood work and while they waited at a insults. All have an -- all our cholesterol went up from what you're saying which is absolute correct. Now they monitor. Where it doesn't become chronic problem. Because he took those hormones. The columns -- it. I think there. Among the role women and not to speak you're watching obviously had a different. Experience but I have never been given a drug war I was not tested for lead. Oh. Just saying you know I'm I'm actually not tested or I'm not general testing. I'm saying testing for the specific treatment that your it or individual exec -- what he. So that it would. That certain agencies like general -- by saint. That a piece on television. Speak about it and it worked out. At all spoke -- -- the -- market weathered -- okay that didn't speak. Took all surge that was printed where there was that difference between man and that's the crops this'll for the Ambien could be other things to do but it all. It's sweet to be additional points are trying to make our -- with these -- Giving and patience. As Antonin -- because their bodies -- individual. All have. Bank branch at all. People. So it all on saint reactive chemicals and drugs and waited someone else which means tree. Not just keep -- up and it's sitting back and -- -- -- -- article ball. I think -- respect the Ambien appointment was made -- Eddy the used ten milligrams of Ambien dosage in a woman reaches and the -- dosed EU's. Never found to have more problems with the same dosage in women and men. And the FDA came out and said cut that those in the half for women and keep the same goes on men. Now that is something that comes out of post marketing trials because they all is the company's nominees don't 1000 -- Right after the drug comes not just on safety not necessarily for the effect that they have the drug far. And I think this was one of the post mocking that aided by safety showing it was not as safe. In -- from the same dosage so it is not necessarily that -- trying to bring out the point but I think from this perspective. I think it is important. That company did this trial on Ambien because we showed you -- not won -- -- -- in the morning after taking a big dose of Ambien may not be too. The write down is. Adding additional action -- my perspective I think was an eye opener for me. Because when I went back and looked at drugs. Believe me look at drugs Pacific -- thought Imus isn't hateful women but the -- we have so many nations and I treat. That I eighty and not in now 98. Each right. And I'm fine looking out for myself. If that drug that I musing on the seventy year old can be safely used on the -- -- And I think you're one of the few doctors I know that it would that they dig deep -- out second ball one more point saint oracle were. -- -- -- That it was all in the television show sure that it was -- its. Let's Robert oh put it to decides that we can come out with is god but he treats women -- That's when the idea of the person on and they got -- at a -- died Wednesday. And ask the question do we get people back -- -- That was -- whole -- right well and so that's in that. Women are different in that man and Indian. Could cause problems on -- in the crux of his old discussion all that with the FDA. In the report there was a difference. But they came out with these guidelines. Without now -- on. -- under -- terrific to call I appreciated and I appreciate your thoughts always call. And let's take a quick break we'll be right back this is Angela under the W. So grateful to doctor from -- -- monument of Allah issue cardiologist. At Health Science Center but were talking about. The differences and dosages of drugs to men to win. And her specialty of course -- heart. And we're hearing more and more. About I think happened here in more and more that there are very different symptoms for women and heart and are from. Absolutely if you look at some of the recent things that come on -- in an empty he and it definitely an electric chair. The -- present differently they do not prison with a classic instant on the chest symptoms the pain down bullets bombs and jaw line and sledding and shortness of breath. -- -- out -- different animal they present he would chart -- a -- as big as symptoms of heart pain. They Amy has CTV may have weakness they may have some on -- a shoulder pain back pain. It is very difficult to evaluate the symptoms of women to say yes I believe mrs. Hart -- this may not -- -- may be -- oval working -- strained a muscle up pulled a muscle. It -- I it is difficult -- present differently they present at a much higher age group than normal anomalies seen in males. Trick an all of this is get a good history from these people in at the end of the day you and you gonna have to be able to say. Do you think that this patient has heart disease and not from the symptoms. Women and also minimize the symptoms says so much of things going on behalf to take of the what clothes and go home. They bit off focused on our own families and our husbands so when we have an eight -- -- say I just didn't look too much today and then we kind of just ease it off. And I think women tend to be a little bit more attuned to their own symptoms and realized that something is different. And if they think something is different and I would suggest that if they have risk factors if they have high blood pressure. If to have diabetes in their smokers if to have a family history that someone in their family having heart attacks and a young needs. In their 40s50s. -- sixties. They should -- their position and say something is different view of being this could be my heart acting up as a symptom rather than a classic -- And in effect if the doctor says in a lot I know your history you're telling me it's different. What -- they do with that is like either tests that guy in I used to -- into an -- in the office -- the -- solar limited is because -- -- -- it's normal to -- doesn't mean -- that I don't I'm not gonna have a heart -- tomorrow morning when -- leave the office. ET Jesus dot if it's norm that also something of its abnormally tells it gives us some information. Majority of them women tend to have stressed -- done. Stressed -- have also been a problem for women as a high incidents off Alfonse abnormalities on -- stressed as -- -- So we tend to do a lot of imaging X ray tests on amendment would be distressed as and that takes only defaults abnormalities but just have to know and he -- -- -- Thought that false emblematic DC I don't -- this as a real. I think this is not merely in this nation that this symptom they thought I'm not going to treat because once you -- Doing one tested comes back abnormal you're going to do another test and another as -- at the end you wanna do an invasive angiogram. That may be completely normal but it is that risky procedures even though we do it often. The -- it there is at risk you do have to sign a consent form -- -- so if I'd be very careful and you ought to test what are you gonna get out of the test what are you looking for. What is it besides -- going to get out of it and what are you going to do with that result and -- that the music you have to ask if what you ought to test. Back to our our thing with the the differences in drugs -- drug reactions treatment when our caller Mike brought incorporated. Should the FDA now knowing what it's very clear. On new drugs coming -- Should there be more tests. On -- separate tournament. It's not easy to include women in clinical trials but now and you might -- that the money you can do is maybe pharmacological. Testing and -- being the promises in the pharmacologist. Who was looking at these tests these drugs in the lab -- May be able to do it in female mice it was a male -- I don't know what the differences in terms of hormonal therapy. Maybe we can do it India and the females. And males and compare at the metabolism of the drug India. Dosages that they needed and I think now that this has happened with -- acting. A little bit more push is going to be down from SP saying look at these drugs far safety pro fop. In equally among women and men so that at -- and -- dual. That opened the drug out there for treatment -- no it is safe and that dosage for the -- The issue of the child -- woman age moment. Not being involved in testing. Is understandable but if there were a voluntary thing you said earlier college students and I'm just an. Animal thing you know I'm not going to have children. Then she might be a good candidate to be an accident and even some of the women who had maybe Tubal ligation maybe are you had a hysterectomy may be -- not gonna get death. But not gonna have a town town in the future those I'd be very nice patients to put in the Strauss. The other question is also. What about at him and what taking oral contraceptives. Yes you know should they be included in the -- What is what are the hormones that they hate due to the drug. What is a harmonious note that drug metabolism that we don't know about so would that. Actually helpless. In looking at the drug. I am not I have no clue I think. Perspective from -- pharmacology industry would be very good on this. And see what -- they do that testing on the drug in the lavatory before it is released a clinical trials. Well in the same article about -- Using more male -- and female rats but the mice run that they were talking about. There's differences in male and female mice her. Absolutely accident even with that it can't be you cannot be -- I think it it it I think this study to meet. Opens -- -- to say that maybe before the drug is released. Maybe they should look and see what is the effect of the drug in the female population the male population and in the elderly -- nation. And I think there should be study showing that it is safe in all three groups and that has to be something to back them -- Stay with this will be right back this is WW well. Again and so grateful to a doctor for Milla -- -- -- who is with the Alicia Health Science Center cardiologist. And just so again your final thoughts on what you see in the future. I think if you -- going to be studies done in the have for first looking at drugs specifically. At. The normal healthy individuals of different age groups. Different genders. Different ethnic groups in between home. That says drugs like this team did an African Americans and us as the caucasians was as they Hispanics me an idea. And I think we gonna have to look at that drug metabolism. Than drug. Dosages and all of those in these different groups because of the hodgepodge of group a page at people in this country. So once you do that typing in the lavatory and in healthy individuals then -- it deep into clinical trials looking at disease prevention I thank you so very much for this hour as I -- our listeners do. Stay with this will be talking. About the honoring special lawn. Special wonderful group from Southern University ballots go to the newsroom and Chris Miller.