Antibiotics online: digital pharmacy marketplaces and pastiche medicine
Many health agencies, including the World Health Organisation, employ a ‘One Health’, intersectoral approach to address the challenge of antimicrobial resistance (AMR). However, according to Lyall et al (2023) such mitigation efforts are complicated by the growth of online pharmacy services and their marketing of antimicrobials. Considering the problem posed by the easy online availability of antimicrobials through digital pharmacy marketplaces, Lyall et al (2023) note that the COVID-19 pandemic ‘has helped to normalise digital healthcare and contactless prescribing, amplifying the need for caution.’
Little is known, the authors state, about how antibiotics are consumed via digital pharmacy and what the implications are for AMR prevention. Citing a 2015 database that estimated between 2000 and 3500 merchants were operating some 35000 websites, unregulated online pharmacies provide consumers with direct access to medications without gatekeepers like doctors and pharmacists.
One key finding highlighted is the paradox whereby the legitimate online pharmacy sector does relatively little to engage consumers, yet on the other hand ‘unregulated e-pharmacies provide consumers with copious information of dubious soundness.’ The overall impact of this ongoing ‘pastiche medicine’ pattern of absence and overcompensation, claim the authors, is to increase the volume of poorly communicated advice that may compromise mitigation efforts to reduce the use of antimicrobial agents.
Identifying depression and its determinants upon initiating treatment: ChatGPT versus primary care
Depression is a prevalent disorder for which people often first seek help from primary care physicians, and accurate diagnosis and treatment are crucial for continuity of care. This is cited by Levkovich and Elyoseph (2023) who also note that Chat Generative Pretrained Transformer (ChatGPT) is an advanced conversational artificial intelligence (AI) technology that has so far attracted some 100 million users, making it the most rapidly expanding AI consumer application to date.
In this study of eight vignettes – including man/woman; blue collar worker/white collar worker; mild/severe depression – the authors sought to compare depressive episode evaluations and suggested treatment protocols generated by two ChatGPT variants with those of primary care physicians. Specifically, to investigate adjustment of treatment protocols for mild and severe depression; modification of pharmacological treatments as required in specific cases; and scrutiny and handling of gender or socioeconomic biases.
For each vignette ChatGPTs were asked: What do you think a primary care physician should suggest in this situation? Both ChatGPTs conformed with accepted guidelines for managing mild and severe depression, without demonstrating the gender or socioeconomic biases that were observed among primary care physicians. However, despite the potential benefit of using chatbots such as ChatGPT in enhanced decision making, further research is needed to refine AI recommendations for severe cases and to consider potential risks and ethical issues.
Does the ketogenic diet improve neurological disorders?
Since the 1920s the ketogenic diet (KD) – typically consisting of a tightly controlled high-fat, low-protein, and low-carbohydrate diet – has been shown to benefit paediatricresistant epilepsy. Such a diet, studies show, increases the concentration of ketone bodies (KBs), ‘which are anticonvulsants and provide brain energy as alternatives to conventional fuel’, and KBs’ antioxidant and anti-inflammatory properties are essential neuroprotective agents.
These observations are cited by Mazandarani et al (2023) who undertook a systematic review of 13 studies – 6 clinical trials and 7 cohort studies, all published between 2016 and 2022 – to evaluate the changes in gut microbiota (GM) induced by KDs as a potential underlying mechanism in the improvement of neurological diseases.
The authors reported that most studies demonstrated that a KD improved clinical outcomes by reducing disease severity, attack frequency, and relapse rate. Further, several studies showed that consuming a KD confers neuroprotection by restoring and/or promoting the accumulation of beneficial microbes in the GM of patients with neurodegenerative diseases. In addition, such a dietary regime also has the potential to improve and regulate memory, learning, and disease progression, reducing the frequency of relapses and attacks. A KD-based regime prescribed in neurological patients, conclude the authors, ‘has effectively altered the GM composition and GM-derived metabolites.’
A qualitative analysis of nutritional needs during cancer treatmentMost cancer patients undergo involuntary weight loss at some stage, which can impair the performance and outcomes of anticancer treatments. Nutrition impact symptoms (NIS) often arise in clinical treatment, and dietitians are central to ensuring that nutrition requirements are being met.In this qualitative study Ní Fhlannagáin et al (2023) assessed the nutrition needs and dietary changes made by cancer patients in Ireland. Four online focus groups were conducted for 15 individuals (11 cancer patients, 4 caregivers), representing 18 cancer experiences as some caregivers were responsible for multiple patients or relatives.Novel themes revealed by this research included that symptoms were varied and transient – coming and going rapidly – with patients dissatisfied with dietetic and broader nutrition services provided by hospitals. The authors found that NIS can often be alleviated through practical dietary changes that support the maintenance of muscle and ensure that nutrition requirements are being met, which may in turn lead to increases in survivorship and quality of life.Treatment of NIS, conclude the authors, must be rapid and responsive, with the development of appropriate self-management resources like booklets and apps for patients probably valuable in ensuring that patients can access support for their NIS.