Amgen profit rises, weight-loss data expected in 4th quarter

 Amgen on Tuesday posted quarterly financial results that beat Wall Street expectations as a 9% increase in product sales offset higher operating expenses due in part to development of experimental weight-loss drug MariTide.

The California-based biotech company’s second-quarter revenue rose 9% from a year earlier to $9.2 billion. Adjusted earnings per share increased 21% to $6.02.

Analysts had expected an adjusted profit of $5.29 on revenue of $8.94 billion, according to LSEG data. 

The "strong quarter for Amgen (NASDAQ:AMGN) starts to reshape the narrative for the (company) as we look to the back half of the year," BMO Capital Markets analyst Evan Seigerman said in a research note.

Shares of Amgen, which closed at $300.08, were down about half a percentage point at $298.50 in extended trading.

Sales of cholesterol-lowering medication Repatha rose 31% to $696 million. Sales of bone drug Prolia fell 4% to $1.1 billion and the company said it expects further erosion this year due to new competition from biosimilars.

Adjusted operating expenses rose 8% from a year earlier, while research and development costs rose 18%.

The company said it expects to have data in the fourth quarter from two key mid-stage MariTide studies. One is testing the drug in obese or overweight adults with or without type 2 diabetes, while the second is looking at MariTide as a treatment for type 2 diabetes.

MariTide is an antibody linked to a pair of peptides that activate receptors for the appetite- and blood sugar-reducing hormone GLP-1 while simultaneously blocking a second gut hormone called GIP.

Several companies are working to develop weight-loss drugs, encouraged by booming demand for current medicines and estimates that sales of obesity treatments could hit $150 billion in the coming years.

For the full year, Amgen slightly raised its financial outlook to adjusted earnings per share of $20.20 to $21.30 on revenue of $35 billion to $36 billion. It had previously forecast earnings of $20.00 to $21.20 per share on revenue of $34.3 billion to $35.7 billion.

Analysts, on average, have estimated 2025 earnings of $20.91 per share on revenue of $35.4 billion.

The company said its 2025 outlook includes the impact of implemented tariffs, but does not account for any future levies, including potential sector-specific tariffs, or pricing actions that could be implemented in the future.

The pharmaceutical industry is facing intense pressure from U.S. President Donald Trump to lower prices Americans pay for prescription medicines, while preparing for 15% tariffs on imports from the European Union.

Amgen CEO Robert Bradway, during a conference call with investors, said the company agrees that reform is needed in the U.S. healthcare system, but that it is too early to comment on specific plans. "We expect to work with the administration," he said.

https://www.investing.com/news/stock-market-news/amgen-quarterly-results-beat-wall-street-estimates-4171186

'Explosion In Student Loan Delinquencies Marks The Start Of Next Debt Crisis'

 Total household debt rose by $185 billion in the second quarter of 2025, a 1% rise from Q1 2025. Balances now stand at $18.39 trillion and have increased by $4.24 trillion since the end of 2019, just before the pandemic recession.

Before is a snapshot of the latest Q2 data, courtesy of the NY Fed:

Balances

• Mortgage balances grew by $131 billion during the second quarter of 2025 and totaled $12.94 trillion at the end of June.
• Balances on home equity lines of credit (HELOC) rose by $9 billion, the thirteenth consecutive quarterly increase. There is now $411 billion in outstanding HELOC balances, $94 billion above the low reached in the first quarter of 2022.
• Credit card balances rose by $27 billion during the second quarter and now total $1.21 trillion outstanding and are 5.87% above the level a year ago.
• Auto loan balances rose by $13 billion, and now stand at $1.66 trillion.
• Other balances, which include retail cards  and consumer finance loans, were roughly unchanged at $540 billion.
• Student loan balances edged up by $7 billion and now stand at $1.64 trillion.
• In total, non-housing balances increased by $45 billion, a 0.9% increase from 2025Q1. 

Originations

• Mortgage originations increased slightly, with $458 billion newly originated in Q2.
• There were $188 billion in new auto loans and leases during Q2, an increase from the $166 billion observed in the first quarter of 2025.
• Aggregate limits on credit cards continued to rise, with a $78 billion (1.5%) uptick in the second quarter.
• Home equity lines of credit (HELOC) limits rose by $18 billion, continuing the growth in HELOC limits that began in 2022

Credit Quality

• Credit quality of newly originated loans was mixed: The credit scores of newly originated auto loans decreased, as the median score for auto loan originations decreased by 6 points.
• There was an improvement in the credit quality of mortgages, as the median score of newly originated mortgage loans increased by 5 points and the tenth percentile score increased by 13 points.

• About 53,000 individuals had new foreclosure notations on their credit reports, a decline from the previous quarter

All of the above is more or less as expected: yes, the US consumer is drowning in (ever more) debt, but that's hardly a surprise: since life for middle class Americans is now largely unaffordable, most Americans have no choice but to take on even more debt. 

There was, however, one big shock, and it had to do with the trillions in student debt in general, and the end of the repayment moratorium in particular (see "Trump Admin Begins Collecting On Student Loans In Default").

As the NY Fed notes, aggregate delinquency rates "remained elevated in the second quarter of 2025" which is putting it mildly. As of the end of June, 4.4% of outstanding debt was in some stage of delinquency, which is 0.1% higher than the first quarter.

And while transition into early delinquency held steady for nearly all debt types; the exception was for student loans, which saw another uptick in the rate at which balances went from current to delinquent due to the resumption of reporting of delinquent student loans on credit reports after a nearly 5-year pause due to the pandemic.

Student loan delinquencies have been on the rise since the beginning of the year, after the government ended Biden's years-long payment freeze. 

As the charts below show, transition rates into serious delinquency, defined as 90 or more days past due, were largely stable for auto loans and credit cards (although both were elevated compared to previous years), edged up slightly for mortgages and HELOCs ... and absolutely exploded higher for student loans, as the share of student-loan debt entering serious delinquency was 12.9%, the highest in 21 years of data!

In fact, as one can clearly see there has never been such a catastrophic deterioration in student loan in US history across borrowers of virtually all ages, but especially those 50 and over!

The record surge in delinquencies suggests American households, especially those with student loans, are facing increasing financial distress this year amid high interest rates and a slowdown in hiring. Recent data showed consumer spending fell in the first six months of 2025, even before tariffs started to boost prices.

While transitions into delinquency is the start of the bankruptcy pipeline, the end is also getting busier, and about 131.000 consumers had a bankruptcy notation added to their credit reports in Q2, an increase from the previous quarter. Expect this number to explode once all those student loan delinquencies transition to defaults in a few months at which point the student loan crisis becomes front and center. 

The dramatic deterioration will be another factor forcing the Fed to cut rates in September. Last week, Fed chair Jerome Powell said of delinquency rates, “Essentially, you have a consumer that’s in good shape and is spending,” though admittedly “not at a rapid rate.” Actually, turns out the consumer - when it comes to student loans - is now broker than ever.

In a briefing with reporters, New York Fed researchers said student-loan delinquencies would likely continue to rise, eventually returning to pre-pandemic levels. Between late 2012 and early 2020, the share of student debt that was seriously delinquent ranged between 10.7% and 11.8%.

“This quarter’s flow of household debt into serious delinquency was mixed across debt types, with credit card and auto loans holding steady, student loans continuing to rise and mortgages edging up slightly,” Joelle Scally, an economic policy adviser at the New York Fed, said in a press release, underplaying the clearly catastrophic surge in student loan delinquencies, and soon, defaults which will result in tens of millions of consumers suddenly finding themselves carved out from the US consumer economy just as the student loan crisis goes front and center. 

Full New York Fed Household Credit slideshow can be found here.

https://www.zerohedge.com/markets/shocking-record-explosion-student-loan-delinquencies-marks-start-next-debt-crisis

'Dementia Diagnosis Takes an Average of 3 Years'

 The average time to diagnosis (TTD) of dementia was 3.5 years in a new meta-analysis, with younger age at onset and having frontotemporal dementia consistently associated with even longer diagnostic intervals.

METHODOLOGY:

• This systematic review and meta-analysis used data from 13 cohort studies published up to December 2024. More than 30,000 patients with a diagnosis of dementia were included, with the age at onset ranging between 54 and 93 years.
• TTD was defined as the interval between the onset of symptoms, rated by family carers or patients using interviews or medical records, and the final diagnosis.

TAKEAWAY:

• A meta-analysis of 10 studies showed the average TTD across all types of dementia was 3.5 years (95% CI, 2.7-4.3), with moderate-quality evidence.
• An analysis of six studies showed that the average TTD of young-onset dementia was 4.1 years (95% CI, 3.4-4.9), also with moderate-quality evidence.
• An analysis by dementia type showed consistently longer TTDs for young-onset Alzheimer’s disease (TTD, 4.0 years; 95% CI, 2.7-5.2) and frontotemporal dementia (TTD, 4.7 years; 95% CI, 3.0-6.4).
• In contrast, TTD in late-onset dementia was 2.9 years (95% CI, 2.6-3.2) in analysis of two studies.

IN PRACTICE:

“Timely diagnosis of dementia remains a major global challenge, shaped by a complex set of factors, and specific healthcare strategies are urgently needed to improve it,” lead investigator Vasiliki Orgeta, PhD, Division of Psychiatry, University College London, London, England, said in a press release.

“Clinician training is critical to improve early recognition and referral, along with access to early intervention and individualized support, so that people with dementia and their families can get the help they need,” Orgeta added.

SOURCE:

The study was published online on July 27 in International Journal of Geriatric Psychiatry.

LIMITATIONS:

Definitions of TTD varied across studies, with different methods used to assess the first symptoms of dementia. The current meta-analysis did not assess factors affecting TTD. Additionally, individuals with severe dementia may not have accurately remembered when they first experienced symptoms, potentially introducing a recall bias. The findings were also not applicable to low- and medium-income countries.

DISCLOSURES:

The investigators reported having no relevant conflicts of interest.

https://www.medscape.com/viewarticle/dementia-diagnosis-takes-average-3-years-new-data-2025a1000kr0

'Over Half of UK Gen Z Report Music-Linked Hearing Issues'

 With music festivals and concerts drawing crowds across the UK this summer, new data has revealed that more than half of people aged 18-28 — Gen Z — have experienced hearing problems linked to loud music.

A poll of 2000 young adults for the Royal National Institute for Deaf People (RNID) found that 58% of Gen Z respondents reported hearing loss, tinnitus, or both after attending festivals, gigs, or nightclubs. While most symptoms were temporary, the charity warned that repeated exposure could lead to permanent, preventable damage.

One in Three Adults Affected by Hearing Loss

According to the hearing loss charity, these problems currently affect around one in three adults in the UK — about 18 million people — while the British Academy of Audiology (BAA) said that hearing loss is the second most common disability in the UK, albeit an “invisible” one. 

Hearing loss has been linked with a range of mental health conditions including an increased risk of dementia and with physical conditions including diabetes, cardiovascular disease, anaemia, chronic kidney disease, rheumatoid arthritis, sleep apnoea, balance problems, and falls. 

It also affects employment rates and income. The BAA said hearing loss costs the UK economy £25-30 billion annually in lost productivity and unemployment, in addition to £1 billion spent by the NHS on hearing services.

Unsafe Listening Habits Among Young People

While most hearing loss occurs in people over 60, around 28% are aged between 16 and 60. Some have congenital issues or sequelae of childhood ear infections, but unsafe listening habits are increasingly recognised as a key factor.

Research from the Medical Research Council’s Institute of Hearing Research found that 18.8% of young people are exposed to music at levels harmful to hearing. Up to 80% of nightclub attendees experience temporary tinnitus.

Despite three-quarters of Gen Z respondents being aware of a risk of permanent hearing damage when exposed to noisy venues, 35% said they do not plan to wear hearing protection such as earplugs at live music events this year. 

‘We Need to Raise Awareness’

Franki Oliver, audiology manager at RNID, noted that live music events and nightclubs generally now provide free earplugs, while comfortable and reusable earplugs are readily available. “We need to raise awareness of this more among the general public,” he told Medscape News UK.

“There is growing concern that headphone use, both by over-ear headphones and in-ear buds, could risk permanent hearing damage, especially if people aren’t aware of the risks,” Oliver added. He highlighted recent research suggesting that gamers could be at increased risk of hearing loss and tinnitus due to headphone use. Also, people who wear headphones in the presence of background noise, such as during a noisy commute, could be increasing the volume to dangerous levels without realising. 

“Experts generally agree that 85 decibels is the level at which hearing damage can start, which is about the same as a food blender,” said Oliver. 

Risk of noise induced hearing damage is influenced by duration of exposure as well as intensity. At 85 dB, the ‘safe’ length of exposure is 8 hours over the course of a day, but sound intensity increases logarithmically, so the safe exposure time halves with every 3 dB increase. 

“By the time you’ve reached 100 dB — common in live venues and nightclubs, and even on some sections of the underground — the length of time you can be safely exposed is around 15 minutes,” Oliver said.

Changing Habits for Festival Goers 

The RNID survey also showed a potential for change among younger adults:

• 28% of respondents said they would protect their hearing if it didn’t affect their enjoyment of music
• 23% would do so if earplugs were more comfortable
• 22% would use protection if free earplugs were available at events

Oliver described these findings as “encouraging.”

The RNID recommends several steps to reduce the risk of hearing damage:

• Use earplugs: Specially designed music earplugs lower volume without distorting sound quality
• Avoid speaker proximity: Position yourself away from speakers at gigs or clubs
• Take breaks: For every hour of sound, rest your ears for at least 5 minutes
• Lower headphone volume: Keep it below 60%, especially in noisy settings
• Consider noise-cancelling headphones: These reduce the need to turn up the volume

Oliver said that GPs could play a greater role in prevention. “GPs could provide invaluable support in raising awareness of hearing protection through surgery posters or when talking to patients, especially those who are concerned about their hearing or tinnitus,” he said.

https://www.medscape.com/viewarticle/over-half-gen-z-report-music-linked-hearing-issues-2025a1000ks0

Tamiflu Findings Raise Questions About Drug Label Warning for Kids

 

• Compared with untreated flu, oseltamivir treatment reduced the risk of serious neuropsychiatric events in children.
• Prescribing information for oseltamivir carries warnings about abnormal behavior in kids with flu based on case reports.
• Concerns about possible side effects may contribute to oseltamivir being underused in kids at high risk for flu complications.

Treatment with the antiviral oseltamivir (Tamiflu) was tied to a reduced risk of serious neuropsychiatric events in children and adolescents, an analysis of Medicaid beneficiaries in Tennessee suggested.

Compared with untreated flu, the risk of serious neuropsychiatric events was lower in kids treated with oseltamivir during flu exposure periods (adjusted incidence rate ratio [IRR] 0.53, 95% CI 0.33-0.88) and post-treatment periods (adjusted IRR 0.42, 95% CI 0.24-0.74), reported James Antoon, MD, PhD, MPH, of Vanderbilt University Medical Center in Nashville, Tennessee and colleagues.

Relative risks of neuropsychiatric events also were low during periods with neither flu exposure nor oseltamivir dispensing (adjusted IRR 0.08, 95% CI 0.06-0.11) and during oseltamivir prophylaxis periods (adjusted IRR 0.10, 95% CI 0.03-0.32) compared with untreated flu, the researchers wrote in JAMA Neurologyopens in a new tab or window.

"Influenza antivirals are safe and effective and should be used as early as possible during influenza illness. Yet, they are substantially underused, especially in children," Antoon said.

"Almost 40% of children at high risk for influenza complications do not receive antiviral treatment. One important reason for this is concern about possible neuropsychiatric side effects," he told MedPage Today.

"We found that influenza itself, rather than oseltamivir, is associated with neuropsychiatric events," Antoon stated. "In fact, oseltamivir treatment lowered the risk of neuropsychiatric events in children by about 50%."

The findings raise questions about warnings on oseltamivir's label. Postmarketing surveillanceopens in a new tab or window in 2005 suggested an increase in serious neuropsychiatric events among children using oseltamivir, prompting the FDA to change oseltamivir's warning label, Antoon and colleagues noted. Prescribing informationopens in a new tab or window for oseltamivir now states that some flu patients who receive the drug, particularly pediatric patients, may be at an increased risk of confusion or abnormal behavior early in their illness.

"It is important to note that these warnings were placed on the basis of case reports rather than studies on associated risks for these events," Antoon and co-authors wrote.

The CDCopens in a new tab or window and the American Academy of Pediatricsopens in a new tab or window recommend antiviral treatment with drugs like oseltamivir for children with suspected or confirmed influenza who are hospitalized or have severe or progressive disease, or those who have underlying conditions that increase their risk of complications.

In their analysis, Antoon and colleagues studied children ages 5 to 17 years who were enrolled in Tennessee Medicaid during the 2016 to 2017 and 2019 to 2020 flu seasons.

The primary outcome was a neuropsychiatric event requiring hospitalization. The primary comparison for the study was treated flu versus untreated flu.

Each person-day of follow-up was assigned to one of five mutually exclusive exposure groups: (1) untreated flu, (2) treated flu, (3) post-treatment period (between oseltamivir completion and end of flu period), (4) flu prophylaxis, and (5) no exposure.

The cohort included 692,295 children (median age 11 years and 50.3% girls) who experienced 1,230 serious neuropsychiatric events during 19,688,320 person-weeks of follow-up. Clinical characteristics were generally similar across exposure groups.

There were 129,134 children and 151,401 flu episodes. Among kids with a flu episode, 66.7% were dispensed oseltamivir; most were dispensed the drug the same day as their flu diagnosis. Among children at high risk for flu complications, 60.1% received an antiviral.

Overall, the most common serious neuropsychiatric events in the study were mood disorders (36.3%) and suicidal or self-harm behaviors (34.2%), followed by seizures (13.7%). Seizures (34.1%) were the most common events during flu exposure periods.

Secondary analyses suggested the study's findings were driven more by a reduction in neurologic events (adjusted IRR 0.45, 95% CI 0.25-0.83) than psychiatric events (adjusted IRR 0.80, 95% CI 0.34-1.88) among oseltamivir-treated children.

The analysis did not account for influenza strain or vaccination status, which are not reliably captured in databases, the researchers acknowledged.

The study focused on neuropsychiatric events that required hospitalization, they added. Findings might not apply to children outside of Tennessee's pediatric Medicaid population.

Disclosures

Researchers were supported by the National Institute for Allergy and Infectious Diseases and the National Institute of Child Health and Human Development of the NIH.

Antoon reported personal fees from serving on an AstraZeneca Scientific Advisory Board during the conduct of the study.

Co-authors reported grants from the NIH, the Agency for Healthcare Research and Quality (AHRQ), GSK Merck, Syneos Health, the CDC, and the FDA.

Primary Source

JAMA Neurology

Source Reference: opens in a new tab or windowAntoon JW, et al "Influenza with and without oseltamivir treatment and neuropsychiatric events among children and adolescents" JAMA Neurol 2025; DOI: 10.1001/jamaneurol.2025.1995.

https://www.medpagetoday.com/neurology/generalneurology/116827

Menopause Hormone Therapy Still Divides Physicians

 Rachel Weinerman, MD, a reproductive endocrinologist at Case Western Reserve University and University Hospitals in Cleveland, explains why menopause hormone therapy remains controversial more than 20 years after the landmark Women's Health Initiative (WHI) trial.

She discusses what clinicians have learned about hormone replacement therapy since then, which patients may benefit the most, and how different formulations may alter the risk-benefit balance.

Menopause hormone therapy, or hormone replacement therapy, is essentially a way to give women a combination of either estrogen and progestin or some sort of progestin activity, it's called progesterone, or estrogen alone, depending on whether or not she has a uterus. And the goal is to alleviate the symptoms that occur during menopause when a woman's ovaries stop producing the hormones estrogen and progesterone.

That time period actually could be a while. It could be 5 to 10 years. The hormones are fluctuating as the ovaries stop producing those hormones, and that can cause very bothersome symptoms. So giving back the hormones that the ovary naturally produces -- specifically estrogen and progesterone -- can alleviate those symptoms. And that really was a prevailing view for many, many years in the healthcare community, that we should be giving women hormone replacement therapy. It helps them feel better, and it probably would help them long-term, and that's what smaller studies showed.

However, the Women's Health Initiative study was a large randomized controlled trial, and that demonstrated that giving women hormonal replacement therapy did not help prevent some of the long-term outcomes like cardiovascular disease problems, but it did increase the risk of breast cancer. So for that reason, the trial actually was stopped earlier than planned. And once that was published, many physicians and patients totally turned around and said, "Wait a second, we shouldn't be giving this hormone therapy to women because it's dangerous."

In the 20 years since that study has come out, we have learned a lot. Age matters and indication matters. So in that study, women were started on hormone replacement therapy at all ages, and what we've since learned is that women who start hormone replacement therapy under the age of 60 or within 10 years from the onset of menopause, have a much more favorable risk-to-benefit profile.

The other thing that we learned is that the reason for starting hormone replacement therapy, or the indication, matters. So for women who start hormone replacement therapy because they have significant symptoms like hot flashes or vaginal dryness, that actually is more beneficial than women who are starting it in an attempt to prevent the long-term complications of having low estrogen.

The formulations that we used have also changed. In that study, the estrogen that was used is actually something called Premarin [conjugated estrogens]. It was an estrogen that we had at the time, and we still have, but it's not a hormone that is naturally produced by women. It was actually a combination of horse estrogens. And the progestin that we used in that study was a synthetic progesterone that we call a progestin. And there were some health risks that were found with that combination.

Now we use what's called bioidentical hormone, so we use a combination of estradiol -- it's the same hormone that's naturally produced by women's ovaries -- and natural progesterone. Those hormone combinations may be more similar to what's actually produced by women's ovaries and may give different health risks. And that combination has not been studied as significantly as the WHI.

So the WHI is still a very important study that should guide treatment going forward. One of the most important things that we learned from the WHI study is that it's not so clear-cut that giving estrogen therapy or a combination of estrogen and a progestin therapy to women is always going to be beneficial. There are definite risks that come from giving hormone replacement therapy, specifically for women who have a high risk of breast cancer. We see that in that study, a combination of estrogen and progestin increased the risk of breast cancer. So for women who have risks, it may not be the best therapy for them.

Additionally, it didn't improve cardiovascular health in the way that we expected. So what we have learned from that study is that we should be careful about who we give hormone replacement therapy to. It is indicated for many women, but not all. And I think the enduring lesson of the WHI study is that menopause hormone therapy can be a very effective and important treatment for women, but it has to be an individualized decision between a woman and her physician based on her own specific needs and risk factors.

There's a difference in safety between what we call systemic hormone therapy and vaginal or local hormone therapy. So we can give very low-dose estrogen therapy to women vaginally, and that can help relieve many of the symptoms that come from low estrogen, specifically sexual dysfunction and vaginal atrophy that can lead to painful urination and painful intercourse. And we can give that therapy very safely, even to women who don't want to take on the risks of having what we call systemic hormone therapy, which is higher-dose hormone therapy that they would take either by mouth or by a skin patch.

It is a very important topic. All women are going to experience menopause at some point in their lives, and it's a problem that I'm happy is coming to the forefront of our conversation, and I really hope that we can improve the lives and health of women going forward.

https://www.medpagetoday.com/obgyn/hrt/116842

'Screen Every Adult for Unhealthy Alcohol Use, USPSTF Says'

 

• Unhealthy alcohol use is a leading cause of death and serious illness among U.S. adults.
• In new draft guidance, the USPSTF reaffirmed that all adults should be screened for unhealthy alcohol use, and recommended brief behavioral counseling interventions when appropriate.
• The task force found insufficient evidence to make the same recommendation in adolescents.

In updated draft guidance, the U.S. Preventive Services Task Force (USPSTF) said that all adults should be screened for unhealthy alcohol use in primary care settings, recommendationsopens in a new tab or window that align with those from 2018.

For adults who screen positive for "risky or hazardous drinking," the task force recommended brief behavioral counseling interventions -- a grade Bopens in a new tab or window recommendation, based on moderate net benefit.

"Unhealthy alcohol use is really a major cause of death and serious illness in this country, and we can reduce that risk by asking adults about their drinking and providing brief counseling," James Stevermer, MD, MSPH, a member of the USPSTF, told MedPage Today.

HHS and the Department of Agriculture define moderate drinking as no more than two drinks per day for men and no more than one drink per day for women. Unhealthy alcohol use reflects "a spectrum of behavior from risky drinking to alcohol use disorder," the task force noted.

Unhealthy alcohol use is a leading cause of preventable death in adults.

In recent years, alcohol-related organ complications,opens in a new tab or window including pancreatitis and liver diseaseopens in a new tab or window, have grown, particularly among young adults and teenagers. Rates of alcohol-induced liver disease-related hospitalizations and liver transplantsopens in a new tab or window have also surged over the last two decades, with a concerning rise among younger adults, especially women.

According to an analysis from the Lancet Commission, at least 60% of liver cancersopens in a new tab or window globally could be prevented with control of certain risk factors, with alcohol use responsible for roughly 20%.

The USPSTF made no recommendations for or against screening and counseling among adolescents ages 12 to 17, pointing to insufficient evidence of benefits versus harms (I statement). Specifically, there was inadequate evidence that screening instruments can detect unhealthy alcohol use, and that counseling interventions were tied to reduced alcohol use.

As a family physician in rural Missouri, Stevermer said, "I have plenty to do when I see patients, and I want to spend my time where there's evidence that it's beneficial."

As new research emerges, Stevermer said he hopes the task force will be able to make a different recommendation for adolescents in its next review.

"In the absence of evidence, healthcare professionals should use their judgment when determining whether or not to screen their teen patients," task force member John Ruiz, PhD, said in a statement.

While alcohol-related deaths are typically due to the "health effects of chronic excessive use" (heart disease, cancer, and liver disease), alcohol-related injuries also represent a "significant cause of loss of life," especially among young adults, the task force said.

The USPSTF called for more studies on the effectiveness of interventions to reduce unhealthy alcohol use in adolescents and adults, and on the accuracy of the U.S. Alcohol Use Disorders Identification Test (USAUDIT) and the USAUDIT-Consumption.

The recommendations for adults, including pregnant persons, were based on the following criteria:

• Adequate evidence that current screening instruments can detect unhealthy alcohol use
• Convincing evidence that the recommended interventions are linked to reduced unhealthy alcohol use and epidemiological evidence that such reductions lower the risk of mortality and morbidity
• Adequate evidence that the harms of interventions are "no greater than small"
• Inadequate evidence regarding the harms of screening

The recommendations do not apply to adults previously diagnosed with unhealthy alcohol use or those who seek evaluation or treatment for such use.

The USPSTF warned that consuming alcohol while pregnant can lead to fetal alcohol spectrum disorders and other adverse birth outcomes, and that starting to drink alcohol at younger ages as the brain is still developing "may contribute to an increased risk of unhealthy alcohol use."

The task force's evidence reviewopens in a new tab or window highlighted 79 trials, involving more than 40,000 participants. In pooled analyses, those participating in interventions to reduce unhealthy alcohol use reduced alcohol consumption by an average of 1.6 drinks per week more than those in control groups.

The USPSTF also reviewed 13 studies of 12 screening instruments used among adolescents, and noted adequate evidence for detecting alcohol use disorder, but the screening tools for unhealthy alcohol use were "limited in quantity with lower sensitivity and specificity measures."

Across four U.S.-based trials in adolescents that assessed the benefits of counseling to reduce unhealthy alcohol use in the primary care setting, three did not demonstrate statistical significance.

The American Academy of Pediatrics recommends universal screening for substance use,opens in a new tab or window including alcohol useopens in a new tab or window, among adolescents as part of routine healthcare.

The recommendations will be open for public commentopens in a new tab or window until Sept. 2.

https://www.medpagetoday.com/primarycare/preventivecare/116829