Deb's Daily Dose

Prescription Drug Ads: AMA Calls for a Ban

November 27th, 2015 by Deb Wilson

Drug CostsThe American Medical Association (AMA) has taken the stand that “direct-to-consumer advertising for prescription drugs and devices drives up health care costs and should be banned”.

Currently, ads for drugs to treat diabetes, depression, impotence and more deluge TV viewers. This drives demand for expensive treatments, the nation’s most influential doctor group said when it adopted the new policy.  “Today’s vote in support of an advertising ban reflects concerns among physicians about the negative impact of commercially driven promotions, and the role that marketing costs play in fueling escalating drug prices,” Dr. Patrice Harris, the association board chair-elect, said in an AMA news release. …

Hoping to make prescription drugs and medical devices more affordable, the new policy also calls for a physician task force to study the issue, a campaign to demand choice and competition in the drug industry, and greater transparency in prescription drug prices and costs.  The United States and New Zealand are the only countries that permit direct-to-consumer ads for prescription drugs, according to the AMA.

Leading Doctors’ Group Wants to Ban Prescription Drug Ads

This is another “it’s about time” issue for me.  Consumers need unbiased, fact based information about new drugs and devices to help drive their medical decisions, not profit driven commercial advertising.  However, I’m not holding my breath considering the size of the pharmaceutical industry and the power of their lobbyists.  Although, we did manage to get cigarette commercials off the airwaves,  so perhaps there is some hope.

Birth Control Pills: Two States Allowing Pharmacists to Prescribe

November 26th, 2015 by Deb Wilson

PharmacistThe states of Oregon and California have new laws that will make access to birth control a whole lot easier for women when it become legal to obtain contraceptives from their pharmacist without a doctor’s prescription.

Even as the Supreme Court prepares to consider another divisive case involving access to contraception, public health advocates hope these arrangements could spread across the country, as states grappling with persistently high rates of unintended pregnancy seek to increase access to birth control with measures that so far have been unavailable under federal law.

Most Western countries require a doctor’s prescription for hormonal contraceptives like pills, patches and rings, but starting sometime in the next few months, women in California and Oregon will be able to obtain these types of birth control by getting a prescription directly from the pharmacist who dispenses them, a more convenient and potentially less expensive option than going to the doctor. Pharmacists will be authorized to prescribe contraceptives after a quick screening process in which women fill out a questionnaire about their health and medical histories. The contraceptives will be covered by insurance, as they are now.

The laws are the latest effort to make birth control more accessible, a longstanding goal of medical professionals and policy makers. But unlike other recent debates over contraception — including the firestorm over the Obama administration’s requirement under the Affordable Care Act that all health plans pay for contraceptives — these legislative efforts have been largely free of political rancor.

“I feel strongly that this is what’s best for women’s health in the 21st century, and I also feel it will have repercussions for decreasing poverty because one of the key things for women in poverty is unintended pregnancy,” said State Representative Knute Buehler, a Republican who sponsored Oregon’s [l]aw.

Advocates of this approach, including pharmacists’ organizations, plan to lobby for it across the country. “We are actively going to come up with a statute to spread to other states, and I think it can spread pretty quickly,” said Mr. Buehler, the Oregon legislator, who is also an orthopedist. Pharmacy board representatives from states including Arizona and Idaho observed a recent meeting in Oregon about the new rules.  A New Mexico proposal that failed in 2012 is expected to be revised to reflect the Oregon and California measures, said Dale Tinker, the executive director of the New Mexico Pharmacists Association.

…Many reproductive health experts have come to support pharmacist-prescribed contraceptives, persuaded that pharmacists can safely dispense contraception without a doctor’s prescription and that women can assess their health risks on questionnaires.  “There’s a growing body of evidence that there isn’t a safety concern,” said Dr. Daniel Grossman, vice president for research at Ibis Reproductive Health and a professor of obstetrics and gynecology at the University of California, San Francisco. “There are studies showing that women can really accurately identify the conditions that make it appropriate to use certain contraceptives, using a simple checklist.”

The new laws are extensions of arrangements now found in almost every state: collaborative practice laws that allow pharmacists to administer vaccines or prescribe certain medications if they have agreements with physicians or other health providers. The laws vary widely, and some include only specific diseases or drugs. But in some places, like Washington State and Washington, D.C., collaborative practice laws are broad enough for pharmacists to prescribe birth control if their physician agreements permit it.

The laws in Oregon and California differ in some ways. California’s has no age restriction; the Oregon law requires that teenagers under 18 obtain their first contraceptive prescription from a doctor. In California, pharmacists will also most likely have to take women’s blood pressure for contraceptives containing estrogen.

States Lead Effort to Let Pharmacists Prescribe Birth Control

Interesting.

End of Life Discussion: Now a Medicare Covered Expense

November 25th, 2015 by Deb Wilson

Doc_Patient Consultation2It’s taken 6 years, but Medicare has finally incorporated payment to doctors for end of life discussions.

What changed this time around? “The apprehension and concern has slowly ebbed as public support got stronger,” Mr. Blumenauer said. “And some of the people making the most outrageous charges have gone on to make outrageous charges about other things.”  Public support does appear strong. The federal Centers for Medicare and Medicaid Services received hundreds of comments this fall on its proposed rule, a spokesman told me; the great majority felt the agency should pay doctors to confer with patients about the end of life.

… In a survey of 1,200 adults in September, more than 80 percent said Medicare should cover doctor-patient discussions of end-of-life treatment. A similar majority thought private insurers should, too.  The poll also demonstrated how rarely these conversations take place. Fewer than one in five respondents reported actually having had such a discussion with a health care provider, including only about a third of those over age 75 and about a third of those with a debilitating disability or chronic medical condition.

Any emergency room physician or intensive care unit social worker can tell harrowing tales of frantically trying to locate a relative, a neighbor, a document — any clue to what an incapacitated older adult wants when she can’t speak for herself.  Medicare reimbursement, alas, will not magically solve that problem. A lot has to happen first.

Somehow patients must learn that they can have extended discussions about life and death decisions with a doctor if they want to. … Somehow, too, doctors must learn how to broach and explore very tender subjects. The prospect makes them hesitant and anxious, said Dr. Diane Meier, who leads the Center to Advance Palliative Care at Mount Sinai Hospital in New York.  “The great majority of providers allowed to use these new codes have had no training in effective communication about what’s most important to people with a serious illness,” Dr. Meier said. “People are not born knowing how to have these conversations any more than they’re born knowing how to do an appendectomy.”

End of ‘Death Panels’ Myth Brings New End-of-Life Challenges

It’s about time.  Next steps will be to get doctors the training that they need, and find ways to efficiently and effectively store and access Advance Medical Directives so that they are available if, and when, they are needed!

Blood Sugar Control: People Are Individuals

November 24th, 2015 by Deb Wilson

DiabetesInteresting study from researcher Dr. Eran Elinav, a senior scientist at the Weizmann Institute of Science, in Israel.  Have you noticed that eating certain foods make your blood sugar spike but have no effect on others eating the same foods?  Another component of personalized medicine came to light as a result of the study.

A new study from Israel suggests that people have very different blood sugar responses to the same food — with some showing large spikes even after eating supposedly healthy choices.  Researchers said the findings, published in the Nov. 19 issue of the journal Cell, underscore the message that there is no “one-size-fits-all” diet.  The investigators also suggested that carefully tailoring diets to meet individuals’ blood sugar tendencies could be the wave of the future.

The new study focused largely on people’s blood sugar levels two hours after eating a meal — also known as the post-prandial glucose response.  Research has linked habitually high after-meal glucose responses to increased risks of obesity, type 2 diabetes and other health problems, said co-researcher Eran Segal, who is also a scientist at Weizmann.  That’s the premise behind so-called low-GI diets, which tell people to shun foods that tend to trigger a large increase in blood sugar. The list of bad guys includes white bread, potatoes, instant oatmeal and certain fruits.

But in the current study, a number of surprises emerged, Segal said.  “We saw vast variability (in blood sugar responses) when we gave people identical meals,” he said.  “With bread, some people showed almost no change in glucose, while others showed a large response,” he said. “Some had higher responses to bread with butter than to bread alone.”  That, Segal pointed out, goes against the conventional wisdom that adding fat to a simple carbohydrate reliably reins in the blood sugar response.

The findings are based on 800 Israeli adults who gave detailed information on their diet, lifestyle and medical history. Over one week, they used a smartphone app to record all of their daily activities, including the food they ate, while glucose monitors kept track of their post-meal blood sugar changes.  Each participant also gave a stool sample so the researchers could analyze their gut “microbiome” — the collection of bacteria that reside in the digestive system. Recent research has been suggesting that the makeup of that microbiome may play an important role in a person’s risk of obesity and health conditions such as diabetes.  For the most part, study participants ate their normal meals, but the researchers did give them identical breakfasts so they could compare people’s responses to the same meal following a fast.  Overall, there was “immense” variation in blood sugar responses to particular foods, depending on the person, according to Segal. In one woman’s case, for instance, the researchers suspect that tomatoes were a major culprit behind her blood sugar surges.  That’s based on the fact that tomatoes were part of every meal that caused her blood sugar to soar, Segal explained. …

Foods May Affect Each Person’s Blood Sugar Differently, Study Suggests

As you might suspect, not everyone agrees with  Dr. Elinav’s findings.  “A dietitian who reviewed the study expressed doubt about how useful this information might prove, however.  For one, designing your diet based on short-term blood sugar responses does not ensure that it’s “healthy,” said Lauri Wright, an assistant professor of community and family health at the University of South Florida, in Tampa.  “I’d be concerned about it meeting a person’s nutritional needs,” said Wright, who is also a spokesperson for the Academy of Nutrition and Dietetics.”  Still, it is interesting.

Reversing Drug Overdose: FDA Approval Received for Narcan

November 23rd, 2015 by Deb Wilson

drugsThe U.S. Food and Drug Administration (FDA) has announced approval of a nasal spray that treats narcotic painkiller and heroin drug overdoses.

The newly approved nasal spray (Narcan) contains the medication naloxone hydrochloride, which can stop or reverse the effects of a narcotic (also called opioid) drug overdose. Narcan is the first approved nasal spray version of the medication and offers an important new easy-to-use treatment option for family members and first responders dealing with a heroin or narcotic painkiller overdose, the FDA said.

Narcotic painkillers include prescription pain drugs such as oxycodone (OxyContin), hydrocodone (when combined with acetaminophen, it’s called Vicodin or Percocet) and morphine. Narcan can also reverse the effects of heroin.

Drug overdose deaths are currently the leading cause of injury death in the United States, the FDA said. Every day, 44 Americans die from a prescription narcotic painkiller overdose, according to the U.S. Centers for Disease Control and Prevention.

In narcotic painkiller and heroin overdoses, it can be difficult to awaken the person. Breathing may become shallow or stop, resulting in death if there is no medical help. When administered quickly, naloxone can counter the overdose effects, usually within two minutes, according to the FDA.

Previously, naloxone was only approved in injectable forms, such as syringes or auto-injectors. However, there was widespread use of unapproved kits that enabled the drug to be delivered nasally. …Clinical trials showed that spraying Narcan in one nostril delivered about the same or higher levels of naloxone as a single dose of a naloxone injection. The drug can be given to adults or children, the FDA said.

FDA Approves Nasal Spray to Reverse Narcotic Painkiller Overdose

The FDA cautioned that Narcan is not a substitute for obtaining immediate medical treatment when an overdose occurs, but rather a mechanism to keep the individual alive long enough to receive the appropriate care.  While it is blessing to have the ability to reduce the number of deaths from drug overdoses, the biggest challenge remains to find ways to keep an overdose from happening in the first place via better mental health benefits.

Medication: Mistakes Prevalent in Surgeries

November 7th, 2015 by Deb Wilson

surgical teamSo today’s scary thought comes from a project within Boston-based Massachusetts General Hospital that sought to quantify and address drug-error risk during surgery.  According to their research, medication errors are seen in 50% of surgeries, with 80% of them likely preventable.

In a new study on how often medication errors occur during surgery, researchers report that mistakes were made during almost half of the operations they analyzed.  The mistakes included drug labeling errors, incorrect dosing, drug documentation mistakes, and/or failing to properly treat changes in a patient’s vital signs during surgery.

Overall, a medication error or adverse drug event was documented in 124 of 277 surgeries. Of the 3,675 medication administrations (most patients receive more than one drug during surgery), 193 medication errors and adverse drug events were recorded, the Harvard researchers said. And almost 80 percent of those events were determined to have been preventable.

The study authors noted that rigorous safety checks commonly in place across many hospital settings are often loosened or bypassed in the surgical environment, when fast-moving events and changing circumstances can require quick decisions and immediate action.  With that in mind, the investigators focused on operations performed at Massachusetts General over seven months in 2013 and 2014.All drugs and drug errors were recorded (or gleaned from medical charts) covering the time a patient entered a pre-operative area until they were out of surgery and in either a recovery room or an intensive care unit.

The result: more than 5 percent of the time, drugs were given in error or negative drug events were observed.

Two-thirds of the drug errors were categorized as “serious,” while 2 percent were considered life-threatening (though none of the patients died as a result). The remaining errors were considered “significant.” …

Medication Errors Seen in Half of All Operations in Study

As Dr. David Katz, director of the Yale University Prevention Research Center in New Haven, CT, comments in the article: “awareness of problems is where all solutions begin.”

 

 

Mammogram Guidelines: New Controversy

November 2nd, 2015 by Deb Wilson

Breast Cancer MythsGuidelines for when and how often to get a mammogram screening seems to be the most regularly appearing controversy in the medical industry.  Once again, the American Cancer Society has made adjustments to their guidelines that are not expected to be popular.  The new guidelines suggest that routine mammograms do not need to start until age 45 rather than age 40.

…Under the new guidelines, the American Cancer Society recommends that women 45 to 54 receive annual mammography screening, and at age 55 switch to screening every other year.

Women 40 to 44 should discuss mammography with their doctor, and exercise the option of starting annual screening based on their risk factors or personal preferences, the new guidelines state.

The guidelines were changed to reflect new data that indicate that the average risk of breast cancer increases as a woman nears menopause, according to the cancer society.

“We found that women who are 45 to 49 are very similar to women 50 to 54 with respect to the burden of cancer, the risk of dying from cancer and the reduction in mortality from mammography,” Oeffinger [lead author of the new guidelines, family physician Dr. Kevin Oeffinger at Memorial Sloan Kettering Cancer Center] said. “That helped us in our thought process. We felt the evidence is very clear.”

The new guidelines, published Oct. 20 in the Journal of the American Medical Association, present mammography for women 40 to 44 as an option or an opportunity, rather than a required screening.

“Some women will value the potential early detection benefit and will be willing to accept the risk of additional testing and will thus choose to begin screening earlier,” the ACS guidelines committee wrote in its report. “Other women will choose to defer beginning screening, based on the relatively lower risk of breast cancer.”

The new cancer society guidelines are closer to those of the U.S. Preventive Services Task Force (USPSTF), which is the nation’s leading panel of experts in preventive medicine.

The USPSTF received some criticism back in 2009 when it recommended that most healthy women without increased breast cancer risk wait until age 50 to begin mammography, and then undergo the procedure every other year. …

New Mammogram Guidelines Already Creating Controversy

While the guidelines do include an option for women under age 45 to start annual screening, the big question will be whether insurance companies will continue to cover the expense.  While the report states that “health insurers should cover all mammograms, regardless of the age of the patient or the frequency of the screening” it will be interesting to see if the insurance industry agrees.

 

Memory Blanks: Don’t Think of It As Getting Old

October 30th, 2015 by Deb Wilson

????????????????????????????????????????????????????????????????????????????????????????????????I have good news for those of us who have reached a point in life where retaining information becomes just a bit more difficult.  It’s not an “aging” thing, it’s our brain conserving energy.  Yep, according to Swedish researchers, we’re not getting old, just more energy efficient!

Our brains not only contain learning mechanisms but also forgetting mechanisms that erase “unnecessary” learning. A research group at Lund University in Sweden has now been able to describe one of these mechanisms at the cellular level.

The premise is that human or animal subjects can learn to associate a certain tone or light signal with a puff of air to the eye. The air puff makes the subject blink, and eventually they blink as soon as they hear the tone or see the light signal. The strange thing, however, is that if the tone and the light are presented together (and with the air puff), the learning does not improve, but gets worse.  “Two stimuli therefore achieve worse results than just one. It seems contrary to common sense, but we believe that the reason for it is that the brain wants to save energy”, says brain researcher and professor Germund Hesslow.

His colleague Anders Rasmussen, who performed the present study, has previously shown that when the brain has learnt a particular association sufficiently, certain neurons that act as a brake on the learning mechanism, are activated.

“You could say that the part of the brain that learned the association (a part of the brain called the cerebellum) is telling its ‘teacher’: ‘I know this now, please be quiet’. When the brain has learnt two associations, the brake becomes much more powerful. That is why it results in forgetting, usually only temporarily, however”, explains Germund Hesslow.

Maintaining unnecessary association pathways requires energy for the brain. The researchers believe that this is the reason for the brake mechanism – even though in this case it happened to be a little too powerful.

The Lund researchers were able to describe how the nerve cells learn and forget through studies of animals, but believe that the mechanisms are likely to be the same in the human brain. Therefore, these findings are of fundamental interest for both brain researchers and psychologists. They could also be of practical interest to educators.

“Obviously, it should be important for teachers to know the mechanisms by which the brain erases the things it considers unnecessary. You do not want to accidentally activate these mechanisms”, says Germund Hesslow.

The brain forgets in order to conserve energy

Yep, energy efficient I am!  That’s my story and I’m sticking to it!

Dislocated Shoulder: Is Surgery Really Necessary?

October 29th, 2015 by Deb Wilson

surgeryOne of the more common injuries among athletes, especially within contact sports, is a dislocated shoulder.  And the traditional treatment plan includes surgery.  A recent study out of St. Michael’s Hospital in Toronto,  suggests that surgery may not actually be necessary for the injury to heal well.

A common shoulder injury that is usually repaired with surgery can heal just as well with nonsurgical treatment, a new study suggests.  And, the researchers added, those who decide against surgery for a dislocated shoulder joint develop fewer complications and get back to work sooner. But, surgery patients seem more satisfied with the appearance of their shoulder after treatment. …

…[T]he study’s authors assigned 83 people with moderate to severe AC joint dislocations to either undergo surgery and rehabilitation or receive nonsurgical treatment with a sling and rehab.  The participants were followed for two years. The researchers kept track of their complications, level of disability and satisfaction with their shoulder’s appearance.

The study, published Oct. 22 in the Journal of Orthopaedic Trauma, found that patients treated without surgery could move their shoulders better than those who had surgery at follow-up sessions six weeks and three months after their injury.  After six months, researchers found no major differences between the two groups.

“Three months after the initial injury, more than 75 percent of the patients who did not have AC joint surgical repair were able to return to work, whereas only 43 percent of those who underwent surgery were back at work,” McKee [study author, Dr. Michael McKee, an orthopedic surgeon at St. Michael’s Hospital].

Of 40 patients who had surgery, seven developed major complications such as a loose plate or a deep wound infection. Seven others, meanwhile, experienced minor infection, numbness at the point of the incision or another minor complication.

In contrast, of the 43 patients treated with a sling and rehabilitation, only two had major complications, the study found. Both were the result of a repeat injury.

Surgical patients, however, were more satisfied with the appearance of their shoulder after treatment. Only 5 percent of the surgical patients were unhappy with their appearance a year after treatment, compared to 16 percent of nonsurgical patients. After two years, the difference was even greater, with 21 percent of nonsurgical patients dissatisfied compared to 4 percent of those who had surgery. …

Common Shoulder Injury Heals Well Without Surgery: Study

While surgery may lead to a better cosmetic result, it certainly appears that recovery time, expense and risk of complication can be saved with the non-surgical alternative.

 

Warts: Dermatologist Offers Tips

October 28th, 2015 by Deb Wilson

???????????????????????????????????????????????????????????????????????With Halloween just around the corner, this seemed to be a great topic to share.  No one likes to think about getting warts, or talk about them when they appear, but they do need to be addressed if one “pops up”.  As a kid I got one on my hand and to this day I still have the scar that came from letting it get too big before seeking treatment (not to mention the fact that treatment “back then” including burning them off with what I remember to be a “blow torch”).  Fortunately we have Dr. Adam Friedman, an associate professor of dermatology at the George Washington School of Medicine and Health Sciences, to offer some better guidance on how to treat them.

“Warts are caused by a virus, and the virus can sometimes spread from one place on your body to another or from person to person,” Friedman said in an American Academy of Dermatology (AAD) news release.  “However, each person’s immune system responds to the wart virus differently, so not everyone who comes in contact with the virus develops warts,” he added.

There are ways to prevent warts from spreading. Don’t pick or scratch your warts, and don’t touch someone else’s wart. Wash your hands after treating warts, Friedman advised.  Another way to help prevent the spread of warts is to wear flip-flops in public showers and pool areas. It’s also important to keep warts on your feet dry, because moisture helps warts spread, according to the AAD.

Most warts go away without treatment within two years, but there are home treatments that can help get rid of them sooner, Friedman said.  One method is to use an over-the-counter wart treatment product with salicylic acid. Before using the product, soak the wart in warm water and then sand the wart with a disposable emery board. Be aware that it can take several months to see good results, Friedman said.

Duct tape is another option. Cover the wart with duct tape and change the tape every few days. Doing so may peel away layers of the wart-affected skin and trigger the immune system to fight the wart, according to Friedman.

Before applying duct tape, soak the wart in warm water, and then sand it with a disposable emery board. Remove and reapply duct tape every five to six days until the wart is gone, he suggested.

Consult a dermatologist if the skin around your wart is raw or bleeding; you can’t get rid of your wart; your wart hurts, itches or burns; you have many warts; you have a wart on your face or genitals; or you have a skin growth and unsure if it’s a wart, because some skin cancers can look like a wart, Friedman said.

Dermatologist Offers Tips for Dealing With Warts

Good advice.  Where was Dr. Friedman when I needed him 🙂