Friday, March 31, 2017

Many Doctors Get Payments from Drug Companies

Researchers surveyed 3,500 adult patients and then checked on their doctors in Open Payments, a government website that reports drug and medical device company payments to physicians.

The study found that within the previous year, 65% of patients visited doctors who got payments or gifts from drug or medical device companies, but only 5% of the patients were aware of those doctor-industry links.

Patients who visited certain types of specialists were even more likely to have seen a doctor who had been paid. For example, the rates were 85% among patients who saw an orthopedic surgeon and 77% among patients who saw an obstetrician or gynecologist.

The study was published recently in the Journal of General Internal Medicine.

“Patients should be aware of the incentives that their physicians face that may lead them to not always act in their patients’ best interest. And the more informed patients are about their providers and options for care, the better decisions they can make,” said study author Genevieve Pham-Kanter, an assistant professor in Drexel University’s Dornsife School of Public Health in Philadelphia.

Study co-author Michelle Mello said, “Drug companies have long known that even small gifts to physicians can be influential, and research validates the notion that they tend to induce feelings of reciprocity.” Mello is a professor of law and health research and policy at Stanford University in Stanford, Calif.

The Open Payments data showed that the average amount received in drug and medical device company payments and gifts by doctors was $193. But when the researchers focused only on the doctors visited by patients in the survey, the median payment amount over the last year was $510, more than 2.5 times the national average.

Wednesday, March 29, 2017

Bioidentical Hormones

Two weeks ago I attended a seminar on hormones in the aging male and female. The use of ‘bioidentical hormones” came up repeatedly. There is a lot of misinformation about this therapy, especially on the internet. So I thought I would address some of the confusion.

‘Bioidentical hormones’ are derived from steroidal phytochemicals in plants. For example, chemical extracts from wild yam can be converted in a laboratory into progesterone. Although they are created in a lab, they are structurally identical to human hormones.

However, ‘bioidentical hormones’ can cause wide-spread side effects unless used appropriately and monitored correctly.

Synthetic hormones are very different from ‘bioidentical hormones’ as they are patentable compounds that mimic human hormones but are not structurally identical. Therefore the side effects are more pronounced, including the risk of cancer.

Bioidentical estrogen and progesterone are often added to skin care products. As long as they are less than 3% of the total product, they do not have to be listed as an ingredient. They both attract water to the skin to create soft, smooth and wrinkle-free skin.

Any exogenous hormone taken for more than a couple of months will cause down-regulation of the hormone receptors for that particular hormone causing a relative hormone deficiency, even in the presence of excess levels of hormone.

Monday, March 27, 2017

Higher Spending by Docs May Not Buy Better Health

Just because your doctor orders more – or more high-priced – tests and procedures when you’re in the hospital doesn’t mean that you get better care, a new study suggests.

Medicare patients treated by higher-spending physicians are just as likely to be re-admitted or die within 30 days of being admitted to the hospital as patients treated by doctors who order fewer or less-expensive tests and treatment, the study revealed.

“Spending more doesn’t always mean you get better health,” senior study author Dr. Anupam Jena, of Harvard Medical School, said in a statement.

Health care spending in the United States varies widely from one region to the next, and even across hospitals within the same community, studies have shown.

However, this new analysis is believed to be the first to assess spending differences between physicians within the same hospital, and patient outcomes.

Among “hospitalists” – who treat patients while they’re in the hospital – average adjusted spending per hospitalization varied by more than 40% between the highest – and lowest-spending physicians.
The study was published online March 13 in the journal JAMA Internal Medicine.

The study authors concluded that policies targeting physicians within hospitals “may be more effective in reducing wasteful spending than policies focusing solely on hospitals.”

Hospitals began monitoring physicians spending patterns years ago using patients’ length of stay, and over the years the list of measures has expanded. Beginning in 2019, for example, Medicare will begin rewarding or penalizing physicians on the quality of cost efficiency of care they provide.

Friday, March 24, 2017

Study Ties Some Migraines to Artery Tears in Neck

Some young adults who suffer migraines may be at risk for stoke from tears in their neck arteries, a new study suggests.

Of the nearly 2,500 stoke patients studied, aged 18 to 45, only 13% had strokes related to neck artery tears. This group was more likely to have high cholesterol, diabetes or be current smokers.

When the researchers looked closer at the pattern of migraines linked with vessel tears and stroke, they found that migraine without aura was more closely linked to the blood vessel abnormalities.

Aura describes sensory changes – such as flashes of light, other vision disturbances or tingling of hands or face – that can occur before or during a migraine.

“Overall, migraine is a benign condition in the great majority of affected individuals,” said Dr. Alessandro Pezzini, study author and professor of neurology at the Universita degli Studi di Brescia in Italy. The two disorders may have a common genetic basis, Pezzini said. Or an underlying abnormality may predispose a person to both the blood vessel problem and the stroke.

The findings were published online March 6 in the journal JAMA Neurology.

Wednesday, March 22, 2017

Wisdom Wednesday: ACA Repeal-Replace Bill Troubles Medical, Nursing Groups

Major medical societies such as the American Medical Association (AMA) worry that a House bill to repeal and replace the Affordable Care Act (ACA) will translate into fewer people with health coverage and the care they need.

They say that the bill’s new tax credits for buying and private plan are less generous than those under the ACA, particularity for low-income Americans, a claim supported by a recent Kaiser Family Foundation analysis. They are also troubled by major changes to Medicaid – namely, a per-capita cap on the federal contribution to state programs, which could leave them underfunded, and a rollback of expanded eligibility in 31 states and the extra federal dollars that come with it.

“While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations,” ACA CEO James Madara, MD, wrote members of Congress yesterday.

Speaking for the American Nurses Association, President Pamela F Cipriano, PhD, RN, FAAN, joined the dissent. “In its current form, the bill changes Medicaid to a per capita cap funding model, eliminates the Prevention and Public Health Fund, restricts millions of women from access to critical health services, and repeals income based subsidies that millions of people rely on. These changes in no way will improve care for the American People,” she said in a prepared statement.

Other medical societies expressing similar criticisms and reservations include the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP), the American Congress of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Osteopathic Association.

Monday, March 20, 2017

Do You Need an Antibiotic?

Researchers from Duke Health in Durham, N.C., said they’ve identified a group of proteins that could be used to tell if an infection is caused by a virus, which triggers cold or flu.

Antibiotics can only fight bacterial infections, not viral illnesses.

When detected in specific quantities in the mucus of runny noses and inflamed throats, the proteins targeted in the new study were 86% accurate in confirming a viral infection, the scientists said.

“In the past, science has focused on identifying the pathogen someone is infected with in the blood or other sample, said study lead author Thomas Burke. He’s director of technology advancement and diagnostics at Duke. “Our approach flips the paradigm of how we look for infection. Instead of looking for the pathogen, we study the individual’s response to that pathogen,” Burke said in a health system news release.

The researchers said their findings could lead to quick, noninvasive tests for upper respiratory infections that could be easily done in a doctor’s office. Being able to quickly diagnose a viral infection could help limit the unnecessary use of antibiotics, helping to prevent the rise of antibiotic resistance, the researchers said.

Friday, March 17, 2017

Downside to Gluten-Free Diets: Diabetes Risk?

In a large study of U.S. health professionals, scientists found that those with the least gluten in their diets actually had a slightly higher risk of developing type 2 diabetes over a few decades.

Gluten is a protein found in grains such as wheat, rye and barely. Gluten-free diets are a must for people with celiac disease. But gluten-free, or at least gluten-light, diets have caught on as a way for anyone to lose weight and improve their health. One recent study found that the number of Americans who say they’ve gone gluten-free tripled between 2009 and 2014.

The new findings are based on nearly 200,000 U.S. health professionals whose health and lifestyle habits were followed over three decades. Over 30 years, just under 16,000 study participants developed type 2 diabetes. The investigators found study participants who ate the least gluten actually had a somewhat higher risk of developing diabetes over time.

Most people consumed no more than 12 grams of gluten each day, with the average being 6 to 7 grams. Those in the top 20% for gluten intake were 13% less likely to develop type 2 diabetes, versus those in the bottom 20% - who typically ate fewer than 4 grams of gluten each day, the findings showed.

Lead researcher Geng Zong said his team did try to account for other factors, including people’s exercise habits, weight, typical calorie intake and family history of diabetes. However, lower gluten intake was still tied to a higher type 2 diabetes risk. Zong is a research fellow in nutrition at Harvard T.H. Chan School of Public Health, in Boston.

Wednesday, March 15, 2017

Wisdom Wednesday: Subway Chicken or Soy?

Most of you have heard the news about Subway. According to tests performed at Trent University in Canada, the company’s chicken strips and oven-roasted chicken contained just 43% and 54% chicken DNA, respectively, consisting otherwise of soy and other filler ingredients.

Subway denies the charges and has demanded a retraction from CBS Marketplace. According to Subway, its chicken strips and oven-roasted chicken contain less than 1% soy protein.

Popular chicken sandwiches from Wendy’s, McDonalds, A&W and Tim Hortons were also included in the testing. All, with the exception of Subway, tested as “mostly” chicken, ranging between 85 and 90% chicken DNA.

So what’s in processed chicken other than chicken? Well, it’s a long list of chemicals, fillers including high amounts of refined starches and sugars, but mostly soy.

Soy has a number of health issues. In the Asian culture, people eat small amounts of whole, fermented, non-GMO soybean products. In the western culture, food processors separate the soybean into the protein and the oil, neither of which is safe to consume.

Unfermented soy foods contain anti-nutritional factors such as soyatoxin, phytates, protease inhibitors, oxalates, goitrogens and estrogens. These chemical compounds inhibit digestion and disrupt the endocrine system. In small amounts, these chemicals are tolerated by the body, but many Americans now eat a large amount of soy. Soy is the third most common food allergen. Only wheat and dairy allergies are more common. This is directly related to the rate of consumption. Soy is a component of most processed food.

Monday, March 13, 2017

Heart Disease Could Cost U.S. $1 Trillion Per Year By 2035

Heart disease is increasing at a troubling pace in the United States, with costs expected to double from $555 billion in 2016 to a whopping $1.1 trillion in 2035, a new American Heart Association report estimates.

“Our new projections indicate cardiovascular disease is on a course that could bankrupt our nation’s economy and health care system,” said AHA President Steven Houser. He’s also associate dean of research at Temple University in Philadelphia.

By 2035, 45% of the total U.S. population – about 131 million people – will have at least one health problem related to heart disease, the AHA report projected. Heart disease is spreading much more quickly than previously estimated, Houser said at a news conference.

The AHA’s previous projections underestimated the impact of American’s ongoing obesity epidemic on the nation’s heart health.

“The burden of cardiovascular disease is growing faster than our ability to combat it, and our new report indicates it could get much worse in the coming years,” Houser said.

Friday, March 10, 2017

Mildly Low Thyroid Function in Pregnancy Not a Threat

There’s no benefit to treating pregnant women who have mildly low thyroid function, researchers report.

Very low thyroid function during pregnancy is associated with impaired fetal brain development and increased risk of preterm birth and miscarriage. Some studies have suggested that even mildly low thyroid function (so-called subclinical hypothyroidism) during pregnancy could also pose a threat to a newborn.

This new study of more than 97,000 pregnant women across the United States found no evidence of that. Researchers saw no differences in brain development between children born to mothers with low thyroid function who did or did not receive medication during pregnancy.

There were also no differences between the groups in rates of preterm birth, stillbirth, miscarriage and gestational diabetes, according to the study, conducted by a U.S. National Institutes of Health (NIH) research network.

“Our results do not support routine thyroid screening in pregnancy since treatment did not improve maternal or infant outcomes,” study author Dr. Uma Reddy said in an NIH news release. Reddy is with the U.S. National Institute of Child Health and Human Development’s pregnancy and perinatology branch.

Thyroid hormones help regulate energy levels and other vital bodily functions. For the study, Reddy and her colleagues tested thyroid hormone levels of more than 97,000 women before the20th week of pregnancy.

The researchers randomly assigned about 500 women with mildly low thyroid function to receive either treatment with the drug levothyroxine (Synthroid) or a placebo.

Wednesday, March 8, 2017

Wisdom Wednesday: Sunscreens

I have just finished three months of intense lab review. From December through February, we reduce out lab fees to encourage our patients to perform yearly blood and urine analysis. This year the response was great and I’ve been looking a test results night and day.

For the past few years testing vitamin D levels has been standard practice in my office. Initially I was shocked at the number of patients we found that were deficient in vitamin D. After all, I practice in South Florida where the sun shines about 362 days a year.

In Michigan the deficiency is from the lack of sun, in Florida, we hide from the sun. We wear protective clothing, avoid the noon day sun and wear lots of sunscreen.

I don’t always wear sunscreen. If I have a tennis match at 8 AM or run the beach early in the morning, I want that sunlight striking my skin converting cholesterol to vitamin D3.

However, if I am going out on the boat or any outdoor activity during the late morning or afternoon, I want protection from the UVA and UVB rays.

My preference is clothing. I wear a hat with a wide brim and a long sleeved shirt with a rated SPF (sun protection factor). That lets me avoid all those chemicals on my skin.

For my face and hands or any other exposed skin I have to use sunscreen.

There are two basic types of sunscreen – physical and chemical. Physical sunscreens generally contain titanium dioxide or zinc oxide. They sit on top of your skin to deflect UV rays from penetrating and doing damage. They are often thicker, greasy, and less comfortable. They need total coverage in order for form a shield from the sun. But they last a long time and continue to protect as long as they sit on top of your skin.

Monday, March 6, 2017

Review Raises Questions About Herbal Meds for Heart Problems

While there’s scant evidence that herbal medications are safe or effective to treat heart disease, they remain popular among people with heart disease, a new review suggests.

“Physicians should improve their knowledge of herbal medications in order to adequately weigh the clinical implications related to their use,” said senior review author Dr. Graziani Onder.

Onder, of the Catholic University of the Sacred Heart in Rome, Italy, is an assistant professor in the department of geriatrics, neurosciences and orthopedics.

“Physicians should explain that natural does not always mean safe,” he said in a news release from the American College of Cardiology.

In the United States, herbal medications can be sold without being tested in clinical trials. As a result, there’s little evidence of their safety or effectiveness, the review authors explained.

To explore the issue, the investigators looked at 42 herbal medications that have been identified as a possible treatment for one or more heart conditions, including high blood pressure, heart failure and hardening of the arteries.

Onder’s team found there isn’t enough evidence to determine if herbal remedies are causing potential complications.

Friday, March 3, 2017

Toxins in Your Fast-Food Packaging?

Many grease-resistant fast-food wrappers and boxes contain potentially harmful chemicals that can leach into food, a new study contends.

Testing on more than 400 samples from restaurants nationwide revealed that nearly half of fast-food wrappers and one out of five paperboard food boxes contained detectable levels of fluorine, said lead researcher Laurel Schaider. She’s an environmental chemist at the Silent Spring Institute in Newton, Mass.

Previous studies have linked some fluorinated chemicals such as perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) to kidney and testicular cancer, low birth weight, thyroid disease, decreased sperm quality, pregnancy-induced high blood pressure, and immune system problems in children, the study authors said in background notes.

Major U.S. manufacturers voluntarily phased out PFOA and PFOS for most uses starting in 2011, but other countries still produce them. These study results show than fluorinated chemicals are still widely present in food packaging, the authors said.

“One of the challenges in avoiding exposure is you can’t tell by looking a t a wrapper whether it contains fluorine,” Schaider aid. “We can choose not to purchase a stain-resistant carpet or a stain-resistant coating on our furniture. But it’s difficult for a consumer to choose food packaging that doesn’t have fluorinated chemicals.”

Fluorinated chemicals are referred to as per- and polyfluoroalkyl substances (PFASs). They are used in a wide range of products, including carpeting, upholstery, floor waxes and outdoor apparel. The study authors said.

Some fast-food packaging is treated with PFASs to make the wrappers and boxes grease-resistant, Schaider said. It has been found that PFASs can leach into food from packaging, she said. Heat and grease appear to help the chemicals migrate into food, she added.

According to the Foodservice Packaging Institute, only “short-chain” fluorinated chemicals are still used in fast-food packaging. The “short-chain” chemicals “have been rigorously reviewed by the U.S. Food and Drug Administration and found to be safe for their intended use,” the industry group said in a statement.

Wednesday, March 1, 2017

Wisdom Wednesday: Data Silos in Healthcare

A health data divide between clinicians and data scientists is wasting precious medical research and healthcare resources, hampering innovation and resulting in poorer outcomes than would otherwise be achievable.

That’s the conclusion of researchers from the Massachusetts Institute of Technology’s Critical Data group, an affiliation of research labs at MIT focused specifically on data that has a critical impact on human health.

As the use of IT and data grows within healthcare, the researchers suggest that data science should be included in the core curriculum during medical school and residency training.

Despite the digitization of healthcare and abundance of health data from disparate sources including EHRs, mobile devices and wearables, they say the fundamental quality, safety and cost challenges of providing care have not been resolved and that better use of clinical data has the potential to address these issues.

According to Leo Anthony Celi, MD, head of the MIT Critical Data group, the problem is that a lot of the data exists in silos and is not integrated. He believes that the idea of data sharing is still foreign in healthcare because of stubborn cultural barriers that continue to stand in the way of science and progress.

“If we are to learn as a healthcare system, there has to be more data integration and harmonization,” contends Celi. “There is a persistent gap between the clinicians required to understand the clinical relevance of the data and the data scientists who are critical to extracting useable information from the increasing amount of healthcare data that are being generated” wrote Celi in a recent viewpoint article published in the Journal of Medical Internet Research.