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Archive for May 2010
While writing one of the installments for my radio show this past weekend I came across some alarming statistics concerning tanning booth use and melanoma. I’ve known about the possible connection for some time but it really struck me as to what a serious problem this is. And unfortunately the most affected group appears to be young females who might not be making decisions based on the most reliable information. Couple this with a dose of feeling bullet proof and you’ve got a recipe for disaster.
A recent study from the University of Minnesota found that there is strong evidence that ”indoor tanning increases the risk for melanoma and should be avoided.” In 2006 the World Health Organization’s International Agency for Research on Cancer stated that there was only a weak association between indoor tanning and the risk of developing melanoma. Recently the group changed their stance and now calls tanning devices carcinogenic.
The tanning industry is a big money maker and of course they refute the findings of the latest study saying that the lead researcher was not a neutral party. One of the main concerns of the authors was the same as mine. That the main users of the indoor tanning devices are teens. The study noted that in looking at 116 American cities the average number of tanning salons surpassed the average number of Starbucks or McDonalds!
To tan or not to tan. Indoor tanning appears to be a serious public health problem. As mentioned by the authors of the study it needs to be addressed in schools much like obesity and smoking. There is talk of possibly making it unlawful for anyone below the age of 18 to use tanning salons. At least not without parental consent. Do we need more laws or just allow common sense to prevail? While I hate more laws it doesn’t appear that common sense is working very well. bjmdjd
Material modifications since posting: none
indoor tanning · melanoma · tanning booths · University of Minnesota
The Food and Drug Administration appears to be earning its pennies this week. They have issued several warnings/recommendations that are important. I feel the need to write about the doings of the FDA because most patients will never hear about these warnings on medications that they may already be taking.
This week the FDA issued a warning concerning the possibility of severe liver injury with the use of a popular weight loss drug called orlistat. The 120mg formulation is prescription only and is marketed as Xenical and the over the counter 60mg formulation is Alli. This warning is based on reviews being done by the agency since last August and involves 13 patients with severe liver injury. Some died and some required liver transplantation.
The agency also issued a warning concerning a suicide risk with the use of tramadol. Tramadol is a pain reliever marketed as Ultram and as Ultracetwhich is tramadol with acetaminophen. It is recommended that it not be prescribed to patients who are suicidal or addiction prone and to be cautious with patients who use alcohol excessively, are depressed, or take tranquilizers or antidepressants.
The FDA also issued a recommendation that physicians exercise caution in prescribing proton pump inhibitors due to evidence that high doses or long term use of these drugs may increase the risk of various fractures. These gastroesophageal drugs include both the prescription and over the counter formulations of Prevacid, Nexium, Prilosec, and Zegerid. While the studies are not conclusive the FDA is working with the various drug manufacturers to further examine the risk.
One of the things that bothers me about the above FDA concerns is that some of these drug formulations are over the counter and there is nothing stopping patients from misusing these medications and further exposing themselves to more risk. If you are taking any of these drugs it might be wise to at least discuss it with your physician. bjmdjd
Material modifications since posting: On May 27, 2010 Krishan Maggon PhD was kind enough to let me know via Medpedia that the Food and Drug Administration can recommend label changes on over the counter drugs so that the warning is on the package. Thanks for your contribution Dr. Maggon. bjmdjd
Food and Drug Administration · fracture risk · orlistat · proton pump inhibitors · severe liver injury · suicide risk · tramadol
Drop side cribs may finally be meeting their waterloo. For many years several child advocate groups and government agencies have complained about the strangulation dangers of these cribs. There have been numerous infant and toddler deaths associated with these cribs in the last ten years.
The Consumer Product Safety Commission has been working on the problem for some time and now they have a senator from New York involved. Legislation was introduced this week that would ban the manufacture, sale, and resell of the cribs. They would also be banned in hotels and day care centers.
Seven million of these cribs have been recalled since 2005 and many stores have already stopped selling them. With what appears to be solid evidence that these cribs are definitely a strangulation danger for small children and infants, Senator Kirsten Gillibrand is to be applauded for trying to accomplish something worthwhile in Congress. Now that’s a change for Congress. bjmdjd
Material modifications since posting: none
Consumer Product Safety Commission · drop side cribs · Senator Kirsten Gillibrand · strangulation danger
I rarely feel the need to comment on commercials I see on television or in the print media. Even if it bothers me I’ll usually just blow it off. Not so with what I saw today.
The medical establishment had quite a few negative things to say about the retail store medical clinics that started popping up in stores several years ago. While I’ll admit that I’m sure much of it had to do with money there were some valid complaints made. One of the main problems was felt to be that patients need to get their primary care at one location. One person should know everything that is going on with a patient so they can direct their care. Fragmented care can be a bad thing.
To answer this complaint the clinics assured everyone that they were there to treat simple illnesses like sore throats, bad colds, sprains, etc. And they provide these services at times when most primary care physicians are not in their offices. They stressed that they treated only simple illnesses and that their non physician providers could easily treat these sort of problems and that they did not want to treat chronic illnesses.
Today I see a television commercial by one of these clinics promoting diabetes blood testing, related exams, and education. Everything that they advertise as the diabetic services that they offer are the services that should be provided and tracked by the patients primary physician. I’m sure that most of their providers are well trained to treat diabetes and that they try to get the results sent to the patients primary doc but not always.
My main complaint is that their needs to be a “medical home” for patients with chronic illnesses so that someone can be running the show. This home needs to be with the primary care physician. Many may disagree but that’s what I love about this great country. We can agree to disagree! I wonder if the fact that many of these retail store clinics are having financial problems is the reason that they are expanding their scope of care? Many physicians have certainly done that recently. bjmdjd
Material modifications since posting: none
18
Is There A Connection Between Pesticides And ADHD?
1 Comment · Posted by bjmdjd in Medical Studies
The big story in the news today is the results of a new study published in Pediatrics journal which shows a possible connection between pesticide exposure and attention deficit hyperactivity disorder. Pesticides now join a growing list of possible causes of the popular diagnosis including too much television exposure and simply over diagnosis.
The Harvard study measured the pesticide levels in the urine of 1,139 children between the ages of 8 and 15 years old. Through caretaker interviews it was found that 150 children with positive urine tests carried the diagnosis of ADHD. The higher the pesticide level the more likely the child was to have the disorder.
It is important to note that while the study does show a possible connection it is only one study and much more work and research needs to be done to make a definite correlation. The authors of the study recommended buying organic products and washing all fruits and vegetables well before eating. bjmdjd
Material modifications since posting: none
ADHD · fruits and vegetables · Harvard study · Pediatrics journal · pesticide and ADHD connection · pesticides
15
Do We Really Need This Warning?
No comments · Posted by bjmdjd in FDA Alerts and News, Rants
I never really understood why we needed to be warned not to operate a bulldozer after taking medications that make us sleepy! But then again most every physician has heard of the pregnant women who had their partner take their birth control pills for them for a few days or they spread contraceptive jelly on toast and ate it. I guess instructions are just not obvious or understandable to everyone.
This week the Food and Drug Administration issued a warning not to swallow Benadryl Extra Strength Itch Stopping Gel meant to be spread on the affected skin. The problem is in getting too large of a dose of the active ingredient diphenhydramine. Large doses can cause confusion, unconsciousness, and hallucinations.
I guess that I just like to assume that common sense and reading/understanding simple instructions are a common thing. I guess it is the folks that don’t fall in this category that help keep the plaintiff attorneys (and the FDA for that matter) in business. bjmdjd
Material modifications since posting: none
For many years it was felt that nuts were an unhealthy snack. More recently many kinds of nuts have been found to be better for you than originally thought.
A recent study published in the Archives of Internal Medicine revealed that eating almost any kind of nut lowers total cholesterol levels and the bad kind LDL. The amount of lowering was found to be dependent on how many nuts were consumed. The authors of the study said that the risk of coronary artery disease was almost 40% lower in folks who ate at least four servings of nuts per week compared to those who rarely or never ate them.
It does seem that the benefits of eating nuts on cholesterol lowering was better in those who started with higher cholesterol levels. This study seems to support the 2003 statement by the Food and Drug Administration that the consumption of certain types of nuts might lower the risk of heart disease. The nuts mentioned at that time by the FDA included almonds, hazelnuts, pecans, pistachios, walnuts, and peanuts. bjmdjd
Material modifications since posting: none
Archives of Internal Medicine · coronary artery disease · Food and Drug Administration · nuts can lower cholesterol
10
Prediabetes And Prehypertension Can Be A Deadly Combination
No comments · Posted by bjmdjd in Medical Studies
Two terms you have read about on this blog recently are prehypertension and prediabetes. Both are fairly new terms developed to identify patients earlier for diabetes and high blood pressure.
The terms came up again at the American Society of Hypertension 2010 Scientific Meetings held last week in NYC. Various studies identified these patients at being easy to identify and that those with both diagnoses are at an increased risk of cardiovascular disease. Several of the meeting participants stated that these patients should at least be receiving lifestyle change information.
Physicians: Nearly every patient that is seen in a primary care office has their blood pressure checked and a fasting blood sugar measured at some point. If you believe this statement you must admit that this subset of patients is really already identified within your patient population. All you have to do is label them. Any primary care physician worth his/her salt is already addressing both of these diagnoses but this information does add some incentive for both the patient and the physician to see the importance of starting at least life style changes as an intervention. I believe that you will find that patients with both of these diagnoses also have other risk factors for cardiovascular disease bjmdjd
Material modifications since posting: none
American Society of Hypertension · cardiovascular disease · prediabetes · prehypertension
I have never been shy about expressing my opinion concerning healthcare reform. I have always said that I am a huge supporter of healthcare reform but not a supporter of the bill that was recently passed. It may be a good start but it has some serious flaws that I feel if corrected would free up lots of money to take care of the currently under served population.
Maybe it’s because of my past experience working in the emergency room but the waste and abuse of the system by some patients gets under my craw more than I can even express. If you spent a couple of hours as an observer in an ER you would be absolutely sickened by the way the system is abused by some. I recently sent an email to this effect to someone and got an interesting response. In fairness to all I decided (with her permission) to print her response.
I am fortunate to be a friend and student of a nice lady named Nora Johnson. She is a medical billing advocate. In other words, she scours medical bills for mistakes and saves patients thousands of dollars. You may have seen her on CBS News, CNBC, The Wall Street Journal, Smart Money Magazine, and the list goes on and on. This lady is no slouch. In addition to a top notch education, her experience and resume make her an expert. And like one of the television commercials of the past says, “When she talks, people listen.”
I appreciate Nora allowing me to print her words of wisdom. She did not write this for publication and I did not check for spelling or grammar so read it for content only.
| “From a non-physician standpoint, but one who is involved in the daily plights of patients who can’t afford healthcare, permit me to share my perspective.
I have no love for healthcare insurance providers. I view them as subscribers to the modern day Machiavellian business philosophy of ‘profit justifies the means’…or ‘profit makes right’. It doesn’t take much of an intellectual leap to deduce why 45 million Americans can’t access the health care system…and why a substantial portion of the ‘have nots’ rely on Emergency rooms. It is a fact that Emergency rooms are the lowest or no-profit revenue centers for hospitals. It is also a fact that some patients abuse the privilege of accessing emergency rooms. What is completely overlooked by critics are the millions of uninsured people who, when diagnosed with cancer or other major illnesses, cannot afford chemo or radiation or any type of continuing treatment. Emergency rooms do not provide ongoing treatment for chronic diseases. I have talked with too many people who fall between the cracks in our current system. Too rich for Medicaid or charity care, and too poor or sick to afford astronomical premiums. The cannot cough up $200 thousand dollars IN ADVANCE, to pay the likes of MD Anderson or any cancer hospital for the first series of treatments. I believe these people constitute the majority of these 45 million uninsured…or under-insured. And, even if they don’t, are the rest of us willing to consign their plights to——you don’t deserve to live? From their perspective death is their reality, and potential life saving treatments are a privilege of the wealthy, or the lucky who have health care coverage through employment. I can hear the refrain——-let ‘em get jobs and work like the rest of us! Don’t be too cocky about your coverage through employment. This too is vanishing as self-insured companies are breaking under the cost burden, downsizing staff, outsourcing to the rest of the world, limiting employees to part time thereby escaping the mandate to provide health care coverage, decreasing coverage in general, and shifting more health care costs to the remainder of the employees. What about those folk who worked hard all their lives, and took the promise of early retirement and continuing health care coverage till Medicare kicks in, only to find their employers determined at some later date, that a good way to cut costs was to eliminate coverage for retirees? By now, many of these folks between 50 and 65 have conditions that virtually eliminate them from Blues, United, Cigna, Aetna, (BUCAs) coverage…or maybe if they can pay $3K a month for premiums. Even then, the BUCAs will do what they can to disqualify and deny these insureds from coverage——–after accepting months/years of premium payments. We cannot be so naive to imagine that the private profit making sector is going to care about anything or anybody other than profits. Hospitals are huge profit making businesses, and not-for-profit hospitals are even worse! I know how these bandits bill!! I know how they demand full payment from the uninsured when virtually 95% of their patient load doesn’t have to pay even half for the same services. So count them out of caring for non-paying patients, or doing the right thing because profit trumps compassion and responsibility. Does this mean that Obamacare is the answer? No, it is only a beginning, and one full of holes; the most glaring of which is the healthcare profit mongers are still in control, and do not have meaningful sanctions to counter their new and creative ways to deny claims payment. The health of our nation cannot be consigned to monolithic entities that worship the profit gods. Obama missed the boat by not having a government agency compete with the BUCAs. Yeah, yeah, that’s socialism———-as is Medicare, Social Security, Medicaid, etc. For those who denounce socialism, please forgo your Medicare and Social Security and put your money in the same bag with your righteous indignation. What is true and evident is that our population of 45 million uninsured/underinsure Americans have made no progress, were denied healthcare and have died within the last few decades that subscribed to various economic policies, beginning with the trickle-down theory to business’ self-regulation. Now that’s a hoax promulgating the fox guarding the hen house theory that many bought into, excepting perhaps, the have-nots. If you are poor (http://www.partnershiptoendpoverty.org/PovertyGuidelines2009.pdf, ) sick, unable to access health care to survive, lost your home and believe that Obamacare or a dose of socialism will ruin our country, stand up and be counted. …I can’t hear you! If you don’t qualify, what is your responsibility to your countrywomen and men? Said better by many: “Any society, any nation, is judged on the basis of how it treats its weakest members; the last, the least, the littlest.” How will America be judged?” I told you. Whether you agree with her or not…this is one smart lady. If you are interested in a CBS story with Nora here is the link: http://youtube.com/watch?v=huOcg9uN5pw bjmdjd Material modifications since posting: none |
access to care · health · Healthcare Reform · Nora Johnson · underinsured · uninsured
Sorry I’ve been absent for a while but we had some family drama that needed to be dealt with. Forunately all is well and I’m back in the saddle again.
Even though it’s not funny, one of the jokes in an emergency room I worked in was all of the trouble that some folks went to when trying to find an instrument to get some attention through a suicide gesture. Some thought they would try to “fake” it by using the readily available acetaminophen. Little did they know that this inexpensive over the counter medication is one of the most dangerous drugs you can take if you take too much.
A recent study at the University of Rochester in New York has found that a majority of teenagers and young adults take over the counter medications without even knowing what the medicine actually is or the possible dangerous side effects.
Even though various studies document that acetaminophen toxicity is the cause of more cases of acute liver failure than viral hepatitis, few adolescents realized the possible dangers of taking that drug or many others that are freely available to them. In this study it was found that 77% of those studied that were determined to be “health literate” did not even know the maximum daily dose of acetaminophen.
While this study focused on young people the findings for adults are not much better. It is imperative that people educate themselves about the medications that they take and become familiar with the dosage instructions printed on the bottle. bjmdjd
Material modifications since posting: none
acetaminophen · acetaminophen dangers · health · over the counter drug toxicity · University of Rochester · wellness
