Saturday, January 28, 2017

This physician wants her patients to use fewer medications - The Washington Post

There was nothing unique about that patient encounter except that it was my first appointment of 2017 and everyone at the office was buzzing about their New Year's resolutions.

It went like this:

Me: "Are you taking all of your medications?"

Patient: "Yes, of course."

Me: "Okay, let's review them. Do you remember what they are?"

Patient: "I am not sure, but they are all here." (Patient hands me a plastic bag brimming with orange pill bottles, boxes and over-the-counter containers.)

Me (in my head): Oh, brother!

That's when I made my resolution: In 2017, I will try to tip the balance: I will not only try to write fewer prescriptions, I will also try to get more of my patients off their drugs altogether.

The "why" was obvious to me: Too many patients are taking too many drugs, for too long, in too-high doses, suffering harmful effects.

The "how"? That was less obvious. Starting in the second year of medical school (course name: Pharmacology) and continuing through residency training and beyond, doctors are taught how to prescribe drugs.

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Tuesday, January 24, 2017

Insomniacs Are Helped by Online Therapy, Study Finds - The New York Times

The same digital screens that have helped nurture a generation of insomniacs can also help restore regular sleep, researchers reported on Wednesday. In a new study, more than half of chronic insomniacs who used an automated online therapy program reported improvement within weeks and were sleeping normally a year later.

The new report, published in the journal JAMA Psychiatry, is the most comprehensive to date suggesting that many garden-variety insomniacs could benefit from the gold standard treatment — cognitive behavior therapy — without ever having to talk to a therapist. At least one in 10 adults has diagnosable insomnia, which is defined as broken, irregular, inadequate slumber at least three nights a week for three months running or longer.

"I've been an insomniac all my life, I've tried about everything," said Dale Love Callon, 70, known as Dacie, a math tutor living in Rancho Palos Verdes, Calif., who recently used the software. "I don't have it 100 percent conquered, but I'm sleeping much better now."

Previous studies have found that online sleep therapy can be effective, but most have been smaller, or focused on a particular sleep-related problem, like depression. The new trial tested the digital therapy in a broad, diverse group of longtime insomniacs whose main complaint was lack of sleep. Most had used medication or supplements over the years, and some still did.

"These results suggest that there are a group of patients who can benefit without the need of a high-intensity intervention," like face-to-face therapy, said Jack Edinger, a professor in the department of medicine at National Jewish Health in Denver, who was not a part of the study. "We don't know yet exactly who they are — the people who volunteer for a study like this in first place are self-motivated — but they're out there."

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Monday, January 23, 2017

Cervical Cancer Taking Deadlier Toll in U.S. Than Had Been Thought - The New York Times

The death rate from cervical cancer in the United States is considerably higher than previously estimated and the disparity in death rates between black women and white women is significantly wider, according to a study published Monday in the journal Cancer.

The rate at which black American women are dying from the disease is comparable to that of women in many poor developing nations, researchers reported. What makes the findings especially disturbing, said experts not involved in the research, is that when screening guidelines and follow-up monitoring are pursued, cervical cancer is largely preventable.

"This shows that our disparities are even worse than we feared," said Dr. Kathleen M. Schmeler, an associate professor of gynecologic oncology at the University of Texas M. D. Anderson Cancer Center. "We have screenings that are great, but many women in America are not getting them. And now I have even more concerns going forward, with the" expected "repeal of the Affordable Care Act, which covers screening, and the closing of family planning clinics, which do much of that screening."

The racial disparity had been noted in earlier studies, but it had been thought to have narrowed because cervical cancer death rates for black women were declining. But this study said that the gap was far greater than believed.

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Sunday, January 22, 2017

Why Medical Advice Seems to Change So Frequently - The New York Times

Medical scientists and academics must publish their research to advance. Medical organizations must release health recommendations to remain relevant. News organizations feel they must report on research and recommendations as they are released. But sometimes it's hard to separate what's truly a medical certainty from what is merely solid scientific conjecture.

I thought about this recently when the National Institute of Allergy and Infectious Diseases expert panel changed course and recommended that we start giving babies peanut powder or extract in food before they are six months old rather than make sure they go nowhere near it. The panel said this is good advice, especially if the babies are at higher risk for developing an allergy.

I've written about the research supporting these new recommendations before. A recent well-designed study showed that infants exposed to peanut protein developed significantly fewer peanut allergies than those who were not. The measurement, called number needed to treat (N.N.T.), was powerful: For every seven infants exposed to peanut protein, one fewer developed allergies. In the high-risk population, for every four infants exposed, one fewer became allergic. Those numbers are stunning.

But it's important to remember that the earlier recommendation wasn't made in the Dark Ages. As recently as 2000, the American Academy of Pediatrics declared that children at risk for allergies be given no peanuts until they were 3 years old. It's not unrealistic to think that this might have increased the number of children with peanut allergies, not decreased them.

This isn't an isolated incident. As a pediatrician, I'm more aware of the academy's recommendations than those of some other medical organizations, and I've taken to The Upshot to discuss their statements on car seats on planes, the use of retail clinics and where babies should sleep. In each case, I've expressed concerns that the recommendations, which were not supported by strong evidence, may be doing more harm than good.

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