Articles Posted in Clinical guidelines

bp-300x169Did you feel yourself just get less well? U.S. heart experts have just issued new guidelines on what Americans’ optimal blood pressure should be—effectively and suddenly shifting just under half of the adults in the nation younger than 45 into an unhealthful status as hypertensive.

Doctors say there’s no doubting data that shows that blood pressure readings exceeding 130 over 80 can be detrimental to patients’ health. That’s down from the previous warning level of 140 over 90.

But what exactly has the medical establishment wrought with this sweeping metric? Have they deemed so many of us unwell in this way that we’re about to see public doubt and confusion—even profiteering—as has surrounded the description of tens of millions of Americans as “prediabetic?”

soccerknee-300x97Here’s another painful reminder to grownups about youngsters and sports: Moderation matters, and youthful games are supposed to fun, diverting, and character building—and most definitely should not leave today’s aspiring athletes as tomorrow’s hobbled adults.

The New York Times has reported on what a pediatric sports medicine expert has described as a “dirty little secret” of orthopedics, which is “the chance of getting arthritis within a decade of tearing a tendon or a ligament in the knee is greater than 50 percent.” And more and more youths, as they participate aggressively and frequently in sports programs, are undergoing surgeries on damaged or torn anterior cruciate ligaments, a procedure well-known as the ACL repair.

The sports medicine doc says he is gathering data for a study that will show that patients at 26 children’s hospitals he has focused on underwent 500 ACL repairs in 2005, but by 2014, more than 2,500 youths had these surgeries.

urine-sample-cup-263x300With opioid drugs now the leading cause of death for Americans 50 and younger and killing more than 64,000 people last year, was it inevitable that some shady characters are profiteering off the miseries of those struggling to get off potent painkillers?

And is it predictable that key politicians keep talking big but still haven’t backed up their boasts with the money and means to attack a public health crisis that is claiming more lives than cars or guns and at a faster pace than HIV-AIDS did at the peak of that epidemic?

Americans have plenty cause to be — forgive the vulgar word play — pissed off at the doctors and labs that are raking in profits on urine testing for drugs. This business has exploded but with little or no oversight. As reporters Fred Schulte and Elizabeth Lucas have written:

traumatower2-300x205In the torrent of the relentless 24/7 news cycle, let’s not allow a new normal to prevail. We can’t forget that just days ago, a madman opened fire on a church in a small town south of San Antonio, Texas, killing at least 26 and wounding 20 or so. It was the worst mass shooting in the Lone Star State’s history, and it added to a horrific and growing toll for recent such gun-related outbreaks.

These incidents not only devastate the communities in which they occur. They also put giant strains of doctors, nurses, emergency medical technicians, and hospitals. All respond in ways that deserve a major salute, as well as empathy, compassion, and shared grief for the victims, their families, and those who seek to save and protect lives in chaotic situations.

The killing in Sutherland, Texas, posed its own unique stresses, with medical experts heaping praise on EMTs and first-responders for their heroic work at the scene, and then speeding those in need to care at hospitals at least 35 miles away.

bowser-240x300Even as District of Columbia officials struggle with deepening woes at the United Medical Center (UMC), advocates from a national, independent, and nonprofit group have offered a dim review of hospitals in the DC area.

The bad news keeps piling on at UMC, a leading provider of medical care for communities of color in the District’s Southeast area and in Prince George’s County, Md.

To its credit, the sometimes locally slumbering Washington Post has put out a disturbing, well-documented report about the death of a 47-year-old HIV-AIDS patient in UMC’s nursing home care. As others witnessing the scene clamored for them to help, UMC nurses, the Post says, let the patient fall to the floor, where he sprawled in his own waste for 20 minutes while his caregivers argued with a security guard. When the patient finally was returned to his bed, he was dead.

choosing-wisely@2x-300x197Up to a third of medical spending goes for over-treatment and over-testing, with an estimated $200 billion in the U.S. expended on medical services with little benefit to patients. But getting doctors and hospitals to stop this waste isn’t easy, nor is it a snap to get patients to understand what this problem’s all about so they’ll push their health care providers to do something about it.

Which is why kudos  go to Julie Rovner, of the nonprofit, independent Kaiser Health News Service, and National Public Radio for the recent story on how older women with breast cancer suffer needlessly and run up wasteful medical costs due to over-testing and over-treatment.

Rovner and Kaiser Health News worked with a medical benefit management company to analyze records of almost 4,500, age 50-plus women who received care for early-stage breast cancer in 2017. She found that just under half of them got a medically appropriate, condensed, three-week regimen of radiation therapy. Research has shown this care is just as effective as a version that’s twice as long, costs much more, and subjects patients to greater inconvenience, especially with more side-effects.

soccerheader-211x300Although state and local laws may be curbing some of the harms the young can suffer with sports-related concussions, parents, coaches, teachers, and players may wish to reconsider even more the risks of head traumas: That’s because early such injuries may be tied to later diagnoses of multiple sclerosis.

To be sure, this is a developing area of research and the studies suggest an association between MS and head trauma, and not that concussions are a cause of the chronic, unpredictable disease of the central nervous system.

MS, as the disease’s national society reports, “can cause many symptoms, including blurred vision, loss of balance, poor coordination, slurred speech, tremors, numbness, extreme fatigue, problems with memory and concentration, paralysis, and blindness and more. These problems may come and go or persist and worsen over time.”

Darkchocolate-300x180Although most of our elders have preached at us from a chapel of common sense, dietary nonsense seems to rain on our heads faster than the autumn leaves.  It ought to go without saying that dark chocolate really isn’t a health food. And, to repeat again something that many pregnant women ought to know already: Getting your placenta commercially prepared after your baby’s born, and eating it isn’t a great idea.

Vox, the online news site, deserves credit for debunking a long campaign by candy makers and Big Sugar to persuade consumers that dark cocoa products somehow are “superfoods” like red wine, blueberries, and avocados.

Special interests, Vox reports, have poured tens of millions of dollars into “nutrition research” that purports to show chocolate’s health benefits. The problem is the science here is less than objective and sound: “Here at Vox, we examined 100 Mars-funded health studies, and found they overwhelmingly drew glowing conclusions about cocoa and chocolate — promoting everything from chocolate’s heart health benefits to cocoa’s ability to fight disease.” The Vox story later points out:

condoms-300x200Gentlemen, rev those engines of anxiety: Male infertility rates are on the rise, as are those for testicular cancer. Meantime, a global effort to improve one of the most common forms of male contraception may provoke some uncomfortable discussions about masculine misconceptions.

When there’s a break in the Major League Baseball championships, or the NCAA or NFL football regular season football games, or the NBA basketball contests, see how much the buds can be startled by researchers’ latest medical worry about men, as summarized in a summer Newsweek report:

Sperm levels—the most important measurement of male fertility—are declining throughout much of the world, including the U.S. [A review of] thousands of studies … concluded that sperm concentration had fallen by 52 percent among men in Western countries between 1973 and 2011. Four decades ago, the average Western man had a sperm concentration of 99 million per milliliter. By 2011, that had fallen to 47.1 million. The plummet is alarming because sperm concentrations below 40 million per milliliter are considered below normal and can impair fertility.

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