Gynecology

July 13, 2018

For women, more reasons to consider HPV test, while fertility rates decline

Women and their doctors may need to give even more consideration to a test for the human papilloma virus (HPV) because research increasingly shows that it detects precancerous cervical changes sooner and better than the long used and widely accepted Pap smear.

The latest findings on the HPV test’s benefits could lead to improvements in women’s reproductive health, even at a time when experts are seeing sharp declines in American female fertility rates and getting more insights into why US women are having fewer babies. And it may lead more experts to urge women to drop “co-testing,” both the HPV test and the Pap smear.

Researchers in Canada’s British Columbia potentially gave the HPV test one of its more significant boosts with a randomized clinical trial involving more than 19,000 women and following them for four years or so. Their newly published results showed that “there were significantly more cases of precancerous lesions detected early in the trial among the women in the HPV-tested group, compared with the Pap cytology group,” the Washington Post reported. Further, “there were fewer cases of precancer in the HPV test group, compared with the Pap smear group. That’s because cases of worrisome cellular changes already had been detected and dealt with after the women were first screened.”

May 20, 2018

Dangerous doctors rip off Medicare, creep out coeds, harm transplant patients

by Patrick A. Malone

Callous institutional inertia can allow dangerous doctors to keep harming patients. But media digging deserves credit for raising needed alarms when professional caregivers and others fail to step up to protect individuals as disparate as taxpayers, seniors, coeds, and heart transplant recipients.

The Milwaukee Journal-Sentinel and MedPage Today performed a public service, reporting that they found more than 200 doctors nationwide who surrendered a license, had one revoked, or were excluded from state-paid health care rolls in the previous five years but somehow remained on the federal Medicare rolls in 2015.

This meant the problem doctors could keep bad practices afloat, in part because Uncle Sam ─ that’s taxpayers like you and me ─ paid these hundreds of MDs $25.8 million to care for seniors, among the nation’s most vulnerable patients.

May 13, 2018

Why do we tolerate up to 80,000 mothers each year suffering big injuries in childbirth?

by Patrick A. Malone

maternalmorbidity-300x193 Here is a sobering public health angle on Mother’s Day.

Experts on international health and development, including the likes of Pulitzer Prize-winning foreign correspondent and columnist Nick Kristof, long have argued that a key way to major improvements in distant lands rests in boosting the lot of women and girls. It’s an issue that clearly also needs attention closer to home.

National Public Radio and Pro Publica, a Pulitzer-winning investigative site, deserve yet more credit for their continuing dig into a shame of contemporary American health care — why U.S. mothers die in childbirth at a far higher rate than in all other developed countries. Their latest disturbing reporting focuses on some unacceptable numbers:

April 30, 2018

Princely birth underscores how poorly U.S. moms fare in comparison

by Patrick A. Malone

The birth of Prince Louis Arthur Charles brought joy to the Duke and Duchess of Cambridge, but the regal baby’s arrival also provided cause for harsh comparisons of maternal costs and safety for more ordinary expectant moms on this side of the Atlantic.

Two magazines — Foreign Policy and the Economist — both poked at how much less the fabulously wealthy royals paid for a posh delivery of their baby, as compared with what a typical American mom might. They reported that 24 hours in the luxe Lindo Wing of St. Mary’s Hospital in London goes for $8,900, vs. the $12,900 an American would pay for a routine delivery in a noisy, regular U.S. hospital. And if the royals had gone without the private frills, their cost would have been zero.

If an American woman has a cesarean or any delivery complications, her delivery costs typically jump to almost $17,000, or $30,000, or even more, whereas her British and Canadian counterparts, as Foreign Policy reported, typically “pay nothing for their maternity care and delivery, with low risks of maternal and infant mortality.”

February 2, 2018

Gymnastics scandal offers a tragic reminder of challenges in protecting kids

by Patrick A. Malone

His basic credentials would come under fire, but they were sufficient for the “doctor” to insinuate himself into major institutions, and, worse, into the lives of hundreds of girls and young women on whom he inflicted a tragic toll. His combination of enthusiasm — he was a rah-rah kind of guy— extreme controlling conduct, and horrific “treatments” never seemed to set off the red flags they should have.

Instead, Larry Nassar — an osteopath who served as an athletics and team caregiver for USA Gymnastics and Michigan State University — got away for years with abusing adolescent females put under his sway. He purportedly provided medical services to them, many in exclusive and demanding athletic camps where young participants were cut off from their friends, family, coaches, and personal physicians. He “treated” aspiring Olympians, at all hours of the night and day, alone and without any other adults around, in their bedrooms, on their beds — not in medical offices or athletic training facilities.

He enthusiastically told his patients, many of whom excelled at their sport because of their willingness to please adults and to be coached, that he could deal with their pains and injuries with what he termed pelvic manipulations in which he digitally penetrated them in their private parts. Without medical cause or justification, he conducted repeated and invasive “exams” of girls and young women’s genitals.

January 5, 2018

What’s a key factor in black moms’ high death rates? Segregated hospitals

by Patrick A. Malone

The bad news for expectant black moms isn’t confined to those living in the nation’s capital: A new investigation has found higher risks of harm for women in New York, Florida, and Illinois when they deliver at hospitals that disproportionately serve black mothers.

ProPublica, a Pulitzer Prize-winning investigative site, analyzed two years of hospital inpatient discharge data from the three states to “look in-depth at how well different facilities treat women who experience one particular problem — hemorrhages — while giving birth.” Reporters found negative patterns that underscored big woes identified by other research before:

[B]lack women … fare worse in pregnancy and childbirth, dying at a rate more than triple that of white mothers. And while part of the disparity can be attributed to factors like poverty and inadequate access to health care, there is growing evidence that points to the quality of care at hospitals where a disproportionate number of black women deliver, which are often in neighborhoods disadvantaged by segregation. Researchers have found that women who deliver at these so-called ‘black-serving’ hospitals are more likely to have serious complications — from infections to birth-related embolisms to emergency hysterectomies — than mothers who deliver at institutions that serve fewer black women.

December 21, 2017

Why worry about gung-ho approvals for medical devices? FDA’s own record

by Patrick A. Malone

gottlieb The Food and Drug Administration has closed out the year by issuing a new white paper reaffirming the agency’s three-year-old warning to surgeons and women to avoid in general the use of a surgical device called a morcellator in “key-hole” or laparoscopic gynecological operations.

It wasn’t a surprise that the FDA retained this caution. That’s because the Wall Street Journal, back in 2014, had published a major investigative series linking morcellators to increased cancer incidences, recurrences, and risks in women. Researchers found that the popular surgical tool, by grinding up tissues such as those found in common female fibroid tumors, purportedly to permit their easier, faster removal, spread cancerous tissues throughout the body. The FDA has taken major, deserved criticism for failing for two decades to better protect thousands of women from harms caused by this medical device.

But what else did the agency do in its busy December? Scott Gottlieb, the FDA commissioner, also has reaffirmed that the FDA is motoring ahead with a stepped program to speed up an already loose approval and oversight process for medical devices like the morcellator.

April 14, 2017

Experts find cancer-causing HPV a widely spread infection among U.S. adults

by Patrick A. Malone

More Americans ages 18 to 59 may be infected with the human papilloma virus (HPV) than previously had been known, with 1 in 4 men and 1 in 5 women carrying high-risk strains, federal experts say.

The new findings from the Centers for Disease Control and Prevention may become a key part of campaigns to get more parents to vaccinate youngsters against HPV infections. They have been found to cause cervical cancer and have been tied to cancers of the throat, anus, and male and female reproductive organs.

HPV-related cancers are on the rise, and it is concerning that the CDC found that almost half of Americans’ are infected. But public health leaders have confronted ignorance and adult prudery—by physicians, public officials, and parents—as they try to get boys and girls, ages 11 and 12, inoculated and protected against the virus.

February 10, 2017

Pot may be more legal and common, but it’s still unwise for pregnant moms

by Patrick A. Malone

Although marijuana is marching toward legalization across the United States, expectant moms may wish to think long and hard still about smoking or ingesting a substance that has become as ubiquitous in some households as aspirin or a bottle of chardonnay. The New York Times has delved into this discussion, even as other news outlets recently have provided parental warnings about hype over apps for baby care and tossing some toxic homeopathic teething remedies.

Pot? Not for expectant moms

Let’s turn first, and not be blue noses about it, to why moms would consider pot while pregnant. Data show that few do (an estimated 4 percent of more than 200,000 women in one 12-year sample — though the number had doubled in recent time). For younger women, the answer may be, just because. They don’t equate it with risk but with recreation. They say they try to be cautious with it, just as they might curtail their alcohol consumption but still have a rare drink. Older and expectant moms may use pot, as many women do, because they find it helps with depression, anxiety, stress, pain, nausea and vomiting.

January 4, 2017

Questions grow about rise in aggressive surgery for early breast cancer

by Patrick A. Malone

It’s described as an “aggressive, costly, morbid, and burdensome” surgery that often lacks “compelling evidence” that it contributes to patients’ “survival advantage.” So why are increasing numbers of women deciding to have both their breasts removed when doctors detect early stage cancer in one breast?

New research, based on a questionnaire and follow-up with more than 2,400 women, recommends that surgeons be clearer and more direct about treatment options and outcomes with breast cancer patients. That’s because 17% of respondents said, incorrectly, that they think that removing the other healthy breast in a woman with cancer in one breast helps prevent the disease’s recurrence, while almost 40 percent said they didn’t know this procedure’s effects.

Researchers found that many women—including more than 40 percent of their respondents—with breast cancer contemplate the surgery known as contralateral prophylactic mastectomy (CPM), and that sufficient numbers of surgeons may not explain why it may be inappropriate for them. Their study has been published in the peer-reviewed Journal of the American Medical Association Surgery. As the Los Angeles Times reported: