Articles Posted in Gynecology

aspirinDoctors subject older patients to risky, costly, invasive, and painful tests and treatments, perhaps with good intention but also because they fail to see that the seniors in their care are individuals with specific situations with real needs that must be considered.

If  physicians too readily accept conventional wisdom in their field, for example, they may push patients 65 and older to take low-aspirin, with the popular but mistaken belief that this practice will help prevent heart attacks, strokes, and dementia. This doesn’t work, and, it increases the risk in seniors of “significant bleeding in the digestive tract, brain or other sites that required transfusions or admission to the hospital,” the New York Times reported.

The newspaper cited a trio of studies, published in the New England Journal of Medicine and based on “more than 19,000 people, including whites 70 and older, and blacks and Hispanics 65 and older. They took low-dose aspirin — 100 milligrams — or a placebo every day for a median of 4.7 years.”

cdcstd-2-300x238Although Americans may be having less sex, it’s getting riskier than ever, with the federal Centers for Disease Control and Prevention reporting that new cases of chlamydia, gonorrhea, and syphilis spiked for the fourth consecutive year in 2017 to a record high of nearly 2.3 million diagnoses.

“We are sliding backward,” Jonathan Mermin, a doctor and director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a statement. “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”

The sustained increases in the three common forms of sexually transmitted diseases worry public health officials for multiple reasons, not the least of which is that the infections, untreated, can result in infertility or pregnancy complications and increase the risk of HIV transmission.

HPV2NIHWomen 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.”

medicare-300x109Callous 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.

maternalmorbidity-300x193Here 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:

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.”

Nassar-Mich-AG-and-AP
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.

blkmom-300x222The 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.

gottliebThe  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.

https://www.protectpatientsblog.com/wp-content/uploads/sites/69/2017/04/hpv-vaccine-uptake-infographic.__v100248120-216x300.jpgMore 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.

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