Articles Posted in Testing

thyroid-300x222Check the neck? If you’re doing so routinely, especially if you lack worrisome symptoms or haven’t had past problems, please reconsider: Regular thyroid cancer screenings received a “D” grade from a blue-ribbon panel of experts. The exams can cause more harm than good, says the U.S. Preventive Services Task Force, which does periodic, evidence-based reviews of common medical screens.

Its most recent review finds cause for concern that doctors and hospitals, pushed by a prominent patient advocacy group that Big Pharma’s helping to underwrite, keep recommending and subjecting patients to unneeded thyroid cancer screens. The screens, with ultrasound and physician exams, too often lead to more tests, and then to painful, invasive, and costly procedures.

Doctors worldwide are detecting thyroid cancer at increasing rates, with the found incidences going up by 5 percent annually in this country. But at the same time, the relatively small numbers of thyroid cancer deaths haven’t budged. They’re neither rising nor falling. (See the diagram).

Prostate-e1492269148971-483x1024A burst of bad headlines and not so great news reports may have confused some men. But to put it in lay terms:  The use of the common test for routine prostate cancer screening got a dim grade of C for many men, up from a dismal D, in a re-evaluation by independent experts who assess the nation’s preventive medical services.

That blunt review of regular prostate-specific antigen (PSA) tests, despite some reports to the contrary, keeps with how the influential U.S. Preventive Services Task Force (USPTF) looked at annual  screening for this most common form of cancer for men when it issued its first guidelines in 2012, notes healthnewsreview.org.

The health information site says the USPTF earlier had surprised many, downgrading routine prostate cancer screening to a D, and noting, “There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” It now says it rates a C for many men younger than 70, meaning physicians should “Offer or provide this service for selected patients depending on individual circumstances,” and that “There is at least moderate certainty that the net benefit is small.”

peanutsAlthough many of us would like nothing better than to dote on a favorite baby all day long, medical experts have offered some surprising turnarounds and concessions for the new year about what they do and don’t know about infant care-giving.

They have made a 180-degree reversal on their advice to parents on dealing with the rising problem of peanut allergies, while also suggesting that a familiar product may be more useful than thought to combat a common skin woe. And they have said that 90 percent of the medications given to newborns aren’t approved for such uses by the federal Food and Drug Administration.

Feed the baby peanuts, docs now say

knee-replacement-300x240Uncle Sam is struggling to figure how best to ensure the safety, quality, and accessibility of a major surgery for a sharply rising number of seniors who need it and want the government, through Medicare, to pay for it. Baby boomers, after decades of running, dancing, aerobics, football, basketball, zoomba, and all manner of joint-stressing activity, are lining up for knee replacements. Where should these procedures occur and how should they be paid for and evaluated?

The New York Times has reported that surgeons, some in hospitals and some in free-standing surgical centers, are riven by proposed rule changes that would allow patients 65 and older with Medicare to undergo complex, extensive knee replacement operations on an outpatient basis.

The surgeons who now do these operations in hospitals say this is a risky move for patients, who now typically spend several days hospitalized in recovery. The “hospital” docs say knee replacement is a complex procedure, with high risk of infection and post-operative complications, because, for example, patients receive powerful clot-busting drugs and potent painkillers as part of the surgical regimen.

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Celebrity is a powerful force in public opinion, and it often has been pursued by medical experts eager to tap its do-good potential. But a pair of recent star turns on preventive testing have caused consternation over their unintended and unwelcome outcomes. Have Angelina Jolie and Ben Stiller led their fans astray, prompting some to misunderstand the best, most current, evidence-based thinking on cancer care and others even to undergo unnecessary, invasive, and costly screenings?

New research, published in the peer-reviewed and well-respected British Medical Journal (aka the bmj), examined the aftermath of Jolie’s disclosure, in a New York Times Op-Ed three years ago, that she had been tested and found to carry the BRCA gene mutation that predisposes some women to breast and ovarian cancer.

She urged women to be screened for BRCA and told how, prophylactically, she had decided to undergo a double mastectomy and reconstructive surgery. She said she did not make this decision lightly and did so only based on her mother’s early cancer death and after Jolie received extensive medical counsel. To Jolie’s credit, her Op-Ed was thoughtful, careful, and nuanced. It was more disclosure than advocacy by one of the globe’s mega-stars, partly explaining her prolonged absence from the spotlight’s glare. Although the piece said the BRCA mutation is not common and the decisions can be complex about surgery and other means to deal with its potential effects, did that message get through?

mdmaMental health experts aren’t suffering Sixties flashbacks. But they are seeing a new day for Molly (aka MDMA, Ecstasy, or 3,4-Methylenedioxymethamphetamine) and magic mushrooms (psilocybin). These hallucinogenic drugs are getting serious consideration in helping those with post-traumatic stress disorder (PTSD) and depression and anxiety due to cancer.

The federal Food and Drug Administration, which won’t comment on the matter, has approved Phase 3 clinical trials (large-scale human research) of MDMA for treatment of PTSD, according to  Multidisciplinary Association for Psychedelic Studies (MAPS).  

MAPS is a nonprofit research and educational organization that “develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana.”

Facts line up in some challenging ways:

Cranberries20101210Cranberry juice doesn’t work on urinary tract infections

Despite longtime belief in its potency, cranberry juice doesn’t help women with urinary tract infections (UTIs), new research confirms. Experts administered cranberry capsules to 185 female nursing home patients for a year. The standardized doses were equal to  drinking 20 ounces of juice daily. They fared no better with UTIs. That led the peer-reviewed Journal of the American Medical Association to editorialize that, “The continuing promotion of cranberry use to prevent recurrent UTI in the popular press or online advice seems inconsistent with the reality of repeated negative studies or positive studies compromised by methodological shortcomings. Any continued promotion of the use of cranberry products seems to go beyond available scientific evidence and rational reasoning.” JAMA says it is time not only to bust this myth but for proponents, including those who have a well-intentioned wish to find antibiotic alternatives, to “move on.”

Cytomegalovirus_01Although awareness has grown about viruses  like Zika that can devastate the unborn, cytomegalovirus (CMV), a much more common and equally harmful prenatal viral  infection, doesn’t get discussed with pregnant moms as much as it should. Medical counseling, testing, and administration of anti-viral medications could save more babies and their families from a lifetime of CMV woes.

More than half of adults older than 40 and one in three children by the age of 5 have been infected with CMV, a common virus in the herpes family. An estimated 1 in 150 babies gets infected at birth with CMV, with 1 in 5 of these infants sickened or harmed, including with hearing loss, microcephaly (a deformity so they have tiny heads), intellectual deficits or impaired vision.  This means CMV seriously harms as many as 8,000 youngsters annually across the United States, and it is fatal for about 400 infants.

Affected families and medical experts have told the New York Times that more needs to be done to increase CMV awareness, testing, and prevention, especially in comparison to the public health attention that has been paid to Zika and the damage it may inflict on the unborn.

spermeggjpgA reported rash of new lawsuits offers a poignant, sadly recurrent reminder: Aspiring parents who rely on commercial sperm banks for critical reproductive tissues must heed an ancient consumer prescription: caveat emptor. The New York Times says litigation, from Florida to California, Canada to the UK, all raises serious questions about the light or nonexistent regulation of assisted reproduction centers and the materials and services they tout. As the Times describes it, the latest suits highlight “claims of deception and negligence, and [add to] an array of challenges beyond the longstanding issue of undetected genetic problems,” in donor sperm.

The sperm banks, the paper notes, stand accused of “careless record-keeping, or mishandling or misappropriation of sperm banked for a client’s personal use. Others say the banks use hyped, misleading descriptions to market their donors.” The Times reports on cases in which banks have given out wrong tissues that may lead to offspring with serious genetic-related conditions, and from donors with bad or difficult histories, including cases in which mothers assert they have learned, post hoc, that they will bear children of a different race.

Regulators exercise minimal oversight over these operations, often mostly to ensure sanitary conditions in storage facilities and steps to try to curb transmission of disease.

Hypodermic-NeedleFederal officials have advanced a key way  to combat the zika virus, permitting clinical trials of a vaccine against the tropical infection.

The Food and Drug Administration has approved the preliminary testing  of GLS-5700, an experimental vaccine by Inovio, of Plymouth Meeting, Pa., and GeneOne Life Science, of Seoul, South Korea.

It is the first but not the only vaccine-based effort to attack zika, a rapidly spreading viral infection that afflicts most people in relatively mild fashion (fever, chills, muscle pains) but can cause severe deformities for the unborn if pregnant moms are exposed. Brazil, in particular, has struggled with hundreds of children born with microcephaly after their mothers were zika-exposed.

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