Tests & Treatments

Information and new research about advances in discovering and treating diseases and conditions.

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Despite Obamacare, Big Gap in Substance Abuse Treatment

Jessica Schabel, 19, is under treatment at the Impact Drug and Alcohol Treatment Center in Pasadena for heroin and methamphetamine addiction. Her insurance benefits only allowed for 30 days, but the facility paid for her to stay an additional 30 days to continue treatment. (Heidi de Marco/KHN)

Jessica Schabel, 19, is under treatment at the Impact Drug and Alcohol Treatment Center in Pasadena for heroin and methamphetamine addiction. Her insurance benefits only allowed for 30 days, but the facility paid for her to stay an additional 30 days to continue treatment. (Heidi de Marco/KHN)

By Anna Gorman, Kaiser Health News

The nation’s health law has promised sweeping changes to help millions of people with drug or alcohol addiction get treatment. Many unable to afford services in the past now can receive them without first landing in jail or an emergency room, health officials say.

An old law bars many residential drug treatment centers from billing Medicaid.
“There is no illness that will be more favorably affected [by the Affordable Care Act] than substance abuse,” said A. Thomas McLellan, former U.S. deputy drug czar who now heads Treatment Research Institute in Philadelphia. “This is the beginning of substance abuse disorders being part of mainstream health care.”

The law requires that substance abuse treatment be offered to people newly insured through the insurance exchanges or Medicaid, the government health plan for the poor and disabled.

But serious impediments remain to widespread access, including a shortage of substance abuse providers and available beds nationwide, say treatment experts and government officials. Continue reading

Your Doctor’s Skill at Colonoscopy May Reduce Your Later Colon Cancer Risk

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If you’re going to go to the trouble of having a colonoscopy, you’d probably prefer that you get as much as you can out of the screening test. A new study this week shows that a doctor’s rate of finding and removing adenomas — these are pre-cancerous growths — is linked to the patient’s lower risk of developing colon cancer later.

For every 1 percent increase in adenoma detection there was a 3 percent decrease a person’s colon cancer risk. 

Colonoscopy is one of the recommended screening tests for colon cancer. Yet doctors have differing rates at how often they find these adenomas. This is the first study in the U.S. to look at the association between finding adenomas and later cancer risk, as part of a national review funded by the National Cancer Institute. It was published in the New England Journal of Medicine.

In the study, researchers at Kaiser Permanente Northern California reviewed more than 300,000 colonoscopies performed by 136 gastroenterologists between 1998 and 2010. Continue reading

50-Year Review: Mammography Benefits Oversold, Harms Minimized

(Getty Images)

(Getty Images)

By Nancy Shute, NPR

Two months ago, a widely publicized Canadian study found that mammograms did not reduce breast cancer deaths, but that study was fiercely criticized by the nation’s radiologists as “incredibly flawed and misleading.”

A few weeks earlier, an analysis found that screening all women annually starting at age 40, as the American Cancer Society recommends, costs $6.5 billion more a year more than following the U.S. Preventive Service’s Task Force recommendation that women be screened every other year starting at age 50.

Now, the latest entries — two studies that try to put all the previous research on mammography’s harms and benefits in perspective.

First, researchers at Harvard took a broad look at all the research on mammograms since 1960 — more than 50 years of study. They also looked at evidence on the harms of false positives and overdiagnoses, in which a woman is treated for a cancer that would never have proved deadly. And they reviewed whether current efforts to try to personalize a woman’s cancer risk helped a woman figure out whether it was worth her while to get a mammogram. Continue reading

Yes, It’s A Headache. No, I Didn’t Need That Brain Scan

Headaches are almost never caused by a tumor, say neurologists. (Getty Images)

Headaches are almost never caused by a tumor, say neurologists. (Getty Images)

Over at NPR, the Shots blog reports that Americans get $1 billion (yes, with a “B”) worth of brain scans every year — because they have a headache. That’s according to research at the University of Michigan.

Headaches are one of the most common reasons people go to the doctor  – up to a quarter of all doctor visits, says Shots.

Sending a billion dollars “down the drain.” Annually.
Presumably people are getting the scans because they’re worried that headache is a sign of something much more scary — say a brain tumor.

There’s just one problem. Most headaches are just that — a headache.

From the Shots post: Continue reading

Study: Estrogen Therapy May Help Some Older Women at Risk for Alzheimer’s Disease

Estrogen replacement patches. (Ian Waldie/Getty Images)

Estrogen replacement patches. (Ian Waldie/Getty Images)

Postmenopausal women have heard just about everything when it comes to hormone therapy. In the 1990s, doctors routinely recommended it, believing that it helped women avoid heart attacks, thinning bones and other problems of aging. Then along came the Women’s Health Initiative study, which first found hormone therapy (HT) created more risks than benefits – then found that over time some of those risks subsided, at least somewhat.

“It’s a very provocative finding, without a doubt.” 

But one main criticism of the Women’s Health Initiative study was that women were recruited to start on hormone therapy long after they had gone through menopause. The women were ages 65 or older.

Today, many doctors believe that HT started at the time of menopause — or soon after — can help women with hot flashes, vaginal dryness and other symptoms.

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New Autism Designation Likely a Central Topic at Statewide Conference

(Getty Images)

(Getty Images)

By David Gorn, California Healthline

A recurring theme at the annual California Association for Behavior Analysis conference starting today in Burlingame likely will be the new definition of autism in the medical community.

Does the new designation make it harder to get a key treatment covered? 
The national guidelines for doctors and other clinicians was updated last year. DSM-5 is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, put out by the American Psychiatric Association.

In DSM-5, there is a new category in the autism spectrum — social communication disorder, or SCD. Since there are no clinical guidelines for treating SCD, autism advocates worry the new designation could be used by insurance companies to stop covering applied behavior analysis (ABA therapy) in treating autism disorder.

“It’s likely a small percentage [of SCD children among those with autism spectrum disorder], but it definitely will affect some people,” said Karen Fessel, director of the Autism Health Insurance Project. “There are no guidelines put out by insurance companies yet, so likely there will be no adjustments till October this year.” Continue reading

HPV Vaccine Prevents Cancer, Yet Parents Slow To Make Sure Kids Get It

Studies show the HPV vaccine is highly protective, but as many as two-thirds of 11 and 12-year-old girls don't get it. (Art Writ/Flickr)

Studies show the HPV vaccine is highly protective, but as many as two-thirds of 11 and 12-year-old girls don’t get it. (Art Writ/Flickr)

By Patti Neighmond, NPR

You would think that a vaccine that could prevent cancer would be an easy sell, but that’s hasn’t proven to be true so far with the vaccine to prevent cervical cancer.

“This is a vaccine that protects against cancer; what could be better than that?”   

Just 33 percent of girls and less than 7 percent of boys in the U.S. have gotten all three recommended doses of the vaccine to protect against the human papillomavirus, which causes cervical and other cancers. Compare that to the tiny African nation of Rwanda, where more than 90 percent of sixth-grade girls were vaccinated in 2011, or Australia, where 73 percent of 12- and 13-year-old girls have gotten all three vaccines.

“This is a vaccine that protects against cancer; what could be better than that?” asks Shannon Stokley, an epidemiologist with the Centers for Disease Control and Prevention. She and other public health officials are trying to figure out the best ways to persuade American teenagers and preteens to get the HPV vaccine. Continue reading

In Light of the Mammogram Study: Two Thoughts on Breast Cancer

(Getty Images)

(Getty Images)

More evidence is in this week that casts doubt on the value of mammograms. To recap: Canadian researchers followed nearly 90-thousand women since the 1980s. The women were randomly assigned to mammography or physical breast exam. Now 25 years later, the researchers say that roughly equal numbers of women in each group died of breast cancer — mammography, according to this study, is not affecting the death rate at all.

In addition, mammography comes with harms. More than 1 in 5 cancers found in the mammography group were not ones that pose a threat to women’s health, the researchers say. Doctors call this “overdiagnosis.” This is a problem because the treatments for cancer are aggressive — surgery, radiation therapy, chemotherapy — and can cause harms in and of themselves. “There is no question that there is an excess in the diagnosis of tumors that are not going to kill you,” Dr. Laura Esserman, head of the UC San Francisco breast care center, told me, “We all know this phenomenon exists, but this quantifies it.”

Those are the headlines. Thursday morning, KQED’s Forum got into more detail. I was particularly interested in two points the guests made. The first was about new approaches to screening and the second was about screening as distinguished from prevention. Continue reading

Can Marijuana Help Children with Severe Epilepsy?

(David McNew/Getty Images)

(David McNew/Getty Images)

By Danielle Venton

Mark Kohr doesn’t smoke pot. But open his freezer and among the tamales and organic chicken strips, you’ll also find four pounds of cannabis. He plans to process the cannabis, worth about $900, into an oil for his daughter.

Camille, who is 13, has a severe, sometimes fatal, form of epilepsy known as Dravet Syndrome. Like many kids with Dravet Syndrome, conventional medications didn’t seem to work. Kohr says that the cannabis her parents prepare for her does.

“Here we are with one of the most difficult medical things to treat — seizures,” Kohr says. “And we’re making the medicine at home. Isn’t that the weirdest thing on earth?” Continue reading

Medi-Cal Expansion Opens Doors to Care for Transgender Patients

Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED)

Darryl Avery is a transgender man seeking medical care to complete his transition. (Angela Hart/KQED)

By Angela Hart

Among those estimated to enroll in the expansion of Medi-Cal, some of those most likely to benefit are among the most stigmatized in health care — transgender patients. Darryl Avery, 48, is one of them. Avery was born female, but identifies as a man. Several years ago, he began his transition. He moved to San Francisco where he sought medical care, stable housing, culinary schooling, and eventually, sex reassignment surgery.

“I’ve seen so many trans people with mental health problems, they get access to treatment, and it’s like you’ve flipped a light switch on.” 
“Where I grew up in New Jersey, there were no resources for me,” Avery said. “I never had anyone I could relate to until I moved here. I was no longer called a freak.”

Avery lives without a steady source of income. Because California is expanding its Medicaid program, known as Medi-Cal here, Avery now has access to health insurance. More than one million Californians are newly enrolled as of January 1.

And for people like Avery, who are seeking transgender care and sex-reassignment surgery, it’s a “big deal” says Dawn Harbatkin, Avery’s primary care physician who is also executive director for Lyon Martin Health Services, an LGBT-focused community health clinic on Market Street near San Francisco’s Hayes Valley neighborhood.

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