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.
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
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
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
(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
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.
The issue of how often a woman should be screened for breast cancer has been a topic of hot debate for years. But of the many different issues that are closely examined, cost is rarely among them.
Even mentioning cost typically gets patients somewhat understandably up in arms — no one wants her life to be determined by mere dollars.
But what if those dollars are being spent poorly? The harms of mammograms are well-known — false positives and overtreatment among them. What if reconsidering what we’re doing and how we’re doing it could actually lead to more lives saved?
Into the fray comes an analysis from several researchers, including Dr. Laura Esserman, a breast cancer surgeon with UCSF. They calculated the costs for screening mammography in the U.S. under different scenarios. Continue reading
If you’re like most of my colleagues in the newsroom, you read that headline and thought, “GREAT! What is the alternative test?!”
Here’s the quick background: Colorectal cancer is the third most common cancer killer in the U.S. A colonoscopy is an excellent screening tool. But more than one-third of people who are supposed to get it (that’s people ages 50-75) don’t.
Why? I think you can guess.
A colonoscopy is an invasive screening test that can involve missing one to two days of work, an inconvenient preparation process and then a “colonoscope is gently eased inside the colon and sends pictures to a TV screen,” the American Cancer Society says. Continue reading
A prescription label for the cholesterol-lowering drug Lipitor, a brand name statin medicine. (Tim Boyle/Getty Images)
Last Monday two major groups released a set of new guidelines designed to lower cholesterol. Now, it appears a major component of the guidelines — an online risk calculator — may be flawed, the New York Times reports.
Since the publication of the guidelines, two Harvard Medical School professors “evaluated the guidelines using three large studies that involved thousands of people and continued for at least a decade,” the Times reported. They knew the patients’ health status at the start and then they looked to see how many had had a heart attack or stroke in the next decade. How accurate was the new calculator in predicting risk? From the Times:
The answer was that the calculator overpredicted risk by 75 to 150 percent, depending on the population. A man whose risk was 4 percent, for example, might show up as having an 8 percent risk. With a 4 percent risk, he would not warrant treatment — the guidelines that say treatment is advised for those with at least a 7.5 percent risk and that treatment can be considered for those whose risk is 5 percent.
By Rob Stein, NPR
The Food and Drug Administration Thursday announced that it wants the federal government to impose tough new restrictions on some of the most widely used prescription painkillers.
The FDA said it planned to recommend that Vicodin and other prescription painkillers containing the powerful opioid hydrocodone be reclassified from a “Schedule III” drug to a “Schedule II” drug, which would impose new restrictions on how they are prescribed and used.
OxyContin, another opioid painkiller, is already a Schedule II drug, defined by the Drug Enforcement Administration as “potentially leading to severe psychological or physical dependence”.
In a statement posted on its website, the agency said it was taking the step after becoming “increasingly concerned about the abuse and misuse of opioid products, which have sadly reached epidemic proportions in certain parts of the United States.” Continue reading