January 25, 2010

Radiation Therapy Treatment for Cancer Patients at All-Time High

For many years, radiation therapy has been considered one of the standard treatments given for cancer patients with more than half of all cancer patients receiving some type of radiation therapy. And while radiation does help save many lives, it also presents serious risks for patients and may cause life-threatening injuries or result in potential Illinois medical malpractice.

Medical%20Symbol%204.jpgTherefore, when radiation is used, safety rules must be strictly adhered to because sometimes even the most powerful and technicologically complex machines go awry. And while new technology allows doctors to more accurately attack tumors and reduce certain mistakes, its complexity has created new possibiliities for error through software flaws, faulty programming, poor safety procedures or inadequate staffing and training. When those errors and medical negligence do occur they can be devastating.

Hospitals and doctors trust computer systems and software to apply radiation in many cancer victims. However, there is no single agency that oversees medical radiation and no central clearing house of cases. Furthermore, radiation accidents are chronically underreported, and some states, including Illinois, radiation accidents are not required to be reported at all.

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December 23, 2009

New Risk Calculator Available For Bone Fractures To Women

Osteoporosis poses a serious health risk for women both in Chicago and nationwide. According to the National Osteoporosis Foundation, one out of every two women will experience an osteoporosis-related incident during their lifetime, compared to one in every five men.

Spine%20xray%202.jpgOsteoporosis is a condition characterized by thinning bones as people age. More fragile bones means that even low-trauma, seemingly minor falls can be debilitating and costly for those who suffer from osteoporosis. An estimated $17 billion is spent nationwide for treatment of fractures connected to fractures to those afflicted with osteoporosis.

Common treatment for osteoporosis involves placing the patient on medications that attempt to slow the disease's progression. However, there is some question as to at what point patients should be started on medications. For example, should patients whose bones are being to weaken be placed on medications even if they are not yet osteoporotic? Or how about those who have no history of any episode or prior fractures due to osteoporosis, but has osteopenia, a state of lower bone density that may or may not lead to osteoporosis?

To help answer these questions, the World Health Organization (WHO) devised a controversial tool called FRAX, an online risk calculator to help doctors and patients analyze the likelihood of future osteoporotic fractures and determine whether drug therapy might prevent them.

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December 11, 2009

Cancer Patient Saved by 43 Hour Ex Vivo Resection Surgery

A 59 year-old man with a large tumor on his liver recently underwent a grueling 43 hour surgery to remove the tumor and give him a new lease on life. The lengthy surgery was performed by a team of physicians at New York Presbyterian Hospital/Columbia University Medical Center.

Scrubs%202.gifThis particular surgery is unique in that it was an ex vivo resection, which essentially involves removing the organs and operating on them outside the body. This type of procedure is done when tumors cannot be treated or removed in any other way. Once the tumor is removed, the organs are returned to the body and sewn back in.

Ex vivo resections are highly complicated and can require the work of dozens of surgeons and anesthesiologists, which is in turn reflected in the high cost of the procedure. However, according to one of the surgeons in the present case, Tomoaki Kato, MD, "If you don’t do it, the patient would have no chance to live." Dr. Kato has been the lead surgeon in about 16 ex vivo operations and assisted in half a dozen others.

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December 9, 2009

High Blood Pressure Could Be Better Controlled By Applying Teamwork Approach

High blood pressure is a fairly common complaint among Americans. A new study has shown that many Illinois and American patients with high blood pressure have a difficult time keeping their blood pressure under control. Generally, fewer than 40% of Americans with high blood pressure have their hypertension under control.

Pills%20C%202.bmpThe Midwest study was conducted by researchers at the University of Iowa. The clinical trial involved over 400 patients with uncontrolled hypertension, i.e. high blood pressure, who were treated at six different clinics around the Midwestern state. While all of the clinics employed clinical pharmacists, only three of those clinics had the pharmacists teamed with physicians.

The outcome of the new study suggests that results can improve if the physician and pharmacist work together as a team to help lower blood pressure. After six months, 53.9% of the patients who were being cared for by a doctor/pharmacist team had gotten their blood pressure under control, compared to 29.9% of the patients of the regular care group.

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November 30, 2009

Diabetes on the Rise Could Lead to Higher Insurance Costs

It is predicted that the number of Americans with diabetes would nearly double over the next 25 years. At the same time, the cost of care would almost triple as patients live longer and develop more of the disease’s long-term complications.

Med%20Money%203.gifA University of Chicago researcher, Dr. Elbert S. Huang, the lead author of a recent paper says that, “In 25 years, there is going to be this convergence of the population getting older but also many people having had diabetes for a long period of time, and that would lead to higher costs”.

The projections estimate that the population of diabetic individuals will rise to 44.1 million by the year 2034. At the present time there are approximately 23.7 million persons afflicted with diabetes with medical spending increasing to $336 billion from $113 billion.

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October 28, 2009

Heart Valve Replacement Surgery To Be Made Safer

Leading heart valve manufacturers Edwards Lifesciences and Medtronic are racing each other to perfect new heart valves that could revolutionize heart valve replacement surgery. The new heart valves would result in a less-invasive surgery because they can be inserted via catheters without the requirement for an open heart procedure. And because the procedure is less invasive, more people would be candidates to receive valve replacements. Currently there is a significant population of critically ill or elderly patients who are considered too frail to undergo open heart surgery and therefore are not able to receive new heart valves.

Heart%20Anatomy%202.jpgThe new heart valves have been available in Europe for 18 months and have thus far yielded positive results. Medical trials of the valves are being conducted in the U.S. amongst older, critically ill patients who are not candidates for open heart surgery. Medical experts predict that if the devices live up to their makers’ claims they could revolutionize heart valve replacement, a common heart operation, and extend the lives of thousands of frail patients who are not now considered candidates for the open heart surgery.

An estimated 20,000 people die annually from heart valve-related diseases, including those too sick to withstand the open-heart surgery. The new valves would be meant to enable more such patients to have life-saving valve replacements. Furthermore, a less risky surgery lessens the possibility of transplant errors from occurring.

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August 31, 2009

Arthritis Pain Can Be Eased By Certain Foods Found in Mediterranean Diet According to Several Studies

Arthritis is becoming more and more of a common problem with research showing that as many as one in four Illinois residents suffering from some form of arthritis. Oftentimes there is no cure for arthritis so scientists are constantly searching for methods of alleviating arthritis pain.

Elderly%20Hands%202.jpgA recent diet analysis involving various types of arthritis examined data from more than 800 patients taken from 15 studies. The analysis focused on several diets that were popular among arthritis patients.

A Mediterranean-style diet was found to be the most effective and emphasized eating fruits, vegetables, grains, fish, and olive oil while also limiting red meat consumption. Over a 12 weeks those on this diet reported about a 15% reduction in joint pain, but showed no improvement in morning stiffness or physical function.

The study showed that similar results could be achieved through a vegetarian diet that included eggs and dairy. Other research has suggested that consuming daily capsules of fish oil along with antirheumatic medications yielded greater benefits for tender and swollen joints than when the medications were taken on their own. These results are suspected to be due to the anti-inflammatory properties of oils.

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August 17, 2009

Asperger’s Syndrome Draws Attention As Subject of Three New Movies

Over 20 years have passed since we were introduced to Dustin Hoffman's portrayal of an autistic man in "Rainman". Since then there has been little or no film portraits of Asperger’s syndrome, a complex and mysterious neurological disorder linked to autism, but that will all change this year as three upcoming films offer a broader view of autism disorder.

movie-reel%201.jpgThe first of these films, "Adam", has already been released and has garnished significant attention, including receipt of the Alfred P. Sloan Prize at the Sundance Film Festival for outstanding feature films focusing on science and technology. The film centers on the life of an adult male with Asperger's syndrome and a passion for astronomy and his romance with a neighbor.

Adam is portrayed as a young man with Asperger’s who is left to defend for himself after his father dies. Adam is about life, not his disability. It uses Asperger’s as the lens that views his life. The movie is about relationships, love and family. It is now playing at the Evanston Theater on Maple Street in Evanston, Illinois.

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August 12, 2009

Chemotherapy Patients Acknowledge Memory Loss

Two years ago The New York Times published an article dealing with chemo brain, a type of mental fog experienced by cancer patients. Recent research has indicated that this phenomenon might be more widespread than previously believed.

Stethoscope%202.jpgWhile memory and concentration problems are common among chemotherapy patients, for most these effects are short-term and their cognitive function returns to normal. However, for about 15 percent of these patients the memory impairment is prolonged. It is these patients who are suffering from chemotherapy-induced cognitive impairment, or "chemo brain".

Many studies are being done to try and pin down the cause of chemo brain. Some researchers are exploring whether there is a connection between hormonal changes from chemotherapy and chemo brain, while others are examining which drugs have the strongest links to chemo brain. Yet there are some therapists who argue that chemo brain is the result of the psychological strain of cancer and can be attributed to anxiety, depression, stress, fatigue and fear rather than direct effects of chemotherapy on the brain.

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August 7, 2009

Child Birth Injuries And Maternal Deaths On The Rise In Poor Countries

A recent New York Times editorial caught my eye about a woman in Pakistan who lost her baby after a long, difficult labor and delivery. Her experience was used to demonstrate the lack of emphasis placed on medical practices that we in America take for granted, such as giving birth to your child at a hospital, and the effect that this has on maternal and child birth injuries in impoverished countries.

Pregnant%20Woman%201.jpgRecent research suggests that worldwide perhaps as many as one woman dies every minute from complications of pregnancy or childbirth, which is about 20 times greater than the number who have suffered childbirth injuries. As a firm we have taken on several Illinois birth injury cases and there are no words you can offer the family for their loss and pain. What is so striking about The New York Times article is that it suggests that these startling statistics could improve if more emphasis was placed on maternal well being.

For example, while Sri Lanka is an impoverished country it has succeeded in saving more mothers because it simply has tried to do so. And while this sounds like an oversimple solution in our country where a great deal of emphasis is placed on prenatal care and delivery, in impoverished countries this is not the case. The girl portrayed in the article was not taken to a hospital until after she had already been in labor for over 24 hours. By the time a c-section was performed her baby was already too weak to survive. If she had been taken to the hospital and followed by medical professionals from the start of her labor then the outcome might have been different. Yet this is not the standard in her native Pakistan, where one in 74 woman die from pregnancy complications.

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July 8, 2009

Medical Advances Expand Kidney Transplants

The number of Americans and Chicagoans suffering from chronic kidney disease has drastically increased in recent years, driven by high rates of hypertension and diabetes. Likewise the reported cases of patients with end stage renal disease has risen, which can only be treated with dialysis or a kidney transplant. And despite improvements in dialysis technology and the possibility of transplant errors, the transplant remains the most effective and preferred treatment due to its better long term outcomes and quality of life.

Kidneys%201.jpgAccording to the National Kidney Foundation, almost 80,000 Americans are currently on a waiting list for a new kidney. However, not everyone is considered a prime candidate for transplant surgery.

Consider the case of a stunned patient suffering from kidney failure who was informed by a group of physicians that her mother's attempts to donate one of her own kidneys was out of the question. Like 3 out of 10 kidney-transplant candidates, this patient had tested positive on a panel reactive antibody (PRA) blood test, which revealed that the patient had high levels of PRAs, or proteins that attack foreign tissue. So even though her mother's kidney would have been a good match based on its blood type and tissue, the patient's body would have attacked it.

Until recently patients with high PRA levels had little chance of success for transplantation and were oftentimes forced to remain on dialysis. In fact, as recently as 10 years ago a kidney transplant was absolutely contradicted for patients with high PRA levels. Increased PRA levels can be caused by blood transfusions, pregnancy, or a previous transplant.

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July 1, 2009

Birth Injury Reduction Unlikely to Occur Under Revised Fetal Monitoring Strip Guidelines for Doctors in the Delivery Room

The current standard for labor and delivery practices is to use electric fetal monitoring (EFM) to evaluate a baby's status. Physicians and nurses will review the EFM readings in order to reduce the risks of a birth injury, such as erb's palsy or cerebral palsy (CP), and death as a result of inadequate oxygen to the fetal brain. However, there is some concern regarding whether the EFM does more harm than good due to inconsistent interpretations of the EFM strips by both physicians and nurses.

Fetal%20Monitoring%20Strips%201.gifEFM has been used in the labor and delivery setting since the early 1970s. Essentially the EFM monitors the fetal heart rate and reproduces the fetal heart tracings on both a screen and paper to enable the medical staff to determine when a baby is distressed. The readings are ultimately used to determine if the baby needs to be delivered surgically by Cesarean section or can be delivered vaginally.

However, unlike a basic medical marker like temperature or blood pressure which is not subject to interpretation, the EFM tracings can be interpreted differently by different doctors. Depending how the individual physician interprets a monitoring strip there can be a difference in opinion about the proper course of action. Recent information has show an increase in the number of c-section deliveries. For example, in Chicago almost 40 percent of deliveries are done via Cesarean.

Some critics say that this rise in c-section deliveries is the result of an increased fear among labor and delivery physicians of potential medical malpractice litigation. While a Cesarean is not necessarily a dangerous option, it still carries risks for both the mother and infant and is much more expensive than a simple vaginal delivery.

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May 22, 2009

Medical Industry Gifts To Doctors To Be Made Public

Vermont recently enacted a law (S.48) requiring doctors to publicly disclose any and all medical industry payments they receive. Under the law 'medical industry payments' includes any money and/or gifts made to healthcare providers. The healthcare providers are required to specify the names of the gift givers and the corresponding dollar amounts. The new law goes a step beyond just making all gift exchanges a matter of public record and bans nearly all industry gifts to doctors, nurses, medical staff, pharmacists, health plan administrators and healthcare facilities.

Gift%20Box%201.jpgAfter the new law goes into effect on July 1, 2009, state citizens can learn which doctors have been paid by manufacturers of brand-named drugs that they have been prescribing their patients, or how much money surgeons have received from the makers of stents, pacemakers, artificial knees, and other implant devices. The law is designed to provide a window into the considerable efforts and spending by device and drug makers to influence doctors.

This law, and others like it, is in response to concerns that drug and medical device manufacturers exert too much influence over doctors and their practice. For more information on this debate, please see our March 2009 blog "Do Drug Companies Really Influence Doctor’s Decisions Regarding Dispensing Drugs to Illinois’ Residents?".

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May 21, 2009

Cancer Patients Sue Over Gene Patents

Advances in the field of genetics has made for some exciting medical advances in the past few years. For example, the sequencing of the human genome has led to many medical breakthroughs. Furthermore the availability of more genes and sequences has increased research in the use of gene patterns to silence human tumors and allowed for better classification of tumors and disease. Genetics can also be used to predict a client's prognosis and potential response to various anti-cancer treatments.

Genes%202.jpgRecently a lawsuit was filed against Myriad Genetics, a gene company that owns a patent on BRCA1 and BRCA2, two genes closely associated with increased risk for breast cancer and ovarian cancer. The patent system gives companies like Myriad the ability to exclusively promote its innovations and allows for substantial research and development investments. The result is that the patent restrictions allows Myriad to restrict others from measuring the risk the gene poses for closely associated cancers.

The New York lawsuit against Myriad was brought by the American Civil Liberties Union (ACLU) on behalf of the plaintiffs. The case blends medical science, patent law, breast cancer, activism and an unusual civil liberties argument that could make this case a landmark.

While Myriad Genetics is the defendant in the lawsuit, the plaintiffs claim that they have a bigger bone to pick with the U.S. patent office than they do with the company holding the gene patent, i.e. Myriad.

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April 29, 2009

Dementia Up in Patients with Type 2 Diabetes – Linked to Drops in Blood Sugar

A long term study of older patients with Type 2 diabetes found that those who had experienced even one episode of hypoglycemia, or life threatening drops in blood sugar, were at a higher risk for developing dementia than diabetic patients who had not experienced such an episode.

Diabetes%201.jpgThe findings to be published in the Journal of the American Medical Association are significant given the high rate of Type 2 diabetes patients in the world and the expectation that dementia rates will increase as the population ages.

“We’ve known for some time that patients with Type 2 diabetes are at greater risks of dementia and cognitive problems,” said Rachel A. Whitmer of the Division of Research at Kaiser Permanente in Oakland, California. “This adds to the evidence that balance of glycemic controls is important, and that trying to aim for a very low glycemic target might not be beneficial and it might even be harmful.” Ms. Whitmer is one of the authors of this article.

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April 24, 2009

Hospitals in Illinois and U.S. Report C. Difficile Bacteria Causes 350,000 Infections Each Year

Recently, a local Chicago doctor working in a Veterans Affairs Hospital recognized signs of clostridium difficile, also known as C. difficile, a contagious and potentially deadly bacteria that is difficult to track. The illness kills an estimated 15,000 to 20,000 people annually with most of the cases occurring in health care settings.

Bacteria%201.jpgThe Chicago public health community has been sounding the alarm for years about the overuse of antibiotics and the emergence of “super-bug bacteria” that have developed an immunity to a wide number of antibiotics.

“One of the things that we consult consumers about is to make sure that an antibiotic is really necessary,” said Dr. Dale N. Gerding, an infectious disease specialist at the Stritch School of Medicine at Loyola University in Chicago. “There are many good reasons for taking an antibiotic, but an illness like sinusitis or bronchitis winds up being treated with antibiotics even though it will go away by itself anyway.”

C. difficile is not a new illness, but it appears to be spreading at an alarming rate. The rate of C. difficile infection among hospital patients doubled from 2001 to 2005. The rise in C. difficile cases around the world is linked with the growing use of all the antibiotics, particularly a class of drugs called fluoroquinolones, which came into widespread use around 2001. The use of acid-suppressing drugs, including proton pump inhibitors like Prilosec, also may be a risk factor.

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April 17, 2009

Cervical Cancer Causing Virus Can Be Tested with New DNA Test as an Alternative to a Pap Smear

A new DNA test has been developed by Qiagen to identify the human papillomavirus (HPV), a virus found to be associated with cervical cancer. Scientists state that this new test is an improvement on current testing methods and might eventually replace the Pap smear test as a way to diagnose HPV.

DNA%201.bmpEarly diagnosis is key in fighting all types of cancer, including cervical cancer. In fact, the most common pitfall doctors fall into regarding patients with cancer is failing to diagnose cancer early enough to provide treatment. This new test could reduce the number of missed cervical cancer cases and improve cancer patients' outcomes.

The optimism around this new DNA test is based on the results of an 8-year study of 130,000 women in Indian that was recently published in the New England Journal of Medicine. The study, financed by The Bill and Melinda Gates Foundation, revealed that a single screening with the DNA tests met all the same standard as all other methods of early diagnosis of cancer.

Similarly, a study by the University of Chicago reports that a predictive model based on family history of breast or ovarian cancer can aid genetic counselors in diagnosing breast cancer in African women. Development of genetic testing for different ethnicities is important because research shows that genetic mutations vary among racial and ethnic groups.

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February 17, 2009

Spinal Cord Injury Clinical Trial Given Go-Ahead to Inclue Stem Cell Research

The U.S. Government has given the go-ahead for the world’s first test in people of a therapy derived from human embryonic stem cells. The federal drug regulators have said that political considerations had no role in this decision. It did however coincide with the inauguration of President Obama who has pledged to remove the restrictions placed on the field by the previous administration.

Stem%20cells%201.jpgThe FDA approval comes a little more than 10 years after the first human embryonic stem cells were isolated at the University of Wisconsin. Because these cells can turn into any type of cell in the body, the theory is they may one day be able to provide tissues to replace worn-out organs or non-functioning cells to treat diabetes, heart attacks and other diseases. The field is known as regenerative medicine.

The clearance of the clinical trial is to be announced by the biotechnology company, Geron . The trial focuses on treating spinal cord injuries, which could help people suffering traumatic injuries from car accidents or motorcycle accidents. When Geron first applied to the Food and Drug Administration to conduct the trial last March their request was refused and more information was requested about the trial.

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January 19, 2009

Elevated Blood Sugar Linked To A Poor Memory

The other day my wife and I were trying to remember what we had for dinner the night before at a local Chicago restaurant. According to a new study, our rich dessert might be to blame for this temporary memory loss.

Gumdrops%201.jpgThe new study showed that spikes in blood sugar affect the dentate gyrus, which is the area of the brain that helps form memories. Researchers found that effects can be seen even when levels of blood sugar or glucose are only moderately elevated. This study could be provide a reason for declining cognitive abilities because glucose regulation worsens with advanced aging.

According to Dr. Scott A. Small, the lead investigator on the study, "If we conclude this is underlying normal age-related cognitive decline, then it affects all of us.” Typically the body's ability to adjust glucose begins to decline by the third or fourth decade of life. However, the degree of decline can be improved with physical exercise, which tends to improve glucose regulation. According to Dr. Scott physical exercise can then be seen as a behavioral recommendation.

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January 12, 2009

Illinois Reports That Dangerous Drug Interaction Could Affect Older Adults

A new study by researchers at the University of Chicago Medical Center has stated that at least 2.2 million U.S. adults take medicine in combinations that could trigger dangerous drug interactions. Some of the possible dangerous interactions include muscle breakdown, gastrointestinal bleeding, disruption in heart rhythm, and other serious problems.

Pills%20Hands%201.jpgPerhaps even more alarming is that at least half of these dangerous interactions involve the use of over-the-counter medications, such as aspirin or dietary supplements. According to the study, one in 25 older adults are at risk for serious drug interactions, the study has found. And for men ages 75 and 85, the risk is as high as 1 and 10.

However, the risk might be even higher because the research focused on major interactions among the 20 most common drugs and dietary supplements. “The public has an awareness that two prescription medications used together might be dangerous,” said the study author, Dr. Stacy Tessler Lindau. Lindau is the assistant professor of geriatric medicines, obstetrics and gynecology at the University of Chicago Medical.

The dangerous drug interactions cited in the study were more a byproduct of individuals unknowingly mixing medications rather than the result of pharmaceutical prescription errors by medical providers.

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December 17, 2008

New Study Finds Widening Gap in Colon Cancer Occurrences Among Different Races

In the 1970s the occurrences of colon cancer were equal for blacks and whites. Then in the mid-1970s blacks began to show higher rates of colon cancer, with a large jump in black mortality rates in the 1980's. The American Cancer Society stated that current instances of colon cancer are 50 percent higher in blacks than in whites.

Stethoscope.jpgExperts blame this trend on the lower rates of screening among blacks as compared to whites, and less access to quality healthcare. Physicians have encouraged colon screening as a way to early diagnose any colon problems, including colon cancer. Currently the screening rate for whites is 50 percent compared to 40 percent for blacks.

Yet if this were the reason for the widening gap then Hispanics, who traditionally undergo even less regular screening and have lower quality healthcare than blacks, would have higher rates of colon cancer than blacks. But in reality Hispanics are less susceptible to colon cancer than both blacks and whites, despite a screening rate of only 32 percent.

This paradoxical lower death rate is not unique to colon cancer. Researchers have found that poorly insured Hispanics have fared better than whites and blacks in several measures of cancer and heart disease.

Physicians admit that there is no reasonable explanation for the disparity in the rate of colon cancer deaths among whites, blacks and Hispanics. However, physicians recommend that everyone get regular check ups and colonoscopy exams from age 50 and up.

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December 15, 2008

Therapeutic Hypothermia: Studies Show it Could Effectively Treat Cardiac Arrest

Recent studies have shown that decreasing body temperature through the use of the therapeutic hypothermia method increases the chance of surviving a heat attack. The practice of cooling patients was endorsed by the American Heart Association in An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation , and is starting to influence hospital critical care practices nationwide. Therapeutic hypothermia involves cooling the body's temperature for 24 hours and then gradually returning it to normal temperature in an effort to slow cerebral metabolism.

Ambulance1.jpgThe University of Chicago Hospital has adopted the practice and developed a Therapeutic Hypothermia Protocol for dealing with emergent cardiac arrest patients. Other cities have taken it a step farther by requiring that hospital emergency rooms are capable of performing therapeutic hypothermia.

On January 1, 2009, New York City will institute a rule that ambulances may only transport certain cardiac arrest patients to hospitals that have cooling systems available, even if it is not the closest hospital. The idea behind this new initiative is that the benefits of therapeutic hypothermia outweigh the benefits of a speedy arrival at a hospital.

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December 10, 2008

When MRI Scan Shows Abnormalities They May Not Be the Cause of the Problem

It has become more commonplace in Chicago medical circles to order an MRI scan early on in the assessment process. Most Chicago and Illinois doctors view MRI scans as a useful tool to get to the bottom of a patient's symptoms and aid them in diagnosing problems from headaches to foot aches.

mri_scannerlg%201.jpgFor example, if you come in complaining of constant knee pain then your physician may order an MRI scan. Let's say that the MRI scan shows torn cartilage and your physician tells you that surgery is the only way to relieve your pain and fix the problem. So you undergo surgery and then physical therapy, but still are experiencing the same pain. Eventually you find out that the torn cartilage was not responsible for your pain- your newly diagnosed arthritis was.

More and more we see patients who have some sort of irregularity on an MRI scan that may not necessarily be responsible for their medical problems. This is a particularly prevalent problem among the millions of people who go to doctors complaining of constant pain. Many of these patients demand that a scan be done to determine why their pain persists.

But in many cases it's not clear whether what is shown on the scan is the real cause of pain. Take our above hypothetical- the scan did show torn cartilage which in time was determined to not be the pain's cause, but not until after numerous procedures and many dollars later. This lack of a definitive cause is leaving many people in a medical conundrum of whether to have what amounts to unnecessary surgery that could make their condition worse, or do nothing decisive at all.

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October 17, 2008

United States and Illinois Fall Behind Other Countries in Infant Death Rates: What Does This Say About Quality of Health Care?

Even though a recent study showed infant death rate declining by 2% in the United States and Illinois declined recently, the percentage of decline is much less than in prior years. In fact, this is the smallest decrease since we first began recording the infant death rate in 1907. This trend is compounded by the fact that Illinois and the U.S. have more infant deaths than most other industrialized countries, a trend that has worsened with each passing year.

Line%20Graph%201.jpgEach year more than 28,000 infants under one year-old die in the United States. Two-thirds of these infant deaths are preterm babies. In 2006, 6.71 infants died in the United States for every 1,000 live births. In 2006, Illinois was well above the national average with 7.2 infants deaths for every 1,000 births. Illinois's death rate seems even more startling when compared with that of other countries. In 2004, twenty-two countries had infant mortality rates below 5.0 infant deaths for 1,000 live births, and many Scandinavian and Asian countries posting rates below 3.5.

The infant death rate is important because it is used as an international indicator of a nation's health and quality of medical care. So even though individuals in the United States spend a much larger portion of its income on health care than those in other industrialized nations, we continue to fall short of the international standard. In 1960 the United States had the 12th lowest rates of infant mortality in the world. But by 2004 we had dropped to 29th lowest, the same rank as Slovakia and Poland.

If we are spending so much more than these other countries, why are we falling further and further behind the world-wide standard? Some look towards recent trends in preterm births, Cesarean deliveries, and other types of birth injury as the source of this problem. Others feel the problem is due to cultural issues, like drug use and obesity. And yet another group feels that the decentralization of our health care system is to blame.

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October 8, 2008

Medical Credit Card- Beware of Chicago and Illinois Hospitals' New Methods of Securing Payment for Medical Bills

Hospitals and doctors have begun to explore new ways of obtaining payment for their billed services. However, oftentimes these hospitals and doctors are only looking out for their best interests, not their patients'.

Medical%20Money.jpgHealth care providers have teamed up with credit card companies to create a 'medical credit card', which is essentially a credit card that can only be used on medical purchases. You can fill out an application in your doctor's office and get approved while sitting in the waiting room. From a doctor's perspective this is ideal because they receive instant payment for their services. But oftentimes the patient is the one who loses.

Patients are lured in with low interest rates and the ease of applying, but are not told that if they miss one payment the interest rates skyrocket. Also, some patients have reported that they didn't even know they were applying for a credit card- they thought they were signing a financial payment agreement with their doctor. Not to mention that when these credit cards are offered to patients they are often in need of care, so their focus is more on their treatment and not their finances.

Another way hospitals have started to solve the problem of unpaid medical bills is to obtain a patient's credit report. Hospitals attest that they only use these reports to determine whether they should offer charity care or if they should pursue them through bill collectors, but some worry that there is an ulterior motive. Hospitals are only required by law to treat patients with an emergency problem, or who constitute a medical necessity. So what's to stop them from turning you away if they find out you have bad credit?

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September 26, 2008

Doctors Spread Infection Through Contaminated Scrubs

Hospitals in Chicago and nationwide could be affected by new evidence that suggests that doctors and nurses could be spreading infectious diseases through contaminated scrubs and clothing. Given all the new antibiotic-resistant disease, like methicillin-resistant Staphylococcus aureus (MRSA), now it is more important than ever to stem the spread of infection.

Scrubs%201.gifChicago and Illinois hospitals have initiated programs advocating that medical providers wash their hands frequently to prevent spreading infection to their patients. And while this is a proven measure to stem the spread of diseases, physicians' clothes and scrubs can still carry infection from patient to patient. Not to mention that when medical providers continue to wear their hospital clothes outside of the hospital, whether their scrubs or own clothes, then they can carry and spread infections to other areas.

The idea of clothes as a means of transferring infections is a fairly new concept, and as of yet there aren't any definitive studies proving the extent of harm that can occur. But a recent U.S. study showed that if a hospital worker is in the same room as a patient with MRSA, then the bacteria ends up on their clothes 70% of the time, even if the employee had no physical contact with the patient. This discovery was particularly disturbing because it has been proven that bacteria and disease can live on fabrics for long periods of time.

Given the amount of interaction hospital employees have with numerous sick people throughout the course of their workday, there is an overwhelming likelihood that an employee is carrying some sort of bacteria. But what is the solution? If everyone is walking around in a hospital harboring disease in their very clothes, then how can they avoid transferring to others?

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September 17, 2008

Chicago Residents Size Up MRSA and Other Superbugs: What You Should Know

It's becoming all too common of a tale in Chicago, Illinois and across the country- you go into your hospital for a simple procedure and end up being contaminated by an antibiotic-resistant bacteria. The prevalence of these resistant infections occurs more and more and is not going away any time soon.

Virus%201.jpgPerhaps the most well-known of these is methicillin-resistant Staphylococus aureus (MRSA), a type of "staph" infection that is resistant to the broad spectrum antibiotics typically used to treat it. However, unlike many of the other superbugs coming to light, MRSA can be treated with alternate antibiotics. But the fear is that in time MRSA will also become resistant to these alternative antibiotics.

And while MRSA can still be treated by current medications, there are numerous "superbugs" out there that are virtually untreatable. One of these is Klebsiella, a bacteria similar to MRSA, except that it has an extra cellular layer that blocks out antibiotics that MRSA lets in. And strains resembling Klebsiella are becoming more prevalent, both in hospitals and within our community.

Why Are Bacteria Becoming Resistant to Antibiotics?
Since the introduction of antibiotics in the mid-twentieth century, bacterial infections were suddenly curable. Antibiotics soon became a cure-all and were prescribed to treat not only bacterial infections, but also for viral infections, even though antibiotics have no effect on them. Because of the widespread use of antibiotics, the bacteria soon began developing resistances and the common antibiotics no longer worked.

For awhile drug companies continued to develop new antibiotics to treat these mutations. Eventually, however, many of these sames pharmaceuticals withdrew from this area as the complexity of the research increased and profits decreased. So now we are not only seeing more and more bacteria that are developing resistances to common antibiotics, but we are developing fewer new treatments for these new strains. In short, we are quickly returning to the days before antibiotics were even invented- when bacterial infections were untreatable.

They're Scary and They're Out There- Now What?

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September 12, 2008

Autism Vaccine Debate Continues: New Study Further Contests Link

For the past decade there has been a heated debate over the link between the Measles/Mumps/Rubella (MMR) vaccine and instances of autism. A new study adds further weight to the argument that there is no link between the two, but like all prior studies, does nothing to definitely disprove the opposing view.

Child%20Vaccine%202.jpgThe new study was done by researchers from Massachusetts General Hospital, Columbia University and the Center for Disease Control and Prevention. In it they tried to duplicate prior findings that showed the MMR vaccine caused autism, but were unable to do so. As has happened with many other medical studies, this recent one found no evidence that the MMR vaccine caused harm or was in any way linked to autism.

However, those who believe that autism is directly linked to the MMR vaccine are not convinced that the lack of a causal link in this recent study scientifically proves that they are not related. Many of the proponents of the vaccine causing theory have directly witnessed the development in autism in their child after they received the MMR vaccine. For these people nothing short of evidence that refutes the link beyond a shadow of a doubt will do.

Why Do People Think There's A Link Between Vaccines and Autism?

Many parents began to notice that their children began to display autistic symptoms around the same time they received multiple vaccines. Additionally, a British study by Wakefield et al developed the theory that the MMR vaccine did in fact cause autism. However, it is important to note that it has seen come out that the Wakefield study could have been compromised because the lead researcher had a conflict of interest- part of the study was funding by a legal group involved in bringing cases against drug companies that distributed the MMR vaccine.

But again, while the medical community has not come up with any definitive evidence to refute this link, they have not come up with any evidence to support it. To explain why autism developments following administration of the MMR vaccine, scientists have suggested that the symptoms of autism manifest themselves around the same time that children receive these vaccines.

Regardless of which side of the debate you are on it is clear that too little is known about the cause of autism. Research should be directed at finding what leads to autism and how it can be prevented or cured.

Should My Child Receive Vaccines?

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September 4, 2008

How to Prepare for the Chicago Winter: New Studies Show Flu Vaccine May Be Ineffective For Elderly

Every fall my now 93 year-old mom calls and reminds me that with the Chicago winter on its way, it is imperative that I get my annual flu shot. Being an obedient son, I comply by hustling over to the nearest clinic to get that shot. And of course, my mom also gets her prescribed flu shot and has thankfully avoided the dreaded flu during the winter season.

SyringeA%201.jpgBut now immunologists are coming forward with new studies reporting that the vaccine doesn't work very well for those over 70. Yet the over 70 age bracket accounts for 75% of all the flu deaths.

When explaining the drastic shift in these new studies, researchers pointed to the faulty logic used in prior studies. Instead of evaluating the effectiveness of the vaccine against the flu, the studies instead seemed to support evidence of who received the shot and who didn't.

People who are health conscious, like my mom, are more likely to get an annual flu shot. Whereas people that are frail and have trouble taking care of themselves are less likely to leave home to get the vaccine. And this second group is at greater risk of death, with or without the flu shot.

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August 20, 2008

U.S. Supreme Court Receives Unsolicited Drug Safety Advice From Top Doctors Questioning the FDA's Ability to Protect Patients

The United States Supreme Court is expected to hear the case of Wyeth v. Levine this November which could have far reaching implications as to pharmaceutical litigation cases against drug companies, including those in Illinois and the Chicago area. Syringe%201.jpg The legal advice comes from top doctors and editors of the New England Journal of Medicine who have submitted a friend-of-the-court brief. The doctors state that the Food and Drug Administration (FDA) “is in no position” to guarantee drug safety. The doctors went on to to say that lawsuits can serve as “a vital deterrent” and protect consumers if drug companies don’t disclose risks.

The underlying case is about Diana Levine, a Vermont guitarist, who lost her right arm below the elbow after being injected with the drug Phenergen, a medicine used mostly for nausea. She sued the drug manufacturer, Wyeth, contending that the drug company had a duty to warn consumers that injections, like the one she experienced, could have devastating consequences. The state courts in Vermont agreed with Ms. Levine in awarding her nearly $7 million.

But Wyeth appealed stating that it was protected from such lawsuits. It argued that the FDA’s judgment could not in effect be overruled by a state court. FDA scientists had weighed the risk and benefits of Phenergan in approving the drug’s safety literature as a guide for doctors. The FDA was aware of the risks associated with injecting some forms of Phenergan, but the label did not specifically warn about the technique used for this patient.

It has been commented before that the FDA has been the “gold standard” in drug evaluation. The New England Journal of Medicine editors warned the justices to be skeptical in taking such a view now.

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July 27, 2008

Do Doctors Listen To Their Patients?

Doctors are trained to diagnose and treat symptoms of illness. Patients come to their doctors with preconceived notions of how they should be medically treated, knowledge gleaned from the plethora of medical information readily available to all on the Internet, books and magazines. More and more patients are finding a gap between their expectations and the reality of their doctor visits.

Some doctors admit that they are squeezed for time, pinched by the insurance company's scrutiny of their submitted reimbursements and pushed to see more patients by their employers and/or partners. The system no longer allows for lengthy, one-on-one visits with your doctor. The result is that more and more patients report that they simply do not trust their physician.

Doctor_Patient.jpgBut what can we do to force our doctor to focus on us? To assert our visit is important and demands his or her full attention and expertise? Do we need to lobby for different rules governing the system? Do we need to pay by the minute so that a physician will review our case until we are satisfied?

There is no need to go to such extremes. By adjusting how you, the patient, approaches the visit you can ensure that you are getting the most out of your doctor.

Patients should be encouraged to enter the exam room with a written list of questions for the doctor they are seeing. And you should insist that the doctor give the necessary time to answer each question. I know of several friends and family members who go to important medical consultations with written questions and a video camera to make sure the answers are well documented for further reflection or to allow for a comparative second or third opinion. Whatever method you use it is important that you are in control of your medical care.

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April 26, 2008

Breast Cancer Specimens Misdiagnosed: How Accurate Are Your Test Results?

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Recent studies have exposed inconsistent and inaccurate results of breast tissues tested for cancer, which has led to the misdiagnosis of cancer. The most troubling aspect is that thousands of women may have failed to receive the proper treatment because of errors in two laboratory tests.

One of these laboratory tests is Her-2, which is used to help determine how aggressive a breast cancer tumor is. The test is done not to diagnose cancer, but to help decide on the proper treatment course once breast cancer has already been diagnosed. If the test is positive then the patient likely has an aggressive tumor that will not only respond poorly to hormone treatment, but to chemotherapy as well.

So these patient will then be treated with Herceptin therapy. Herceptin is an FDA-approved drug that works at slowing the growth of aggressive tumors and at destroying cancerous cells. However, in order to be a candidate for this type of treatment one must first test Her-2 positive because the drug only focuses on Her-2 genes.

The introduction of this drug was a breakthrough- by focusing on a subset of cancer patients the drug was more specific and thereby more effective for its subset. However, because one must first be diagnosed as Her-2 positive before receiving the drug it is crucial that Her-2 testing is accurate. And right now that isn't the case.

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