Tens of millions to lose coverage under GOP health plan

The nonpartisan Congressional Budget Office says the GOP alternative to Obamacare would cost 14 million people their health insurance in 2018 and millions more thereafter. Republican leaders criticized the report after its release. Nancy Cordes reports.

From: http://www.cbsnews.com/videos/tens-of-millions-to-lose-coverage-under-gop-health-plan/

Brain could be far more active than scientists thought

Research from UCLA could challenge scientists’ conception of how the brain works

From: http://www.cbsnews.com/news/brain-could-be-ten-times-more-active-than-we-thought-scientists-say/

Who should take omega-3 fish oil supplements?

New study identifies which patients may benefit from taking omega-3 fish oil – and which ones probably won't

From: http://www.cbsnews.com/news/omega-3-fish-oil-supplements-for-heart-health/

Fish oil supplements might not help everyone

Millions of people take fish oil supplements for heart health, but a new report from the American Heart Association shows only certain patients actually benefit. Danielle Nottingham has the details.

From: http://www.cbsnews.com/videos/fish-oil-supplements-might-not-help-everyone/

Injuries from baby products land kids in the ER

Strollers, carriers and other baby products have become safer over the years, but researchers are seeing a rising number of kids going to the hospital with injuries from them. Chris Martinez reports.

From: http://www.cbsnews.com/videos/injuries-from-baby-products-land-kids-in-the-er/

ADA urges governor of Puerto Rico to reconsider defining dental benefits as ‘optional’

San Juan, P.R. — The ADA has asked the Puerto Rico Gov. Ricardo Rosselló to reconsider defining dental benefits as “optional” within the Medicaid program.

From: http://www.ada.org/en/publications/ada-news/2017-archive/march/ada-urges-governor-of-puerto-rico-to-reconsider-defining-dental-benefits-as-optional

Should first-year doctors work 24-hour shifts?

New rules will allow first-year residents to work up to 24 hours straight, but not everyone thinks that's a good idea

From: http://www.cbsnews.com/news/should-first-year-doctors-be-allowed-to-work-24-hour-shifts/

Infectious Diseases A-Z: Avian influenza (bird flu)

From: Mayo Clinic http://www.youtube.com/watch?v=eHkJbnbkdkg

Trump compares Obamacare's popularity to Obama

President says that people think Obamacare "is so great" only because it's about to be repealed

From: http://www.cbsnews.com/news/trump-compares-obamacare-to-obama/

"Fake weed" much riskier than marijuana, study says

Synthetic pot linked to increased risk for teen violence, drug abuse and other problems, the CDC finds

From: http://www.cbsnews.com/news/synthetic-pot-fake-weed-much-riskier-than-marijuana/

Study: Strollers, cribs linked to more baby concussions

Baby products seem to be driving an increase in infant head injuries treated at ERs, according to new data

From: http://www.cbsnews.com/news/strollers-cribs-baby-concussions-er-emergency-room-treatment/

The Class of 2020 presents…Planet Mayo

From: Mayo Clinic http://www.youtube.com/watch?v=75hsVIWUNnI

Dental handpieces, fluoride varnishes, abutments up for comment

Dental professionals are invited to contribute their expertise by reviewing and commenting on two draft dental standards and one technical report.

From: http://www.ada.org/en/publications/ada-news/2017-archive/march/dental-handpieces-related-motors-fluoride-varnishes-abutments-up-for-comment

Children's dental health focus of Feb. 28 briefing

Meg Booth, executive director of the Children's Health Dental Project, discusses opportunities for children's dental health during the ADA's Feb. 28 briefing, "Making the Case for Oral Health Within Health Care Reform," at the Rayburn House Office Building on Capitol Hill.

From: http://www.ada.org/en/publications/ada-news/2017-archive/march/childrens-dental-health-focus-of-feb-28-briefing

Office of Inspector General warns of hotline scam

Washington — The U.S. Department of Health and Human Services Office of Inspector General has issued a fraud alert saying that the OIG Hotline telephone number is being used as part of a telephone spoofing scam targeting individuals throughout the country.

From: http://www.ada.org/en/publications/ada-news/2017-archive/march/office-of-inspector-general-warns-of-hotline-scam

Mayo Clinic Minute: Colorectal cancer rates rising among younger people

From: Mayo Clinic http://www.youtube.com/watch?v=nNasjfZ1PsQ

What’s the evidence for evidence-based medicine?

Patients come in all the time asking about things they read about on the internet, or heard about from a friend. It may be an unexpected explanation for their mysterious symptoms, or a new test, or an amazing treatment they want to try.

Heck, when I see things that I’m curious about, I research them, and sometimes I try them, too.

When I was hugely pregnant and due and couldn’t stand even one more day as an awkward whale, I tried red raspberry leaf tea. When breastfeeding proved both difficult and painful, I tried …oh. just about everything, actually. Fenugreek tea, lanolin ointment, chamomile poultices. When I wanted to lose the fifty-odd pounds of baby weight I’d gained, do you think I didn’t try pouring apple cider vinegar into everything I drank?*

Most of the things that are brought to my attention are like these, natural and apparently harmless remedies for which there just aren’t a lot of available scientific data. There may be anecdotal evidence supporting the safety and benefits of these things — family remedies; blog posts and articles on the internet; and word of mouth (the “my neighbor tried this and it worked for her” type stories). I know that many Western doctors immediately disregard this type of evidence without conversation or consideration, and I don’t think that’s an effective (nor patient-friendly) approach.

Yes, so many factors can play into anecdotal evidence: expectations, unconscious bias, cultural pressure, interference from other factors, and pure coincidence, to name a few. But history is full of examples of both ineffective remedies being harmfully perpetuated, as well as effective remedies being unfairly ignored.

Separating the useful from the useless (and potentially harmful)

How can we tease these out? To (briefly, I swear) look at a real example: fevers. Historically, fevers were treated with myriad ancient remedies, including bloodletting. Yes, slicing someone’s wrist and draining them of a couple of pints of blood was long deemed a treatment for all sorts of ailments, and was practiced widely from ancient Egyptian times through the 18th century.

This seems ridiculous to us today, but for centuries, people believed that all illness was caused by an imbalance of the four bodily fluids, or “humors” (blood, yellow bile, black bile, and phlegm). Fevers were thought to be caused by too much blood, and so… it all made perfect sense. The overwhelming evidence that bloodletting was not only ineffective, but harmful, was apparently ignored for about 3,000 years. Even in the late 1700s, when early physician researchers began comparing statistics and sharing data, the practice persisted, endorsed by many venerable and respected medical leaders.^{1, 2}

At the same time, extremely effective treatments for fevers were ignored, even ridiculed. Puerperal fever, also known as childbed fever, is a bacterial infection that was the common killer of women up until the mid-nineteenth century. It was thought to be caused by an invisible cloud of “miasma,” or bad air, that would hover in certain hospital wards and thus cause so many deaths. Ignaz Semmelweiss, an Austrian physician, made observations in his own hospital, tested his hypothesis, and published his findings. His statistics provided hard evidence that simple handwashing could not only decrease the number of cases of childbed fever, but even prevent any deaths at all. Regardless of his meticulous data collection and strident warnings, he was publicly humiliated and ostracized. Tragically, after years of being ignored and ridiculed, he was involuntarily committed to an insane asylum, and ended up dying (ironically) (?) from a bacterial infection.^{3, 4}

Simple handwashing, which we all know and accept now as the most basic way to prevent all sorts of infections, was initially considered a crazy thing, despite ample evidence to the contrary.

In the 1760’s, a Scottish doctor for the Royal Navy named Robert Robertson took note of the fact that the bark of a certain South American tree had long been used to treat fevers. Europeans were very busy colonizing the world at that point, and many were contracting illnesses such as malaria and typhus, nasty infectious diseases that were not uncommonly fatal. Peruvian (cinchona) bark seemed to have a curative effect, much more effective than the standard treatment of the time, which was… bloodletting. Considering that malaria causes progressively worsening anemia as the organism destroys all of a person’s blood cells, draining the patient of more blood was probably not helpful.⁵

Dr. Robertson then proceeded to use statistics in comparing treatment of fevers using Peruvian bark against traditional bloodletting. His accumulated data was powerful evidence, and he alerted the Royal Navy. We now know that cinchona bark contains quinine, still used in the treatment of certain malaria cases today.⁶

Show me the…data

There’s a classic Saturday Night Live skit from 1978 called Theodoric of York.⁵ It’s about medicine, and as silly as it is, it’s on point. Steve Martin plays the medieval doctor, and Gilda Radner his trusty assistant. Jane Curtin is a concerned mother who has brought in her pale and thin daughter, played by Laraine Newman.

Curtin beseeches the doctor: “Will she be all right?”

Martin reassures: “You know, medicine is not an exact science. But we’re learning all the time. Why, just fifty years ago, we would have thought that your daughter’s illness was brought on by demonic possession or witchcraft.” They all chuckle at this ridiculous idea. He continues: “But nowadays, we know that she is suffering from an imbalance of bodily humors, perhaps caused by a toad or a small dwarf living in her stomach.”

When his prescribed bloodletting causes the daughter to die and Curtin calls him a charlatan, Martin steps forward and speaks to the camera:

“Perhaps I’ve been wrong to blindly follow the medical traditions and superstitions of the past centuries. Maybe we should test those assumptions analytically, through experimentation, a scientific method…” He gets excited at the idea but then recants: “…Naaah.”

But the bottom line is that medical interventions — from tests to treatments — should neither be recommended nor condemned without considering and weighing the evidence. That was true centuries ago, is true today, and will be true in the future. In his article about bloodletting, physician and historian Dr. Gerry Greenstone concludes:

What will physicians think of our current medical practice 100 years from now? They may be astonished at our overuse of antibiotics, our tendency to polypharmacy, and the bluntness of treatments like radiation and chemotherapy… In the future we can anticipate that with further advances in medical knowledge our diagnoses will become more refined and our treatments less invasive. We can hope that medical research will proceed unhampered by commercial pressures and unfettered by political ideology. And if we truly believe that we can move closer to the pure goal of scientific truth.¹

Not all evidence is created equally.

In a future post, I’ll review what physicians look for when they review “the evidence” behind a theory.

*No, none of these things worked for me. If they worked for you, that’s great.

Sources

1. Greenstone, G. The history of bloodletting. British Columbia Medical Journal, January/February 2010.
2. Kerridge, I.H., Lowe, M. Bloodletting: The story of a therapeutic technique. Medical Journal of Australia, December 1995
3. http://www.historylearningsite.co.uk/a-history-of-medicine/ignaz-semmelweis/
4. Wyklicky, H., Skopec, M. Ignaz Philipp Semmelweis, the prophet of bacteriology. Infection Control, September/October 1983.
5. Short, B. Dr Robert Robertson (1742-1829): Fever Specialist and Philosopher-Experimenter in the Treatment of Fevers with Peruvian Bark in the Latter Eighteenth-century Royal Navy. Vesalius, December 2015.
6. Maehle, A-H., Four early clinical studies to assess the effects of Peruvian bark. The James Lind Library.
7. “Theodoric of York: Medieval Barber.” Featuring Steve Martin, Dan Aykroyd, Gilda Radner, Jane Curtin, Laraine Newman, John Belushi, and Bill Murray. Saturday Night Live, NBC, Season 3, 1978. http://www.nbc.com/saturday-night-live/video/theodoric-of-york/n8661?snl=1

The post What’s the evidence for evidence-based medicine? appeared first on Harvard Health Blog.

From: Monique Tello, MD, MPH http://www.health.harvard.edu/blog/whats-evidence-evidence-based-medicine-2017031311194

Is pot for pets safe and effective?

The national debate over medical marijuana is taking an unexpected turn as more people are choosing pot to treat their ailing pets

From: http://www.cbsnews.com/news/pot-for-pets-liquid-cannabis/