Tag Archives: women’s health

The Trauma of Politics in Medicine

It’s been a quick reversal for the Susan G. Komen for the Cure Foundation, reinstating funding some 72 hours after cutting off Planned Parenthood because of new criteria barring grants to organizations under investigation, prompted in this case, by a Republican congressman.

“We will amend the criteria to make clear that disqualifying investigations must be criminal and conclusive in nature and not political,” Komen CEO and founder Nancy Brinker said in a statement issued Friday.

The uproar brought more than $3 million in donations to Planned Parenthood in just three days, but also highlights the volatile mixture of politics and medicine.

Dr. Richard Carmona recently observed that one of the most popular presentations he made during his tenure as the 17th Surgeon General of the United States did not address emerging infections, physical trauma, or national diasters, but rather the plague of politics in medicine.

“This traumatic plague of politics is more insidious and virulent than emerging infections; has potentially more morbidity and mortality than hemorrhagic shock or blunt or penetrating trauma; has virtually no diagnostic criteria; and is resistant to all therapy, especially voices of reason, substantive discussion or positions of compromise,” he said during a memorial lecture at the recent meeting of the Eastern Association for the Surgery of Trauma.

Dr. Richard Carmona Patrice Wendling/Elsevier Global Medical News

Dr. Carmona didn’t have far to look for examples to flesh out his diagnosis.

More than a century ago, public health officials’ efforts to control the bubonic plague outbreak of 1900 in San Francisco were nearly derailed by politicians who claimed that quarantine procedures, including closing the city’s harbor to incoming ships, were an over-reaction that would impede commerce and tourism, and result in the collapse of San Francisco, and possibly California. The Surgeon General who intervened based on the scientific evidence was labeled a heretic and asked to resign.

In the 1980s, similar calls were made after former Surgeon General Dr. C. Everett Koop refused to back down from statements that HIV could be prevented. At the time, Dr. Carmona reminded the audience, senior elected officials were telling the American public that HIV was God’s way of punishing homosexuals.

In the 1990s, the tenure of Surgeon General Dr. Joycelyn Elders  was cut short after controversy erupted over a 1994 speech at the United Nations World AIDS Day that included remarks that masturbation was a normal part of sexuality and that abstinence-only education was “child abuse.”

During his own term under President George W. Bush, Dr. Carmona said, abstinence-only became the mantra of the administration, “based solely on ideological and theological concepts, and not science.

“Science had really demonstrated that abstinence alone was a failed proposition,” Dr. Carmona said. “Ironic, that an administration that was repeatedly caught up in the issue of abortion did not see the connection that comprehensive sex education was the best method to prevent STDs, unwanted pregnancies, and therefore abortions. As Surgeon General, this is a science-based position I have always held.”

Dr. Carmona, the only Surgeon General to be unanimously confirmed to the position in over 200 years, said the trauma of politics and its preventable deleterious outcomes are owned equally by politicians on both sides of the aisle.

He pointed out that over-the-counter sales of Plan B stalled under the Bush administration before gaining limited approval in December 2006, but fared no better seven years later under the more liberal Obama administration. In December 2011, HSS Secretary and Democrat Kathleen Sebelius overruled the FDA’s decision to make the emergency contraceptive available, without prescription, to girls of all childbearing ages. While Sebelius cited a lack of conclusive data, Dr. Carmona said it was the administration’s desire to avoid a political battle in the face of an upcoming election.

“The immunization for preventing the continued viralness of political trauma is transparency, full disclosure, accountability for elected officials, a citizenry that is informed and participatory, coupled with civil discourse of complex issues,” he said.

–Patrice Wendling

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Filed under Family Medicine, Health Policy, health reform, IMNG, Obstetrics and Gynecology

Mouseopause: Implications for Older Women

What do older mice and older women have in common? Menopause. But research in mice suggests that stem cells can postpone ovarian aging and improve the quality of life for older mice (and perhaps women).

courtesy of wikimedia user Raka (creative commons attribution-Share Alike 2.0 France)

In the keynote address at the annual meeting of the North American Menopause Society, called, “Can Science Turn Back the Clock on Ovarian Aging?” Jonathan L. Tilly, Ph.D., of Massachusetts General Hospital and Harvard Medical School, both in Boston,  described research showing that adult mouse ovaries contain stem cells that can generate new eggs, and these eggs can be fertilized to yield viable offspring.

Mice, it turns out, undergo “mouseopause,” Dr. Tilly said, meaning that their ovarian reserve is depleted before they die. But Dr. Tilly and his colleagues found that if stem cells from the ovaries of older mice are transplanted into younger mice, they will continue to differentiate into eggs.

“Most people don’t care about postponing mouseopause,” Dr. Tilly said. But parallel studies show that primate ovaries have  stem cells similar to those in mice. These early findings question the long-held belief that a woman is born with all the eggs she will ever have and that the number declines with age and can’t be reversed.

The implications of these findings go beyond fertility, though; Dr. Tilly and his colleagues also have shown that sustaining ovarian function in mice by maintaining an adequate stash of eggs makes the mice healthier, without the aging joints, aging skin, or cancer seen in naturally aging mice.

This research is highly preliminary, but the findings suggest that pursuing ways to prevent or delay ovarian failure could make a huge difference in the quality of life for all women as they age.

Calling Mickey and Minnie: You have put it off since when? 1930? But thanks to modern medicine, you might still be able to start that family (just don’t do it in my basement).

–Heidi Splete (on twitter @hsplete)

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Filed under Family Medicine, IMNG, Obstetrics and Gynecology

Hysterectomy Disconnect

At least two-thirds of hysterectomies in the United States are still performed through an abdominal incision, despite the availability of minimally invasive approaches that are associated with less pain, shorter hospital stay, more rapid recovery, and better cosmesis. In an attempt to change that, the AAGL  Advancing Minimally Invasive Gynecology Worldwide has just issued a position statement calling for nearly all hysterectomies that are done for benign uterine disease to be performed vaginally or laparoscopically, rather than abdominally.

"TAH" stands for Total Abdominal Hysterectomy. Image courtesy of Intuitive Surgical Inc.

According to the AAGL, the few contraindications to laparoscopic hysterectomy (LH) include conditions in which the risks of general anesthesia or intraperitoneal pressure are deemed unacceptable or where uterine malignancy is suspected. For both LH and vaginal hysterectomy (VH), exceptions include situations where trained surgeons or required facilities are unavailable, or in certain cases of distorted anatomy.

Otherwise, AAGL said, “When hysterectomy is necessary, the demonstrated safety, efficacy, and cost-effectiveness of VH and LH mandate that they be the procedures of choice.” 

So why aren’t they?  After all, in some European countries the rate of abdominal hysterectomy (AH) is less than 25%.  Interesting insight can be found in the results of a recently published online/paper survey sent to a random sample of 1,500 practicing U.S. obstetrician-gynecologists.

Among the 376 who responded, the most commonly performed hysterectomy procedure in the previous year was AH (by 84% of respondents), followed by VH (76%).  But when asked to rank which hysterectomy approach they would prefer for themselves or their partner, 56% ranked VH as their first choice and 41% ranked LH as their first choice, with only 8% opting for AH. 

When asked about barriers to performing minimally invasive procedures, the most common ones reported for VH included technical difficulty, potential for complications, and personal caseload. For LH, respondents cited lack of training during residency, technical difficulty, personal surgical experience, and operating time as barriers. 

Nonetheless, when asked about their ideal goal for mode of access, the respondents felt on average that minimally invasive techniques should comprise 79% of all hysterectomy procedures. 

According to the AAGL’s position statement, “Surgeons without the requisite training and skills required for the safe performance of VH or LH should enlist the aid of colleagues who do, or should refer patients requiring hysterectomy to such individuals for their surgical care.”

-Miriam E. Tucker (@MiriamETucker on Twitter)

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Filed under Anesthesia and Analgesia, Family Medicine, Geriatric Medicine, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Obstetrics and Gynecology, Plastic Surgery, Practice Trends, Surgery, Uncategorized

Suffering for Fashion

American beauty icon Marilyn Monroe purportedly once quipped, “I don’t know who invented high heels but all women owe him a lot.”  Well, it turns out that he owes women a lot…of apologies. 

While covering the annual meeting of the American Orthopaedic Foot & Ankle Society, I came across a public service campaign warning women of the dangers of those darling stilettos.  “There are savage shoes in every closet,” according to the print advertisements, jointly sponsosored by AOFAS and the American Academy of Orthopaedic Surgeons.

High heels cause discomfort and can lead to a future of foot pain, bunions, hammertoes, other foot deformities, and knee and back problems.  For those women who are determined to keep their Manolos and Jimmy Choos, the AOFAS offer tips to share with patients to help minimize the damage.  There are also footwear guides and tips for those–like me–who like their well-cushioned and properly fitting flats.

By the way, I’m not going to be the one to give the bad news to Carrie Bradshaw and the rest of the Sex in the City women.

—Kerri Wachter, @knwachter on Twitter

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Filed under Family Medicine, IMNG, Internal Medicine, Obstetrics and Gynecology, Orthopedic Surgery, Physical Medicine and Rehabilitation