Every so often a story comes around that reduces the cynicism that often prevails when it comes to the US health care system. The story of Zion Harvey is one such story. It reflects the best of many people, from the basic scientists whose research informed the surgical team that executed a remarkable surgery on young Zion Harvey, to the community and nation that funds the efforts via tax supported research and charitable contributions to organizations like the Shriners. And of course this kid and his mom rock. Watch the videos of Zion throwing the first pitch at an Orioles game, interviews with Zion, and stories of his surgery:
The World Health Organization defines disability as an umbrella term that encompasses impairments, activity limitations, and participation restrictions that reflect the complex interaction between “features of a person’s body and features of the society in which he or she lives.” The Americans With Disabilities Act tells us that disability is “a physical or mental impairment that substantially limits one or more major life activities.” Since this category is broad and constantly shifting, exact statistics are lacking. However, the Centers for Disease Control and Prevention estimate that one in five adults in the United States is living with a disability and The National Organization on Disability says there are 56 million disabled people. People with disabilities are thus the largest minority group in the United States. So, this New York Times essay asks, where is the pride movement for people with disabilities?
Pride movements can be considered the emotional components of the anti-discrimination and desegregation movements that asserted the rights of full citizenship to women, gay people, racial minorities, and other groups. Yet pride movements for people with disabilities have not gained the same sort of traction in the American consciousness. Why? One answer is that we have a much clearer collective notion of what it means to be a woman or an African American, gay or transgender person than we do of what it means to be disabled, given the scope of the definitions.
The essay goes on to explore disability growth areas as well as diminishing disabilities and how “most Americans don’t know how to be disabled.” Discussing disability in itself can be a fraught experience, sometimes stepping into a maze of courtesy, correctness, and possible offense. There is a new way of talking about disability and that is discussed here. This important essay is the first in a weekly series by and about people living with disabilities.
It was 1967, when abortions were generally illegal and 26 states barred single women from obtaining birth control. Few laws protected “girls” in the workplace from gender discrimination, and employers had the right to lay off women who became pregnant. At-home pregnancy tests were unheard of up until this point, but Margaret Crane, a 26-year-old product designer at Organon Pharmaceuticals saw what at-home tests could mean – “It was a way for a woman to peer into her own body and to make her own decisions about it, without anyone else — husband, boyfriend, boss, doctor — getting in the way.” Ms. Crane built her own prototype and brought it in to her managers for consideration; they all said no.
The top two reasons why an at-home pregnancy test disturbed them so much? The company was worried about their market which was doctors, believing doctors would hate the product; they were also terrified that a woman may harm herself if she were unmarried and found out she was pregnant. Thus the test did not become available in the United States until 1977. This New York Times article that recently appeared in the Opinion Section provides this history, and also presents Ms. Margaret Crane’s story, which offers an insight into social and political forces that can keep medical tools – even trusted and easy ones – out of the hands of patients.
Each year, 400,000 Americans who are middle-aged and older have meniscus surgery. Given that there is not a clear relationship between knee pain and meniscus tears, orthopedists have wondered if the operations even make sense.
The results of a clinical trial performed by Dr. Jeffrey Katz, a professor of medicine and orthopedic surgery at Harvard Medical School, concluded that meniscus surgery offered little to most who have it. Other studies have come to the same conclusion; then in July, yet another study was published in The British Medical Journal that showed the surgery offered no additional benefit.
An accompanying editorial added that the surgery is in fact “a highly questionable practice without supporting evidence of even moderate quality,” and that “Good evidence has been widely ignored.”
Patients should be told that physical therapy is a good first-line therapy for pain relief and whether the surgery should be mentioned at all is up for debate among doctors. Ultimately, it is up to the patient to decide, but patients need all the information in order to make an informed decision about what is best for them. This New York Times article discusses this surgery among other potentially “useless” surgeries. Unlike drugs, which go through rigorous testing under the watchful eye of the Food and Drug Administration, surgeries do not undergo clinical trials and are not regulated by the FDA.
According to a new, long-term study of middle-aged men, poor physical fitness may be second only to smoking as a risk factor for premature death. Although there are countless previous studies that have shown that aerobic capacity can influence lifespan, many of these studies only followed people for about 10 to 20 years. By scientific standards that is a lengthy amount of time but still nowhere near most actual lifespans. In a new study, discussed in this New York Times article and published by the European Journal of Preventive Cardiology, researchers turned to a large, long-term database of information about Swedish men. To determine what impact fitness may have on lifespan, the scientists grouped the men into three categories: those with low, medium or high aerobic capacity at age 54. They then followed the men for almost 50 years and during that time, the surviving volunteers completed follow-up health testing about once each decade. Although it has been speculated by scientists previously, the findings from this research raise the possibility that by strengthening the body, better fitness may lower the risk of a variety of chronic diseases. Check out the article to learn more about their findings!
A recent Washington Post article tackles the issue of why limiting gun access may cut the suicide rate by over a third. Disturbingly, more and more Americans are killing themselves, and the fast-rising suicide rate is in sharp contrast to most other developed countries where suicide rates have been declining over the past decade.
According to the Centers for Disease Control and Prevention, 42,773 Americans killed themselves in 2014; half of that number did so with guns. It is difficult to separate out the role of guns in facilitating suicides due to the other psychological and cultural factors that also play a role. However, research does show that the longer it takes someone to obtain a weapon, the more likely they are to decide against killing themselves; or, if they do make a suicide attempt during a wait period, they are prone to choose a less lethal method. The wide availability of guns in America has an impact on suicide rates because guns are more lethal than any other suicide method. Per the Post article, experts contend that if you reduce a suicidal person’s access to firearms, it’s likely to save their life, even if they attempts suicide with a different method. The article is a worthwhile read and explores the spiking suicide rate in the United States, gun access, and how government policy fits in.
According to a recent article in The New York Times, researchers are tracing the origins of being overweight and obese as far back as the pre-pregnancy weight of a child’s mother and father. Beyond simple genetic inheritance, there are twenty-three genes known to increase the risk of becoming obese, and these genes can act very early in development to accelerate weight gain. Additionally, being a child in the 2000s means being surrounded by unwholesome, calorie-dense foods which in turn are not being burned off — due to a more sedentary environment. “There is no going back to a world in which calories are scarce and obtaining them is physically demanding,” wrote Dr. Daniel Belsky, an epidemiologist at Duke University School of Medicine, in an editorial in JAMA Pediatrics. “In the face of the obesity epidemic, eliminating the handful of opportunities for kids to be active during the day is a shame. Sedentary behavior becomes a life pattern.” This is a critical issue, along with the cycle of being overweight that starts with future mothers and fathers. According to Dr. Belsky, there are multiple pathways by which unhealthy levels of weight before and during pregnancy can influence the weight of a child in the future. Another column on the subject of childhood obesity that accompanied the above mentioned article can be read here.
In recent months, federal agencies and state health officials have been pressing doctors to first treat pain with alternative methods before resorting to opioids. There are even plans to possibly restrict how many pain pills a doctor can prescribe. Millions of people in the United States suffer from chronic pain and the task of getting these people to turn to alternative treatments over pain medications is a daunting one. According to this New York Times article, inconsistent insurance coverage and resistance from patients and their doctors to make changes are at the heart of why this transition continues to be a difficult one.
“We are all culpable,” said Dr. David Deitz, a former insurance industry executive and a consultant on pain treatment issues. “I don’t care whether you are a doctor, an insurer or a patient.”
Alternative treatments for pain may include chiropractic and osteopathic manipulation, meditation, massage, yoga, acupuncture, and cognitive behavioral therapy. Not all these treatments are covered by insurance plans or plans impose strict limits on them – and these alternative therapies can be very expensive. An underlying issue also surrounds the effectiveness of certain treatments and evidence varies widely as to what works better, which is why so many insurance companies are hesitant to provide coverage for these programs. Regardless of insurance coverage, many patients reject non-drug treatments, perhaps because as suggested in the article, taking a pill is fast, easy, and generally reliable. On the flip side, alternative treatments take more planning and time out of the day, and the effects are not immediate. The opioid epidemic has helped to create a necessary landscape for change in our approach to pain relief.
Last week we shared two articles that expressed the dangers surrounding the drug Fentanyl, and the disturbing actions a pharmaceutical company has taken to ensure a high rate of sales. Over the past few months Fentanyl has made news for numerous reasons — most prominently as the drug involved in the musician Prince’s death from overdose. An article published in the New York Times last week now discusses the interest that Mexican cartels are taking in the drug because of its extreme potency and profitability in the United States. States like California, Massachusetts, and New Hampshire have had alarming rises in overdose deaths and have seen Fentanyl penetrating their drug markets, for which officials are blaming Mexico’s cartels and warn that they are using their own labs to produce the drug. There are some experts who are wary about overemphasizing the role of cartels due to a lack of hard data showing how extensive their involvement may be. However, a possible reason that Fentanyl is not showing up in the majority of drug seizures in Mexico is because the Mexican authorities have not been testing for it. Meanwhile, American law enforcement across the United States has seen a massive rise in recovered Fentanyl, from 640 samples tested in 2010 to 13,002 samples tested last year.
As a follow-up to yesterday’s blog post regarding the dangerous drug Fentanyl and the inappropriate marketing by Insys Therapeutics to increase its sales, the following article from Southern Investigative Reporting Foundation is a worthwhile read. Pharmaceutical companies’ compensating physicians for discussing their product is a longstanding, and legal, practice. It wasn’t until 2013 that concerns were raised within the medical community and regulations were put in place to ensure disclosure of all physician payments. However, another unremarked-upon issue is the nature in which potentially dangerous prescriptions such as Fentanyl are prescribed. Doctors are not heavily constrained by the law to restrict whether drugs can be prescribed for reasons other than what they are designed for. In the case of Fentanyl, data from the Food and Drug Administration shows that Subsys (a Fentanyl spray) is proving lethal to a growing number of patients who are taking it for reasons beyond what the drug was designed for. The article further delves into studies that have been done showing adverse events resulting in deaths since Subsys was approved by the FDA in January 2012. The overwhelming question is how a company like Insys can continue to grow exponentially despite this sort of data. This article tackles this question, taking a close look at Insys’ sales force and the leading prescribers at the center of serious allegations regarding their prescription-writing practices.