Articles Posted in Medical Trends

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.

According 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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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.

EFM 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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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.

After 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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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.

Recently 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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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.

The 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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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.

The 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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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.

Early 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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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.

The 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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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.

The 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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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.

Perhaps 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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