ACNE VULGARIS

Acne vulgaris is a highly prevalent inflammatory skin condition associated with substantial morbidity that affects people of all ages, but is most prevalent among teenagers. According to some estimates, 95% to 100% of teenage boys and up to 82% of teenage girls suffer some degree of acne. In total, acne may affect as many as 50 million people in the United States.

The pathophysiology of acne is multifactorial and involves a combination of increased sebum production, follicular hyperkeratinization, inflammation, and follicle colonization by Propionibacterium acnes. Treatment strategies and options are based on targeting different aspects of these pathophysiologic mechanisms. However, pathophysiologic mechanisms alone are an insufficient basis for selecting treatments. Encouraging patient acceptance of treatment—which may vary by patient age—is also an important consideration. The goals of treatment are to control the acne and to achieve a clear or almost clear status, especially on the patient's face.

Given these considerations, topical combination products that target multiple disease mechanisms (while minimizing the number of products and frequency of application) are of great appeal to clinicians and patients. A variety of products that combine topical antibiotics, such as clindamycin with benzoyl peroxide, are available and have demonstrated efficacy superior to that obtainable with either product alone. Acanya® (clindamycin phosphate and benzoyl peroxide) Gel 1.2%/2.5%, offers effective once daily treatment of acne with a favorable cutaneous profile.

HEROIN OVERDOSES

CDC says deaths due to heroin overdoses doubled over two-year period.

Bloomberg News (10/3, Cortez) reports that the number of Americans “dying from heroin overdoses doubled across 28 states in 2012 from 2010,” citing the CDC. The shift has mainly been due to ready access “and rising rates of opioid addiction,” the piece adds. Bloomberg notes that the “unusual analysis” unveiled today by the CDC’s weekly bulletin came in the wake of the agency’s effort to find out “if reports from some states about spikes in heroin use and related deaths since 2010 were part of a larger nationwide trend.” In sheer numbers, there were 3,635 heroin deaths in 2012, compared with 1,779 two years earlier, the piece adds.

        The Washington Times (10/3, Pace) highlights that death rates from heroin rose “in every age cohort, ethnic group (except American Indians/Alaskan Natives) and region of the country.” According to the paper, “men were nearly four times as likely to overdose from heroin as women, and 25- to 34-year-olds had the highest heroin-overdose death rate.” The piece notes that from 2010 to 2012, “the death rate from heroin overdose increased from 1.0 to 2.1 people per 100,000 in the population.”

        According to the AP (10/3, Stobbe), officials have been most concerned about “powerful prescription ‘opioid’ painkillers” such as Vicodin (hydrocodone bitartrate and acetaminophen) and OxyContin (oxycodone). The piece notes that “deaths involving such painkillers continue to be much more common than heroin-related deaths.” However, “while those deaths are leveling off or declining in many parts of the country, heroin-related deaths” jumped between 2010 and 2012 in the 28 states, the AP adds.

        Reuters (10/3) highlights that the shift in the drug use pattern, from prescription painkillers to heroin, raises potentially new problems for public health officials because it suggests more people are resorting to intravenous drug use, which raises the risk of spread of diseases.

ORGAN TRANSPLANT PATIENTS FACE HIGHER RISK OF SKIN CANCER

The San Francisco Chronicle (10/1, Colliver) reports organ transplant patients have higher risks of skin cancer because of the anti-rejection drugs they take. Dr. Sarah Arron, director of UCSF’s High Risk Skin Cancer Clinic, said, “It’s really devastating for transplant patients, given a new lease on life from their transplant, to discover they’re struggling with skin cancer.” The Chronicle adds UCSF researchers “are also involved in a National Cancer Institute study on melanoma in organ transplant patients, which includes examining how safe it would be for a patient already diagnosed with melanoma to have a transplant.” The Chronicle notes, “UCSF will serve as the lead among 20 centers in an American Academy of Dermatology study looking at the incidence and death rates of skin cancer in transplant patients.”

YOUR TAX DOLLARS AT WORK

Analysis: Healthcare.gov has cost $2.1 billion so far.

Bloomberg News (9/24, Wayne) reports on a Bloomberg Government analysis of contracts related to healthcare.gov finds the project “has cost about $2.1 billion so far.” According to the analysis, the spending exceeds the most recently-provided government estimate (9/25) (pdf) of cost, which was $834 million. Bloomberg Government, which shares an owner with Bloomberg News but is editorially independent, included several factors that the government’s estimates of ACA costs have not included: “$387 million in spending for healthcare.gov by the IRS and other agencies outside the health department; a $300 million contract to process paper applications; and spending by CMS after Feb. 28.”

        The Hill (9/25, Viebeck) reports that, according the same analysis, the implementation of the Affordable Care Act has cost a total of more than $73 billion to date. One of the reports authors noted, “Whether policymakers and the public judge the $73-billion-plus tab for health reform reasonable or exorbitant may ultimately turn on what’s used as the measuring stick,” noting it exceeds the cost of the DOD’s F-35 program but pales in comparison to total healthcare spending. The Centers for Medicare and Medicaid Services (CMS), the Federal agency responsible for implementing much of the ACA, pushed back against the report, with spokesman Aaron Albright saying, “The GAO, HHS’s Inspector General and the Department all measured the cost of Marketplace-related IT contracts for Healthcare.gov. But this report measures different things, and not surprisingly, produces a different number.”

CASTLE BIOSCIENCES DEVELOPES MELANOMA TEST THAT PREDICTS METASTATIC RISK

Castle Biosciences is a cancer focused molecular diagnostics company with six laboratory-developed tests clinically available (www.castlebiosciences.com).  They have developed a cutaneous melanoma test (DecisionDX-MELANOMA) which is a proprietary gene expression profile (GEP) assay that accurately predicts metastatic risk and survival from the primary melanoma tumor. In over 600 cutaneous melanoma samples obtained from 13 U.S. centers, the GEP assay has been shown to be superior to, and independent of AJCC stage, Breslow Thickness, Ulceration status, Mitotic Rate, and Sentinel Lymph Node Status.  The test identifies a low risk (Class I: 97% 5 year metastasis free survival) and a high risk group (Class II: 31% 5 year metastasis free survival) with high accuracy, as presented at the 2014 ASCO and AAD meetings.

IMMUNE CHECKPOINT INHIBITORS MAY BE THE KEY TO TREATING MANY CANCERS

In the last couple of years, there has been active research looking at enhancing our immune system to fight cancer.  Dr. James Allison, Ph.D., a professor at University of California in Berkeley, and now a professor and chair of the Department of Immunology at MD Anderson, discovered Cytotoxic T Lymphocyte Antigen 4, (CTLA-4) a protein that attached to the T cell lymphocytes and  "puts the breaks" on the T lymphocytes preventing these important cells from fighting cancer.  It is thought that the CTLA-4 occurs when there is a genetic mutation, which produces this abnormal protein.
T lymphocytes are very important in the immune response to actively fight cancer cells. Dr. Allison and his team discovered that blocking the CTLA-4 allowed the T Lymphocytes "get to work" attacking and inactivating cancer cells resulting in tumor regression.  An antibody drug was developed, initially known as anti-CTLA-4 (and now known as ipilimumab - approved by the F.D.A. in 2011), to inhibit the CTLA-4 antigen. This drug and other drugs being developed along these same lines (see my previous blog posting) are known as "Immune Checkpoint Inhibitors".  In the past, there was very little hope for patients with metastatic and advanced melanoma.  In clinical trials, these newer drugs are significantly extending the survival of patients with advanced melanoma and other forms of cancer, such as Renal Cell Carcinoma. My prediction is that developments in enhancing the immune system to fight cancer is the future of cancer treatment and will be a "game changing" blessing.

NEW DRUG FOR TREATING ADVANCED MELANOMA

FDA approves new immunotherapy for melanoma.

There was wide coverage of the news that Merck & Co. on Thursday received FDA approval for a novel cancer medication called Keytruda (pembrolizumab), with major newspapers, news agencies and trade journals reporting. Many media outlets highlighted the significance of the medication, noting that Keytruda belongs to a new class of medications for treating advanced melanoma, using the body’s own immune system. The Wall Street Journal (9/5, Loftus, Subscription Publication) discusses the importance of the approval, noting that it is aimed at treating patients who have exhausted other therapies, including those people who did not respond adequately to Bristol-Myers Squibb Co.’s immunotherapy Yervoy (ipilimumab).

        Writing about the mechanism of action of the new therapy, the New York Times (9/5, Pollack, Subscription Publication) reports that cancer researchers have been struggling to solve how cancerous cells manage “to evade the body’s immune system” and the “answer is that tumors activate brakes on the immune system, preventing it from attacking them.” The paper notes that Keytruda “is the first drug approved that inhibits the action of one of those brakes, a protein known as PD-1, or programmed death receptor 1.” The Times notes that the general approach could “work for many types of cancer, though so far the main successes in clinical trials have come against the deadly skin cancer melanoma, lung cancer and kidney cancer.”

        Discussing the results of trials that facilitated the approval of the medicine, the Los Angeles Times (9/5, Healy) reports the FDA disclosed Keytruda “showed promising early results in 173 clinical trial participants with advanced melanoma whose disease progressed after prior treatment.” About a quarter who were given one of two doses of Keytruda “saw their tumors shrink.” According to the piece, “the effect lasted at least 1.4 to 8.5 months and continued beyond this period in most patients.”

        According to Bloomberg News (9/5, Edney, Koons)melanoma “accounts for 2 percent of skin cancer cases and causes the majority of deaths from the disease,” including nearly 10,000 expected this year, citing the American Cancer Society. The article notes that the treatment “was approved under the FDA’s accelerated approval program,” but Merck will still have to show “the benefits through an improvement in survival or disease-related symptoms.”

        The treatment, however, does not come cheap, with “early shipments” of Keytruda costing “$112,000 a year for an average patient,” and later versions reaching $150,000 a year, reports the Philadelphia Inquirer (9/5), citing Bernstein Research analyst Tim Anderson. In a note to clients Thursday Anderson expects “that Merck’s sales from Keytruda will be about $3.5 billion in 2020,” the paper adds.

WORLD HEALTH ORGANIZATION RELEASES RECOMMENDATIONS ON E-CIGAREETES

In a story widely covered by major news outlets and healthcare news sites, the World Health Organization has issued a report that calls for a ban on indoor e-cigarette use and stronger regulations to keep minors from using the devices, among other recommendations. Most stories also mentioned the recent policy statement from the American Heart Association urging stronger FDA regulation of e-cigarettes.

        The New York Times (8/26, B3, Jolly, Tavernise, Subscription Publication) reports that the WHO paper “summarizes the growing body of evidence on the health impact of electronic cigarettes,” and was written in preparation for the United Nations Framework Convention on Tobacco Control in October. The article notes that “the organization has no power to enforce its recommendations, but delegates to the meeting could, in theory, endorse the measures for inclusion in a treaty or call for yet more studies before taking further action.”

        The Wall Street Journal (8/26, Esterl, Evans, Subscription Publication) reports that the WHO called for restrictions on advertising and notes particular concern on the growing role of large tobacco companies in the e-cigarette industry. Phillip Morris responded that the agency was calling for industry to be forced out of the policy making process. British American Tobacco PLC also said that overly restrictive regulations would hinder the industry and the public health benefits it could provide.

        According to the Los Angeles Times (8/27, Raab), the report recommends “advertising for e-cigarettes shouldn’t be allowed to make health claims – including claims that the devices help people quit traditional smoking – unless such claims are borne out by clinical trials,” that “marketing for e-cigarettes shouldn’t target children or people who don’t already use nicotine,” and urging that “fruit, candy-like and alcoholic-drink flavors” be banned.

        The AP (8/27, Heilprin) reports that e-cigarette “sales are banned in 13 of the 59 countries that regulate the devices, the WHO reported, but most of those 13 countries say they are still available because of illicit trade and cross-border Internet sales.”

NEW RESTRICTIONS ON HYDROCODONE PAIN MEDICATIONS

News that the Federal government is tightening restrictions on hydrocodone combination painkillers in an effort to curb widespread abuse received wide coverage, with several major newspapers and news agencies reporting. Some news outlets noted that the rule change was welcomed by many, including lawmakers from states that have been plagued by opioid abuse. Others quoted sources who were skeptical whether the rule change would help curb abuse of the painkillers.

        USA Today (8/21, Leger) reports the change, for instance, will “sharply reduce how many pills a doctor can prescribe for them at one time.” Also, manufacturers and pharmacies will now have to keep hydrocodone combination products such as Vicodin (acetaminophen and hydrocodone) under tighter security, along with “more extensive records.” The new rule, which takes effect from mid-October, elevates the painkillers to Schedule II from Schedule III under the Controlled Substances Act.

        Highlighting the importance of the rule change, the New York Times (8/22, A12, Tavernise, Subscription Publication) notes that it is “one of the most far-reaching efforts to stop the growing epidemic of prescription drug abuse.” The paper points to a grim statistic, noting that “more than 20,000 Americans die every year because of prescription drug abuse,” citing Federal data. Still, the Times notes, the change is expected to “draw strong criticism from some pain management experts,” who argue that the new restrictions impose “unfair obstacles for patients in chronic pain, making it harder, for example, on those who cannot easily make a trip to the doctor.”

        The Wall Street Journal (8/22, A3, Radnofsky, Walker, Subscription Publication) examines both sides of the debate, citing sources who are against tighter restrictions and those who seek tougher rules. The paper notes that Linden Barber, a former DEA attorney, who now works with the law firm Quarles & Brady LLP in Indianapolis, pointed out the rule change may not have a major impact because painkillers such as OxyContin (oxycodone), which already have tough safeguards in place, continue to be abused. The AP (8/22, Perrone) also covers the story.

ACTINIC KERATOSES

Actinic keratoses are common skin lesions caused by overexposure to sunlight with the potential to convert to malignancy. As it is impossible to predict which lesions will convert to cancer, treatment of all AK lesions is recommended. Topical treatments offer the best strategy for treating large areas of clinically visible and subclinical lesions. Of the available topical treatments, Picato®, available in 2 formulations, and proven to safely and effectively clear AK, has the shortest application period, which may help improve patient adhere and overall outcomes.

NEW PROGNOSTIC FACTORS MAY PREDICT SURVIVAL FOR PATIENTS WITH THIN MELANOMAS

 

Publish date: JUL 23, 2014

By: Sarah Thuerk

New prognostic factors may help to predict survival in patients diagnosed with thin melanoma, recent study findings suggest.

Researchers with Istituto Nazionale dei Tumori, Milan, reviewed data from 2,243 patients with thin melanoma, using multivariable Cox regression to investigate survival predictors, according to the study. Median follow-up was 124 months, and 12-year overall survival was 85.3 percent (95 percent confidence interval 83.4-87.2 percent).

The worst prognosis categories for thin melanoma were patients older than age 60, Breslow thickness more than 0.75 mm, mitoic rate of 1 or higher, presence of ulceration, lymphovascular invasion, and regression of 50 percent or more. Researchers used age, ulceration, mitotic rate, lymphovascular invasion, regression and sentinel node status to construct a nomogram to predict 12-year overall survival. They noted the nomogram was well calibrated and had good discriminative ability.

“Our findings suggest including LVI (lymphovascular invasion) and regression as new prognostic factors in the melanoma staging system,” study authors concluded. “The nomogram appears useful for risk stratification in clinical management and for recruiting patients to clinical trials.”

The findings were published online July 7 in the Journal of Clinical Oncology. 

MELANOMA COMBINATION THERAPY STUDY SHOWS PROMISING RESULTS IN TREATING ADVANCED MELANOMA

 

By: Bill Gillette

Genentech has announced that its phase 3 coBRIM study, evaluating the safety and efficacy of a combination of cobimetinib and vemurafenib for the treatment of melanoma, has met its primary endpoint.

Genentech, a Roche company, studied the combination in 495patients with BRAF V600 advanced or metastatic melanoma. According to Genentech, cobimetinib is designed to block the activity of MEK, one of a series of cellular proteins that make up a signaling pathway that helps regulate cell division and survival. Cobimetinib binds to MEK while vemurafenib (Zelboraf, Genentech) binds to mutant BRAF, another protein on the pathway, to interrupt abnormal signaling that can cause tumors to grow.

“The study demonstrated, in a randomized fashion, that the investigational MEK inhibitor cobimetinib, used in combination with Roche’s BRAF inhibitor Zelboraf, helped patients with previously untreated BRAF V600 mutation-positive advanced melanoma live significantly longer without their disease worsening, compared to Zelboraf alone,” Omid Hamid, M.D., coBRIM investigator and chief of research/immuno-oncology at the Angeles Clinic & Research Institute in Los Angeles, tells Dermatology Times. “Advances in the combination of targeted agents in melanoma hold the promise of improved survival. This combination, with initial data recently presented in Lancet Oncology, will be the backbone of future trials in combination with promising immunotherapies in melanoma. It represents the pinnacle of personalized medicine for melanoma, targeting known mutations for optimal benefit.”

Dr. Hamid says adverse events were consistent with those observed in a previous study of the combination, adding that full results will be presented at an upcoming meeting.

Genentech officials say they plan to submit the data to the Food and Drug Administration for potential approval.

ANOTHER TRAGEDY IN THE DOMINICAN REPUBLIC

NEW YORK (WABC) --

An apparent botched surgery claimed the life of a mother from Long Island.

Rachene Hutchinson, like many women, flew to the Dominican Republic to get cheaper plastic surgery.

But the low cost had a high risk.

Her family says she died on the operating table.

Now they're caught in an international legal tug of war.

"This is so devastating. We can't believe it. It's still like a nightmare. My daughter is now coming home in a box," said Diane Shields, Rachene's mother.

Rachene Hutchinson green hoped to enhance her appearance and found a more affordable way to do it by traveling to the Dominican Republic.

The Long Island woman died from complications after getting liposuction and a tummy tuck last week, her three young children and their dad were there.

"There's no way to make up for her. I got to raise three kids here without a mother and they're so young and all the stuff she would do for them. It was so much. There's no way we can ever replace that," said Miguel Corporan, Rachene's husband.

"I am very, you know depressed, because this is very difficult for all people who stay with her," Dr. Hector Cabral said.

Diane Shields' called the doctor who performed the surgery to find out what happened to her daughter.
Dr. Hector Cabral said it could have been a heart attack, but he still doesn't know.

So Eyewitness News called to get answers, but was told Dr. Cabral was in surgery.

Rachene paid $6,500 for the surgery, a fraction of what it would cost in the U.S.

A handful of American women have died at the Santo Domingo facility and dozens more complain online that they were disfigured.

28-year-old Beverly Brignoni died in February after getting a tummy tuck and liposuction.

Two years ago, 31-year-old Ericka Hernandez died after getting a tummy tuck, liposuction, and butt implants.

"I saw the website. It looks great. You would think this was the place, but it's not. It's a death palace," said Jasmine Shields, Rachene's sister.

Last year, the New York Attorney General's office fined Dr. Cabral more than $20,000 and sent him home for unauthorized practice of medicine, because he recruited patients in Washington Heights by examining them in beauty salons.

But a spokesperson says because the surgeries were done in a different country the office can't pursue tougher charges.

So Rachene's family is going after him themselves by hiring an attorney and hoping to shut him down.

"If he would have been in jail from the last women he killed my daughter would be alive today," Diane Shields said.

ALLERGIC REACTIONS TO ACNE MEDICATIONS

The Food and Drug Administration has issued a warning that some common over-the-counter acne treatments can cause severe irritation or even life-threatening allergic reactions.

The products — available as gels, lotions, face washes, solutions, cleansing pads, toners and face scrubs — contain benzoyl peroxide or salicylic acid. They are marketed under brand names such as Proactiv, Neutrogena, MaxClarity, Oxy, Ambi, Aveeno, and Clean & Clear.

The FDA says the potentially serious allergic reactions such products can cause — throat tightness, shortness of breath, wheezing, low blood pressure, fainting, or collapse — are not listed on their labels along with the less serious reactions that do appear there, such as dryness, itching, burning, peeling, redness and slight swelling.

Between 1969 and February 2013 the FDA received 131 reports of serious allergic reactions to these types of acne products in people ages 11 to 78. Though no deaths were reported, 44 percent of the patients required hospitalization, the FDA noted in a statement, adding that it will continue to monitor the situation. The agency is asking manufacturers to include label information advising first-time users on how to test the product’s safety.

While the cases of hypersensitivity reaction to the acne products are rare, the potential for the reactions to be life-threatening is what led to the FDA's warning, according to a spokeswoman.

"It is important for consumers and healthcare professions to be aware of this potential serious adverse event so they can make informed decisions about using the products," FDA press officer Stephanie Yao said in an emailed statement to Dermatology Times. "Also, consumers should be aware that the severity and potential consequences of these hypersensitivity reactions may be distinct from the application site reactions, which consumers may more readily associate with product use and for which warnings already exist on product labels.

"As the FDA continues to monitor and evaluate this safety issue, the agency will work with industry with regard to any future labeling changes that would address the risk of serious hypersensitivity reactions," Ms. Yao said.

EXCESSIVE ALCOHOL CONSUMPTION

CDC study: One in 10 deaths among working-age adults attributable to excessive drinking.

USA Today (6/26) reports that a study conducted by the Centers for Disease Control and Prevention found that excessive drinking was the cause of one in 10 deaths among working-age adults between 2006 and 2010. The paper notes that the CDC defined excessive drinking activities to include “binge drinking, heavy weekly alcohol consumption and drinking while underage or pregnant.” The CDC found those activities instigated “long-term health effects such as liver disease and heart disease, as well as short-period effects such as violence, alcohol poisoning, car crashes and drowning.”

        The Washington Post (6/27, Bernstein) “To Your Health” blog reports that CDC researchers estimated that “excessive drinking cost the United States about $224 billion in 2006, or about $1.90 per drink” in public health costs. The study found that deaths caused by excessive drinking varied greatly by state from the 16.9% of deaths occurring in New Mexico as the highest to the 7.6% of deaths occurring in Maryland as the lowest nationwide,

        The Los Angeles Times (6/27, Kaplan) “Science Now” blog reports that to calculate the years of life lost, the CDC “compared the age at which victims died to their expected life span,” which was based on age and gender. Following the calculation the paper reports that the CDC found that “the total number of unlived years added up to an average of 2,560,290 per year.” Also covering the story are Bloomberg BusinessWeek (6/26), NBC News (6/27, Carroll), NPR (6/27, Shute), Congressional Quarterly (6/27, Subscription Publication) , HealthDay (6/27), MedPage Today (6/27), the Huffington Post (6/27, Almendrala), CNN (6/27, Christensen, Cnn), the New Orleans Times-Picayune (6/27), and the Milwaukee Journal Sentinel (6/27).

MAINTAIN AN ACTIVE MIND

Cognitive engagement, intellectual activities may stave off dementia.

The Los Angeles Times (6/24, Healy) “Science Now” blog reports that in people “at higher genetic risk of developing Alzheimer’s disease, completing more school and going on to a lifetime of mentally challenging work and leisurely pursuits can delay the onset of dementia by close to nine years,” according to a study published June 23 in JAMA Neurology.

        Bloomberg News (6/24, Ostrow) reports that the study of 1,995 Minnesota seniors also revealed that “lifelong intellectual activities such as playing music or reading kept the mind fit as people aged and also delayed Alzheimer’s by years for those at risk of the disease who weren’t college educated or worked at challenging jobs.”

        HealthDay (6/24, Mozes) reports that “at the time of the study’s launch, mental functioning was lower among carriers of the APOE4 genotype,” which is considered “the most significant genetic risk factor for late-onset Alzheimer’s,” and “among those who scored lowest on education, job, and/or activity measures.” Surprisingly, the study “authors found that those with the lowest educational and occupational scores actually gained the most protection against dementia by embarking on intellectual activities from middle-age onward.” Reuters (6/24, Doyle) also covers the study.

BE CAREFUL WITH FAT INJECTIONS

Fat proponents rarely discuss the problems this natural filler can cause in inexperienced hands. In his presentation, “Fat is unpredictable, overrated, has significant complications, can grow and even distort the face,” Dr. Lambros emphasized and demonstrated issues that frequently arise with fat.

First, he pointed out, fat is unpredictable. On one hand, fat may not “take” and completely disappear. On the other, it can multiply and create an undesirable result. For example, a rookie mistake might be to overgraft fat into the face to smooth away wrinkles. But if that fat grows over time, it can make the face unnaturally big, thereby masking the natural contours. Thus, the wrinkles may be gone, but patients tend not to be happy when they no longer look like themselves, Dr. Lambros said.

Second, if fat is used in a younger person, acceptable results today may not be so in the years to come. We gain weight as we grow older, and fat behaves in the face as it did in the area in which it was harvested from, he said. Whether it was taken from the tummy, thighs or other area that tends to be more prone to weight gain, it will likely multiply with age and can negatively affect the appearance of injected portions of the face. This, Dr. Lambros said, can be particularly devastating under the eyes.

His take-home message today was this: Fat is a valuable tool in the plastic surgeon’s armamentarium. However, use it cautiously. Take the time to build experience and get comfortable with fat behavior and the various complications that potentially come with this natural filler.

THE CHALLENGES FACING PHYSICIANS TODAY

BY NICK MADIGAN

Special to the Miami Herald

It’s getting harder to be a doctor. Gone are the days of Marcus Welby, when a doctor focused solely on treating the sick, assured that bountiful compensation would follow. Today, physicians are as much business people as healers, hamstrung by rising staffing and technology costs, increased paperwork demands by the government, stratospheric malpractice premiums and limited reimbursements from muscle-flexing insurance companies.
The price tag for healthcare in the United States, says the federal government, was $2.7 trillion in 2012, or about 18 percent of gross domestic product. Less than 9 percent of that goes to physician compensation, reported a 2012 study by Jackson Healthcare, an Atlanta-area staffing company.
Still, more than 80 percent of medical students graduate with $100,000 or more in debt, reports U.S. News & World Report. Tuition and fees at the private University of Miami Miller School of Medicine, for instance, are estimated at about $42,000 for out-of-state students and $36,000 for Florida residents for 2014-2015. At the public Florida International University Herbert Wertheim School of Medicine, the costs are nearly $70,000 for out-of-staters and around $38,000 for the same period.
Add in office start-up costs that run into hundreds of thousands of dollars, and it’s easy to understand why many physicians are turning away from solo practices and small doctor-owned offices. Some are selling their practices to hospitals or joining large doctors’ groups. Others are banding together and creating their own group offices and vertically integrated practices that offer a range of services within a single medical specialty. Still others are staying on their own by charging annual access fees or requiring patients to pay up front and seek their own insurance reimbursements.
The process of running a business “can be overwhelming for physicians,” said Steven G. Ullmann, the director of health sector management and policy programs at the University of Miami’s School of Business Administration. By joining a hospital or a group of doctors, he said, “you give up your independence, but you also give up some of the anxiety.”
Traditionally, private-practice doctors became affiliated with hospitals, which granted them rights to refer patients to the facility, and visit them there. Today, for instance, about 2,000 private physicians are credentialed to practice at Baptist Health hospitals, according to Jack A. Ziffer, an executive vice president and chief medical and clinical transformation officer at Baptist Health South Florida, the region’s largest medical system, with seven hospitals. The advantages: access to a wide range of specialists and 24/7 care.
But increasingly, physicians aren’t just affiliating with hospitals, they’re becoming employees, said Yolangel Hernandez-Suarez, the chief executive at FIU Health, the clinical enterprise of Florida International University’s Herbert Wertheim College of Medicine, “The technology platform and the increasing overhead needed to provide quality care make it increasingly difficult for physicians to practice alone or in small groups.”
For instance, the Baptist Health system now has about 225 doctors who are full-time employees — “two or three times” the number employed just a few years ago, Ziffer said. In addition to providing a range of facilities, a large hospital “can be seen as a stable environment that offers a multispecialty culture,” he said, with more employment stability and fewer administrative headaches.
And from the hospitals’ point of view, patients’ needs are met more efficiently when medical care is consolidated under one roof.
Professor Min Chen, who teaches in the College of Business at FIU and has conducted analyses of various economic aspects of the health industry, said that the trend toward such consolidation makes economic sense, not least because employing more physicians increases a hospital’s ability to “lock in referrals,” which keeps most of the business in-house. Employing more doctors may also preempt competition from specialists with their own outpatient services, and may increase hospitals’ bargaining power, enabling them to negotiate higher rates from health plans.
“If the health plan does not increase the rates, it may lose both the hospital and its many integrated or affiliated physicians,” Chen said. In addition, “hospitals are better able to spread fixed costs — for example, administrative, billing, overhead — over a larger number of physicians, and receive volume discounts on supplies. As a result, they have lower per-unit costs than do independent physicians.” Still, one in two physicians in 2013 were self-employed.
But in healthcare, far more is at stake than dollars. Experts and doctors themselves debate which systems result in the best care.
Once a doctor is part of a larger entity, he or she must inevitably abide by strictures and practices that might have been merely theoretical when working alone, UM’s Ullmann said. Hospital administrators subject to quality ratings by outside agencies are “going to make sure that quality is not compromised,” he said.
Chen agrees. The growing emphasis by insurers, employers, and Medicare on quality reporting and pay-for-performance standards provides hospitals with a competitive advantage in attracting patients and receiving bonuses for achieving certain quality benchmarks, she said. And hospitals are better positioned than independent physicians to invest in clinical information systems and case management processes.
Others take a different view. For them, the V.A. scandal is a sobering reminder that large, unwieldy healthcare systems do not always focus on the best interests of the people they serve.
“Hospitals are taking over,” said Dr. Pepi Granat, a family medicine doctor in South Miami who has practiced alone at the same location since 1971. “Doctors have no powers now. We’re like little fish swimming in a huge pond.”
Granat and others lament the growing corporatization of medical care.
“Hospitals can become more bureaucratic and more micro-managerial,” said Richard Prager, a veteran pulmonologist who has been part of a three-doctor private practice in Miami for more than a decade. He has no intention of joining a hospital or a large doctors’ group, he said. “I can’t be in a system that tells me what I have to do. There’s something about the joy of medicine that’s lessened by being part of that. You’re enslaved to a larger system.”
Prager, who graduated from Chicago Medical School in his home town and moved to Miami in 1984, said he and his partners have a viable financial business while seeing only 10 or 12 patients for office visits per day. But some primary-care physicians, he said, are seeing as many as 50 patients a day.
“The system is so complex that they have to do that, but I don’t find that ethical,” Prager said. “How can any physician see that many patients and still deal adequately with them?”
Still he acknowledged that it is “very important to keep your overhead low.”
With the rising complexities of insurance and technology, that’s no easy task.
“You need to borrow at least $150,000 to get started to buy basic instrumentation, do a build out in an office and hire an office appointment coordinator, to get your name out to the community,” said Robert M. Easton, an optometrist who runs his own practice in the Broward County community of Oakland Park. (Although optometrists are often referred to as eye doctors, unlike ophthalmologists, they do not have medical degrees.)
Easton, who has been in practice for 32 years, pays a monthly rent of $4,000. He has four staff members who earn between $14 and $22 per hour. He pays $300 a month for electricity, $200 for water, $225 for internet and phone service, $200 for electronic health records, and at least $200 for maintenance on the building.
“If you add equipment purchases, your monthly overhead increases and the lists go on,” he said. “In order to pay the bills, I have to provide services to patients at least 40 hours per week.’’ That works out to 16 to 20 patients per day, with appointments lasting 15 to 45 minutes. “This barely covers the overhead and what I care to make.”
Easton, who accepts only Medicare and preferred provider organization policies, said that insurance payments “are probably barely paying the bills.” If a solo practitioner wishes to remain that way, he or she must accept the notion of earning less, Easton said.
“I teach a course in jurisprudence to my peers to make a few dollars on the weekends to supplement my income,” he went on. “I have a 10-year-old car and I’ve lived in the same house since 1986. The key is to live within your means.”
Other private physicians have turned to “concierge” practices that promise patients quick access and highly personalized care in exchange for a fixed annual fee. Office visits and other services typically bring an additional fee.
In South Florida, the going rate is $1,500 and $5,000 per patient per year. In some other markets, the rates go as high as $25,000.
Miami Beach cardiologist Juan Rivera turned to the concierge model 2 1/2 years ago, after years of working in a physicians’ group and for a hospital. That decision, he said, “is allowing me to stay in business and remain independent.” That arrangement, he said, eliminates “the pressure of doing unnecessary testing or seeing a lot of patients in one day."
His decision was in part driven by the math. To launch his practice, Rivera took out a loan of $300,000 and split the cost of his office and overhead with another cardiologist. The revenue from a traditional practice, where a doctor might see an average of 20 patients per day, is no longer sufficient to cover the overhead of a fully staffed clinic, with its machinery and other technology, he said, forcing doctors to increase patient volumes and seek other revenue streams from cosmetic surgeries, alternative therapies or weight-loss programs.
“Unless you are independently wealthy, it is almost impossible to finish your specialty and set up a private practice,” Rivera said. “The banks are not lending money for that any more, and reimbursement from insurance is too low.”
Atlanta-based Medicast has devised a “Doctors on Demand” model that last summer began sending physicians on house calls in South Florida at a cost to the patient of $199 per visit or a monthly subscription fee of $29 or $49 per month, depending on the level of care required. For that they can expect a visit from a doctor any time they ask for one, within two hours, day or night.
The average waiting time for such visits since Medicast’s launch has been 46 minutes, said Sam Zebarjadi, the 30-year-old co-founder of Medicast. The company has signed up a handful of South Florida physicians, he said, though he declined to give specifics.
“Doctors hate that they have to see 30 to 40 patients a day, and patients hate that they have to sit in a waiting room for an hour to see a doctor for six to eight minutes,” Zebarjadi said. “People deserve access to high-quality healthcare — when and where they want it.”
The doctors who work for the company — all as private contractors — are paid according to the number of patients they see in a day, which is now an average of five. All the doctors are paid outside the traditional insurance system. Each is provided with an iPad equipped with the company’s tools, through which they can generate medical charts and conduct other tasks.
Medicast expanded its service to Los Angeles on June 1 and plans to open up shop in coming months in San Diego, San Francisco and New York.
Other doctors are banding together on their own.
“In order to survive at least somewhat independently, you’re going to have to develop an infrastructure across a number of doctors,” said Dr. James S. Leavitt, one of the partners at Gastro Health, comprised of 57 doctors at 17 “care centers” in Miami-Dade County. The practice has expanded to Palm Beach County and is planning to do so in Broward. The group hopes to expand statewide.
Leavitt started out in 1980 as part of a three-doctor office. In 1993, the group began adding physicians with expertise related to a wide range of gastrointestinal afflictions, such as diseases of the liver or inflammatory bowel syndrome.
The group has combined resources to acquire same level of diagnostics and technology in its main South Dade location that might be available in a small hospital. For patients, that means one-stop shopping for care such as consultation and a complex screening procedure.
And with a wide range of specialties, referrals generally go to colleagues within the practice. For the doctors, that means consistency in both pricing and care levels. Those critical variables have become increasingly important under the Affordable Care Act, which favors pay for coordinated care and outcomes over the traditional pay-for-procedure model.
Medical care groups — called Accountable Care Organizations — will soon be the norm for serving the growing number of Medicare patients, predicted Dr. Sanford Silverman, president-elect of the Broward County Medical Association. “Within 10 years or so — maybe even five — if you’re not a member of an ACO, you might not get paid [by Medicare].”
Strength in numbers also makes it easier for groups to compete with hospitals. “Our goal is not to be bought by a hospital,” said Leavitt.
“The cost of care goes up dramatically in a hospital. I can do a CAT [computerized axial tomography] scan for $400; a hospital can’t do it for $1,000 and make money.”
For the doctor-members, joining a group can erase the non-medical headaches of negotiating leases, hiring staff and dealing with auditors while maintaining their medical independence.
After 20 years as a solo practitioner, Kendall family physician Fleur Sack joined a large doctors’ group last fall.
“If you look at the future of medicine, you can’t survive as a solo physician,” said Sack, whose employer is VitalMD Group Holding, a privately held Miami-based entity that claims a roster of some 330 doctors, including specialists in radiology, pediatrics, urology, maternal-fetal medicine, obstetrics and gynacology, dermatology and internal medicine.
One of the big advantages, she said, is that matters such as insurance coverage are now out of her hands. “They do the negotiating for me,” Sack said. Her last insurance negotiation as a solo practitioner took 18 arduous months, she said.
“And no one’s telling me what to do,” she said, “or how to practice medicine.”

Read more here: http://www.miamiherald.com/2014/06/08/4163687/doctors-dilemma-physicians-weigh.html#storylink=cpy

BEWARE OF MEDICAL TOURISM

19 Americans Infected During Plastic Surgery Trips, Report Finds

     

Nineteen women who traveled to the Dominican Republic for cheap plastic surgery over the past year came home with nasty, hard-to-treat infections, health officials reported Thursday.

More than half got treated at a single clinic, but cases were traced to seven other clinics in the Caribbean nation, the officials reported. They all seem to be caused by bacteria related to the tuberculosis bug, especially one called Mycobacterium abscessus.

    

“Fourteen (74 percent) were hospitalized in the United States and required multiple therapeutic and corrective surgical procedures and long courses of antibiotics,” the officials wrote in the Centers for Disease Control and Prevention’s weekly disease and death report.

HOSPITALIZATION AFTER CAT BITES

ROCHESTER, Minn., Feb. 9 (UPI) -- Cats bites can be dangerous -- 1-in-3 people bitten on the hand by a feline have to be hospitalized, U.S. researchers say.
Dr. Brian Carlsen, a Mayo Clinic plastic surgeon and orthopedic hand surgeon, says two-thirds of those hospitalized needed surgery.It's not that the mouths of cats have more germs than dogs' mouths or people's, it's because of the cat's sharp teeth, Carlson, the study leader, and colleagues say. "Dogs' teeth are blunter, so they don't tend to penetrate as deeply and they tend to leave a larger wound after they bite. The cats' teeth are sharp and they can penetrate very deeply, they can seed bacteria in the joint and tendon sheaths," Carlsen said in a statement. "It can be just a pinpoint bite mark that can cause a real problem, because the bacteria get into the tendon sheath or into the joint where they can grow with relative protection from the blood and immune system."In addition, the bacteria injected by a cat bite can include a strain common in animals that is particularly hard to fight with antibiotics, Carlson says. The study conducted by Carlson and his colleagues involved 193 Mayo Clinic patients with cat bites to the hand from Jan. 1, 2009, through 2011. Of those, 57 were hospitalized, with the average stay three days. Of those hospitalized, 38 needed to have their wounds surgically irrigated, or flushed out, and infected tissue removed, Carlson says. The study, published in the Journal of Hand Surgery, found eight patients needed more than one operation, and some needed reconstructive surgery. About half of the patients first went to the emergency room, and the others went to primary care. The mean time between the bite and medical care was 27 hours, the study said. Patients with bites directly over the wrist or any joint in the hand had a higher risk of hospitalization than people with bites over soft tissue, the study said. Physicians and victims of cat bites to the hand need to take the wounds seriously and carefully evaluate them, Carlsen says. If patients have inflamed skin and swelling, aggressive treatment should be pursued, Carlson said.

THE SOLO PRACTITIONER - "A DYING BREED"

Part healer, part entrepreneur, and part "trapeze artist" trying to balance and wrestle with insurance companies, trial lawyers, hospital regulations, government red tape, patient demands and family pressures - this pretty much sums up the life of a solo practitioner.

"The self-employed physician straddles two worlds at once, responsible for tending to patients and keeping the lights on. Owning a practice means running a small business.  There is no end to the shift and no hour to clock out." 

The new breed of "physicians seem not to covet this life, and it's hard to blame them. After the long, hard slog of medical education and training which results in a tremendous debt burden, solo and small-group practice offers neither optimal work-life balance nor a guaranteed income level. This is to say nothing of the costs of malpractice insurance (as well as the constant worry about loosing everything in the "malpractice lottery"), the regulatory and administrative complexities of modern health care delivery, the expense of information technology, and the advent of new care and payment models.  Most self-employed physicians must invest thousands of dollars in office equipment and surgical instruments - oftentimes literally betting the house on the solvency of their practice."

 "The emerging model, featuring the physician as a labor unit, challenges the very notion of what it means to be a "good doctor."  In place of ingenuity, availability, and patient advocacy, the new philosophy is more likely to prize those who play well with others and meet quality improvement metrics.  Physicians who chafe at authority, pushing against bureaucratic hurdles as the champion of their patients, may find themselves in danger of being deemed relics at best, disruptive physicians at worst.  The men and women who run these small practices are, or at least were, the silent majority of the medical profession. They tend not to be found on the editorial boards of topflight journals, in charge of major professional organizations, or at the helm of blue-ribbon committees.  Frankly, they don't have time.   They are the "soldiers on the battleground" of medicine. 

The surgeon lives and dies by the labor of his two hands. It is an honorable profession and offers a comfortable income. I would not choose any other path in life - it has been, and continues to be, a joy and a blessing to me.  I want to continue on this path as long as my mind is sharp, my hand-eye coordination remains exceptional and patients continue to come to my door and offer me joy.

Insight and some commentary provided by Charles G. Kels, JD in the Office of Health Affairs, Dept. of Homeland Security and The Judge Advocate General's Corps, US Air Force Reserve.  Washington D.C.
  

U.S. HEROIN USE HAS DOUBLED OVER THE LAST FIVE YEARS

Two network television news segments, major US newspapers and wire sources report that heroin use in the US has skyrocketed. NBC Nightly News (2/3, story 3, 2:30, Williams) reported, “The death of...star Philip Seymour Hoffman at 46 is bringing attention to a heroin problem that is exploding among people in all walks of life across our country.” NBC News correspondent Kate Snow explained, “Heroin use in the US nearly doubled over the last five years. More than a quarter million people a year end up in the” emergency department.

CBO: ACA WILL CAUSE 2.5 MILLION TO LEAVE THE WORKFORCE OVER TEN YEARS.

A Congressional Budget Office (CBO) report released Tuesday touched off a partisan debate over how to interpret its conclusion that the Affordable Care Act will spur more than two million full-time workers to leave the labor force in the coming years. That debate played out across the media, garnering several front-page stories in major newspapers, over four minutes of airtime on the nightly news broadcasts, and many more print and online accounts.

VOICE CHANGES AFTER RHINOPLASTY

Arlington Heights, Ill. - Patients who have undergone plastic surgery to change the appearance of their nose may also notice changes in the sound of their voice, reports a study in the February issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Changes in voice after rhinoplasty are perceptible to patients as well as to experts, but generally don't cause problems with speech function, according to the new research by Dr. Kamran Khazaeni and colleagues of Mashhad University of Medical Sciences, Iran. However, they believe that patients considering rhinoplasty -especially those who use their voice professionally-should be aware of "potential voice alterations."

AGENT ORANGE AND SKIN CANCERS

HOUSTON, Jan. 29 (UPI) -- Vietnam War veterans who were exposed to the herbicide Agent Orange may be at higher risk for certain types of skin cancer in old age, U.S. researchers say.
Lead author Dr. Mark W. Clemens of The University of Texas MD Anderson Cancer Center and colleagues said the study adds to previous evidence risk of non-melanotic invasive skin cancer could increase even four decades after Agent Orange exposure, with at least some exposed veterans having unusually aggressive non-melanoma skin cancers. During the Vietnam War, Agent Orange was widely used as a herbicide to remove jungle vegetation. It has been linked to a wide range of cancers and other diseases, caused by the toxic dioxin contaminant TCDD."TCDD is among the most carcinogenic compounds ever to undergo widespread use in the environment," Clemens and co-authors said in a statement.

MYCOBACTERIUM INFECTIONS

January 27, 2013

CDC urges plastic surgeons to be alert for rapidly growing Mycobacterium infections from cases performed in the Dominican Republic

The Division of Global Migration and Quarantine and the Division of Healthcare Quality Promotion (DHQP) at the Centers for Disease Control (CDC) are investigating cases of surgical-site infections caused by rapidly growing Mycobacterial species (e.g. M. abscessus and M. chelonae) following plastic surgery in the Dominican Republic.

Fifteen cases – all resulting from procedures performed in the Dominican Republic – have been identified in five states, prompting several state and local health departments in the northeast United States to issue an advisory for health-care providers to be aware of the condition, and to notify their local health department in the event they should identify or suspect a case.

“Though the cases so far appear to have been identified only in the northeast, it’s important for all ASPS members to be alert to the potential of this infection,” says ASPS President Robert X. Murphy Jr., MD. “Ease of travel has turned medical tourism into a booming industry. Unfortunately, people often don’t think of the downside of medical tourism – you’re not guaranteed the same quality of safety measures that exist in this country, and should you have problems after you return, your surgeon is not there to take care of you.”

The advisory is aimed at all plastic surgery; dermatology; primary care; family, emergency and internal medicine; general surgery; infectious disease; laboratory medicine (including Mycobacteriology laboratory and staff) and infection control staff.

The American Society of Plastic Surgeons is now collaborating with the CDC, in order to effectively disseminate this information to the ASPS membership.

“These surgical-site infections represent a serious public health problem affecting patients who opt for low-cost cosmetic plastic surgery procedures overseas, in this case, the Dominican Republic,” says ASPS Patient Safety Committee Chair C. Bob Basu, MD, MPH.  “Medical tourism may attract patients with ‘cheap deals,’ but unfortunately, these deals may compromise, or worse, completely ignore recognized quality and safety standards.

“It underscores why it is vital for patients to choose a board-certified plastic surgeon who is an ASPS member,” he adds. “Our members only perform procedures in fully accredited facilities that ensure the highest standards for infection control and patient safety.“

Initial cases were reported by the Maryland Department of Health and Mental Hygiene in August 2013, with additional cases identified since then in Connecticut, Massachusetts, New York and Pennsylvania. All patients were women in the 18-50 age range who had undergone elective procedures that include abdominoplasty, mammaplasty and liposuction in the Dominican Republic from April through September in 2013. Symptoms have included abdominal abscess, pain, fever and wound discharge.

No deaths have occurred.

“At least nine of the case-patients had surgery at the same surgical center and were attended by the same surgeon,” notes Duc Nguyen of the CDC’s Prevention and Response branch of the DHQP, via e-mail. “Symptoms of infection developed after return to the United States; several patients consulted with plastic surgeons after their return who, in turn, notified their state and local health departments.”

“Given that at least nine of the cases are arising from the same surgery center in the Dominican Republic,” adds Dr. Basu, “it raises deep concerns about the violation of sterilization procedures and the quality of the sterile products utilized.”

Others who may have undergone surgical procedures in the Dominican Republic may be at risk for the “rapidly growing non-tuberculous mycobacterium” (RG-NTM) infections.

“It is possible that additional infected patients have not yet been reported,” notes Nguyen.

Healthcare providers should be aware of these cases and obtain cultures for mycobacterial culture from patients with cellulitis, soft tissue infection or cutaneous abscess who had a surgical procedure in the Dominican Republic after April 1, 2013.

RISKS OF TESTOSTERONE

Testosterone supplements linked to increased heart attack risk in men. The CBS Evening News (1/29, story 9, 1:45, Pelley) reported that new research suggests “a link between testosterone supplements and heart attacks.”         USA Today (1/30, Szabo) reports that the study, published in PLOS One, found that “taking testosterone therapy doubled the risk of heart attack among men over age 65 and nearly tripled the risk in younger men with a history of heart disease.” This research, “which involved 56,000 men, is the latest in a series of studies raising concerns about the heart attack risk from testosterone therapy, whose popularity has ballooned in recent years.”         On its website, NBC News (1/30, Fox) reports that “to be sure,” the researchers “compared the men getting testosterone to those getting prescriptions for erectile dysfunction drugs, as the two groups are similar in many ways.” The investigators found that the ED medications “only very slightly raised the risk of heart attack.”         The New York Times (1/30, O'Connor) “Well” blog reports, “By itself, the new study, which was not a randomized trial...’may not tell us very much,’ said Dr. Michael Lauer, the director of cardiovascular sciences at the National Heart, Lung and Blood Institute, who was not involved in the study.” However, added Dr. Lauer, “when you put this together with the rest of the medical literature, this tells us that we potentially have a problem.” Meanwhile, “in a statement, Andrea Fischer, an F.D.A. spokeswoman, said the agency was reviewing the new findings.”         On its website, TIME (1/30, Sifferlin) reports that although it is unclear “why testosterone can harm the heart, some studies suggest that it can lower levels of HDL, or good cholesterol, and therefore increase the risk of heart disease.”         Meanwhile, on the CBS News (1/30) website, CBS’ Dr. Jon Lapook writes that a “possible way testosterone might be causing problems is by increasing clotting within arteries supplying the heart.”         Forbes (1/30) contributor Ed Silverman points out that these “findings come amid years of aggressive promotion of testosterone treatments.” Research “published last fall in the Journal of the American Medical Association noted that annual prescriptions for these elixirs rose more than five-fold from 2000 to 2011, reaching 5.3 million prescriptions.”         The Los Angeles Times (1/30, Healy) “Science Now” blog also covers the story.

TANNING BEDS

Study: More people using tanning beds than previously believed.

USA Today (1/30, Szabo) reports that research published in JAMA Dermatology indicates that more people are using tanning beds than previously believed. Researchers found that “more than 35% of American adults report ever using a tanning bed, along with 59% of college students and 17% of teens in the analysis.” Additionally, “the percentage of Americans who have used a tanning bed in the past year also was high – 13% of adults, 43% of university students and 10% of teens.” The article points out some groups, including the American Medical Association and the American Academy of Dermatology “have called on states to bar children under 18 from tanning salons.”

        HealthDay (1/30) quotes Dr. Mark Lebwohl, incoming president-elect of the American Academy of Dermatology, as saying, “It is appalling how often exposure to indoor tanning takes place in presumably educated populations and particularly worrisome that we allow adolescents to be exposed to this carcinogen.” Dr. Lebwohl added, “We must do a much better job at educating people of all ages about the risks of indoor tanning.”

DOCTOR'S DRESS CODE AIMED AT HALTING GERMS

A new dress code for doctors, nurses and other health care workers calls for outfits that may be short on style, but long on what it takes to keep dangerous germs from spreading among patients. Short sleeves, bare hands and forearms and white coats that are laundered at least once a week – if not more often – are the keys to keeping nasty bugs such as Staphylococcus aureus from hitching a ride on a doctor's wrist. Neckties are questionable. Watches and rings have to go. It's not clear what to do about name tags, lanyards, necklaces and cell phones, but when in doubt, it’s best to clean the offending items – or get rid of them. That's according to new guidance on hospital attire released Monday by the Society for Healthcare Epidemiology of America, or SHEA. The group obsessed with stopping infections in hospitals and health care settings turned its attention to dozens of studies that suggest that grimy hospital garb might be responsible for spreading germs

CIGARETTES MORE ADDICTIVE

Study: Cigarettes increased nicotine content over last 15 years.

The Boston Globe (1/16, Kotz) reports a Massachusetts Department of Public Health and University of Massachusetts Medical School study published online in the journal Nicotine and Tobacco Research indicates that particular cigarette manufacturers have increased the nicotine in their product. Researchers found the average cigarette contained 1.65 milligrams of the substance in 1999, but increased 15% to 1.89 milligrams in 2011. Study leader Thomas Land believes the increase may have resulted from redesigning several brands with alterations on filters or product length.

        The Springfield (MA) Republican (1/16, Flynn) also quotes Land as saying, “Cigarettes are getting more efficient at delivering nicotine to smokers. This could make it more difficult for a current smoker who is trying to quit, and easier for a young smoker to become addicted.”

FDA - LIMIT ACETAMINOPHEN

FDA asks physicians to curb usage of medications with high levels of acetaminophen.

In continuing coverage, CBS Evening News (1/15, story 12, 0:20, Pelley) reports that “there is a warning tonight about acetaminophen, the active ingredient in Tylenol. It’s also found in prescription painkillers such as codeine and hydrocodone.” CBS says the FDA is asking “doctors to stop prescribing medication that contains more than 325 milligrams of acetaminophen per pill” because in high doses it can cause severe liver damage.

        NBC Nightly News (1/15, story 8, 2:00, Williams) reports the FDA “was very pointed today” in why it is taking this action “and it has to do with the fact that so many people don’t know that acetaminophen is a common component in prescription pain killers like Vicodin and Percoset.” NBC says that many a time patients take an additional OTC acetaminophen “without realizing that they are at risk for liver damage and that is why the agency is asking doctors to stop prescribing combination medications with more than 325 milligrams of acetaminophen per dose.”

        USA Today (1/15, Painter) reports the step by the agency is one of several moves by the FDA to curb “high-dose use of the popular painkiller.” USA Today also notes that the agency has said “it soon will withdraw approval for any of those medications” that have more than 325 mg of acetaminophen. The FDA also plans to unveil “new regulatory action on over-the-counter acetaminophen,” though it didn’t provide details.

        The Los Angeles Times (1/15, Kaplan) says pharmacists getting requests to fill prescriptions for medications “with more than 325 mg of acetaminophen should contact the” prescribing doctor or dentist to check if “lower dose would suffice,” the agency has recommended. TIME (1/15), Alabama Live (1/16, Lord) reports and FOX News (1/15) also cover the news.

SURIGCAL EXPERIENCE IS MOST IMPORTANT

Arlington Heights, Ill. - What do patients look for when choosing a surgeon to perform their facelift, nose job, or other cosmetic plastic surgery procedure? Surgeon experience and a personal recommendation from a doctor or friend are the most influential factors, reports a study in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

MELANOMA AND CHEMOTHERAPY

FDA approves combination treatment for melanoma.

Reuters (1/9, Hirschler) reports that the FDA has granted accelerated approval to a combination treatment for melanoma offered by GlaxoSmithKline. According to the article, both dabrafenib and trametinib are approved for treatment of melanoma, but GSK believes they will last longer when given together.

SURGICAL ADHESIVES

Researchers develop surgical glue for heart patients.

The Boston Globe (1/9, Weintraub) reports that researchers have developed a “surgical glue” for heart patients that “is nontoxic, biodegradable, and fast-drying even in the presence of blood, forming a bond that is strong enough to close a hole on a beating heart.” Research published in Science Translational Medicine shows “that the glue works in the harsh conditions of a surgical site.”

        The NPR (1/9, Doucleff) “Shots” blog reports that thus far, the product has only been tested on animals, so it “is far from reaching the operating room or battlefield.” However, one of the researchers “hopes the adhesive will eventually replace traditional sutures and staples for some operations, especially heart surgery.”

        HealthDay (1/9, Preidt) reports that “the adhesive is activated by ultraviolet light and provides an anti-bleeding seal within five seconds of UV light application when applied to high-pressure large blood vessels and heart wall defects, according to the study.”

STDs ON THE RISE NATIONWIDE

 

The Washington Times (1/9, Wetzstein) reports that the Centers for Disease Control and Prevention Sexually Transmitted Disease Surveillance 2012 report (pdf) released yesterday shows that gonorrhea rates increased in 2012 and syphilis rose 11%, while chlamydia remained relatively flat, although a record 1.4 million cases existed. The report states, “This is the largest number of cases ever reported to the CDC for any condition,” with the National Coalition of STD Directors adding that “rising STD rates have a major negative impact on our ability to address the HIV epidemic.” Public health officials are encouraging sexually active individuals to undergo annual STD screenings, with men who have sex with men (MSM) screened at shorter intervals if partners are not monogamous or use illicit drugs.