Saturday, September 26, 2015


Americans eat up to 15 hours a day, study says

The Los Angeles Times (9/25, Healy) reports a study by researchers at the Salk Institute in La Jolla “that detailed the consumption patterns of just over 150 nondieting, non-shift-working people in and around San Diego for three weeks,” showed “that a majority of people eat for stretches of 15 hours or longer most days – and fast for fewer than nine hours a night.” The study suggests that “Americans’ erratic, round-the-clock eating patterns...have probably contributed to an epidemic of obesity and Type 2 diabetes.”


Seniors who work longer are healthier, study suggests

The Los Angeles Times (9/25, Kaplan) reports a recent study concluded that seniors who keep working are healthier than those who are retired. “Researchers from the University of Miami and their colleagues examined data on more than 83,000 Americans,” all of who “were at least 65 years old when they were interviewed, and 13% of them were still working part time or full time,” according to the LA Times. Of those still working, 61% held white-collar jobs. The study found that “compared to people with white-collar jobs, those who were unemployed or retired were 2.75 times more likely to report their health as ‘poor’ or ‘fair.’”

Sunday, September 20, 2015


Lawsuit alleged that patient-safety education and messaging caused direct financial damage to non-plastic surgeons

The 10th District U.S. Court of Appeals on Aug. 31 affirmed the September 2013 dismissal of a lawsuit filed by a group of non-plastic surgeons calling themselves “cosmetic surgeons” against the Utah Plastic Surgery Society, ASPS, the American Board of Plastic Surgery (ABPS) – as well as 19 individual plastic surgeons – that alleged patient-safety education advertisements amounted to monopolistic efforts and messaging that caused direct financial damage to the non-plastic surgeons.
The plaintiffs claimed that the Utah Society’s advertising – specifically billboards and media interviews modeled after the ASPS “Do Your Homework” campaign – were in violation of the Sherman Antitrust Act and asserted false advertising claims in violation of the Lanham Act. The plaintiffs claimed the campaign was deceptive by indicating that cosmetic surgery is safer when performed by ABPS-certified plastic surgeons rather than ” cosmetic surgeons.”
The Appeals Court concluded that the plaintiffs failed to show any plausible antitrust or deceptive advertising violation and affirmed the previous ruling in favor of UPSS, ASPS, ABPS and the individual plastic surgeons named in the lawsuit.
“This decision further confirms the value and importance of our efforts to provide public awareness on the distinctions between ABPS-certified plastic surgeons and lesser-trained physicians who present themselves as similarly skilled,” says UPSS President Brian Brzowski, MD. “We were helped tremendously by ASPS through its early financial and material support and its guidance in crafting the overall ‘Do Your Homework’ effort.”
“The public safety education campaign was modeled largely after the ASPS campaign,” adds UPSS immediate past President Trenton Jones, MD. “And it’s a huge win for the patient-safety efforts in our state.”
ASPS acknowledges Dr. Brzowski, Dr. Jones and the Utah Plastic Surgery Society for their efforts to both bring the ASPS “Do Your Homework” campaign to their state and defend the patient-education efforts.


Recent Article in the International Business Times Investigated the Performance of Plastic Surgery Procedures by Non-Board Certified Plastic Surgeons

American Society of Plastic Surgeons President Scot B. Glasberg, MD, recently responded to an International Business Times article titled "Medical Turf Wars," which investigated the performance of plastic surgery procedures by non-board certified plastic surgeons. Below is his full letter to Editor Peter S. Goodman.

Dear Mr. Goodman,
As the president of the American Society of Plastic Surgeons, I found your recent article investigating the performance of plastic surgery procedures by non-board certified plastic surgeons ("Medical Turf Wars" - September 7, 2015) disgracefully unbalanced. I am deeply disappointed and, frankly, shocked that the article did not include any input from the American Society of Plastic Surgeons (ASPS), the largest plastic surgery organization in the world, and the subject of serious negative accusations throughout the piece. I feel compelled to address some egregiously presented points.

The article, inspired by the recent dismissal of a case against ASPS for the implementation of a public service campaign encouraging consumers to "Do Your Homework" when considering plastic surgery, points out that physicians who perform cosmetic procedures without the benefit of being board certified in plastic surgery charge board certified plastic surgeons with protectionism.
We are not interested in protectionism. We are interested in protection—of patients, of the reputation of our specialty, and of an essential component of our mission—advancing the highest standards of training, ethics and physician practice.
By educating consumers on the importance of choosing a board certified plastic surgeon, ASPS believes we are not only guarding the specialty of plastic surgery from the indelible mark of illegally performed, often fatal procedures by non-physicians, but also protecting patients and assuring they make choices that assure the safest, highest quality of care.
This objective is the foundation of our Do Your Homework and "truth-in-advertising" efforts. The current president of the American Board of Cosmetic Surgery (ABCS) asserts that our objective is financial, but this is not the case. (I would note, however, that ABCS is conducting a nationwide campaign to undermine the sort of truth-in-advertising, described below, that ASPS is seeking to instate. The benefit for ABCS if they are successful? More money.) He claims that ASPS is seeking to prevent physicians who are not board certified plastic surgeons from providing cosmetic surgery. This is simply false. In reality, such a pursuit would be an antitrust violation. What our efforts are aimed at is instead preventing under-trained, under-qualified physicians from acquiring a substandard "certification"—like, for example, the certification offered by ABCS—and then advertising themselves to the general public as "board certified."
While our members can look at the ABCS training requirements and see that they are lacking, the general public typically doesn't have a nuanced understanding of just how dramatically quality in medical training can vary. However, what they do understand is that the phrase "board certified" is a sign of excellence. We seek only to maintain that truth and, in doing so, maintain patient safety.
Through the messages of the ASPS's Do Your Homework public service announcements, consumers learn that board-certified plastic surgeons are certified by the American Board of Plastic Surgery—the specialty board in plastic surgery that is overseen by the American Board of Medical Specialties (ABMS), an organization that is widely recognized as the gold standard in specialty certification. They learn that board-certified plastic surgeons undergo vast, specific training in plastic surgery that includes residencies and fellowships that are certified by the Accreditation Council for Graduate Medical Education (ACGME), the body responsible for accrediting the majority of graduate medical training programs, and have passed rigorous oral and written board exams to demonstrate that their training and education have successfully prepared them to practice plastic surgery.
While the article clearly states that members of the American Board of Cosmetic Surgery also receive education and training (a "fellowship" and the completion of 300 cosmetic procedures) it fails to mention the most important piece of information about that training—it is substandard.
Think of it this way: there are 38 ABMS specialty board certifications and 88 subspecialty certifications available, and there are 38 AOA specialty board certifications, 25 certifications of special qualifications, and 40 certifications of added qualification. Nowhere among this huge number of potential certification options is one for the practice of "cosmetic surgery." This is the case because there are no ACGME-accredited cosmetic surgery fellowship programs in existence.
That's not to say that cosmetic surgery is not a legitimate component of medicine or that physicians cannot be well-trained cosmetic surgeons. Instead, this reflects the fact that cosmetic surgery is a component of the comprehensive training board-certified plastic surgeons receive. It is not a discipline unto itself. And when board-certified plastic surgeons receive cosmetic training—and this is the key—it is a part of an ACGME-accredited program. Because its standards are so high, ACGME accreditation is one of the driving forces behind the quality of American medicine, and its independence ensures that participating training programs must strive to meet those standards.
The ABCS certification programs, on the other hand, create their own criteria, their own training qualifications, and their own standard for what is an acceptable level of training. Since when does the student write the test? It all comes down to quality
Sadly, patients are bombarded with confusing messages about their choices when seeking a plastic surgery provider. Ambiguous promotions made by physicians who are not board certified in plastic surgery maintain that their training is equal or even superior to that of a board-certified plastic surgeon. For the earned esteem of the plastic surgery specialty and more importantly for the safety and quality of the care provided to plastic surgery patients.
I stand by the ASPS's mantra that patients should do their homework. Respected publications reporting on this important consumer healthcare issue should, perhaps, do a bit more homework, as well.
Scot B. Glasberg, M.D.

Sunday, September 13, 2015


All types of cancer involve Uncontrolled Cellular Division.  Cancer fighting drugs can vary in their mechanism of action and side affects.

Most chemotherapeutic drugs fall into three categories:
(1) Cytotoxic
(2) Targeted Therapy
(3) Immunotherapy

Cytotoxic drugs can not distinguish normal cells from cancer cells, and thus, these drugs kill or damage all types of cells, even healthy cells. Mechanisms of action may relate to preventing the cells from replicating (Alkylating agents); interference with RNA or DNA replication (Anti-metabolites & anti-tumor antibiotics); disrupting the activities of enzymes that aid in the separation of DNA strands during DNA replication (Topoisomerase inhibitors); and drugs that stop mitosis - a process where a single cell splits into two cells (Mitotic Inhibitors).  These drugs typically have significant side effects to include hair loss, nausea and vomiting, fatigue and nerve damage.

Targeted therapy is more selective.  These drugs disrupt the activity of specific molecules that promote the growth of cancer cells. Mechanisms of action may relate to blocking enzymes that signal cancer cells to divide (Signal transduction inhibitors); controlled and targeted cell death in cancer cells (Apoptosis inducers); blocking formation of new blood vessels to tumors, thus "starving" the tumors from oxygen and nutrition which results in cancer cell death (Angiogenesis Inhibitors); blocking hormone production that may stimulate the growth of certain cancers (Hormone Therapies);
a molecular cytotoxic drug or radioactive agent is linked to a monoclonal antibody that targets and kills cancer cells (Antibody-drug conjugates). Targeted therapy drugs tend to have less serious side effects, but can result in diarrhea, fever, blood clotting issues, wound healing problems and skin problems, hypertension and liver problems.

Immunotherapy drugs stimulate the body's natural immune system to fight cancer. Interferons boost the ability of the body's immune cells to fight cancer or infections.  Interleukins help immune cells to grow and replicate more quickly, thus allowing the body to fight the cancer more efficiently. Some immunotherapies may cause flu-like symptoms, rashes or hypotension.

Many times, combining the different categories of chemotherapeutic drugs to treat certain cancers add benefit and reduces the chance of resistance to chemotherapy.

For some cancers, surgery is the first line treatment.  For other types of cancer, radiation is the preferred treatment.  Some cancers are treated by chemotherapy alone.  Other cancers are better treated with a  combination of surgery, radiation and chemotherapy.

Wednesday, September 2, 2015


Two new medications are now available to treat metastatic or locally advanced Basal Cell Carcinoma.  Erivedge (Vismodegib) and Odomzo (Sonidegib)  have been approved by the F.D.A. and have similar mechanisms of action.

Oral medication used to treat metastatic B.C.C., or locally-advanced B.C.C.
  that has recurred following surgery or in patients who are not candidates
  for surgery and are not candidates for radiation therapy

Dosage: 150 mg p.o. daily for Erivedge and 200 mg. p.o. daily for Odomzo

Cost:       $11,268.79 for a 28 day treatment for Erivedge

Mechanisms of action: B.C.C. may be associated with mutations in Hedgehog pathway components. Hedgehog regulates cell growth and differentiation in embryogenesis;  while generally not active in adult  tissue, Hedgehog mutations associated with B.C.C. can activate the pathway resulting in unrestricted proliferation of skin basal cells. Erivedge is a selective Hedgehog pathway inhibitor.

Adverse Reactions:
Teratogenic effects
Muscle Spasms