SMALLER BREAST IMPLANTS

More women trading in large implants for smaller sizes Demand is growing for "explant" procedures -- removal of implants altogether or in exchange for smaller sizes, according to the American Society of Plastic Surgeons. Demand grew by almost 10% from 2010 to 2014, and nearly 24,000 women had an explant procedure last year. "Surgeons are seeing a definite shift in the look many women are asking for, away from the very round, prominent 'stripper boob' toward something more in keeping with their natural shape," said American Society for Aesthetic Plastic Surgery President-Elect Daniel Mills.

NEW MEDICATION FOR MELANOMA

FDA approves first-of-its-kind skin cancer medication

Bloomberg News (10/28, Chen) reports that the Food and Drug Administration approved Imlygic (talimogene laherparepvec), Amgen Inc.’s “treatment for melanoma lesions in the skin and lymph nodes that can’t be removed completely by surgery.” Imlygic, also known as T-vec, “uses a modified version of the herpes simplex virus to attack cancer cells.” The drug will have an average cost of about $65,000 annually, according to the company.

        The Boston Globe (10/28, Tedeschi) reports in “Stat” that the drug is “the first tumor-killing virus to receive the FDA’s blessing” and it could “usher in a new wave of immune-stimulating viral therapies.” Other immune-stimulating viral therapies include “a genetically tweaked poliovirus being tested in patients with brain tumors, while another, based on a version of the common cold virus, is now under evaluation in people with bladder cancer.”

        The AP (10/28) reports that “despite the drug’s groundbreaking approach, FDA officials stressed it has not been shown to extend life,” but rather has been demonstrated to shrink tumors.

HOSPITALS ACQUIRING DOCTORS' PRACTICES - MORE COSTS TO PATIENTS

The Boston Globe (10/20, Boodman) reports the study, conducted by Harvard Medical School researchers, “found that when small doctors’ practices join large hospitals, their patients pay an average of $75 more every year for outpatient services like check-ups.” The article adds that the “steady march of doctors into hospitals could continue thanks to the Affordable Care Act,” which “encouraged the integration of different parts of the health care system in the hope that it will reduce costs.”

HOSPITALS HIRING PHYSICIANS MAY NOT BE HEALTHY

Whistleblower offers warning as hospitals hire more physicians

Kaiser Health News (10/8) reports that a third of physicians “now work directly for hospitals or for practices with at least partial hospital ownership, estimates the American Medical Association.” Dr. Michael Reilly, a Florida surgeon who filed a whistleblower lawsuit against Broward Health for engaging in “improper financial relationships” with physicians, is worried that this trend will lead to higher health costs and worse care for patients. According to the article, not “only does hospital employment ‘dramatically’ boost chances that a doctor will refer to that hospital, but it also raises odds that patients will end up at a higher-cost, lower-quality facility, finds a recent study from Stanford University researchers.”

ADVANCED MELANOMA TREATMENT

FDA approves ipilimumab-nivolumab combination for melanoma treatment

The Wall Street Journal (10/2, Loftus, Winslow, Subscription Publication) reports that the FDA approved a combination of Yervoy (ipilimumab) and Opdivo (nivolumab) to be taken together for advanced melanoma treatment, drugs expected to cost each patient $256,000 in their first year. The article highlights the high price of drug treatment cocktails, citing the annual cost by Novartis as $226,428 per patient.

        Reuters (10/2, Berkrot, Nathan) notes that Merck is testing Keytruda (pembrolizumab) to work as part of a melanoma treatment cocktail in at least ten studies. The article points out that bought separately Opdivo and Yervoy would cost around $295,000.

        Bloomberg News (10/2, Koons) explains that in May’s Yervoy-Opdivo trial, “58 percent of those who received both drugs had significant tumor shrinkage, compared with 44 percent in the group that took Opdivo alone and 19 percent for just Yervoy.” Yet, there was “a 36 percent dropout rate due to side effects,” as the combination precipitated “diarrhea and elevated liver enzymes.”

RHINOPLASTY DATES BACK TO THE SIXTH CENTURY B.C.

The rhinoplasty, colloquially known as the nose job, is now popular enough that it’s considered minor plastic surgery. Still, the procedure earns comment when the proboscis being shaped is a famous one and plenty of people express concern over the current boom in cosmetic surgeries. Yet nose jobs aren’t new. The earliest recorded schnoz shaping happened in ancient India in the 6th century B.C., The ancient Indian procedure included taking a flap of skin from the patient’s cheek and reshaping it into a new nose. The ayurvedic physician Sushruta describes that procedure in his Sushruta samhita, now considered a foundational Sanskrit text on medicine.Still, rhinoplasty didn’t enter the limelight in the West until syphilis struck Europe in the late 16th century.

One of the unfortunate symptoms of advanced syphilis is soft-tissue decay, which affects the nose and leaves a gaping hole in the middle of one’s face. Such a disfigurement carried the social stigma of disease and infection, even if the afflicted had lost their nose by another means. Different methods were employed to recreate noses. One of the most popular procedures involved taking skin from the patient’s arm and grafting it to their face in an effort to make a new nose (or something resembling one, anyway).

People have long sought out rhinoplasties to address cosmetic concerns and conform to society’s beauty ideals. Some of that led people to try and make their features look less like that of a racial minority in America (still a motivating factor today). But not all nose jobs were motivated by beauty standards. Facial surgery experienced a real boom during the two World Wars, as soldiers with injuries to their jaws, lips and noses became the proving ground for surgeons experimenting with reconstruction techniques. In her book, excerpted by The New York Times, Harken writes of surgeons who pioneered ways to build up noses, rather than reduce them. So-called "saddle-nose" could be caused by syphilis, but also could be inherited or caused by trauma or infection. A surgeon observed in 1926 that ""Many persons with a saddle nose ... are suspected of having inherited disease and are greatly handicapped, both in their social and business relations."Building up the nose presented the challenge of figuring out what to build with. The human body rejects many substances, such as ivory, that were used for other protheses. For a time, surgeons in the early 20th century settled on paraffin, but over time the substance tended to move, especially if people spent time in the sun and frequently caused cancer.Then, as now, plastic surgery was sometimes ridiculed, but still the demand increased. A pioneer in the field, Charles Conrad Miller, noted that the serious surgeon should not turn away patients seeking facial surgery. The rise of unskilled, untrained "surgeons" to fill that need presented a professional dilemma. Harken writes:

For this, Miller blamed neither the charlatans nor the gullible patients, but the physicians who did not take seriously their patients' needs. "Physicians cannot longer disregard the effect of the `Beauty Columns,'" Miller insisted. "Every practitioner who laughs at the patient who questions him regarding an operation for improving the appearance of the face takes the chance of seeing that patient return from the advertiser disfigured for life."

 

NICOTINE ADDICTION

Low-nicotine cigarettes may motivate smokers to quit, study finds

The AP (10/1, Marchione) reports on a study published Oct. 1 in the New England Journal of Medicine suggesting that “smokers who switched to special low-nicotine ones wound up smoking less and were more likely to try to quit.” For the study, special cigarettes with nicotine levels of as little as 0.4 milligrams of nicotine per gram of tobacco were made, compared to the usual 15.8 mg of nicotine per gram of tobacco. The study covered “about 800 people who smoked five or more cigarettes a day.” Participants were given cigarettes ranging in nicotine levels of 0.4 mg up to 15.8 mg for six weeks. Those who received the lower concentrations of nicotine “were a little more likely to smoke some regular cigarettes,” yet they all “reported fewer symptoms of nicotine dependence.”

        The Los Angeles Times (10/1, Healy) reports in “Science Now” the study explained that “smokers restricted to very low nicotine cigarettes will not smoke more, nor inhale more deeply, to get the same addictive hit.” Researchers found that participants with low-nicotine cigarettes “did not experience some of the extreme withdrawal symptoms — constipation, distraction, increased appetite — that cause many would-be quitters to turn back.”

        Reuters (10/1, Emery) reports that those who were given the lowest levels of nicotine were more likely to report that they tried to quit smoking altogether within 30 days of the study concluding.

        USA Today (9/30, Szabo) reports that the researchers are now conducting a longer-term, five-month study, as some say the FDA should refrain from regulations until there is additional research proven over time.