Medical News July

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MEDICAL NEWS

E-CIGARETTES DON’T HELP YOU QUIT SMOKING

Some studies have shown that they do reduce cigarette smoking at 1 month, but then at 3 and 6 months after starting e-cigarettes the number of regular cigarettes goes back up to baseline. So then the person is not only smoking cigarettes but also getting nicotine another way. The total daily dose of nicotine is now higher which may be associated with many of the health injuring effects of tobacco. As a reminder, the liquid in e-cigarettes has not been shown to be safe, so one is putting chemicals in the lung, and then the blood that may have long-term consequences in various parts of the body after they enter the blood. Sounds pretty dangerous to me.

ALCOHOL AND THE HEART

A Harvard study found that drinking more than 14 drinks/week (1 drink=12 oz beer, 1 glass of wine, or 1 shot of spirits) was associated with weaker hearts in the elderly (more than 65 years of age). There was a moderate heart-weakening effect in women if they drank between 7 and 14 drinks/week. As we age, we become more susceptible to the bad effects of alcohol and women more than men.

WHEN TO USE THE HOSPITAL PAPER SPACE SUITS

A study at UCLA’s Ronald Reagan Hospital, showed that resistant Staph and C dif (the diarrhea germ) did not spread more when the paper suits, gloves, and masks were not used. Much money and time was saved without the personal protective equipment. When hospitalized patients are in isolation, they are visited less and may become depressed so this is welcome news.

HOW TO MAKE A (HIV-) BABY

The French did a study that used statistics and predictions to see what is the most cost-effective approach to minimizing the risk of having an HIV+ baby if one of the partners were positive.  They used multiple methods: Sperm washing, keeping the viral load to undetectable, using PrEP all the time or just around ovulation, and timing the sex around ovulation with a urine test of the lady. I was recommending taking the temperature since it rises when she ovulates—not as accurate as the urine test. Of course they found sperm washing very expensive and timing the sex the least expensive and it really added to the PrEP strategy, preventing the woman from getting HIV and therefore the baby too.

INDIANA COUNTY WITH RISE OF HIV

The lone physician in that area noticed a doubling of HIV cases, so more testing occurred and they found that at least 108 persons are infected. The governor is not a fan of needle exchanges but allowed it and the legislature passed it, but the state is not paying for it. It is paid for by donations. The government will not pay for a program they have doubts about, but the evidence shows needle exchanges work and it is working here. Rural, poor areas with intravenous drug abuse do not receive as much services as the cities. How many more areas are having outbreaks that are undiscovered so far?

They traced the rise in intravenous drug use to prescriptions that could be heated up and injected. Now they are going after the physicians and pharmacists who prescribed these medications to see if there practices were legal.

PHYSICIAN PAYMENT PLANS CHANGED

There was a system that kept physician reimbursements from rising and Congress wouldn’t fix it or delayed it so that payments were delayed. It was very hard to run a business with this kind of spotty and poor support. Now there is a plan to pay physicians based on better care—a great idea! It is wise to reward for the outcome you want to achieve.

HEPATITIS C DRUG COSTS CHALLENGED

At least 5 countries are hesitant to grant Gilead Sciences a patent for their drug, Sovaldi®. They may be putting pressure on Gilead to lower the prices. The latest figure I have is $180,000 to cure one Hepatitis C patient.

STAGING THE LIVER FOR HEPATITIS C TREATMENT

Those with later stage liver disease get their medications approved more easily by their insurance companies.  In the US a biopsy is preferred, but in many countries a test using vibrations is the less costly and dangerous, and a quicker way. It is called a fibroscan and the machine costs $130,000. There are very few of these in the US. MediCare pays about $135 per scan. So you have paid the machine off after a thousand scans, not counting the people to do the scan and billing etc. This machine checks the entire liver whereas a biopsy takes a tiny piece of the liver with a long needle. A biopsy is better in obese people and the fibroscan doesn’t tell which of the early stages of liver damage you have as well as a biopsy, but the later stages is what is important.

Keep those questions coming. Be Safe!

Daniel Pearce, D.O., FACOI, AAHIVS

Clinical Associate Professor of Medicine, Loma Linda University School of Medicine

Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic                      Medicine

HIV Specialist, Assistant TB Physician, Riverside County Public Health Department

Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside

REFERENCES: Medscape®

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