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April 2007 News Archives
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April 2: Vaccine cuts repeat ear infections, cnn.com
CHICAGO, Illinois (Reuters) – A Wyeth vaccine to fight common bacterial diseases has produced significant and unexpected drops in repeat ear infections and the need for inserted ear tubes in children since its U.S. introduction in 2000, researchers reported Monday.
"This is exciting news for parents whose children suffer from frequent and painful ear infections," said Katherine Poehling, a pediatrician at Wake Forest University Baptist Medical Center and lead author of the study.
The vaccine "is going beyond what it was supposed to do," she said in an interview.
The vaccine, called PCV7, is marketed under the brand name Prevnar in the United States and Canada and as Prevenar elsewhere in the world.
The vaccination, given initially at 2, 4 and 6 months of age, was designed to combat a number of pneumococcal infections, including ear infections that most children have at least once by the time they turn 2 years old.
But Poehling said the new research shows that the vaccine also was preventing repeat infections, which occur three or four times a year in up to nearly a third of all children, often requiring the insertion of ear tubes to equalize pressure.
The vaccine also has helped adults, she said, by preventing the general spread of disease.
"We have seen declines in the incidence of serious infections such as pneumococcal meningitis in both children and adults, as well as the number of children developing frequent ear infections," she said.
The study, published in the April issue of Pediatrics, the journal of the American Academy of Pediatrics, looked at data from more than 150,000 children in Tennessee and another 26,409 in upstate New York enrolled in health insurance programs from birth to age 5.
Since the introduction of Pneumococcal Conjugate Vaccine, it found, the proportion of children who developed frequent ear infections and the proportion who received ear tubes declined by 16 percent in Tennessee and 25 percent in New York by age 2.
Poehling called the results "very exciting" but said public health officials need to keep watch of the situation to make sure pneumococcal strains not included in the vaccine do not become a problem.
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April 3: Cochlear Implantation Increases Meningitis Risk, Infection Control Today
Confirming what physicians have long speculated, a new study published in the April edition of Otolaryngology–Head and Neck Surgery determines that the presence of cochlear implants increases the risk of bacterial infections that can cause meningitis in recipients. The discovery increases the need to educate the public on the need for meningitis vaccinations in potential cochlear implant recipients.
The study involved making cochleostomy incisions in the ears of 54 healthy rats, implanting cochlear devices in 36 of them, and then monitoring them for the presence of meningitis, a third of the rats with cochlear implants were stricken with meningitis. The study’s authors found that in these cases, cochlear implantation lowers the threshold needed for pneumococcal baterial infection, the bacterium that causes meningitis.
The study’s authors stress that it remains their belief that the benefits of cochlear implants far exceed the risk of meningitis, which can be managed by education and vaccination efforts.
Worldwide, 90 of the 60,000 people receiving cochlear implant have been stricken with meningitis, drawing deep concern within the international medical community. Previous research by the Centers for Disease Control and Prevention determined that children who receive cochlear implants to counter hearing loss are more likely to develop meningitis.
The study’s authors are Benjamin P.C. Wei, MD, PhD; Robert K. Shepherd, PhD; Roy M. Robins-Browne, MB, PhD; Graeme M. Clark, FRCS, PhD; and Stephen J. O’Leary, FRACS, PhD. They are associated with the University of Melbourne’s Royal Victorian Eye and Ear Hospital in Melbourne, Australia.
The study is the recipient of the Academy’s 2006 Resident Research Award in the Basic Science Category.
Source: American Academy of Otolaryngology – Head and Neck Surgery
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April 3: Trees put pollen at 9–year high, The News and Observer
Dust bugs car dealers, allergy sufferers and just about everybody
Benjamin Niolet and Frank Norton, Staff Writers
Your eyes are watering, you’re sneezing and your car has turned a nauseating yellow.
The pollen is everywhere; that’s how you know it’s mating season for trees. Here’s a refresher on where the powder comes from and how to deal with it:
HOW BAD IS IT? Pretty bad. The amount of tree pollen – the male cells of flowering trees – reached a nine–year high last week, the N.C. Division of Air Quality says. Oaks were the alpha producers Monday, followed by pines. Birch, sweetgum and ash trees are doing their part.
WHY IS IT SO BAD? North Carolina trees release most of their pollen from mid–March to mid–April as the first step in their reproductive dance, and warm, dry weather makes it worse.
Unless heavy rains settle the stuff, tree–pollen levels should remain high for the next couple of weeks, says Mary Clark, who measures pollen for the Division of Air Quality.
COLOR-COORDINATED CARS: While oak pollen is tougher on people with allergies, pines leave that yellow dust all over your stuff.
In the case of Crossroads Ford in Cary, it’s all over 630 cars.
"Right now, we just have a sea of yellow. That’s the only color we have right now," says Gerrett Fitzpatrick, the dealership’s detail manager. "There is no way to keep that stuff off your car."
FORGET THE SOAP: Fitzpatrick says it’s a waste of money and time to wash your car right now, and frequent washing, especially with dish soap, will damage the clear coat. Just use a garden hose to rinse the pollen away and immediately dry the car. Missed wet spots turn into stubborn water spots that even pros have a hard time getting rid of.
Meanwhile, "we’re just basically kind of praying for rain, which is very unusual in our business," said Doug Harbison, general manager of Rick Hendrick Chevrolet in Durham.
AAH, AAAAH, AAAAH CHOOO: After a weekend of nice weather, allergy sufferers flock to doctors, says Dr. Gurdev Judge of the Allergy Asthma and Sinus Center, which has offices in Raleigh and Cary.
"Basically, people are miserable right now," Judge says.
For some, over–the–counter, non–drowsy antihistamines such as Claritin bring relief, he says. Others turn to products like Benadryl and ChlorTrimeton, but they induce drowsiness. For severe allergies, a doctor can prescribe a nasal spray or vaccine.
Katrina Little, 47, of Wilson works as a technician at the Person Street Pharmacy, and she says she just about has her sinus symptoms under control. But there’s not much she can do for her eyes.
"Every time I walk outside, in five minutes literally, it’s like a little piece of glass that’s flown into my eye," she said.
At least the trees feel romantic.
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April 5: Outpatient Thyroid Surgery Found to Be Safe, Cost–Effective, Peer View Media Bar
ALEXANDRIA, VA – Thyroid surgery, which has traditionally been an overnight hospital procedure, can be done safely in an outpatient setting, and in fact is preferable because it is less expensive, according to a new study published in the April issue of Otolaryngology–Head and Neck Surgery.
The study’s authors found not only were complications low, but conducting the procedure in an outpatient environment significantly lowered the cost by several thousand dollars.
The authors observed 91 patients undergoing thyroid surgery during an 11–month period. Of the 52 patients who had the procedure done on an outpatient basis, only two experienced complications, compared with one in the hospital setting. Furthermore, the average cost of outpatient surgery ($7,814, compared with $10,288 for an inpatient stay) indicates that outpatient surgery is a more cost–effective scenario.
The study’s authors stress that outpatient thyroid surgery should involve the careful selection of candidates based on medical history and desire to convalesce at home. They add that potential complications can be minimized by prescribing calcium supplements to prevent calcium deficiencies that can arise when the procedure involves thyroidectomy.
The Academy will observe the Yul Brynner Head and Neck Cancer Foundation’s Oral, Head & Neck Cancer Awareness Week from April 16 through April 22, 2007, which is designed to both educate and increase public knowledge about oral, head, and neck cancers.
Otolaryngology–Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). The study’s authors are David J. Terris, MD; Brent Moister, BA; Melanie W. Seybt, MD; Christine G. Gourin, MD; and Edward Chin, MD. They are associated with the Medical College of Georgia in Augusta, GA.
SOURCE: American Academy of Otolaryngology Head and Neck Surgery
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April 8: A reason to remove tonsils?, parade.com
Second Opinion™: A reason to remove tonsils?
By Dr. Isadore Rosenfeld
About 4.4 million children have been diagnosed with attention–deficit/hyperactivity disorder. Since 1991, the number of prescriptions to treat the condition has increased by 500%. Now there may be another treatment option: removing the tonsils and/or adenoids of ADHD sufferers.
Years ago, most children had their tonsils removed if they often got sore throats. Today, the surgery usually is done only if a child is troubled by repeated ear and throat infections or obstructed breathing, especially while sleeping. A recent study at the University of Michigan found that respiratory symptoms improved in children after their tonsils and adenoids were removed. And about half of those with ADHD before surgery no longer qualified for that diagnosis one year later. The researchers theorize that the positive effect on ADHD may be the result of better sleep.
Doctors caution that these operations should not be done solely for ADHD but only if the tonsils and adenoids are causing serious respiratory problems. That’s because tonsils function as part of the immune system.
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April 10: When modern life pumps up the volume, give your ears some TLC, cnn.com
By Debbe Geiger
Whoever’s rocking your iPod today, do yourself a favor and turn it down. Those tiny earbuds pump music directly into the ear canal, making it easier to do permanent damage. Live music or sports, power tools, and even hair dryers can spell trouble for your hearing, too.
But thankfully, the more you protect your hearing now, the less likely you’ll be asking people to repeat themselves later. Here’s how you can do it.
Choose a better earbud
It’s tempting to crank up the volume on a personal music player because the digital technology cuts back on the usual distortion of loud music. A much healthier move, however, is to use noise–canceling earbuds, which block out excess background noise so you can enjoy music at lower volumes, says Andrew Resnick, Au.D., director of Audiology at New York’s Columbia University Medical Center Eastside. If the buds won’t stay in your ears, Resnick says noise–canceling headphones are helpful, too. Whatever you use, remember that if the person standing next to you can hear the music, it–s too loud.
Savor a little silence
Nix the all–day soundtrack. Researchers at Harvard University–affiliated Children’s Hospital Boston who have studied personal music players say one hour a day at 60 percent of the maximum volume is safe. More than an hour isn’t. Even rock icon Pete Townshend of The Who, a band famous for earth–shattering sound, is warning fans to listen less and lower the volume. He writes on his blog that years of listening to loud music through headphones has seriously damaged his hearing.
Avoid gym din
Aerobics instructors like to pump up the volume to get people motivated, but a recent study found that 80 percent of health clubs blare music exceeding 105 decibels (dB) in their classes. It’s even higher when the instructor belts her directions into a wireless microphone. If the club won’t turn down the music, move away from the speakers and wear $1 disposable foam earplugs you can buy at most pharmacies, says lead study author and audiologist Ray Hull, Ph.D., a professor at Wichita State University in Kansas.
Try hi-fi earplugs
Live concerts, loud action films at theaters, and sporting events such as a NASCAR race can send you home with your ears ringing. Officially known as tinnitus, it’s a sign of ear damage. Rock concerts are notoriously noisy, and not just right in front of the amps. A recent University of Minnesota study found that pop, rockabilly, and heavy–metal concerts can hurt your hearing no matter where you sit.
If you attend these events often, Resnick recommends high–fidelity earplugs. They let you hear the highs and lows while protecting your ears and allowing you to carry on a conversation. An audiologist can create a custom set ($150 to $200) based on a mold of your ear and the type of music you like best.
To find an expert near you, just go to the Web site for the American Academy of Audiologyexternal link. A cheaper option: standard high–fidelity earplugs ($10 to $15), available at most music stores and manufacturers’ sites. Just keep in mind that they won’t last as long or fit as well as custom plugs. Although both types are made of plastic, silicone, or vinyl, custom plugs can be used for several years; the standard ones need replacing after several months.
Block out power–tool noise
If you’re a DIYer whose idol is the Toolbelt Diva on the Discovery Home channel, you may need earplugs to match your moxie. Lawn mowers, leaf blowers, chain saws, power drills, and the like can spew noise at unhealthy volumes.
A government database on the Web lists sound output of power tools by both manufacturer and type; go to http://www.cdc.gov/niosh/homepage.html and search for "noise solutions."
If your power tools are louder than 85 decibels, head to the drugstore for foam earplugs. (Earmuffs block noise, too, and last longer than ear–plugs, but they can be bulky and uncomfortable.) Most foam plugs have a Noise Reduction Rating indicating how much sound they block. A higher NRR is best for a loud environment, notes Andy Vermiglio, an audiologist at the House Ear Institute, a nonprofit research group in Los Angeles, California. You can use foam earplugs at a live show, of course, but Resnick points out that they will muddy the sound.
Massapequa, New York–based freelancer Debbe Geiger also writes frequently for Newsday.
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April 10: Prevention: Meningitis Vaccine Provides Immunity to Ear Infections, The New York Times
By NICHOLAS BAKALAR
The pneumococcal conjugate vaccine, originally designed to prevent meningitis and blood infections in infants, also provides immunity against the virus that causes ear infections, and may be even more effective at doing so than researchers first thought.
A study of 150,000 children in Tennessee and 27,000 in New York State found that the benefits of the vaccine might extend even to children who are not fully vaccinated.
Frequent ear infections declined by 17 percent in Tennessee and 28 percent in New York among children born in 2000 and 2001, after the vaccine was put into widespread use, compared with children born in 1998 and 1999. The surgical insertion of draining tubes, a common treatment for chronic ear infections, went down by 16 percent in Tennessee and 23 percent in New York. About 75 percent of the children were vaccinated in the 2000–1 cohort, compared with less than 1 percent in the older group.
The declines in frequent infections and tube insertions matched or exceeded those of randomized trials of the vaccine. That suggests that children other than those fully vaccinated are also benefiting, because vaccinated children are less likely to pass the disease to others.
The authors, writing in the April issue of Pediatrics, acknowledged that they did not know the vaccination status of individual children, and that difficulties in estimating vaccine coverage, incomplete reporting by health professionals and differences in diagnoses among doctors could have affected the results.
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April 10: Heart failure, sleep apnea a deadly combination, Canada.com
Tom Blackwell, CanWest News Service; National Post
TORONTO – Heart–failure patients are twice as likely to die if they suffer from sleep apnea, yet most experience no symptoms of the insidious disorder and have no idea they face higher risk, a new Canadian study has found.
The study’s authors suggest that screening the 500,000 Canadians with heart failure for sleep apnea – which involves problems breathing while asleep – and treating those who have the condition could save countless lives.
"Although the overall death rate for heart failure has fallen ... it’s still very high and it’s still a very common cause of disability and hospital admissions," said Dr. Douglas Bradley, director of the University of Toronto centre for sleep medicine and a lead author of the study.
"Anything we can do to improve that is obviously very good. ... We believe that treatment of sleep apnea should now become routine."
The primary treatment for sleep apnea – continuous positive airway pressure or CPAP – has had dramatic results in some of his heart failure patients. One 68–year–old lawyer "couldn’t walk" and was headed for a heart transplant. He is currently on an extended hike through Spain after being diagnosed with apnea and going on CPAP treatment, said Bradley.
The new study, to be published in the Journal of the American College of Cardiology this month, drives home the connection between the two conditions, said Dr. Larry Hryshko, head of the University of Manitoba cardiovascular sciences centre. He advocates widespread screening and treatment for sleep apnea at the family–doctor level.
"There is little to no downside to implementing CPAP and it’s very inexpensive," said Hryshko. Screening for sleep apnea would involve the patient camping overnight in a special lab.
The death rate for heart failure – where the heart is unable to pump sufficient amounts of blood to the rest of the body – is as much as 40 per cent in the most severely ill. The long–term treatment for many is still a heart transplant, prompting researchers to look for alternative therapies.
Previous studies have suggested that close to a third of heart–failure patients have sleep apnea and that treating the disorder can alleviate symptoms of the cardiac disease. Sleep apnea, in which the windpipe blocks airflow during sleep, obstructing breathing 15 to 20 times a night, appears to exacerbate high blood pressure and other symptoms of heart failure.
To better understand the link, Bradley and his colleagues followed 164 heart–failure patients at Toronto’s Mount Sinai Hospital between 1997 and 2004.
The study found that those who had obstructive sleep apnea were twice as likely to die, with a mortality rate of 8.7 deaths per 100 patient years, compared to 4.2 for those who did not have sleep apnea.
"We didn’t expect it to be double," said Bradley. "We’re not talking about a trivial difference. We’re talking about a very large difference."
What is more, none of the 14 patients in the study who had sleep apnea but were treated with CPAP died, though the numbers of that group were too small to be considered statistically significant.
Other sleep apnea patients have recognizable symptoms, especially heavy snoring at night and chronic sleepiness during the day.
But, for reasons that are unclear, people with heart failure usually have none of those clinical signs. The only way to diagnose them is to have the patients spend a night in a sleep lab, where sensors are attached to them to detect disruptions in their breathing.
Those who test positive usually start wearing the he CPAP device at night. It uses a mask, tubes and a fan to push the tongue forward and allow a clear path for air into the throat and lungs.
A female patient of Bradley, now in her early 60s, appeared to need a transplant to survive, as her heart was ejecting a fraction of the normal amount of blood into the body: "almost incompatible with life."
Her husband, a physician, noticed she stopped breathing repeatedly at night and she underwent testing that revealed she had sleep apnea. With the CPAP device, her heart function is now back to normal, and she is currently on a Caribbean cruise, said Bradley.
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April 22: Head and Neck Cancer Vaccine Targets Proteins to Create Immune Response, Medical News Today
Most attempts to create therapeutic cancer vaccines are based on custom–made approaches that use a patient’s own tumor cells to generate a strong immune response against cancer. However, developing these kinds of personalized vaccines is time–consuming, expensive and often impractical. Using an alternative approach, researchers at the University of Pittsburgh Cancer Institute (UPCI) in collaboration with the Gunma University School of Medicine in Japan, have developed a vaccine strategy for head and neck cancer that targets multiple peptides (parts of proteins) to activate the immune system to attack tumors. Their findings, abstract number 5113, were included in a press briefing on cancer vaccines at the annual meeting of the American Association for Cancer Research.
The researchers created the vaccine to target a tumor suppressor gene called p53, which is mutated in most cancers and associated with poor clinical outcomes. Previous research has determined that mutated p53 also expresses unaltered, or "wild–type," p53 peptides in tumors. When presented on dendritic cells, these wild–type p53 peptides may induce an immune response to strengthen the body’s natural defenses against cancer and decrease the chance of cancer recurrence and the formation of secondary tumors.
"The key to our strategy is to select those p53 peptides that can best activate the immune system and induce it to produce immune cells able to recognize and eliminate the tumor," said Theresa Whiteside, Ph.D., who in collaboration with Albert DeLeo, Ph.D., directed the study. Both investigators are professors of pathology and immunology at the University of Pittsburgh School of Medicine. "Through animal models and human cells in culture, we have found that this strategy is very effective at stimulating T cells into action," said Dr. Whiteside, who also directs UPCI’s Immunologic Monitoring and Cellular Products Laboratory. According to Dr. DeLeo, the vaccine based on these findings also could be relevant to other types of cancer given that the loss of p53 function is a common feature across many cancers.
The vaccine is based on three peptides derived from p53 that target killer T cells and helper T cells. Although killer T cells directly destroy tumor cells, they are assisted by helper T cells that secrete small proteins called cytokines to regulate or "help" the immune response.
Given that the proof of principle for the vaccine has been determined, a phase I clinical trial of the vaccine has begun at the University of Pittsburgh Cancer Institute to assess its safety in head and neck cancer patients.
Head and neck cancer accounts for about 5 percent of all newly diagnosed cancers in the United States. More than two–thirds of head and neck cancer patients have a locally advanced stage when diagnosed and have a poor five–year survival rate even after treatment.
Co–authors of the study include Kazuaki Chikamatsu, Ph.D., Koichi Sakakura, Ph.D., and Nobuhiko Furuya, Ph.D., Gunma University School of Medicine in Japan. The study is funded by a grant from the National Institutes of Health.
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April 23: Trustees warn about rising Medicare costs, msnbc
By Krishna Guha in Washington
Medicare trustees issued the first ever statutory warning over the long–term finances of the government–backed health programme for senior citizens on Monday.
The warning, required by law, came as new projections showed the share of Medicare costs paid out of general taxation would exceed 45 per cent by 2013. More realistic assumptions suggest this threshold could be breached as early as 2010.
Under the 2003 Medicare modernisation act President George W. Bush will now be obliged to propose legislation that would reduce the burden on general taxation within 15 days of submitting his next budget proposal next February.
Congress will be required to consider the proposal but is under no obligation to endorse it or provide alternative ways of improving Medicare’s finances. The new Democratic Congress has shown no interest in Mr Bush’s latest proposals to curb costs, in part by introducing more means–testing.
"Today is a historic occasion and not a happy one," Hank Paulson, the Treasury secretary, said. He said he was frustrated at the lack of response to his efforts to generate a bipartisan initiative to tackle the problem of financing Medicare and the other main entitlement programmes, Medicaid and Social Security.
"There was a time when I was a bit more optimistic than I was today," he said. "I am getting a little bit tired of playing solitaire."
Monday’s projections show Medicare’s hospital insurance trust fund will be exhausted in 2019. The trustees project that Medicare costs will rise from 3.1 per cent of gross domestic product last year to more than 11 per cent of GDP in 75 years.
The Social Security trustees, meanwhile, released separate projections showing the retirement programme also faces serious challenges, with dedicated revenues from payroll taxes continuing to exceed Social Security spending for another 10 years and cash flow turning negative from 2017.
Accumulated surplus revenues from the past – ascribed to notional trust funds – would in principle then cover Social Security spending until 2041.
The estimates show that, to fix the finances of Social Security for the next 75 years without changing benefits, the government would have to raise payroll taxes by a fraction under 2 percentage points.
Mike Leavitt, secretary of health and human services, said the one bright spot was the lower–than–anticipated cost of the new prescription drug benefit, which he said proved that competition worked to bring down costs.
However, Medicare actuaries still project that the cost of the prescription drug benefit will rise by 7.8 per cent a year over the next decade.
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April 23: Stomach Bacterium May Thwart Asthma, WebMD
Helicobacter Pylori, Which Can Cause Ulcers, May Make Asthma Less Likely
By Miranda Hitti
WebMD Medical News
Reviewed by Louise Chang, MD
A stomach bacterium that causes ulcers and is linked to stomach cancer may make asthma less likely.
That news appears in the Archives of Internal Medicine.
The bacterium is called Helicobacter pylori (H. pylori). It is associated with ulcers and increased risk of stomach cancer.
H. pylori is found worldwide, but it’s more common in developing countries, note Yu Chen, PhD, MPH, and Martin Blaser, MD.
Chen and Blaser work at the New York University Cancer Institute; Blaser also works with the Department of Veterans Affairs New York Harbor Healthcare System.
They studied data on 7,663 U.S. adults who took part in a national health study conducted from 1988–1994.
Participants were asked if they had ever had asthma. They also took a blood test to see if they had ever been infected with H. pylori. A subgroup of nearly 2,400 participants also took skin tests to check their skin’s sensitivity to pollen and molds.
H. Pylori and Asthma
Overall H. pylori infection didn’t affect participants’ odds of currently having asthma. But it apparently reduced their risk of having had asthma in the past, especially in childhood.
H. pylori infection was also linked to never having had hay fever (allergic rhinitis), allergy symptoms, or skin sensitivity to pollen or molds.
"The present observations are consistent with the ‘hygiene hypothesis’ that microbial infections during early childhood may prevent or diminish [skin] sensitization and asthma," write the researchers.
H. pylori may have "costs and benefits," Blaser says in a New York University news release. "The relative costs and benefits clearly differ among individuals," he adds.
The study doesn’t show how H. pylori makes asthma less likely.
"One hypothesis is if you have H. pylori in your stomach, you have an inflammatory process that is ongoing for decades, and this is skewing the immune system in a particular direction," Blaser says.
SOURCES: Chen, Y. Archives of Internal Medicine, April 23, 2007; vol 167: pp 821–827. News release, New York University Medical Center and School of Medicine.
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April 24: Sleep apnea flow generators are recalled, ScienceDaily
WASHINGTON, April 24 (UPI) – The U.S. Food and Drug Administration has announced the voluntary worldwide recall of about 300,000 flow generators used to treat sleep apnea.
The recall was initiated by ResMed Inc. because of the potential for a short circuit in the company’s S8 flow devices’ power supply connector.
ResMed said patients can continue to use S8 flow generators until they receive a replacement unit but should immediately discontinue using the device if there are any signs of electrical failure such as intermittent power, cracking sounds, sparking or a charred odor.
ResMed’s S8 flow generators are distributed worldwide through medical equipment suppliers. Affected products can be identified by the serial number on the bottom of each device. A list of the recall’s serial numbers is available at resmed.com/en-us/s8program/s8program.html. Patients in the U.S. and Canada may also contact the company at 888–899–8991.
Contact information for patients in Latin America, Europe and the Asia–Pacific region is available at resmed.com/s8program.
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April 26: 10 Things Your Plastic Surgeon Won’t Tell You, SmartMoney.com
By Jim Rendon
1. "I trained a whole weekend to learn this procedure."
With skyrocketing malpractice premiums and the Kafka–esque insurance system, it’s little wonder M.D.s are flocking to the plastic surgery biz. It’s easy to get into (legally, any doctor can do it), patients pay up front for surgery, and demand is surging: The number of cosmetic procedures doubled between 2000 and 2006, making it a $12 billion–a–year industry.
The best surgeons spend years honing their chops in residencies; by contrast, those hoping to offer a little Botox along with flu shots tend to opt for less rigorous training – like the popular weekend classes at the International Society of Cosmetogynecology, an odd but official–sounding organization that promotes plastic surgery as an extension of gynecology. Its three–day courses cover liposuction and injectables. Empire Medical Training offers an even thriftier nine–hour seminar on lipo – two hours of which are devoted to marketing.
Real plastic surgeons are appalled. "Any licensed physician can put up a plaque and say they do plastic surgery regardless of training, and that’s scary," says Roxanne Guy, president of the American Society of Plastic Surgeons.
2. "I make a mint off other surgeons’ mistakes."
When 35–year–old Kelley Young of Fresno, Calif., looks at her wedding photos, all she can see is her plastic surgery disaster: Young’s nose is bent to one side, and its tip is misshapen. "Those photos just look ugly, ugly all all over," she says. Later, when Young went back to her doctor for a fix, he tried snapping her nose back into place – without anesthetic. A year later she finally found a competent plastic surgeon to fix the problem.
Young is hardly alone. In fact, she’s part of a new growth area in the field: fixing botched cosmetic procedures. According to a survey by the American Academy of Facial and Plastic Reconstructive Surgery, one in five nose jobs are corrections of a failed procedure. Stanley Frileck, an associate clinical professor of plastic surgery at UCLA, says that 35% of his work is fixing the mistakes of other surgeons. Botched rhinoplasty, face–lifts and eyebrow procedures are the most common. Not only are these repairs more complex than the initial surgery, but they can cost up to three times as much, Frileck says – and the result is never quite as good as a well–done procedure would have been in the first place.
3. "Sure, I can turn back the clock, but it just starts ticking again."
Just because you shelled out $10,000 for a face–lift doesn’t mean you’re set for life. Even the most skillful work will need some attention a decade or two down the line. Some jobs may require supplemental fillers (compounds that are injected under wrinkle lines in the skin) or minor surgery to tighten up a few sags, while others could call for a repeat of the same procedure. "All cosmetic surgery has a life span," says Richard D’Amico, president elect of the ASPS. "Procedures will not last forever."
Surgery to tighten droopy eyelids, for example, often needs to be revisited after a decade, and any work on the lower face will age more quickly than that on the upper face since the lower is fleshier and has less bone for sagging jowls to hang onto. Breast implants are the most predictable: Like any foreign objects in the body, they’ll eventually be surrounded by scar tissue, which can make breasts hard and painful. That’s why every decade or two, depending on the patient, most implants need to be replaced. While 300,000 women receive implants annually, 25,000 have them removed. "It’s strictly a function of time," Frileck says.
4. "You’d be better off spending this money on a good therapist."
Plastic surgery doesn’t make you crazy, but those who have had it, both men and women, are more likely to suffer from psychological problems. Several studies in the mid–1990s found that women who chose to get breast implants were two to three times more likely to commit suicide; other studies have found that 20% of plastic surgery patients have undergone some form of psychological treatment.
Up to 15% of plastic surgery patients suffer from "body dysmorphic disorder," marked by obsessive and exaggerated concern over aspects of one’s appearance. It may sound like a convenient diagnosis for our beauty–obsessed culture, but it is a very real, very dangerous condition, says David Sarwer, an associate professor of psychology at the University of Pennsylvania School of Medicine. "At the extreme, people will not leave their home they’re so preoccupied with how they look," Sarwer says. BDD sufferers often seek plastic surgery hoping it will magically transform their lives, and when it doesn’t, they may harm themselves. Every plastic surgeon worth his salt asks probing questions to gauge patients’ motives, but to date there’s no standardized screening tool for BDD.
5. "Of course I’m board certified – for what that’s worth."
A board–certified plastic surgeon should be the best, right? Not always. Because any doctor can perform any cosmetic procedure, and because certification boards are self–regulating, many certifications aren’t so telling. The American Board of Laser Surgery, for example, certifies nurses, veterinarians and oral surgeons in laser surgery – through a take–home written exam. Meanwhile, two different boards certify practitioners of "mesotherapy," the use of injections to dissipate cellulite, although there’s little evidence to suggest it works. "To say you’re ‘board certified’ is meaningless," says Michael McGuire, of the ASPS.
There are some certifications that matter: The American Board of Plastic Surgery is the most rigorous for this specialty and the only certification body for plastic surgery recognized by the American Board of Medical Specialties. Members of the ABPS have completed residencies in both general surgery and plastic surgery and are trained to do all procedures from liposuction to nose jobs. Likewise, physicians with board certifications in either otolaryngology or in facial plastic and reconstructive surgery also have reliable training in procedures above the collarbone.
6. "You can get this done for a fraction of the price overseas."
When Janette McNeal decided to get some work done, the 55–year–old Tulsa, Okla., homemaker balked at the $10,000 cost of a face– and neck–lift. McNeal decided to look overseas and wound up having surgery in Malaysia, where the same $10,000 bought her the face–lift plus liposuction in three areas, a tummy tuck and an eyelid lift.
It’s not for everyone, but "medical tourism" is less risky than it used to be. Since 2000, Joint Commission International, the international wing of an organization that accredits U.S. hospitals, has okayed 110 facilities overseas. Also, private companies that do their own screening have sprung up to guide patients through the process. One of those, Med Retreat, visits each hospital it uses and guarantees that the best surgeons will be on the case.
But medical tourism still has its hazards. It can be tough determining doctors’ qualifications, and eager patients may try to cram in too many surgeries at once, requiring a longer recovery and boosting the chance of lethal blood clots, a risk already increased by flying. Travel following surgery can also up the possibility of infection. And if something goes wrong, well, forget a malpractice suit.
7. "I make my living off the fat of the land – literally."
The number of Americans who lose 100 pounds or more is increasing. But dropping the weight is just part of the process; next comes what’s known as body contouring. After a person loses so much weight, his skin does not snap back, leaving folds of excess skin on his thighs, back, torso, abdomen and neck, which can cause rashes and make fitting into clothes and exercising problematic. In many cases the extra skin must be removed through extreme versions of breast augmentations, tummy tucks and other procedures. And there are often complications: The remaining damaged skin can die or separate after the procedure, requiring additional surgeries. Despite all the problems, body–contouring surgery is increasingly popular; between 2004 and 2005, the number of procedures increased by 22%, to 31,000.
After Michele Fitch, a teacher in Melbourne, Fla., lost 190 pounds, she waited eight years to have the follow–up surgery. She wanted to make sure she could keep the weight off, and she needed to save money – insurance often pays for the gastric bypass, but it rarely covers contouring. First she had skin removed from her arms and chest. Then 10 pounds of skin was cut from her sternum to her bikini line and from hip to hip. Out–of–pocket cost to date: $33,000. And Fitch still faces two more surgeries on her legs.
8. "Long-term effects? Beats me."
More than most other specialists, plastic surgeons are under pressure to compete with one another, and an easy way to get the upper hand is to offer all the latest technology. "There is great pressure for physicians to jump on the bandwagon of a new filler or technique before it is really evaluated," McGuire says. "And their ethics are not too high to begin with."
Doctors are often happy to try new techniques before the long–term effects are known, and in some cases they’re performing procedures that already have poor track records. Injecting a person’s own fat from other areas into her breasts for enlargement is on its way to popularity again. When this was tried years ago, much of the fat died, causing unsightly rippling and lumps. But that wasn’t the worst of it: The tiny calcifications that resulted from the dead fat were easily confused with tumors and rendered mammograms less effective. While some argue that new techniques and better mammograms have eliminated these problems, McGuire is certain that this rush to the latest and greatest will once again produce disastrous consequences.
9. "Silicone's back – and putting my kids through college!"
Fifteen years after the U.S. Food and Drug Administration banned them for elective use and after massive class–action lawsuits bankrupted their manufacturer, silicone breast implants have gotten the green light again. Though there’s no conclusive evidence that silicone from ruptured implants causes the problems once associated with it, the FDA is staying cautious, recommending that patients undergo a long list of expensive follow-up tests over the long term. Due to concern about leaks, the FDA has required labeling that instructs those with the implants to get MRIs to check for ruptures after three years, then once every two years after that. Silicone implants should also be replaced every 10 years.
There’s no actual mandate for these procedures, and some doctors say that patients won’t follow through, especially once they start tallying the bill: The initial surgery can cost between $5,000 and $10,000; MRIs are about $1,500 apiece, and you'll need four over a decade; and the replacement surgery can cost about as much as the original procedure. Grand total: between $11,000 and $16,000 every 10 years.
10. "Those who need surgery the most will benefit from it the least."
Most people turn to plastic surgery when they feel age has finally caught up with them and nothing else will rid them of that troublesome bulge. But the dirty little secret of plastic surgery is that with many procedures, the more you need it, the less you can expect.
Those who have damaged skin, more common as we age, can expect some serious complications. Skin stretched by weight gain, for example, loses its elasticity; following liposuction it may not snap back into place but hang like an apron over the area that was suctioned. Because smokers have poor circulation to the epidermis, their skin can die after surgery, meaning months of unsightly scars and possible additional surgery. And procedures such as a face–lift done on sun–damaged skin won’t last as long and may result in more–prominent scarring. Likewise, those hoping for dramatic weight loss from liposuction are looking in the wrong place; surgeons say it’s meant only to shape a certain part of the body in conjunction with diet and exercise.
Ironically, those who need cosmetic surgery the least – generally, those who are younger and opt for a little tweaking here and there – are going to fare the best. "How well a person cares for themselves throughout life is very important," says Mark Jewell, former president of the American Society for Aesthetic Plastic Surgery.
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April 27: Analysis: Hayfever Costly on the Job, United Press International
By ED SUSMAN
UPI Medical Correspondent
WEST PALM BEACH, Fla., April 27 (UPI) – Hay fever might be seen as a seasonal annoyance, but for the more than 20 million Americans who have allergies – the itchy, watering eyes, sneezing and coughing – it adds up to as many as 4 million days of lost work a year.
That’s just the start of the cost of hay fever, though, experts told United Press International Friday.
"Allergies such as hay fever cost untold millions of hours in lost productivity among people who go to work sniffling and sneezing," said Dr. Jordan Josephson, a sinus and allergy specialist at Lenox Hill Hospital, New York.
"And don’t forget about the toll on children in schools who miss classes or don’t perform well in class due to hay fever and other seasonal allergies," said Josephson, author of the new book "Sinus Relief Now!"
In a new study of nearly 577 people with hay fever symptoms, including sneezing, watery eyes and runny and itchy noses, researchers determined that the average worker lost an hour of work per week during peak hay fever season.
Multiply that by 20 million to 50 million people with allergies and the loss of work is enormous, said Sheryl Szeinbach, professor of pharmacy practice and administration at Ohio State University.
"That means the potential loss of millions of hours of work productivity, not to mention the associated economic costs," she wrote in her study on the Web site for the Primary Care Respiratory Journal.
Szeinbach said hay fever symptoms can disrupt all areas of life, and study participants cited a lack of sleep and a negative impact on their overall health as the two main reasons for missing work.
She suggested that people who suspect they have hay fever get an allergy test, either from a primary care doctor or an allergist. In previous work, she found that some people with allergy–like symptoms don’t actually have allergies. Allergy–type symptoms can come from multiple sources, including perfumes, sinus infections, exercise, dust, or cold air, even if a person doesn’t have an allergy.
"Diagnostic testing followed by the right kind of treatment may mean less time out of work," she said.
Szeinbach and her colleagues collected questionnaires from 577 people whose medical and prescription records showed a diagnosis of allergic rhinitis. Participants were asked about the severity and type of allergy symptoms they had, and whether they had seen a physician for treatment.
The researchers placed participant responses into one of three groups, 240 patients received care from a family physician, 172 patients saw an allergist for treatment and 165 chose to self-manage their symptoms.
Work time missed due to allergy symptoms ranged from zero to 32 hours a week. Although collectively the participants missed an average of one hour of work per week during the year–long study, most hours were missed during peak hay fever seasons, namely spring and fall. This may result in missing a couple to several days of work a week during allergy season.
People under the care of a family physician reported a greater severity of symptoms than did patients treated by an allergist as well as those who self–managed their allergy symptoms.
"Family physicians tend to be the gatekeepers to allergists, and as such, are more likely to have initial contact with allergy patients," Szeinbach said. "So it makes sense that family physicians would see patients with a broad spectrum of allergy symptoms."
A lack of sleep and a decrease in quality of life had the greatest impact on a person’s ability to work, regardless of the treatment group they were in. Participants also cited watery eyes and sneezing as having a moderately negative effect on their productivity at work.
Josephson told UPI that people with hay fever can reduce their risk of symptoms during high pollen days by changing out of pollen–laden garments and taking showers to wash pollen from their hair when they get home from work or play.
He also said they should use air conditioning in cars, rather than ride with open windows, and avoid open windows in houses on breezy days. He also said that people should remember to frequently change their air conditioner filters.
Josephson suggested that patients should consult board–certified specialists in allergies or otolaryngology – ear, nose and throat doctors – who can help determine types of allergies and treatment.
Szeinbach’s study was funded by Phadia US Inc., manufacturer of allergy tests. Szeinbach said she and her colleagues have no ties to the company beyond the scope of this work.
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