TIME medicine

Tylenol and Panadol Prove No Better Than Placebo at Helping Back Pain

Paracetamol Reportedly Not Effective Drug For Back Pain
Paracetamol tablets sit on a table on July 24, 2014 in Melbourne, Australia. In a new study published in the prestigious medical journal, 'The Lancet' the most common pain reliever for back pain, paracetamol, does not work any better than a placebo. Scott Barbour—Getty Images

Acetaminophen isn't curing your aches after all

Two-thirds of adults experience back pain sometime during their lives, and most take acetaminophen, found in brands like Tylenol and Panadol, for relief. But new research has found that those medicines are no more helpful than swallowing a sugar pill.

A study published this week in a medical journal called The Lancet split 1,643 people with acute low-back pain into three groups, each given two boxes. One group received two boxes of 500-miligram acetaminophen tablets, with instructions to use the second box “as needed'; the second group got a box of acetaminophen and an as-needed box of placebos; and the third group received two boxes of placebos. Researchers told the participants to take six tablets per day from the regular box and up to two from the as-needed box.

Over the course of three months, the researchers found no difference among the three groups. Subjects showed no variation in terms of pain, recovery time, function, disability, symptom change, sleep or quality of life. About 75% of the participants were happy with their results, whether or not they had received the placebos.

TIME Health Care

Johns Hopkins to Pay $190 Million to Victims of Secretly Recorded Exams

A sign stands in front of part of the Johns Hopkins Hospital complex on July 8, 2014, in Baltimore.
A sign stands in front of part of the Johns Hopkins Hospital complex on July 8, 2014, in Baltimore. Patrick Semansky—AP

A male gynecologist secretly filmed and took pictures during exams with female patients

Johns Hopkins Hospital announced on Monday that it reached a $190 million settlement with patients whose exams were secretly recorded by a gynecologist.

The class-action lawsuit involved more than 8,000 former patients of Dr. Nikita Levy, the Associated Press reports, and the deal marks one of the largest involving sexual misconduct by a doctor. Most of the discovered videos and photographs—about 1,200 videos and 140 photos—did not include the women’s faces and were taken with a pen-like camera he wore around his neck.

The case never led to criminal charges but essentially argued that Johns Hopkins should have been aware of what the doctor was doing. Levy committed suicide 10 days after he was fired in February 2013, which occurred after an employee came forward with suspicions.

Johns Hopkins released a statement in October on the discovery of Levy’s “misconduct and breach of trust,” writing: “We have redoubled our efforts to ensure that all of us in the Johns Hopkins community understand our responsibility, and we want to encourage you to speak up if you have any concerns about patient care or privacy.”

In a statement sent to reporters, Jonathan Schochor, the lawsuit’s lead attorney, said: “When learning of Dr. Levy’s behavior, our clients were extremely distraught. They felt a great breach of faith and trust. They felt betrayed. Now, with this proposed settlement, we can begin the process of healing our community.”

The settlement still needs final approval by a judge, the AP reports.

“We assure you that one individual does not define Johns Hopkins,” the hospital system said on Monday, acknowledging the settlement. “Johns Hopkins is defined by the tens of thousands of employees who come to work determined to provide world-class care for our patients and their families.”

TIME Military

Navy Nurse Refuses Gitmo Force Feed Order

Guantanamo Hunger Strike
In this photo Nov. 20, 2013 file photo reviewed by the U.S. military, a U.S. Navy nurse stands next to a chair with restraints, used for force-feeding, and a tray displaying nutritional shakes, a tube for feeding through the nose, and lubricants, including a jar of olive oil, during a tour of the detainee hospital at Guantanamo Bay Naval Base in Cuba. Charles Dharapak—AP

A detainee described the act as a conscientious objection

A Navy medical officer at the U.S. military prison at Guantánamo Bay, Cuba has refused an order to continue force-feeding hunger-striking prisoners in what one detainee lawyer described as an act of conscientious objection.

“There was a recent instance of a medical provider not willing to carry-out the enteral feeding of a detainee. The matter is in the hands of the individual’s leadership,” a Pentagon spokesperson said in an email. “The service member has been temporarily assigned to alternate duties with no impact to medical support operations.”

It is the first known instance of a U.S. service member rebelling against the Pentagon’s force-feeding policy. An unknown number of the 149 detainees at Guantánamo’s Camp Delta have been on hunger strike for the past year and a half to protest their indefinite detention.

News of the refusal comes to the public by way of an attorney for one of the detainees, who, according to The Miami Herald, says his client described how some time before the Fourth of July a Navy medical nurse suddenly shifted course and refused to continue force-feeding prisoners. The nurse, he said, was abruptly removed from duty at the detention center. The attorney said his client described the nurse’s action as a conscientious objection.

The Herald reports that the prisoner who provided news of the incident described the nurse as a roughly 40-year-old Latino man most likely with the rank of lieutenant in the Navy.

Last year, civilian doctors writing for the New England Journal of Medicine declared that medical professionals taking part in force-feeding was unethical and called the Guantánamo medical staff to refuse to participate.

TIME medicine

Study: Phones, Tablets May Irritate People With Nickel Allergies

Ken Miyauchi, vice president and chief operating officer of Softbank Corp., left, holds an Apple Inc. iPad Mini during a ceremony as the device goes on sale at the Softbank store in the Ginza district of Tokyo on November 30, 2012.
Ken Miyauchi, vice president and chief operating officer of Softbank Corp., left, holds an Apple Inc. iPad Mini during a ceremony as the device goes on sale at the Softbank store in the Ginza district of Tokyo on November 30, 2012. Bloomberg/Getty Images

One boy had skin rashes from his iPad

A nickel allergy is one of the most common types of skin allergies, causing many people to experience irritation from jewelry, for example. New research shows that nickel allergies are becoming more common among kids, with one case being triggered by exposure to an iPad tablet.

In a recent case study published in the journal Pediatrics, an 11-year-old boy with a history of skin rashes had a particularly persistent breakout that lasted over six months. The doctors ultimately determined the trigger was nickel in his family’s iPad. An iPad cover was added, the boy changed his diet, and the rashes improved.

Apple did not respond to requests for comment.

The report’s authors say dermatologists should be mindful that some electronic devices may cause irritation for people with nickel allergies. As the Associated Press reports, only about 25% of children tested for skin allergies are allergic to nickel. Individuals who have no problems when it comes to the metal — the majority of people — shouldn’t worry about the nickel in their gadgets.

 

TIME

Dad-to-Be Films the 95 MPH Race to the Hospital for the Birth of His Child

GoPros aren't just for extreme sports anymore.

What do you do when your wife is pregnant and you need to get out of the house as soon as possible and rush to a hospital? Stick a GoPro camera in your car and record the whole thing, of course.

Troy Dickerson filmed his wife Kristin being driven to the hospital at speeds in excess of 95 miles per hour, recording himself trying to soothe her as she moans in pain. They pull up to the hospital’s car port, but Kristin can’t make it inside—she gives birth right out of the car. It’s amazing that everything went as smooth as it did, all things considered.

And when the baby is grown up, they will be able to watch their entire emergence into the world in HD! Good for them, I guess? At least they can time-lapse the footage.

TIME Drugs

Natural Depression Supplements’ Dangerous Drug Interactions

St. John's wort alternative medicine
Raphye Alexius—Getty Images/Image Source

St. John's wort can interact dangerously with many common drugs

Physicians may need to more carefully communicate the risks of natural treatments, a new study finds.

St. John’s wort—the most frequently used alternative medicine for depression—reacts dangerously with many common medicines, but it turns out many people taking the supplement don’t know that.

A study from Wake Forrest Baptist Medical Center looked at data from 17 years of the National Ambulatory Medial Care Survey and found that 28 percent of patients who said they were taking St. John’s wort were also taking drugs that have potentially dangerous interactions with the supplement. Many of those drugs are widely prescribed and taken.

The most dangerous interactions come from selective serotonin reuptake inhibitors (SSRI antidepressants) and benzodiazepines. Other drugs that can interact dangerously with St. John’s wort include oral contraceptives, blood thinners, cancer chemotherapy medicines, digoxin, HIV medicines, statins, immunosuppressants, and verapamil. When St. John’s wort is combined with some drugs, they can reduce the concentration of the prescribed drugs in the body, leading to impaired efficacy and treatment failure.

Herbal supplements fall under a category called “dietary supplements,” and manufacturers do not need FDA approval before putting them on the market, according to the Mayo Clinic.

“The treatments that you can buy over the counter are not regulated as heavily as things you’re prescribed,” says study co-author Scott Davis. “Just because they’re natural doesn’t mean they’re safer.”

Davis, a researcher at Wake Forest School of Medicine, says he was surprised by how many people were prescribed dangerous combinations of drugs. But the real number could be even higher. He believes some patients might feel embarrassed to tell their physicians they are taking natural treatments, which could prevent them from learning about potentially dangerous consequences.

“There are certainly lots of physicians out there who prescribe alternative medications,” says Davis. “Patients should inform physicians of all supplements, vitamins, minerals—anything they are taking—and make sure to ask before a physician prescribes another drug if there are interactions they should know about.”

TIME medicine

Painkiller Use High Among Soldiers Returning From War, Study Finds

A soldier salutes the flag during a welcome home ceremony for troops arriving from Afghanistan on June 15, 2011 to Fort Carson, Colorado.
A soldier salutes the flag during a welcome home ceremony for troops arriving from Afghanistan on June 15, 2011 to Fort Carson, Colorado. John Moore—Getty Images

Of the 2,597 soldiers surveyed, 15% had taken opioids in the past month. Among civilians, that number is around 4%

A study published by a U.S. medical journal found that soldiers returning from war experience pain and take prescription opioids much more than civilians.

U.S. Army researchers surveyed an infantry brigade that had recently come home from Afghanistan. Of the 2,597 soldiers, 44% reported experiencing chronic pain that lasted for three months or more. 15% had taken opioids in the past month.

By contrast, the study’s authors suggest that 26% of civilians endure chronic pain, whilst 4% take opioids. Robin Toblin, who led the study, told the Los Angeles Times: “We were surprised by the percentages.”

Of the 1,131 soldiers who experienced chronic pain, nearly 14% described it as “severe”. Combat injuries were the main reason for the pain whilst rates of chronic pain were higher in those suffering from post-traumatic stress disorder and depression. 60 soldiers said the pain was so bad that they were taking opioids nearly every day.

The study, published in the JAMA Internal Medicine noted that use and misuse of opioids, prescribed for chronic pain, has “ballooned” recently. But experts said the study didn’t answer the questions it raised about whether opioids are being correctly prescribed.

“American medicine in general is overprescribing,” said Dr Mark Edlund, a psychiatrist and pain expert who was not involved with the survey.

The study did suggest some soldiers might have been incorrectly prescribed opioids. Amongst those taking the drugs, 17 soldiers said they experienced no pain and 144 reported it as “mild”.

Painkillers such as oxycodone and hydrocodone have faced a public backlash as addiction rates and fatal overdoses continue to increase. These drugs are considered most beneficial for short-term pain. When prescribed for chronic pain, the benefits might not exceed the risks.

TIME Infectious Disease

Study: Measles, Mumps and Rubella Vaccines Not Associated With Autism

Although vaccines have eliminated many communicable diseases, some parents have chosen not to vaccinate their children in recent years

A new study on childhood vaccines determined that immunizations do not lead to autism — a finding that researchers hope will dissipate fears propagated by antivaccine campaigners such as Hollywood stars Jenny McCarthy and Jim Carrey.

Researchers in the study referenced 67 scientific papers, which were chosen for their control and comparison groups and relevance, to expose the low-risk factors of vaccinations.

“Without this work there would be a lack of transparency around this issue, so by doing this important research in a thorough and systematic way, we acknowledge that there are rare but actual side effects,” said co-author Margaret Maglione, a policy analyst at RAND Corp.

The study published in the peer-reviewed journal Pediatrics concluded there is no link between vaccines and leukemia or food allergies. Vaccines for measles, mumps and rubella (MMR) were found to occasionally have the severe side effects of fever or seizures; although, crucially, the report concludes that the “MMR vaccine is not associated with autism.”

Although vaccines have eliminated many communicable diseases, some parents have chosen not to vaccinate their children in recent years. A 2010 study showed that California had the highest cases of whooping cough since 1947. Researchers did not directly study the effects of vaccine opt-out, but found that a cluster of unvaccinated children played a role in the epidemic.

Researchers in the Pediatrics study hoped parents would be convinced by the effectiveness of vaccines, which they wrote represent “one of the greatest public-health achievements of the 20th century for their role in eradicating smallpox and controlling polio, measles, rubella and other infectious diseases in the United States.”

Study co-author Courtney Gidengil, a pediatrician at Boston Children’s Hospital and professor at Harvard Medical School, told AFP that while some parents may still be reluctant, the research should “increase some trust in the vaccine process and the trust between parents and their health care provider.”

 

TIME medicine

Skip the Pelvic Exam, Says the American College of Physicians

But not everyone in the medical community agrees

A pelvic exam for women who are not pregnant and do not have symptoms of cancer may be unnecessary, says the American College of Physicians (ACP) in a controversial new set of guidelines published Monday in the Annals of Internal Medicine. The ACP, which reviewed studies on the harms and benefits of pelvic exams, says the procedure does not detect disease as well as previously thought; it doesn’t reduce mortality; and it leads to many false positives, resulting in unnecessary testing and anxiety.

For the uninitiated, here’s what happens when women visit the gynecologist: their legs go up in stirrups and the doctor looks at the genitals before inserting a speculum into the vagina to examine the cervix. (If a woman is getting a Pap smear, cervical cells are gently scraped off with a Q-tip-like tool.) Then, the doctor places one hand inside the vagina and the other on the abdomen and feels for anything that isn’t right on the ovaries and uterus. In some cases, the doctor inserts a finger into the rectum for the same purpose. This is the pelvic exam.

While the process is not painful, it’s certainly invasive. Now, ACP is questioning the necessity of this part of the checkup — commenting that “pelvic examination can cause anxiety, discomfort, pain, and embarrassment, especially in women who have a history of sexual abuse.”

But their guidelines are not being met with widespread praise. “I think in the obstetrics and gynecology world, everyone will laugh at this and think this is the silliest thing they have ever heard,” says Dr. David Fishman, a professor and director of gynecologic oncology research at Mount Sinai Hospital. “As a gynecological oncologist, my whole career has been spent on women who have no symptoms, and then an abnormal mass is found.”

Just on Monday, Fishman met with a young, healthy woman who had a mass on her ovary she had no idea was there. “We all know the pelvic exam is flawed. It’s not comfortable for the patient, some doctors do not like doing it.” says Fishman. “Maybe statistically [the pelvic exam] doesn’t make a difference, but to that family, you’ve saved a life.”

The American Congress of Obstetricians and Gynecologists (ACOG), considered the authority on reproductive health, still recommends yearly pelvic exams for women 21 years and older, though in a 2012 committee opinion, ACOG acknowledged that the “limitations of the internal pelvic examination should be recognized.”

The new recommendations open the doors to continued debate over physical exams, and when they are appropriate.

 

TIME Education

Why Pediatricians Are Prescribing Books

Temperature, Child
BSIP—UIG via Getty Images

Children under five years old see their doctor at least once a year, and the opinion of a physician often carries more weight with parents than that of a teacher or counselor.

Earlier this week, the American Academy of Pediatrics issued a policy statement recommending story time with mom and dad start in infancy: parents should be reading to their children, the group says, from the first days of their lives.

Research shows that one-third of American children start kindergarten lacking the basic language skills they will need in order to learn to read, a deficit that can ripple through all the years of schooling to follow. Reading aloud is one of the best ways to build such skills, but surveys find that only about half of low-income parents in the U.S. are reading to their children every day. Scientists have repeatedly demonstrated that better-educated people live longer and have a lower risk of disease than their less-educated counterparts. It makes perfect sense, then, that many pediatricians are adding a new tool to their doctors’ kits: books.

There are hurdles, however, in the way of many parents taking this advice: they may not themselves be literate, for example. A study released earlier this month by the Stanford University School of Medicine reported that immigrant parents and parents with low education levels or low household incomes were less likely to read to their children. In addition, poor families may not have access to books. One study found that in low-income neighborhoods, only one book was available for every 300 children, while in middle-income neighborhoods the ratio was 13 books for each individual child. And many parents may know that they should be reading to their children each day, but find that work schedules and other household activities get in the way.

Pediatricians make ideal conduits for the message that reading is important. Ninety-six percent of children under five years old see their doctor at least once a year, and the opinion of a physician often carries more weight with parents than that of a teacher or counselor. Taking advantage of this privileged position, a growing number of pediatricians are “prescribing” books to their young patients at each visit (some of them even write out the directive to read on a prescribing pad).

Many are doing so under the auspices of an organization called Reach Out and Read, which was founded in 1989 by a group of doctors at Boston City Hospital (now called Boston Medical Center). Over the past 25 years, Reach Out and Read has trained thousands of primary care providers to speak with patients about the benefits of reading. They have distributed millions of books through these medical partners. Each enrolled child gets a new, age-appropriate book at every well-child visit, from six months to five years of age. That means they’ll start kindergarten with a home library of as many as 10 books—and these are often the only children’s books they own.

When working with parents who are unable to read themselves, doctors in the Reach Out and Read program demonstrate how they can page through a picture book with their children, making up their own stories as they go. And when counseling parents who say they’re too busy or too tired to engage in story time at the end of the day, some physicians read aloud a book to their young patients right in the consulting room, to demonstrate to parents how quickly book reading can be accomplished and how much their children enjoy it. In another literacy-promoting program, developmental specialists at the Langone Medical Center at New York University actually videotape parents reading to and playing with their children; then the parents and the specialist watch the video together, a practice that encourages parental self-reflection and self-improvement.

Researchers who have evaluated the effects of Reach Out and Read report that participating parents are up to four times more likely to read to their young children, and that their children enter kindergarten with larger vocabularies and stronger language skills. Interestingly, families who participate in Reach Out and Read are also more likely to show up for their doctors’ appointments: yet another way that health and learning can work together.

Annie Murphy Paul writes The Brilliant Blog and is the author of the forthcoming book Brilliant: The Science of How We Get Smarter.

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