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.

TIME Drugs

Los Angeles Is Getting a Farmers’ Market for Pot

Legalizing Marijuana
Marijuana is displayed during the grand opening of the Seattle location of the Northwest Cannabis Market, for sales of medical marijuana products, Wednesday, Feb. 13, 2013. Elaine Thompson—AP

Farm-to-table marijuana

Say hello to the newest addition to the farmers’ market: marijuana.

Los Angeles medical-marijuana users will soon be able to buy their product straight from the people who grew it, according to Paizley Bradbury, executive administrator of the California Heritage Market. The farmers’ market is set to open the weekend of July 4, and anyone with a medical-marijuana card will be able to walk through and check out the booths, where vendors will peddle cannabis flowers, edibles and more.

“It’s going to be so much easier for patients to get their medicine at a more affordable rate, and something that they can trust,” Bradbury tells TIME. “They can say ‘How did you grow this? Is it organic? What kind of nutrients did you use? What kind of strain is this?’ There’s just so much more behind it.”

Bradbury hopes direct patient-farmer contact will protect customers from what she calls the major problems in the industry: big markups from brokers who shuttle the product from farms to dispensaries, and dishonest practices by dispensaries, which Bradbury says sometimes post inaccurate analyses of the product hoping the average consumer won’t know any better.

The California Heritage Market hopes to keep running every weekend, provided it does not hit any legal barriers. Bradbury says she has been working very closely with an in-house lawyer to ensure everything goes smoothly.

“With this industry, you just never really know how things are going to turn out until after you do it,” she says.

TIME Research

Parents Are More Worried About Milk and Egg Than Peanut Allergies

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Photo by Maren Vestøl—Getty Images/Flickr Select

In surprising findings

Peanut allergies are terrifying for parents, but recent research shows they’re actually even more concerned about milk and egg allergies.

Researchers from the University of Michigan studied 305 caregivers of kids with milk, egg, peanut or tree nuts allergies, and analyzed their understanding of their child’s allergy as well as their quality of life. Parents of kids with milk and egg allergies have increased anxiety and strain over their child’s allergies compared to parents of kids allergic to peanuts, the researchers found.

“It’s assumed peanut and tree allergies are the most severe, and therefore it may be presumed they would cause the most strain for caregivers” allergist and study author Dr. Laura Howe said in a statement. “But because eggs and milk are everywhere, and used to prepare so many dishes, caregivers with children allergic to those two ingredients feel more worried and anxious.”

Peanut allergies affect about 400,000 school-aged children in the United States, according to the American College of Allergy, Asthma & Immunology. By comparison, milk allergies affect about 300,000 U.S. kids under age three, and egg allergies effect about about 600,000. But about 70% of people with egg allergies will outgrow it by age 16.

The researchers concluded that milk and eggs are ubiquitous in the American diet. Another study showed 72% of 614 allergic infants had another reaction to their milk or egg allergies within three years—showing that avoidance is difficult.

The study was published in the journal Annals of Allergy, Asthma and Immunology.

TIME

HIV Did Not Stop Me From Having a Biological Child

Author Ben Banks with daughter Finley and wife Kasiah
Author Ben Banks with daughter Finley and wife Kasiah Rachel Taylor—Piedmont Photography/Palmyra, VA

Though I have been HIV-positive since childhood, it has always been my dream to have a family. Last year, my wife and I welcomed our biological daughter

On Monday, April 15, 2013, at 8:00 a.m., my life changed forever. My wife, Kasiah, and I welcomed our first child, a healthy girl named Finley Elizabeth Banks, into this world. She was perfect. But the journey to have a healthy, HIV-free biological child began many years before Finley’s birth.

In 1981, when I was two years old, I was diagnosed with Bilateral Wilms’ tumors, a cancer of the kidneys, which had also spread to both of my lungs. The prognosis was grim; treatment was aggressive. My tiny toddler body fought a battle that required 15 months of chemotherapy, radiation therapy, and surgeries that required multiple blood transfusions.

Unknowingly, I was transfused with blood that infected me with HIV. Ten years later, having lived through a cancer-free childhood, doctors screened my blood during a routine oncology check-up. They discovered that I was HIV-positive.

In 1991, the epidemic was still raging, and very little was known about how HIV/AIDS infected and affected children. Pediatric treatment options were limited — AZT (the drug that drives the plot of Dallas Buyers Club) had only been approved for young patients the previous year.

Support from family and friends gave me the hope and strength I needed to fight every day and continue to plan for my future: graduate from high school and college, get married, and start a family. School required hard work and determination on my part, but starting a family would require unconditional love and support from another person, someone who could look past my HIV-positive diagnosis and see all of me.

That person was my best friend, Kasiah. We married in 2003. She believed in our future together, which included trusting that research would be developed to allow us to have a healthy, HIV-free biological child.

As we began to explore options, Kasiah and I were frustrated at the lack of family-planning data or information out there for serodiscordant couples like us, in which one partner is HIV-positive and the other is negative.

After endless telephone calls and consultations, we opted for sperm-washing and artificial insemination. Sperm washing is a technique commonly used to screen for genetic disorders, but the process is especially important for mixed-status couples who choose to have biological children. Doctors separate sperm from infected fluid, producing a virus-free sample (as with anything in medicine, the process does not 100% guarantee no transmission, and it is illegal in some states, but studies have shown its vast success).

After the sperm was washed, two samples were tested for HIV and both results were negative. This step was critical because we wanted to reduce the chances of horizontal (to the woman) or vertical (to the child) transmission of HIV as much as possible. And as mentors to younger HIV-positive children, adolescents, and young adults, we wanted to give the message of prevention.

Despite the now-wide research and documentation of prevention of mother-to-child transmission of HIV (PMTCT), there is still little dialogue around a father’s role in PMTCT. By not considering an HIV-positive male in terms of reproduction, a large portion of the HIV population is being ignored. We share our story and our daughter’s story to let other HIV-positive men know that the possibility of having a healthy, HIV-free family is very much a reality.

In the year we have loved Finley, we know what it means to be truly unselfish. Our hearts melt when we hear the words, “Ma-ma!” or “Da-da!” And we would not trade the sleepless nights, early wake-up calls, or dirty diapers for anything in the world.

Ben Banks is an HIV-positive Ambassador for the Elizabeth Glaser Pediatric AIDS Foundation, which celebrate its 25th anniversary this week. He lives in Virginia with his family.

TIME medicine

5 Weird Migraine Treatments

5 Weird Migraine Treatments That Could Give You Relief
Philippe Bigard—Getty Images/OJO Images RF

It’s no secret that migraines are a serious pain. About 37 million Americans get migraines, and women are three times more likely to have them than men, according to the National Headache Foundation. Ouch!

If you’re plagued by migraines, you’ve likely popped different pills to ease the throbbing. But would you ever try a high-tech headband or a battery-operated patch to soothe your aching head? Yes, such treatments exist. In honor of Headache and Migraine Awareness Month, here are five wacky migraine fighters explained. (The first three are available by prescription only.)

Health.com:18 Signs You’re Having a Migraine

Cefaly headband

The U.S. Food and Drug Administration recently approved the Cefaly headband, which was found to reduce patients’ number of migraine days by 30% in a clinical trial published in the journal Neurology. The headband has an electrode that presses against the middle of your forehead, delivering a round of electric impulses that work to stimulate the nerves above the eyes. It’s safe to use for 20 minutes a day, and some experts believe that daily use could help prevent migraines before they start. “In my practice, this device has helped quite a few patients, cutting headache days per month in half or more,” says Richard Lipton, M.D., Edwin S. Lowe Chair in Neurology for the Albert Einstein College of Medicine.

Transcranial magnetic stimulation (TMS)

Now that’s a mouthful! A portable device with TMS technology uses a pulse of magnetic energy to target migraines with aura, which plague about 20% of migraines sufferers, according to the National Headache Foundation. “A patient with visual aura might report seeing spots of light, zig-zag lines, or a graying of vision lasting 10 to 60 minutes,” says Dr. Lipton, who tested the treatment himself in a clinical trial for Lancet Neurology. When these visual symptoms appear, just hold the TMS device against the back of your head and press the button. A magnetic pulse will help target your occipital lobe, the brain’s center of visual processing, and help relieve aura symptoms. Just don’t go overboard with this machine: You should only use it once a day, per the FDA, which approved the treatment just last year.

Health.com:11 Surprising Headache Triggers

Zecuity patch

Most migraine sufferers are used to taking medicine, but it’s not always the best option. “Migraine sometimes paralyzes the digestive system,” Dr. Lipton says. “Once this happens, oral medications can’t be absorbed until the attack is over.” That’s where this battery-operated patch, approved by the FDA in 2013, comes in handy. For people who can’t absorb their medication properly or find it just plain nauseating, the Zecuity Patch (worn on your arm or thigh) sends the commonly prescribed migraine drug sumatriptan (brand name Imitrex) through the skin, so it bypasses your digestive system completely.

Health.com:8 Ways to Headache-Proof Your Home

Tinted glasses

For some sufferers of migraines with aura, their pain is triggered by looking at certain patterns. A 2011 study published in the journal Cephalalgia found that precision-tinted eyeglasses helped normalize brain activity for chronic migraine sufferers. All patients (some with and without headaches) were asked to look at high-contrast striped patterns through three different pairs of glasses. Those who regularly battled migraines reported feeling less discomfort when they viewed the patterns using the tinted pair. It’s thought that the visual cortex gets overstimulated during a migraine attack, leading some patients to suffer perceptual illusions, says study author Jie Huang, Ph.D. Tinted lenses help suppress that visual stress and consequently reduce migraine frequency.

Would you believe a line of glasses for migraines already exists? Axon Optics offers frames with FL-41 therapeutic lenses. They use a rose-colored filter to block the annoying blue-green light you’ll usually find in florescent lamps, so people stifled by bright spaces can get a little relief, too.

Health.com:21 Natural Headache Treatments

Acupuncture

This one’s kind of controversial. Though studies have shown that there’s not a large difference in pain reduction between placebo or “sham” acupuncture and the real thing, a study in the Canadian Medical Association Journal found 50 to 75% of patients with migraines felt better after receiving each type, respectively. Acupuncture is a practice based on traditional Chinese medicine where needles inserted into the skin are used to realign the flow of energy, or qi, in the body. Medical professionals still aren’t sure exactly how it works, but it’s possible acupuncture helps stimulate electromagnetic signals in the body to release chemicals that dull pain. Acupuncture may provide some relief to people who haven’t responded to other treatments. “When done by someone good, it’s safe and sometimes very helpful,” Dr. Lipton says.

This article originally appeared on Health.com.

TIME

Doctor Suspended For Sexting During Surgery

Getty Images

Hopefully he washed his hands afterwards

The doctors on Grey’s Anatomy have been involved in a lot of questionable behavior in their fictional hospital’s on-call room and supply closets, but even Shonda Rimes could not have envisioned the accusations this Seattle doctor faces.

47-year-old Arthur K. Zilberstein, a Seattle-based anesthesiologist, had his license suspended for allegedly sending explicit selfies and swapping racy text messages during surgeries. While his hands should have been monitoring patients at their most vulnerable moment, instead he was spending his time hitting send on some sexts, approximately 250 times between April and August of last year.

The findings, released Monday by the Washington State Department of Health, reveal that Zilberstein was sexting during all kinds of procedures, including Cesarean deliveries, pediatric appendectomies, epidurals, tubal ligations and one notable cardiac-probe insertion, during which he allegedly exchanged 26 text messages “including explicit sexual comments,” according to the official statement of charges. During one stomach surgery, Zilberstein reportedly exchanged 45 texts “with sexual innuendo” in less than an hour and a half and another time, he interrupted his sext stream to allegedly text: “I’m hella busy with C sections.”

Washington state health authorities said that Zilberstein compromised patient safety with his “preoccupation with sexual matters,” allegedly sent risqué selfies to a patient while wearing his hospital badge and scrubs and is accused of looking at private medical records for his own sexual gratification, having sexual rendezvous at work and issuing at least 29 unauthorized prescriptions. McDreamy he is not.

Zilberstein is not permitted to practice medicine in Washington until the charges are resolved.

[Via The Washington Post]

MORE: These People Will Act Out Your Sexts For Just $80 and a Lifetime of Shame

MORE: Ooh, La La: The French Word for Sexting Is Textopornographie

TIME Research

Birth Control Works in Long-Term Acne Treatment, Study Says

More effective than previously thought

Birth control pills are as effective as antibiotics for treating women’s acne in the long term, according to a new review of clinical studies.

The dermatological study shows that antibiotics are more effective than the Pill for the first three months of treatment, but are equally successful after six months.

“This confirms that birth control pills are a good solid treatment for acne, and they’re probably underutilized,” Dr. Steven R. Feldman, a dermatologist at Wake Forest University School of Medicine, told Reuters. “Given the desire to minimize antibiotic resistance and exposure, hormonal birth control could be a good alternative.”

Birth control pills may soon be the more benign alternative to some of the antibiotics and harsh topical gels used in acne treatment. Dermatologists are already recommending low doses of birth control for female acne patients, Feldman said.

TIME medicine

Viagra May Boost Risk for Developing Skin Cancer, Study Finds

Men who use the little blue pill may have twice the risk of developing melanoma

There may be a dangerous link between Viagra and melanoma, according to new research.

Men involved in long-term health research who used Viagra for erectile dysfunction nearly doubled their risk of developing melanoma, a study published in the June issue of JAMA Internal Medicine found.

Researchers evaluated nearly 26,000 men who disclosed during a Harvard study in 2000 that they used sildenafil citrate, or Viagra, for erectile dysfunction. None of the men evaluated had any instance of cancer during the initial study. Between 2000 and 2010, however, researchers found the men who took Viagra were at nearly twice the risk of developing skin cancer.

Over the course of the study, during which participants were given questionnaires once every two years, the researchers identified 142 cases of melanoma, 580 of squamous cell carcinoma, and 3030 of basal cell carcinoma. They did not, however, find a direct link between erectile dysfunction and melanoma.

The study’s authors say though the results may indicate Viagra increases the risk for melanoma, their research alone is not enough to affect clinical recommendations.

TIME medicine

Chicago Sues Painkiller Makers for Deceptive Marketing

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Rafe Swan—Getty Images/Cultura RF

Five pharmaceutical companies stand accused of marketing a highly addictive painkiller, normally used for cancer treatments, as an answer to everyday aches and pains

The city of Chicago filed suit against five pharmaceutical manufacturers on Monday, for allegedly marketing a class of highly potent painkillers for common aches and pains, while masking the risks of addiction.

The lawsuit charges Purdue Pharma L.P., Cephalon, Inc., Janssen Pharmaceuticals, Inc., Endo Health Solutions Inc. and Actavis plc for marketing highly addictive opioids normally used in cancer treatments as a remedy for everyday pains, including back pains, arthritis and headaches.

“This has led to a dramatic rise in drug addiction, overdose and diversion in communities across the nation, and Chicago is not immune to this epidemic,” said Mayor Rahm Emanuel in a statement.

The city is seeking compensation for approximately $9.5 million in prescription payments. It also alleges drug abuse burdened local hospitals with an influx of patients. The mayor’s office said painkiller abuse had climbed 65% between 2004 and 2011, resulting in 1,080 trips to the emergency room.

 

 

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