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Tuesday, July 22, 2014

Do You Ask Your Doctor for Antibiotics?

By Michael Smith, MD
WebMD Chief Medical Editor

woman talking to doctor

When WebMD published the results of a survey on antibiotic prescribing, it hit a nerve with doctors. Overall, 77% of patients said they have never asked for antibiotics. Many doctors say that’s not what they hear.

I’m not surprised many docs don’t buy it. I have certainly felt pressure to prescribe an antibiotic when I was confident it wasn’t needed. Some patients even argue or just head over to the urgent care center to get them.

Let’s Be Honest and Listen

As a patient, you have the responsibility to be honest with your doctor and help him come to an accurate diagnosis. Doctors have the responsibility to listen and use their years of experience and expertise to diagnose and treat patients appropriately.

If you have a stuffy nose, sore throat, cough – even if you’re blowing green gunk out of your nose – you probably have a cold. An antibiotic will do absolutely nothing. You also risk side effects (and some can be serious). There’s also significant concern that over-prescribing of antibiotics may make bacteria more resistant to the antibiotics we have.

And that last time you got better a couple of days after starting the antibiotic? That would have happened even if you didn’t take an antibiotic, because that’s how colds progress.

Unneeded Antibiotics Are Bad Medicine

Doctors must take responsibility, too, and help patients understand why an antibiotic is not in their best interest — not just because the doctor said so.

The survey shows health care providers prescribe antibiotics when they’re not totally sure they’re necessary about 20% of the time. But doctors are under increasing pressure to make patients happy. Many doctors’ pay is even linked to patient satisfaction. So sometimes we give in. That’s not good medicine for the doctor or the patient.

Honestly, it’s easier for us to give you an antibiotic. And we fully understand why you might expect that. You’ve paid the co-pay, taken off of work, and made the trip to the doctor’s office. You expect something out of that effort and cost. I get that.

Instead of an antibiotic, though, I would hope that you would expect your doc’s full attention, and for her to do what’s healthiest for you. Your doctor’s rational explanations and alternatives, like holding off on antibiotics to see if you get better on your own, are based on solid science and knowledge – not just stubbornness.

And I would hope that doctors would understand where patients are coming from. Understand they feel horrible and want help. They’ve made sacrifices to get to you. Appreciate that and advise and talk to them. Don’t just tell them what to do. Some studies have shown that dissatisfaction with care was due to poor communication – not due to whether patients got an antibiotic.

In the end, we all have responsibility to improve the patient-doctor relationship, and that may start with a cold.

Posted by: WebMD Blogs at 10:17 am

Friday, July 11, 2014

Expert QA: NIH’s Anthony Fauci on “Mississippi Baby”

viral load

News reports in 2013 touted that a baby infected with HIV given a potent cocktail of anti-HIV drugs 30 hours after birth had been “functionally cured” of the infection.

But after 27 months during which HIV was undetectable in the child’s blood, the virus was discovered during a routine checkup this month, the National Institute of Allergy and Infectious Diseases (NIAID) announced Thursday.

Relatively few U.S. babies are born with HIV, because infected pregnant women are usually treated with antiretroviral drugs to prevent transmission. But this child’s mother received no prenatal care or antiretroviral drugs when she delivered in July 2010 in Mississippi. Because of the great likelihood that the baby was infected, doctors decided to start the child on three antiretroviral drugs less than 2 days after birth. By the baby’s 29th day of life, HIV was nearly undetectable in the child’s blood.

Writer Rita Rubin talked to HIV/AIDS expert Anthony Fauci, MD, executive director of the NIAID, about what this new development with the un-named “Mississippi baby” means for future research:

Q. Would you call the reappearance of HIV in this child a scientific setback?

A. “It’s clearly disappointing for the patient, the patient’s family, and the researchers,” Fauci says. “People ask me, ‘Is this a major setback?’ I certainly don’t think it’s an advance, but I don’t think it’s a setback.”

“Some very important things did happen,” Fauci continues. Going 27 months with no detectable virus or HIV antibodies was an “important accomplishment” that raised many questions, he says. “What was it that was suppressing the virus if there was no detectable immune response during those 27 months?”

Q. Back in 2013, you talked about how this child could provide “a promising lead for additional research toward curing other children.” Does this relapse suggest you were wrong?

A. “I generally tend to be reserved and academically conservative,” Fauci says. “The whole arena of ‘cure’ is still in the very early discovery phase. We know in science that when you’re in the discovery phase, you lose more than you win. You get it wrong more than you get it right.”

Q. This child is infected with the same HIV strain as the mother, so it’s the same infection the child was born with. Where was it during the 27 months it was undetectable?

A. “This tells us in a very cold and sobering way that our assays (to track HIV in infected individuals) … are woefully inadequate. Clearly, it was there, because it rebounded. It took 27 months to rebound.”

Q. Would this child have been better off or worse off if the antiretroviral therapy had continued uninterrupted since birth?

A. Fauci emphasizes that the child went off therapy because the mother stopped bringing her baby in for care, not because doctors decided to stop the drugs. But “taking medicines from the time you’re born throughout life has consequences,” he says. That’s why even a temporary hiatus from therapy in infected children without detectable virus would be desirable, Fauci says. According to the NIAID, the child is back on retroviral therapy, which has decreased HIV levels without any side effects.

Q. What does this mean for the planned trial designed to see whether children born infected with HIV could eventually stop treatment?

A. No babies have yet been enrolled in the study, which is supposed to be done at multiple sites in the United States and in Africa, Fauci says. “It was getting set to be launched.”

Now, he says, “we have to look at the ethical considerations.” HIV-positive mothers with eligible babies — namely, those who did not receive antiretroviral therapy while pregnant — must fully understand that the premise of the trial is the possibility of a prolonged remission, not a cure, Fauci says. If researchers don’t make that point perfectly clear, he says, women might enroll their children because they mistakenly think, “Wow, that baby was cured. I’m going to get my baby cured.”

Another aspect of the trial that needs to be reconsidered is “how long do you want the person on therapy before you stop it?” Fauci says. Clearly, children in the trial will have to be monitored much more closely than originally thought, he says, not just every few months or so. Hannah Gay, MD, the University of Mississippi Medical Center pediatric HIV specialist who has been involved in the child’s care since birth, detected the reappearance of HIV “as soon as the virus blipped up,” Fauci says.

Posted by: WebMD Blogs at 2:38 pm

Monday, June 30, 2014

Doctors’ Group: No More Pelvic Exams?

gynecologist exam

By Kathleen Doheny

A routine pelvic exam, long a part of the annual visit to the ob-gyn or primary care doctor, is no longer recommended for women who aren’t pregnant and don’t have symptoms.

The new and controversial recommendation was released Monday by the American College of Physicians. Its members are internists, doctors who treat adults.

Mary Jane Minkin, MD, is a clinical professor of obstetrics and gynecology and reproductive sciences at Yale University School of Medicine and advisor for the WebMD menopause community. WebMD asked Minkin to discuss why the new recommendation was made and why some doctors may not agree with it.

What are doctors looking for during a pelvic exam?

The doctor looks for anything unusual in the ovaries, uterus, and other organs of the pelvis.

“We’re looking for several things,” Minkin says. A doctor will feel for masses, fibroids, cysts, and other unusual signs.

How and why was the new recommendation made?

The American College of Physicians looked at 52 published studies from 1946 through 2014. It could find no supporting evidence for routine pelvic exams. The possibility of finding cancer or other diseases in non-pregnant women without symptoms was low. Also, the doctors found some harms, such as incorrect exam results that led to unneeded testing. For some women, the exam also causes embarrassment and anxiety, they found.

The bottom line, according to Minkin, is that the doctors’ group is saying, “We don’t find enough on annual exams to make it worthwhile to put all women through an annual exam.”

The recommendation addresses only the pelvic exam, not the Pap smear to look for cervical cancer. In general, women should get a Pap smear every 3 years, according to guidelines from the U.S. Preventive Services Task Force, a panel of experts.

In April,  the FDA approved using an HPV test as a first one to use as a cervical cancer screening test.

The new recommendation on pelvic exams is at odds with that of the American College of Obstetricians and Gynecologists. In 2012, the gynecologists’ group continued to recommend annual pelvic exams in all women age 21 and older; those guidelines were reaffirmed this year.

What are the benefits of a pelvic exam?

“We do occasionally pick up a cyst or a mass,” Minkin says.

What are the harms?

“Occasionally we will be doing an unnecessary ultrasound, if we think we feel something,” Minkin says.

The doctors’ group found women most likely to report anxiety or pain during pelvic exams were those who had a history of sexual abuse.

What do you recommend women do?

”I tell my patients, when this question comes up, that I still think it’s a good idea to have an annual exam, but that it is controversial,” Minkin says. “I think a lot of women like the reassurance of [pelvic exams],” she says. She believes many doctors will continue to do them, as long as insurers continue to cover them.

The annual exam is a great opportunity to gauge how the patient’s life and general health are going, Minkin says. “I think a doctor picks up so much other stuff by an annual visit. The important thing to me is having the patient sit in front of me” and finding out health information just by talking.

The recommendations cover routine exams in women who are not pregnant. But when might a pelvic exam be needed for a non-pregnant woman?

If a woman has a symptom, such as bloating, she should ask for a pelvic exam, Minkin says. Bloating could point to a serious problem, such as ovarian cancer.

“If she has funky bleeding, before or after menopause, I would like her to have an exam,” Minkin says. Pain would also be a reason to get an exam, she says.

Posted by: WebMD Blogs at 4:29 pm

Tuesday, June 24, 2014

Are Fortified Foods Harmful to Kids?

child eating cereal

By Hansa Bhargava, MD
WebMD Medical Editor, Pediatrics

I still remember the 8-year-old girl who came to the emergency room with vomiting and drowsiness. She’d been complaining of headaches and abdominal pain for several weeks. The parents had brought her in that night because now she was acting strangely, not being able to talk properly and acting very lethargic.

She was admitted to the hospital that night with vitamin A toxicity and liver failure due to excess vitamin A in her body. Her parents had been giving her large doses of vitamin A supplements.

As a pediatrician, I see many parents who give their children vitamin supplements. Generally, this is okay, if the dosage is appropriate. It becomes a serious issue, though, if the dosage is excessive. This is where the issue of our foods being “fortified” with vitamins raises eyebrows. Could the vitamins in foods combined with supplements “overdose” our children with too many vitamins?

Today the Environmental Working Group released a report that raises concerns about the amounts of vitamins added to common foods, such as cereals. Many cereals contain up to 25% of the required daily amount of certain vitamins; unfortunately, these numbers are very outdated and based on adult requirements. This means that many of the added vitamins may exceed how much a child needs per day. What makes this issue even more worrisome is that if kids are taking vitamin supplements (such as the vitamin gummies) too, many of them may be at risk of overdosing on the vitamins.  In fact, an analysis of data, published earlier this year, from the National Health and Nutrition Examination Survey 2003-2006 reported that just from food alone, 13% of kids get too much vitamin A and 45% take in too much zinc.

Too much vitamin A can lead to bone abnormalities, brittle nails, peeling skin, hair loss, and in rare cases, liver failure. Excess zinc can cause the blood condition anemia and may suppress your immune system. So what is a parent to do?

As a mom of twins, I think about the issue of  nutrition for my kids every day. And I do want to tell you, all is not lost.  First of all, you should know that most kids will not have overdoses of vitamins, especially if they eat a healthy diet based on the USDA’s healthy plate guidelines — i.e., mostly fruits, vegetables, and whole grains. The key is to be mindful of the ingredients that are in processed foods and to balance that with the vitamin supplements that you may give your children. It’s obviously important for our children to get the vitamins but equally important for them not to “overdose.” So here are a few tips that I use myself to walk that line:

  1. Pay attention to the label. Look at cereal labels carefully to see what vitamins have been added. Maybe the day your child had a “fortified” cereal or waffle, he doesn’t need that gummy vitamin. Also, some cereals may not have vitamins added– these tend to be the organic brands.
  2. Go back to basics: Serve simple, non-processed foods often. The more “real” food that is on the table, the less “added” ingredients there are. Fresh or frozen fruits and vegetables don’t have “added” vitamins. They’re the best sources of the nutrients for your kids. Fill those plates with veggies and fruits.
  3. Cook at home as much as possible. Don’t groan — our grandmothers’ advice does turn out to be true in this case. I cook a lot on a Sunday — this way I have meals for a few days. Then, I cook on Wednesday so we have meals for 2 more days. This is good for my kids and my wallet.
  4. Be a role model. I only eat cereal once or twice a week; usually we have smoothies, eggs, or on a Saturday, homemade pancakes.

 

And remember, be mindful about those vitamin supplements. It’s okay to have them, but most pediatricians, including myself, will remind you that the very best nutrients come from natural sources. So feed your kids a colorful plate with plenty of fruits, whole grains, dairy, and vegetables, and chances are they’ll get plenty of the vitamins that they need.

Posted by: Hansa Bhargava, MD at 4:17 pm

Friday, May 23, 2014

Drink Your Sunscreen?

By Kathleen Doheny

lady on the beach

Just in time for the Memorial Day summer kick-off, a skin care company is promoting its drinkable sunscreen.

Take a few swigs, head outdoors, and you’ve got sun protection, or so the claim goes. But is it too good to be true? Here’s what you should know about this product:

What does this drinkable sunscreen claim to do?

According to Osmosis Skin Care, its UV Neutralizer Harmonized Water uses ”cellular vibrations” and ”isolates the precise frequencies needed to neutralize UVA and UVB.”

Directions suggest taking 2 milliliters with 2 ounces of water every 4 hours while in the sun.  The product neutralizes UV radiation, according to the company, and ”allows for increased sun exposure (30x more than normal).”

Its listed ingredients are distilled water and “multiple vibrational frequency blends.”

A 100-ml bottle of UV Neutralizer, either tan-enhancing or non-tan-enhancing, sells for $30 online. Other formulas of Osmosis harmonized water claim to aid vigor or joint health, and combat hangovers, among other purposes.

The harmonized water “contains frequencies that cancel out UV radiation,” Osmosis Skin Care’s founder, Dr. Ben Johnson, writes on its web site. “If 2 mls are ingested an hour before sun exposure, the frequencies that have been imprinted on water will vibrate on your skin in such a way as to cancel approximately 97% of the UVA and UVB rays before they even hit your skin.”

The water does not work for everyone, Johnson writes, and fails to provide protection for “less than 1% of the population.” He recommends that users test its effectiveness first, and that those taking medication that increases sun sensitivity take extra precautions.

According to the company, the FDA has not reviewed the product.

What do dermatologists say?

“It’s ridiculous,” says David J. Leffell, MD, the David Paige Smith Professor of Dermatology & Surgery at Yale School of Medicine. “It’s scientific jibberish. Unless they are willing to present scientific, peer-reviewed data to support these claims, we have no choice but to dismiss it.”

“You don’t want to take something internally that can be prevented or treated by external means,” says Leffell, who reports scientific work for Coppertone.

The American Academy of Dermatology issued a statement on the product, reading in part: “This drink should not be used as a replacement for sunscreen or sun-protective clothing. There is currently no scientific evidence that this ‘drinkable sunscreen’ product provides any protection from the sun’s damaging UV rays.”

What’s the best plan to protect against cancer-causing sun exposure?

“Use sunscreen every couple of hours while you are active outdoors,” Leffell says. He recommends SPF 30. A brimmed hat can help. Parents should pay special attention to protecting children from the sun.

Wearing sun-protective clothing is another good strategy, according to the academy. “Sunscreen is the only form of sun protection that is regulated by the U.S. Food and Drug Administration.”

Posted by: WebMD Blogs at 1:27 pm

Friday, April 25, 2014

E-cigarettes: What the FDA’s Rules Don’t Cover

By Arefa Cassoobhoy, MD, MPH

e cigarettes

As a doctor and as a mother, the FDA’s announcement to regulate e-cigarettes should be great news to me. The best news is that it bans sales of e-cigarettes to anyone under the age of 18. But I wish the proposal included the same bans on advertising and marketing that are in place for traditional cigarettes.

Nicotine and Tobacco

First, it’s incredible to me that e-cigarettes weren’t automatically considered a tobacco product.

Nicotine is the key ingredient in an e-cigarette. Nicotine is the key addictive chemical in tobacco.  An e-cigarette is a tobacco product. Isn’t it that simple?

E-cigarettes should be regulated just like old-school cigarettes. And I know plenty of people who are surprised when they hear the rules for cigarettes don’t apply to e-cigarettes.

But of course it’s not that easy. The FDA’s fight to control tobacco has been a slow, long process.  The Tobacco Control Act is recent – from 2009.  Only then did the FDA pass rules to limit the sales of tobacco to anyone under 18, along with advertising and marketing directed at young people.  Only then did the FDA ban tobacco companies from sponsoring sports and entertainment events. Only then did it ban flavored cigarettes because of their appeal to kids.

E-cigarettes

Since then, the tobacco industry got a boost with the invention of the e-cigarette. An e-cigarette uses a battery to heat and vaporize liquid nicotine that a user inhales, or “vapes.” It does not have the carcinogens you get from smoking traditional cigarettes. It is a better choice if you’re a smoker not ready to quit.

But it’s not a better choice if you are a teen. Public health officials worry that the marketing of e-cigarettes is targeted to teens. Between 2011 and 2012 e-cigarette use doubled among middle and high school students. That translates to 1.78 million teens who tried an e-cigarette in 2012. And the majority of teens who tried an e-cigarette also smoked a regular cigarette.

Why is this concerning? We know “virtually all new users of tobacco products are under 18.”  And we know of the 3,000 teens who try their first cigarette each day in the U.S., 700 of them will go on to become daily smokers.

We don’t need another generation of Americans sick from tobacco-related illnesses.

Today’s FDA Proposal

In addition to banning sales to minors, the FDA proposal expands the types of tobacco products that come under its regulation. This also includes cigars, pipe tobacco, and hookahs.  It also says:

  • No free samples
  • No e-cigarette vending machines in areas with young people present
  • Warning labels required

All this is great, and it’s important progress, but something major is missing.

No Ban on E-cigarette Advertising or Marketing

While e-cigarettes are now regulated as tobacco products, all the rules don’t apply. There’s no ban to limit advertising and marketing directed at teens. There’s no limit on e-cigarette company-sponsored events. Flavored e-cigarettes are not banned.

Also surprising, the tobacco industry can still advertise e-cigarettes on TV.  To put this in perspective, traditional cigarettes were banned from TV in 1970.

What Happens Now?

The FDA has made a step in the right direction, but it falls short by not including limits on advertising and marketing.  The proposed rules are open for public comments for 75 days.

Each day 700 teens become daily smokers.  We’ve established the guidelines limiting their exposure to cigarettes. Those rules should apply to all tobacco products, including e-cigarettes.

I’m planning to send my opinion to the FDA. I hope you do.

For more information on submitting your comments, visit the FDA’s web site.

Posted by: Arefa Cassoobhoy, MD, MPH at 2:31 pm

Monday, March 10, 2014

Oil Pulling: Is There a Kernel of Truth?

By Arefa Cassoobhoy, MD, MPH

coconut oil

In a short time, I’ve gone from wondering ‘what is this crazy new fad of oil pulling?’  to respecting the research going on around the world to improve oral health. As a WebMD medical editor, I read the health news every day and keep up with medical developments. When I heard about the fad of oil pulling I was intrigued.  What is this ancient practice from my ancestors’ home in India that’s all over the Internet and social media as a potential cure-all?

Can there really be a medical silver bullet? Of course not.  But I do believe most health practices – if they’ve stood the test of time – probably have a kernel of truth. In this case, the test of time has lasted thousands of years. But, as a doctor, I believe even that’s not enough. It also must “do no harm.”

Let’s start from the beginning and I’ll share my findings.

What is oil pulling?

Oil pulling refers to swishing a vegetable oil — like sunflower oil, sesame oil, or coconut oil — in your mouth.  The way you swish is important. The oil is supposed to half-fill the mouth and then be sucked back and forth through the teeth. The oil and saliva mix as you swish sideways and back and forth for about 10 minutes.

Where did oil pulling come from?

The practice goes back to the Ayurvedic health habits in ancient India, where it was believed to cure many diseases, from headaches to high blood pressure to diabetes and asthma. And, of course, it helped with oral and dental health.

This is where the kernel of truth comes in.

I suspect that back in ancient India, the people who had the leisure time to swish valuable oils in their mouths and then spit them out were not struggling for existence. They were the wealthy or the honored of India.  These were likely people who did not toil in the fields to bring home a little rice.  But rather they took part in all the wonderful Ayurvedic therapies and rituals we now know about and practice — like yoga and meditation.

My point is that this group would have suffered less from illness than those who barely have enough food to feed their families. Was it really the oil pulling that made all the difference in their health?

Why is it in the news now?

So here we are 2014, and oil pulling is in the news, which brings me back to the kernel of truth.

One key to preventing dental cavities and gum disease is regularly getting rid of the plaque buildup on your teeth (just like they say on toothpaste commercials).  Apparently, the swishing and “pulling” of the oil for a long period of time in your mouth decreases plaque and gingivitis.  The study where I got my information was a small one, but it was logical.  It was done at a dental school in India – where this could be an important part of daily oral health.

Today, in India, the cost of swishing cooking oil every day is much less than swishing a mouth rinse. And the poor don’t get 6-month dental checkups. In that light, oil pulling could be an important way to improve oral hygiene and worth further research.

Will I start oil pulling?

So, does oil pulling cure everything from headaches to asthma? That hasn’t been proven and probably won’t ever be. But it does seem to keep your mouth cleaner by cutting plaque.  And that could be very useful information for many in today’s world.

For me, I want to learn from the Ayurvedic way of the past. But as long as I have easy access to floss and the electric toothbrush, I’m sticking with that and skipping oil pulling.

Posted by: Arefa Cassoobhoy, MD, MPH at 3:41 pm

Tuesday, February 25, 2014

Why Your Pediatrician is Your Best Choice

doctor examining child

By Hansa Bhargava, MD
WebMD Medical Editor

If you’re a parent, it’s likely this has happened to you. You’ve had a hectic morning: getting ready for work, making breakfast and getting the kids ready for school. And then a wrench is thrown in: your child comes down with a sore throat and fever. If your child is sick, where do you take him?

Many parents would opt for what seems to be convenient solution: the retail clinic in the pharmacy down the street. Over the last decade there has been a large rise in retail based clinics. In a recent study, close to 25% of patients said they used them. Most thought about going to their pediatrician first but didn’t, mostly because the retail clinic seemed more convenient.

Recently, the American Academy of Pediatrics has taken issue with the use of retail clinics to treat children. The AAP’s statement specifically points out that retail based clinics are not appropriate for kids. Not only do these clinics often lack a pediatrician to provide the best care, there is also a lack of continuity of care for the child. Continuity of care means that the doctor at that clinic does not know your child and does not have his medical record. The lack of information could have significant medical consequences. What may seem like a small issue may be part of a bigger problem that could go unrecognized if the doctor does not know your child’s history.

From a medical standpoint, your doctor should know the most about your child and your family. This includes the previous illnesses he might have had, family history, allergies, medications previously taken and in certain cases, even social circumstances. All of this information can impact the diagnosis and the treatment. For example, if a child has had multiple strep throats, he may be a carrier and may need to be tested when he doesn’t have symptoms.

Seeing a pediatrician can also get you the best quality of care. Recently I saw a 3-year-old who was diagnosed with ‘bronchitis’ at a retail clinic and given an injection of steroids. It turned out that this child had a respiratory virus and did not need such a strong medication.

Good quality of care is especially important in cases of sports injuries, such as a fracture or concussions. Often, fractures in kids are difficult to see, so a wrist or elbow fracture may be missed if the provider at the clinic is not used to seeing children. And concussions definitely need to be followed, as they can affect a child’s ability to go back to sports and school.

Another benefit of a visit with your pediatrician? The chance to ask your doctor about other concerns that may have fallen off the radar, such as, ‘By the way, his grades have slipped’ Or, ‘He complains about not seeing the board at school’. These issues are important for the developing child.

As a working mom of two kids, I do understand the need for ‘quick care.’ And there are some cases, like when you are traveling, that you need to use retail clinics. But at all other times, seeing your pediatrician is the best choice. The good news is that more pediatric offices are adapting to the needs of busy parents. Most offices have open slots so you can get an appointment that day. Nurses are always available on the phone during the day to help you decide whether your child needs to come in. The majority of offices have weekend hours and a doctor on call in the evenings to help you at other times. And many doctors’ offices are trying to reduce wait times as they realize how this can impact the family.

So next time your child gets sick or injured, take your child to the doctor who knows him best and knows how to treat children best. Because, for all of us, getting the best care for our children is our most important priority.

Posted by: Hansa Bhargava, MD at 4:08 pm

Friday, February 7, 2014

Expert QA: CDC’s Tom Frieden on CVS and Tobacco

CDC Director Tom Frieden

Medscape’s Susan Yox, RN, EdD, interviewed CDC Director Tom Frieden, MD, MPH, about the news that national drug store chain CVS Caremark Corporation will stop selling tobacco products at its 7,600 stores by October of this year.

What is your reaction to this news? Do you believe that this will put pressure on other retailers to do the same?

We’re delighted that CVS has done this. It’s a great step. I think they’ve recognized that trying to be both a healthcare facility and selling tobacco is just a paradox that’s unhealthy and untenable. And I join Secretary of Health and Human Services Kathleen Sebelius in hoping that others will follow their lead.

When pharmacies decide not to sell tobacco products, is the primary benefit the reinforcing of the social unacceptability of tobacco?

I think that is important. In fact, one of my first jobs was in a mental health hospital where we were still using tobacco as a behavior modification modality — as in, “If you behave well you can get 5 cigarettes.” It’s a very shameful history of the healthcare sector. When we look back at advertisements from the 1950s of doctors recommending one brand or another of cigarettes, they look completely anachronistic to us. And I think that in a few years we’ll look back on pharmacies selling tobacco in very much the same way.

It’s important that this happened for 2 broad reasons. First, the fewer places that sell tobacco and advertise it in their stores, the fewer kids who smoke, it appears. Second, we don’t want the halo of healthcare provision to rub off in any way on the deadliest legal product that we have out there — tobacco.

Do you think that other retailers (pharmacies, grocery stores, or big-box stores) will follow CVS’s lead?

I’m optimistic that others will follow the lead of CVS. I think CVS has done a great thing in deciding that it will no longer sell tobacco products, and I hope others do follow their lead.

How many people in the United States still smoke? How much illness and death is related to smoking in 2014?

More than 40 million Americans still smoke, and tobacco use remains the leading preventable cause of death in this country. It causes 480,000 deaths per year and many times that number of severe illnesses. The Surgeon General’s report just released a number of new statistics on this; your readers may want to review the very latest facts.

Can you talk a bit about what else should be happening in the United States to reduce/prevent smoking?

Broadly, there are 2 things that we need to do. First, we need to implement what we know works; in all too many places that’s not yet happening. Second, we need to find new ways to help people quit smoking and prevent kids from starting. So we need to both maximize our currently proven interventions and continue to innovate new ways to protect our communities and our kids from smoking. Unless we take urgent action, 5.6 million kids alive today will be killed by tobacco.

Posted by: WebMD Blogs at 11:05 am

Thursday, February 6, 2014

What Weekend Warriors Can Learn from Shaun White

By Arefa Cassoobhoy, MD, MPH
WebMD Medical Editor

Shaun White

When I heard that Shaun White was not going to compete in slopestyle at the Olympics because of the risk of injury, I thought, “Wow, what an extreme case of managing risks and benefits.” And what bravery to pull out, although not everybody sees it as bravery.

But how do you know when you shouldn’t do more? Especially during those years where you don’t work out as often or as intensely as you did years before.

I’m talking about the rest of us. We like to play sports but have no time for a league any more. No more jumping on your bike racing to a friends’ house to play pick-up basketball.

Now it’s occasional hikes in the mountains, swimming at the lake, maybe skiing in the winter.  Or more likely we’re sweating with a home improvement project.  Paint brush up and down.

You know where I’m going with this – the weekend warrior.  So why do I bring all this up? I’m an internist and a person in the same boat. Realizing our limitations and owning up to them is a big deal.  If we want to ski or bike in the mountains we need to realize, adults need protection from injury. That’s true whether it’s actual trauma or an injury from muscles you didn’t realize you had.

I want all of us to avoid the trauma and overuse injuries that cause the sprains, strains, fractures, and pulled ligaments and tendons of the weekend warrior.  Here are a few tips I share with my patients and try to remember myself:

  • Wear the appropriate gear: helmets, mouth guards, elbow/knee pads, and proper shoes.
  • Exercise during the week to build up for your weekend adventures.
  • Focus on endurance with aerobic work outs and strength with resistance training.
  • Cross-train to get all around fitness.
  • Warm up, cool down and increase your flexibility.
  • Listen to your body. Stop when you are tired.

Posted by: WebMD Blogs at 3:16 pm

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