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Denying Hearing Aids to the Deaf

Two sad cases were reported lately – one by Medgadget in which a young child with Treacher Collins syndrome was denied a special bone-implanted hearing aid.  Children with this genetic syndrome usually have normal intelligence, though their appearance reflects underdeveloped facial bones.  Apparently her insurance company would pay for the procedure to install the hearing aid, but the $15K device was not covered in her parents’ insurance policy.  Her parents could not afford the device, and the child has little hope of developing the ability to speak normally without the aid.

The second case was of Britain’s most elderly woman – a 108 year old who was told that she’d need to wait 18 months to receive a hearing aid from the National Health Service.  Mrs. Beal is wheelchair bound, and unable to communicate without a hearing aid.  Her favorite hobby is listening to music.  Doctors say that she is unlikely to live long enough to receive the new hearing aid.

These two cases demonstrate that care is rationed in both a free market healthcare system, and a government run single payer system – and that rationing affects the disabled and the elderly first.  This is the sad inevitability of limited resources, with only the independently wealthy enjoying the best of what healthcare can offer.  Perhaps charity alone will hear the cries of these hearing impaired individuals?This post originally appeared on Dr. Val’s blog at

Lidocaine Jelly Reduces the Pain of Urinary Catheterization for Men and Women Alike

Thanks to ED nurse Ian Miller who brought this research study to my attention: lidocaine jelly can substantially reduce the pain of having a Foley catheter inserted into the urethra – for both men and women.  And yet the jelly is not always used for women.  Many nurses, PAs and physicians erroneously believe that only men benefit from the numbing gel because they have longer urethras.  But new research suggests that women benefit substantially from this pain reducing gel.  What amazes me is that it took this long to research the issue – imagine all the women who could have had a more comfortable experience with this process.  So ladies, if you (or your mom) need a bladder catheterization for any reason, be sure to ask for lidocaine jelly.This post originally appeared on Dr. Val’s blog at

Face Transplants: Ethical Challenges

You may remember the horrifying story of a young French woman who passed out after taking some sedatives, and her dog tried to wake her up by gnawing on her face.  She was the first recipient of a face transplant, and is on immunosuppressant therapy to this day to prevent rejection of the donor tissue.  This immunosuppression puts her at greater risk for cancer and infections and raises the issue of whether the benefits (a closer approximation of a normal appearance than reconstruction of her face from her own body tissue) outweigh the risks (a shortened lifespan and potential hospitalizations for infections, eventual tissue rejection, and perhaps cancer.)

Many people suffer severe facial disfigurement from accidents and burns every year.  Face transplants could give them a chance at a relatively normal appearance – but American doctors are unwilling to put them at risk for what is in essence a cosmetic procedure.  However, Harvard physicians are now offering face transplants to those who are already on immunosuppressants for organ transplants they’ve previously received.  As you may imagine, the number of people who qualify for face transplants is rather small – as you’d have to have had an organ transplant and then coincidentally sustained severe trauma and tissue loss to the face.

The Boston Globe ran an interesting story on a man who was severely disfigured by facial burns and could have been eligible for a face transplant in France.  He chose to undergo reconstruction from his own tissues, which requires no immunosuppression.  He says that he is glad that his body is healthy, that he requires no medications, and that the risks of a face transplant are not worth the benefits, though he remains severely disfigured.

I think it’s interesting that the French took a different stand on this issue – allowing people to choose to have a cosmetic procedure at the expense of general health, longevity, and risk for life-threatening illness.

I have known patients who decline limb amputations for fear of disfigurement – even though the gangrene in the limb is sure to result in sepsis and eventual death.  A person’s appearance and personal identity are sometimes inextricably linked – so that some would choose death over disfigurement (even of a limb).  Is this choice pathological, or is it their right to choose?  Given the choice between disfigurement or death, I’d choose disfigurement.  I’d also not choose a face transplant over reconstruction from my own tissues, even if the aesthetic outcome is inferior.  Still, I’m hesitant to say that those who’d rather live a shorter, less healthy life with a more natural face are unilaterally making the wrong choice for them.  For the time being, though, people who wish to make that choice will need to do so outside of the US.This post originally appeared on Dr. Val’s blog at

Obese Girls Less Likely To Go To College

A new study in the journal Sociology of Education suggests that obese girls are only half as
likely to go to college as non-obese girls.
I interviewed the study’s author, Dr. Robert Crosnoe, to learn more
about the relationship of weight, self-esteem, and peer popularity to the
education of young women.

Dr. Val: What did your study reveal about the impact of
obesity on the education of young girls?

Dr. Crosnoe’s response – audio 1

Dr. Val: How does popularity figure into the equation?

Dr. Crosnoe’s response – audio 2

Dr. Val: How do you explain the gender gap – that obesity
didn’t seem to influence whether or not boys went on to college?

Dr. Crosnoe’s response – audio 3

Dr. Val: What should we do based on the study results?

Dr. Crosnoe’s response – audio 4

This post originally appeared on Dr. Val’s blog at

Low Cholesterol And Cancer Risk

A provocative press release crossed my desk today, “Study Finds Association Between Low Cholesterol Levels and Cancer” with subtitle: “Benefits of Statin Therapy Outweigh Small Risk.”  Well that’s fairly terrifying, isn’t it?  It sounds as if they’re saying that taking a statin (like lipitor or zocor) is good for your heart but might carry with it the “small” risk of developing cancer.

First of all, let me assure you that this is a gross misinterpretation of the metanalysis.  The authors themselves never postulated a cause and effect between statins and cancer, and in fact did all they could to avoid drawing this conclusion.  They merely observed that there was a slight trend towards higher cancer rates among people with low LDL cholesterol.

There are two very good explanations for the higher cancer rates in people with low cholesterol:

1. Everyone knows that “unexplained weight loss” is an ominous sign.  Often times a patient’s first clue that they have cancer is sudden weight loss – since cancer has a voracious appetite and steals nutrients from the rest of the body.  When people lose weight, their cholesterols decrease.  So it’s possible that low LDL cholesterol is really just a surrogate marker for those who already have very early stages of cancer that have not yet been detected otherwise.

2.  Statins are well known to reduce cholesterol and the atherosclerotic plaques that put people at risk for heart attacks and strokes.  Lower cholesterol levels can reduce overall mortality risk/year by 30%, and so people live longer when they have lower cholesterol levels.  People who live longer extend their opportunity to develop cancer.  And so lower cholesterol levels inadvertently raise your cancer risk simply because they may extend your life.

Why else do I think the link between cancer and statins is faulty?  Because the observed increase in cancer rates was in ALL cancer types – the genetics of cancer is so complex, and the reasons why certain cell types begin to divide in an uncontrolled manner is so diverse, that it’s hard to imagine any possible trigger could stimulate all cells to become cancerous.  Also, most cancers develop very slowly, and the 5 year window in which the authors observed people taking statins and developing cancers is too short to be a cause and effect.  And finally, previous statin safety studies showed no link between them and the development of any form of cancer.

The Journal of the American College of Cardiology admits in an
accompanying editorial, “In the 5 years that we have been stewards of
the Journal, no other manuscript has stimulated such intense scrutiny
or discussion.”  Do I think they should have published this study?  Yes – but to me the most interesting question out of all of this is: could cholesterol screening be used for early cancer detection?  If an extra low LDL is observed, maybe that should prompt some additional investigations to rule out occult malignancies?

Obviously, more studies are needed to determine the potential validity of such an approach… but for now, there is absolutely no reason (based on this study) to cease statin therapy for fear of developing cancer.  Hope that allays some fears!This post originally appeared on Dr. Val’s blog at

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