Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Finding Cheap Birth Control Even As States Withdraw Planned Parenthood Funding

If you live in New Hampshire, or some other state that is withdrawing Planned Parenthood funding, you may need to find an alternate source of affordable birth control, at least until the states get their heads screwed back on straight. In the meantime, please, don’t stop your birth control because you think you can’t afford it – the costs of not using it are much, much higher.

But what can you do to make the choice to use birth control even more cost effective?

Birth Control Pills

  • Buy them cheap locally. Walmart, Target and Kroger sell very low priced birth control pills – only $4 to $9 a pack. It’s only a few brands (Trinessa, Sprintec and Trisprintec), but ask your doctor if it makes sense to switch if cost is a barrier for you.

*This blog post was originally published at The Blog That Ate Manhattan*

Yaz (An Oral Contraceptive Pill) And Blood Clots: What The “Higher Risk” Means

Two studies published in this weeks’ British Medical Journal, one from the US and the other from the UK, report that users of drosperinone containing oral contraceptives (Yaz, Yasmin and their generics) have increased relative risks for non-fatal blood clots compared with users of pills containing levonorgestrel.

While neither study is perfect, and indeed have some very major limitations, they add to a growing body of evidence that pills containing drosperinone may impart higher risks for blood clots than older pills. Yaz is not alone in this regard – other studies have suggested that pills containing the newer progestins gestodene and desogestrel also impart slightly high clot risks than the so-called first and second generation pills containing the older progestins norethindrone and levonorgestrel.

I won’t go into the studies’ limitations here, but will say that trying to get our hands around comparative data on clot risks between various pills is an extraordinarily difficult process given that the diagnosis of blood clots is not always straightforward (or correct), pill choices are not randomized and fraught with prescribing bias, and confounding risk factors for clotting are numerous and difficult to control for. I wish folks would stop trying to answer these questions on the quick and cheap using claims and pharmacy databases without requiring chart review and strict diagnostic criteria. But that’s the way these studies are being done, and that’s the data I am being forced to contend with in my practice, so let’s talk about it. Read more »

*This blog post was originally published at The Blog That Ate Manhattan*

End-Of-Life Care: When Medicine Prolongs Dying, Not Living

The recent Washington Post article entitled, “Who decides when medicine prolongs dying, not living?” perfectly captures my earlier blog on why we’re afraid of death. An excerpt from the Post piece:

[There’s a] huge gap between Americans’ wishes about end-of-life care, as expressed in numerous public opinion polls, and what actually happens in too many instances–futile, expensive, often painful procedures performed on people too sick to leave the hospital alive–much less survive with a decent quality of life. Ninety percent of Americans say they want to die at home but only 20 percent do so. Half of Americans die in hospitals and another 25 percent in nursing homes, after a long period of suffering from chronic, incurable conditions that finally become untreatable. An astonishing one out of five die in intensive care units, often unconscious, isolated from loved ones and hooked up to machines that do nothing but prolong an inevitable death.

This happens partly because of the natural human tendency to procrastinate about addressing painful subjects with relatives and partly because doctors are often too pressed for time–and too uncomfortable with death and dying themselves–to respond when patients do bring up such issues. Just try to get a straight answer out of an oncologist, as an 89-year-old friend of mine did when her doctor advised another course of chemotherapy even though her cancer had metastasized to her brain. “Doctor,” she asked, “what chance is there that I’ll have a few months more of life that I can enjoy with my family?” He replied, “We can’t know these things.” She replied, “No, but we can use our common sense,” and declined further treatment. She died a month later in hospice, surrounded by her children, grandchildren and great-grandchildren. What if she hadn’t been clear-minded enough to to speak for herself? What if her children, out of love, guilt or a combination of the two, had subjected her to treatment that she wouldn’t have wanted? That is what advance medical directives are intended to prevent. Read more »

*This blog post was originally published at A Medical Writer's Musings on Medicine, Health Care, and the Writing Life*

Miscarriage? Don’t Wait To Get Pregnant Again

About 15 to 20 percent of women who know they are pregnant will have a miscarriage. The loss of a pregnancy before 20 weeks is considered a miscarriage. Many women suffer grief and shock after a miscarriage and fear there is something wrong with them or that they did something to cause it. But the reasons for miscarriage are usually not known. Women are often told to wait “a few months” to get pregnant again to let their bodies recover.

A new study published in the British Medical Journal looked at over 30,000 women who had a miscarriage in their first recorded pregnancy and subsequently became pregnant again. They found that women who conceived again within six months were less likely to have another miscarriage or problem pregnancy. They were even less likely to have a cesarean section, preterm delivery or infant of low birth weight. These women were more likely to have an induced labor.

The researchers wrote: “Women wanting to become pregnant soon after a miscarriage should not be discouraged.” These women had the best reproductive outcomes.

*This blog post was originally published at EverythingHealth*

More Babies For Diabetic Mommy?

While I was at CBC a few weeks ago, one of the staff members asked me if I was planning on having more children. “I don’t think so,” I said, without hesitation. “I love my daughter endlessly, and now that she’s part of my family, I can’t imagine my life without her, but I can’t lie to you. I didn’t enjoy being pregnant. I wanted a baby, but spending nine months pregnant was very, very stressful.”

The staff member who asked the question looked disappointed. And in that moment, I sort of wish I had lied. “Oh, you look disappointed. I’m sorry! It’s not just because of diabetes stuff. It’s my own personal preference. I don’t want to lie!”

And I won’t lie. The end result of my pregnancy was the most beautiful, smiley baby I have ever laid eyes on, and having her as part of our family has been the greatest joy that Chris and I have ever experienced. Seriously — it sounds like a cheesy Hallmark card, but it’s true. This kid fills a hole in my heart that I didn’t even know existed until I heard her cry and I finally felt complete. But being pregnant, the actual journey of carrying her inside of me, was not an experience I’m looking to repeat. This isn’t entirely a diabetes-based decision, either. Read more »

*This blog post was originally published at Six Until Me.*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles