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Bad Medical Marketing: An Ad The FDA Should Pull

If ever a medical device company crossed a line with their marketing, this one has. Essure, which makes a sterilization device for women, is trying to scare men away from vasectomy in order to drive women to use their device.

“We made men watch footage of an actual vasectomy,” says the female voiceover — and then they proceed to show men’s reactions to watching a surgical procedure, with “That’s frickin’ gross, man” being the most memorable quote. The final tagline: “You can only wait so long for him to man up.” Yeah, and to be sure he doesn’t, they’ve created this ad.

The ad is slimy, harmful, obnoxious, and just plain stupid. A couple’s decision as to which sterilization procedure is best for them should be one informed by real information, not frat-boy marketing.

How dare they? The FDA should pull this ad — now.

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Addendum: I just emailed the FDA at BadAd@fda.hhs.gov. Feel free to copy my message below and send your own email:

To the FDA,

I find this ad for Essure both inflammatory and unethical. I am incensed at the impact this ad could have on couples’ informed choices about sterilization. I ask that you mandate that the company who makes Essure immediately pull this ad, both from the Web and from any media outlet where it’s playing.

Thank you for your attention to this matter.

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

EMR And The Pathologist: A Winning Combo

A pathologist uses the EMR to find out just a little more about the patient whose cerebro-spinal fluid she has under her microscope — and changes her diagnosis:

This patient had a diagnosis of plasma cell myeloma with recent acute mental status changes. So the lone plasma cell or two I was seeing, among the lymphs and monos, could indicate leptomeningeal spread of the patient’s disease process. I reversed the tech diagnosis to atypical and added a lengthy comment – unfortunately there weren’t enough cells to attempt flow cytometry to assess for clonality of the plasma cells to cinch the diagnosis. But with the information in the EMR I was able to get a more holistic picture on a couple of cells and provide better care for the patient. I cringe to wonder if I might have blown them off as lymphs without my crutch.

The much-hoped-for improvement in quality due to the adoption of EMRs has been elusive to date, so anecdotal experiences like this will be important evidence to consider in judging the impact of the EMR on healthcare outcomes.

Kudos to pathologist Gizabeth Shyner, who writes over at Mothers in Medicine and her own blog, Methodical Madness,  for “thinking outside the box.”

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

Bioadhesives For Repair Of Childbirth Lacerations

Bioadhesives are a reasonable alternative to sutures for repair of perineal lacerations sustained during childbirth, according to a poster presentation at last week’s annual meeting of the Society for Maternal-Fetal Medicine.

Researchers at the Hadassah Hebrew University Medical Center in Jerusalem randomized women with first degree perineal tears to either 2-octyl cyanoacrylate (Dermabond) adhesive glue or suture for wound closure. While healing and incisional pain was similar, women who received the adhesive closure were more satisfied than those who were sutured.

In Portugal, bioadhesives have been studied for closure of the top skin layer of an episiotomy repair, and found to shorten the duration of the procedure with similar outcomes to suture in terms of pain, healing, and infection.

Biologic adhesives are chemically related to Super Glue, which is ethyl-cyanoacrylate. Midwives have been using Super Glue for perineal wound repair for some time, according to Anne Frye, who has authored a book on wound closure for midwives, and who gives instructions for its use in repair of perineal lacerations. Apparently Super Glue was also used by the military during Vietnam for wound closure.

A PubMed search on Dermabond finds multiple studies of its use, from plastic surgery to mastectomy, surgical wound closure, retinal surgery, lung and gastric leak closure, and even on esophageal varices. RL Bates mentions Dermabond as an option to repair skin tears in elderly patients. This stuff is turning into the duct tape of the medical profession.

It’s important to remember that adhesives are only for superficial skin closure, as use in deeper layers can cause irritation and burning of tissues. Side effects of their use include irritation and allergic reactions and of course wound infections, and pain can always occur no matter how one closes a wound.

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

Building A Hospital In Haiti

Partners in Health is building a state-of-the-art teaching medical facility in Mirebalais in Haiti’s underserved Central Plateau.

My niece Annie helped design the waste and water treatment systems of the project as part of her engineering internship with Northeastern University, and will be joining the Partners in Health group upon graduation. It’s so inspiring to see this wonderful project coming to fruition and to know that she’ll be part of it.

You can be part of it, too, by donating, volunteering or, like Annie, working for Partners in Health.

Partners in Health was founded by Dr. Paul Farmer and colleagues in 1987 to serve the poor in Haiti. Dr. Farmer’s story is the subject of Tracy Kidder’s new book “Mountains Beyond Mountains: One Doctor’s Quest to Heal the World.”

[Editor's note: Also see the NPR article "The Quest of Dr. Paul Farmer."]

*This blog post was originally published at tbtam*

Abortion Doesn’t Cause Mental Illness

Here’s yet another study showing that abortion does NOT lead to future psychiatric problems. From The New York Times:

The New England Journal of Medicine has taken on one of the pillar arguments in the abortion debate, asking whether having the procedure increases a woman’s risk of mental-health problems and concluding that it doesn’t. In fact, researchers found, having a baby brings a far higher risk.

The study, by Danish scientists (and financed in part by the Susan Thompson Buffett Foundation, which supports research on abortion rights), is the most extensive of its kind to date. It studied 365,550 Danish women who had an abortion or gave birth for the first time between 1995 and 2007. Of those, 84,620 terminated their pregnancies and 280,930 gave birth.

In the year after an abortion, 15.2 out of 1,000 sought psychiatric help (defined as admission to a hospital or clinic), which was essentially the same as the rate of that group (14.6 per 1,000) in the nine months before the abortion. In contrast, among women who went on to give birth, the rate at which they sought treatment increased to 6.7 per 1,000 after delivery from 3.9 per 1,000 before.

Why do first-time mothers have a lower overall rate of mental illness both before and after pregnancy than those who choose termination? The researchers suggest that those who have abortions are more likely to have emotional problems in the first place. Compared with the group who give birth, those who have abortions are also statistically more likely to be struggling economically, and to have a higher rate of unintended pregnancies.

And why do first-time mothers seem to nearly double their risk in the year after giving birth? That is likely to have something to do with the hormonal changes, decreased sleep, and increased stress of parenting, which women who terminate do not experience.

Can we please talk about something else? Like maybe how to help these young women with the issues and unmet contraceptive needs that led to unplanned pregnancy in the first place?

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

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