January 28th, 2011 by Elaine Schattner, M.D. in News, Opinion
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The FDA [has] issued an alert about a possible link between breast implants — saline or silicone — and a rare form of lymphoma called anaplastic large cell lymphoma (ALCL). These lymphoma cases are exceedingly rare, but the association appears to be significant.
The FDA identified a total of approximately 60 ALCL cases in association with implants, worldwide. Of these, 34 were identified by review of published medical literature from 1997 to May, 2010; the others were reported by implant manufacturers and other sources. The agency estimates the number of women worldwide with breast implants is between five and 10 million. These numbers translate to between six and 12 ALCL cases in the breast, per million women with breast implants, assessed over 13 years or so.
In women who don’t have implants, ALCL is an infrequent tumor, affecting approximately one in 500,000 women is the U.S. per year. This form of lymphoma — a malignancy of lymphocytes, a kind of white blood cell — can arise almost anywhere in the body. But ALCL cases arising in the breast are unusual. The FDA reports that roughly three in 100,000,000 women are diagnosed with ALCL in the breast per year in the U.S.
These are very small numbers. Still, the finding of ALCL tumors by the implant capsules is highly suggestive. Almost all of the implant-associated ALCL cases were T-cell type, whereas most breast lymphomas are of B-cell type. The lymphomas arose in women with both silicone and saline-type implants, and in women with implants placed for purposes or augmentation and for reconstruction after mastectomy. Read more »
*This blog post was originally published at Medical Lessons*
January 26th, 2011 by Elaine Schattner, M.D. in Health Tips, Opinion
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A few years ago I started writing a book on what it was like to be a cancer patient and an oncologist. This morning I came upon this section on second opinions:
Is It OK To Get A Second Opinion?
Definitely. And there’s no need to be secretive about it, or to worry about hurting the doctor’s feelings. Second opinions are routine in fields like oncology, and are often covered by insurance. Be up-front: Any decent oncologist can understand a cancer patient’s need to find a doctor who’s right for them, with whom they’re comfortable making important decisions. And in difficult cases, some specialists appreciate the chance to discuss the situation with another expert. So a second opinion can be beneficial to patients and physicians alike.
When things can get out of hand, though, is when patients start “doctor shopping.” For example, I’ve cared for some patients with leukemia who’ve been to see over 10 oncologists. If you’re acutely sick, this sort of approach to illness can be counterproductive — it can delay needed therapy. From the physician’s perspective, it’s alienating: Who wants to invest her time, intellectual effort, and feelings for a patient who’s unlikely to follow up? Besides, oncology is the sort of field where each consulting doctor may have a distinct opinion. (If you see 10 oncologists, you may get 10 opinions.) Beyond a certain point, it may not help to get more input, but instead will cloud the issue. Read more »
*This blog post was originally published at Medical Lessons*
January 19th, 2011 by Elaine Schattner, M.D. in Better Health Network, Research
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There’s hematology news, times two (at least):
1. Progress in developing synthetic red blood cells
A University of North Carolina-Chapel Hill research group has created hydrogel particles that mimic the size, shape and flexibility of red blood cells (RBCs). The researchers used PRINT® (Particle Replication in Non-wetting Templates) technology to generate the fake RBCs, which are said to have a relatively long half-life. The findings were reported on-line yesterday in the Proceedings of the National Academy of Sciences (PNAS) (abstract available, subscription required for full text). According to a PR-ish but interesting post on Futurity, a website put forth by a consortium of major research universities, tests of the particles’ ability to perform functions such as transporting oxygen or carrying therapeutic drugs have not yet been conducted.
Developing competent, artificial RBCs is a hematologist’s holy grail of sorts, because with that you might alleviate anemia without the risks of transfusion.
2. Progress in using human stem cells to generate lots of platelets
In an exciting paper published today in Cell Research, investigators stimulated human embryonic stem cells to become platelet-producing cells, called megakaryocytes. According to the article (open-text at Nature PG), the platelets were produced in abundance, appeared typical and clotted appropriately in response to stimuli in vitro. The researchers injected them into mice, used high-speed video microscopy for imaging, and demonstrated that the stem cell-derived human platelets contributed to clot formation in mice, in vivo (i.e., they seem to work). Read more »
*This blog post was originally published at Medical Lessons*
January 14th, 2011 by Elaine Schattner, M.D. in Opinion
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An online friend, colleague, and outspoken patient advocate, Trisha Torrey, has an ongoing e-vote about whether people prefer to be called a “patient,” a “consumer,” a “customer,” or some other noun to describe a person who receives healthcare.
My vote is: PATIENT. Here’s why:
Providing medical care is or should be unlike other commercial transactions. The doctor, or other person who gives medical treatment, has a special professional and moral obligation to help the person who’s receiving his or her treatment. This responsibility — to heal, honestly and to the best of one’s ability — overrides any other commitments, or conflicts, between the two. The term “patient” constantly reminds the doctor of the specialness of the relationship. If a person with illness or medical need became a consumer like any other, the relationship — and the doctor’s obligation — would be lessened.
Some might argue that the term “patient” somehow demeans the healthcare receiver. But I don’t agree: From the practicing physician’s perspective, it’s a privilege to have someone trust you with their health, especially if they’re seriously ill. In this context, the term “patient” can reflect a physician’s respect for the person’s integrity, humanity and needs.
*This blog post was originally published at Medical Lessons*
January 5th, 2011 by Elaine Schattner, M.D. in Better Health Network, Health Tips, News, Opinion, Research
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Three recent stories lead me to my opening topic for the year: The value of open-mindedness. This characteristic — a state of receptiveness to new ideas — affects how we perceive and process information. It’s a quality I look for in my doctors, and which I admire especially in older people.
Piece #1 — On the brain’s maturity, flexibility and “cognitive fitness”
For the first piece, I’ll note a Dec 31 op-ed piece that appeared in the New York Times: This Year, Change Your Mind, by Dr. Oliver Sacks, the neurologist and author. In this thoughtful essay, he considers the adult brain’s “mysterious and extraordinary” power to adapt and grow: “I have seen hundreds of patients with various deficits — strokes, Parkinson’s and even dementia — learn to do things in new ways, whether consciously or unconsciously, to work around those deficits.”
With appropriate and very-real respect, I question Sacks’ objectivity on this subject — he’s referred some of the most outstanding (i.e. exceptional) neurological cases in the world. And so it may be that his careful reports are perfectly valid but not representative; for most of us, the adult brain’s capacity to establish new circuitry for language learning or music appreciation may be limited. What his stories do show is that unimaginably strange things happen in our brains, at least occasionally. And maybe we should just accept that and take notes (as he does so carefully), and keep an open mind. Read more »
*This blog post was originally published at Medical Lessons*
