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Lexapro For Treatment Of Hot Flashes

In a well done placebo-controlled study published in this week’s Journal of the American Medical Association (JAMA), use of escitalopram (Lexapro) reduced hot flashes in menopausal women.

Investigators enrolled 205 women, randomizing them to either Lexapro 10 mg or placebo, with instructions to increase to two pills a day if needed after four weeks. Lexapro users experienced about a 60 percent reduction in hot flash frequency over the eight-week study. About half ended up on the larger 20 mg daily dose by study’s end. The drug’s effect was apparent at about one week of use, and it was well tolerated.

As in almost studies of menopausal treatments, the placebo group also experienced a significant reduction in symptoms — about 40 percent — but the difference between placebo and drug groups was significant. Compared to placebo users, Lexapro users had a bigger rebound of symptoms when stopping their treatment, were more satisfied, and more likely to want to continue the study drug, another validation of the drug’s efficacy. Read more »

*This blog post was originally published at tbtam*

Ovarian Cancer Screening Is Still Subpar

Cancer of the ovary is a particularly nasty disease. It often remains asymptomatic until it has reached an advanced, incurable stage, and scientists have been unable to develop an effective screening test for the disease like the ones in widespread use for cancers of the breast and cervix.

The dismal status of ovarian cancer screening was underscored a year ago when an NIH-sponsored study showed that over 70 percent of cancers detected by transvaginal ultrasound and CA 125 biomarker testing — the two best ovarian screening tests we’ve got — had reached stage III or IV at the time the patients screened positive. That’s about what happens when women aren’t screened at all.

That wasn’t the worst of it, however. In just the first year of that screening program, positive test results obligated 566 surgical procedures which uncovered only 18 cancers. That’s an awful lot of unnecessary surgery and associated morbidity right there. Things were no better on the false-negative side of things. Overall, 89 cases of ovarian cancer were diagnosed during the NIH study, and a third of them had been missed by both screening modalities.

What’s new?

The NIH study didn’t evaluate the impact of screening on ovarian cancer mortality, but a recent study by Laura Havrilesky and colleagues at Duke did indeed address the point. Sadly, the results were abysmal. Read more »

*This blog post was originally published at Pizaazz*

Chewable Birth Control

Just in time for the new year, the FDA has approved the first low-dose chewable birth control contraceptive. 

The daily chew will be marketed by Watson Pharmaceuticals, Inc. Fred Wilkinson, executive vice president of Global Brands said: “We believe this product is an important addition to the oral contraceptive category, and that its characteristics will make it a desirable choice for women.”

I have to ask myself: “Why?”

Most birth control failures occur because the woman forgets to take the pill. Will a chewable be more reliant? Is it aimed at gals who just love chewing gum? I don’t get the concept.

Marketing for this breakthrough will begin the in the second quarter of 2011.

*This blog post was originally published at EverythingHealth*

Five Dead Babies: A Lesson In Prenatal Politics

When the Nebraska lawmakers voted to end Medicaid prenatal care for approximately 1,500 women, their unborn babies paid the ultimate price.

Any labor room hospitalist who is responsible for the care of unassigned pregnant women will tell you that it is far easier to take care of pregnant women who have had prenatal care than it is to take care of women who haven’t. The recent vigil of the Equality Nebraska Coalition in front of their state capitol to honor five dead babies whose death can be related to the lack of access to prenatal care speaks volumes.

On or about February of 2010, Nebraska expectant mothers received a “Dear John” letter from Nebraska’s Health and Human Services stating that their pregnancies were no longer covered under Medicaid. It appeared that the rationale for making such a drastic decision involved a resistance of state politicians to pay for medical services of “illegal immigrants.”

However, when one reads the comments on a popular website called Baby Center.com, the pregnant women who were affected were U.S. citizens who were college students, wives of husbands who had lost their medical insurance, and unemployed women. Eventually all the women were able to receive government-sponsored healthcare coverage, but the panic preceding their reinstatement was palpable. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Breast Implants: A Geographical Comparison

This article (full reference below, free access) came to my attention via MDLinx. It was interesting to read. The conclusion verified my expectations rather than surprised me.

The authors conducted a retrospective review of patient demographics and implant information from three university settings: Kelowna (British Columbia, Canada), Loma Linda (California, USA), and Temple (Texas, USA). Each cohort included 100 consecutive breast augmentation cases. Characteristics analyzed included age, height, weight, BME, parity, and average implant volume. 

When considering the 300 as one cohort, the average age was 34 years with a height of 163 cm (5’4”), weight of 58.1 (127.8 lb) and parity of 1.7 . The average implant size was 370 ml. Read more »

*This blog post was originally published at Suture for a Living*

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…

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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…

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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…

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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…

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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…

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