July, 2009

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Lawmakers: direct-to-consumer ads for prescription drugs are a problem

Friday, July 31st, 2009

As I’ve written before, I am troubled by direct-to-consumer advertising of prescription drugs. Only a doctor who knows your medical history and has done and interpreted any necessary tests can determine whether you need a prescription drug and which one you should be taking.

Now, a few lawmakers have proposed bills that would help limit this practice. Here is an excerpt from a New York Times article about the legislative proposals:

“For some legislators and consumer advocates, the ads are a daily reminder of a health care system run amok. Critics contend that drug ads are intended to prompt people to diagnose themselves with chronic quality-of-life problems like insomnia or restless leg syndrome; lead people to pressure their doctors for prescriptions for expensive brand-name drugs to treat these conditions; and steer people away from cheaper generic pills.

“And, critics say, such ads may overstate benefits and understate risks of drugs, or by drumming up audiences for the latest pills at a time when the side effects of such drugs may not yet be fully known.”

I agree with all the above and hope that Congress will act. One suggested bill would deny pharmaceutical companies a tax break for the cost of creating and running such ads. That sounds like a good start. The rest of us shouldn’t subsidize these direct-to-consumer ads through our tax dollars.

– Yvonne S. Thornton, MD, MPH

Another letter from a reader of The Ditchdigger’s Daughters

Wednesday, July 29th, 2009

It always moves me to hear from readers that my book inspired them. But I’m amazed that I’m still getting such letters, 14 years after The Ditchdigger’s Daughters was first published.

Here are a few excerpts from what a young nursing/pre-med student named Maria, who said that my book changed her life, wrote me:

“I read your book last summer The Ditchdigger’s Daughters and I have wanted to email you for so long but I have been so busy with school full-time and working part-time. But I really want you to know that I admire you so much. My dream is to become a pediatrician, take care of children, and to encourage them, especially young girls, that they can become whatever they want, to never give up, have faith in God, and believe in themselves. I have three sisters and three brothers and my parents have really sacrificed a lot to make sure we could all go to college. Financially it has been difficult and for a while I even contemplated not going to med school because it was so costly …

“I will be graduating with honors and then enroll at The College of William & Mary to finish my pre-med courses… I love to read and I am truly blessed to have come upon your book.”

Hearing from people like Maria is especially gratifying because I know how difficult it is to keep such a dream in sight when money is tight.

I’ve heard from so many readers over the years. I can’t tell you what it means, knowing that my book helped someone get through difficult moments. What I can say to Maria and others is, I’ve been there. I know it’s tough. Keep going. You’ll make it. And when you do, you’ll inspire others.

– Yvonne S. Thornton, MD, MPH

A blast from my past

Tuesday, July 28th, 2009

Those who read my first book, The Ditchdigger’s Daughters, know that my parents, a blue-collar laborer and a domestic, valued education above all. They knew it was the way to a better life for their daughters.

But how did they find the money to put five girls through college, with four of us going on to get advanced degrees in medicine, dentistry and law?

We spent our weekends touring as The Thornton Sisters, playing for college dances, appearing at the Apollo, and recording records.

I’m writing the above because I just discovered that, 44 years after we recorded it, an old Thornton Sisters record is playing on YouTube.  Who would have thought it?

– Yvonne S. Thornton, MD, MPH

Why your Ob-Gyn should be board-certified

Wednesday, July 22nd, 2009

It’s almost impossible to judge a professional’s skills if you’re not a member of that profession. Only a radiologist can say whether another radiologist accurately read a CT scan. Only a dentist can attest to the quality of the crown another dentist fits over a molar.

So how do you, a layperson, judge the qualifications of your doctor? If they drive fancy cars, wear designer clothes, and charge the highest fees in the community, you can be sure they’re successful. But does that mean they’re qualified? You can ask your girlfriends or your sister or mother to recommend someone. You can determine whether you have rapport with a physician. But that won’t tell you about qualifications, either.

If you want to know whether the kind, caring person you select has the minimum qualifications, there’s one way to determine that. Go here to see whether your doctor is board-certified.

Board certification isn’t mandatory. Once a doctor gets a medical degree and a state license to practice medicine and surgery, he or she can practice any specialty. No law requires a doctor to complete a four-year residency in a specialty, such as ob-gyn, in order to be called a specialist. Nothing prevents a doctor from giving him or herself the title of obstetrician or fertility expert or perinatal specialist or really, almost anything.

But only board certification assures you that the doctor has earned that title.

A board certified doctor has gone a giant step further than a physician who hasn’t passed her boards. After completing a residency program, passing a written test in the specialty, and practicing for a year or two, she’s gathered up all her cases and submitted them to an august body known as the American Board of Obstetrics and Gynecology. Before these distinguished university professors and chairs of departments, she’s been extensively questioned about real and hypothetical situations and asked about diagnoses, patient management and treatment.

As an oral examiner for the American Board of Ob-Gyn since 1997, I’ve certified hundreds of new ob-gyn candidates who have proven their capabilities under difficult circumstances. And there were some who did not pass because they didn’t meet those high standards.

So I speak from experience when I say that board certification is the minimum you should expect from your doctor.

Yvonne S. Thornton, MD, MPH

Danish study links hormone replacement therapy to ovarian cancer. Should you worry?

Tuesday, July 14th, 2009

In the news today is a Danish study, published in the Journal of the American Medical Association (JAMA), that indicates there may be an increased risk of ovarian cancer among users of hormone replacement therapy.

While this may sound like scary new information, it’s not actually news. Thirteen years ago, for my masters degree in public health, I wrote my final epidemiology paper on the link between hormone therapy and ovarian cancer.

Other studies link hormone replacement therapy, especially estrogen alone rather than estrogen plus progesterone, to breast cancer and endometrial cancer.

After reviewing the available information, you and your doctor may still decide that estrogen’s benefits outweigh any risk. Or you may want to try a different tactic to alleviate menopausal symptoms. As I mentioned in a previous blog post, other treatment options, including SSRIs and blood pressure medications, may work as well and cause fewer concerns.

– Yvonne S. Thornton, MD, MPH

Only in America: insured – but bankrupted by medical bills

Wednesday, July 8th, 2009

There was a story recently in The New York Times about a married couple in Austin, Texas, who thought they were covered by medical insurance. They discovered otherwise when one of them actually needed to use it:

“Too many other people already have coverage so meager that a medical crisis means financial calamity.

One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital.

He and his wife, Claire, filed for bankruptcy last December, as his unpaid medical bills approached $200,000.”

You might assume that, because both my husband and I are doctors, affiliated with two of New York’s most prominent hospitals, we’d never face the issue of inadequate insurance.

If so, you’d be wrong.

When my daughter was in graduate school, she became ill and needed to be hospitalized. She had health insurance through her school. Her hospitalization, CT scans, and other tests, were covered.

But the hospital discharged her before she was completely well and she continued to have severe pain. That’s when we learned that her medical expenses under her policy were capped at $25,000 – and she’d used up the maximum during her first hospital stay.

Because my husband and I had the resources to cover the staggering bills that resulted – physicians, another hospitalization, surgery, tests – our daughter was able to get the care she needed and not go into debt.

But what if we couldn’t be there for her?

It’s not unusual for people, even those who are insured, to lose everything once a major illness strikes. I know of one couple in Michigan. Both had good jobs and health insurance. Then, she got cancer and he needed a heart bypass. His treatments were only partly covered and they fell into debt. They lost their jobs and with it, their insurance. They went bankrupt, lost their home, and just about everything else.

I wish I could say this was unusual but it happens all the time. A recent study showed that 62 percent of bankruptcies in the U.S. in 2007 were due to medical costs. What’s more alarming is that, at the time those people became ill, 78 percent had health insurance. They either lost it when they lost their jobs due to illness or it was inadequate to cover their medical expenses.

And this should illustrate, as nothing else can, why this country desperately needs a public option in healthcare coverage, one that can’t be taken away if you’re too sick to work, one without the fine print that explains how the insurance company isn’t going to cover you when you most need it.

I know there are politicians in Washington, making all sorts of arguments about how, if we allow a public option, we’re on our way to socialized medicine or rationing or, who knows what the latest nonsense is. I’m here to tell you that that’s all it is: nonsense.

These guys rake in tons of money from the health insurance lobby and others who want to keep making huge profits by denying you care when you need it most. Don’t let them fool you as they’ve fooled the American people for so many years. Call your senators and tell them you’re mad as hell, and you’re not going to take it any more. Tell them that all you want from them is a public option so you can be certain help will there when you need it to keep your family well.

– Yvonne S. Thornton, MD, MPH

Daily sex for healthier sperm?

Monday, July 6th, 2009

A new study by an Australian fertility expert, Dr. David Greening of Sydney IVF, has caused a bit of a stir. Greening studied 118 men whose sperm had greater than average DNA damage and found that, when they ejaculated daily, the resulting sperm was healthier.

All well and good so far but Greening’s prescription for greater fertility success made me cringe in empathy for my patients who are trying to get pregnant.

Greening recommends that couples engage in sex every day to improve their chances of conceiving.

Maybe it takes a woman to understand that this isn’t the greatest advice in the world. Too many women come to my office, sore and miserable, because their husbands want to do it every day. They don’t want to say no when they’re on a mission to conceive. And now, this (male, you’ll notice) doctor is saying this is the best way to go?

All right ladies, sit down (if you’re not too sore), because you don’t have to take Greening’s advice. Greening’s findings were that daily ejaculation improves sperm quality, not daily sex.

If you and the man you love want to improve your chances of conception, having intercourse three times a week is plenty.

Don’t look at clocks; don’t look at calendars and yell, “Honey, get in here quick, I’m ovulating.” That causes so much performance dysfunction for men. And it’s completely unnecessary.

All it takes is one sperm. Men ejaculate about 60 million of those little guys at a time. And the sperm hang around, ready to jump on that egg when it appears, for up to seven days. So, even though, when we ovulate, the egg is only fertilizable for up to 24 hours, it doesn’t mean that conception is now or never. With up to 60 million sperm hanging around waiting, one of them is likely to be in the right spot when the ovum shows up.

Most important for couples who want to conceive is to remember that sex, even when you’re on a baby-making mission, should never be a chore. Make sure neither of you skimps on romance, cuddling and cooing. In other words, keep the love in making love. It should be as much fun today as it was the first time (even if that first time was in the back seat of a vintage Chevy). Relax and enjoy the experience and each other. Soon enough, if neither of you has problems with fertility, baby will make three.

– Yvonne S. Thornton, MD, MPH