Women’s health issues

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The Latest News From the CDC on Birth Defect Risks

Saturday, March 5th, 2011

In a report published in the American Journal of Obstetrics and Gynecology, the Centers for Disease Control (CDC) [] warned against using prescription opiate-based painkillers such as codeine, hydrocodone or oxycodone (brand names include Vicodin and Oxycontin) during pregnancy.

According to an article about the CDC report:

In the study of data from 10 states, the CDC researchers found that 2 percent to 3 percent of mothers interviewed received prescription opioid pain killers, or analgesics, just before they got pregnant or early in their pregnancy. Any illicit use of painkillers was not assessed.

For those women, the risk of having a baby with hypoplastic left heart syndrome — a critical heart defect — was about double that of women who took no opioid drugs.

Risks of other birth defects, including spina bifida (a type of neural tube defect), hydrocephaly (build up of fluid in the brain), congenital glaucoma (eye defect), and gastroschisis (a defect of the abdominal wall), also somewhat increased among babies whose mothers took these drugs either shortly before or during pregnancy.

I have concerns about the generalization of both articles, but the conclusions may be valid. Taking a drug before you’re pregnant, or up to 17 days after conception, is unlikely to cause birth defects. It will either cause a miscarriage or will have no effect. But because most women don’t know precisely when they conceived, it’s best to avoid taking drugs at any time during pregnancy.

The greatest risk to a developing baby from a pregnant mother taking potentially toxic drugs occurs between 17 days post-conception to 12 weeks (end of the first trimester).

You’ve probably heard of Thalidomide, a sedative given in the 1950s to pregnant women in their first trimester. It dramatically illustrated the risks to a fetus’s development from drug effects during the critical first weeks. Thalidomide given early in pregnancy stunted the development of babies’ arms, legs, hands and feet, and caused other limb deformities.

If you’re pregnant, or planning to be, you should also be aware that most drugs, whether prescription or over-the-counter can have unknown effects on a growing fetus. The bottom line is: Every drug is, in some sense, a poison. Don’t consider any drug safe in pregnancy unless prescribed by someone who knows its toxicity as well as the risks and benefits of the drug.

– Yvonne S. Thornton, MD, MPH

When You Can’t Buy Health Insurance, at Any Price

Monday, February 21st, 2011

As you might already know, I’m a staunch advocate for access to health care, and cheered when health care reform became the law last year. We need the opportunity to stay well and keep our families well, and we need to be able to afford medical care when things go wrong. As a mother and a physician, I’ve seen firsthand how imperative this is.

There are those who say we should repeal the recent landmark health care reforms that Congress passed last year. But that would mean that some people would be shut out of health care completely. Some seem to believe it’s just those who are too poor to afford health insurance, or who can afford it but choose not to buy it, who go without. Those are faulty assumptions, as this op ed by the co-founder of Palm Computer, who was denied insurance before the new law passed, shows:

It never occurred to me that we would be denied! Yes, we had listed a bunch of minor ailments, but nothing serious. No cancer, no chronic diseases like asthma or diabetes, no hospital stays.

Why were we denied? What were these pre-existing conditions that put us into high-risk categories? For me, it was a corn on my toe for which my podiatrist had recommended an in-office procedure. My daughter was denied because she takes regular medication for a common teenage issue. My husband was denied because his ophthalmologist had identified a slow-growing cataract. Basically, if there is any possible procedure in your future, insurers will deny you.

If a woman with $millions couldn’t get approved because of a corn on her toe, what would happen to the average woman, or a child, with a more serious issue if health care reform were repealed?

We need to keep ourselves informed about what’s really at stake. And, trust me, there’s a great deal at stake. If health care reform is repealed, we go back to the days when life-saving care is denied to people who can’t pay the costs—oftentimes, hundreds of thousands of dollars—out-of-pocket. We go back to seeing our kids kicked off our policies when they’re just out of high school and don’t yet have jobs that offer health insurance. We go back to denials for pre-existing conditions as tiny—and ludicrous—as a corn on the toe. Or acne. Or depression. Nevermind more serious illnesses.

We can’t go back. Look at how far we’ve come. Please, be as informed as possible about your new rights under health care reform. You can find most of the information you need at this website set up by the government to guide you through your options and your rights.

– Yvonne S. Thornton, MD, MPH

New Research Shows Women Doctors Still Earning Far Less Than Men

Friday, February 4th, 2011

Anyone who has read my new memoir, Something to Prove: A Daughter’s Journey to Fulfill a Father’s Legacy, knows that I encountered at least as much gender bias as racial bias in my career. Now, a new study by economics professor Anthony T. Lo Sasso, PhD, and coauthors, of the University Illinois School of Public Health in Chicago, shows that women doctors are routinely paid much less than their male counterparts. Worse, the gap between the pay offered male and female doctors has been widening, according to this article about the study from MedPage:

Among new physicians entering the work force, women earned almost $17,000 a year less than their male counterparts — almost regardless of which specialty they picked — according to an analysis of starting salaries over a 10-year period.

In fact, the analysis of starting salaries for more than 8,000 physicians found that the pay gap between men and women increased almost fivefold — from $3,600 in 1999 to $16,819 in 2008.

It’s great to have the pay gap out in the open, but I must take exception to the way the authors of the study seem to place the blame for lower pay on the shoulders of the women doctors. The authors speculate that the pay gap might be explained because women take jobs that give them more balance between lifestyle and career, or because women are poor negotiators.

I am married to a fellow physician, and I’m sure he’d agree that I’m a terrific negotiator, and I’ve always worked as hard, if not harder, than him or any male physician we know. This is true of all the working women I know: physicians, administrators, nurses, executives, salespeople – all women. Blaming women for bias against them is just another aspect of the bias.

The perpetuation of the myth that it’s a woman’s own fault if she’s paid less, or passed over for promotion in favor of a less qualified man, must end. We women have to cry foul every time we hear it.

It’s still true that women must work twice as hard as men to be thought half as good. Even now, in the 21st century.

Isn’t it time that changed?

– Yvonne S. Thornton, MD, MPH.

Time to Deliver? Mother Nature Knows Best

Thursday, December 30th, 2010

For years, I’ve been sounding the alarm about Cesarean delivery on-demand, and have persuaded my patients that childbirth isn’t something you can simply pencil into your schedule when convenient. It’s not just that a baby needs all the time nature gives her within the womb to develop, and that delivering just a few days early can mean that lung development and other functions may be potentially compromised. Cesareans are major surgery, which brings inherent danger to both mom and newborn. Necessary Cesareans are often life-savers. Unnecessary Cesareans can be just the opposite.

And now, at last, the word is spreading.

The San Jose Mercury News reports:


Babies born early through induction or C-section without a medical reason are nearly twice as likely to spend time in the neonatal intensive care unit, researchers say. They also are more likely to contract infections and need breathing machines, according to a 2009 study in the New England Journal of Medicine and a number of other reports.


“We are finding out that the last weeks of pregnancy really do count,” said Leslie Kowalewski, an associate state director for the March of Dimes.


“At 35 weeks, the brain is only two-thirds of what it will weigh at 40 weeks.” Many organizations are responding with programs designed to eliminate early elective deliveries. Most significantly, chapters of the American Congress of Obstetricians and Gynecologists have begun to notify doctors about the serious consequences of performing early elective births.

With luck, as information about potential consequences spreads, expectant mothers and their doctors will decide to let nature take her course, for the sake of the mom’s health and her baby’s.

– Yvonne S. Thornton, MD, MPH

Aspirin, a “miracle” drug, adds another notch to its belt

Friday, December 17th, 2010

Most people know that daily low-dose aspirin is often prescribed by doctors to help prevent heart attack and stroke. Now, a new study shows that aspirin may help prevent cancer, as well.

We’ve known for some time that people who take aspirin appear to have lower incidences of certain cancers, but this study, published in the December 7, 2010 issue of The Lancet, and authored by Oxford University neurologist, Peter Rothwell, offers far more convincing evidence than we’ve had to date. Rothwell analyzed eight previous randomized, controlled studies, that studied the effects of regular aspirin use among more than 25,000 people. About half were given a daily low-dose aspirin (equivalent to a “baby” aspirin) and the other half were given a placebo. Those on aspirin had a 21 percent lower death rate from solid tumor cancers.

According to Time magazine, here’s what Rothwell found:

“Deaths from esophageal cancer were reduced by 60% in the aspirin-takers (who took the drug for at least five years), compared with the placebo group. Lung cancer deaths were reduced by 30%, colorectal cancer deaths were cut by 40% and prostate cancer deaths were lowered by 10%, compared with the patients who got placebo.

“What’s more, the longer people took aspirin, the greater their reduction in cancer risk. The findings are in line with other research that has found anticancer benefits of aspirin in the lab, as well as observational studies that have shown aspirin’s protective effect against colorectal and other cancers. Researchers say the drug’s benefit may have to do with its anti-inflammatory effect.”

Does this mean that everyone should take aspirin? Well, no. Even that innocent looking little pill you buy over-the-counter at the drug store comes with some very serious potential side-effects. Bleeding in the gut, caused by aspirin, can, itself, cause serious illness and even death. Only use aspirin on a regular basis  – or any other drug, over the counter or not –if your physician has recommended it and is monitoring your use.

But if your doctor already has put you on an aspirin regimen, it’s good to know that you might be getting a very valuable side-benefit.

– Yvonne S. Thornton, MD, MPH

Happy Holidays to All – With a Few Tips to Keep the Season Merry

Tuesday, December 14th, 2010

You probably already have a hectic life that just got that much more hectic with the added responsibilities of the holidays. We women often feel pressure to do it all, and to make the holiday special for everyone else. But sometimes, we forget ourselves in the process. So, I thought I’d offer a few tips to plan a holiday that you can enjoy as much as your family and guests.

1. DON’T SHOP UNTIL YOU DROP: I know that budgets are tight for many, many people this year. So, resist the urge to splurge. Even if money isn’t an issue, time is. Don’t try to buy everything at once. Shop in the way that makes the most sense for you, whether that means strolling the mall or surfing the web.

2. LEAVE THE HAUTE CUISINE TO THE FOOD NETWORK GROUPIES: Having company over? Prepare what you can a day or two before, and keep it simple. Forget Mastering the Art of French Cooking this season. Your guests are there to see you, not the Iron Chef champion, so set things up in a way that lets you enjoy the celebration, too.

3: COUNTER THE CALL OF THE BUFFET TABLE: No matter how hard we try to stick to our eating plans, the holidays make it difficult. Fill up your plate with veggies and salad, and leave just a small space for the too-good-to-resist high calorie treats. Balance the inevitable extra calories with an extra walk around the neighborhood after meals. You’ll feel better, and you won’t have to hide the bathroom scale.

4: MAKE YOUR OWN SEASON MERRY AND BRIGHT: Be good to yourself this season. Check the local listings for gatherings that might be fun, or for church choir concerts. Go to a holiday movie. Re-connect on the phone or online with friends and family who have moved away. One of the most rewarding things you can do for yourself is to help those less fortunate. Donate to a food pantry. Visit a senior citizens home. Offer to take a shelter dog for a walk.

I know how tough it is for women to follow this simple advice (hey, I’m a woman, too), but I also know we’ll feel better if we do. So, I’ll try if you will.

Meanwhile, please stop by if you’re in the New York tri-state area for my book launch party at Barnes & Noble in West Nyack this evening for my new memoir, Something To Prove: A Daughter’s Journey to Fulfill A Father’s Legacy. Details are here.

– Yvonne S. Thornton, MD, MPH

New Rules on Health Insurance Keep Insurers Honest.

Tuesday, November 23rd, 2010

Starting in 2011, health insurance companies will be limited in how much they can charge you for insurance. If you work for a large employer, your health insurer will have to use at least 85 percent of your premiums to pay for actual health care or activities that improve health care quality. If you’re self-employed or work for a small business, your health insurer will be required to use 80 percent of your premiums for health care and improving health care.

That means that health insurance companies can no longer divert more than 20 to 25 percent to profits, or salaries, or marketing, and other overhead.

How much will this affect you? Potentially, a great deal.

Kathleen Sebelius, secretary of the Department of Health and Human Services (HHS), told reporters at a press event that some health insurers currently spend less than 60 percent of premium revenues on health care. And that drives up your costs for health insurance:

“Those overhead costs contribute little or nothing to the care of patients and to the health of Americans. And while some administrative costs are certainly necessary, we believe that they have gotten out of hand. And that’s going to change in 2011.”

But what if health insurance companies fail to follow the new regulations? Starting in 2012, if your insurer doesn’t spend 80 to 85 percent of revenues on health care or activities that improve health care quality, you’ll be due a rebate on your premiums.

It’s about time that consumers had some clout when dealing with health insurance companies, and I applaud these changes. I also look forward to hearing your stories about how the new health care law affects you and your family. Has the new law helped your family get or keep health insurance? Get better care? Please let me know in the comments section.

– Yvonne S. Thornton, MD, MPH

Three ways to lower breast cancer risk

Thursday, October 14th, 2010

The conventional wisdom has been that, if you have a genetic predisposition to breast cancer, lifestyle changes, that might benefit other women, won’t help you. Your genes rule, so the thinking has gone until now, and there isn’t much you can do about it.

Now, I’m happy to report, new research in the journal Breast Cancer Research suggests that you don’t have to be a hostage to your genes. The study,  by researcher Dr. Robert Gramling of the University of Rochester in New York, followed approximately 85,000 post-menopausal women for more than five years. And while it was true that women with a family history of breast cancer were at greater risk to get the disease, he discovered something very promising. Women who:

  • exercised moderately (20 minutes per day for five days a week);
  • maintained normal body weight;
  • and drank no more than one alcoholic beverage per day

… lowered their risk of breast cancer. Yes, even those who had a family history of the disease.

Among those with a family history who followed the above guidelines and developed breast cancer, the rate was six in one thousand, compared to seven in one thousand among those who failed to follow the guidelines.

As I’ve been telling my patients and readers for years, there are so many benefits to maintaining a healthy weight. This study adds one more.

For your own health and the sake of those who love you, take good care of your body and it should take care of you for a very long time.

– Yvonne S. Thornton, MD, MPH

All your questions answered on how Healthcare Reform will affect you

Thursday, September 23rd, 2010

You might have read that as of  today, September 23, 2010, consumers will have several new rights when dealing with health insurance companies:

  1. Children can no longer be turned down for health insurance due to pre-existing conditions.
  2. Your insurer can no longer cancel your health insurance policy if you get sick.
  3. Your insurer can no longer charge you a co-pay for preventive care or tests such as mammograms and colonoscopies.
  4. If you have a medical emergency and need to go to an out-of-network hospital, insurers can’t charge you additional fees.
  5. You won’t need a referral from your primary care physician to visit your Ob-Gyn.
  6. Insurance companies can no longer cap the dollar amount of lifetime benefits available to you for essential medical care.
  7. You now have a right to appeal to an outside authority if your insurer denies a claim.
  8. Your adult children can stay on your health insurance policy up to the age of 26.

One thing the above should tell you: you’ve lost your last excuse for putting off that mammogram (make an appointment today, if you haven’t yet).

These changes are hugely valuable – but most people don’t yet know about them.

And the above are just the beginning. The Kaiser Family Foundation has one of the most comprehensive explanations I’ve seen of just how healthcare reform is likely to affect you and your family. And while you’re at the website, check out the animated video for an entertaining, thorough explanation of your expanded rights under the new legislation. It covers just about every question you might have.


– Yvonne S. Thornton, MD, MPH

Painful fibroids? An alternative to surgery

Friday, August 27th, 2010

Plenty of us suffer from fibroids (medical term is myoma), which are benign tumors that form in the uterus.  Up to 40 percent of all women will be diagnosed with fibroids at some point in their lives, but only a relative few have severe symptoms. If you’re among the unlucky ones, and you’ve had to cope with extreme cramps and heavy bleeding during your period, backaches, painful sexual intercourse, or urinary problems, you might believe that the only way to end the misery is by getting a hysterectomy.

But there is another treatment, one that has been proven effective for many women, and doesn’t require surgery. Uterine artery embolization (UAE) is a minimally invasive outpatient or inpatient procedure performed by an interventional radiologist.  Using a small x-ray camera (fluroscope), small, inert particles (embolic agents) are injected through a thin, flexible tube called a catheter into the arteries that nourish the fibroids and essentially block the blood flow, thus causing the fibroid to shrink.

A recent study in the American Journal of Obstetrics & Gynecology showed that for the vast majority of women, five years after the procedure was done, UAE had relieved symptoms enough so that a hysterectomy was not required.

Of course, any procedure has risks and there is always the possibility of side-effects from any treatment. But for women who suffer greatly from painful fibroids, who want to avoid a hysterectomy, UAE is an alternative worth considering.

– Yvonne S. Thornton, MD, MPH