Medical Monday: Weekly News Update in Obstetrics and Gynecology

Good Monday !

I am returning from a great five days back at Stanford with our son Forest, who is now also an alumni. We attended “ Classes without Quizzes” and enjoyed ourselves immensely. We learned about numerous things, including a little about the way the brain functions during early language development, the latest in nutrition research, and a MMOG, yes, a massive multiplayer online game called EteRNA which has become a powerful tool in the design of tiny RNA machines which may be used to treat disease. We also took a yoga Piyo Hip Hop Fusion class, went on a pro multi-ethnic eating tour and saw tons of old friends. 

So now we return inspired, excited to move the needle forward in everything we do, including Medical Mondays ! 

Flibanserin went on sale this last Saturday. Flibanserin is of course the pill to treat low libido in women. It goes by the name Addyi. Does anyone know how to pronounced this ? Someone got paid to think of that name, you know. I can’t wait to see the commercials. For some real information about this drug, please see my prior post HERE

This week, in a 2000 word opinion piece in the New York Times, a political scientist Courtney Jung, criticized breast feeding activists for putting too much pressure on women to breastfeed. She states broad based research indicates the benefits of breastfeeding are  “ modest”. Could this op ed have anything to do with the fact that she is releasing a sensational new book called “Lactivism” next month ? Imagine running a 2000 word ad for your upcoming book in the New York Times. I wonder if they even paid her for her ad.

Her subtitle includes many of us: 

How Feminists and Fundamentalists, Hippies and Yuppies, and Physicians and Politicians Made Breastfeeding Big Business and Bad Policy

I am just going to go out here on a limb and disagree and say that I do not think breastfeeding is bad policy. I guess I’m kind of a rebel that way. 

The American Academy of Pediatricians has come out saying that "no amount of alcohol is safe for unborn babies". The new guideline “identifies prenatal exposure to alcohol as the leading preventable causes birth defects and intellectual disabilities in children.” It was previously thought that "a small amount" of alcohol is okay in pregnancy. According to the CDC (The Centers for Disease Control), about 10% of women self-report that they drink alcohol in pregnancy. So in my simplistic mind this means that if women comply with this recommendation, 10% of the entire next crop of babies could be significantly developmentally better off than the last group. Wouldn’t this have staggeringly good effects on the population ? 

The American Cancer Society has revised its recommendations for mammograms once again stating that they should start at age 45 in a patient of average risk, and go to every other year at the age of 55, provided that the woman is expected to live at least 10 more years. The purpose here is to "eliminate false positives and over treatment’.

Has anyone ever considered asking the question, How bad is the badness of a false positive? And what do they mean by overtreatment? Do they mean biopsies which turn out to be benign or do they mean lumpectomies or mastectomies? Most physicians do not consider a biopsy to be a treatment. Most patients consider a benign result a great relief. I have never heard of a patient saying ”Doctor, my biopsy was benign. It looks like I really didn't need that biopsy after all ”. If biopsies were taken out of the “over treatment “ calculations would there really be any unnecessary “treatments” left to lament ?

The American College of Obstetricians and Gynecologists (ACOG) has maintained their stance on mammograms every one to two years from the age of 40 forward. It also recommends a clinical breast exam annually. The American Cancer Society is dropping their recommendation for an annual clinical breast exam since it has not"been shown to save lives.” They say nothing about whether it extends lives. Is important for readers to know that there are many studies designed to determine whether or not a certain intervention prevents death in the course of the study. Preventing death is the same thing as saving life, no matter if you die at one year or ten years after treatment.  Studies geared to show an interventions ability to save life do not necessarily have the power to show it extends life. ACOG keeps its position on mammograms and clinical breast exams because earlier more frequent mammograms and clinical breast exams are associated with earlier diagnosis and longer life after breast cancer. 

I had better stop writing since there is steam coming out of my keyboard and my ears again. 

Stay tuned for more news from the wacky world of OB/GYN next week on Medical Monday.