Greetings on this Cyber Monday. I am happy to report that we had a great Thanksgiving Break and that I did not even go into town for Black Friday, the official start of the Christmas season. I may however, patronize Cyber Monday. Accordingly, politics has taken a bit of a back seat to commerce and the holiday, and I rather like it. Nonetheless there are a few things to report.
Massachusetts is bringing good cheer as Governor Charlie Baker, Republican (!) signs a law protecting free birth control without copay. The Baker administration has declared that women of Massachusetts right to contraception will be protected regardless of what goes on in Washington. All the while, the Trump administration is trying any way it can to demand the contraceptive protections set in place through the Affordable Care Act (ACA).
Contraception again made the news in that a group of states Attorney's General are filing suit against the Federal government over their weakening of the contraceptive mandate for corporations which hold religious or moral objections to it. I still think it is ridiculous to confer beliefs to corporations.
Meanwhile enrollment in the ACA is up for this stage compared to last year, despite the enrollment time being cut in half.
The funding of the proposed Trump tax cuts is really no mystery. They are to be funded by repealing the individual mandate, the insurance subsidies and the contraceptive mandate, saving the federal government money that would have been spent on health care. The Fed can then garner support from those people who need deductions, i.e. those who have taxable income. The greater the income, the greater the benefit. So yes, the tax plan is a case of robbing Peter to pay Paul where Peter is health care and Paul is people with substantial income. Again, I have have emphasized this so much: Investment into health care pays itself of many times over, in both human and economic terms. The trump Administrations simply does not seem to know or care about this. They are interested in keeping their campaign promise of cutting taxes. However there is no free lunch, and those that elected him should have realized the money for the tax cut would have to come from somewhere. Perhaps Trump supporters value the short term gain of lower taxes more than they value the long term gain brought by comprehensive, universal and affordable health care.
Math: The Trump administration quietly cut $200 million from Teen Pregnancy Prevention Programs only to greatly promote a $10 million dollar program of their own that they have recently unveiled. Their philosophy: abstinence only.
On the medical news. In the Fun and Clever Obstetrics category, there is a new study reporting on work by a Canadian charity to foster early prenatal care in African women. Bridge to Health Medical and Dental is bringing early Ultrasound to women of Africa, but more importantly they are bringing women to Ultrasound. How ? By advertising that “ you will see your baby”. They have shown that women are 9 times more likely to show up for early US if they hear this message.
More Zika data is filtering in. We know that Zika virus infection in pregnancy is associated with a high rate of fetal malformations. However, we now know it is also associated with a very high rate of miscarriage compared to controls. Among those who survive and are assessed at one year, 94 % appear grossly normal.
In the news that may impact you department, we have the revision in the definition of normal blood pressure. Formerly normal Bp was defined as anything less than 140/90. Now it is anything less than 130/80. What’s your blood pressure ? The best thing to do to answer this question is to get a BP cuff for home, ideally one that is smartphone connected. Take lots of readings under different circumstances, and see where you really live. Share your data with your doctor.
We used to recommend having a normal period or two before reattempting pregnancy after a miscarriage. However newer data suggests this may not be necessary.
New data suggests that Advanced Maternal Age patients 35 or older should be induced by 40 weeks. In the past we waited until 41-42 weeks, but this has proven to be associated with increased rate of complications.
Kratom. This is the newest herbal supplement to a.) become popular b.) cause serious health problems and even 36 deaths. It is Southeast Asian plant used to treat pain anxiety and depression. It produces euphoria. People in opioid withdrawal use it on the street to treat their symptoms. It is clearly dangerous and the word is not yet out.
In an interesting twist of research fate, a new study has identified risk associated with the discontinuation of hormone therapy. In particular, women under 60 who discontinue hormone treatment had a higher risk for cardiac death and stroke during the first year of discontinuation. The same was not true in those after 60. Clearly more research is needed to understand the reasons behind this.
Periodically, research comes out noting the association of lower rates of C sections and episiotomies in those who see midwives. Every time I look at this type of research I find it to be disingenuous to some degree. This means, it does not account for the factor of self selection to midwife care or provider veto of midwife care. I am the principal Obstetric backup for our local midwife practice. We work very closely with one another to see that midwife patients are low risk, and that those who become high risk transfer appropriately to a higher level of care. Additionally, Should point out the patients are generally insightful and understand when low risk care is appropriate, and risk themselves out of midwife care when they feel they are likely to have complications. See how all this would skew these studies ?
We know that obesity has many adverse health effects. Here is a new one: Breast cancers in obese women are larger at the time of diagnosis. They are harder to feel, and harder to image as a result of obesity. Another reason to attain a healthy weight.
We have a great entry for the we-already-knew -this-deparment. Americans are not eating enough fruit and vegetables ! Only 12% of Americans ate the recommended amount of fruit while only 9 % at the recommended amount of vegetables. Compliance with recommendations tracked with income but even the highest bracket did a poor job.
Finally, also in the we-already-knew -this-deparment, 71 % of American women would prefer an annual mammogram rather than every two years. Many groups, including ACOG and the American Cancer Society had to publicly disagree with the US Preventive Services Task Force over a controversial interpretation of data in 2009 saying annual mammograms conferred to benefit. Confusion still reigns in the media. In 2016 the USPTF still reaffirmed hat the harms of screening outweigh benefits. Benefits are early detection of cancer, but that is not addressed by their data. Harms they define include pain of mammograms, fear of mammograms, and indicated breast biopsies whose results return benign. I’d say this last one in particular is actually a blessing.
Stay tuned next week more more news from the world of Obstetrics and Gynecology.