Historically a new President is evaluated at the 100th day in office. This day comes next week, and for this reason there is a special emphasis on trying to get a Republican health bill pushed through next week. The various key features of the new proposal must please not only moderate Republicans but hard line conservatives.
Anxiety remains over whether or not the Trump administration will continue to pay health care subsidies to insurance companies. These government subsidies to insurance companies is what allows them to offer coverage to their ACA clients at such low rates. This last week, the National Association of Insurance Commissioners indicating that these are “ ...essential for keeping insurance markets stable next year”. Last Tuesday health insurance representatives met with Trump administration officials but received little assurance that the subsidies would continue. House speaker Paul Ryan indicted he would consider continuing the payments until the end of the year to avoid “…disruption”.
In the common sense department, a new study has confirmed that paid medical leave is associated with higher breastfeeding rates. The ACA stipulation that businesses of a certain size provide time and space for breastfeeding has also been associated with increased breastfeeding rates.
We have a new study on marijuana in pregnancy. According to a new large survey based study from the National Institute on Drug Abuse in Bethesda Maryland, US teen girls are more than twice as likely to smoke marijuana if they are pregnant. The rates are at 14% versus 6% in those aged 12-17. The ratio is reversed if all ages of pregnant women are considered. In that case, 4% of pregnant women smoke, versus 8% of non pregnant women. Researchers speculated that pregnant teens use marijuana medicinally to treat nausea. However, others have opined that risky behaviors such as marijuana use and teen pregnancy run together.
Currently no specific pattern of malformation (anatomic or structural) has been uniquely associated with marijuana use. However, sustained use of marijuana has been associated with a trend toward decreased birth weight. Additionally, reported childhood effects of marijuana use in pregnancy include lower scoring on verbal and memory testing, and difficulty analyzing and integrating specific cognitive processes.
Some authorities believe that the use of pot by any kind of teen is more dangerous than use for adults. This is because there are more consequential impacts on the teen's still developing brain. According to Dr. Seth Ammerman at Stanford University and Lucile Packard Children’s Hospital, just telling teens about the risk of pot may be enough to get them to quit.
The Trump administration has announced they will follow through with the $485 million dollar grant approved last year to fight the opioid epidemic.
The Trump administration has also extended the “Veteran’s Choice Program” which enables some veterans to receive care from local doctors and hospital rather than travel to VA hospitals for their care.
Breast implant linked lymphoma is again in the news. The FDA (Food and Drug Administration) has identified 359 women with a rare cancer called ALCL or anaplastic large cell lymphoma. It seems to occur with women who have had textured rather than smooth implants. Though over 350 cases have been identified, the incidence is very low at about 1/30000 women with textured breast implants. Those with implants should seek regular annual exams and mammograms making sure that their caregiver knows about their implants.
A recent review in the Annals of Internal Medicine revealed a problem. This is a problem that could be 100% solved, and that could help patients with any disease that they are treating. The problem is medication non-compliance. Studies show that 20-30% of medications are never filled, and that of the ones that are, 50% are not taken or not taken as prescribed. It goes a long way to explaining why some patients don’t get better or relapse. The reasons are many from cost, to wanting to “be natural”. Patients may believe need for medication reflects weakness. They may avoid it since they don’t want to be reminded of their disease. Solving the medication compliance problem would save over a hundred thousand deaths and hundreds of billions of dollars every year.
By now most of you know that Serena Williams is pregnant. Perhaps you don’t know she won the Australian Open while being so. A recent editorial in the American Journal of Obstetrics and Gynecology highlights the fact that healthy pregnant women need not curtail their exercise. This is in line with the ACOG Committee opinion document on physical activity and exercise in pregnancy. Recommendations are that pregnant women engage in aerobic exercise for 35-90 minutes 3-4 times each week. Those with any high risk factors should consult their doctors first. By the way, Serena wasn’t the only one to compete at this level; eighteen pregnant women have competed in the Olympics.
Earth Day and March for Science have recently taken place. In an unprecedented move, 25 medical organizations including ACOG (American College of Obstetricians and Gynecologists) issued a joint statement for March for Science. They stated that they are issuing a “….nonpartisan call for the appreciation of scientific evidence, education and investment”.
Stay tuned next week for more breaking news from the world of Obstetrics and Gynecology, here on Medical Monday.
