One test too many?

How’s this for a dichotomy?  During the same week we learned that America is $13 trillion in debt, a new study reported that over 90% of US doctors knowingly order more tests and procedures than are medically necessary.

No surprise then that the United States spends more than any other industrialized country on healthcare expenses.  A staggering $2 trillion annually to be exact.

The new survey by Mount Sinai School of Medicine, published in Archives of Internal Medicine questioned 2,416 physicians. 91% of respondents believe that concerns over malpractice lawsuits result in them practicing “defensive medicine.”

About $60 billion is spent annually on defensive medicine and many physicians feel they are vulnerable to malpractice lawsuits even when they practice competently within the standard of care,” said Tara Bishop, MD, co-author of the study.

The majority of physicians (90.7%) also stated that for them to decrease the ordering of unnecessary medical tests, better protections against unwarranted malpractice suits are needed.

Word on Health could not agree more.  At a time when the healthcare system is in such crisis that hospitals nationwide are reporting major drug shortages, we should not be forcing physicians to waste money to protect themselves from malpractice concerns. Not only are we exposing patients to unnecessary, and often invasive, procedures, this crippling fear of litigation is surely impacting health care reform efforts.

Time for tort reform?  Let us know what you think .

A New, Less Invasive Technique for Kidney Donation

Surgeons at a leading US hospital are studying a new way to make kidney donation safer, less invasive and almost scar free for women by using a new technique that removes kidneys transvaginally.

The technique is called natural orifice translumenal endoscopic surgery (NOTES), in which surgeons use a natural opening in the body to minimize pain and scarring, making recovery much easier.

According to the United Network for Organ Sharing (UNOS), more than 60% of living kidney donors are female.

Currently, kidney donors undergo either open or minimally invasive laparoscopic surgery.  During the latter operation the surgeon prepares the kidney for removal by working through three ¼-inch incisions. However, when it comes time to remove the kidney, a larger three- to four-inch incision must still be made for the extraction. The larger incision is the source for most of the pain and scarring. Other complications of current surgical techniques include hernias and wound infection.

Removing the kidney transvaginally, where there are relatively few pain fibers, results in a nearly painless operation with no extraction scar.  The first procedure was performed, to media fanfare in February 2009 at Johns Hopkins University, in Baltimore, MD.  Although deemed a success, there was, at the time, considerable skepticism from other clinicians.

Now, a study is being undertaken at the Methodist Hospital in Houston, TX, which intends to examine some of these concerns.

The investigators will conduct a microbiological analysis of the cervix and vagina of patients undergoing laparoscopic transvaginal hysterectomy. A sterile mock kidney will be placed in the patient’s abdomen and extracted transvaginally at the end of the hysterectomy procedure. They will conduct a microbiological analysis of the mock kidney after the procedure, as well.

If this analysis shows no evidence of contamination, or other adverse effects, this technique may become a future standard, improving donor and recipient safety while reducing pain and recovery time for the donor.  Ultimately, it is hoped, it will also increase the number of donors.

According to UNOS there are, as of today, over 108,000 people in the US awaiting a transplant. For them, and their potential living donors, the results can probably not come soon enough.

Happy 4th of July

Word on Health wishes all it’s readers a safe and happy holiday.

We will be back on Wednesday 7th, bringing you all the latest news from the world of health and pharma.

Take up your bed and walk!

For years, “rest” – generally meaning a few days to a week in bed – was the standard prescription for acute low-back pain.  More recently, doctors have started counseling back pain patients to stay as active as they can.

The latter approach has now been confirmed by a new Cochrane Library review. According to Kristin Thuve Dahm, a researcher at the Norwegian Centre for the Health Services and lead author of the review, “Normal daily activity seems to be the best way for patients with low-back pain to get better.”

The review directly compared bed rest and staying active, in patients with and without sciatica (low-back pain accompanied by signs of nerve compression or damage, causing numbness, tingling or weakness in the leg).

The comparison between bed rest and normal activity for low-back pain without sciatica used data from three studies that included 481 patients. All three found improvements in pain intensity with both treatments, with no significant differences between them. One of the studies, however, involved a highly specific group of patients – young combat trainees who were hospitalized for their back pain – “and thus, it’s applicability to the general population is questionable” the authors wrote.

When the reviews pooled data from the other two studies, the group who stayed active found significantly greater improvements in the ability to function four weeks and 12 weeks after treatment.

In comparing treatments for sciatica, the reviewers analyzed data from two studies of 348 patients. No difference existed in pain intensity, directly after treatment or 12 weeks later, between sciatica patients who received advice to stay active and those whose doctors prescribed bed rest. Similarly, there was no difference between groups in patients’ ability to function.

The available evidence neither supports nor refutes that advice to stay active is better than resting in bed for people with sciatica,” Dahm said. “However, considering that bed rest is associated with potential harmful side effects, we think it is reasonable to advise people with sciatica to stay active.”

Given that back pain is the second leading cause of absenteeism from work, after the common cold, this new advice could have a massive economic impact on society. Estimates suggest that back injuries account for 15% of sick leave, or over 100 million lost days of work annually in the US.

If you have a back pain story that you’d like to share, Word on Health would love to hear from you.