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The CMG Voice

JAMA releases guidelines for what doctors should know about weight loss supplements.

Posted Thursday, March 1, 2018 by Tyler Goldberg-Hoss

If you have recently visited your local pharmacy, you may have come across the shelf (or shelves, or aisle, or aisles) of supplements geared at weight loss. There are so many different supplements – promising to do many different things – that it can be difficult for a physician to counsel his or her patient about using them. And there are so many people using these supplements – by one count more than half of adult Americans have used one such product.

The Journal of the American Medical Association (JAMA) recently set out guidelines for doctors regarding their patients’ use of vitamin and mineral supplements. Although the guidelines do not attempt to analyze the merits of using any particular supplement, they do group each supplement by category, and within each category define the possible issues associated with taking the supplement.

This guidance appears to be a useful tool for clinicians in addressing this with their patients, as it gathers in one place the recommendations from different sources in one convenient location.

If you have any questions yourself about what the guidelines say about how such supplements may affect you, you can read here:

Vitamin and Mineral Supplements - What Clinicians Need to Know

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How will we address the health of our aging population? Look into the future by looking at Japan.

Posted Monday, February 26, 2018 by Tyler Goldberg-Hoss

A country is defined as “super aging” if more than 20 percent of its population is 65 or older. While the United States is not there yet, it is expected that we will be in another 40 or so years.

Given the current state of our health care system, how might we begin to address the increased burdens on it as we age? We might learn a thing or two from how Japan is doing it, and in particular how it is experimenting with technology and the well being of its elderly citizens.

The Japanese government has invested millions in this research. In one area, a bot named Palro helps to keep Japanese seniors engaged and happy, as a dancer, exercise instructor or performer. Japan is also experimenting with Virtual Reality (VR) and how it may be used.

The future is exciting and scary, but Japan’s work in this area makes it more palatable to envision.

You can read more about this here:

Watch: Japan faces its old age with robots and virtual reality

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Recent study suggests inducing labor after 39 weeks reduces need for C section

Posted Monday, February 19, 2018 by Tyler Goldberg-Hoss

The National Institutes of Health (NIH) recently published the findings of a study it funded on the issue of inducing labor in otherwise health mothers after their 39th week of pregnancy.

Current guidelines recommend against inducing labor electively (that is, without a medical reason) before the 41st week because of the perceived increase in need for a C section.

However, the results suggest that, for healthy first time mothers, when labor is induced in the 39th week of pregnancy, the risk of cesarean delivery and preeclampsia went down, as did the need for infants to need help breathing in the first three days of life.

In the study, the differences between the induced labor group and the control group (not induced after 39 weeks) were not striking. C-sections went down 3 percent in the induced labor group, preeclampsia and gestational hypertension went down 5 percent, and the number of newborns needing respiratory support went down only 1 percent.

Still, this is a decided shift in current thinking about the management of labor. We will have to see if it catches on and changes our collective thinking on the issue.

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American Heart Association warns breast cancer survivors of increased risk for cardiovascular disease

Posted Thursday, February 15, 2018 by Tyler Goldberg-Hoss

Recently the American Heart Association published a Scientific Statement outlining the risks of cardiovascular disease in breast cancer survivors, and directing oncologists to weight the risks and benefits of those treatments in light of this increased risk.

Heart disease is the leading cause of death among women. Unfortunately, the treatment for breast cancer – especially chemotherapy – has a negative impact on cardiovascular health. Because treatment now is starting earlier for breast cancer patients (with the advent of early detection), more and more women are at risk of long term cardiac complications. And for older women diagnosed with breast cancer, the cardiovascular risks of treating it with at least certain modalities may outweigh the potential benefit.

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What are “right-to-try” laws?

Posted Monday, February 12, 2018 by Tyler Goldberg-Hoss

Recently, in his State of the Union speech, President Trump voiced support for a pending federal “right-to-try” bill.

Currently, there are approximately 33 states that have enacted similar laws (Washington thus far as not), which remove legal obstacles for terminally ill patients to get treatments that have not yet been approved by the FDA. Many of the remaining states are also seeing legislative efforts to enact similar legislation.

For the terminally ill patient, when options for treatment have become quite limited, the argument seems quite simple. If I am already going to die with the treatment options currently approved, why shouldn’t I have the right to attempt to save my life with other possible treatments. While the treatment may not be approved yet – and it may never be approved – it gives me a chance I otherwise don’t have.

However, the issue is more complex than just that. First, some bills as written may be too broad, including more patients than just those with terminal illnesses. Second, under at least the proposed federal legislation, the right-to-try scheme would eliminate the FDA completely from the transaction, sot that doctors and patients work directly with drug makers.

This is important because without the FDA, there would be no regulatory body to protect patient safety, and the opportunity is there for drug makers motivated by profit to put patients at unnecessary risk of harm. When such drugs have not been approved for use, there is not a full understanding of what the drug may do. So patients are not going to be fully apprised of the possible risks of taking the drug, let alone the potential benefits. Terminal patients may thus become willing guinea pigs of the pharmaceutical industry.

Further, the FDA currently has its own way of allowing terminally ill patients to access drugs that have not yet been fully vetted. Through its Expanded Access program, most all terminally ill patients are approved for access to experimental drugs already. The application process was streamlined in 2015, and one can get expedited approval over the phone in cases of emergencies.

Certainly, anecdotal stories are powerful motivators for legislatures to support such laws. However, there are regulatory processes in place (at least currently) for a reason, and without them all patients are a risk of harm, even those with nothing to lose.

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