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The CMG Voice

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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Is exercise really good for the brain?

Posted Thursday, February 8, 2018 by Tyler Goldberg-Hoss

Recently, the American Academy of Neurology recommended for the first time that their members should recommend regular exercise to patients with Mild Cognitive Impairment (MCI).

However, another study looking at the possible benefits of exercise on the brain found that there was not enough empirical support for that claim.

So who is right?

At this point, it seems that regular exercise is good for lots of other things, including cardiovascular health. So you should exercise in any event. And even if exercise doesn’t directly positively affect the brain, at least indirectly it does. Consider, if you have a healthy heart and good blood flow in the body, that means good blood flow to the brain. One would think that would be better than poor flow and poor brain perfusion.

And there is little downside to recommending exercise in most cases – it can’t hurt, right?

More than anything, this apparent conflict in the medical community has as much to do about how much proof one needs to make such a claim. My guess is neurologists are not going to be faulted for suggesting exercise, whether or not it is the miracle cure for cognitive decline.

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Does Coffee Prevent Liver Disease?

Posted Monday, February 5, 2018 by Gene Moen

We have written another blog post regarding a meta-analysis of studies focused on various possible health benefits of moderate coffee consumption. Here is another one, which may cause readers to wonder whether we are part of the Starbucks public relations team. A recent article in Medical News Today focuses only on coffee and the liver. The conclusion: the evidence is very strong that consuming 4 cups of coffee a day keeps the liver doctor away.

The article was about an event held at the Society of Medicine in London, chaired by Prof. Graeme Alexander, a senior advisor to the British Liver Trust of University College London. At the event, there was discussion about the rise of liver disease: an estimated 31,000 people in the U.S. die each year from cirrhosis. This is presumed to result from excess alcohol, calorie, and fat intake. And a major problem with liver disease is that it is often non-symptomatic, which means it is often undiagnosed until treatment is not effective.

Dr. Alexander stated about this problem “Liver disease is on the rise across Europe, and it is important that we understand how coffee, one of the most popular drinks in the world, and diet affects the disease.” Research papers discussed at the conference included one that suggested that coffee drinking, versus no coffee consumption, is associated with a 40% reduction in liver cancer risk. Another study found a 25-70% reduction in liver cirrhosis risk.

While recognizing that coffee may be good for the liver, there is uncertainty as to “why.” As one participant asked “How does coffee weave this hepatic magic?” There are some theories bouncing around. One is that caffeine might be involved, with a focus on paraxanthine (one of caffeine’s main metabolites). It decreased the synthesis of connective tissue growth, which in turn may decelerate the development of liver fibrosis, alcoholic cirrhosis, and cancer.

A major problem with this theory is that consumption of tea – which also contains caffeine — does not seem to have the same liver benefits as coffee. Another theory points to other constituents of coffee (kahweol and cafestol) because there is some evidence that these compounds may provide some anti-cancer effects.

There may be a range of compounds and mechanisms involved which benefit the liver, and whatever the scientific explanation, many researchers now think that having a few cups of coffee every day is just what your liver wanted for Christmas.

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