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Health Updates 13 August 2012

  • New gene-based prenatal testing has pros, cons: “Scientists say that new high-tech ‘microarray” prenatal testing can spot many more genetic abnormalities in a fetus than current screens, but some experts worry that the test might leave parents with more questions than answers.  As reported by The New York Times, the test still requires sampling of fetal cells via amniocentesis (in which a needle is inserted into the uterus) or via tissue removed from the placenta.  However, the new test replaces standard examination of fetal chromosomes under the microscope with a DNA-sensing chip that spots genetic aberrations that would otherwise remain unseen.  Those mutations often lie behind conditions such as autism or mental retardation.  A study validating one of these new tests is expected to be published in a peer-reviewed journal soon, the Times said.  Those who support the new test say any new information it can give will be valuable, while others worry that parents will be presented with complicated genetic information with a myriad of possible outcomes, a situation that will only cause unnecessary worry and make already difficult decisions even tougher.  Barbara Bernhardt, a genetic counselor at the University of Pennsylvania, has spoken with women who have undergone microarray prenatal testing.  She told the Times that many of these women ‘are just not prepared for the uncertain information they are getting, often very late in a pregnancy’.  But the test has its supporters, too.  ‘There definitely are complicated things you run into,’ Dr. Arthur Beaudet, chairman of molecular and human genetics at Baylor College of Medicine, which offers the newer form of testing through its laboratory, told the Times.  ‘But in order to avoid that, are you willing to give up detection of clear-cut terrible disorders?’  The tests are not cheap, either: According to the Times, microarray testing can carry price tags of between $1,500 to $3,000, not including the cost of the amniocentesis.” (womenshealth.gov)
  • No spike in heat deaths despite record temps: “Extreme hot weather across much of the country does not seem to have translated into unusual numbers of heat-related deaths or emergency room visits, at least so far.  The National Oceanic and Atmospheric Administration reported Wednesday that last month was the hottest July in the US since record-keeping began in 1895.  The monthly average temperature in the lower 45 states of 77.6 ° F beat the old mark of 77.4 ° F set in the Dust Bowl year of 1936.  But news reports from areas hit hardest by the heat wave, and an informal survey of emergency rooms physicians by MedPage Today  and ABC News, suggested that a feared jump in heat-related illnesses and deaths has not materialized.  Media coverage of the extreme weather appears to have routinely included advice on avoiding adverse health effects, such as staying hydrated and not engaging in excessive exertion during the hottest part of the day.  The physicians contacted by MedPage Today and ABC News said that such advice appears to have been heeded more than in past years.  Corey Slovis, MD, of Vanderbilt University in Nashville, credited the media with educating people on ways to avoid heat stress.  ‘We did not see a significant increase in patients’, he said in an email, even though central Tennessee had much higher than normal temperatures.  ‘I strongly believe the media made a major impact in decreasing both heat stroke and heat-related illnesses’.”  (John Gever, MedPage Today)
  • Soaring ointment prices are a dermatologic mystery: “They are the staples of most dermatology practices: generic creams and ointments that treat everything from skin rashes to athlete’s foot to scabies.  Many doctors prescribe the drugs without a second thought.  But increasingly, some dermatologists say, patients are complaining about a recent, mysterious and rapid rise in price.  Take betamethasone dipropionate, a cream used to relieve itchy skin.  In 2008, a tube cost $18.17.  The medicine now costs $71.28, according to Red Book, which tracks wholesale drug prices.  Permethrin cream, which kills scabies mites, cost $29.25 in 2008 but has jumped to $71.28 today.  The hefty price increases have stumped doctors and their patients.  ‘It seems to me that something is going on, but I don’t have quantitative details,’ said Dr. Steven R. Feldman, a professor of dermatology at Wake Forest Baptist Medical Center in Winston-Salem, NC.  ‘I wouldn’t have thought that these old-timey, generic drugs would be very costly.  ‘The added revenue from the higher prices has improved the bottom lines of the handful of companies that make such drugs, and have even figured into a contested buyout of one of the companies by an India-based drug maker, Sun Pharmaceuticals.  The phenomenon offers a window into the murky and often illogical world of drug pricing, where prices are not always driven by the usual rules of supply and demand.  ‘In most markets, basic economics would say the lower the price, the higher the volume,’ said Les Funtleyder, the health care fund manager for Poliwogg, a private equity and hedge fund manager.  ‘But health care isn’t one of those standard markets’.  Doctors often write prescriptions without considering the price of a drug, and while patients complain about the cost, no one really considers rashes to be public emergencies.  Still, many doctors are shocked to find that the cost of a generic cream – or any cream – exceeds the cost of a doctor’s visit.  In all, the prices of more than a dozen generic dermatology drugs have increased significantly since 2010.  No one is sure when, or if, the prices will go down. (NY Times)
  • Workers counseled on back pain return to job sooner: “Workers on medical leave because of lower back pain are more likely to return to work if they receive reassurance and medical advice on how to stay active, according to a new study.  People with nonspecific lower back pain who avoid activity could delay their recovery, say researchers Dr. Marc Du Bois and Peter Donceel, at KU Leuven,  a university in Belgium.  Their study involved more than 500 workers — mostly blue-collar — on sick leave because of low back pain.  Workers who had symptoms of a serious back problem were not included.  The study was published in the Aug. 1 issue of Spine.  The researchers randomly selected half of the workers to receive information and advice on their condition.  Specifically, these workers were told their pain would likely resolve over time.  They were also advised to avoid bed rest, to remain active and continue with their normal daily routine.   The remaining participants did not receive this information and advice and were only given a standard disability evaluation.  Workers who were educated about back pain and reassured that they would get better were more likely to return to work.  After one year, the study showed, only 4 percent of these workers had not done so. In comparison, 8 percent of those who did not receive the counseling on back pain remained on leave.  The researchers found that the 38 percent of those who were given the advice on back pain had repeated episodes of medical leave, compared with 60 percent of those who did not receive this advice.  ‘Combined counseling and disability evaluation by a medical advisor results in a higher return to work rate due to a lower sick leave recurrence as compared to disability evaluation alone.’ the study’s authors wrote in a  journal news release.  Advice on low back pain should be part of routine disability evaluations to prevent it from becoming a chronic and disabling condition, the authors concluded, and this advice should be provided within six weeks of a worker going out on medical leave.” (HealthDay)
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