MD Consult - Find The Answer

This time of year people tend to worry about sun exposure and what that means for their skin. But not a lot of people openly talk about the pain that comes from the emotional effects of dermatologic problems.

The psychological and emotional side of dermatology was highlighted in an article on MD Consult this week. Dr. Richard G. Fried suggests that interventions such as psychotherapy, hypnosis, and meditation can improve the conditions of patients suffering from psoriasis, eczema, urticaria and other skin ailments.

“This self-perpetuating negative interaction between stress and impaired skin function has been well-described and often underlies the so-called ‘vicious cycle’ that exists between skin and negative emotional states,” Dr. Fried said in an article in the June issue of Seminars in Cutaneous Medicine and Surgery.

This theory isn’t just focused on those with dermatologic problems though; Dr. Fried also believes that the effects of aging on a patient can lead to negative emotional backlash that could also be improved by nonpharmacologic interventions.

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Teenage pregnancy has grown legs in the media over the past few years. With MTV’s Teen Mom (and the previous series 16 and Pregnant) showing both the highs and lows of teen pregnancies, it’s now more accessible than ever. This also means that more education is needed now to help young girls who are sexually active.

The North American Society for Pediatric and Adolescent Gynecology (NASPAG) recently held their annual meeting where they spoke about adolescent and teen needs for contraceptives and support.

The first article looked at discusses the importance of confidentiality and trust between patient and doctor, specifically for the use of long-acting reversible contraceptives (LARC). Dr. Aparna Sridhar spoke, saying that there were “four key components of LARC use in teens: counseling, confidentiality, consent, and cost.”

Dr. Sridhar believes that in order to gain trust, assure them that everything said is in confidence and will not be shared with another person unless they want it to be. She suggests starting off with simple questions about when they see themselves having children and how their partner might feel about a pregnancy. It’s only once this trust is built that LARCs should be brought up.

When not to hesitate is also important. “Do not wait for the adolescent patient to raise concerns,” said Dr. Sridhar. “Explain in nontechnical terms how each long-acting method works to prevent pregnancy, and assure patients that they can always share concerns and worries.”

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There are a lot of things in life that aren’t fun. I could list a few of the things I don’t like, such as doing the dishes, talking to people, or being outside, but they wouldn’t be the same for everybody. However if there’s one thing that the majority of people would agree on, it’s that undergoing surgery is not a walk in the park (which I actually would not want to do either per the aforementioned ‘being outside’ in my list of dislikes).

Surgery comes at a high cost, both financially and emotionally. But it’s the financial aspect that was highlighted on MD Consult this week in an article exposing the average costs of hip and knee replacements worldwide. There was also a look at how bisphosphonates can help hips and knee implants to survive.

But first we look at the monetary cost. According to the article, the United States has the highest cost worldwide for hip and knee replacements.

A report published by the International Federation of Health Plans (IFHP) revealed that in 2012 costs were considerably higher than in other industrialized countries, with a difference of $37,172 between the highest cost in the US and the lowest cost in Argentina. The IFHP spans 25 countries, consisting of 80 companies.

“The U.S. average for all hospital and physician costs was $40,364 for hip replacement and $25,637 for knee replacement. The next most expensive country for both surgeries was Australia, where the total cost averaged $27,810 for hip replacement and $22,421 for knee replacement. The least most expensive country included in the survey was Argentina, where hip replacement cost $3,365 and knee replacement averaged $3,192 last year, according to the IFHP.”

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The genetic makeup of human beings was spotlighted on MD Consult this week from two separate angles, from patents on genes to the prediction of cancer through DNA.

The Supreme Court is looking to decide in late June whether or not human genes can be patented. “In Association for Molecular Pathology, et al. v. Myriad Genetics, the high court is considering the validity of patents held by Utah-based Myriad Genetics for the BRCA1 and BRCA2 genes, which are associated with an increased risk of breast and ovarian cancer.”

It brings forth some interesting questions over what can and cannot be patented by a company and what, if any, are the ramifications of that, such as the need for second opinions.

This goes back to 2009 when the patents were first disputed; opponents believe that “Myriad doesn’t have the right to patent human genes because these are products of nature and have not been altered.” However Myriad claims that they aren’t patenting the genes, but the synthetic molecules based on the genes.

“Medical innovations that provide insight into natural human biology must remain freely accessible and widely disseminated, not hidden behind a vast thicket of exclusive rights,” Dr. Jeremy Lazarus, AMA president, said in a statement. “Blocking this information interferes with diagnosis and treatment of patients and inhibits new medical discoveries.”

Arthur Caplan, PH.D., director of the division of medical ethics at the New York University Langone Medical Center, doesn’t believe there will be a major impact on the practical side of things regardless of what the court decides.

It will be interesting to watch and see how this progresses over the next couple months.

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The seasons are changing, time is passing from one month to the next, and winter is coming. Wait, sorry, that’s Game of Thrones. And this isn’t the place to talk about that unless you guys want to talk about Jaime Lannister.  No? Fine.

As I meant to say, spring is coming and with that comes warmer weather and more opportunities to be out in the sunlight. Dresses, shorts, and t-shirts are beginning to make their way back into people’s wardrobes revealing more skin than has been visible in months. But with more skin comes more responsibility…. Or does it?

A recent article on MD Consult revealed that one in four melanoma patients do not use sunscreen.

“Although we found that melanoma survivors did better than the general public at protecting their skin from the sun, we also found that more than a quarter of melanoma survivors never wear sunscreen. That blew my mind,” Dr. Anees B. Chagpar said at the annual meeting of the American Association for Cancer Research.

The findings were taken from a 2010 National Health Interview Survey including 27,120 adults, 171 of which had a history of melanoma.

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