Latest / Morning Medical with Dr. Chow / CDC Updates, Migraine Treatments, and Breast Cancer Advances

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CDC Updates, Migraine Treatments, and Breast Cancer Advances · Morning Medical with Dr. Chow

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  Good morning and welcome to another episode of Morning Medical with Dr.
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  Chow.
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  Today, we're diving into some of the most pressing and thought-provoking statements made
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  in the medical field this week.
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  I'm your host, Dr.
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  Chi-Ming Chow.
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  Let's explore what experts have been saying about the current state of healthcare and some
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  of the challenges and innovations that are shaping the future of medicine.
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  First, we heard from Anne Schuchat, Doctor of Medicine, who is the former principal deputy
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  director of the Centers for Disease Control and Prevention.
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  She described the ongoing organizational changes within the agency as 'unusually chaotic
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  and costly.' This comment comes in light of mass layoffs and the closure of several offices
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  at the Centers for Disease Control and Prevention, sparking concerns about the
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  agency's ability to effectively respond to public health crises in the future.
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  Meanwhile, Michael Barry, Doctor of Medicine, from Harvard Medical School, expressed worries
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  about the future of the United States Preventive Services Task Force amid the
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  Department of Health and Human Services reorganization.
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  He warned, 'Without that [Agency for Healthcare Research and Quality] support, we will become
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  ineffective.' This highlights the critical role that the Agency for Healthcare Research and
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  Quality plays in supporting preventive health services across the nation.
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  Jane Armitage, Bachelor of Medicine, Bachelor of Surgery, an emeritus professor at the
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  University of Oxford, shared insights on the use of aspirin for primary prevention.
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  She noted that in the United States, aspirin is used more commonly than in Europe for primary
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  prevention, a practice that dates back many years.
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  This was in response to President Trump's use of aspirin, which goes against both guideline
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  and United States Preventive Services Task Force recommendations.
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  On a more hopeful note, Hope O'Brien, Doctor of Medicine, Master of Business Administration,
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  from the Headache Center of Hope in Cincinnati, discussed a groundbreaking treatment for
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  children and adolescents.
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  For the first time, a CGRP-targeting treatment, fremanezumab, has shown statistically and
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  clinically meaningful results in children as young as six years old.
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  This is a significant advancement in the treatment of migraines in the pediatric
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  population.
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  Jason Smith, Doctor of Philosophy, from Johns Hopkins Bloomberg School of Public Health,
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  highlighted a potential link between treating hearing loss and delaying dementia.
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  He emphasized that up to 32 percent of population-level dementia risk could
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  potentially be delayed or prevented if hearing loss is fully treated, assuming a causal
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  association exists.
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  This underscores the importance of addressing hearing loss as part of dementia prevention
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  strategies.
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  Melissa Simon, Doctor of Medicine, an obstetrician and gynecologist at Northwestern
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  Medicine, voiced her concerns over potential losses in critical contraceptive guidelines
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  from the Centers for Disease Control and Prevention.
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  She stated, 'Safety knowledge regarding use of medications including birth control should be
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  an absolute right for all Americans to have access to.' This emphasizes the essential
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  nature of accessible, accurate information for safe medication use.
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  Gavin Giovannoni, Doctor of Medicine, Doctor of Philosophy, from Queen Mary University in
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  London, discussed the results of the HERCULES and GEMINI trials.
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  He remarked that in treating multiple sclerosis, 'We should be targeting the disease
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  and not the immune response to the disease.' This statement reflects ongoing debates in the
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  medical community about the best approaches to treating complex autoimmune diseases.
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  Finally, Matthew Goetz, Doctor of Medicine, from the Mayo Clinic, highlighted a critical
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  issue in cancer treatment.
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  He noted that more than 40 percent of women with estrogen receptor-low early breast cancer
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  did not receive endocrine therapy, leaving many in the medical field unsure of the best course
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  of action.
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  His comment, 'No one really knows quite what to do,' captures the uncertainty and challenges
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  faced by clinicians in providing optimal cancer care.
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  In a concerning update for consumers, the Canadian Food Inspection Agency has issued a
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  recall for two brands of frozen pastries due to potential salmonella contamination.
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  The affected products, which include Sweet Cream brand and D.
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  Effe T.
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  brand pastries, have been distributed across Alberta, Manitoba, Ontario, Quebec, and Nova
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  Scotia.
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  However, the agency warns that these products might have reached other provinces and
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  territories as well.
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  The specific varieties involved in this recall encompass a range of pastries such as apollini
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  mignon, mini lobster tail, Apollo K2, big lobstertail, sfogliata Napoli, big sfoglia
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  Napoli, mini sfogliatella, and mini sflogliatella cioccolato.
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  Consumers should be particularly vigilant as these items might be sold in clerk-served
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  packages, smaller packages without labels, or even under different brand names, which could
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  complicate the identification process.
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  It's important to note that food contaminated with salmonella may not exhibit any signs of
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  spoilage, such as an off smell or appearance, yet it can still pose a significant health
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  risk.
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  The Canadian Food Inspection Agency emphasizes that young children, pregnant individuals, the
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  elderly, and those with compromised immune systems are especially susceptible to severe or
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  potentially life-threatening infections from this bacterium.
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  Symptoms of salmonella infection can vary but typically include fever, headache, vomiting,
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  nausea, abdominal cramps, and diarrhea.
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  Unfortunately, the outbreak linked to these pastries has already resulted in illnesses,
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  with 61 individuals across five provinces reportedly sickened.
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  This underscores the urgency for consumers to check their freezers and ensure that any
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  potentially contaminated pastries are disposed of safely to prevent further cases.
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  As the population ages, we're witnessing a substantial rise in dementia rates across the
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  United States.
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  This is bringing to light a concerning issue within our healthcare system, particularly in
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  hospital emergency rooms, which are reportedly underprepared to handle the influx of dementia
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  patients.
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  This situation is exacerbated by the static number of staffed hospital beds, which have not
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  increased despite a significant rise in emergency department visits.
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  Take the case of Tracy Balhan and her father, Bill Speer, who struggled with dementia.
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  During a particularly distressing episode, he was taken to the emergency room at Endeavor
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  Health's Edward Hospital in Naperville, Illinois.
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  Unfortunately, Bill experienced what is known as 'ER boarding,' where he waited 12 hours for
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  a psychiatric evaluation, restrained by staff at one point.
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  ER boarding is a symptom of broader systemic issues within the U.S.
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  healthcare system.
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  It's a consequence of limited entry points for patients seeking care outside of emergency
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  rooms and hospitals prioritizing beds for procedures that are more lucrative, often
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  leaving emergency rooms overwhelmed and under-resourced.
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  Experts warn that as the number of people aged 65 and older with dementia increases, the
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  boarding issue will worsen.
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  From 2003 to 2023, the number of staffed hospital beds remained nearly the same, while
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  emergency department visits increased by 30 to 40 percent.
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  This disparity highlights the urgent need for systemic reform.
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  Geriatric psychiatrist Shafi Siddiqui, Doctor of Medicine, emphasizes the dangers of long ER
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  stays for dementia patients, which can lead to delirium—a temporary state of mental
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  confusion—and sometimes hallucinations.
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  These prolonged stays can significantly impact patient outcomes, making boarding a critical
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  issue in need of immediate attention.
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  The president-elect of the American Academy of Emergency Medicine, Vicki Norton, Doctor of
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  Medicine, and Alison Haddock, Doctor of Medicine, president of the American College of
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  Emergency Physicians, have pointed out that boarding represents a failure of the entire
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  healthcare system.
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  Addressing it requires a comprehensive, systemic approach, not just piecemeal
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  solutions.
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  Historical policy decisions have limited the number of hospital beds, while people are
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  living longer with more complex illnesses.
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  Currently, there are fewer staffed beds than in the past, exacerbated by the prioritization of
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  scheduled care over emergency needs.
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  This is particularly challenging for dementia patients, who often experience aggression and
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  require specialized care.
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  Families, like Nancy Fregeau with her husband Michael Reeman, face the difficult task of
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  navigating these challenges.
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  With limited alternatives and resources for dementia care shrinking, families are often
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  left to find their own solutions, such as adult day centers, which are also becoming scarce.
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  The closing of nursing homes and behavioral health centers further strains the system,
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  limiting discharge options and prolonging hospital stays.
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  This was evident in Bill Speer's case, where his prolonged stay in the emergency room was
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  due to a lack of available behavioral care beds for dementia patients.
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  Tracy Balhan felt the healthcare system failed to treat her father with dignity, highlighting
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  a need for change.
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  As dementia rates continue to climb, it's crucial that our healthcare system adapts to
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  provide humane and efficient care for all patients, particularly those most vulnerable.
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  In the evolving landscape of pharmacy services, both Amazon and Walmart are making significant
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  strides to enhance convenience for their customers by expanding their same-day
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  prescription delivery services.
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  This move comes amid a broader trend that gained momentum during the COVID-19 pandemic,
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  where the demand for fast and efficient drug delivery became increasingly important.
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  Traditional drugstore chains, along with companies like Instacart and DoorDash, have
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  also been rushing to offer rapid prescription deliveries.
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  The expansion of these services is partly driven by the closure of many traditional
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  drugstores, as well as the rise in telemedicine and subscription-based care, which naturally
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  encourage regular deliveries.
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  However, the U.S.
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  healthcare system, with its complex drug costs and insurance coverage, presents some
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  challenges that could limit the widespread adoption of these quick delivery options.
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  Brigid Groves from the American Pharmacists Association notes that independent drugstores
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  have long provided same-day deliveries, especially for homebound patients or those
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  recovering from surgeries.
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  Larger chains like CVS Health and Walgreens have also embraced this trend, with CVS Health
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  having delivered over four million prescriptions through its same-day service in
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  2023 alone.
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  Amazon aims to offer same-day deliveries to nearly half of its U.S.
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  customers by the end of the year.
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  The company is adding small pharmacies to its distribution centers and has opened several
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  prescription processing centers to enhance delivery speeds.
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  According to Hannah McClellan, an Amazon Pharmacy executive, the goal is to create a
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  'modern pharmacy' that offers rapid deliveries and 24/7 access to pharmacists.
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  Walmart, having launched its same-day delivery service last fall, has expanded it to almost
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  every state, offering several levels of service, including half-hour deliveries.
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  Kevin Host from Walmart mentions that customer demand was a significant factor driving this
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  expansion, as many customers prioritize pharmacy proximity and convenience, like having
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  a drive-through window.
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  The push for faster deliveries is not just about convenience.
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  Rapid delivery can be crucial for starting treatments quickly, such as antibiotics or
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  COVID-19 medications, especially for those utilizing telemedicine.
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  Amazon's Hannah McClellan points out that quick delivery helps ensure patients adhere to their
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  medication schedules, which is a vital part of effective treatment.
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  Despite the advantages, there are potential drawbacks that might deter some people from
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  using these services.
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  Same-day deliveries often come with additional fees, and patients are likely to weigh these
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  costs against the convenience offered.
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  For those on maintenance prescriptions, who typically have regular refills, the financial
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  implications of switching to a delivery service need careful consideration.
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  Andrew Mulcahy from RAND Corporation emphasizes that while these delivery programs can offer
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  convenience, their practical impact might be limited.
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  Customers must trust that their prescriptions will arrive on time and that they are covered
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  by insurance, which can be complicated if pharmacy benefit managers restrict coverage to
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  certain pharmacies.
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  Moreover, some people prefer the traditional experience of visiting a pharmacy, where
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  pharmacists can provide more personalized care and manage conditions such as high blood
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  pressure.
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  Don Watson, a 72-year-old from Indianapolis, expresses this sentiment, noting that while
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  delivery might be an option in the future, he currently has no issues picking up his
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  prescriptions in person.
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  In an intriguing development, experts are raising concerns about a common dental practice
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  that might have implications for heart health.
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  This practice, tongue-scraping, has been around for centuries as a method to enhance oral
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  hygiene by removing bacteria, food debris, and dead cells from the tongue's surface.
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  Traditionally, it has been associated with benefits like improved taste and fresher
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  breath.
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  However, recent discussions suggest there might be more to consider when it comes to heart
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  health.
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  Dr.
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  Bradley Serwer, an interventional cardiologist and chief medical officer at VitalSolution,
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  warns that tongue-scraping could lead to 'macroscopic cuts' on the tongue.
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  These cuts might allow bacteria to enter the bloodstream, increasing the risk of
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  endocarditis, an infection of the heart valves.
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  This is a serious condition that, if untreated, can cause significant heart damage.
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  The underlying concern is that while tongue-scraping can be beneficial for oral
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  health, performing it too aggressively or frequently might disrupt the balance of
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  beneficial microbes on the tongue.
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  Some of these microbes play a crucial role in producing nitric oxide, a compound that helps
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  regulate blood pressure and overall heart health.
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  Dr.
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  Whitney White from Aspen Dental advises moderation, suggesting that less frequent
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  scraping can help maintain a healthy balance.
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  It's essential to note that while tongue-scraping can complement oral hygiene, it
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  should not replace daily brushing and flossing.
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  Regular dental visits, along with brushing and flossing, remain the cornerstone of maintaining
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  healthy gums and teeth.
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  According to Dr.
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  Serwer, the benefits of tongue-scraping are minimal compared to these established
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  practices.
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  For those who still wish to incorporate tongue-scraping into their routine, the key is
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  to do so gently and infrequently.
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  This approach ensures that the potential risks are minimized while still enjoying the benefits
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  of this age-old practice.
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  Remember, oral health is intricately linked to overall health, and maintaining a balanced
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  routine is crucial for both.
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  As we wrap up today's episode, it's clear that the intersection of oral and heart health is an
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  area worthy of attention.
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  Thank you for joining me on Morning Medical with Dr.
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  Chow.
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  Stay informed, stay healthy, and I'll see you next time with more insights into the world of
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  medicine and health.
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  Have a great day!