Anchor lead: More women are choosing reconstruction after mastectomy for breast cancer, Elizabeth Tracey reports

More women than ever are choosing to have their breasts reconstructed after having mastectomy for breast cancer, newly released data from the Agency for Healthcare Research and Quality reveal, and the greatest rise is among women older than 65. Gedge Rosson, a breast reconstruction expert at Johns Hopkins, says these findings confirm those from a Hopkins study.

Rosson: We were able to look at patients who were over 65 with Medicare and then patients below 65 and we found that it was not so much age that impacted the patient’s outcome, their short term outcomes like complications, but really just more their medical comorbidities. So if you have someone who is over 65 as long as they are otherwise healthy and haven’t had strokes or heart attacks or diabetes then they will do just as well as someone who is younger than 65.  :29

Rosson says the good news is women do have time following a mastectomy to consider whether they’d like to have reconstruction. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Do breathtakingly expensive new cancer drugs really help? Elizabeth Tracey reports

Too many cancer drugs that costs tens or even hundreds of thousands of dollars don’t really help, a scathing study published in the BMJ concludes. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the data.

Nelson: Out of the 68 indications that 39 or them or 57% were without evidence of a survival benefit or improved quality of life. They argued that if you wait another five years only eight drugs in addition showed these kinds of improvements. They believe that some of the approval pathways that use surrogate endpoints – surrogate endpoints the most common one used is the cancer shrunk – may be inadequate, although they have led to accelerated approval and accelerated introduction of drugs into the marketplace.  :34

Nelson believes that strategies like genetic analysis of tumors will be able to determine which patients will benefit from a treatment and limit its use to that subset, so costs will also be lowered. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Emerging technologies can’t replace physical exam skills in medicine, Elizabeth Tracey reports

New technologies to assess your heart, blood pressure and all kinds of indicators of health are constantly emerging, leading some to predict the demise of basic tools like stethoscopes and even the need for a doctor to physically examine a person. Not so fast, says Brian Garibaldi, co-president of the Society for Bedside Medicine and a physician at Johns Hopkins. Studies do show the benefits of the physical exam for both patient and physician.

Garibaldi: Technology is transformative. The things that we’re able to do with technology are incredible in terms of diagnosis. But it’s also important to remember that there are some physical exam maneuvers, many in fact, that are just as reliable as technological testing. I think that there’s this misconception that technology is inherently more reliable or reproducible than the physical exam and I don’t think that’s true. The other thing that I think is really important to recognize is that there are many diagnoses that are still made predominantly by the clinician at the bedside.  :27

Garibaldi says improving physician skills also reduces burnout on the part of clinicians. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a medical society help revive bedside skills of physicians? Elizabeth Tracey reports

Can the practice of medicine be improved by helping physicians hone their skills at the patient’s bedside? That’s the mission of the Society of Bedside Medicine, which seeks to reinvigorate bedside examination and diagnosis. Brian Garibaldi, the Society’s co-president and a physician at Johns Hopkins, says early results indicate that doctors also feel happier and more satisfied with their practice when these skills are improved.

Garibaldi: Physicians, particularly trainees, spend as little as 10% of their time in direct contact with patients. As we spend less time at the bedside our physical exam skills have started to erode. Exam skills of people today are not as good as they were several years ago. That’s a problem that’s going to lead to diagnostic error, a potential erosion in trust between doctors and patients. It also contributes to the sense of burnout that a lot of physician feel, because we’re spending most of our time engaged in practices that are not what we trained for. We didn’t train to be sitting in an office working on a computer. We trained to be at the bedside helping our patients deal with their illnesses.  :33

At Johns Hopkins, I’m Elizabeth Tracey.

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This week’s topics include health and wealth, gun show sales and gun injury, management of epilepsy, and outcomes relative to robotic surgery.
Program notes:
0:34 Today is last PodMed
1:19 Epilepsy management
2:19 Not a single type of surgery
3:16 Identify the focus
3:30 Robotic surgery outcomes
4:30 Is it that much better?
5:31 Instruments going down in price?
6:05 Gun shows sales and adjacent states
7:05 About 86,000 gun related injuries annually
8:00 Health and wealth linked
9:00 Other factors associated
10:22 End
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Anchor lead: Identifying thyroid disease may need to change as people age, Elizabeth Tracey reports

Thyroid diseases are common as people age, especially an underactive thyroid gland known as hypothyroidism. Now a new study by thyroid expert Jenna Mammen at Johns Hopkins and colleagues has shown that as people age, making the diagnosis correctly may require more than just testing thyroid stimulating hormone, or TSH, as is commonly done.

Mammen: What these findings mean is that in addition to checking TSH we probably should be looking at thyroid hormone directly in our people in their 70s and 80s. In younger people including people in their fifties and sixties, the vast majority of changes that we see are changes driven by primary thyroid dysfunction and the TSH remains a reliable indicator of thyroid function.  :25

Mammen says older folks may want to ask their physician to test thyroid hormone directly as well as TSH if thyroid disease is suspected. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Should we add lithium to drinking water to reduce the incidence of dementia? Elizabeth Tracey reports

The drug lithium is used to treat some mental illnesses. Now a recent study reports that it may reduce the incidence of Alzheimer’s disease. Constantine Lyketsos, an Alzheimer’s expert at Johns Hopkins, says it does impact on two important substances known to be involved in the disease, amyloid and tau.

Lyketsos: For a while now people have been reporting out of laboratories that lithium impacts the development of amyloid and even phosphorylation of tau.  :09

The study looked at lithium in drinking water.

Lyketsos: Very creative Finnish investigators realized that if you measured lithium in drinking water in Finland at least there’s a range in the amount of lithium that naturally exists in the drinking water. In situations where drinking water had more lithium there seemed to be less dementia.  :18

Lyketsos says he’s not ready to advocate for adding lithium to drinking water but would follow up this study with one looking at blood levels of lithium and Alzheimer’s risk. At Johns Hopkins, I’m Elizabeth Tracey.

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