February 22, 2013 | 3:33 pm

Healthcare That You Should Avoid, part 2

Posted by Albert Fuchs, M.D.

Follow me on or

A chest X ray. One of many
tests you shouldn't have
routinely. Credit: Aidan
Jones/Wikimedia commons

16% of all spending in the US is on healthcare. About half of that is spent by federal, state, and local governments, and the other half is spent by the private sector. In 1970 about 7% of all spending was for healthcare. Total annual spending on healthcare per person has increased from less than $1,000 in 1970 to about $8,000 now.

Defenders of our current healthcare spending are quick to point out that while we’re spending much more, we’re getting much better healthcare. New technological developments are constantly bringing better treatments to patients, and patients are living longer. The increased expense, they would argue, is worth it. But we shouldn't believe them. In all other sectors (housing, transportation, food, …) quality improves while prices drop. We spend a smaller fraction of our money on transportation than we did a generation ago despite the fact that cars are safer and more fuel efficient and that commercial airline travel is inexpensive enough to be enjoyed by the middle class. We are right to expect medical care to become both better and cheaper over time.

Why hasn't it? I believe our current insurance payment system rewards overutilization and drives prices up. (I wrote a series of posts analyzing the issue in 2009.) Because the vast majority of healthcare dollars are not paid by the patients receiving the care, there is little disincentive to provide care that has little or no benefit. In fact there is a great incentive to the doctor to provide as much such care as possible.

Besides high prices, this has resulted in a healthcare culture in which doctors offer and patients have come to expect tests and treatments which have been proven to be entirely without benefit. Last April in an attempt to educate both doctors and patients about interventions that are valueless, the American Board of Internal Medicine Foundation partnered with a number of physician specialty societies and formed an initiative called Choosing Wisely. I wrote about it at the time. The program listed 45 different tests and treatments in nine different specialties that doctors shouldn't offer and that patients should question.

This week, Choosing Wisely has expanded this list. Many new physician specialty societies have come on board and the list of valueless tests and treatments has grown to 90. Among the new recommendations are:

• Don’t perform EEGs for headaches. The American Academy of Neurology finds that EEGs don't help in diagnosing the cause and do not improve outcomes.
• Don’t recommend feeding tubes in patients with advanced dementia; instead offer oral assisted feeding. The American Geriatrics Society reviewed the evidence that careful hand-feeding is as safe in patients with severe dementia and that tube feeding leads more frequently to agitation and worsening skin sores.
• Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium. The American Geriatrics society reminds us of the risks of motor vehicle accidents, falls and hip fractures can more than double in older adults taking sleep medicines.
• Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age. The American Academy of Pediatrics reminds us that these medicines have little benefit in young children and have potentially serious side effects.

Feel free to browse the list yourself. It is a fascinating gallery of bad medicine. I must confess that I’m guilty of some of the misdeeds myself. I have a handful of older patients who take Ambien (zolpidem). How delighted will they be when I refuse their pharmacy’s request for the next refill and tell them that there are safer alternatives?

Choosing Wisely is a worthwhile effort. It may prevent patient harm and improve care. But I suspect it will not make a dent in costs. As long as doctors have a financial incentive to provide inappropriate care, some of them will. As long as patients have little financial incentive to assure that their care is appropriate, many of them will not.

Learn more:

Medical Waste: 90 More Don'ts For Your Doctor (Shots, NPR’s health blog)
Group Urges Health-Test Curbs (Wall Street Journal)
Doctors list overused medical treatments (Los Angeles Times)
Choosing Wisely

My last post about Choosing Wisely: Healthcare That You Should Avoid

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

February 15, 2013 | 2:41 pm

The Pathogens on Cupid’s Arrow

Posted by Albert Fuchs, M.D.

“Love is a burning thing
And it makes a fiery ring”
-- Johny Cash

On Valentine’s Day some think of chocolate, or wine, or flowers. Physicians think of sexually transmitted infections (STIs). This week with perfect timing, the Centers for Disease Control and Prevention (CDC) released two studies quantifying the burden of STIs in the U.S. The studies estimated the nationwide burden of eight STIs – chlamydia, gonorrhea, syphilis, genital herpes, human papillomavirus (HPV), hepatitis B, HIV, and trichomoniasis. The results showed that there are about 20 million new cases of these STIs annually, and that the prevalence of STIs, that is the number of new and existing infections at a given time, is 110 million. Over half of the STIs, both in terms of new infections and prevalent infections, are due to HPV, the virus that can cause genital warts and cervical cancer. And most of the infections are in young people between the ages of 15 and 25. How romantic!

As if that wasn’t enough to throw a wet blanket on the national mood, this week’s Morbidity and Mortality Weekly Report followed up on a story I first wrote about a year ago – the emerging threat of multi-drug resistant gonorrhea. Gonorrhea remains a serious public health threat in the U.S. with over 300,000 new cases reported in 2011. Peruse my post from a year ago for the detailed history of the gonorrhea bacterium repeatedly overcoming whichever antibiotic we use against it. Since the 1940s gonorrhea has developed resistance to sulfanilamide, penicillins, tetracyclines, and most recently fluoroquinolones. That leaves cephalosporins as the last family of antibiotics uniformly effective against gonorrhea.

This week’s report warns that strains of gonorrhea resistant to cephalosporins have been isolated in Japan, France, and Spain in the last few years. Strains in the U.S. remain sensitive to cephalosporins, but laboratory measures of cephalosporin sensitivity in isolated strains are slowly decreasing. No other effective antibiotic alternative is on the horizon, so the appearance of cephalosporin-resistant gonorrhea may essentially mean the appearance of untreatable gonorrhea. How romantic!

So as we approach the end of the antibiotic century, perhaps we should all try to rediscover the virtues of monogamy. That may sound quaintly retrogressive, but no more so than the notion of having no treatments for common infections.

“You must remember this
A kiss is still a kiss
A sigh is just a sigh
The fundamental things apply
As time goes by”
-- Herman Hupfeld

Learn more:

'Ongoing, severe epidemic' of STDs in US, report finds (Vitals, NBC News)
CDC Warns of Super-Gonorrhea (ABC News)
'Severe epidemic' of sexually-transmitted diseases is sweeping the nation, warns CDC on Valentine's Day (Daily Mail)
CDC Grand Rounds: The Growing Threat of Multidrug-Resistant Gonorrhea (Morbidity and Mortality Weekly Report)
Incidence, Prevalence, and Cost of Sexually Transmitted Infectious in the United States (CDC Fact Sheet)

My last post about multi-drug resistant gonorrhea: Untreatable Gonorrhea – The Next Infectious Threat

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

0 Comments — Leave your comment

January 25, 2013 | 3:15 pm

Newsflash: Smoking is Very Unhealthy

Posted by Albert Fuchs, M.D.

Image credit
Wikimedia commons

I have shocking news. Smoking is very very bad for you.

In 1964 the US Surgeon General issued a report summarizing the known adverse health effects of smoking. At that time about 40% of American adults smoked. A widespread campaign followed informing Americans about the link between smoking and lung cancer, emphysema, stroke, and heart attacks. Federal law required the placement of health warnings on cigarette packages, and school children all learned about the adverse health effects of smoking.

By 2010 the prevalence of smoking decreased to 19% of American adults, mostly because of more people quitting (rather than fewer people starting). But from 2004 to 2010 the prevalence of smoking has changed little. We seem to have reached a steady state, a nadir of smoking despite the now well-known health hazards. And while smokers were much more representative of the general population in the 1960s, they are now disproportionately poor and less educated. Current smokers are also on average younger than non-smokers, since so many smokers quit as they get older.

This week the New England Journal of Medicine (NEJM) published two studies that attempted to quantify the differences in longevity between smokers and non-smokers. The studies followed hundreds of thousands of men and women and compared the information about their smoking status to their longevity and cause of death.

The results were fairly dramatic. On average, those who never smoked live over 10 years longer than those who continue to smoke their whole lives. For those between 25 and 79 years old, the death rate for smokers is three times that of those who never smoked. Those who quit also did much better than those who didn’t. Those who quit between the ages of 25 and 34 lived 10 years longer than those who continued smoking, almost reaching the longevity of those who never smoked. The benefit of quitting decreased with increasing age, but never disappeared. Smokers who quit between the ages of 55 and 64 still lived 4 years longer than those who kept smoking.

My regular readers will recognize that these are not randomized studies, and they therefore deserve some skepticism. That’s true. One study was controlled for alcohol use, educational level, and body mass index, but one can easily imagine other confounding factors (poverty, poor access to health care) that may be more prevalent among smokers and independently increase the risk of death. So we can’t be certain that the effect of smoking is as large as the study suggests. Still, the studies add to a mountain of evidence that has already established the risk of smoking. And a randomized study will never be done, so we will never be able to measure the risk exactly.

The bottom line is that smoking is likely to cut your life short. Quitting at any age has benefits. Sooner is better.

The author of an accompanying editorial in the same NEJM issue concludes with this concern.

Because smoking has become a stigmatized behavior concentrated among persons of low social status, it risks becoming invisible to those who set health policies and research priorities. Yet, the need for greater attention to the policies known to reduce the prevalence of smoking remains urgent. As former Australian Health Minister Nicola Roxon has said, “We are killing people by not acting.”

But the increasing “invisibility” and disenfranchisement of smokers seems to me inevitable. For half a century we have very successfully educated people about the risks of smoking. We have waged a campaign that has made it clear that smoking is hazardous and we have tried to make it uncool. We cannot simultaneously applaud our important success while being surprised that those most resistant to the message are those whom information and solid judgment are least likely to reach.

All diseases that are predominantly acquired through behaviors, like HIV or cervical cancer, follow the same pattern over time. As education about prevention of the disease spreads, those who have access to information and value their health will stop contracting the disease. A generation later those who are still engaging in the risky behaviors are very difficult to reach. Few problems are more intractable than people in free societies choosing to harm themselves.

Further progress in decreasing the prevalence of smoking is likely to be incremental and slow. I suspect further attempts at addressing this problem through policy will involve tradeoffs, not solutions.

Learn more:

Smokers Lose 10-Plus Years of Life, Studies Find (Wall Street Journal)
Quitting smoking prolongs life at any age (LA Times)
Putting a Number on Smoking’s Toll (NY Times)
21st-Century Hazards of Smoking and Benefits of Cessation in the United States (NEJM article)
50-Year Trends in Smoking-Related Mortality in the United States (NEJM article)
New Evidence That Cigarette Smoking Remains the Most Important Health Hazard (NEJM editorial)

Tangential Miscellany

Seven years and over 300 posts ago I decided to start writing a weekly health news blog. Since then my posts have been republished in half a dozen publications, started some fascinating debates, and I hope educated and stimulated you. Thank you for reading. I promise to try not to bore you in the next seven years.

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

0 Comments — Leave your comment

January 4, 2013 | 3:37 pm

Many Women Who Don’t Need Them Are Still Getting Pap Tests

Posted by Albert Fuchs, M.D.

Cervical cells collected in
Pap tests: normal cells on
the left, precancerous cells
on the right.
Ed Uthman/Wikimedia
Commons

My regular readers know that I frequently bemoan the fact that we have no effective way to test for most cancers, and that in many cancers early diagnosis does not improve survival. Cervical cancer is one of the few exceptions. Since Georgios Papanikolau developed the test named after him, the Pap test has dramatically reduced the incidence and mortality of cervical cancer.

More recent advances have shown that cervical cancer is caused by human papilloma virus (HPV), a sexually transmitted infection. Specific testing for HPV is now frequently performed in addition to the Pap test, and a vaccine against the most dangerous strains of HPV is likely to further decrease cervical cancer incidence.

We also now understand that the changes that HPV cause are detectable years before cervical cancer occurs, so the interval between tests can be quite long. Current recommendations are for all women between the ages of 21 and 65 to have a Pap test every three years. If HPV testing is also used, women over 30 can be safely tested every 5 years.

Women over 65 who have been previously tested and have had normal test results are unlikely to benefit from further testing. Also women who have had a total hysterectomy (surgery in which both the uterus and cervix are removed) do not need further Pap tests, because they don’t have a cervix. (An important exception is women who have had a hysterectomy because of cervical cancer or pre-cancerous changes.)

This week brings us evidence of too much of a good thing. The current issue of Morbidity and Mortality Weekly Report (MMWR) published a survey of women over 65 and women who have had hysterectomies. It asked them if they had a recent Pap test. Two thirds of women over 65 answered affirmatively as did 59% of women who have had hysterectomies. I found that as surprising as if 59% of bald men were still going to their barber regularly. It’s hard to know what’s behind this behavior. These women can’t benefit from the tests they’re undergoing. Perhaps this is a manifestation of long-established habits for both the doctors and the patients. Another possible explanation is that some of the women surveyed are simply wrong. The study didn’t actually check medical records, and some of the women may have thought that they had been tested when they hadn’t. Obviously, the most pernicious possibility is that many doctors are still recommending useless testing to patients who trust them. (If Medicare paid for haircuts one wonders how many bald men would still go to their barbers, just for the attention and social interaction, and how many barbers would sent reminder postcards to their bald patients.)

So if you’re between 30 and 65 and are having both Pap tests and HPV testing and your results have been normal, give yourself 5 years between tests. And if you’re over 65 and your tests have been normal, or you no longer have a cervix, congratulate yourself for permanently escaping cervical cancer and feel free to forego further testing.

Learn more:

Pap Tests For Cervical Cancer Are Often Wasted (Shots, NPR health news)
CDC: Women with hysterectomies getting unneeded Paps (USA Today)
Cervical Cancer Screening Among Women by Hysterectomy Status and Among Women Aged ≥65 Years — United States, 2000–2010 (MMWR)
Announcement: Cervical Cancer Awareness Month — January 2013 (MMWR)
US Preventive Services Task Force recommendations for cervical cancer screening
My post in 2009 summarizing the recommendations for Pap tests: Should You Have a Pap Smear?

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

0 Comments — Leave your comment

December 21, 2012 | 1:59 pm

Niacin: Ineffective, and Now with Fewer Side Effects!

Posted by Albert Fuchs, M.D.

Photo credit:
Wikimedia commons

I haven’t written about niacin for over a year, and like a misunderstanding of the Mayan calendar that won’t go away, niacin is in the news again this week.

You can catch up on the old news by reading my previous posts (links below) but here’s the story in a nutshell. People with high levels of a cholesterol molecule called LDL tend to have more strokes and heart attacks than people with normal LDL levels. People with low levels of a cholesterol molecule called HDL tend to have more strokes and heart attacks than people with normal HDL levels. (Does that mean that LDL causes strokes and heart attacks or that HDL prevents strokes and heart attacks? Nobody knows.) We've long known that taking niacin raises HDL and lowers LDL. That should be good, right? And in fact a study called the Coronary Drug Project in the 60s and 70s showed that in patients with a previous heart attack, taking niacin modestly reduced the risk of another heart attack.

More recently, many other medications have been proven to prevent strokes and heart attacks – aspirin, statins (a family of cholesterol reducing medicines), and beta blockers (a family of blood pressure medicines). These medicines are now in widespread use. Statins especially have very solid evidence that they greatly decrease the frequency of strokes and heart attacks, and now that some of them are available generically they are used extensively. Last year, the AIM-HIGH trial tried to discover whether patients with a history of cardiovascular disease and low HDL had better outcomes by taking niacin with a statin than by taking a statin alone. They didn't  The rates of strokes and heart attacks were the same in both groups, strongly suggesting that in the age of statins, niacin has no additional benefit.

Now, when faced with a medication that has no benefit, I typically decide not to prescribe it, but not the folks at Merck. They were thinking “How can we decrease the side effects?” Why it would be valuable to decrease the side effects of a medicine without benefit is a mystery that only Mayan astronomers are likely to solve. In any case, the most common and bothersome side effect of niacin is facial flushing, so Merck came up with a tablet in which they combined niacin and a second drug, laropiprant, which prevents the flushing. This combination medicine, called Tredaptive, has been in use in Europe since 2007.

A large trial designed to win FDA approval for Tredaptive ended this week. The results won’t be formally published for some time, but Merck has already released some important tidbits. The study randomized over 25,000 patients to Tredaptive and simvastatin or to simvastatin alone. The patients were monitored for over four years. There were no differences in rates of strokes or heart attacks between the groups, but the Tredaptive group had an increase of a “serious adverse event” the details of which Merck has yet to release. In an unusual move, Merck has asked European physicians not to start new patients on Tredaptive.

This new finding should throw a wet blanket on the few remaining niacin enthusiasts. Niacin use has declined since the AIM-HIGH study and now should decline further. It has no benefit in the vast majority of patients who can tolerate statins.

Learn more:

Why Merck's Niacin Failure Will Scare Drug Researchers (Forbes)
Merck Says Niacin Drug Has Failed Large Trial (New York Times)
Merck: Niacin Drug Mix Fails To Prevent Heart Attacks, Strokes (NPR Shots)

My previous posts about niacin:
Niacin Much Less Helpful in the Age of Statins
Niacin Does Not Prevent Strokes or Heart Attacks

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

0 Comments — Leave your comment

December 7, 2012 | 5:10 pm

Flu Season Hits Earlier than in Recent Years

Posted by Albert Fuchs, M.D.

Flu incidence by week
(CDC)

This year’s flu season seems to be starting earlier than usual and is getting more intense by the week. The Centers for Disease Control (CDC) reports in its weekly summary of flu surveillance that flu cases are increasing across the country. California still is showing only sporadic flu activity, but 8 other states report widespread activity and 15 others report regional activity.

The CDC reminds us that it’s not too late to protect yourself and those around you by getting a flu shot. The vaccine is recommended for everyone over 6 months of age. And the CDC also has other helpful suggestions for preventing flu transmission. If you’re sick, stay home and limit contact with others. Avoid touching your eyes, nose, and mouth. Cover your coughs and sneezes with a tissue. And wash your hands frequently.

I've seen no randomized studies suggesting that lighting candles, singing songs, or eating latkes decreases transmission of flu, but I recommend it anyway. Happy Hanukkah!

Learn more:

Unusually Early Flu Season Intensifies (NPR Health)
Situation Update: Summary of Weekly FluView (CDC)
Google Flu Trends for Los Angeles
Key Facts About Seasonal Flu Vaccine (CDC)
CDC Says “Take 3” Actions To Fight The Flu (CDC)

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

0 Comments — Leave your comment

October 26, 2012 | 1:24 pm

Many Terminally Ill Patients Believe Chemo Might Cure Them

Posted by Albert Fuchs, M.D.

Image credit:
Flikr, Juni A.

Metastatic (stage IV) colon cancer and lung cancer are fatal incurable illnesses. That doesn’t just mean they are life-threatening. A fatal incurable illness is one which has zero survivors. You don’t know anyone who had metastatic colon or lung cancer who survived and is no longer ill.

Chemotherapy is still occasionally used in such cases and sometimes can prolong life by a few months. Chemotherapy might also help temporarily alleviate some of the symptoms caused by the cancer. But what chemotherapy never does in these cases is cure the disease. The distinction is important because chemotherapy itself frequently has serious and uncomfortable side effects and patients who are considering undergoing it should understand the benefits they may gain.

A disturbing study in this week’s issue of The New England Journal of Medicine suggests that many terminally ill patients misunderstand why they are receiving chemotherapy. The study was a survey of over 1,100 patients with a recent diagnosis of stage IV lung or colon cancer who had opted to receive chemotherapy. The survey asked several questions about their expectations of chemotherapy. One such question was “After talking with your doctors about chemotherapy, how likely did you think it was that chemotherapy would cure your cancer?” Response options were “very likely,” “somewhat likely,” “a little likely,” “not at all likely,” and “don't know.”

“Not at all likely” is the only response that conveys an accurate understanding of what chemotherapy can do for these patients. Yet 69% of patients with lung cancer and 81% of colon cancer patients chose one of the first three responses, reflecting mistaken expectations of their treatment. Though previous studies suggested that some patients are mistakenly optimistic in the face of a terrible prognosis, the very high fraction of patients in these studies who apparently believed they might be cured was surprising.

What could account for this? An accompanying editorial ponders the possibilities. Might the oncologists not be giving patients an honest explanation of their prognosis? Prior studies show that most oncologists give bad news honestly, so that is not likely to account for the majority of patients misunderstanding the goals of treatment. Perhaps patients actually know that a cure is impossible and have discussed this with their doctors and their families but are reluctant to share this painful realism with a researcher who is a stranger. Perhaps many patients heard the bad news and chose not to believe it.

Certainly some selection bias is involved. The study, after all, interviewed only patients who chose to undergo chemotherapy. That would include whichever patients were most likely to ignore bad news or exaggerate the possible benefits of treatment. Those who were mostly likely to accept bad news and minimize the possible benefits of treatment were the most likely not to have pursued chemotherapy and would not have been included in the study.

The distressing possibility is that many of the patients surveyed are fooling themselves. In other facets of life self-deception might be beneficial, or at least harmless. (“I look terrific.” “I think I’ll do great in this interview.”) But in this case patients with limited time are choosing to spend that time in healthcare facilities experiencing side effects instead of at home (or on vacation) with loved ones.

One final worrisome finding is that the patients who reported better scores for how well their physician communicated with them were less likely to give accurate responses for the goals of chemotherapy. That means that patients who best understood that chemotherapy could not cure them reported that their physicians were worse communicators than patients who misunderstood their likelihood of cure. Does telling bad news inevitably strain the physician-patient relationship? Do patients bond best with physicians who misinform them with optimism or allow them to misunderstand important aspects of their care?

As patient satisfaction surveys begin to play a larger role in physician compensation we may ironically find that doctors will be increasingly paid to cater to patients’ unstated desire for misinformation.

Learn more:

Many Terminal Cancer Patients Mistakenly Believe A Cure Is Possible (NPR Shots)
Study: We overestimate how much medicine can do (Washington Post, Wonkblog)
Patients' Expectations about Effects of Chemotherapy for Advanced Cancer (New England Journal of Medicine)
Talking with Patients about Dying (New England Journal of Medicine editorial)

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

0 Comments — Leave your comment

October 12, 2012 | 9:48 am

Fourteen Deaths Linked to Fungal Meningitis from Tainted Injections

Posted by Albert Fuchs, M.D.

Exserohilum rostratum. Photo by Wikipedia

This week you’ll have to learn a little medical jargon, and I know that you love that. The meninges (men-IN-jees) are the membranes that line the brain and spinal cord. Meningitis is inflammation of those membranes, usually caused by an infection. Meningitis can lead to brain damage, deafness, and sometimes death. Meningitis is usually caused by viruses or bacteria. OK? That wasn’t so bad.

Recently an outbreak of meningitis has come under the attention of investigators. 170 patients in the last few months have been diagnosed with meningitis due to a fungus. This is strange because fungi are a very rare cause of meningitis. Investigators tracked the infection to contaminated vials of a steroid medication (methylprednisolone) prepared by New England Compounding Center (NECC), a Massachusetts compounding pharmacy.

The medication is used to administer epidural injections – injections into the spine intended to relieve back pain. This presumably introduced the contaminating fungus directly into the spinal fluid and resulted in meningitis.

Three lots of potentially contaminated medication have been recalled by NECC. Health officials have determined that about 14,000 people may have been injected with the medication since May 21. About 12,000 of the patients have already been contacted and informed. As of yesterday 14 have died of fungal meningitis. Two different fungus species have been isolated from sick patients, Exserohilum (pictured above) and Aspergillus.

Some of the medication was also used to inject painful joints, and one fungal ankle infection was found in a patient who earlier received an injection into that ankle.

There are four facilities in California which received medication from NECC that was later recalled: Cypress Surgery Center in Visalia, Encino Outpatient Surgicenter in Encino, Ukiah Valley Medical Center in Ukiah, and Universal Pain Management in Palmdale. (The complete list of facilities across the nation is here.)

Fungal meningitis and fungal joint infections are not transmissible from person to person. So if you have not received a steroid injection into your spine (epidural) or joint from a recalled medication lot since May 21 you have nothing to worry about.

If you have received such an injection, be aware that meningitis or joint infections can occur 1 to 4 weeks after the injection, or perhaps even later. These 14,000 exposed patients are being asked to be vigilant for symptoms, and to report symptoms immediately to their physician. Symptoms of fungal meningitis are fever, new or worsening headache, neck stiffness, sensitivity to light, new weakness or numbness, slurred speech, and increasing pain, redness or swelling at the injection site. Symptoms of an infected joint are fever, increased pain, redness, warmth, or swelling in the joint or at the injection site.

How the medication became contaminated is still being investigated.

Learn more:

Fungal meningitis outbreak: Death toll hits 14; Idaho reports case (Los Angeles Times)
CDC: Meningitis outbreak growing, 14 people dead (Associated Press)
Meningitis Deaths Increase (Wall Street Journal)
Frequently Asked Questions For Patients: Multistate Meningitis Outbreak Investigation (CDC)

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor.

0 Comments — Leave your comment