Community Magazine April 2013

To • • Health DOCTORS LIST OVERUSED MEDICAL TREATMENTS A growing number of experts have concluded that a considerable amount of medical care administered in the U.S. is wasteful and even dangerous for patients. A coalition of leading medical societies issued a new report aimed at improving healthcare and controlling runaway costs, and the report showed that nearly 100 medical procedures, tests and therapies are overused and often unnecessary,. The groups said that medical interventions – including early caesarean deliveries, CT scans for head injuries in children and annual medical tests for middle- aged women – may be necessary in some cases, but often they are not beneficial and may even cause harm. The list, which was organized by the American Board of Internal Medicine’s ABIM Foundation, is a minor milestone in efforts to rein in unnecessary services, a leading cause of the skyrocketing healthcare tab. Studies show that although the high cost of U.S. healthcare is driven in large part by prices – American hospitals and doctors charge much more than their international counterparts – U.S. physicians also perform many more tests and elective procedures, contributing further to exorbitant healthcare costs. For example, American doctors order nearly twice as many CT and MRI exams as doctors in other countries, and also perform more knee replacements and deliver more babies by caesarean section. Some of this extra care may result in better outcomes, and, indeed, the U.S. boasts some of the highest cancer survival rates in the world. But America lags far behind other countries in other areas of healthcare, such as caring for children with asthma and adults with chronic bronchitis and emphysema, among other illnesses. NERVE STIMULATIONMAY HELPWITHMIGRAINES A nerve stimulator placed on the forehead may help prevent migraines among some frequent sufferers. Researchers found that people who used the stimulation devices for a short period every day over three months had fewer headaches than those who used a “sham” stimulator. According to a company representative, the device, known as Cefaly made by STX- Med, was submitted to the U.S. Food and Drug Administration but has not yet been approved. In a recent trial, 67 migraine sufferers were treated with the electrical nerve stimulator or an identical sham stimulator for 20 minutes every day for three months. During that time, average monthly migraines fell from seven to five among study volunteers treated with stimulation, but held steady between six and seven in the sham comparison group. Furthermore, 38 percent of headache sufferers in the nerve stimulation group had their number of monthly migraines at least cut in half, compared to 12 percent of sham-treated subjects. “The effects are clear, but modest,” said lead author Dr. Jean Schoenen from Liege University. Dr. Schoenen said there are medications that have better results than nerve stimulation, but they also come with a number of side effects. Stimulation, on the other hand, wasn’t linked to any serious side effects in the new study. As the new procedure will not be effective for all patients, Dr. Schoenen recommends that migraine sufferers who are interested in trying nerve stimulation rent the device for a couple of months before buying one. The cost to purchase one is just over $400. RITALIN TREATS APATHY IN ALZHEIMER’S PATIENTS Dr. George Grossberg, director of geriatric psychiatry at St. Louis University, and a team of researchers at the university, recently received a grant from Noven Pharmaceuticals Inc. to study the use of Ritalin as a therapy for apathy and fall risk in Alzheimer’s patients. Both are common symptoms of Alzheimer’s disease, affecting about 70 percent of patients suffering from the disorder. Grossberg said family members frequently notice that loved ones with Alzheimer’s are indifferent, socially disengaged and have lost all enthusiasm. “There’s a lot of evidence that Ritalin has mood-elevating effects and also makes them more aware of their environment and obstacles,” Grossberg said. “They also make better decisions.” Scientists are not sure what causes apathy in patients with Alzheimer’s disease, but preliminary data indicate that it might be related to a decrease in the transmission of dopamine, a feel-good chemical in the brain. Ritalin, which is commonly used to treat attention deficit disorder, increases the transmission of dopamine in the brain. A previous international clinical trial showed marked improvements when Ritalin was given to Alzheimer’s patients exhibiting apathy. “Once you have depression or apathy, it makes it harder to focus on the environment,” Grossberg said. “So by improving patients’ energy levels, we think it will contribute to them being less likely to fall.” “It’s very safe,” he added. “We’re using ultra-low doses in patch form. A lot of older people with Alzheimer’s have trouble swallowing. Plus, with the patch you can have a gradual introduction to the blood stream and keep it level without peaks and valleys. So it’s better tolerated.” Grossberg and his team are in the process of recruiting 40 local Alzheimer’s patients at three nursing homes to participate in the four-week study. They hope to have data within a year. 92 COMMUNITY MAGAZINE