Man collapses at 30,000 feet. Quick, who’s in charge? Hint: It’s not the doctor. Last month, Dr. Tamika Cross was told to sit down when she tried to help an unresponsive man. Why? Apparently, the flight attendant was looking for an “actual” medical doctor, not a black woman. Turns out she’s not the only doc making headlines for being turned down in a medical crisis. What in the world is going on up there? I interviewed pilots, flight attendants, and physicians to find out. Here’s what I discovered:
If you’re going to indulge in anticipatory medicine, it is best to anticipate those at highest risk. An elegant study by Wald et al in the NEJM shows how precision primary prevention can be done. The researchers screened toddlers, who presented routinely to their general practitioners for vaccinations, for an uncommon, but not rare, familial predisposition to high cholesterol known as heterozygous familial hypercholesterolemia (FH), in which premature cardiovascular death can be deferred by statins and lifestyle changes. Blood drawn from the toddlers by a heel prick was tested for serum cholesterol and genetic mutations indicative of heterozygous familial hypercholesterolemia (FH). The parents of toddlers who met criteria for FH were also tested for cholesterol and genetic mutations. Obviously, identifying affected parents and increasing their longevity is also beneficial for their children.
Buprenorphine was a fantastic drug in the emergency department. Patients would come to our ED feeling awful from opiate withdrawal, and we made them feel so much better. We can recall so many patients coming in vomiting, anxious, sweaty, dehydrated, and looking awful — and with one or two shots of buprenorphine, we made them feel well enough to take on the task of beating opiate addiction. A clinic in our community could see these patients in a day or so and start the process of treating their opiate addiction with oral Suboxone (buprenorphine and naloxone). The system worked. We ED docs loved it, and our patients benefitted immensely. Our experience was confirmed by a 2015 study on buprenorphine/naloxone in the emergency department at Yale University, which demonstrated — in a randomized controlled trial — that patients treated with buprenorphine in the emergency department were significantly more likely to be engaged in addiction treatment, significantly less likely to use illicit opioids, and significantly less likely to need inpatient addiction treatment.
Risk of antibiotic resistance and environmental impact should be among the considerations for ingredients added to over-the-counter and household products
A new commentary from Patrick McNamara and Stuart Levy cautions that the Food and Drug Administration’s ban on triclosan and 18 other biocidal chemicals that promote antibiotic resistance is only a starting point. Triclosan’s long-term impact, as well as the risks substitute chemicals may pose, must also be addressed.
The commentary is in the December 2016 issue of Antimicrobial Agents and Chemotherapy, published by the American Society for Microbiology.
No drug is free of risks, or the potential for causing harm. Every decision to take a drug needs to consider expected benefits and known risks. One of the ways we can reduce harms is by studying drug use rigorously. Only by understanding the “real world” effects of drugs can we understand the true risks (and benefits) and design strategies to reduce the risk of iatrogenic harm — that is, harms caused by the intervention itself. Adverse events related to drug treatments are common. Some lead to hospitalization. Studies suggest 28% of events are avoidable in the community setting, and 42% are avoidable in long-term care settings. That’s a tremendous amount of possible harm from something prescribed to help. A new study published this week shows that adverse drug events (ADEs) continue to cause significant problems, sending over a million Americans to the emergency room every year.