By now you have heard about the side effects of this commonly used both over-the-counter and prescription medication to raise HDL and lower LDL. But I finally got the article in the July 17 New England Journal of Medicine and wanted to give you a little more scientific information.

I almost didn’t write this segment because I’ve been overwhelmed with what’s happening in Israel. The good news is that my daughter and her young children came to Los Angeles two days ago. They literally got out on the last flight before the 24-hour closure of the Ben-Gurion airport. I think it’s open now to flights on all airlines and hopefully some of this conflict will be resolved. I can’t stop watching the news and despair over the fighting in Gaza that has destroyed the homes and lives of civilian population that could not or would not find refuge and the hourly bombardments of missiles sent by Hamas to Israel, intended to cause widespread killing of anyone in range. (Thankfully, the iron dome works.) I like everyone, hope that a valid cease fire will be negotiated. But how does one negotiate with a terrorist organization whose goals are to hold on to power and eliminate the country of Israel and it’s citizens from the face of the earth? They show no regard for their civilian population (other than to allow them to shield weapon stores) and take every opportunity to run with cameras to record their suffering, and mourning…and yes, we all have to be appalled. As many of you know, I am on the board of Save the Children. We have programs in Gaza and have tried over the years to improve the health care, education and hope for a better future for the children there. Children are never to blame for conflict and are always the ones who suffer. Unfortunately, it would seem that much of the millions of dollars sent there by so many NGO’s has been used to building tunnels and purchasing weapons rather than for infrastructure and care of the population.

I”ll stop now…I know I am not supposed to wax political, but it’s hard to always be the evidenced based doc.)

So on to niacin… Ever since I went to medical school we’ve been taught that high density lipoprotein or HDL particles help decrease coronary heart disease. The higher the HDL the lower the disease in the general population. Likewise LDL or low density lipoprotein cholesterol increases plaque formation and enhances heart disease. The question is, are these two types of cholesterol risk factors or signs of heart disease or do they indeed have an impact in causing heart disease? The articles published in the July 17 New England Journal of Medicine may have changed our assumption of causation. In the heart protection study two- treatment of HDL to reduce the incidence of vascular events (HPS 2-THRIVE), 25,673 adults ages 50 to 80 with underlying cardiovascular disease were given either an extended release niacin combined with laropiprant (an agent that helps prevent flushing) or placebo and were followed for four years. Prior to the randomization, they had been put on statin based therapy. During the trial, the participants who received niacin raised their HDL 6 mg/dL and lowered the LDL cholesterol 10 mg/dL as well as their trygliceride level 33 mg/dL compared to those receiving placebo. Despite these favorable responses there was no significant reduction in major vascular events. Moreover, there were significant side effects which included an increase in gastrointestinal complications, infections, muscular skeletal pain, development of diabetes and a 9% increase in the risk of death. The American Heart Association now gives a very limited and cautious recommendation regarding the use of niacin…They state that niacin may still have a role in patients with very high risk for cardiovascular events who truly have contraindications for taking statins and who have a high LDL-cholesterol level. They also suggest that there may also be a use for those who have very high triglycerides and for whom it could be used to prevent pancreatitis. In an editorial in the same journal the author suggests that “it is time to face the fact that increasing the HDL cholesterol level in isolation seems unlikely to offer cardiovascular benefit”.

So before you take niacin as a so-called easier way to deal with cholesterol problems, please consult your physician. Next week, I hope I can write an article that doesn’t also deal with the middle east conflict.

I have devoted several website articles about the importance of HPV vaccination to help prevent cervical cancer in women and genital and anal cancer in men. I now have another reason to promote this vaccine. It comes from news from the Centers for Disease Control and Prevention reported in last week’s JAMA. The journal summarized an article that was published in the Journal of Infectious Diseases on the correlation between HPV infection and oral and or throat cancers. (Note, there’s a medical journal on everything, I don’t get a chance to read most of them and depend on JAMA or the New England Journal of Medicine to bring important articles to my attention.)

A recent analysis showed that 72% of 557 invasive oral pharyngeal squamous cell carcinoma samples tested positive for human papilloma virus (HPV). In nearly 2/3 of the samples, the investigators detected HPV-16 and HPV-18, the strains most often linked with cervical cancer. The HPV vaccines that are currently available actually target HPV-16 and -18 and therefore should be highly effective against this type of cancer.

The current estimates indicate that worldwide there are about 85,000 cases of oropharyngeal cancers that are diagnosed annually and in the United States about 12,000 new diagnosis are made each year. Most are classified as this type of squamous cell carcinoma. Wouldn’t it be amazing if we could immunize all adolescents and young adults and prevent these often fatal cancers! One more reason to make sure that the vaccine is given.

As I sit here worrying about the Middle East and talk to my family in Israel, I’m experiencing hot flashes. Admittedly, they are from anxiety and not a hormonal imbalance, but they have made an editorial I read this week in the Journal Menopause more compelling. It’s titled “Hot flashes: is a hot flash just a hot flash?” The author, Dr. Lila Nachtigall a professor from New York University, has long been an advocate of hormone therapy and has written multiple articles and given many lectures on menopause. Her current editorial highlights issues that may be of interest to many of my patients.

Studies conducted in 1990 have shown that among untreated women, 80% of hot flashes will stop in three years and 90% of hot flashes will be over after six years. A few women, however, can have them for 40 years or more. In more recent studies of women who have hot flashes, 25% reported that the symptoms remained for more than five years and 10% reported that the symptoms continued for more than 10 years. Why? Well, we know it’s lack of estrogen that causes these vasomotor symptoms. The brain has an inner thermostat zone that impacts the body’s ability to heat or cool with minimal temperature changes. There is a hormone; norepinephrine (now aptly called brain norepinephrine) which is released from brain estrogen receptors when they are not receiving estrogen. This hormone sets off responses in the body to impose heat regulation and cool the body though dilation of superficial blood vessels (flushing) and evaporation of fluids (perspiration). Women who are recently or suddenly postmenopausal have more of these used-to-work-estrogen receptors. Estrogen deprivation together with what we call up-regulated receptors cause these women to have more frequent and more severe hot flashes. (I know this doesn’t explain why 10% continue to have significant hot flashes. We do know if the hot flashes were severe from the start they are more likely to continue…perhaps because the estrogen receptors remain robust.)

There have been studies that have shown that the severity of hot flashes is associated with lower levels of health and even work productivity. One study called The Study of Women’s Health Across the Nation has shown that hot flashes are associated with a higher incidence of insulin resistance. Other studies including the Women’s Health Initiative have shown that there are higher risks of cardiovascular disease in women with significant menopausal symptoms. Those experiencing severe hot flashes have an increased risk of coronary heart disease by a factor of five compared with their counterparts who had less or no symptoms. Similarly, the risk of stroke was elevated by a factor of almost 4. Brain PET scans have shown that there is a significant decrease in cerebral blood flow during a hot flash. The author goes on to state that this may explain a woman’s inability to continue her tasks during a severe hot flash.

As a result of some of this data the American College of Obstetricians and Gynecologists has added new clinical guidelines for the management of menopausal symptoms. This directive encourages physicians to treat vasomotor symptoms i.e. hot flashes and not use age as a guideline, stating that the decision to treat should be individualized and there is no need to discontinue medication if a woman is still symptomatic after age 65.

Although it’s clear that estrogen will indeed prevent those brain receptors from releasing vasomotor causing norepinephrine there are other pharmacologic medications that are available to help diminish or stop the hot flashes. One of these is a low-dose SSRI (Paxil) called Brisdelle. A new formulation of gabapentin was found in a recent phase 3 study to statistically reduce frequency and severity of hot flashes.

The pros and cons of hormone therapy, types of hormone therapies, and alternatives to hormones have become a major subspecialty in the treatment of women over the age of 50. It’s difficult to give an assessment of what can and should be done in one article or one exam. Like everything in medicine, symptoms, personal and family history, health risks and of course symptoms have to be properly assessed by both the patient and her physician. New studies and expert insights improve our ability to make more informed decisions. So I thought I would share …and no, I have no ready solutions, despite copious reading, that helps me cope with my Middle East anxiety.

I know most of you may not be reading this email on Friday because it’s the Fourth of July. I’ll try to send it out earlier or you might pick it up after the holiday. So Happy 4th and enjoy the barbecue, parades and fireworks.

I couldn’t let the week go by without reporting on an article in the June 25 issue of JAMA that reports on a study of breast cancer screening using a method called tomosynthesis. The efficacy of tomosynthesis combined with digital mammogram was compared to digital mammogram only for breast cancer screening. A debate about the utility of digital mammogram has once more been brought up by the recent publication of the 25 year follow-up results from the Canadian National Breast Screening Study. It showed that there was no difference in breast cancer-related mortality in screened women versus controls. Many physicians and organizations have however, countered that these results were not valid for current U.S.policy; that the study was based on mammograms that were of poor image quality and that there were significant problems in randomization. Indeed, 14 more recent studies published between 2001 and 2010 have indeed shown a 25 to 50% reduction in breast cancer related mortality for women aged 42 to 74 years who had modern (and presumably better) types of digital mammogram screening. The American Cancer Society, the American Congress of Obstetricians and Gynecologists and other organizations still recommend screening mammography annually for women older than 40 years. The American Cancer Society also recommends annual MRI for women with a 20 to 25% or higher lifetime risk of breast cancer.

The article in JAMA is a retrospective analysis of screening in 13 centers over two time periods. During the initial period more than 281,000 examinations were done with digital mammogram alone. The second period included more than 173,000 examinations during which patients underwent combined digital mammogram and tomosynthesis screening. I know the word “tomosynthesis” sounds very synthetic biology. It is high tech but but not a biological creation. Basically, it is composed of a set of low-dose images produced by x-rays as they moves across the breast. The images are then put together to form a picture by a computer algorithm (of course) that reconstructs the images as slices of the breast. The advantage is in the resolution and clarity of the final image. An area may look suspicious because tissue overlaps from the pressure of a simple mammogram procedure; tomosynthesis is meant to prevent this effect and hence reduce false densities while making a cancer appear more conspicuous.

So does adding tomosynthesis to usual breast screening make a clinical difference? In this study the authors found that the introduction of tomosynthesis was associated with a significant decrease in recall rate (i.e the. need to get additional films, ultrasound, MRI or even biopsy) of 1.6%. There was however, a significant increase in the biopsy rate (1.3%), but perhaps the biopsies were more likely to confirm a cancer. There was an increase in the cancer detection rate of 0.12%. The latter doesn’t sound like much, but it made a difference for the 1.2 women whose cancer was found per 1000 screenings… They might not have had that early diagnosis with standard mammograms. There is however, as always, a drawback in medical innovation and the one here is that tomosynthesis requires twice as much radiation as a regular digital mammogram. And it is too early to know if adding this procedure will impact mortality rates from breast cancer.

In an editorial in the same journal the authors state that “Recent work has suggested that tomosynthesis is likely to outperform mammogram in finding small invasive cancers and lobular cancers, the ones that are most likely to be lethal.”

This and other studies raise some major questions for both physicians and women. Should we seek screening with tomosynthesis over digital mammogram? Should breast cancer screening centers convert to tomosynthesis and abandoned digital mammography? (Which will be costly.) Right now there doesn’t seem to be enough data or financial incentive to do so. But, tomosynthesis may indeed be an advance over digital mammogram for breast cancer screening and one day may become the norm in breast screening. As usual, I’ll end with the off-stated refrain…More studies are needed.

Up to 20% of women experience at least one episode of clinical depression in their lifetime. Talking to my patients and surveying my family, I sometimes think it might be even more than that… But I will cheerfully tell you about an article that came out in the New England Journal of Medicine on June 19. (The day before my birthday, a somewhat depressing event although I kept telling myself that aging is a privilege.) The article was titled “Antidepressants on Pregnancy and Risk of Cardiac Defects”.

According to the authors from the Department of Medicine at the Brigham and Women’s Hospital and Harvard Medical School, clinical depression occurs in 10 to 15% of pregnant women. The use of antidepressant medications during pregnancy has increased and is now reported to be 8 to13% in United States.. The chief concern is use of these meds in the first trimester pregnancy when potential teratogenic effects are more likely to occur, especially cardiac malformations. There been many studies that tried to address this issue and indeed on the basis of early results of two epidemiological studies, the FDA warned physicians that early prenatal exposure to Paxil could increase the risk of congenital cardiac malformations. Since then, however, other studies have been done with conflicting results and there is still significant controversy regarding whether this is (as the authors put it) “a serious concern or much ado about little.”

The current study published last week used a large national database of women from 46 U.S. states and Washington D.C. who were insured through Medicaid and were pregnant and delivered during the period between 2000 and 2007. Apparently this included close to 950,000 pregnancies. (Just so you know, Medicaid covers the medical expenses for more than 40% of births in the United States!). During the first trimester, 64,389 women or 6.8% used an antidepressant. The most common were Zoloft, Paxil and Proxac. When the researchers restricted their study to women with a recorded diagnosis of depression, they found that there was no increase in the risk of cardiac malformations among infants born to women who took the antidepressants during the first trimester as compared with infants whose depressed mothers did not. Other studies had not done this, they simply compared women who took antidepressants in pregnancy to those who most likely were not depressed and didn’t need them. The authors pointed out that in restricting the study to women with a recorded diagnosis of depression they have corrected for the potential influence on pregnancy of underlying psychiatric illness and associated conditions and behaviors which could increase the risk of malformations. These include smoking, alcohol and illicit drug use, poor maternal diet, obesity, diabetes and hypertension all of which are more common in women with depression than in those without. They also pointed out that women with depression and anxiety are more likely to use health care resources and hence there’s a higher chance of detecting a cardiac malformation in an infant who has a minor malformation that might otherwise have remained undetected and even self-corrected in early childhood.

Their conclusion: the use of antidepressants during the first trimester does not substantially increase the risk of cardiac malformations. They then add the phrase that is applied to just about every medication used in pregnancy. “In making decisions about whether to continue or discontinue treatment during pregnancy, clinicians and women must balance the potential risks of treatment with the risk of not treating”… In this case severe depression.

Although many of my readers are not pregnant, they may have used antidepressants in past pregnancies and worry about potential consequences an/or they have friends and family who will need to consider using antidepressants in current or future pregnancies. This study gives reassurance.

As we read, hear and see the news of the violent onslaughts in Iraq, the ongoing civil war in Syria and learn about the horrific impact of these events on the women and children in these areas as well as in conflict zones in Africa, most of us are appalled and don’t know how to begin to become personally involved. And to add the bad news about these distant emergencies, we now have headlines about the one that is occurring in our own country, namely the wave of young migrants that are crossing the border of Mexico in an attempt to escape violence and severe economic deprivation. I just returned from a board meeting of the Save the Children trustees that was held in Washington, DC. We were updated on these emergencies and what Save is doing to help. If you would like to see some of our programs and our messages, please download from Save the Children’s website. I also suggest that you watch two amazing YouTube videos. The first is titled “Save the Children Most Shocking Second a Day Video”. The link is HERE and the second is “The Most Important “Sexy” Model Video Ever”, watch HERE. I think they will help you (and anyone you want to send these to) understand what this organization is doing and why we all should care, get involved and yes, if possible donate.

Okay, that’s my on-line solicitation, now on to my usual medical website article… JAMA this week had two short stories that I thought would be of interest. One was based on an article that demonstrated that stroke risk increased after shingles infection: When researchers looked at the time at which strokes occurred in relation to shingles episodes, they found that the rate of stroke with significantly higher during the first six months following a shingles episode compared with before an episode. The risk was approximately 63% higher during the first month, 42% higher during the second and third months, and 23% higher during the fourth through sixth months. I have pointed out in previous articles that the CDC now feels that we should all get our shingles shots by the time we reach 50. Without immunization, one in three adults are destined to have shingles as they age. I am sure you have seen those direct to consumer ads that have someone say how horrible their shingles episode was. Indeed it can result in significant pain which lasts for months or even years. So if you have not had your shingle shot you now have another reason (i.e. stroke) to get it.

The second short article had to do with physical activity and the fact that it can stave off diabetes for women who are at-risk for this disease. (This week, the entire Journal was dedicated to diabetes.) Women who develop gestational diabetes are at increased risk of developing type 2 diabetes later in life. About 35% to 60% of women who had gestational diabetes will develop type 2 diabetes within the subsequent 20 years. Studies have shown that a combination of a healthy diet, weight maintenance and physical activity may protect against diabetes in this at-risk group. A new study published in May suggests that even a small increase in physical activity, about 2.5 hours a week of moderate activity like walking, reduces the risk of developing type 2 diabetes. What fascinated me was the additional data… In this study the number of hours per week that participants spent watching television was associated with an increased risk of diabetes. Women who watched 10 or more hours of television each week had a greater risk of developing diabetes than those who watched less, regardless of weight. Perhaps it was their inactivity, their snacking while watching or their exposure to the ads for on unhealthy foods between the shows; but there was a very real association between television viewing and diabetes risk.

Bottom line: Don’t snack while watching television. DVR the shows you want to see so you don’t have to watch all of those ads for unhealthy foods. Get out and walk 30 minutes a day. This advice is appropriate for both at-risk and normal-risk individuals as well as our kids. And don’t put off that Shingles shot. You can get it without a prescription at most pharmacies.

This article is not based on a Colorado medical journal…it’s from a review article that was published in the New England Journal of Medicine on June 5. It was authored by the National Institute on Drug Abuse at The National Institutes of Health. They stated that, “In light of the rapidly shifting landscape regarding the legalization of marijuana for medical and recreational purposes, patients may be more likely to ask physicians about its potential adverse and beneficial effects on health.” So in case you ask me…here is a summary of what they said in seven and a half densely worded pages (with graphs).

Twelve percent of people over the age of 12 report using marijuana in the past year. In case you didn’t know, the most common route of intake is by smoking the shredded leaves, flowers, stems and seeds of cannabis sativa. Hashish is created from the resin of marijuana flowers and is also smoked. Marijuana can also be used to brew tea and it’s oil based extract can be mixed into food products. (I am trying to be serious here and will not discuss brownies.)

The article’s objective is to explain the potential adverse health effects of marijuana use. (Actually that’s it’s title.) It reports that evidence clearly shows that long-term use can lead to addiction and approximately 9% of those who experiment with marijuana will indeed become addicted. That number goes up to about 1 in 6 among those who start using marijuana as teenagers and to 25 to 50% among those who smoke marijuana daily. According to the 2012 National Survey on Drug Use and Health, an estimated 2.7 million people 12 years of age and older met the definition for dependence on marijuana, 5.1 million met criteria for dependence on any illicit drug and 8.6 million for dependence on alcohol. The NIH is particularly worried about adolescents…as compared to persons who begin to use marijuana in adulthood, those who begin in adolescence are approximately 2 to 4 times as likely to have symptoms of cannabis dependence within 2 years after first use.

The report states that in adolescents, certain brain regions are more vulnerable to THC, the primary ingredient in marijuana, than in adults. THC may impair the ability of neurons to connect in specific brain areas (functional connectivity). It goes on to state that regular marijuana use is associated with an increased risk of anxiety and depression… but that no one is sure that it causes this. (It might be used to self medicate anxiety and depression.) Heavy marijuana use has been linked to impairment in memory and attention that persist and worsen with increasing years of regular use and with initiation during adolescence. It has been linked to lower income, greater need for socioeconomic assistance, unemployment, criminal behavior and lower satisfaction with life. Just to add to this list of woes…they also report that the overall risk of involvement in an accident increases two fold when a person drives soon after using marijuana. (and 5 fold for drivers with a blood alcohol level above 0.08% and 27 for persons younger than 21 years if age!)

Another fact of interest: the THC content or potency of marijuana as detected in confiscated samples (I guess they did not buy and smoke joints to measure this) has been steadily increasing from 3% in the 1980s to 12% in 2012.

OK, now onto the positive…The Institute of Medicine has acknowledged the potential benefits of smoking marijuana by stimulating appetite, particularly in patients with AIDS, in combating chemotherapy induced nausea and vomiting, severe pain and some forms of spastic muscle disorders. It may also decrease eye pressure due to glaucoma. Recent reports have also shown that it can reduce epileptic seizures.

The article concludes that legal drugs such as alcohol and tobacco offer a sobering perspective of their potential harm, not because they are more dangerous than illegal drugs but because their legal status allows for more widespread use. And “as marijuana achieves a similar widespread use, so will the number of persons for whom there will be negative health consequences.”

Just thought I would share!

I obviously cannot read every journal that comes out; I rely on JAMA to review important articles from disparate journals in the section “Clinical Trials Update” to stay as up to date as possible on non-gynecologic issues. This week, as I continued to recover from my own jet-lag induced insomnia, my attention was drawn to a review of a study that had been published in the journal “Stroke”. (Yes there are medical journals that specialize in just about every disorder.) The study was based on a review of claims data from 21,438 people with insomnia and 64,314 age and sex-matched controls in Taiwan. (I can’t help but do this; if it were a movie it would be called “Sleepless in Taiwan”!)

The researchers compared the two groups of participants for a period of four years. They found that the overall incidence of stroke was eight times higher among those who had been diagnosed as having insomnia between the ages of 18 and 34 when compared with controls who were without sleep problems. The risk seemed to become less with age, but in all age group, those with insomnia had a higher risk of stroke than those who slept well. Interestingly, women with insomnia had a 28% lower risk of stroke compared with insomniac men. (This may demonstrate that there are additional gender factors protecting our brains, perhaps our estrogen…)

The JAMA editors cite evidence to explain the study results. Insomnia can alter cardiovascular health by increasing inflammation, diminishing appropriate response to glucose (i.e. glucose intolerance), increasing blood pressure and causing increased activity of the sympathetic nervous system.

There are so many reasons to treat insomnia but now we have one more, especially in young adults. Medical research (and our own sense of alertness and well being) continues to demonstrate that a good night’s sleep is as important as our daytime behaviors for future healthspan and lifespan.

I spent the last week in Berlin at the International Women’s Forum (IWF) conference in Berlin. It was a thrill to be among 700 women from all over the world who have been elected to their respective leadership forums. The panel discussions centered on innovation in areas of education, finance, the internet, human rights and career women in Germany. The most rewarding aspect of the conference was the opportunity to become acquainted with women in leadership roles from all over the world. At this conference, there were very few women from clinical medicine, however there were a significant number of women who had major positions with pharmaceutical and biotech companies. We were all surprised by the fact that in Germany only 6% of women who have two children continue with full-time careers. There seems to be a significant prejudice against working moms. Hopefully this will change…

Now on to medical news… This week’s JAMA reported on the FDA warning against a common procedure used in removing fibroids. The US Food and Drug Administration (FDA) is discouraging the use of a surgical technique that is often used during minimally invasive surgery to treat uterine fibroids. They feel it poses a risk for inadvertently spreading cancer cells from an undetected cancerous tumor. In the past, when there were large fibroids that were clinically bothersome and of concern because of their size, rapid growth, impact on pregnancy, pain, bleeding or pressure, surgery with removal of the fibroids (myomectomy) or hysterectomy would be performed through a large horizontal or vertical abdominal incision (laparotomy). But with the development of power morcellators which basically “chew off” the fibroids so that fragments can be removed separately through laparoscopy, surgeons could switch from a large incisions too much smaller ones. The first power morcellator was cleared for marketing in 1995 and 24 devices are currently marketed for laparoscopic use. In a safety communication released in April, the FDA states that current data has shown that one in 350 women treated for fibroids with a hysterectomy or myomectomy have been found to have an unsuspected uterine sarcoma (cancer of the wall of the uterus). They stated that “if power morcellation is performed in women with unsuspected uterine sarcoma, there is a risk that the procedure will spread the cancerous tissue within the abdomen and pelvis, significantly worsening the patient’s likelihood of long-term survival. For this reason, and because there is no reliable method for predicting whether a woman with fibroids may have a uterine sarcoma, the FDA discourages the use of laparoscopic power morcellation during hysterectomy or myomectomy for uterine fibroids.” The major medical centers have now issued statements about the importance of counseling patients about the procedure and potential risks of morcellaton. Although this warning has received a lot of attention, in many ways it simply points out that a decision about the type of surgery a patient will need and how it is performed will always warrant a discussion about risks and benefits. The minimal procedure of laparoscopy does allow for early discharge and a much faster healing process than the more invasive laparotomy, but consideration about a rare, albeit real risk of having an unknown cancer inadvertently spread should be considered.

Many of my website articles cover medical tests, services and therapies that can significantly impact and increase women’s health spans and lifespans. And I have deplored in some of these reports the fact that so many women have neither access nor insurance coverage to “do the right thing”. Despite all the brouhaha about Obama Care (correctly termed The Affordable Care Act or ACA), it is here, despite partisan controversy, it will stay and it should make a positive difference in the health of millions of women. A single page overview of what we can now expect from the ACA was published by The Kaiser Family Foundation in the May 14 issue of JAMA. Some of the stats of the” before-and-what-will-be after” ACA are important for women to know:

82% of women did have a general checkup in the past 2 years. But in the past 3 years:

  • Only 44% discussed smoking
  • 31% discussed alcohol or drug use
  • 41% discussed mental health issues such as anxiety and depression (at this point I am getting depressed)
  • 70% discussed diet, exercise and nutrition.

Counseling on sexual health issues among reproductive- age women in the past 3 years was inconsistent:

  • 61% were counseled on contraception or birth control
  • 50% on sexual history/ relationships
  • 34% were counseled about HIV
  • 30% counseled about other STDs
  • 23% Discussed domestic or dating violence

Most women thought STD testing is routine, but it was not:

  • 56% did not receive a test
  • Only 14% of doctors or providers recommended a test

Uninsured women have much lower screening rates than insured women

  • Over 70% of insured women were tested for blood cholesterol, mammogram and Pap test in the past 2 years.
  • Less than 44% of uninsured women had cholesterol testing or mammogram
  • 52% had a Pap test

Cost is a barrier

  • More than 50% of uninsured women put off or postponed preventive medical service or a recommended test because of cost
  • 13% of insured women put off these tests

The good (or great?) news is that the ACA requires plans to cover these preventive services with no cost sharing; this means:

  • Cancer screening
  • Chronic condition screening
  • Healthy behaviors counseling
  • Vaccinations
  • Reproductive and sexual health services
  • Pregnancy – related services

According to the Kaiser Family Foundation Survey 4 in 10 women are unaware of this new preventive coverage! So when you your physicians and we ask you about your exercise, diet, smoking, drinking, drug use, contraception, partner history, mental health issues and go over previous medical tests and conditions…we are not being intrusive, but need this information so that we can appropriately go on to discuss, council and screen your health and behavioral issues. And discussion of these health parameters and tests should be covered by your health insurance.

I know all this may be initially cumbersome for the physician and patient (especially since all this has to be entered on an electronic medical record), but let’s all be patient…the ACA should improve our health care and who knows…maybe our health behaviors!