Issue 20: Blockchain, Female Cyclists Sex, Antibiotics, Terminal Dementia

Big insurance companies dabble with blockchain 
Image from CoinTelegraph

UnitedHealth Group and Humana, two of the biggest health insurance companies in the US, have announced that they will be piloting blockchain technology to improve healthcare data quality and decrease costs. Although the HYPE is real and the details vague, we know that these companies don’t joke around with such investments without $$$ in mind. The hope is that they streamline data reconciliation across their platforms, and reduce some of that $2 billion dollar cost burden. Let’s hope that a lean administration and accurate database will help individual patients navigate their plans more easily and lower their monthly premiums. 

Female cyclists get more UTIs, but have way better sex
Female cyclists with dope AF tattoos 

In a new study published in the Journal of Sexual Medicine (yes, there is one), author Thomas Gaither debunked the myth that cycling may result in sexual dysfunction. More than 3,000 women were surveyed, and high-intensity cyclists were 30% less likely to experience sexual dysfunction than non-cyclists, runners, and swimmers. However, they experienced UTIs more frequently. This was not a randomized controlled study, but to be fair how many study participants can you force to ride on a bike for hours. Probs not many. 

Antacids and antibiotics are associated with allergies in infants

It is not uncommon for parents to resort to antacids or antibiotics for their infants experiencing reflux or infections. An ENORMOUS new study in JAMA took a look at 800,000 children and the connection between using antacids (like Pepcid) and antibiotics and the development of allergies. Children who took antacids before 6 months of age doubled their chances of getting food allergy, while those who took antibiotics doubled their chances for asthma. Both groups saw about 50% increase in probability of getting anaphylaxis. 

Black America deserves better healthcare
Image from Getty Images

With numbers this bad, people should be talking. Atlanta, Georgia is one of the biggest cities in the country with world class healthcare providers and facilities. But when you look at Atlanta health disparities between black and white patients, the difference is absolutely shameful. Looking at breast cancer mortality, 44 black patients (per 100,000 residents) will die as compared to 22 white patients. Prostate cancer in men is even worse— 49.7 deaths (per 100,000 residents) in black men as compared to only 19.3 deaths in white men. There are many other similar disparities like mortality in HIV, stroke, diabetes, and heart disease. It brings the question: how in a country as advanced and free as the United States still having these awful disparities among race? This is not a healthcare issue alone; it is also a systematic issue as well. Reflecting on the last one-hundred years, the differences in wealth have been very different between black and white people. This can have effects on healthcare affordability, health literacy, and accessibility. It is not just Atlanta; it is the entire country. 

A new advanced directive option for patients with terminal dementia
Image From Twitter

Terminal dementia affects more than 5 million people, a number that is expected to triple by 2050 according to a study published by the New England Journal of Medicine. Unlike some other terminal illnesses, it is not included in laws covered by the 7 states that allow medical aid-in-dying. A controversial new directive by End Of Life Choices in New York now allows two options for patients suffering from dementia: the first allows patients to have food and water at the end stages of the disease if the patient appears to enjoy it, and the second halts all feeding and water service in the end stages of disease EVEN IF the patient appears to want it. These options will only be available to patients with Stage 6 or 7 dementia according to the the Functional Assessment Staging Tool. This is obviously a very controversial new advanced directive, and critics say that the document has an important flaw: people who aren't demented now may not know how they'll react later as the disease progresses. In addition, it is unclear whether it will be honored in the state of New York (a court case is very likely). However, supporters of the document say that this is an important first step in advocating for the rights of patients with dementia who do not want their disease to be prolonged. The future of this ethical and legal gray area remains to be seen.

How the tables turn: when the drugs cause disease
Dame Sally Davis getting woke AF about antibiotics. Image from Telegraph

According to Professor Dame Sally Davies, the Chief Medical Officer of England, antibiotics have increased average life expectancy by 20 years. Antibiotics are an extremely powerful tool in combating infectious disease, and have even opened doors to new cancer treatments. However, the rampant use of antibiotics, particularly fluoroquinolones, comes with a price. Fluoroquinolones (including ciprofloxacin and levaquin) are widely used to treat UTIs, pneumonia, sinusitis, and bronchitis. By 2008, the FDA added a black box warning to these drugs about the risk of tendonitis. By 2013, the FDA included warning about permanent nerve damage and finally by 2016, they reported that these drugs should only be used as a last resort due to an incredibly long list of potentially irreversible side effects (including nerve damage, muscle/joint pain, depression, prolonged QT interval, and hallucinations, just to name a few). 

Unfortunately, the medical community still continues to prescribe fluoroquinolones routinely, leading to a large community of people suffering from what the FDA calls "fluoroquinolone associated disability." On top of that, the indiscriminate use of broad spectrum antibiotics is leading to a new generation of "super bugs" which are resistant to all drugs. This really is a dangerous future, but one that can be prevented by increased physician awareness about the downstream effects of prescribing drugs like fluoroquinolones. As Professor Davies puts it, "Just as we look after old churches, beautiful landscapes, and endangered animals, we need to look after our bugs." And by being cognizant of side effects to what was previously considered a benign drug, we can look after our patients too.

Nurse talk: gonorrhea with the wind
An American Clasic

"A woman in her 40's who had had a colostomy for several years following a bad MVA was admitted for an infection in her colostomy site. She came to my unit and sure enough, green pus was everywhere. The site was cultured and.. guess what? She had gonorrhea in her stoma. She reluctantly admitted that she had met a man in a fetish chatroom and let him "make love" to her stoma! Now, there is some patient teaching I would have never thought of! By, the way, if you let someone sexually penetrate your stoma, make sure they wear a condom."

~Anonymous Nurse

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