How your Primary Doc Makes a Referral to a Specialist--the reason may NOT be what you expect

When your primary care doc finds something concerning, alarming, or otherwise worthy of further perusal, you assume the specialist he/she is sending you to is a product of much thought, concern, and motivated by sending you to the "best" person, after all your, primary doc should know.

Actually, there may be a lot of reasons (akin to the "free pens" from the pharma reps) why your doc might send you somewhere, and reasons that have nothing to do with medicine and your condition.

This doctor tells us:

Here are some reasons, beyond medical quality, why certain medical specialists are chosen.

• Reciprocity –- patients are referred in both directions
• Personal relationships
• Corporate enforcement keeping consultations within the network
• Economic pressure exerted by consultants to maintain referrals. I have seen this happen.
• Specialist willingness to do tests and procedures on request
• Habit
• Patient or family request

That is, you might serve yourself a little better by doing some research on your OWN and seeing how things compare instead of immediately being sent to the guy's goofball neer-do-well brother-in-law who will supposedly figure out what that suspicious lump is.

Read more here.

Hidden (not to me!) Risks of Egg Donations/IVF

They recently had a big article in the New York Times about the soaring prices infertile couples are paying for eggs...again, little mention of the possible long-term side effects of the repeated blasts of synthetic hormones. Over the years I've noticed women who've publicly shared their infertility journies, and I've noted that a lot of women who undergo IVF, especially if it fails, seem to develop ovarian cancer (a stated risk of ovarian stimulating drugs, for obvious reasons). Interested to see I'm not the only one keeping track. Here's a letter published in response to the article:

Dear Editor:

Re “Payment Offers to Egg Donors Prompt Scrutiny” (May 11): After postwar physicians routinely placed pregnant women at risk for miscarriage on diethylstilbestrol, it took decades before the deadly effects of that synthetic hormone were uncovered.

Without long-term follow up, it is simply not possible to offer potential egg donors a truly informed consent about the long-term risks of taking the powerful synthetic hormones associated with the egg retrieval process. Yet, there is no effort now under way to establish a registry to find out what the long-term risks are. Why is that?

Consider what happened to magazine editor Liz Tilberis, comedian-actor Gilda Radner, playwright Wendy Wasserstein and many other women who underwent hyperstimulation and died of cancer in the prime of their lives. Shouldn’t we first attempt to provide a full informed consent before financially encouraging women to take powerful hormones?

Diane Beeson

Tina Stevens

San Francisco

More reading on egg donation with some interesting firsthand comments here:

ADHD Kids have high levels of Pesticides

Look, we already know that pesticides are probably implicated in Parkinsons and many cancers. This is HUGE news. Need better motivation to go organic?

From Medpage:

Children with greater exposure to organophosphate pesticides appear to have an increased risk of developing attention-deficit/hyperactivity disorder (ADHD), a cross-sectional study showed.

A 10-fold increase in the concentration of the most common dialkyl phosphate metabolites -- a measure of organophosphate exposure -- was associated with a 1.55-fold increase in the odds of having ADHD (OR 1.55, 95% CI 1.14 to 2.10), according to Maryse Bouchard, PhD, of the University of Montreal, and colleagues.

read more here.

Don't take these herbs with these drugs

Herbs can actually interfere with some prescription drugs, so watch out for

ST. John's Wort - Don't take with antidepressants--can cause serotonin syndrome

Turmeric - Don't take with blood thinners like Coumadin (wafarin)

Licorice - Don't take with diuretics for high blood pressure.

Feverfew - Don't take if you have allergies to ragweek, don't take with blood thinners

Freakishly obese the new norm

On my flight yesterday, I saw between two men who were AT LEAST this large. This is what "freakishly obese" looks like now:

"Chauncy Morlan (1869-1906) who, because of his 'freakish' weight, people once paid good money to see as he toured Europe and America with the Barnum & Bailey circus".

Read more at Theatlantic.com.