The Medical News Report

#126

July, 2022

 

Samuel J. LaMonte, M.D., FACS

www.themedicalnewsreport.com

samlamonte@gmail.com

 

Subjects:

1. Roe vs Wade overturned

2. Ob/Gyn Series—Part 3-Endometriosis updates

3. Autoimmune diseases Series—Part 6—glaucoma, psoriasis/psoriatic arthritis, ankylosing spondylitis

4. The health of our country and mismanagement of it; Last minute news on COVID-19; f

Fentanyl epidemic

5. Social Security is not so secure! Medical insurance companies under scrutiny for denial for access to medical services, especially Medicare Advantage

6. FDA closer to banning menthol in cigarettes

IMPORTANT REMINDER!!!! PLEASE READ!!!

  I remind you that any medical information provided in these reports is just that…information only!! Not medical advice!! I am not your doctor, and decisions about your health require consultation with your trusted personal physicians and consultants.

  The information I provide you is to empower you with knowledge, and I have repeatedly asked you to be the team leader for your OWN healthcare concerns.  You should never act on anything you read in these reports. I have encouraged you to seek the advice of your physicians regarding health issues.

  Feel free to share this information with family and friends, but remind them about this being informational only. You must be proactive in our current medical environment.

  Don’t settle for a visit to your doctor without them giving you complete information about your illness, the options for treatment, care instructions, possible side effects to look for, and plans for follow up. Be sure the prescriptions you take are accurate (pharmacies make mistakes) and always take your meds as prescribed. The more you know, the better your care will be, because your doctor will sense you are informed and expect more out of them. Always write down your questions before going for a visit. Stay well, my friends!

                                         Thank you, Dr. Sam

 

 

1. Roe vs Wade overturned

  On June 24, in a 6-3 decision, the Supreme Court overturned the right of the federal government to allow abortions, something the constitution never gave the federal government the right to do since the constitution was written. It does pass the authority for abortion rights to the states, which can put it in the hands of the people in each state. It has nothing to do with contraception, the morning after pill, or anything else about women’s rights.

  For 46 years, the federal government had been given a decision by Roe vs Wade that was not theirs to give. It has always been the responsibility of the states unless the constitution gives the federal government the authority…and it never has. 

  This will give the pro-abortionists a volatile issue to use in the November election, because the misinformation in most people’s minds has led to many groups promoting it wrongly and will certainly create massive demonstrations, destruction, and possible physical harm.

  Justice Cavanaugh had an attempted assassination on him and his family when some derelict justice clerk (still not divulged) leaked the information from one of the justice’s office a few weeks ago. This gave the Democrats the fuel to pass some ridiculous law trying to stop the states from having the authority to decide, and it thankfully was not passed. They wanted abortion to be legal up until the time of the birth. Hard to believe.

  The police force will be tested, and the justice system better uphold the law for crimes against facilities for pro-choice, which has happened in several already with no action from the attorney general. The Congress in Arkansas on 6-24 was surrounded in their Capitol by a massive crowd, requiring police to disperse them and allow he congressmen to go home.  

  1 in 5 pregnancies are aborted as of 2020. States can now decide what they want to support, and will put every politician on the hot seat to declare which side they are on. I find that very refreshing, as many have not addressed this. In November, we will find out.

  Most of the blue states will approve laws protecting abortion rights, and some red states will not, but it is not just about pro or con abortion. There is the question of when an abortion should or should not be performed. The Bible says from conception, there is life; the heartbeat begins around the 5th week, however it is not easily heard on Doppler or ultrasound until around 10th week when the heart is fully developed. This issue is commonly discussed as the time when an embryo becomes a fetus. This will likely be debated when the states are asked to pass regulations.

  Mississippi had a ruling that was upheld by the justices today as well, that no abortion after 15 weeks can be performed legally. Restrictions on abortions will vary in the states, so there will be no uniform rule.

  Women deserve to make medical decisions for themselves, but when a human is growing in their bellies, they deserve serious consideration, and help from centers that like pro-life. Also women that get health care at centers for pro-choice deserve attention too. Hopefully that will be considered when the states take up this issue.

  I was surprised that almost half of abortions occur from using the night after pill. Look at this chart from Guttmacher Institute:

 

   For those complaining that women donlt have a choice is not true, and beware the lying will be at an all time high with these advocacy groups causing trouble with little concern by the current administration.

  By the way, just for your information, if someone kills a pregnant women, it is a double homicide! Let that sink in!

 

 

 2. Ob/Gyn Series—Part 4—Endometriosis updates

 

In 2019, I reported on endometriosis, but there are new guidelines presented by a European Reproductive Association, and is worth adding to my 2019 report.

www.themedicalnewsreport/85

  This disease occurs in up to 10-20% of women. It is impacting our society equal to diabetes, rheumatoid arthritis, and Crohn’s disease, according to a Medscape Medical News article, Feb. 8, 2022.

  This is a cause of uterine bleeding and included in that discussion above, but since I am doing a series on common ObGyn issues, and since there is no new research and treatments, I wanted to update the readers.

  Endometrial implants occur in and on the uterus, around the ovaries, fallopian tubes, on the bladder surface, colon, rectum, and lining of the pelvis (peritoneum). It is thought that abnormal tissue cells travel down the fallopian tubes into the abdomen from the uterus (retrograde menstruation), thus creating implants throughout the pelvis. The actual cause is unknown, but does run in families. It is much more common than known, since even imaging can’t always discover these tiny implants.

 

Symptoms 

  The symptoms include excessive cramps during the menstrual period (dysmenorrheal discussed under chronic pelvic pain April, 2022)—please log on:    www.themedicalnewsreport.com/123

Other symptoms include pain on intercourse (dyspareunia)*, cyclic pelvic pain, abnormal or heavy flow, bleeding between periods, infertility, fatigue, pain on urination, painful bowel movements during the menstrual period with diarrhea, constipation, and nausea.

  The endometrial implants from the disease are responsive to the monthly cycle and can swell, bleed, and cause inflammation wherever they implant. Ultimately, they cause scarring which can lead to pain at any time.

*Dyspareunia=painful intercourse

  There are many reasons for painful intercourse, and estrogen insufficiency at menopause is the most likely, but endometriosis must be ruled out as it is common (15% of women), especially if there are any nodules in the tissue between the vagina and rectum, which can possibly be palpated on rectal and vaginal exam, which should always be performed with a pelvic exam. Palpation of the tissues surrounding the uterus is also crucial in the exam for analysis of scarring, fibroids, masses, nodules, etc. to elicit myofascial syndrome from chronic pelvic pain  just recently reported here.

  Eliciting the pain in the exam that occurs during sex is critical to evaluate the exact areas overly sensitive. These exams are critical to be performed by a physician or other healthcare professional well versed in the analysis of dyspareunia. The area over the pubic bone, pelvic floor musculature, and rectum must be palpated to see if those areas elicit pain similar to pain with sex.

  Counseling with the couple is very helpful for the other partner to understand how to assist in the problem. Lubrication, estrogen creams, pills, patches, shots, etc. may need to considered plus more gentle sex.

JAMA Insights-Women’s Health, April 18, 2022

  Endometriosis is estrogen dependent (does not occur before menarche or after menopause),

   

Risk Factors:

  Those more prone to endometriosis are:

 girls who have their first menstrual period before the age of 11, short menstrual cycles, and heavy periods that last 7 days or more, have a family history, give birth after 30, and are white. 

 

Risk of cancer

  Although rare, there is an increased risk of endometrial (uterine) cancer. There are 2 reasons for these patients developing cancer: a) increased susceptibility to cancer, especially ovarian, and b) malignant transformation of endometrial implants wherever they occur.

   a) Increased risk of developing cancer--although only a theory--patients with endometriosis make up 50% of infertile women, and not having babies increases the risk of ovarian cancer. These patients are at an increased risk for ovarian (90% increase) and breast (30% increase) cancer, and non-Hodgkins lymphoma (40% increase). Endometrial cancer occurs in less than 1%. National Cancer Institute

   b) Malignant transformation of endometrial implants

   2.5% of these patient develop malignant transformation (usually clear cell adenocarcinoma) in the implants in the uterus and in the pelvis (ovaries, fallopian tubes, pelvis ligaments, colon, and even abdominal surgical scars.

  It is known that completely removing visible implants of endometriosis will reduce the risk of malignant transformation.

  There is a type of ovarian cancer that is called endometrioid carcinoma accounting for 20% of all ovarian cancer (the  other 80% are called serous carcinoma), and those who have their endometrial implants on the ovaries are particularly prone to this histologic pattern of cancer. The new guidelines de-emphasized the risk of taking contraceptives and causing malignancy.

Increasing symptoms might indicate accelerated growth of these lesions and the possibility of cancer. that is why close surveillance is important.

  It is known there are some genetic ties between  endometriosis and cancer, and if there are known genetic markers present, this should increase closer surveillance.

 

Diagnosis

  Trans-vaginal ultrasound (right drawing) to diagnose endometriosis will provide the best information without an invasive procedure. The new guidelines have suggested that endoscopic laparoscopy is no longer the gold standard for diagnosis, however, it is the gynecologist’s and patient’s decision. 

    

Above (left) are potential implant sites (red dots). Right drawing depicts the transvaginal ultrasound.

 

Laparasocopy allows a biopsy of the implants.

 

 

Below is an actual photo of implants in the pelvis (arrow), while the right photo is an ultrasound showing nodules.

 

    

 

Possible groundbreaking saliva test to diagnose endometriosis

  A French research team developed a genetic test to differentiate endometriosis in a group of chronic pelvic pain patients. It is a cheap easy test to perform and is highly accurate. It tests for miRNA in the saliva produced by the lesions of endometriosis.

  This was a research study with 200 women and will have to be further validated before it could become approved for clinical use.

  They feel that these genetic tests will be used to diagnose other forms of both benign and malignant disease.

Medscape, March 22, 2022 

 

What other disorders can be confused with endometriosis symptoms?

  Many other diagnoses can be confused with endometriosis including fibromyalgia, irritable bowel syndrome, depression, stress, anxiety, periodic pain, chronic fatigue, polycystic ovary syndrome, etc. and part the central sensitivity syndrome well discussed and can be found in the subject index on my website:   www.themedicalnewsreport.com/84

 

Treatment

  1—Pain control can be difficult but NSAIDs (ibuprofen or naproxine) are preferred and hopefully there will be a lower risk of opioid use and abuse since this is a chronic illness, and these patients are at risk becoming dependent on opioids. Progesterone based medications and birth control pills are effective unless the woman plans on getting pregnant.

  2—Hormonal—predominantly progesterone containing medications including contraceptives, vaginal rings, and patches that contain progestins (and some estrogen).  Danazol is commonly prescribed to prevent a woman from having periods and thus prevent the time when the symptoms are at their worse. There are progesterone markers that may guide the physician in using Danazol and be able to predict more success. Reference—NIH

  The new guidelines emphasize that menopausal women with endometriosis should not be taking estrogen alone. If surgical menopause is necessary, it is still recommended to use combincation estrogen/progesterone therapy until the age of menopause.

  There is a new FDA approved oral hormonal treatment and is now the second line of recommended treatment behind hormones—elagolix(Orilissa).

  Danazol, a hormone based chemotherapy is a gonadotropin-releasing inhibitor agonist (this inhibits the stimulating hormone from the pituitary) and is helping pelvic pain and pain during sex. A newer similar medication of this type is Elagolix, felt to be better tolerated. It is also used in certain breast cancer cases. Talk to your doctor about these new therapies. NEJM-Journal Watch, August, 2018

  Aromatase inhibitirs that targets the enzyme that converts androgen to estrogen is being used as well. These are letrozole (Femara) and anastrozole (Arimidex).

  None of these treatments have improved the rate of pregnancy except in the case of in vitro fertilization.

  Hormonal therapy after surgery (for 12 months) has been more successful to relieve pain including the pain on intercourse (dyspareunia).

  There are side effects of hormone therapy and need to be discussed with a woman’s doctor.

  3—Tamoxifen is normally used after breast cancer is treated, and is recommended for 5 years, but this aromatase inhibitor is a potent anti-estrogen medication and effective in endometriosis, but is used only in cases that are not controlled by other medications.

  4—Supplements and diet are limited in their value but many have been tried including fenugreek, Omega 3-fish oil, walnuts, and avocados, vitamin B1, ginger, valerian root, and zinc. A low carbohydrate diet has shown some benefit. Gluten free diets help some in one study. Coffee and caffeine have not proven to have any effect on endometriosis. A healthy diet and exercise always improves symptoms some because of the metabolic release of endorphins, anti-inflammatory foods, and improving mental status.

  4—Surgery is indicated when medical therapy cannot control symptoms or large nodules develops from one of the implants, bowel obstruction or bladder scarring requires it. The surgery is complicated and requires special training.

  Surgical techniques include laparoscopic procedures to remove scar tissue, rapidly growing masses of endometrial implants (endometriomas or chocolate cysts of the ovaries), large cysts that might rupture, with or without using a laser, may require a hysterectomy, removal of the ovaries, and fallopian tubes.

  Epidemiological evidence show that complete removal of visible endometrial implants can reduce the risk of ovarian cancer, as mentioned above.

  Ablation using lasers can be an alternative, but considered to be inferior to surgical removal, because some of the lesions appear like icebergs and only the surface is visible which is usally all that a laser can remove.

  Hormonal replacement therapy will likely be initiated in younger women, but according to new reports, the combination of hormonal and surgical therapy provides the best results.

  Recurrence can be an issue in up to 30% of patients and creates added challenges to relieve their symptoms.

  New recommendations seem to be leaning more conservative by suggesting there be a reduction in the frequency of surgery, laparoscopy for status, and laparoscopic nerve ablation for pain, recommend using the GnRH antagonists listed above. Also, the new recommendations include de-emphasizing that pregnancy will reduce the symptoms of endometriosis.

  It is clear that these are recommendations only and final decisions about treatment are between the gynecologist and the patient. Jumping to more aggressive treatments may have been abused, but it is still each individual’s decision.

Medscape, July, 2018

European Society of Human Reproduction and Embrology, February, 2022; Medpage Today, April 1, 2022

Medpage Medical News, February 8, 2022

 

3. Autoimmune Diseases—Part 6, Glaucoma, Ankylosing spondylitis, Psoriasis/ Psoriatic arthritis

 

A. Glaucoma-open angle

  Is glaucoma an autoimmune disease? The latest observational research implies it is, since the incidence of rheumatoid arthritis and other autoimmune diseases have a higher incidence of glaucoma, open angle type.

  I have described the types and treatment of glaucoma and the report is still very appropriate, and would encourage the reader to review it. A vast amount of research is ongoing for such a serious eye disease. www.themedicalnewsreport.com/41

  Researchers from South Korea found there is also an increase in one of the most important inflammatory markers in autoimmune disease and docotors have an inhibitor in medication (tumor necrosis inhibitor), that counters the chief pathology in glaucoma. JAMA Network.

  Another study in 2020 in the Clinical and Translational Immunology Journal stated that glaucoma was autoimmune. There is solid epidemiological evidence that it is linked to autoimmune diseases. They, however, stated that rheumatoid arthritis does not trigger glaucoma, rather the immune complex that causes RA can damage the tissues involved in open angle glaucoma.

Medpage Today, March 22, 2022

 

B. Psoriasis and Psoriatic Arthritis

  Psoriasis affects 2% of Americans, and about 15% will suffer psoriatic arthritis. It also is very similar to rheumatoid arthritis at the cellular level and another autoimmune disorder. Most commonly the disease begins 18-35 years of age. There is no cure and it will be lifelong.

  Kim Kardasian has psoriasis and Phil Michaelson, famous pro golfer, has psoriatic arthritis, AND Phil is commonly seen advertising for his biologic treatment.

 

  The skin may dry and crack (and bleed). The spots flake off easily, making a challenge to keep their homes clean, especially the bedroom. Itching and burning is not uncommon. These rashes may be cyclic and can last weeks or months only to resolve.

  There are 7 types of psoriatic manifestations of the skin and 5 types of arthritic psoriasis, which may require different options of therapy.

  Heredity plays a role in 40% of cases. In fact, if a parent has the disease, the risk is three times more likely for a child to develop some type of this disease. 85% of those who develop psoriatic arthritis already have dermatologic psoriasis.

Triggers include injury to the skin, cold weather, infections (Strep), bad sunburn (although tanning helps), HIV, emotional stress, smoking, alcohol, and hormones are all possible factors.

This is a serious inflammatory skin and joint disease and deserves a proper workup by a dermatologist and/or rheumatologist, because some of the more serious treatments include immunosuppressive drugs.

  As in all autoimmune diseases, there is an increased risk of other diseases some autoimmune and others including eye (uveitis, keratitis, and conjunctivitis), obesity, hypertension, diabetes, Celiac and Crohn’s disease, cardiovascular disease, and psychological disorders due stemming from embrassment, lack of self esteem, and frustration with the disease.

The standard treatment can start with NSAIDs (non-steroidal anti-inflammatory drugs), but biologic drugs have become the standard of care for more resistant types.  These drugs may be used as topical and systemic in nature.

Prescription steroid creams, shampoos, tar products, light therapy (UV) all will be tried on the skin lesions before the biologic type of drugs are used.

The 7 types of skin manifestations are:

1) plaque2) guttate3) inverse 4) nail 5) pustular 6) scalp

 

Plaque

Scalp

Guttate

Also small pits

Inverse psoriasis

Erythroderm

Pustular type

The 5 types of psoriatic arthritis are:

1) Symmetric-include multiple matching pairs of joints, which are disabling, progressive, and destructive

2) Asymmetric-usually 1-3 joints that are not matching

3) Distal finger-closest to the nail

4) Spondylosis-spine may be involved partially or completely causing stiffness, with difficult motion; involves the ligaments as well; can also involve all joints.

5) Arthritis mutilans-severe deforming, primarily of the fingers and toes

 

      

These are examples of deformity, X-ray evidence of calcification, and joint abnormality.

  Unfortunately there are no diagnostic blood tests for this disease. It is made clinically based on the character of the rash. The arthritis can be confused with any other type of arthritis, but with these rashes and joint pain, it is fairly obvious. A skin biopsy can be helpful.

 

TOPICAL TREATMENTS

a. Corticosteroids—may be topical or systemic

b. Vitamin A-analogues—calcipotriene(Dovinex, Sorilux), and calcitrio. These are often combined with corticosteroids for topical use.

c. Retinoids—Tazarotene (Tazorac, Avage, etc.)

d. Calcineurin inhibitors modified formulations—tacrolimus (Protopic) and pimecrolimus (Elidel). These immunosuppressants used to treat a variety of conditions and are indicated for cases that do not respond to other categories. These are also used to prevent organ transplant rejection. Topical solutions are used in thinner skin areas around the eye and other areas. Not recommended during pregnancy.

e. Salicylic Acid shampoos and scalp solutions--are non-prescription and can be used alone or with other medications.

f. Coal tar preparations—although smelly and can stain clothes, these topical preparations are effective in milder cases and help itchy scaly scalps.

g. Anthralin—a coal tar cream that slows skin cell growth to remove scales and make the skin smoother. Not recommended for the face and genitals.

h. Light therapy—probably one of the few conditions that approves of the use of a tanning bed. That and regular sun exposure is effective in mild to moderate psoriasis. UV-B light is the proper spectrum of ultraviolet light.

  Psoralen compounds used on the skin before UV exposure is called PUVA treatment, increasing sensitivity of ultraviolet light. Some dermatologist may have the machine in their office.

i. Excimer laser—this machine can target just the involved areas and requires fewer sessions.

 

ORAL OR INJECTIBLE MEDICATIONS

a. Corticosteroids—triamcinolone injections into the skin of resistant plaques may be helpful.

b. Retinoids—Acetretin and others are pills to reduce the production of skin

c. Biologic drugs—these are necessary for resistant skin disease and arthritis. These immunosuppressives are injectible usually weekly. This is big business as these medications cost thousands of dollars per month. The number of TV commenrcials tells you they are making big bucks. Otezla, Remicade, Humira, Cosentyx, Talz to mention a few. Testing for tuberculosis is necessary, and blood work to follow the effects on the blood count and other organs is also necessary.

d. Methotrexate—a chemo preparation but less effective with the newer biologics.

e. Cyclosporine—an immunosuppressant but not as commonly used as the biologics.

 

ALTERNATIVE TREATMENTS

  Aloe extract creams, fish oil treatments with UV light therapy, and barberry are some of the topical therapies that may reduce the severity of psoriasis.

www.psoriasis.org  is the website for The National Psoriasis Foundation and worth checking out.

www.mayoclinic.org

 

C. Ankylosing arthritis

More than 200,000 people in the U.S. are diagnosed with this serious disease. This disease of the spine can often fuse vertebrae causing stooping of the posture. If the ribs are included, shortness of breath may occur. It occurs in early adulthood. The inflammation in this disease can include the eye as in other autoimmune diseases.

  Pain and stiffness in the lower back and hips is not uncommon especially present in the morning. If the sacroiliac joint is involved, pain in that joint can be severe and need injections of corticosteroid. The shoulder joints may also be involved and if the ligaments that attach the breastbone to the ribs, this can cause pain and difficulty breathing.

  According to the Mayo Clinic, those with a gene marker HLA-B27 frequently have ankylosing spndylitis.

Complications include:

 --Chronic pain, difficulty standing up straight, shortness of breath, and difficulty sleeping because of the spine fusion and pain.

 --Uveitis (another autoimmune disease causing characterized by floaters in the eye, pain and redness, and decreaed vision—blurry or cloudy, and photophobia, an abnormal sensitivity to light. A rare disease, but 30,000 people go blind each year from this disease, which is not always associated with Ankylosing spondylitis, but often associated wit other autoimmune diseases. The uvea is the middle layer of the eye and iris, and the anterior chamber is most often involved, causing glaucoma, reported on above.

--Aorta and aortic valve abnormality—the aorta can become inflamed and cause distortion which can influence the aortic valve of the heart, causing regurgitation and or stenosis, making the emptying of the heart more difficult.

 

Diagnosis

  X-rays and MRI can define the extent of the disease. Testing the blood for HLA-B27, and the general workup for autoimmune disease. Note the images that demonstrate fusion of the spine and sacroiliac joints, stooping of the posture.

       

Treatment

  As in all the autoimmune diseases, NSAIDs, the non-steroidals—Aleve, Advil, Ibuprofin, etc. may have some value.

  In most cases, there may come a time to use drugs that attack the cytokine and interleukin proinfammatory medications such as Embrel, Cimzia, Simponi, Humira, Remicade, Talz, and Cosentyx. I have repeated this in most of the autoimmune diseases.

  Range of motion exercises are critical for these patients including walking, and strengthening of the core (abds), and proper positioning for sleep. Expertise by physical therapists are very helpful and referral is recommended.

  Surgery is rarely necessary.  

Mayo Clinic; Johns Hopkins Medical Center

 

   

4. The health of our country, the political contamination, and its mismanagement; Last minute COVID News

 

  Our healthcare quality is in jeopardy, and it is my responsibility, as a physician, to seek out all sources of negative ideology that jeopardize it.

  The wokeness and radical left policies are sending the wrong message and are trying to replace parents with their children, recommending COVID vaccine for children 6 months and older when the data shows very few children that age get much of an illness unless at high risk, locking down our country to throw us into a crisis that we are still enduring. We have lost so many military, airline people, and many other businesses that have mandates for vaccines, which has created so much pain. 40,000 national guard are just about to be fired because of mandate. And the pandemic is no more than the flu currently, but the mandates continue. Horrible.

 

Fentanyl crisis is a health crisis

  Over 8000 lbs. of fentanyl has been confiscated this year, but that is a pinch of the amount coming over the border from Mexico via China.

  The border patrol found a pill compressing facility just over the border placing fentanyl in every kind of illegal drug they were smuggling. Heard that from the White House?

  These drugs continue to kill hundreds of young people per week, and now we have a newer version of that illegal Chinese drug fentanyl, called ISO, which is 20X stronger than fentanyl.

  We are spending $millions on the illegals (busing and flying them all over the country plus housing and medical care) crossing our borders when we need to be spending that money on preventing Cartels from bringing fentanyl across our borders including human and sex trafficking. The getaways are now over 800,000, and 2 million illegals have crossed and are staying in our counry since the new administration took over.

  Gof bless the border patrol for staying on their job, because they have been abandoned by this administration.

  The number one cause of death for age 18-45 is drug overdose!! What has happened to our young people? What are we doing about it? How has their path gone so wrong?

Where is the administration on this crisis? And yet, this week, they are discussing taking nicotine out of cigarettes!!!

  Social media is selling illegal drugs to kids by the $millions on Snapchat, etc. using emojis and symbols to confuse adults and the owners of these media giants. Parents are not allowed to monitor their social media accounts!! Parents must be more proactive with their kid’s social media.

  Over 50 people on the Homeland Security’s terrorist list have been captured this year. Heard about that?? How many got away? The Southern border crisis will change our country forever.

  However, there is good news for a change regarding Hispanics. Polls report only 27% of Hispanics favor Biden. I suspect that is quite an eye opener for those radical liberals.

  That is just for Hispanics while 33% of the rest of the country supports the administration’s ability to run this country. Could this be why we are getting a tax gas holiday for 90 days, state gas tax relief maybe, and asking the fossil fuel industry to try and produce more gas, while openly and aggressively trying to destroy that industry, and blames them for high gas prices.

   Cartels are making over $200 million a week on human and sex trafficking, and illegals are acting as “mules” carrying fentanyl into our country besides the big shipments making it across the border daily.

The New York Public Health Department, in advertisements, empowers drug addicts for taking their drugs safely. Nothing about not doing drugs, just be safe. Nice try, but not the most important message.

  There is an ad encouraging addicts to obtain fentanyl test strips free which is quite important. Are we ready to follow European countries and provide syringes, Methadone, and care for addicts in our cities?

  Where is the revenue to finance police protection in our schools (and cities), which in fact is a major healthcare concern with children being killed by crazy and deranged people in our schools.

  And yet, the administration wants to spend months talking about gun reform as the answer, when we need armed personnel in every school.

  The competency of certain police leaders in Uvalde, Texas, has to be questioned. Gun reform is important, but will not fix this issue. Sometimes you need to meet fire with fire. These evil people need to discovered before they commit such atrocities, and put them away for life. These people are beyond reform!

School shooting since 2000

I am in favor of some gun reform, but that will not stop these killings anymore than any Roe vs Wade decision changes, as the abortion rate in our country will continue. (1 in 5 pregnancies were aborted in 2020 according to the CDC). You know the planned countrywide protests and devastation of our cities with paid groups of protestors are just beginning as we get closer to the November election.

 

Status of the pandemic and vaccine

  The coronavirus virus continues with the more new subvariants of Omicron that are somewhat resistant to the vaccines but nothing new about them has occurred, as they are still easily transmitted causing few symptoms to occur in most. We are dealing with a disease that is similar to the flu now…not good but not worth the publicity of a pandemic. This virus is not going away, as it will be seasonal as is influenza.

  The vaccines with a single booster still prevent more serious disease and fewer hospitalizations.

  However, regardless of age, people with underlying diseases or those immunosuppressed (disease or meds) are at risk for more symptomatic illness and hospitalization.

  Patients should talk to their doctor about these vaccine boosters. Some of the experts admit they do not know if a 2nd booster is worth it for any others than those at high risk.

  The FDA approved a COVID vaccine for children 6 months and older. It is 1/10th the strength but Pfizer requires 2 doses to cover Omicron. Moderna requires 2 doses. Few side effects are occurring with the shot except the usual pain in the arm, fever, chills, and headache. There has been no myocarditis.

  Less than 50% of parents have allowed their children 5-17 to receive the vaccine, and it is expected a smaller percentage in the 6 months-4 years group will receive it. I hope there are no mandates on these kids continuing to make children a political pawn. Keep the politics out of it.

  We are seeing continued evidence that pregnant women who get vaccines are protecting their fetuses, and those who get sick can harm their babies by increasing low birth and early term births, which have their own problems.

  The FDA and CDC committees unanimously recommended the vaccine, realizing that there are still many questions for parents but is safe with such a small dose in each shot. Experts agree, like most vaccines, they only prevent more serious disease. Parents need to discuss with their pediatricians, and receive the shots in their offices, not in a pharmacy or grocery store. They make it very clear that the 3rd dose of Pfizer is necessary to prevent Omicron.

   The administration while they have yet to spend near the money allocated for this pandemic, are discussing requesting $billions for the next pandemic!! Spend, spend, spend!!

 

Teachers and children still suffer

  Unfortunately, many teachers are fed up with the politics and it is predicted that 300,000 teachers will be taking early retirement or changing jobs. They are burning out thanks to the CRT and woke ideologies being pushed by the radical liberal advocate teachers.

  Children have suffered so much over the maneuvers created over the pandemic. Will this now create problems for mothers finding daycare, pre-school, etc. if they don’t want their child vaccinated. Will these children be brainwashed with CRT, gender awareness, and woke ideologies as we try to get back on track?

  The government is no longer testing international travelers but require identification, etc., while 2000 illegals cross our borders.

 

Natural immunity still not recognized

  The feds still do not acknowledge that natural immunity has its benefits, and only one vaccine dose is all they need to be even better protected than those with all the shots and no infection. They could be considered fully vaccinated and not get fired over a mandate. And yet, the government considers them as vulnerable as unvaccinated people.

 

Lying, Gimmicks, and Misinformation

  This is our leader’s cheat sheet for a conference. Is it just me or is this telling you something??

The misinformation and plain lying from the administration (and media) about what is going on in this country is astounding regarding inflation (1.4% when Biden was elected and now 8.6%), economic disasters, the energy crisis, a recession impending, causing the record gas hikes and shortages for food, products, and medicine.

  Gimmicks such a gas tax holiday and gas cards to address the record high gas prices is just a bandaid for a massive problem. The prices are dropping slightly, but after the elections, watch out if not before.

  If our country could just get to work on the current issues, maybe we could concentrate in time on climate issues, but not now. BTW, we have Russia, China, and Iran breathing down our necks. Our country has not been this vulnerable since WWII.

  Most experts admit the $13 trillion spent because of the pandemic is the primary reason for inflation, and with those stimulus checks sending our workforce to the couch, it encouraged a work shortage that has yet to recover. Socialism continues at every level.

 

Crime all time high

  Crime comes with injury and death, as it is at an all time high, encouraged by insane police reforms from state and local governments with unfunding, reducing pay for police, and smashing their self esteem and confidence. Their competency has been challenged and most departments are desperate for new recruits as so many are retiring or moving to a state where they are respected.

  Fear in major cities continue to create mental health issues for our residents, especially in poor neighborhoods.

 

  Some in the judicial system have become corrupt. Liberal judges and district attorneys are letting criminals out of jail only to see them commit more crimes. Why??

 

Gender identity emphasis

  In some minds, it is more important to discuss gender identity than protecting unborn children. However, the abortion decisions are now in the hands of the proper authorities (states).

  Male transgenders are being allowed to compete in female sports events causing a huge problem for women’s sports.

  Most people support sexual preference, but why does the administration have to make it such a political issue?

  The latest claim for wokeness comes to schools who are accepting federal funds for lunches. If the school does not allow LBGTQ teachings in the class, they could lose their funding for lunches.

  The entertainment industry is trying to force feed us on alternative life styles. It is a personal and private decision, and no amount of media is going to force people to change their opinion about it.

  Have you heard about the “Privileged Walk” exercise happening in our schools? Pure indoctrination about some having more than others and causing anger in those with less. One more method to divide us.

  Look it up and realize the malignant methods of critical race theory, white supremacy, and the socialist, Marxist movement happening in all levels of education? The significant segment of the youth of our country is all in!! Are they our future?? Are their parents addressing these issues? Respecting people is critical, but forcing these new concepts in gender identity is being met with considerable concern.

  Why don’t we have congressional term limits ridding us of the “old guard” and those who forgot they were elected to serve us, not the reverse. That goes for both sides!!

 

Equity vs Equality; Global Warming and climate change  

  We must be aware that equity is not equality.  They are very different words and concepts. This term is being overused in our liberal academic medical journals more and more as it is already in most college curricula. Everyone deserves the same opportunities, but it can’t be handed to them….that is defining the concepts of equity. Look what is happening in the field of advertisement on TV!

  We all deserve good health, access to care, and top of the line care, but patients must do their share in maintaining their health, following doctor’s orders, and takng their medications properly. If we don’t get our act together, the healthcare in this country is going to suffer greatly.

  It will take until 2050 to transition to electric transportation, and by the way, coal is required to produce electricity to supply energy to every charging station, which is only at a infant stage. We must address this sanely rather than crippling our country trying to go green.

  The medical journals, now that they have exhausted articles on COVID, are falling suit to many of the academicians in medicine and national medical groups already pushing socialized medicine with numerous opinions and conversations about climate change and health, diversity and how it is so abused in medicine, etc.

  Global warming is being pushed hard by the WHO (World Health Organization) and has been used by the socialist liberals to force our country to become a globalist society, a major objective of a socialist, Marxist world.  

  Climate change, as we all know, is the engine driving the socialistic, Marxist movement globally. Expect to see enormous attention regarding this issue in this year and the next few years.

  The attempt for the leftist movement is also to divert attention from the enormous tragedies we are experiencing in this country. I think most people are more concerned about putting food on their table, having a job, a home, paying for gas, raising their children, than major weather occurrences around the world that has been going on since time began.

 

Baby Formula

  Mothers are looking for baby formula, thanks to the incompetence of Big Pharma companies and lack of proper surveillance by the FDA. Federal controls have their place, but they forget they work for us!! It is still a serious issue, and will be months before the shortage ends.

  Abbott’s voluntary recall in Sturgis, Michigan, of specified lots of powder formula sure brought the industry to their knees, when so few producers are in the U.S.  Same old story!! In the meantime, they are shipping millions of Similac Advance Formula from Ireland. The bacteria that was found in the plant was never found in the formula, only on some of the surfaces in the plant. They could have been back in production  if it had not been for the FDA not completing their investigation, which took over 2 months.

  4 infants in different states had the illness, but their formula was not tested. 2 died and the 2 other were quite ill with the specifc bacteria, Cronobacter sakazakii. A naturally occurring bacteria in the enviornment. The CDC said it found no match between bacteria samples from 2 of the sick infants. The production was stopped out of pure precaution by Abbott Labs.

 

 Medical professionals are suffering

   Our overworked practicing doctors and nurses are burning out and retiring early thanks to lack of support from the federal government with doctors and hospitals spending much more to keep their doors open without increased reimbursement for services. Remember Medicaid for all is what socialized medicine will bring us.

  The medical journals have become so “woke”, it is ridiculous. An editor gets to choose what articles get published. If it has anything to do with social equity, racism, economically disadvantaged, pushing the vaccine (and rarely anything about side effects, and failed treatments), it is accepted instead of other very qualified research submissions.

  This month, there is even an article about the “green operating room”. How clean and efficient do they need to be?

  This administration will do anything to divert attention from the “elephant in the room”. Voters will answer those attempts.

 

Obesity and diabetes continue to rise

  The weight of the average American continues to rise with obvious health care deterioration including the epidemic of type 2 diabetes, raising our healthcare costs, and were the 2 most important risk factors in being hospitalized with COVID-19. These medical issues are certainly more deserving of our solutions than global warming in the U.S.

 

  One final note…Dr. Fauci has COVID-19, after 2 doses of vaccine and 2 boosters, and is fine. He, you will recall, stated the vaccine would stop COVID. He needs to retire, as he is 81 and if everything comes out about the origin of COVID nd his involvement, his reputation is gone.

  This is my humble opinion and am open to other points of view.                 

                                                                 Dr. Sam

 

5. Social Security is not so secure!

   Medical Insurance Companies under scrunity after major number of denials for medical services

 

  A. Social Security

  Social Security is 86 years old and it’s financial security has never been less secure. Less than 7% of retirees have steady income from the 3 main sources—pensions, savings, and Social Security, according to the National Institute on Retirement Security.

  In 2020, 57% of Americans were not confident about the future of SS, and younger people are even less confident about the plan.

  SS has been one of the most successful anti-poverty programs on this country.

  Not only does the program provide monthly income to individuals but also provides income for surviving spouses and their children. Social Security Insurance helps pay the monthly bills for qualified disabled workers and their families, which include people under 65—6.9 million adults and 1.2 million children.

  Most of us have been sending SS funds to the federal government since our first paycheck. Unfortunately the annual payments to Americans are larger than the annual tax collections, and it will be out of money in 12 years (2034). With incoming revenue, SS will only be able to pay 78% of promised benefits.

  That makes most of us quite angry, since our tax was 12.4% of our gross income if a person worked for yourself and 6.2% for those who were employees. The worker pays payroll tax on wages up to $147,000, which would be $38,200 for the self employed.

  To date, additional revenues collected by the government and not paid out to beneficiaries go into a trust, now totaling $2.9 trillion, which will be needed when tax revenues are not enough to cover the payouts. Unfortunately, that time has come, and will be depleted by 2034. Because of the Boomer generation (70 million), the number retired by 2034 will be double that number.

  We have lived longer than any previous generation and therefore drawing money from SS for more years.

  The nation’s birth rate continues to decline, except for the people coming over the border, and that means fewer people paying payroll tax.

  However, in 2034, 78% of the SS check will still be sent.

  Those born after 1981 don’t think there will be a SS.

  What will Congress do to keep SS flowing—raise taxes and change benefits? This can be helped by raising the cap on $147,000 in gross wages. The payroll tax could be raised from 12.4% to 14.4%.

  If all state public employees had to pay SS, that would help greatly, since many do not pay into SS.

  Certain forms of income are not counted and that could be changed. The payments to the beneficiaries could be adjusted based on wages, wealth, or income. Currently, the IRS only looks at taxable income, and I have many friends who easily get around that.

  New recipients could be paid less. The administration could adjust the “cost of living” amount, which is less than our current inflation rate, a very unpopular idea. Another adjustment could calculate the amount Americans receive on 40 years of income rather than 35 years.

  Right now you can start receiving SS at age 62 with a reduced amount, which could become lower, etc…. all just being considered.

  12% of men and 15% of women depend on SS to survive, and 37% of men and 42 % of women depend on it for 50% of their monthly income.

  65 million Americans receive SS, and the average check in 2021 was #1,555 a month.

This report came from excepts from AARP.org, March, 2022, article on the status of SS.     

 

  B. Medical Insurance companies under scrutiny after denying access to major numbers of medical services, especially Medicare Advantage(MA)

  Medicare Advantage(MA), essentially the HMO form of Medicare has been routinely denying access to medical services. Understand that MA does have a PPO form for more cost.

  HMO (health maintenance organization=requires a primary doctor and referrals to see a specialist, preferably in a network of doctors; going out of the network costs much more).

  PPO(Preferred Provider Organization=no primary required and seeing a specialist does not require a referral; any provider who accepts Original Medicare can be seen in a PPO.   

  The American Hospital Association has sent a letter to the U.S. Department of Justice asking to investigate as many as 18% denials of requests for medical services normally approved from the Medicare Advantage program. This is also happening routinely in many private insurance companies.

  As usual, it will be months if not years to create and get action from a Task Force to address denials of services and payments for medical services. This came after a report from Health and Human Services.

  Physicians have been complaining for years about denials for legitimate services normally covered. I had the same experience when I was in private practice, and obviously took more of my time to work through the red tape for my patients to be covered. It was not uncommon for an insurance company to call me and deny coverage the day before surgery, causing loss of income for me and a tremendous disappointment for my patients.

  These denials have caused medical harm to many needy patients, and it is time that the insurance industry needs a thorough investigation and resolve this terrible issue that is longstanding and appears worse in the federal program Medicare Advantage.

  Big companies are trying to cut costs and make more money across the country at the expense of our patients.

  The fact that we are in one of the worst inflationary period in decades with the energy crisis creating tremendous delays and shortages across the country has aggravated a long standing inadequate insurance industry trying to make more money for their stockholders at the expense of patients.

  Currently there is a crisis with insurance companies and roofing in Florida, and the results of this economy continue to create more and more devastating consequences for businesses and the public.

  If you think issues like this won’t worsen if socialized medicine comes in the near future, you are not informed. Do not support socialism if you want consistent healthcare and a country you can be proud of.

  46% of beneficiaries of Medicare are now using the private plan of Medicare Advantage (because it is less expensive) and the rate of enrollment is rising rapidly. By 2025, it will be the predominant type. This will diminish the quality of Medicare, in my opinion, often requiring high deductibles and copays.

  There are serious differences between Original Medicare and Medicare Advantage, especially for patients needing specialized care not commonly available everywhere. That applies to cancer patients, those with rarer diseases needing referral to a major center away from the routine network raising unaffordable costs.

  It is critical to steer away from those Joe Namath commercials flooding the TV, and select a local insurance person specializing in Medicare. For now, I recommend the website below as a starter. www.boomerbenefits.com/original-medicare-vs-medicare-advantage/

  These plans are very different and the prices vary greatly. However, the basic Medicare Advantage is much less expensive for people who are healthy, younger, and do not have underlying health conditions that could require specialized care. Copays and deductibles vary widely, but basically you get what you pay for.

  With major number of denials of services by insurance without any rapid resolution, this is very concerning, and may affect all insurance companies especially Medicare. Mark my word, Medicare for all proposed by Bernie Sanders (and originally Obama) and the radical left will be Medicaid for all….trust me on that.

 

   

6. FDA closer to banning menthol in cigarettes and tobacco products

  Cigarette smoking remains the leading cause of death in the U.S. The U.S. spends $300 billion on smoke related illness. 12.5% of Americans over the age of 18 smoke, while blacks in high school smoke 14.4% exceeding all adults, but the good news is it has dropped from 21.5% in 2005. The military still has 21.3% smoking, while 29.5% use some form of tobacco regularly. Sadly 11% of pregnant women smoke. Those with reported mental health conditions have 27.2% smoking, which is very concerning with the rise of drug and alcohol abuse in our country. 19.8% of disabled people currently smoke, so we still have some serious work to do.

  It has been over a year since I first reported that the FDA was in the process of considering banning menthol in tobacco products.

  Menthol has been prohibited in England since May, 2020 and in Canada in 2017.

  The JAMA Network reported that since the ban in England, the rate smoking has dropped from 12% to 3%.

  Menthol containing cigarettes in the U.S. are still legal and account for 36% of cigarettes smoked in the U.S.. Females (10%) and Blacks (60%) smoke more mentholated cigarettes than males (7%) and whites (31%).

  Youth smoking in England smoked menthol cigarettes in 12% of the cases and dropped to 3% after the ban.

  Scientific studies have demonstrated that the same drop in overall smoking in the U.S., if the FDA bans menthol especially in youths.

  Menthol is chosen to reduce harshness of the smoke, and increase taste, and allow deeper inhalation and more absorption of nicotine, which tends to addict the smoker faster.

  Youth smokers tend to be more addicted if smoking mentholated cigarettes potentially increasing youth smoking.

  Statistics have proven that menthol use increased frequency of use.

  The FDA has committed to banning menthol in cigarettes and cigars to reduce frequency in all smokers but particularly in the youth, where we still have a chance of preventing life long smokers.

  Mentholated snuff and dip apparently will be unaffected. The ban will include encapsulated smoking which includes vaping. There is no reason to believe that similar drops in cigarette smoking and perhaps vaping will occur in the U.S. as it did in England.

  The drops in cigarette smoking in England remained the same after a year of the ban. 

JAMA Network, April 23 and May 3, 2022

CDC

BTW, I think it is ironic that there is discussion about taking nicotine out of tobacco as well, when fentanyl and other illegal drugs are killing over 105,000 Americans a year, mostly 18-45. And also the harm of tobacco is not nicotine, it is the tars and carcinogens.

 

This concludes the July, 2022 report!

 

The August Medical News Report will include:

1. Autoimmune Diseases Series—Part 7—vitiligo, PMR-polymyalgia rheumatica and temporal arteritis, atopic dermatitis-eczema

2. Childhood adversity and how it affects illness and the death rate them as adults

3. Blood and blood products

4. Ob/Gyn Series—Part 4—Post-menopausal effects from early removal of the uterus and ovaries

 

The country is suffering and so is our healthcare system. We must realize what is at stake for the future of our country and voice our opinions with our votes. Stay healthy and well, my friends, Dr. Sam