Category Archives: Solutions

Brief: WebMD publishes a very useful interview on the link between talcum powder use and cancer

It has been a busy couple of months for me, with several projects that have required juggling, so I have not been able to post anything on Women’s Health issues. However, given the most recent verdict against Johnson & Johnson on a case filed by a woman with Ovarian Cancer, resulted in Millions of Dollars being awarded to her.

Any time this happens, of course, it causes a stir, as it should. However, I am not going to spend time on this post talking about the merits of courts allowing companies like J&J and many of the drug companies try to get away by not fighting lawsuits as a class, etc. Those discussions are for my other blog, and will go on for a long time. Plus, in this case, we cannot prove a causal relationship between talcum powder use and cancer, yet.

So, I want to touch very briefly on three takeaways from the interview, and suggest you get the rest from the horse’s mouth:

  1. Correlation is not always a result of causation. We may never find lasting proof that talcum powder use causes cancer. This is an important thing to remember.
  2. There appears to be no medical benefit at all from using talcum powder.
  3. So, given the correlation and the lack of any benefit, it is best to stop using talcum powder! This is what the Doctor interviewed in the article suggests! Sound advice, it would appear!

Please read the rest here: http://www.medscape.com/viewarticle/884700?pa=Vor1qEPNxHeNOj5AKsX1Hl55HifEoXQauwdv%2BVDi5uqIdvEbMsfStGAJbHUGqkcC8SIvl8zjYv73GUyW5rsbWA%3D%3D

Image, Courtesy, Pexels: https://www.pexels.com/photo/rear-view-of-woman-with-arms-raised-at-beach-during-sunset-320007/

Endologix Study on AAA treatment for women shows promise

In the past, I have written about how studies on devices and drugs seem to lack focus on women, for several reasons. Reasons range from a poor understanding of the differences in male and female anatomy and physiology, poor access to healthcare, lack of awareness and efforts to enroll women, and lesser demands for evidence from journals, insurers and other healthcare stakeholders. I previously posted about Boston Scientific’s efforts to enroll more women, and now, here is another positive study from Endologix.

Enrolling women, or studying the effects of devices, procedures and therapies exclusively in women go further than improving medical knowledge, when successful, they can also make for sound business sense, regardless of the risks and expenditure.

AAA – Abdominal Aortic Aneurysms 

The aorta is the main artery that supplies blood to most of the body, and in the abdominal region, it splits into two arteries that supply blood to the pelvis and legs. Due to smoking, high blood pressure and/or other risk factors, the aorta can come under pressure and enlarge, and eventually burst, which can cause hemorrhage and death, if not operated on immediately. Aneurysm also presents with a lot of pain, and the risk of rupture when the aneurysm reaches a certain size, requires surgical correction and grafting/stenting.

 Open Vs. Minimally Invasive Repair

There are two ways an abdominal aortic aneurysm is surgically treated – open surgery and minimally invasive repair through a groin incision. Both surgeries have approximately the same effectiveness, but open surgeries can take a long time to recovery, while minimal surgeries requires numerous post-surgical visits to ensure no leaks or other morbidity is present. However, eligibility for surgery varies.

Learn more about Endovascular Aneurysm Repair (EVAR)from this brief video (note that Cook Medical provided a grant towards the video):

The Endologix Lucy Trial

Endologix, which has developed a stent for AAA treatment, enrolled 225 patients, 149 male and 76 female. They claim that, with their stent, termed the Ovation® Abdominal Stent Graft System, increased eligibility for women by 28%.

Besides claims that the device reduces mortality and is better suited for women, the study is also the first to study the effects of the device and surgery on women. Women are at a lower risk for AAA, but the outcomes are worse for women treated through EVAR or through open surgery. I found a study that confounded this outcome difference, however, the study was not specifically well designed to study gender differences. However, it is clear that anatomical differences remain, and thus drive the variability in outcomes, and this is potentially why the Endologix device claim makes sense.

The results Endologix has presented, are of course, initial results based on the 30-day follow up period common for EVAR, and observations over long term will yield more confidence in the device’s ability to treat women better.

However, as I mentioned earlier, it makes for good clinical sense and business sense to enroll more women in clinical trials, and the Lucy trial is one more step in the right direction!

References:

  1. The MASS Device Article: http://www.massdevice.com/endologix-touts-30-day-data-study-ovation-stent-graft-women/
  2. A Business Wire write-up by Endologix: http://www.businesswire.com/news/home/20170531006467/en/Endologix-Reports-Positive-Clinical-Data-Ovation-LUCY
  3. A large, open-access study on gender based outcomes: http://www.jvascsurg.org/article/S0741-5214(12)02188-X/fulltext
  4. A Mayo Clinic Overview of AAA: http://www.mayoclinic.org/diseases-conditions/abdominal-aortic-aneurysm/home/ovc-20197858
  5. Society for Vascular Surgery on AAA Repair: https://vascular.org/patient-resources/vascular-treatments/endovascular-repair-abdominal-aortic-aneurysms#whyitsdone
  6. Image courtesy, Pexels: https://www.pexels.com/photo/woman-water-girl-lake-134670/

 

An ancient imaging system proves to be an amazing cure for infertility!

Towards the end of the work week, Medical News Today revealed a story that looks like a miracle and something out of science fiction simultaneously. Infertility is a huge problem, with expensive, whose treatments are temperamental to say the least, fraught with emotional travails for families and other complicating issues.

And now, a single study appears to upend the problems and probably offer a simple, cost effective solution that will beat infertility right out of the cliched ball park! It is probably imprudent to get so excited, but it is hardly resistible.

Old techniques have gotten a second look in the past. Some of these techniques were trial and error prone, and many times the underlying science has not been understood. Renal Denervation is one such technique. With a surprising and incredible purchase of Ardian by Medtronic, it caused a frenzy, only to be let down by a poorly designed clinical trials. I have seen similar comebacks on old studies that controlled the Over Active Bladder condition. Therefore, one should look at any revivals of old techniques with ample caution.

Interesting Coincidences

Dr. Ben Mol, a Professor at Australia who spearheaded the study into an age old imaging technique as a possible treatment, appears to have been conceived as a result of this imaging treatment and has a younger brother! It seems remarkable that he started research intot his technique even before being made aware of his own history and relationship with the technique. Please refer to the MNT link below for more on this.

The Technique – Hysterosalpingography (HSG)

The technique, whose name is a mouthful, simply refers to imaging of the hystero, the uterus and salpingo, the fallopian tube. It was first carried out exactly 100 years ago, in 2017, just a few years after X-rays came into existence.

The procedure itself is a dye test, performed under X-ray. Water or oil are used to flush the Fallopian tubes. It is the flushing that appears to have aided fertility. In view of this notion, Dr. Ben Mol and others led a study with 1119 women, that produced interesting results.

The Study

The study, titled H2Oil was held in Netherlands, and as mentioned before, recruiting 1119 women, approximately half received HSG with oil, and as MNT put it, Lipidoil Ultra-Fluid, an iodized solution of fatty acids derived from poppy seeds.

The other half received HSG with water.

The Results

Nearly 40% of the women in the oil group, and 29% in the water group all conceived within 6 months. This is an amazing result. It shows immense promise.

Of course, more needs to be known, as I mentioned before. An underlying understanding of science, safety of flushing fallopian tubes and other important, fundamental considerations remain. However, for women and families struggling with infertility, this study shows great promise.

References: 

  1. The MNT Article: http://www.medicalnewstoday.com/articles/317532.php
  2. The NEJM Publication: http://www.nejm.org/doi/10.1056/NEJMoa1612337
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/close-up-of-hands-holding-baby-feet-325690/

A truly elegant innovation helps menstruating women in India

South Asian Woman

My goal with gyn.io is to highlight women’s health issues and relevant solutions. What better way to do this, than to talk about a truly remarkable gentleman, Mr. Arunachalam Muruganantham, with an equally amazing innovation. I am thankful to my friend Tania Marker for having shared this news with me. Her main motivation in doing so, is that Arunachalam is from Coimbatore, India, my hometown, which only makes this all the better!

I am a little peeved that I had not heard about this gentleman before, but I am not wholly surprised, as, in the article linked below states, menstruation is not discussed well in India, and has quite a bit of stereotyping and taboo around a very natural process.

From understanding the need for sanitation during menstruation, to obsessing over a solution, and discovering that sanitary napkins are made with cellulose and figuring out how to get it right, this is an incredible story of ambition, persistence and of course, innovation!

Hats off, Arunachalam!

Reference: 

http://www.pbs.org/newshour/bb/innovator-trying-make-sanitary-pads-affordable-women-india/

Image, Courtesy: 

https://www.pexels.com/photo/colourful-india-wedding-indian-16154/