Better Health Care Newsletter – February 2024 | Patrick Malone & Associates P.C. | DC Injury Lawyers

We all want to look attractive: to family, friends, and lovers. But there is such a thing as trying too hard to buff up our appearance, and in this Valentine’s month, some full disclosures on the perils of cosmetic solutions might be timely.

The problem is not just with dramatic, and expensive, makeovers like cosmetic surgery. Even everyday, seemingly benign substances that we place on or in our bodies can be problematic.

Everything we put on or into our bodies carries risks. These show up in over-the-counter hair straightening potions that may be cancer causing, or in routinely purchased eye drops that aim to deal with redness, itchiness, or irritation but can trigger infections.

The perils can be more pronounced when consumers seek cosmetic, or “life extending” interventions of a medical sort in spas, health clubs and gyms. And still more perilous can be the decision to undergo the surgeon’s knife.

How about living longer by having your whole body scanned in an MRI machine? Like beauty, the chase after longevity turns out to be elusive.

Listen up, Valentines. Those who are truly sweet on you appreciate you for what you are and as you are. If you doubt that, do them the favor of thinking twice about some of the following attempts at tinkering with your looks and well-being.

Medical experts are starting to underscore for people of color, especially black women, that efforts to straighten their tresses can cause real health distresses.

The pomades that many African Americans dress their scalps with to relax or take out the curl, wave, or kink contain toxic chemical substances like formaldehyde. These treatments — long known, too, for containing irritating or even scalp-singeing substances like lye — have been linked to cancers. As the National Institutes of Health reported of recent research on this issue:

“Women who used chemical hair straightening products were at higher risk for uterine cancer compared to women who did not report using these products, according to [an NIH study published in late 2022]. The researchers found no associations with uterine cancer for other hair products that the women reported using, including hair dyes, bleach, highlights, or perms. The study data includes 33,497 U.S. women ages 35-74 participating in the Sister Study … that seeks to identify risk factors for breast cancer and other health conditions. The women were followed for almost 11 years and during that time 378 uterine cancer cases were diagnosed. The researchers found that women who reported frequent use of hair straightening products, defined as more than four times in the previous year, were more than twice as likely to go on to develop uterine cancer compared to those who did not use the products.”

Uterine cancer, the NIH experts noted, “accounts for about 3% of all new cancer cases but is the most common cancer of the female reproductive system, with 65,950 estimated new cases in 2022. Studies show that incidence rates of uterine cancer have been rising in the United States, particularly among black women. Approximately 60% of the participants who reported using straighteners in the previous year were self-identified black women, according to the [NIH] study … [It] did not find that the relationship between straightener use and uterine cancer incidence was different by race, the adverse health effects may be greater for black women due to higher prevalence of use.”

Other increases in cancer risks

The NIH research findings add to related concerns for black women as the National Cancer Institute has reported in a 2023 online posting, which noted this:

“In the U.S., black women with breast, ovarian, uterine, and endometrial cancers have worse outcomes than white women due to lower health care access and more aggressive tumor biology. NIH-funded research has contributed to our growing understanding of how harmful beauty products might contribute to some of these hormone-related cancers among black women. For example … The Women’s Circle of Health Study described an association between use of hair relaxers and hair dye, specifically dark hair dye, and aggressive breast cancer risk in African American women. The Black Women’s Health Study observed an association between use of hair relaxers containing Lye and aggressive breast cancer risk in African American women. The Ghana Breast Health Study found an association between use of hair relaxers and breast cancer in women of African descent. Important efforts are under way to better understand the contents of these products (such as endocrine-disrupting chemicals), which are often used throughout a woman’s life, and variations over time and across populations worldwide.”

Chris Rock — before his Oscars dustup with actor Will Smith over a joke the comedian made about Smith’s wife, Jada Pinkett, and her shaved head — explored the beauty industry and African Americans in the Netflix documentary Good Hair. The film quotes experts and prominent African Americans in dissecting the huge pressures that black people have struggled with to alter their appearance to gain acceptance in a white-dominated society.

Because February also is Black History month, this might be an ideal time for Americans to swear off a negative racial legacy of people putting their health and well-being at risk by trying to conform to perceived societal norms.

By the way, excess stress on the scalp and hair also plays a role in the unnatural form of hair loss known as alopecia, experts say, noting this condition is unfortunately too common among black women.

Party too hardy the night before? Spending too much time poring over stuff online? Or just want to have fresh, sparkly eyes for someone special?

Whatever your reason for taking eyedrops, you need to exercise common sense and caution about over-the-counter remedies for red, dry, itchy, and irritated eyes.

Millions of Americans learned the hard way that popular, convenient remedies are not risk-free. The federal Food and Drug Administration throughout 2023 ordered off the shelves more than two dozen eye drops and gels sold in popular spots like CVS, Rite Aid, and Target and by the Leader, Rugby and Velocity health services and pharmacy systems.

The drops were pulled off shelves after federal inspections found unsanitary conditions and testing detected bacteria in manufacturing sites.

Officials warned consumers to stop using two products, the New York Times reported, “EzriCare Artificial Tears and Delsam Pharma’s Artificial Tears after the eyedrops were linked to a drug-resistant strain of the bacteria Pseudomonas aeruginosa. As of May 15, infections from this bacteria strain had caused at least four people’s deaths, vision loss in 14 others and the surgical removal of four people’s eyeballs.”

The agency acted again at January’s end, warning consumers against knockoff eyedrops, sold online and carrying the names South Moon, Rebright, and FivFivGo.

The products, which also are supposed to help with redness, make unfounded, unapproved claims to treat serious eye conditions for which prescription medications are required.

The agency said its tests found bacterial contamination in one of the medications and that two of them lacked the active ingredient of the branded product from a mainstream manufacturer. The FDA cautioned consumers against the risks of buying drugs online from unknown makers who offer products with big claims and lookalike packaging.

Many consumers incorrectly assume that OTC products carry zero risk. Not true, as a USA Today article reported:

“In 2022, U.S. consumers purchased 149 million eye care products at a cost of nearly $1.6 billion. Even though millions of consumers use retail eye drops, the market is ‘largely self-regulated despite these products’ potential for serious injury,’ according to a viewpoint published … in the Journal of the American Medical Association Ophthalmology. Timothy Milton Janetos, an assistant professor of ophthalmology at Northwestern University and co-author of the JAMA Ophthalmology paper, said the vast majority of eye drops sold over the counter are safe. He said the challenge for both doctors and consumers is evaluating the less than 1% risk that an eye drop is contaminated …

“Prescription drugs are routinely vetted for safety and efficacy before they get FDA approval, however, over-the-counter drugs don’t get a similar review before they land on store shelves. Over-the-counter drug manufacturers must follow FDA requirements for ingredients, uses, doses, labeling, testing and instructions for administering. Because the agency does not approve these drugs before they are sold on the market, ‘it is the responsibility of the (drug) manufacturers to follow the guidance … rather than the FDA to enforce it,’ the JAMA Ophthalmology paper said.”

If in doubt, those with irritated eyes — and the numbers grow due to allergies, pollutants, and other common factors — should talk with medical professionals (opticians, ophthalmologists, and pharmacists, for example) about treatment. They may prescribe medications or discuss suitable OTC products from reputable vendors, the Washington Post reported.

They also can provide helpful suggestions about avoiding irritants like smoke from various sources, caring for allergies in broader ways (rather than treating the eyes alone), and preventing eye strain, including wearing proper eyewear and taking frequent breaks from electronic screen time. The eyes provide invaluable diagnostic information about patients’ overall health — and they should not ignore red, bloodshot, or irritated eyes that can be warnings of serious conditions.

Augmentations. Enhancements. What lovely, benign-sounding terms. Just how long did it take profit-minded surgery marketers or pill- and injection-promoting opportunists to latch on to words like these to hype dubious or risky procedures and treatments targeted at patients’ purported sex appeal and performance?

For women, elective surgery to change the size and shape of breasts and backsides persists in popularity — even as alarms grow about the health damages that the procedures can cause.

Men are not immune to dicey treatments to increase their levels of the sex hormone testosterone, supposedly to boost their vitality and virility.

Breast cancer sickens and kills too many women, though its treatment, experts say, is steadily improving. It is considered a key step for women to discuss fully reconstructive procedures as part of post-operative care and to decide if it is a workable option.

The case is far, far less convincing for elective breast surgery, based on the evidence. While augmentation procedures still are among the leading plastic surgeries in popularity among patients, medical researchers and the federal Food and Drug Administration have steadily raised the alarms about the operations and various kinds of implants.

The devices are not meant to last a lifetime. Women have learned, painfully, that they can face more invasive, expensive, and painful operations to replace, remove, or repair their initial breast surgery and implantation. They may end up disfigured. They may suffer infections and cancers. The FDA’s latest update on this surgery, which went up on the agency site in December, offers stark, sobering warnings to patients.

Deadly derriere decisions

Do such expert cautions matter? They seem to take time to penetrate public consciousness, as the harsh descriptions about the so-called Brazilian Butt Lift show. The medical news site MedPage Today posted online a recent news article containing this terse observation about the procedure to increase and reshape women’s posteriors:

“In surgical circles, the Brazilian butt lift.. is known as the deadliest aesthetic procedure ever performed, and despite several calls to improve outcomes, recent data suggest mortality is only getting worse — especially in South Florida. Sunny, image-conscious Miami is home to a substantial proportion of the country’s high-volume, low-cost clinics where U.S. patients flock for the procedure. Despite widely publicized deaths and changes in rules about performing the procedure in Florida, researchers say it’s still causing harm … The Brazilian butt lift became popular over the past two decades, with procedures surging more than 800% over the last decade alone, from 7,382 in 2011 to 61,387 in 2021, according to data from the American Society for Aesthetic Plastic Surgery.”

The medical news site explains why many experts assail the surgery for the dangers it poses to patients:

“During [the procedure], a surgeon uses liposuction to remove fat from the abdomen, flanks, or back of an anesthetized patient. The surgeon then uses a syringe attached to a cannula to reinject or ‘graft’ the reserved fat into the buttocks. The cannula is inserted repeatedly deep under the skin, fanning out from a few small incision points to distribute the fat across different areas. It’s known as a ‘blind’ procedure, and surgeons can inadvertently injure the large vessels in the muscle or even inject fat directly into those vessels if the cannula goes too deep. The fat can travel via the bloodstream to the heart and lungs, and deaths from such a pulmonary fat embolism can occur within hours of the procedure, or even on the operating table. Sometimes, this has happened when a patient was turned from a prone to a supine position on the operating table, putting pressure on the lower buttocks …”

Medical examiners in South Florida and researchers are trying to assess fully the mortality rate for Brazilian Butt Lifts, but one expert put the issue succinctly. He noted that even one fatality can make an elective procedure unacceptable, telling MedPage Today: “Remember, no one ever died of skinny buttocks.”

Risky Rx for men

As for men and their choices with supposed sexual enhancement, these are not surgical but pharmaceutical. And they too often are not good, experts say.

They warn that guys can put themselves and their heart health in harm’s way by popping pills for erectile dysfunction (a prescription so engrained in U.S. life that it amounted to an estimated $3.2 billion spent in 2023 alone) or by seeking trendy treatments for supposedly low levels of the male hormone testosterone (low-T care).

The ED drugs can interact with other prescription medications that the typically older users are taking, leading to sudden and dangerous falls in blood pressure. Although these meds may be helpful to users, they also may, if obtained without a careful health exam and perhaps by online and overseas vendor, mean that men with heart and health problems don’t get checked fully by a doctor or helped with conditions that cause ED.

Sellers of ED meds and low-T treatments often push their products through video appointments with doctors willing to simply ask a few questions and then prescribe.

This can get sketchy, as MedPage Today reported regarding the flourishing telehealth prescribing of testosterone:

“There’s evidence that a number of online testosterone clinics have inappropriately prescribed the hormone via telemedicine to men who don’t need it. A recent article in JAMA Internal Medicine reported that six out of seven direct-to-consumer, online-only clinics prescribed testosterone to an undercover urologist, even though he had normal levels of the male hormone and didn’t warrant treatment under American Urological Association and Endocrine Society guidelines.”

The medical news site also explains the fad for testosterone:

“The low-T craze began in the 2000s as marketing campaigns urged men to consider testosterone therapy to restore their vitality and virility. In some cases, men went to their regular physicians for help and found it: A 2018 study examining commercial insurance data found that the percentage of men age 30 and older who took testosterone grew from 0.52% in 2002 to 3.2% in 2013, ‘mostly in men without a clear indication.’ The level later dropped to 1.67% in 2016 amid concerns about cardiac risk from testosterone use. Other men bypassed their own physicians and sought testosterone from low-T clinics that popped up across the country. These clinics hawk the hormone to men who believe their levels are too low, not as a component of gender-transition therapy.”

Medical experts quoted in the news article warned that boosting testosterone levels can increase heart problems in some men (a warning that federal regulators require in part of the packaging for the prescribed hormone). They also caution that online vendors have treated men not only with the hormone itself but also with other substances known to boost testosterone levels. These carry their own sometimes significant risks.

Federal regulators are trying to determine their oversight of telehealth in general, especially as this service proved popular during the coronavirus pandemic. This, experts say, has restrained a needed crackdown on improper low-T online prescribing.

Hospitals, clinics, doctor’s offices, and other traditional sites for medical care struggle mightily to safeguard patients. They do so by spending a lot of time, money, and other resources, and by using highly trained personnel. Still, despite their best intentions, patients can experience harm, injury, and death.

Knowing this, why are increasing numbers of Americans willingly subjecting themselves to risky procedures in places with no history or culture of patient safety? These include so-called med spas, hydration clinics, gyms, and fitness centers.

These outlets, claiming to boost customers’ health, well-being, and looks, fill their clients — by injection into muscles or veins — with purported vitamins, “fat melters,” hangover remedies, and more.

In some places, estheticians with basic cosmetology training and scant knowledge about best medical practices are administering powerful agents like the nerve toxin Botox. They do so under the purported supervision of doctors, who may or may not even be on site. This also may laser patients’ skin and employ harsh peeling agents.

NBC News reported that medical safety experts are expressing alarms about the once-novel but steadily expanding procedures that consumers, mostly women, undergo at med spas and hydration clinics.

“The number of med spas and hydration clinics has ballooned in recent years, turning into a $15 billion wellness industry offering a variety of services, from IV therapy to skin care and cosmetic procedures. Federal health officials and representatives of med spa owners warn consumers that, along with the boom, some facilities are using unlicensed workers to inject unapproved products in unsanitary conditions.

“It’s difficult to know how many people have been injured at med spas, because the infections often are not reported to local or state health departments. But some infectious disease and emergency room doctors say they are seeing more adverse reactions associated with the facilities.”

The Wall Street Journal reported that trendy gyms and health clubs — and soon to be copied by their mass-market counterparts — have catered to the wellness-, longevity -, and appearance-conscious with an array of medical-type services:

“Would you get blood work done at your gym? Longevity-focused treatments like IV vitamin drips, biological-age testing, and peptide injections — questioned by many doctors but embraced by a growing group of health enthusiasts —are coming to mass-market fitness centers. Some fitness brands are adding or investing in clinics that offer access to weight-loss drugs, too … Proponents say the new offerings are low-risk and fill a need for those frustrated with traditional medicine. Skeptics say some treatments are a waste of money at best and carry the potential for harm at worst. Many lack robust substantiation of their health claims, traditional doctors and researchers caution. The gyms’ moves are an attempt to capitalize on Americans’ growing interest in finding novel ways to live healthier for longer, industry professionals and analysts say.”

What proponents too often do not discuss, however, is what happens when treatments go awry. How substantial is the training, care, and follow-up by those who break the skin of customers or gym-goers for various treatments? It cannot be overstated how this increases the risk of infection and other serious, costly, and even fatal outcomes.

What happens when a customer or gym user has an adverse reaction to a procedure or substance? The facilities that so readily “treat” the public likely lack the needed medical resources in emergencies. Consider that even highly credentialed, experienced medical specialists, such as those who settled lawsuits in the death of comedian Joan Rivers after a cosmetic surgery procedure, have confronted major problems during office procedures — with tragic results.

Chasing longevity is another way to set yourself apart and show everyone how special you are. If only the really expensive procedures worked, it would be great.

Take the full-body MRI scan, for example.

The idea is it will detect serious medical conditions long before traditional medicine might find them.

The problem is that these scans often find what doctors call “incidentalomas,” incidental odd little spots in the body with unknown significance for the patient’s health. Chasing down these incidentalomas takes a lot of time, expense, and risk of complications. And then they usually turn out to be nothing.

The price for a whole-body MRI is not that much, between $1,350 and $2,500, with one vendor selling five-year “membership” options (and repeat procedures) for $7,000. But that’s only the first price, before any further workup gets done.

As reported in the New Yorker magazine by Dhruv Khullar, an assistant professor at Weill Cornell Medical College and director of the Physicians Foundation Center for the Study of Physician Practice and Leadership, the scan fad can be traced in part to the influencer Kim Kardashian.

Besides Kardashian, others identified by Khullar with this procedure of the moment include supermodel Cindy Crawford, former Google chairman Eric Schmidt, and fashionable test participants like “designer Zac Posen, the model Lily Aldridge, and the editor Olivier Zahm.”

Doctors are skeptical, Khullar noted, recalling a celebrity hype for a similar type of scan:

“In 2000, demand for head-to-toe CT scans — essentially, three-dimensional X-rays — surged after ‘The Oprah Winfrey Show’ featured a Newport Beach doctor who offered them to the general public, without a physician’s referral. The scans weren’t covered by insurance and cost about $1,000 each. Whoopi Goldberg called them ‘the most comprehensive health exam that exists;’ William Shatner said, ‘I’m sending everyone I know’ … Medical societies, however, warned that the scans had high rates of false positives; they also delivered enough radiation to increase the risk of some cancers that they aimed to detect. Before government-funded studies could properly evaluate the scans’ effectiveness, most of the companies offering them collapsed.

“Full-body MRI scans are different from CT scans in two key ways: they don’t subject people to potentially harmful radiation, and they are better at surveying the soft tissue of our internal organs, where cancers commonly arise. The other complaints, however, still seem to apply. MRIs are sensitive enough to pick up subtle abnormalities that can be clarified only with further tests, and sometimes those tests cause harm: pain, radiation, infections, financial and psychological distress. Their growing popularity suggests that our relationship to medicine has continued to evolve. Increasingly, patients are not passive recipients of care, but active customers. Trust in medical leaders keeps falling; these days, a Kardashian post is worth a thousand academic studies.”

As NPR and the Pulitzer Prize-winning investigative news site ProPublica have reported, published research has estimated that in one year alone “more than 600,000 patients underwent a treatment they didn’t need, treatments that collectively cost an estimated $282 million.”

The American College of Radiology (ACR) is the leading organization of doctors who specialize in interpreting MRI scans and other imaging. If anyone had an incentive to promote widespread use of whole-body MRI scanning, this outfit would be it.

The ACR issued an official statement in April 2023 that threw a big bucket of cold water on the idea of whole body MRI scanning for patients without worrisome symptoms or history. They wrote that the ACR “does not believe there is sufficient evidence to justify recommending total body screening for patients with no clinical symptoms, risk factors or a family history suggesting underlying disease or serious injury. To date, there is no documented evidence that total body screening is cost-efficient or effective in prolonging life. In addition, the ACR is concerned that such procedures will lead to the identification of numerous non-specific findings that will not ultimately improve patients’ health but will result in unnecessary follow-up testing and procedures, as well as significant expense.”

Dr. Khullar’s story in the New Yorker has its own twist. He decides to get the scan, though he knows as a much-published researcher about the risks of over-testing and over- treatment.

Khullar is a fine reporter and writer, and his story is worth reading. No spoiler alert here about the story’s finale. Just the questions: Really? Why?