TREATMENTS YOU MAY NOT KNOW ABOUT

One of the things I love about being the Editor of The Doctor Weighs In is learning about new approaches for treating diseases or conditions that have been around forever. In this issue we will focus on three conditions: chronic knee pain due to cartilage injury, sleep apnea, and dandruff (yes, you heard that right - dandruff).

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We are also going to highlight an innovation in care delivery that I think is brilliant, the multidisciplinary specialist care team. Let's start with that.

One of the stories from Isaacson's biography of Steve Jobs that has stuck with me for years was when Jobs' wife convened all of the different doctors who were providing care for him during the later stages of his battle with cancer. Each of them was providing excellent advice from within their own specialty silos. But the "right hand didn't seem to know what the left hand was doing." And, it particularly impacted his pain control. I remember thinking at the time that everyone, not just really rich people, should have access to this type of specialty care coordination. But, of course, until now that really didn't fit into the way our healthcare "system" works.

That is why I was particularly interested in publishing a story by interventional radiologist Andrew Gunn about an innovation in care delivery at the University of Alabama-Birmingham’s (UAB) Pancreatobiliary Disease Center. The idea may seem simple, but as Dr. Gunn explains, the implementation was not. It involved disrupting the status quo.

As Dr. Gunn explains, the new model of care "brings together 13 specialty providers who meet every Wednesday morning. Instead of a haphazard system based on quick “hallway consults” among physicians, our team benefits from formal scheduled presentations of approximately a dozen cases each week. This enables us to have a healthy, holistic discussion of each patient’s needs. It also allows us to better coordinate each patient’s ongoing care." BE SURE TO READ MORE.

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Chances are you or someone you know has had a cartilage injury and is now enduring chronic pain in that knee. This is because knee pain is the second most common cause of chronic pain in America and about half of the time it is associated with a cartilage injury.

Many people with this condition report no longer being able to participate in activities that they love. They also say that they no longer remember what it is to live without pain. Despite that, a large number are not seeking treatment because they think it won't work or they are afraid of surgery.

Orthopedist Geoffrey Van Thiel lays out the reasons to seek treatment as well as the currently available treatment options. Among them is the one that he uses in own practice: autologous chondrocyte implantation. It involves expanding a patient’s own cartilage cells in a lab and then implanting them in the damaged area to restore the tissue. Although he does not discuss it in his article, I couldn't help wonder whether this could one day become an option for people with osteoarthritis - the cause of chronic pain in so many people. READ MORE.

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The treatment of choice for sleep apnea is the dreaded CPAP machine. Although there have been many terrific advancements in CPAP technology, patients are all too familiar with pictures of people using CPAP that make them look like creatures from outer space. They also hate the idea of having to sleep with a device on their face. I remember wondering when I was Chief Medical Officer of a Medicare Advantage health plan, how many millions of unused CPAP machines, paid for by health insurance, were cluttering people's basements around the world.

Unfortunately, these dated misconceptions may cause people to refuse treatment or in some cases fail to get diagnosed in the first place. David P. White, Chief Scientific Officer of Philips Sleep and Respiratory Care reviews some of the changes in CPAP mask design that have improved patients' experience. He also describes a CPAP-free alternative treatment called positional therapy that may fundamentally change the way patients live with sleep apnea. READ MORE.

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Dandruff is a common scalp condition that affects about half of the population. It may not seem like a big deal if you don't have it. But Dermatologist Fayne Frey says that the most common complaint she hears from patients with dandruff is that “It’s so embarrassing.”

The primary treatment is dandruff shampoos. There are many different types including ones that can be bought over-the-counter and others that require a prescription. Dr. Frey reviews the options to help you (and your doctor) decide what is best for you. But she reminds readers that there are other conditions that can cause scalp flakiness, including seborrheic dermatitis. So if your dandruff doesn't improve with the usual remedies, be sure to consult a dermatologist. BE SURE TO READ MORE.

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More on NEW TREATMENTS from around the web

Very early-stage research on a needle-free flu vaccine patch (not yet tested in humans) showed that it stimulated the immune system similar to a traditional flu shot - without any negative side effects. If eventually validated in clinical trials, this could be a boon not only for needle-phobics but also for flu shot campaigns in the developing world.

Warning: this is a very small trial - only eight people. But the approach is so different from the usual pharmaceutical approach to treating the plaques and tangles seen in Alzheimer's disease that it is worth reporting here. The participants in the trial all had mild to moderate Alzheimer's. They were treated with a wearable device worn on the head that emits electromagnetic waves, a treatment already shown to reverse memory loss in mice. Seven of the eight people in the trial showed a measurably significant increase in cognitive function on standardized testing. Remember this is a just baby step but it is sure to generate excitement in the Alzheimer's community.

New cancer drugs and cancer diagnostic tests have been added to the World Health Organization's (WHO's) lists of essential medicines and essential diagnostic tests. Many of the drugs are quite expensive so the question (as always) is how they will be paid for - this is not just a question relevant to the developing world. Ask anyone in the US who is uninsured or has a very high out-of-pocket plan.

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DON'T FORGET TO VISIT THE DOCTOR WEIGHS IN to read more of our stories about innovations in health and healthcare.

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