NEWSLINE: Clinical Insights/Professional Update

NEWSLINE CLINICAL INSIGHTS Ginger probably poses no threat to unborn Women taking ginger during their first trimester of pregnancy to relieve nausea and vomiting are no more likely to experience poor pregnancy outcomes than women exposed to nonteratogenic, nonantiemetic drugs. When investigators compared women taking various ginger formulations to those in the comparison group, they found no evidence that the herb affected the number of live births, spontaneous abortions, stillbirths, therapeutic abortions, mean birthweight, mean gestational age, or major malformations. There were actually more infants weighing less than 2,500 g among women not using ginger (12 vs. 3; P<0.001). A new ACOG Practice Bulletin concludes there is some evidence to support the use of ginger for treating the nausea and vomiting of pregnancy. Portnoi G, Chng L, Karimi-Tabesh L, et al. Prospective comparative study of the safety and effectiveness of ginger for the treatment of nausea and vomiting in pregnancy. Am J Obstet Gynecol. 2003;189:1374-1377. ACOG Practice Bulletin No. 52. Nausea and vomiting of pregnancy. April 2004. Extended-use OCs remain mystery to most women When it comes to suppressing menstruation with extended-use oral contraceptives, most women would welcome the option but had never heard of it before. At least that's what a nationwide study sponsored by the Association of Reproductive Health Professionals (ARHP) found. About 6 out of 10 women agreed or strongly agreed that they'd be "pleased" if they could use a birth control method that suppressed menstruation for a certain amount of time, according to the study. About 7 out of 10 agreed or strongly agreed that they would suppress their periods if they were sure there were no adverse effects. But 73% of the women surveyed said they had never heard of menstrual suppression before taking the survey. Moreover, 80% said their health-care providers had never offered to write prescriptions for birth control pills to skip periods. Could this be due to a lack of knowledge on the part of clinicians? Not according to the survey. More than 81% of health-care providers have heard of menstrual suppression, yet only about 22% offer extended-use contraceptives to all patients on birth control pills. Moreover, most health-care providers cited patient requests and therapeutic reasons such as dysmenorrhea, menorrhagia, or endometriosis as the top factors influencing their decision to prescribe extended-use contraceptives to suppress menstruation. The ARHP's Menstrual Suppression Study, which was funded through an unrestricted educational grant from Barr Laboratories, was based on written surveys of 1,500 women, clinician interviews of 18 women, and written surveys of 500 clinicians. Latex superior to nonlatex condoms when it comes to preventing pregnancy Nonlatex condoms break during intercourse or withdrawal two to five times more often than their latex counterparts, according to a recent analysis of 10 randomized controlled trials comparing three nonlatex and seven latex brands. About 5% of all condoms sold in the US are made of nonlatex materials. Their advantages for those with latex allergy are obvious. Other advantages include that they can be used safely with oil-based lubricants and can withstand a broader range of storage conditions. Many users report that they have a less noticeable odor than latex varieties, that they have a less constricting fit, and that they are better at conducting body heat. In fact, substantial proportions of participants in the studies reviewed reported preferring nonlatex varieties. Gallo MF, Grimes DA, Schulz KF. Nonlatex vs. latex male condoms for contraception: a systematic review of randomized controlled trials. Contraception. 2003;68:319-326. PROFESSIONAL UPDATE When ob/gyns "go bare," dropping their malpractice coverage As malpractice insurance rates continue to climb out of reach, some physicians are choosing to practice without coverage. So far, the practice, known as "going bare" or "self-insuring," has been adopted mainly among physicians in Florida. In Miami-Dade County, for example, nearly 20% of its 6,460 active physicians don't have malpractice insurance coverage. Going bare is most common among high-risk specialties such as obstetrics and neurosurgery, reported The Wall Street Journal (1/28/04). Because going without malpractice coverage puts the responsibility for legal fees and any judgments or settlements squarely in the lap of the physician in the event of a lawsuit, many are advised to shelter their assets in trusts or partnerships. Because Florida state law already protects certain assets, such as a home, from being claimed in a judgment, physicians are taking the risk of practicing medicine without coverage. Moreover, claiming bankruptcy in the event of a lawsuit can further protect other assets. As a result, patients who successfully sue self-insured physicians could receive less money for their injuries than they would have received if the physician had coverage. Most states do not require physicians to carry malpractice insurance, and the American Medical Association voted in December 2002 to leave the decision to carry sufficient coverage to the individual physician. However, most hospitals and managed-care organizations require physicians to have coveragemaking it impractical for most to go bare. Many women still lack health insurance Nationwide, nearly 16 million women ages 18 to 64 are uninsured, according to The Henry J. Kaiser Family Foundation. The uninsured are a problem in the United States because the lack of health coverage can influence when and whether a person will seek medical care, ultimately affecting costs and medical outcomes. By state, the percentage of uninsured women varies considerably: Minnesota has the lowest rate of uninsured women (7.9%), while Texas has the highest rate (28.3%). Rates for low-income women (those who earn less than 200% of poverty) range from a low of 18.9% in Massachusetts to a high of 50% in Texas. Nationally, about nine out of 10 women are covered by Medicaid. Among low-income women, only about one out of five is insured by Medicaid. Nearly three quarters of women nationwide do have some form of health insurance, including employer-based coverage and public insurance such as Medicare and military-related coverage. New Hampshire has the highest rate of privately insured women (84.5%), whereas New Mexico has the lowest (62%). Private health insurance is less common among low-income women, with less than half with such coverage. New Mexico and the District of Columbia had the lowest rate of low income women with private insurance (34.9%), and Hawaii had the highest rate (57.4%). On the subject of trust, MDs still get high grades When it comes to rating which professions are most ethical and honest, nurses and physicians come out on top, reported Managed Care (1/04). Nurses were ranked as being the most honest and ethical out of 23 different professions in a CNN/USA Today/Gallup poll. Physicians, along with veterinarians, came in second, with 68% of respondents celebrating the virtues of each profession. In contrast, only 11% said HMO managers were perceived as honest and ethical. HMO managers beat out car salesmen, who were the least respected of the professions ranked. NEWSLINE: Clinical Insights/Professional Update. Contemporary Ob/Gyn Apr. 15, 2004;49:8-10.