Flowers Used in Chinese Herbal Medicine


Herbal therapies are an integral part of traditional Chinese medicine (TCM). While there are 5,767 substances defined in the Encyclopedia of Traditional Chinese Medicinal Substances, a typical practitioner may routinely use between 200 and 600.

Most often, the herbs (a combination of one to 13 different plants) are added to water and boiled. The liquid is then separate from the herbs and drunk as a water decoction.

The herbs may also be consumed in powdered form, spray-dried concentrates, pill form, or even “honey pills,” which are “prepared by combining powdered herbs with concentrated decoctions and honey to produce a small herbal pill.”1

It used to be customary for Chinese families to maintain a collection of herbal formulas used to treat various medical problems, life changes (pregnancy, menopause, and old age), or even use for the different seasons.

Some still do maintain such knowledge and use herbal remedies in their daily lives, while in the modern day you can find a TCM practitioner to help determine which herbs are right for you.

7 Flowers Used in Chinese Herbal Medicine

You’ve probably heard of some of the more common herbs used in TCM, such as panax ginseng, licorice, and rhubarb root. However, there are others as well, including flowers you might not expect. For instance, the Epoch Times compiled the 7 flowers that follow, which have been used as part of Chinese medicine for centuries.2

1. Lonicera Flower (Jin Yin Hua)

7 Flowers Used in Chinese Herbal Medicine - LoniceraAlso known as honeysuckle flower, this remedy is often used for colds, flu, and sore throats. It was even used in combination with three other herbs as a treatment for swine flu.

Research has shown the flower, in combination with other herbs used to treat acute bronchitis, “had potent pharmacological action” as well as showed antiviral and antibacterial effects.3 It’s also known for its anti-inflammatory actions.4

2. Viola Flower (Zi Hua Di Ding)

Also known as the purple flower earth herb or the Chinese violet, viola flower has anti-inflammatory and antipyretic (fever-reducing) effects. It is often used for clearing heat, releasing toxins, or dissolving masses, and it is an age-old remedy for snake bites (to help reduce both swelling and toxicity).

Viola is traditionally associated with the heart and the liver5 and is also sometimes used for bacterial infections.

3. Pagoda Flower (Huai Hua)

Also known as Sophorae flower, this remedy is used for bleeding disorders, including in the treatment of hemorrhoids and excessive menstrual bleeding.

4. Chrysanthemum Flower (Ju Hua)

Flowers Used in Chinese Herbal Medicine - Chrysanthemum Flower

This common herbal medicine is useful for treating dry, irritated eyes, high blood pressure, and headaches. Chrysanthemum flowers are often used in combination with honeysuckle to lower high blood pressure and treat arteriosclerosis.6

It’s also said to affect the liver and lungs, and is commonly consumed in tea form. According to the Jade Institute:7

“The benefits of long-term consumption of Chrysanthemum tea have been recognized throughout the history of Chinese medicine. It is said to prevent aging and to be a favorite of Taoists and poets, though the benefits are achieved only with drinking the tea over a long period of time.

In the Shen Nong Ben Cao Jing, it says, ‘taken over a long time it facilitates the qi and blood, lightens the body and prevents aging.’”

5. Magnolia Flower (Xin Yin Hua)

If you have nasal congestion or chronic sinusitis, magnolia flower is the herbal remedy for you. An herbal tea containing magnolia flower and other Chinese herbs was found to improve chronic sinusitis when used for six weeks.10

Fermented magnolia flower petal extract has also shown promise as a natural antioxidant and anti-cancer agent.11

Flowers Used in Chinese Herbal Medicine - Magnolia Flower

6. Safflower (Hong Hua)

Also known as Carthamus, this red flower is typically used to treat menstrual disorders, invigorate circulation, and dissolve clots. It’s also useful for treating heart disease, joint pain, and flat warts.

Safflower was among a group of Chinese herbs found to be potentially beneficial for people with elevated blood triglyceride levels, a risk factor for arteriosclerosis, diabetes, and high blood pressure.8

According to the American Botanical Council (ABC), safflower is among the blood-promoting herbs in Chinese medicine that aid circulation, nourish blood and increase its production, and have anti-thrombotic properties. ABC notes safflower may “support coronary blood flow and reduce myocardial oxygen use, ischemia, and arrhythmia.”9

7. Lotus Flower (Lian Zi Xin)

The lotus flower is used for treating bleeding disorders, including bloody noses, as well as irritability and fevers. Its seeds, stem, and leaves are also used in TCM.

Elder Flower: Another Traditional Flower Remedy Worth Trying

7 Flowers Used in Chinese Herbal Medicine - Elder Flower

Elder flowers, the flowers of the elder tree (which also gives us elderberries), are rich in flavonoids, minerals, phenolic compounds, volatile oils, and more. In traditional Greek medicine, elder flowers were used as a diaphoretic (to increase sweating, which is helpful for eradicating a virus from your system).

In Germany, elder flower is commonly used to treat feverish common colds, and in the US and Canada, elder flower may be combined with yarrow flower and peppermint leaf in tea form to relieve colds and flu. According to the American Botanical Council:12

“Its flavonoids and phenolic acids may contribute to the diaphoretic effect. It has demonstrated anti-inflammatory, antiviral, and diuretic actions in in vitro studies. The flavonoids and triterpenes appear to be the main biologically active constituents.

The Commission E [in Germany] approved the internal use of elder flower for colds. The British Herbal Compendium lists its uses for common cold, feverish conditions, and as a diuretic. The German Standard License for elder flower tea calls it a diaphoretic medicine for the treatment of feverish common colds or catarrhal complaints.”

Elder flower has been traditionally used as a tonic to boost immunity. It is also widely known to promote lung and bronchial tract health. If you’re battling a cold or flu, try drinking elder flower tea (combined with yarrow, boneset, linden,peppermint, and ginger, if you like) hot and often to help induce sweating and flush the virus out. Further, as noted by Herb Wisdom:13

“The most common uses [of elder flower] are for colds and flu, sinus infections, and other respiratory disturbances. As a supplement, elderflower also has diuretic and laxative properties and is helpful in relieving occasional constipation.

Elderflower has antibacterial and antiviral properties and may also help alleviate some allergies and boost the functioning of the immune system. Topically, elderflower might help reduce pain and swelling in joints due to some forms of arthritis and is used to stop bleeding.

As an oral rinse, elderflower can be used for its antiseptic properties as a mouthwash and gargle. Elderflower also reduces blood sugar levels, very similar to the way insulin works.”

Lavender: Another Incredibly Useful Herb

7 Flowers Used in Chinese Herbal Medicine - LavenderLavender oil is known for its calming and relaxing properties, and has been used for alleviating insomnia, anxiety, depression, restlessness, dental anxiety, and stress. It has also been proven effective for nearly all kinds of ailments, from pain to infections.

Its name actually comes from the Latinlavare, which means “to wash,” and lavender has long been used as a tonic to help cleanse the skin.14 I am particularly fascinated by lavender oil’s potential in fighting antifungal-resistant skin and nail infections.

Scientists from the University of Coimbra found that lavender oil is lethal to skin-pathogenic strains known as dermatophytes, as well as various Candida species.15 Lavender oil has a chemically complex structure with over 150 active constituents.16This oil is rich in esters, which are aromatic molecules with antispasmodic (suppressing spasms and pain), calming, and stimulating properties. The chief botanical constituents of lavender oil are linalyl acetate, linalool (a non-toxic terpene alcohol that has natural germicidal properties), terpinen-4-ol, and camphor.

Other constituents in lavender oil that are responsible for its antibacterial, antiviral, and anti-inflammatory properties include cis-ocimene, lavandulyl acetate, 1,8-cineole, limonene, and geraniol. Lavender can also be used to:17

  • Relieve pain. It can ease sore or tense muscles, joint pain and rheumatism, sprains, backache, and lumbago. Simply massage lavender oil onto the affected area. Lavender oil may also help lessen pain following needle insertion.
  • Treat various skin disorders like acne, psoriasis, eczema, and wrinkles. It also helps form scar tissues, which may be essential in healing wounds, cuts, and burns. Lavender can also help soothe insect bites and itchy skin (lavender oil can help ward off mosquitoes and moths. It is actually used as an ingredient in some mosquito repellents).
  • Keep your hair healthy. It helps kill lice, lice eggs, and nits. The Natural Medicines Comprehensive Database (NMCB) says that lavender is possibly effective for treating alopecia areata (hair loss), boosting hair growth by up to 44 percent after just seven months of treatment.
  • Improve your digestion. This oil helps stimulate the mobility of your intestine and stimulates the production of bile and gastric juices, which may help treat stomach pain, indigestion, flatulence, colic, vomiting, and diarrhea.
  • Relieve respiratory disorders. Lavender oil can help alleviate respiratory problems like colds and flu, throat infections, cough, asthma, whooping cough, sinus congestion, bronchitis, tonsillitis, and laryngitis. It can be applied on your neck, chest, or back, or inhaled via steam inhalation or through a vaporizer.
  • Stimulates urine production, which helps restore hormonal balance, prevent cystitis (inflammation of the urinary bladder), and relieve cramps and other urinary disorders.
  • Improve your blood circulation. It helps lower elevated blood pressure levels and can be used for hypertension.

Do You Want to Use More Medicinal Herbs?

Herbs can help support your health from a very basic level, just as foods do. In the late 1800s and early 1900s, you could walk into a drug store and find hundreds of herbal extracts for sale. Upwards of 90 percent of the population at that time knew how to use the medicinal plants growing in their backyards to treat common illnesses and injuries; they had too, as this was virtually the only “medicine” available.

With the rise of what is now known as conventional allopathic medicine shortly before World War I, herbalism slowly fell out of favor and became to be thought of as folk medicine. Rather than viewing nature as the source of healing, as had been done for centuries, people began to view drugs and other “modern” healing methods as superior. If you would like to start using medicinal plants more often, here are 9 tips to do so. I also recommend browsing through my “Ultimate Guide to Herbal Oils“:18

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Using a Non-Stick Pan? You May Want to Read This


Pans with a non-stick coating are convenient but new research suggests that the chemical used for the coating is extremely toxic and exposure can prove dangerous to brain health, the reproductive system, and immune system.

The Dangers of Non-Stick Coating

DuPont, the chemical engineering giant, is responsible for the perfluorooctanoic acid (PFOA) used to make Teflon coating. Federal regulators linked the chemical to birth defects and cancer, and these regulators also accused DuPont of hiding these hazard reports for decades. This caused an uproar and forced DuPont to phase out production of the chemical in 2006. Regardless, PFOA has already infiltrated millions of homes; resulting in detectable amounts of the compound in the blood of nearly every American. It’s even been found in polar bears in the Arctic.

non stick pans 02

A new Environmental Working Group (EWG) report suggests that there is no safe level of exposure to the chemical in non-stick coatings, categorizing PFOA in the same league as asbestos andlead. This new report is supported by studies from the University of Massachusetts (UMASS) and Harvard University — studies that suggest blood levels of PFOA 400 times lower than the EPA’s current level could still cause adverse effects.

The Solution

There are some natural, safer alternatives to Teflon that you should be aware of. If you currently own a non-stick pan, throw them out immediately. Replace all non-stick bakeware with glass, and choose steel and cast iron for other cooking needs. Rely on healthy fats, likeolive oil and coconut oil, to provide a natural non-stick surface for your cookware. Ideally, the majority of your diet should be uncooked and raw, meaning you shouldn’t have to worry too much about whether or not your food is sticking to cookware.

Risk Factors ID’d for Fecal Transplant Failure


Inpatient status, immunosuppression, record of C. diff hospitalizations biggest factors

Three factors were strongly associated with failure of fecal transplant in patients with Clostridium difficile infections (CDI), a researcher said here: being an inpatient while receiving the transplant; being in an immunosuppressed state; or a previous record of hospitalization from CDI-related events.

Researchers looked at 345 patients with CDI and found an overall failure rate of 23.7% after a single fecal matter transplant at 3 months of follow-up. Nonsevere cases failed 18% of the time, while severe cases had a 50% failure rate, said co-author Monika Fischer, MD, of Indiana University, in an oral presentation at the annual meeting of the American College of Gastroenterology.

Receiving an inpatient transplant was the largest predictor of failure (odds ratio 6.92, 95% CI 2.94-16.3; P<0.0001), followed by immunosuppression (OR 3.48, 95% CI 1.66-2.78;P=0.001) and number of CDI-related hospitalizations (OR 1.45, 95% CI 1.18-1.77; P=0.0004).

Hospitalization seemed to be a surrogate for severity of the disease, said Fischer at the presentation.

Based on the results, the authors devised a risk stratification system to identify patients most at risk. Inpatients who’d received a transplant were assigned five points, immunosuppressed patients three points, and patients with hospitalizations from CDI-related were given one point.

When they applied this system to their 345 patients, they found that 117 had a low-risk of fecal matter transplant failure, with zero points, at 12.8%. But 123 patients had a medium-risk, with one-three points, and faced a failure rate of 17.1% and high-risk patients with four points or more had a 43.8% failure rate.

“We hope that physicians will find the proposed risk stratification helpful in planning and discussing fecal matter transplants with their patients, and also with regards to preparedness in treating high risk patients,” said Fischer.

All patients in the study had CDI at least once from 2011 to 2015 and were older than 18. Data were taken from electronic medical records, fecal matter transplant databases, and interviews at two sites — Brown University and Indiana University. Patients’ average age was 62 and 72% were female. About a quarter of the patients were immunosuppressed, and 74% had recurrent CDI. Inpatient transplants were provided to 17%.

Transplant success was defined as complete resolution of CDI symptoms or a negative PCR test for C. diff at 3 months without the need for repeat transplants or other CDI-related therapies.

Nearly 22% percent of those with nonsevere refractory CDI had a failed transplant after 3 months, opposed to 17.2% of recurrent nonsevere patients. Among severe patients, half failed: 35.3% of those with recurrent CDI and 59% with refractory CDI.

Also predictive of failure were:

  • Presence of pseudomembranes at transplantation (19 patients failed, a rate of 25%; P<0.0001)
  • Mean albumin (mean level of 3 versus 3.6 for failed versus successful transplants; P<0.0001)
  • Stool delivery beyond splenic flexure (54 patients failed, a rate of 28.4%;P=0.026)
  • Patient directed donor type (23 patients failed, a rate of 28.4%; P=0.014)
  • White blood cell count (13.7 mean for failed transplants versus 10.1 for successful ones; P=0.021)

“Risk of fecal matter transplant failure is predictable based upon pre-fecal matter transplant data,” according to Fischer.

Pot Smoking Pregnant Moms Likely Use Other Drugs


A quarter of mothers and their newborns who tested positive for marijuana use had evidence of other illegal drugs, according to a small retrospective study of mother/newborn pairs.

Based on data collected from an urban non-profit teaching hospital, 26.1% of mother/newborn pairs tested positive for tetrahydrocanabis (THC) in urine-meconium screenings, 11.6% tested positive for opioids, followed by amphetamines (10.8%) and cocaine (6.5%), reported Shirley Chen, MD, of Creighton University in Omaha, and Edith P Allen, MD, of St. Joseph’s Hospital and Medical Center and Phoenix Children’s Hospital in Phoenix.

Of the 491 mother newborn/pairs testing positive for marijuana, only 22.4% picked up marijuana use in both mother and newborn. More than three-quarters (77.6%) of these tests came back positive for one party only, though it was more common in newborns compared with mothers (42.4% versus 35.2%), they stated in a poster presentation at theAmerican Academy of Pediatrics (AAP) annual meeting.

While not involved with the study, Sharon Levy, MD, MPH, director of adolescent substance abuse program and assistant professor of pediatrics at Children’s Hospital in Boston, said she thought the latter data was the most interesting “nugget of information” from the results.

“Fetal samples were much more likely to be positive for marijuana than maternal samples, underscoring that fat soluble THC crosses the placenta and is concentrated in the fetus,” she told MedPage Today via email. “When mothers use marijuana, their fetuses are actually getting a higher dose than they are themselves.”

The authors also screened mothers and newborns separately, and found that the most common illicit substance in THC-positive newborns was amphetamines (8.8%), while the most common among THC-positive mothers was opioids (16.3%). Levy added that these results showed that by collecting both maternal and newborn samples, the authors were able to get more information about drug exposure.

Urine and meconium tests were used to screen drug exposure in infants and a large majority (78.6%) of infants only had positive meconium tests to identify THC exposure. The authors noted that there was no exposure in newborns that urine picked up and meconium did not.

Co-author Allen told MedPage Today that even though mothers are usually open to saying they use marijuana, the meconium of the baby might be the most important piece of information to tell about the history of drug use in the mom.

The retrospective study was done using data from 2006 to 2010. The authors examined data from an urban teaching hospital that averaged 5,000 births a year. About 10% of the sample tested positive for THC/marijuana use.

Screenings for both mothers and newborns were done per Arizona state’s guidelines. Criteria for drug screening included history of previous or current substance use by the mother, noncompliance with prenatal care, symptoms of withdrawal in the mother and signs of neonatal abstinence syndrome, low birth weight, and other adverse outcomes, such as necrotizing enterocolitis.

Mark Hudak, MD, of the University of Florida at Jacksonville and former member of the AAP committee on drugs, told MedPage Today that examining past marijuana use was a new point of view in light of the legalization of medical marijuana in some states.

“Arizona is one of those states that has made a change allowing medical use of marijuana, and I think that was the genesis of going back and looking at their population,” he said. “I think the message they were trying to convey is if you have a mother or baby where you find marijuana, you have to think about other substances and whether those substances may contribute to newborn issues.”

One obvious potential issue would be whether or not to allow a mother testing positive for drugs to breastfeed, and Allen said that was something to be aware of, particularly in states where marijuana is legal for medical or recreational purposes.

“I think it’s our responsibility as pediatricians to really be more objective and more cautious about the decisions that we take about the care of those babies,” she said. “We have to be careful about when we allow this baby to breastfeed if there is a problem with other drug consumption during pregnancy by the mother.”

Hudak said that clinicians need to be aware of the situation and to make sure there is good follow-up on the babies. He added that the pediatrics field is currently working through the conflicting recommendations about breastfeeding in mothers with substance abuse.

“Whether breastfeeding is a good thing or maybe contraindicated in some of these mothers [is] another topic under very active debate,” he concluded. “I don’t think that issue is settled yet.”

Renal Artery Stenosis


Renal artery stenosis (RAS) is a narrowing of the arteries to one or both of the kidneys that can causehypertension (high blood pressure) and, sometimes, reduced kidney function and size (atrophy). It occurs more commonly in older people with atherosclerosis (hardening of the arteries with plaque buildup, leading to narrowing of the channel where the blood flows). Hypertension caused by RAS is calledsecondary hypertension. This means that, unlike essential or primary hypertension (the most common form of high blood pressure, which does not have a specific known cause), secondary hypertension does have a specific cause. In some cases, diagnosing and treating RAS can result in decreasing or eliminating the need to take medication for hypertension. The narrowing of the kidney arteries in RAS is usually due to atherosclerosis; more rarely it can be caused by abnormal growth of tissue within the wall of the artery. The latter condition, called fibromuscular dysplasia, is potentially curable and is more common in women and younger age groups but can also occur later in life. When atherosclerosis is the cause of RAS, it is especially important to be evaluated and treated for related diseases of the heart and brain, since they are also susceptible to narrowed arteries. Atherosclerosis in those organs can lead to heart attack or stroke.

read the complete litrature. URL:http://jama.jamanetwork.com/article.aspx?articleid=182831&utm_source=FBPAGE&utm_medium=social_jn&utm_term=263276288&utm_content=content_engagement|article_engagement&utm_campaign=article_alert&linkId=18243602

Stents Delay Cancer Surgery?


This roundup of cardiovascular news looks at “competing goals for timing of surgical care” in patients with both colorectal cancer and coronary artery disease, issues of affordability and access to the most common cardiovascular medications around the world, and the age of transfused blood in relation to cardiac surgery mortality.

Stent-Associated Cancer Surgery Delay

Getting a stent after colonoscopy was associated with delays in surgery for colorectal cancer that is found and higher mortality risk, a study of the VA system showed.

Among patients who got a diagnosis of colorectal cancer, the median time to surgery was 100 days if they got a stent after colonoscopy versus 42 days for those who already had a stent at the time of colonoscopy (P<0.001), Mary T. Hawn, MD, of California’s Stanford University, and colleagues reported online in JAMA Surgery.

That “incremental 60-day delay in surgery” was longer than previously reported from a VA study, the researchers noted.

“The longer intervals in our cohort may be related to the complexity of the surgical decision-making process for patients with known coronary artery disease,” the group suggested.

These patients have “competing goals for timing of surgical care,” Hawn and colleagues noted, pointing to 2014 guidelines recommending holding off on elective surgery for 30 days for bare metal stents and for 6 months to 1 year for drug-eluting stents.

Although studies have conflicted on whether such a delay in colorectal cancer surgery affects outcomes, the stented patients in Hawn’s study had “a nonsignificantly higher MACE [major adverse cardiovascular event] rate of 10% that is similar to the rates reported for other patients undergoing surgery within 60 days of stent placement.”

The 30-day MACE rate for unstented patients was 4.8% and 7.1% for stents placed before colonoscopy. One-year mortality didn’t differ among groups.

There was no significant surgical timing difference between not having a stent and having one in place before the colonoscopy (P=0.96).

The study included 632 patients in a cohort of Veterans Affairs (VA) patients who had a history of coronary artery disease and who got elective surgery for colorectal cancer, among whom 31% had a stent placed within 2 years prior. A total of 70 patients got a stent after colonoscopy and 126 already had one before it.

“The urgency of a cancer operation may expose patients to additional risk by shortening the interval between stent placement and surgery, and this risk should be considered in the cardiovascular management of these patients.”

Cardiovascular Medication Access

Use of cardiovascular medications in secondary prevention might be low around the world in large part due to lack of availability and affordability in all but high-income nations, a study affirmed.

“Secondary prevention medicines are unavailable and unaffordable for a large proportion of communities and households in upper middle-income, lower middle-income, and low-income countries, which have very low use of these medicines,” Salim Yusuf, DPhil, of McMaster University in Hamilton, Ontario, and colleagues reported online in The Lancet.

In the Prospective Urban Rural Epidemiology (PURE) study surveying pharmacies in 596 communities in 18 countries, the finding on availability of aspirin, beta-blockers, ACE inhibitors, and statins at the pharmacy when surveyed was:

  • High-income countries like Sweden had all four at 95% of urban and 90% of rural communities
  • Upper middle-income areas like South Africa, Poland, and Brazil had all four at 80% of urban and 73% of rural communities
  • Lower middle-income countries like China and Iran had all four at 62% of urban and 37% of rural communities
  • Low-income countries like Bangladesh and Zimbabwe had all four at 25% of urban and 3% of rural communities
  • India, which stood alone in the analysis, had all four at 89% of urban and 81% of rural communities

The combined cost of the four medications was unaffordable (20% or more of household capacity-to-pay) for 0.14% of households in high-income countries, 25% in upper middle-income countries, 33% in lower middle-income countries, 60% in low-income countries, and 59% in India.

“Improvements to the availability and affordability of key medicines is likely to enhance their use and help towards achieving WHO’s targets of 50% use of key medicines by 2025,” the researchers concluded.

Blood Storage

Blood storage duration was not associated with mortality in cardiac surgery, a Swedish observational study said.

In the study of all 47,071 patients transfused in connection with cardiac surgery at nine Swedish hospitals using linked data from national databases on heart surgery and on blood transfusions there from 1997 through 2012, the mortality rates were:

  • 49.5 deaths per 1,000 person-years for recipients of blood stored for less than 14 days
  • 45.4 when stored 14 to 27 days (adjusted hazard ratio 1.02, 95% confidence interval 0.94-1.11)
  • 41.1 when stored 28-42 days (aHR 0.98, 95% CI 0.86-1.11)

Nor were there any significant associations with 30-day or 10-year mortality or with selected serious complications, Ulrik Sartipy, MD, PhD, of the Karolinska University Hospital in Stockholm, and colleagues reported in the Oct. 20 issue of the Journal of the American Medical Association.

Swedish national guidelines allocate the oldest available blood unit of the appropriate blood type to be used first. In the study, 36.6% of patients were transfused exclusively with red blood cells stored less than 14 days, 26.8% with those stored 14 to 27 days, and 8.9% with blood stored 28 to 42 days. The rest got blood of mixed age.

The findings agreed with those of two randomized trials with shorter-term endpoints, the researchers concluded, “providing further reassurance of the safety of current blood storage practices.”

What Now for Mammography?


Now that the ACS has weighed in, how will that change practice?

The American Cancer Society came out with new recommendations for breast cancer screening, calling for annual mammograms beginning at age 45 for average-risk women — even though the U.S. Preventive Services Task Force has said it isn’t justified until age 50, while radiologists’ groups have stood firm on age 40 as the time to start. The recommendations also differ in other respects.

We asked women’s health experts and a variety of healthcare professionals:

What will you tell women in their 40s who ask whether they should get annual mammograms?

How have patients been reacting to the previous controversies around mammography?

How much of a problem are these divergent recommendations, and what should be done about it?

The participants this week are:

Rachel Brem, MD, Vice Chair of Radiology and Director of the Breast Imaging and Intervention Center at the George Washington University School of Medicine and Health Sciences in Washington D.C.

Annina Wilkes, clinical assistant professor at the Sidney Kimmel Medical College at Thomas Jefferson University and Interim Director of Breast Imaging at the Jefferson Honickman Breast Imaging Center in Philadelphia

Kathryn A. Boling, MD, a primary care physician at Lutherville Personal Physicians, part of Mercy Medical Center, in Lutherville, Md.

Karen Oh, MD, associate professor within Diagnostic Radiology and Director of Breast Imaging and sub specialization in Obstetric and Gynecologic ultrasound at Oregon Health & Science University in Portland

Angela DeRosa, DO, MBA, clinical assistant professor at Midwestern University, Arizona College of Osteopathic Medicine, in Glendale and founder, DeRosa Medicine

No Change in Recommendations

Rachel Brem, MD: I will unequivocally recommend that women begin annual screening mammography at age 40 and continue annually thereafter. The new recommendations of the American Cancer Society (ACS) are a compromise between the benefits of screening mammography, lives saved, and the harms, which is the anxiety from mammography callbacks and the possibility of a biopsy for a benign finding. As a physician and a breast cancer survivor myself, the benefits clearly outweigh any “harms,” which are fleeting. My goal is to assure women the right to obtain screening mammograms to optimally diagnose early curable breast cancer. It is also important that women understand that the new ACS recommendations are a compromise. The ACS recommends that women continue to have the opportunity to decide to have screening mammograms beginning at 40 and annually thereafter.

Annika Wilkes, MD: In our practice we will continue to recommend annual mammography beginning at age 40. We will tell our patients that we will continue our recommendation because while it is a good idea to discuss personal risk factors for breast cancer and family history with their doctors, it should not change the interval of screening. Most women who develop breast cancer have no risk factors at all and annual mammography is the best way to catch a cancer when it is at its earliest, most treatable stage. We certainly agree that women should be familiar with the limitations of mammography including the potential need to be called back for additional views, possible short interval follow-up, and biopsy. These so called ” harms” do not occur for most patients. I would doubt that these factors would deter a patient from the possibility of early detection.

Dealing with Different Guidelines

Kathryn Boling, MD: I discuss with patients the fact that there are differing recommendations regarding when to start mammogram screening and how often to have screening. I do discuss with patients the risk of false positive results and attendant testing. I do ask women to have their mammograms done at the same facility as this allows easier comparison with earlier mammograms and may reduce false positive readings. I find in my practice that most women are not aware of the differing recommendations. Virtually all of my patients choose to begin mammograms at age 40. I believe that is a reasonable choice and that women should, at the very least, have that option. I admit, I do have a bias. In my almost 40 years in healthcare, I have seen many women diagnosed with breast cancer in their 40s.

Karen Oh, MD: If they ask me personally, I usually tell them that there is a mortality benefit — meaning mammography does save lives — and the decision to screen or not screen in their 40s is kind of personal, so based on your family history or sometimes your breast density or your desire to start screening versus the risk of false positives. I generally encourage people, personally, to at least consider starting to screen in your 40s just because even though it’s not as frequent in that decade to have breast cancer as in the other decades, the difference it can make for you personally if you catch it early is a big difference. I usually counsel people to think about those issues and then direct them back to their provider to make that decision with them.

Angela DeRosa, DO: I will still recommend women start getting mammo’s at age 40 every other year and then yearly at age 50.The problem is any time in medicine when you go looking for things you often find things. Many women with early breast cancer screening (and increased frequency of mammo/other imaging) DCIS are getting treated very aggressively and active surveillance may be better. But there is a huge divide amongst specialist on this as well. The data and my gut tells me that starting later (45) and doing them less often makes sense, but if any women get breast cancer and I didn’t follow the more aggressive guidelines, I am in the line of fire for lawsuits and board sanctions. Also patient compliance is often a problem…..so I am asking every year, I may be lucky to get them to go every 2 years. That is the practicality.

Potential Patient Confusion

Oh: We actually polled some of our patients about that because you don’t need an order from a provider to get screening, so they’re making their own decisions and a lot of people do look on the Internet. But a lot of people still ask their providers, and if they still have questions, it tends to be when they come in and we see them for something then they ask us as well in Radiology in the Breast Center. So I think there are a lot of questions about when to start and I generally guide them back to “Do you want to screen and have the possibility that you will have a false positive” (couched in different terms, but that’s basically the issue) versus “You will know a little bit earlier, and there is a benefit to knowing earlier,” especially in the younger age group.

Brem: Women are confused. They are unclear what the recommendations actually are and simply cannot understand why three organizations recommend different screening schedules. We need to educate women and we need to partner with the media to reassure women. Mammography saves lives, more lives if screening begins at 40 and continues annually thereafter. However, there is a price which is callbacks and the possibility of benign biopsy. However, it should be the woman’s choice to decide whether the benefits outweigh the “harms” for her.

DeRosa: They are confused and not sure what to think. They look to me for guidance. Many women are terrified (because we have made them that way) about getting DCIS or cancer and want to be aggressive in screening. However, I am seeing a surge of women who believe that the radiation is more problematic.

Recommendations Always Changing

Boling: I believe changing guidelines are more of a problem for physicians, other providers of women’s healthcare, and the medical system in general. When you care for patients, and you are constantly changing your recommendations, I think it erodes trust in the physician-patient relationship. Also, if you follow the “begin at 45” guideline and a late stage breast cancer is diagnosed at a future date, it becomes harder to defend your decision when there are conflicting recommendations. Then there is the question of how insurers will respond to differing recommendations. And of course, it is confusing to patients when they read all these different recommendations.

DeRosa: There are divergent recommendations/clinical guidelines in many areas and this is no different. It has become a tyranny. Many insurance organizations are using these tonot pay for services. Also clinical guidelines are often different depending on the specialty focus. Also they tend to be 5-10 years behind emerging research. So those on the forefront may be punished or considered heretics for practicing outside of these guidelines….even if they are leaders and forging new exciting paths. Anyone can follow guidelines……medicine is an art form and the individual patient needs to be considered.

Wilkes: I strongly disagree with the recommendation against clinical breast examination in average risk women. There has been an increase in breast cancer in young women, younger than age 40. For those women, breast examination, whether it is self breast exam or an exam by a clinician is the only way for cancer to be detected. This is also true for women above age 40 with dense breasts. Recommending breast examination, with familiarity of it’s benefits and limitations should continue.

Mulitasking And The Human Brain: Prefrontal Cortex Determines Concentration Level During Multiple Activities


We are all guilty of doing it, and some of us pride ourselves for it. We text while we walk, send emails during lunch, and talk on the phone while we shop, making us self-proclaimedmultitasking masters. But how exactly does the brain choose what visual and auditory stimuli to suppress when it comes to performing these various tasks?

 

According to a recent study published in the journal Nature, the brain’s prefrontal cortex, which is responsible for decision-making and complex behaviors like planning, saves information sent to the thalamic reticular nucleus (TRN) in order to choose how much visual or auditory information to process at a single time. The study’s results show how the brain uses the TRN “ as a switchboard to control the amount of information the brain receives, limiting and filtering out sensory information that we don’t want to pay attention to,” said Dr. Michael Halassa, senior study investigator and neuroscientist, in the press release.

For the study, Halassa and his colleagues sought to explore how the brain filters out distracting or irrelevant information while multitasking by conducting a behavioral experiment on mice. The researchers monitored mice’s ability to successfully collect a milk reward by paying attention to a light or sound signal. This was designed to measure how well the mice’s prefrontal cortex could direct their focus between the two senses, sight and hearing.

To test this, the researchers distracted the mice with the opposing stimulus — when a mouse expected a flash of light to guide it to the milk reward, the researchers played a sound, and vice versa. At the same time, the researchers recorded electrical signals from the TRN and tracked the mice’s behavior. While all this happened, the researchers were also able to deactivate several regions of the mice’s brains with a laser beam.

The findings revealed that the distracted mice experienced a drop in their ability to collect the food reward — from 90 percent to 70 percent — even when the distracting stimulus was removed. Deactivating the prefrontal cortex disrupted TRN signaling and relegated mice to only random moments of success in obtaining the milk. The researchers also found that deactivating TRN neurons, while leaving the cortical regions activated, decreased the mice’s success with getting the food reward.

“This study shows how the circuits of the brain might decide which sensations to pay attention to,” said James Gnadt, program director at the NIH’s National Institute of Neurological Disorders and Stroke (NINDS), in the NIH news release.

The findings also support the fact that the prefrontal cortex is vital to functioning in our everyday lives. It gives us the ability to focus on one thing and suppress other distractions. However, that doesn’t mean that carrying out several activities at once makes us good multitaskers. Rather, our brains shift attention from one task to the other, causing us to be slower and not nearly as good at both activities — think talking on the phone while driving.

In a 2008 study published in the journal Brain Research , for example, researchers found that a person who was asked to judge whether sentences they heard were true or false experienced a 37 percent drop in their brain’s ability to focus. This study showed that oftentimes we’re not multitasking but simply paying less attention to the task at hand, which causes us to lose efficiency and quality in the way we carry them out.

So, while researchers may have found out how the brain multitasks, sometimes it’s good to just do one thing at a time.