Only one-quarter of people who could benefit from a cholesterol lowering drug were taking one, a recent study by Caleb Alexander, a drug efficacy expert at Johns Hopkins, and colleagues has shown. Alexander says that number is likely to go even lower when cuts to insurance and rising coverage prices are implemented.
Alexander: Prescription drug coverage and the cost of these therapies is an important facilitator or barrier to their use. There are many people in the United states already that report cost related nonadherence. Up to 20 to 30% of people report in the past year that they skipped or stretched a medicine because of cost so I think if there are 10 to 15,000,000 Americans that have lost coverage because they've lost Medicaid insurance those individuals are going to have a harder time managing to fill and maintain their prescription drugs.                     :34
At Johns Hopkins, I’m Elizabeth Tracey.

Weight loss, NSAIDs, physical therapy, you’ve done it all and your knees are even more painful. Stefan Coombs, an orthopedic surgeon at Johns Hopkins, says when surgery seems to be the best option, so called knee replacement should be understood.
Coombs: The surgical procedure really involves a sophisticated sort of shaving of both the knee and the damaged cartilage, one to two to three degrees at very specific angles. So what we essentially do is resurface the damaged knee to accommodate an inert metal implant used to cap the ends of the bones. A good analogy that I use for patients is that compared to a tooth extraction and implantation and knee replacement is more of a crown over tooth being put on.   :32
Coombs says another technique known as a partial knee replacement might be considered based on what’s going on in your knee. A knee expert and imaging can help inform the right decision for you. At Johns Hopkins, I’m Elizabeth Tracey.

Injections of steroids into the knee has been a mainstay of management for knee osteoarthritis, and there’s a new kid on the block with hyaluronic acid or HA. Should you consider them? Stefan Coombs, an orthopedic surgeon at Johns Hopkins, has more.
Coombs: Knee steroid injections have been proven to provide short and medium term pain relief in knee osteoarthritis due to its anti-inflammatory properties, with only minor side effects such as skin atrophy or thinning and a very, very rare side effect of a knee infection. Many patients come in asking about hyaluronic acid. In this procedure this gel like fluid called HA is injected into the knee joint. The theory is that it would facilitate movements and reduce pain. The studies however are relatively weak and the Academy does not support the use of it.    :35
At Johns Hopkins, I’m Elizabeth Tracey.

Knee replacement is the last stop when it comes to managing knee osteoarthritis, says Stefan Coombs, an orthopedic surgeon at Johns Hopkins. Physical therapy is a modality that may enable people to avoid surgery altogether, he says.
Coombs: Physical therapy in knee osteoarthritis has been shown to be of tremendous benefit and a combination of manual physical therapy and supervised exercise yields functional benefits for patients and may delay or even prevent the surgical intervention. Therapy usually involves range of motion, strengthening, manual therapy, aerobic activities as well. The best aerobic activities come in the form of low impact exercises which do not put excessive pressure or stress on your knee.         :32
Coombs says a physical therapist with expertise and interest in knees should be sought, and seen in conjunction with other strategies like weight loss and pain relief. At Johns Hopkins, I’m Elizabeth Tracey.

Let’s say you’ve been diagnosed with osteoarthritis of the knee. Stefan Coombs, an orthopedic surgeon at Johns Hopkins, says management should always begin with conservative measures first.
Coombs: It should take the course of lifestyle changes such as weight loss, activity modification and walking aids, then there's a step up to oral and topical NSAIDs, then there's a step up to injections and nerve ablation procedures and then finally you go to surgery.   :18
Coombs says weight loss is pivotal for many.
 Coombs: Just 10% weight loss of your body weight can actually cut your arthritis pain by 30 to 50%. It may also slow down the progression of the disease or in some cases stop the progression of the disease.    :13
At Johns Hopkins, I’m Elizabeth Tracey.

Knee osteoarthritis is the most common cause of disability in adults in the US, recent data indicate, and the problem is growing. Yet Stefan Coombs, an orthopedic surgeon at Johns Hopkins, says not all knee pain is caused by osteoarthritis.
Coombs: There are many other relatively common causes of knee pain which can include fractures, you can have an ACL injury or tear, inflammatory conditions or tendonitis of both the patella and the quadriceps tendon, or you can have a meniscal tear and very rarely there's a potential of an infection within the knee. In addition to inflammatory causes it should be highlighted that the sensation of knee pain is not always attributed to a structural problem within the knee joint itself.    :31
Coombs says a careful history by someone with expertise in this area and perhaps imaging will begin the process of defining what’s going on in someone’s knees, and that’s foundational to addressing it. At Johns Hopkins, I’m Elizabeth Tracey.

Are you at risk to develop knee osteoarthritis? Stefan Coombs, an orthopedic surgeon at Johns Hopkins, says the answer may be yes if you are older, overweight, female, or have a family history of the condition. And there are also other conditions to be aware of.
Coombs: Individuals with a history of joint trauma are three to six times more likely to develop knee osteoarthritis and are diagnosed approximately 10 years earlier. It can either be from direct impact and damage to the cartilage. It can also be from the ligaments or tendons or the menisci which can then cause secondary injury to the cartilage of the knee. Some studies have shown a weak association with western pattern diets such as soft drinks and saturated fats to have an increased association with knee osteoarthritis.  :33
Coombs says you can engage in activities that help build up the muscles around the joint to help. At Johns Hopkins, I’m Elizabeth Tracey.

The number one cause of adult disability in the US is knee osteoarthritis, recent data indicate. According to Stefan Coombs, an orthopedic surgeon at Johns Hopkins, there are several factors to consider when trying to determine who’s at risk.
Coombs: Risk factors can be broken down into non modifiable risk factors, meaning you can't change or control them as well as modifiable risk factors, which we have the ability to change or control. Some non modifiable risk factors include age, race, genetic predisposition. Female sex is also a non modifiable risk factor. Obesity is by far the greatest modifiable risk factor. Muscle weakness is another modifiable risk factor as the quadriceps muscle acts as a shock absorber for both the knee joint itself and the patella.  :33
Coombs says the take home is to keep those factors you can control under control, and delay or avoid the development of knee osteoarthritis. At Johns Hopkins, I’m Elizabeth Tracey.

If you think everyone you know is considering a knee replacement because of painful knees, you’re not wrong. Johns Hopkins orthopedic surgeon Stefan Coombs says knee osteoarthritis is the number one cause of adult disability nationally, and the number of folks reporting this condition continues to increase. 
Coombs: This is believed to be highly prevalent today because of the significant increase in life expectancy. The number of Americans greater than 65 and older is growing from 58 million in 2022 to 82,000,000 over the next 30 years. Another significant contributing factor is the current obesity epidemic. Using the body mass index, one in every three adults is considered to be overweight and two in every five adults are considered to be obese.  :32
Coombs says while there’s nothing to be done about aging avoiding obesity is something people can attempt to help their knees. At Johns Hopkins, I’m Elizabeth Tracey.

Seems like everyone complains of arthritis in their knees, especially as they age. And that’s no surprise, says Stefan Coombs, an orthopedic surgeon at Johns Hopkins. It’s well known what happens to knees over time.
Coombs: Osteoarthritis is a degenerative joint disease resulting from wear and tear and progressive loss of articular cartilage. Cartilage is a strong flexible connective tissue. It has three main functions: it acts as a shock absorber through this specific joint, it lubricates your joints and allows the bony ends to glide with little friction and it provides support,   helping to maintain the shape of the joints. Knee osteoarthritis is the most common cause of disability in adults.   :30
Coombs says a number of factors converge to wear down the cartilage in the knee joint, resulting in pain and compromised function. Research is ongoing into what specific processes are taking place that might be interrupted to preserve the knee cartilage and full range of knee function. At Johns Hopkins, I’m Elizabeth Tracey.

There’s a new medicine to manage hot flashes, which many women identify as the most troubling aspect of menopause, a recent study reports. Yet Marty Makary, a surgeon and public health researcher at Johns Hopkins, says for many, effective treatment already exists.
Makary: Every woman needs to understand that there is probably no medication in modern medicine that has improved the outcomes of a population more than hormone replacement in postmenopausal women, arguably with the exception of antibiotics. Women who are on hormone replacement therapy after menopause live 3 1/2 years longer, their rate of heart attack goes down in half, they have 50 to 60% less cognitive decline and the brain fog of menopause and their bones are stronger.      :30
Makary notes that data from the Women’s Health Initiative that raised red flags about hormone therapy have since been disproven, so women should talk with their providers about the proven benefits. At Johns Hopkins, I’m Elizabeth Tracey.

Early in life antibiotic use may disrupt the microbiome in children and lead to long term health consequences, and this is one of medicine’s blind spots. That’s according to Johns Hopkins surgeon and public health researcher Marty Makary, in his new book called Blind Spots.
A recent study found that when a child takes an antibiotic in their first few years of life they have massively higher rates of obesity, learning disabilities, asthma and celiac. Now all of those chronic diseases have been going up and we scratch our heads in medicine to say why. Well it may be that some of the food and toxic exposures and the ways in which we alter the microbiome from antibiotics and C sections may be playing a role in the rise of all these chronic diseases.   :30
Rising rates of C-sections are implicated because newborns aren’t colonized with their mom’s bacteria as they are in vaginal deliveries, Makary says, and notes more research is needed to understand the role of the microbiome in health. At Johns Hopkins, I’m Elizabeth Tracey.

Blind Spots is the name of a new book by Marty Makary, a surgeon at Johns Hopkins and public health researcher, illustrating how medicine sometimes gets it wrong and then seems unable to reverse the tide of established treatments and practices. One such example he notes is the medical establishment’s longstanding ignorance of the microbiome.
Makary: We've got areas like the microbiome, that is the bacteria that line the gut, those bacteria live in a balance. It's important for digestion and the immune system, it's related to mood and mental health and it's involved in regulation of hormones but we've been ignoring this because it doesn't fit one of our specialties in medicine but it turns out it's central to health.  :25 
Makary says that willful disruption of the gut microbiome with antibiotic use can have long ranging consequences for the person who takes the drugs, especially if they’re very young, as well as society at large in promoting development of resistant organisms. He hopes that current research efforts on the microbiome point the way to protecting it. At Johns Hopkins, I’m Elizabeth Tracey.

If you’re a woman going through menopause you may have chosen to go online for help. If so you may be the victim of a ‘femtech’ company. Wen Shen, a menopause expert at Johns Hopkins, explains.
Shen: Basically they're there to push compounded hormone therapy that are not FDA approved. They're also there to push products, so they're marketing all these skin things and supplements and everything that are not evidence based not FDA approved. So I think this is where over medicalization happens and have they had full consultations like what are the other options.   :30
Shen says a recent series in the Lancet on menopause may exacerbate women turning online for help with menopause symptoms since it seems to discount research and offer facile solutions. She encourages women to seek help from experienced clinicians so a comprehensive approach to their health may be taken. At Johns Hopkins, I’m Elizabeth Tracey.

 Women may be experiencing overmedicalization as they transition through menopause, a recent Lancet series seems to suggest. Wen Shen, a menopause expert at Johns Hopkins, says that’s not her experience, since she sees many women who avoid physicians until symptoms drive them to seek help. Rather she identifies ‘femtech’ companies as one root of the problem. 
Shen: This is where I think the over medicalization should focus on. There are a lot of fem tech companies that are doing telemedicine, where a patient was signed up for an appointment, pay hundreds of dollars to have this consultation not paid by insurance and then they will have the hormones mailed to them. If they should have complications with the hormones then they are told to go see their OBGYN.  :28
Shen says women often struggle to find a knowledgeable clinician when it comes to helping with menopause symptoms but encourages them to keep trying rather than go online. At Johns Hopkins, I’m Elizabeth Tracey.

A recent Lancet series on menopause may result in many more women turning to the internet for help. That’s according to Wen Shen, a menopause expert at Johns Hopkins, who fears the series may have set back progress on bringing awareness to clinicians and women on how to manage symptoms.
Shen: Women who are 50,51 the average age of menopause, are gainfully employed with insurance and with disposable income and who are experiencing these horrible symptoms. If the women are not getting satisfaction from their primary care providers, who don't understand and are dismissing them, they go online. Doctor Google. There are just ridiculous number of sites that offer these women snake oil.  :31
Shen says there are at least a couple of reputable websites that offer evidence-based insights so surf with a skeptical eye while searching for a clinician with experience. At Johns Hopkins, I’m Elizabeth Tracey.

As women transition through menopause, they should be offered conservative approaches that don’t rely on medicines. That’s one interpretation of a recent Lancet series on menopause, and Wen Shen, a menopause expert at Johns Hopkins, says while such an approach offers a beginning, it is not a one size fits all solution.
Shen: There's so much evidence now that menopause, especially in menopause transition is the time of vulnerability for women for mood changes. They do mention cognitive behavioral therapy and mindfulness. Yes, those have been proven to be very effective in clinical trials, I prescribe that for my patients often. For a lot of patients they have already tried many of those options for themselves and they need more help than that.  :32
Wen encourages women to find a clinician who is knowledgeable about menopause if they continue to experience troubling symptoms. At Johns Hopkins, I’m Elizabeth Tracey.

Is menopause overmedicalized? That seems to be one conclusion of a recent series published in the Lancet on this life stage for women. Wen Shen, a menopause expert at Johns Hopkins, begs to disagree.
Shen: It's unfortunate that they came across with that impression because if anything we have been trying so hard to educate women that they don't have to put up with symptoms of menopause, they don't have to suffer. There are definitely actual benefits to being treated for menopause symptoms. We have very sound data for that and that's in this paper I'm so surprised to read where they said there is no data.  :32
Shen notes that many of the studies cited in this series were quite old and that subsequent studies have come to different conclusions. She is especially concerned that women and clinicians may be influenced to dismiss troubling menopause symptoms based on this series. At Johns Hopkins, I’m Elizabeth Tracey.