Friday, August 31, 2007
"A thunderhead towers at knee level, throwing tiny lightning bolts at my shoes. I'm standing--rather, my avatar is standing--astride a giant map [SLurl] of the continental United States, and southern Illinois, at my feet, is evidently getting a good April shower.
The weather is nicer on the East Coast: I can see pillowy cumulus clouds floating over Boston and New York, a few virtual meters away. I turn around and look west toward Nevada. There isn't a raindrop in sight, of course; the region's eight-year drought is expected to go on indefinitely, thanks to global warming. But I notice something odd, and I walk over to investigate."
To read on, click here.
[Photo Credit: Technology Review]
Associated Press Examines Reaction of People Allegedly Forced To Undergo Abortions, Sterilizations in China
China's one-child-per-family policy seeks to keep the country's population, now 1.3 billion, at about 1.7 billion by 2050. Methods of enforcing the policy, such as fines and work demotions, vary among Chinese provinces and cities (Kaiser Daily Women's Health Policy Report, 8/7). According to the Associated Press, China bans forced abortions, but late-term abortions are not expressly prohibited or defined.
Some attorneys and social advocates recently have documented cases of forced late-term abortions. Human rights advocate and self-taught attorney Chen Guangcheng prepared a lawsuit documenting 20 cases of forced sterilizations and abortions allegedly carried out in China's Shandong province in 2005 (Associated Press, 8/28). In August 2006, Chen was sentenced by a court in Shandong to four years and three months in prison for allegedly "willfully damaging property" and "organizing a mob to disturb traffic." An appeals court in Shandong in October 2006 ordered a retrial, but the Intermediate People's Court in the province rejected the appeal and upheld the sentence in January (Kaiser Daily Women's Health Policy Report, 8/24).
In addition, a couple is suing the Family Planning Bureau in Changli county, China, for an alleged forced abortion. Yang Zhongchen alleges that his wife, Jin Yani, was forced to undergo an abortion in 2000 because the couple did not have a birth permit. A court ruled against the couple, saying that the fetus was conceived before the couple was married. The couple's appeal to a higher court is pending. Yang and Jin are seeking 290,000 yuan, or $38,000, in medical expenses, and one million yuan, or $130,000, in psychological distress (Associated Press, 8/28).
Reprinted with permission from kaisernetwork.org. You can view the Kaiser Daily Reports online, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyrepo
According to ACOG, the procedures are unproven and the potential risks -- including infection, scarring, nerve damage and loss of sensation -- outweigh the potential benefits (Zimmerman, Wall Street Journal, 8/31). ACOG in a statement said it is "deceptive" for physicians to "give the impression" that such procedures are "accepted and routine surgical practices." ACOG's Committee on Gynecologic Practice in a statement published in the September issue of the group's magazine said the "[a]bsence of data supporting the safety and efficacy of these procedures makes their recommendation untenable."
Steven Sondheimer, an ob-gyn professor at the University of Pennsylvania and vice chair of the ACOG committee, said the group is not "really sure" what physicians are doing when performing the procedures, adding, "We have doctors contacting us and asking, 'Is this something now being taught?' And we have to say no." Thomas Nolan, president-elect of the Society of Gynecologic Surgeons, said, "I know of no medical reason to do these surgeries, and no scientific data that proves they are beneficial."
According to the Chicago Tribune, the procedures increasingly are being marketed to women on late-night television, in magazines and on the Internet. Advocates of the procedures say complications are rare, the Tribune reports. Robert Moore, a gynecologist and director of the Laser Vaginal Rejuvenation Institute of Atlanta, said, "Is there overwhelming data and evidence? No. But we're gathering it now, and that's why we've gotten involved in this -- to bring legitimacy to the field" (Graham, Chicago Tribune, 8/31).
Although ACOG does not collect statistics on the procedures, the American Society of Plastic Surgeons in 2005 began collecting data on vaginal rejuvenation, reporting 793 procedures that year and 1,030 in 2006 (Wall Street Journal, 8/31).
Reprinted with permission from kaisernetwork.org. You can view the Kaiser Daily Reports online, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyrepo
- [Editor's note: Bloomberg also did an article on the dangers of this and G-spot amplification -- it can be read in full here.]
"Some people use cynicism to evade moral responsibility. If you can convince yourself that everyone behaves selfishly, then why try to be a better person?" -- Peter Singer in an op-ed not related to bioethics.
Thursday, August 30, 2007
Harvard's loss becomes everyone's gain!
Wednesday, August 29, 2007
I can't help but feel a burning cynicism as I predict the warm acceptance of such a technology: how generous funding from McDonald's will spur its rapid development, how subsidies by the government in light of this "urgent health crisis" will make the vaccine affordable to every low-income child whose parents lack the money to eat anything but fast food, how "vaccine-mobiles" will trek across cities to share the largesse of freedom from flab. "A Modern Miracle!" reads the headlines as nutritionists are shunted back off to the far reaches of food science, their cautions and advice now out of vogue as people celebrate their newfound immunity to prudence.
Meanwhile, a single mother will scrape together her meager finances to give her daughter a chance at a life free of cervical cancer, but $360 is a long way to go, and her pastor says it will promote a sinful life.
Monday, August 27, 2007
As noted around the science blogosphere, something wicked this way comes. PRISM, or the Partnership for Research Integrity in Science and Medicine (created by the Association of American Publishers), is setting up a strawman argument against Open Access publications, claiming that the tradition of peer review is under attack. Open Access, such as PLOS journals and other initiatives, make it easier for people to have access to the research that they, as taxpayers, implicitly fund. Wouldn't you like to know what you are paying for, and whether it benefits your life? Wouldn't you like scientists to have free and easy access to published results so we can use accumulated knowledge rather than burying it?
PRISM's issue is this: if more and more research is made open access (ie, free) how will traditional publishers make any money? The concern is legitamate, but the hoopla, rhetoric, and obfuscation shown on their website suggests that they would rather bend the facts to create a non-issue (that peer review is under attack) rather than face a more real, but less sympathetic issue (how to keep making money). Their main beef seems to be the nebulous threat of "government interference," specifically that the government would like open access to the research that, ya know, it pays for. GASP.
Depending on who you talk to, this is either a very controversial issue that undermines Peer Review, a mainstay of the scientific community … or a Straw Man designed to safeguard publishers' interests. As a technophile with a science background, I admit a bias towards the blogs at Science Blogs, all of whom appear to disagree strongly with PRISM's position, and many of whom are criticizing the tactics being used. (I am also biased against language created by professional "damage control" PR spin-doctors and copyright advocates who "borrow" resources for their website) There is also the juicy matter of the conflicts that arise whenever a new technology (the Internet) displaces an old one (print media).
This issue is germaine to Bioethics for several reasons. First, it is intuitive that the quality and quantity of open discussion within any field increases with greater open access to source material. Second, a large challenge in Bioethics is reconciling the conflicts in economic and ethical interests – this fits as both a meta-issue (should bioethicists support the closed distribution of information only to those who will pay for it?), and a direct issue (should only rich bioethicists have access to NIH papers?). Third, the cause of increasing public awareness and critical approaches to bioethical issues would be facilitated by ensuring the public has access to source material so they can make their own decisions about situations without needing to rely solely upon expert (and possibly biased) interpretations.
While bioethicists may not produce a significant portion of these research papers, it is guaranteed that in the course of our work we will need access to the background information contained within, and if access is controlled by economic interests, there is a distinct risk of asymmetrical access based on how much such information affects an entity's financial condition (ie: a corporation would pay a lot more than a bioethicist could offer, all in order to keep damaging information undisclosed).
I urge attention to this issue and a critical look at all positions because, while peripheral, this affects all of us and the future of scientific and medical dialogue in our society.
More information and links can be found at "A Blog Around the Clock"
Friday, August 24, 2007
A well-publicized study and a spate of popular books raise questions about the ill effects of being overweight. Their conclusions are probably wrong.
By Paul RaeburnTwo years ago Katherine M. Flegal, a researcher at the Centers for Disease Control and Prevention, did a new statistical analysis of national survey data on obesity and came to a startling conclusion: mildly overweight adults had a lower risk of dying than those at so-called healthy weights..."[Full text here]
The article goes on to explain that the states are high in this debate...that a "major thrust of the nation’s disease prevention efforts are aimed at ending what orthodox researchers say is an epidemic of obesity." And if obesity is not the primary cause of heart disease and other serious illnesses, then efforts to trim American waistlines are entirely misplaced.
Language does matter -- I've heard it said that obesity is the last bastion of socially acceptable bigotry. I recently overheard some young women in Europe, standing outside a hotel having a cigarette break, saying that the reason they smoke is so that they don't 'get fat'. But there are worse than being 'fat' -- likely being sedentary. Or dead from lung cancer.
One the things that so many of the articles fail to mention is the importance of regular physical activity -- that the fitness that results from regular exercise confers a variety of health-related benefits in obese patients even if they lose no weight. It seems to me that regular exercise is a far more reliable indicator of health than simple body mass -- based on BMI alone, Brad Pitt, Keanu Reeves, and Michael Jordan are all overweight. And George Clooney and Matt LeBlanc are obese. In fact, a quick review of literature revealed this gem of a study, by Warburton, Nicol, and Bredin: "We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death." All that, with barely a mention of BMI.
To which I say, let's do a celebratory jig.
"Neuroimaging reveals a shared basis for chocoholia and drug addiction...
Mounting evidence shows that compulsive eating and drug abuse engage some of the same brain circuits in similar ways, offering a new angle for understanding and treating obesity. In an interview with Scientific American, Nora D. Volkow, director of the National Institute on Drug Abuse and a pioneer in the study of addiction, explains.
brain remembers not just what the food tasted like but also the sensation of pleasure itself, and the cues or behaviors that preceded it. [To access the rest of the article, click here]
Reuters reports that erectile-dysfunction drugs may increase oxytocin levels in men, promoting more affection and bonding.
"This is one piece in a puzzle in which many pieces are still not available," [Wisconsin physiology professor Meyer] Jackson said in a statement. "But it raises the possibility that erectile dysfunction drugs could be doing more than just affecting erectile dysfunction."
Viagra, made by Pfizer Inc., is an inhibitor of an enzyme called phosphodiesterase type 5. Related drugs such as Eli Lilly and Co.'s Cialis, known generically as tadalafil, and Levitra or vardenafil, sold by GlaxoSmithKline, Bayer AG and Schering-Plough, are also PDE-5 inhibitors.
They block this enzyme, which in turn breaks down other compounds. This increases blood flow in the muscles but it also affects a brain structure known as the posterior pituitary.
This, in turn, boosts oxytocin, at least in the rats. It probably does the same thing in people, Jackson said.
"It does the same thing it does in smooth muscle -- instead of (levels) coming down in a minute or two, they stay up a little longer," Jackson said in a telephone interview.
Sauce for the goose, sauce for the gander, indeed.
Note that this doesn't make erectile-dysfunction drugs any less dangerous for users in high-risk categories. But this may open up their usage (in different formulations and doses) to more people than just those suffering from erectile-dysfunction. Could it be that, like birth control pills that are primarily prescribed to correct hormone imbalances in women, these medications will be one-day used to fine-tune hormone levels in men?
Thursday, August 23, 2007
There are only nine programs in the country designed to treat young children who will not eat. Dr. Manikam runs one of them, in a ward at St. Mary’s Hospital for Children in Bayside, Queens, that can house six inpatients. Inside a row of small rooms at the Center for Pediatric Feeding Disorders, therapists do the slow, careful work of breaking down children’s resistance to eating. They act as detectives, tracing the behavior backward to the experience that may have shaped it.
Underlying the work is the notion that eating is a learned behavior, not an instinctive one. Babies fed by tube after birth may never learn to associate the sensation of hunger with the act of eating; babies who do not move to solid food by the age of 8 months may not learn to breathe, chew and swallow without choking. When those learning opportunities are missed, children can develop a deep anxiety that defies logic, something that Dr. Manikam compares to a fear of flying.
He has spent a career trying to break down that fear, most often in children with disabilities who become accustomed to tube-feeding early in life.
“I am a firm believer that learning never ends,” he said. “If you are living, you can learn.”
What strikes me about this article is that the inability to eat came not from any inherent disorder, but instead from the conditioning that resulted as a secondary effect of the modern technologies that saved their lives as infants. We take certain activities for granted because they are so fundamental to our existence and culture, and the idea of someone who cannot eat because they did not learn the behavior of eating is baffling to most since (until recently) the only way to sustain oneself nutritionally has been to eat food. I can only imagine how lost and helpless the parents of these children must have felt before they discovered these therapists.
While this by no means invalidates the need to use such technologies to save and improve lives, it does emphasize that with continued rapid advances in technology must also come an increased level of empathy and understanding to help us recognize new areas of intervention that are required to allow those lives we saved to thrive.
According to a UNICEF report released in December 2006, about 7,000 fewer girls than expected are born daily in India, and about 10 million fewer girls than expected were born in the past 20 years. The most recent Indian census figures found that the gender ratio decreased from 947 girls per 1,000 boys to 927 girls per 1,000 boys from 1991 to 2001.
Minister for Women and Child Development Renuka Chowdhury last month announced that the Indian government is planning to create a national registry of all pregnancies and abortions performed in the country in an effort to curb sex-selective abortion and infant mortality. The government would like to have public and private health centers, hospitals and maternity homes in the country record pregnancies and abortions. The government also aims to increase the number of health workers who will locate and provide care to pregnant women in rural areas.
The country in 1994 approved the Prenatal Determination Act, which bans the use of technology, such as ultrasounds and sonograms, for the purpose of sex-selective abortion. The law also bans advertisements for prenatal sex determination, as well as the practice of preconception sex selection (Kaiser Daily Women's Health Policy Report, 8/3). According to Reuters, more than 400 cases have been filed under the law, resulting in only two convictions -- a fine of 300 rupees, or about $7, and another fine of 4,000 rupees, or about $98.
Ranjana Kumari, director of the Centre of Social Research, a New Delhi-based organization promoting women's empowerment, asked, "Is 300 rupees the cost of a girl in India?" She added, "We are obviously not doing enough, as we would see many, many more convictions being made." According to officials, there are plans to increase punishments for sex-selective abortion from three years to five years in jail with a maximum fine of 10,000 rupees, or $240, to 50,000 rupees, or $1,215, as well as to boost enforcement of the law.
Officials said it is difficult to catch and charge physicians, patients and other agents involved in sex determination tests and subsequent abortions in private clinics, adding that people can be charged only when there is concrete evidence. "Sex selection has been the main culprit for the declining female-child ratio in the country," Pravir Krishna, a senior official from the Indian Ministry of Health and Welfare, said, adding, "Technology has given us a lot of benefits, but this is one aspect of technology which has given us a serious problem" (Reuters, 8/21).
Reprinted with permission from kaisernetwork.org. You can view the Kaiser Daily Reports online, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyrepo
The United States Patent and Trademark Office (USPTO) announced a decision to open an investigation into whether rabbits and other animals whose eyes have been purposefully damaged can be patented. The patent (#6,924,413) which is being challenged by the American Anti-Vivisection Society (AAVS), the Alternatives Research & Development Foundation (ARDF), and PatentWatch, argues that animals are not patentable subjects and that, in fact, animal patents provide an incentive to harm animals for economic gain. In addition, the patent challenge highlighted numerous instances of prior scientific publications that should invalidate the patent. The USPTO agreed that “substantial new questions of patentability” were raised.
The groups’ first challenge to an animal patent succeeded in having the University of Texas drop its patent claims on beagles who were severely sickened and infected with mold. In addition, the Canadian Supreme Court ruled in 2002 that animals could not be patented, further challenging the legitimacy of animal patents in the U.S.
“Animal patents have no place in our society and are an inappropriate application of U.S. patent law. A rabbit with damaged eyes is still a rabbit,” said Tracie Letterman, an attorney and Executive Director of AAVS.
Results from a 2004 Opinion Research Corp. survey of 1,008 U.S. adults commissioned by AAVS found that two out of three people consider it unethical to issue patents on animals as if they were human inventions. Further, 85 percent of those surveyed were not even aware that universities and corporations are getting patents on animals.
More than 660 patents have been issued on animals since the Patent Office granted its first animal patent in 1988. Interestingly, approximately one-third of all animal patents granted to date are issued to foreign companies. The Japanese-owned Biochemical and Pharmacological Laboratories, Inc., filed the patent that is the subject of this challenge.
“Allowing foreign or domestic corporations to patent animals who have been intentionally injured, sickened, or genetically altered provides an incentive to harm animals for economic gain,” said Sue Leary, President of ARDF. “This directly conflicts with laws encouraging the replacement of animals in experiments with alternatives.”
“We’re pleased with the Patent Office for re-opening this patent application and hope that they will do the right thing by denying this patent,” said Andy Kimbrell of PatentWatch. “Our legal challenge and the poll numbers showing widespread public opposition to animal patenting should send a strong message to the Patent Office that this patent is neither legally valid nor morally acceptable.”
For more information, including document downloads, visit www.StopAnimalPatents.org.
About AAVS: The American Anti-Vivisection Society (AAVS) is the oldest non-profit animal advocacy and educational organization in the United States dedicated to ending experiments on animals in research, testing, and education. Founded in Philadelphia in 1883, AAVS pursues its objectives through legal and effective advocacy, education, and support of the development of non-animal alternative methods.
About ARDF: The Alternatives Research & Development Foundation funds and promotes the development, validation, and adoption of non-animal methods in biomedical research, product testing, and education.
About PatentWatch: The PatentWatch Project of the International Center for Technology Assessment works to expose and challenge the inappropriate use of the U.S. patent system.
Monday, August 20, 2007
- Las Vegas Review-Journal: The "proper" legal question in this case might be where Congress "finds any delegated power to restrict consensual commerce between well-informed doctors and patients who want to try these medicines, and manufacturers willing to sell them," according to a Review-Journal editorial. Rather than determining the constitutionality of regulating medicine, it would be easier to "simply set up the protocols the plaintiffs seek, allowing the experimental use of drugs already confirmed as reasonably safe for human use, in specific cases where a mentally competent patient is otherwise at death's door" -- which is what FDA "should have done in the first place" (Las Vegas Review-Journal, 8/9).
- Ronald Trowbridge and Steven Walker, Wall Street Journal: The Abigail Alliance, which filed the lawsuit against FDA in 2003, has pushed for access to 12 experimental drugs that if "available to people denied entry to clinical trials" might have "helped more than one million mothers, fathers, sons and daughters live longer, better lives," Trowbridge, an adjunct scholar at the alliance, and Walker, co-founder of the alliance and its chief adviser, write in a Journal opinion piece. The Abigail Alliance will appeal the decision to the U.S. Supreme Court and agrees "with only one thing in the majority opinion" -- that "Congress should pass our pending legislation, called the Access Act, now" as part of the Prescription Drug User Fee Act, Trowbridge and Walker write. They continue that the decision "is massive human tragedy, made even worse by the fact that it didn't and doesn't have to be this way" (Trowbridge/Walker, Wall Street Journal, 8/14).
- Bruce Fein, Washington Times: It "seems both mindless and cruel" for FDA to block terminally ill patients' access to "a drug that carries the sole hope of life," Fein, a constitutional lawyer with Bruce Fein & Associates and chair of the American Freedom Agenda, writes in a Times opinion piece. Fein writes that terminally ill patients "should enjoy access to any drug recommended by physicians to treat their afflictions, but only after receiving a comprehensive tutorial explaining the safety risks and probability of success." He adds, "Absolute patient-physician autonomy should prevail" (Fein, Washington Times, 8/14).
Normally recognized for its effect on mother-child bonding in mammals and for promoting uterine contractions and lactation, researchers are discovering a wide range of subtle behavioral effects related to nurturing and socializing behavior. Only mildly surprising is the effect of administered oxytocin on males as well – increased trust and empathy in social situations.
To complicate matters further, the presence or absence of oxytocin receptors and secondary messenger chemicals can amplify, cancel out, or fine-tune an organism's response to oxytocin secretion (which is itself influenced by a variety of factors, such as level of socialization). Genetic studies with knockout genes in mice suggest that they play a large role in affecting mothering behavior in mice.
Why is this of interest to us? First, as we have seen with the marketing of estrogen decades ago (and continuing today) as a "cure-all for all feminine ills" and a way for women to "enhance" and "improve" their personality so that they were more amiable and pleasant to men, oxytocin prescriptions could become the next "mood-altering drug" pushed on women. Additionally, because it is a hormonal supplement for what naturally occurs in our bodies, it is very possible that it will carry less stigma than currently offered anti-depressant drugs, perhaps receiving the label as a "more natural alternative."
Second, it is not far-fetched to expect studies in the near future that evaluate the "beneficial effects of oxytocin supplements" for new mothers, perhaps in an attempt to stave off the difficulties of Postpartum/Postnatal Depression and other postnatal hardships. And remembering how easily free formula samples have been marketed to new mothers concerned about their baby's nutrition, I have to ask: what anxious new mother would turn down a free sample of a hormonal supplement derived from the "motherhood hormone" that purportedly would make her a "better" mother?
It is often the case that the presence of a "cure" will pathologize any condition that could be treated by it. How long until a mother, or even a woman without children, who "lacks a nurturing personality" will experience social pressure to "correct her deficiency"?
Third, the research also discusses a possible link between oxytocin and autism, though the causality remains uncertain. Even as most men would shy away from a hormone labeled as "feminine", it is possible that further research could benefit people suffering from the spectrum disorder of Asperger's and autism, the majority of whom are male. But such benefits could be pushed out of reach, ironically, by the more glamorous application of oxytocin research towards feminine behavioral modification, or even by an impending backlash against chemical behavioral modification.
While actual applications of oxytocin are still distant, I believe that it is our responsibility to speculate and anticipate potentially problematic uses of technologies under development, and the impacts of this technology touch both deep emotional roots and far-reaching societal venues. More research into this field is certainly advised, but we should be wary of indiscriminate and superficial applications of a premature technology spurred by economic and market interests and not by medically sound or humanitarian reasons.
Friday, August 17, 2007
Tamoxifen, which blocks the production of estrogen, is the only FDA-approved drug for reducing breast cancer risk, but it increases risk for uterine cancer and blood clots. Another estrogen-blocking drug, called raloxifene, has been shown to be equally effective as tamoxifen at reducing breast cancer risk, but it increases risk of hot flashes and other menopause-related symptoms.
Aromatase inhibitors work by blocking the production of estrogen. The study would have involved administering either raloxifene or the aromatase inhibitor letrozole to 12,800 women at high risk of developing breast cancer at 500 sites in the U.S. and Canada. A committee appointed by NCI Director John Niederhuber in June decided not to endorse the study, citing the cost and questions concerning its usefulness and safety. In addition, the committee said that two large U.S. and England-based studies of the drugs are under way (Kaiser Daily Women's Health Policy Report, 6/20).
Study researchers have appealed the cancellation to NIH Director Elias Zerhouni, the Journal reports. NSABP in a letter to Zerhouni appealing the cancellation said it "represents a dangerous and unjustified departure" from NCI's traditional review process. NSABP Chair Norman Wolmark said the group is "passionate in [its] belief this is an extremely useful trial that will benefit women," adding that the group "think[s] an injustice has been done to women by canceling the trial."
Niederhuber has said that the agency's funds would be better spent on identifying characteristics that indicate increased breast cancer risk instead of giving preventive drugs to women who might not have a high risk of developing the disease. According to the Journal, NCI also is concerned about possible side effects of the drugs.
Niederhuber in a letter to Sen. Arlen Specter (R-Pa.), who had inquired about the study's cancellation, said there was evidence that healthy women did not want to take drugs to prevent breast cancer because of potential side effects. Niederhuber added that although previous trials of breast cancer prevention drugs have provided "valuable information," they "failed to change the practice of breast cancer prevention among women and their health care providers." Carolina Hinestrosa -- executive vice president of the National Breast Cancer Coalition, which supports the cancellation -- said the group is "very concerned about the approach of treating healthy women with drugs that are toxic in order to reduce the risk for very few who benefit."
According to the Journal, letrozole likely will not be approved for breast cancer prevention if the trial does not take place because such a trial likely would be too expensive for the private sector. Some researchers said that other proposals for clinical trials of breast cancer prevention drugs are unlikely if NIH upholds NCI's decision. The journal Lancet in a recent editorial said the cancellation was "troubling" and that an "independent investigation into how the decision was made and whether it was made fairly is warranted." NCI declined to comment on the editorial but said Niederhuber "got the best scientific advice and acted on it" in canceling the study (Wall Street Journal, 8/14).
Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.
Thursday, August 16, 2007
"Making his way back up the hallway, Oscar arrives at Room 313. The door is open, and he proceeds inside. Mrs. K. is resting peacefully in her bed, her breathing steady but shallow. She is surrounded by photographs of her grandchildren and one from her wedding day. Despite these keepsakes, she is alone. Oscar jumps onto her bed and again sniffs the air. He pauses to consider the situation, and then turns around twice before curling up beside Mrs. K.
One hour passes. Oscar waits. A nurse walks into the room to check on her patient. She pauses to note Oscar's presence. Concerned, she hurriedly leaves the room and returns to her desk. She grabs Mrs. K.'s chart off the medical-records rack and begins to make phone calls.
Within a half hour the family starts to arrive. Chairs are brought into the room, where the relatives begin their vigil. The priest is called to deliver last rites. And still, Oscar has not budged, instead purring and gently nuzzling Mrs. K. A young grandson asks his mother, 'What is the cat doing here?' The mother, fighting back tears, tells him, 'He is here to help Grandma get to heaven.' Thirty minutes later, Mrs. K. takes her last earthly breath. With this, Oscar sits up, looks around, then departs the room so quietly that the grieving family barely notices.
On his way back to the charting area, Oscar passes a plaque mounted on the wall. On it is engraved a commendation from a local hospice agency: "For his compassionate hospice care, this plaque is awarded to Oscar the Cat." Oscar takes a quick drink of water and returns to his desk to curl up for a long rest. His day's work is done. There will be no more deaths today, not in Room 310 or in any other room for that matter. After all, no one dies on the third floor unless Oscar pays a visit and stays awhile.
Note: Since he was adopted by staff members as a kitten, Oscar the Cat has had an uncanny ability to predict when residents are about to die. Thus far, he has presided over the deaths of more than 25 residents on the third floor of Steere House Nursing and Rehabilitation Center in Providence, Rhode Island. His mere presence at the bedside is viewed by physicians and nursing home staff as an almost absolute indicator of impending death, allowing staff members to adequately notify families. Oscar has also provided companionship to those who would otherwise have died alone. For his work, he is highly regarded by the physicians and staff at Steere House and by the families of the residents whom he serves." The complete article can be seen here.
All sorts of explanations have been offered by others for his sense of knowing who is about to die, including the idea that the staff might put a warm blanket on the patient which is why he climbs up on the bed with the patient, but I prefer to think there is a animal sense, as yet, we do not understand nor can explain. So kudos to Oscar the cat who comforts the dying and alerts the staff to impending death.
As John Tierney of the NY Times noted, "it never occurred to me that our universe might be somebody else’s hobby. I hadn’t imagined that the omniscient, omnipotent creator of the heavens and earth could be an advanced version of a guy who spends his weekends building model railroads or overseeing video-game worlds like the Sims...
This simulation would be similar to the one in “The Matrix,” in which most humans don’t realize that their lives and their world are just illusions created in their brains while their bodies are suspended in vats of liquid. But in Dr. Bostrom’s notion of reality, you wouldn’t even have a body made of flesh. Your brain would exist only as a network of computer circuits."
A rather unsettling theory, I think -- but as John Tierney points out, it "might at last dispose of that of classic theological question: How could God allow so much evil in the world? For the same reason there are plagues and earthquakes and battles in games like World of Warcraft. Peace is boring, Dude." Access to the full NY Times article here.
For the abstract and access to the full text of the article (subscription required), click here.
"Smaller Not Always Better: Microcapsules beat Nanoparticles for Making Drugs with Less Waste
... David McQuade knows that nanotechnology is not always the best solution to technological problems. He and his team at Florida State University have developed microspheres that can build a drug by connecting three simple building blocks in a single flask...
Nanoscience may be all the rage, and nanoparticles have very high surface areas which make them fabulous catalysts. But nanoparticles are so small that they can be hard to filter out of a broth once a reaction is over. Using larger spheres is a worthwhile trade off to avoid the hassle of getting rid of particles so tiny that they are hard to filter."
For the rest of the article, click here.
Two stories, one for her and the other for him. First up, an Israeli company is marketing the first "internal" bra, which it's calling minimally invasive mastopexy (MIM). Here's how one of company's doctors described the procedure to Israel21c, an Israeli technology site:
"What we've done is build a silicon bra, insert it into the body and attach it to the ribs and to the fascia. It's like a normal external bra," he continues, "where a strip lies on the shoulder and attaches around the body. We attach it to the ribs instead of to the shoulder, and to the fascia in the lower part of the body."
"It may sound scary but take a look at cosmetic and plastic surgery - that's much more invasive," said Gur. "The most prevalent procedure in the world is breast implantation. Who is the crazy woman who agreed to be the first woman to put silicon into her body? Very strange things happen within the cosmetic world and the MIM is not as crazy as it sounds; that's the end point of what I'm saying."
And now for the "his" story. The Houston Press reports on circumcised men who are trying to restore their foreskin. It seems that many of the men pursuing this goal feel like they were violated when the circumcision choice was made for them. Their drive for restoration often leads them to using odd contraptions and methods, including tape, clips and batteries. Here's how the inventor of one device described the moment he told his wife about his plan:
"It was April 1, 2001, at about nine o'clock in the evening," he says, speaking on the phone from the Chicago suburb of Northbrook. He and his wife "were sitting in front of the TV set and I said, 'Hon, I've got to tell you about something. I'm going to start applying tape to my penis every day because I want to stretch my skin and make a new foreskin grow.' And she said, 'Well, that's crazy. That's ridiculous.' And I had to look her straight in the eye and tell her I was deadly serious. 'It's not crazy, and I'm going to need your support, dear.'" And she's been supportive ever since.
According to the article, there's been little research in the medical community about foreskin restoration. And it does mention recent research indicating that circumcision may lead to lower rates of STI transmission.
(Both stories via Buzzfeed)-Greg Dahlmann
Monday, August 13, 2007
From the BBC, obesity is linked to birth defects and health risks: a large scale study in the journal Archives of Pediatrics and Adolescent Medicine says that women who are obese when they conceive are more likely to have chronic diseases, fertility problems, miscarriages and complications during pregnancy, as well as birth defects including missing limbs and malformed hearts.
Then there's a study reported in Cell, which suggests that the skeleton is part of the endocrine system, specifically helping with the regulation of osteocalcin, which in addition to regulating mineralization appears to regulate glucose and deposits of body fat. This likely explains, at least in part, the connection between obesity and type two diabetes; researchers will move forward to look more closely at this link, next.
Following that, a study out of UPenn says that obese kids are more absent from school than others, and in fact suggests that obesity is more an indication for how much school a child will miss than any other factor, including race, gender, or socioeconomic status. The lead researcher is pretty succinct about why this is, too: the kids don't want to be teased or bullied over their weight.
According to a report at an American Physiological Society meeting, estrogen loss leads to weight gain, as well as hypertension, suggesting that estrogen treatment is beneficial for both the heart and the body.
And finally, it looks like people overeat due to another hormone-gone-wonky. People who don't manufacture leptin tend to overeat, becoming chronically obese. People who are deficient in leptin have the same areas of their brain react, at the sight of food, that react to rewarding emotions/desires.
So what's the point to all the fat talk? For some people, fatness, being overweight, obesity, is simply a medical issue. You are overweight for a reason, be it medical or psychological, it is bad for you, you should work on not being overweight, which is good for you. There are clear concepts of good and bad tied to this model of viewing weight, and it tends to be a part of the general medicalization of weight we see - to be thin (but not too thin) is healthy, to be fat is to be unhealthy. And within healthy/unhealthy there are specific moral and value-laden beliefs that tie into good and bad; to be healthy is to be good, to be fat is to be bad.
But there are people out there, often people who are overweight, that reject this sometimes value-laden, binary attitude towards weight. They are comfortable with their weight, and don't appreciate being "bullied" by society to adhere to an ideal they don't believe is accurate. These folks often espouse the motto "healthy regardless of weight", placing an emphasis on health outside of weight. After all, the reasoning goes, if someone is 65 lbs overweight, but perfectly healthy otherwise, what business is it of anyone just what that weight is? People come in all sizes, and as long as the individual is healthy, what that size is shouldn't matter to anyone. While this group, often known as fat activists, embrace the notion of being healthy, they reject the idea that healthy is thin is good, and unhealthy is fat is bad.
How news reports discussing obesity are received tends to depend on how they are written. If they are written, as most are, in the medicalized and moralized language of the first model, a group of people - perhaps the group of people most affected by the research being reported on - are alienated from the outset by the language, and judgment, being used. People are sensitive to the language being used to describe them, and very few people respond positively to being preached at.
A healthy body is a goal that is hard to argue with, and if we communicated consistently in such a manner, we might very well discover that many of the medicalized concerns about the overweight/obese would be addressed to everyone's satisfaction.
A simple technique using nothing more than cotton swabs and vinegar could help prevent the deaths of more than 250,000 women a year. Cervical cancer – a sexually transmitted disease caused by the human papilloma virus (HPV) – is the leading cause of cancer-related mortality in the developing world. Early diagnosis and treatment is key, but current screening and treatment technologies, such as Pap smears and the newly approved HPV vaccine, are too costly to be used widely in resource-poor countries. Fewer than five per cent of women in Africa, Asia and Latin America are screened for cervical cancer, as compared to 70% of women in North America and Europe.
In 1999, researchers in the U.S. and Zimbabwe showed that trained nurse-midwives who wiped a patient's cervix with acetic acid (white vinegar) accurately detected more than three-fourths of pre-cancerous and cancerous lesions; tissue harboring such lesions turned white when exposed to vinegar, and could be easily seen during a visual inspection of the cervix.
In a study recently published in the British medical journal The Lancet, researchers in India and France have built upon that finding to show that this method – visual inspection of the cervix using acetic acid (VIA) – is as effective as Pap smears for detection of cervical cancer and dysplasia. In the study, 49,311 sexually active women in Tamil Nadu were randomized to receive VIA or existing cervical screening and care. Women who were VIA-positive were offered further treatment, including cryotherapy to remove any lesions, or a referral if they had invasive cancer. Women who underwent VIA had a 25 percent reduction in cervical cancer incidence and a 35 percent reduction in deaths compared with the women who received standard screening and care.
As promising as these results are, however, it is important to note that the Lancet study was performed at a clinic with dedicated staff and in an area where treatment for cervical cancer was readily available. The VIA screening method is simple and cheap, but many women in resource-poor countries still lack access to basic medical services, let alone treatment and care for cervical dysplasia or cancer. As always, technologies are only useful if they are not only effective but also available, affordable and acceptable to the people who need them.
The painful irony is that cervical cancer screening is of no use to women who cannot access treatment to prevent the onset of cancer. This breakthrough only underscores the need to advocate relentlessly for adequate access to the full spectrum of reproductive health care options, including (and especially) treatment for life threatening conditions. This is surely a case in which half a loaf really isn’t better than no loaf at all.
Sunday, August 12, 2007
But it's not all fun and laughs -- University of Haifa is taking this issue very seriously by introducing Israel's first degree program - and perhaps the only degree in the world - in medical clowning. The degree program is a special, one-year BA degree program, which is intended to contribute to the "academization of the field" of medical clowning.
Hmmm, I wonder how a medical clowning course, as an elective, would fare in one of the latest bioethics program... after all, laughter is the best medicine, isn't it?
In addition to Lucy, another juvenile female hominid skeleton was found just a few years ago, offering a remarkable chance to study growth and development in what is believed to be an important human ancestor.
Lucy's bones will be doing a nationwide tour soon -- After years of negotiations of with the Houston Museum of Natural Science in
Saturday, August 11, 2007
"Consider PJ Brent, a woman I worked with and whom I admired deeply. She experienced awful pain and disfigurement from her implants, and was diagnosed with autoimmune disease. Even worse, her children were affected by the silicone, which, I think, caused incredible guilt. She had breastfed, and her daughters later experienced problems similar to hers. If PJ wasn’t emotionally unstable before she received her implants, she certainly had cause to be after. She ultimately took her own life.
Here’s the tragedy: There are countless women suffering from their implants like PJ suffered. The fact is, women with implants are very, very likely to experience major complications. According to the FDA Breast Implant Consumer Handbook, 25 percent of women with saline or silicone implants have complications severe enough for them to undergo re-operation within five years of getting them, and about half of all implants rupture within 10 years, also requiring surgery. Significant numbers of women with implants have reported problems ranging from severe weight gain to impeded ability to breastfeed to autoimmune disease to cancer. In many cases, the illnesses are chronic and debilitating, taking a heavy financial and emotional toll as the women struggle to pay for treatment and their families fall apart from the stress.
So why, in all the coverage of the Swedish study I’ve seen - such as here, here and here - not one item or article asks how those poor women were suffering at time of death? Why does the media, without exception, declare those women flawed from the beginning instead of looking at and asking questions about how they got that way? Because if, from all the pain caused by their implants, there are women who seek relief through killing themselves, no one should be surprised."To read the rest of their post and visit their blog, click here.
Monday, August 06, 2007
From the accompanying AP article:
For six years, the man could not speak or feed himself. On occasion he showed signs of awareness, and he moved his eyes or a thumb to communicate. His arms were useless. He was fed through a tube.
But researchers chose him for an experimental attempt to rev up his brain by placing electrodes in it. And here's how his mother describes the change in her son, now 38:
"My son can now eat, speak, watch a movie without falling asleep," she said Wednesday while choking back tears during a telephone news conference. "He can drink from a cup. He can express pain. He can cry and he can laugh."
Should certainly revitalize the debates on the definition of brain death and the clinical ethics therein.
[Editor's note, added August 16, 2007 : An article from Reuters August 13, 2007 also sheds some interesting new light on the subject: Scans have shown near-normal brain activity in a second patient who is in a vegetative state -- British researchers reported on Monday in a study that may show a way to predict who is likely to recover from the usually hopeless condition. Access the full text here.]
Sunday, August 05, 2007
If that wasn't enough to get you to seriously consider kicking the bottled water habit for good, Art Caplan gives us another reason: the environment.
So at this fashionable eatery, I asked for tap water. Eyeballs rolled, but I was right in my request. Why? Because it’s time for those of us who care about the environment and are concerned about global warming to stop buying and drinking bottled water.
Not too long ago, critics of Al Gore were prattling on about how his daughter had served Chilean sea bass — a rare fish — at her wedding reception and that Gore had eaten it. Well, protecting the fish may be a nice thing to do, but it does not make a difference to the problem of global warning and the even bigger problem of handling the enormous amount of waste humanity is dumping into leaky landfills. If you want to head out on hypocrisy patrol among the environmentally concerned, don’t worry about what they are eating or whether they fly, drive or walk from place to place. Just ask them, “What are you drinking?”
Here are a few facts about bottled water:
- The containers are made of plastic or glass. When full, both become very heavy. It costs a fortune in oil to ship heavy bottles around the country, much less around the world
- Close to 2 million tons of plastic was used to make bottles for water last year. That manufacturing involves an enormous about of petroleum, since it is a key ingredient in plastic. In the U.S. alone, 30 million bottles a day, billions of bottles a year get tossed out. Recycling them costs another small fortune in gasoline to haul them to plants.
- Bottled water is being promoted all over the world by a host of companies such as PepsiCo, The Coca-Cola Co., Nestle and Cadbury Schweppes. These companies, plus the boutique outfits such as Evian and S. Pellegrino, are staking their future on getting you to drink water from bottles since it is getting harder and harder to persuade you to drink soda and other sugared water from their cans — and it’s working.
- According to Beverage Marketing Corp., a provider of beverage-related data, consumption of bottled water has been growing by a gallon a year per capita in the U.S., and consumption has doubled in the past decade. Americans now drink more water from bottles overall than any other nation. However, we are only tenth among nations of the world in drinking bottled water per capita, trailing Italy, Mexico, Spain, France, Germany and Switzerland.
A compelling and well-written essay in the NYTimes Magazine by Slate editor Emily Bazelon suggests that autism is in fact a very different experience for girls; for example, girls on the spectrum tend to be highly proficient in reading and writing, with little inclination or fascination with math. The essay is based on interviews with specialists and girls who've been diagnosed as being on the spectrum, and highlights both where research is going, and where there is a sad lack. Most interestingly, it looks like teenage girls with autism are aware of their inability to navigate the complicated social networks of teen girlhood, and this knowledge of what there is that they cannot participate in helps spiral them into severe bouts of depression.
Now imagine that the girl, because her autism doesn't present like a boy would, has never been diagnosed as being on the spectrum - she is merely labeled a depressed teenage girl. It's so likely a scenario, that thinking back to my teens in the SF Bay Area, one or two socially ostracized girls from my own high school immediately come to mind.
Once again, in a continuing theme in scientific research, women are excluded from scientific research, so the models of health, disease, and affliction don't match what actually occurs in women, and their health suffers for it.
Wednesday, August 01, 2007
"Controversy continues to plague efforts to protect young women against cervical cancer by vaccinating them against HPV, the human papillomavirus, but one leading scientist's discovery could throw a monkey wrench into the debate.
"We found HPV under the fingernails of young men," said Dr. Laura Koutsky, a University of Washington epidemiologist.
Koutsky led some of the pioneering research and clinical trials that resulted in an HPV vaccine, Merck's Gardasil, recently approved for use in girls and young women. The reason her fingernail finding is a potential bombshell has to do with why the vaccine is controversial.
HPV, which is the leading cause of most cervical cancers, is primarily a sexually transmitted disease. Opponents of HPV vaccines believe that immunizing girls against this virus sends the message that engaging in sex at a young age is acceptable behavior.
The presence of HPV under fingernails, she said, at the very least suggests another possible route of transmission. It's an additional route of infection, she said, that could explain some previous apparent anomalies such as HPV infection in infants and young girls who had not yet engaged in sexual activity.
Koutsky's not quite sure what to make of the finding, which has yet to be reported in a journal, but she said it is certainly 'a surprise.' " Read the rest of the article here.
This could turn the whole HPV vaccination debate on its head if it is confirmed that HPV can be spread through non-sexual, non-intimate contact. Not only would the debate about mandating the vaccine in schools be shifted, but this will throw a new issue to objectors on the basis of religion or other moral beliefs about sexual activity.
It came to our attention this week that not only is there a film in development called Repo! The Genetic Opera (apparently based on the stage show of the same name), but that Paris Hilton will play a starring role. Here's how Variety describes Ms. Hilton's part and the storyline:
Hilton will sing in a futuristic thriller framed around musical numbers that range from opera to rock. The setting is 2056, when a plague nearly destroys the human race and survival is dependent upon being able to finance a pricey organ transplant.
Hilton plays a daughter of the organ transplant magnate ([Paul] Sorvino) who is the villain of the piece.
"This movie has become my life," said [Darren Lynn] Bousman. "I have auditioned at least 30 actresses for this role -- Paris came in and owned it. She is this role."
If the idea of Paris Hilton singing about organ transplants doesn't get you lining up at the multiplex, you should know that Repo! the film will be directed by the guy behind a few of the Saw horror films, of which a critic for USA Today commented, "Whether we're talking this go-round, the original or the second sequel the finale seems to promise, I'd rather try standing drunk on a see-saw (though maybe not over dirty syringes) than see Saw."
Caring for the Caregiver: Perspectives on literature and medicine
November 9 – 10, 2007 Radisson Hotel Manchester, NH
Join us to find out ways in which literature and writing can support the personal and professional development of health care professionals. Learn about a range of innovative programs, best practices, new research and evaluation methods and how to implement a program in your own facility.
This conference is organized as part of Literature & Medicine: Humanities at the Heart of Health Care®, a national literature and discussion program for health care professionals that has been held in 19 states. The conference will include an introduction to this program.
Read presenters' biographical information: click on their picture.
We promise you will leave both informed and inspired!Award winning poet, Rafael Campo, M.D., M.F.A.; Rita Charon, M.D., Ph.D., innovative leader in the field of narrative medicine and Anne Fadiman, author of The Spirit Catches You and You Fall Down, will make keynote presentations. In addition there will be over 20 other, smaller sessions to choose from including workshops, discussions, and informal presentations.
Who should come?
All Health care professionals including: chaplains and clergy, educators (health, humanities, medical), hospital and other health care facility administrators, staff and volunteer coordinators, medical and nursing students, nurses, physicians, physician assistants, therapists of all kinds, social workers, service providers.
Benefits of Attending:
- Understand how research and evaluation support literature and writing programs for health care professionals.
- Learn strategies to successfully position literature and writing programs in hospitals and hospice, medical education, and social service organizations.
- Explore model literature and writing programs in a wide range of traditional and non-traditional health care settings through presentations, workshops, posters and performers, drama, visual arts and the written word.
- Develop knowledge and skill to support health care professionals through the use of literature and writing.
- Network with colleagues from around the country.
- Appropriate continuing education credits are available.
Early Registration: only $100 by August 15th!*
Regular Registration: $125 (October 1st deadline)*
* Includes Fri./Sat. continental breakfasts, Fri. dinner, and Sat. lunch
"In a recent experiment, psychologists at Yale altered people’s judgments of a stranger by handing them a cup of coffee.
The study participants, college students, had no idea that their social instincts were being deliberately manipulated. On the way to the laboratory, they had bumped into a laboratory assistant, who was holding textbooks, a clipboard, papers and a cup of hot or iced coffee — and asked for a hand with the cup.
That was all it took: The students who held a cup of iced coffee rated a hypothetical person they later read about as being much colder, less social and more selfish than did their fellow students, who had momentarily held a cup of hot java.
Findings like this one, as improbable as they seem, have poured forth in psychological research over the last few years. New studies have found that people tidy up more thoroughly when there’s a faint tang of cleaning liquid in the air; they become more competitive if there’s a briefcase in sight, or more cooperative if they glimpse words like “dependable” and “support” — all without being aware of the change, or what prompted it.
Psychologists say that “priming” people in this way is not some form of hypnotism, or even subliminal seduction; rather, it’s a demonstration of how everyday sights, smells and sounds can selectively activate goals or motives that people already have.
More fundamentally, the new studies reveal a subconscious brain that is far more active, purposeful and independent than previously known. Goals, whether to eat, mate or devour an iced latte, are like neural software programs that can only be run one at a time, and the unconscious is perfectly capable of running the program it chooses."