Monday, April 30, 2007

The Demise of a Period in Women's History

You feel like your body is stuffed with sand, and if you were to jump into a pool, you would no longer float. Still, everything in the snack machine looks divine, and you crave something salty and sweet simultaneously. One of your coworkers forgets to smile at you in passing, so you stomp back to your office and vow to not smile at anyone the rest of the day. Then you glance at your calendar and realize you are a week away from your period. Suddenly your change in mood makes sense. Now all you have to do is explain to everyone that it is your time of the month, and they will know to keep a distance. What if you could escape this monthly cycle instead?

Since the pioneer efforts of Margaret Sanger, women continue to assume greater control over their bodies. With access to birth control pills, women are able to manipulate the timing and occurrence of their periods. The Seasonale birth control pill already reduces the period to occurring quarterly (1). Now the FDA is debating whether to approve Lybrel, a continuous-use birth control pill manufactured by Wyeth (1). With Lybrel, women would be unburdened of monthly periods altogether.

Pending approval of this new pill, women and healthcare workers experience mixed feelings. Recognizing the setbacks of menstruation and its varying degrees of severity among women, many people argue that the new pill will relieve women of a monthly event that ultimately slows them down (1). Other people remain skeptical of the long-term effects of suppressing the menstrual cycle (1).

Do you want a pre-menopausal way to stop menstruating? Is this type of pill a practical consideration for working women, or is it science's attempt to homogenize the sexes? Would you feel like less of a woman without this natural bodily function? Do you have reservations about the potential long-term consequences of such a pill, or are you willing to accept the risk for monthly relief?

1. Saul, Stephanie. Pill that Eliminates the Period Gets Mixed Reviews. The New York Times. 20 April 2007.

Brains, brains, and more brains!

Slate has an exciting week-long exploration on the latest developments and implications in neuroscience. William Saletan lists the five biggest neuroscience developments of the year, including:

1. The arrival of mind reading. (Scientists in Germany used pattern recognition software to predict decisions with accuracy rate of 71 percent of the time)

2. The neural alteration of morality. (Six people with damage to the ventromedial prefrontal cortex were presented with moral dilemmas and were found to be two to three times more willing to kill than people without brain damage)

3. The medicalization of sexual orientation. (Research suggests brain biology is involved.)

4. The discovery of vegetative consciousness (Brain scan of PVS patients where shown to light up when given a mental task to visualize)

5. The progress of artificial intelligence.

To read more on Brains!, click here.

Sign on to the Microbicide Development Act of 2007

Women and girls are the new face of HIV/AIDS worldwide. As of 2005, 17.3 million women aged 15 years and older were living with HIV – 48% of the global total. In the hardest hit region of the world, sub-Saharan Africa, women comprise 59% of all adults living with HIV/AIDS.

There are a myriad of effective HIV prevention tools – condoms, mutual monogamy, and STI treatment – but these are not available to most women. In many countries, women do not have the social or economic power necessary to insist on condom use and fidelity, or to abandon partnerships that put them at risk.

Microbicides are a class of products currently under development that women (and men) could apply topically to prevent HIV and other sexually-transmitted infections. These user-controlled prevention technologies were hailed as one of the world’s most promising new HIV-prevention technologies at the 2006 Toronto AIDS Conference, and were named in a survey of 28 eminent international scientists and experts as one of the "10 most promising biotechnologies for improving global health."

Right now, a mere 3% of the US budget for AIDS research is spent on developing microbicides. Many public health experts believe that, with increased funding and coordination, an effective microbicide could be available in five to ten years. The longer it takes to develop an effective microbicide, the more people who will be infected needlessly with HIV.

The Microbicide Development Act of 2007 (S. 823 and H.R. 1420) was introduced simultaneously in the House of Representatives and the Senate on 8 March 2007, International Women’s Day. The Act would:

1. Establish a unit dedicated to microbicide research and development within the NIH, and creating a single line of administrative accountability and funding coordination;
2. Authorize funding increases, as needed, at the NIH, the CDC and USAID for the development of microbicidal products; and
3. Require increased coordination between the NIH and other Federal agencies supporting microbicide development.

Please help put the power of HIV prevention in women’s hands by contacting your Senator and Representative … if they are one of the 14 Senate and 26 House co-sponsors, thank them for their support. If they are not a co-sponsor, ask them why.

Sex Trafficking in the US of A and Abroad

Sex trafficking has been seen as a human rights issue that primarily affects women and children and reflects the status of how these groups are treated as property in different countries.

While we all know that Washington D.C., loves a good sex scandal, especially when it's a classic case of "Do as I say, not as I do...", it's a bit dismaying when Randall L. Tobias, the deputy secretary of state responsible for U.S. foreign aid, the same who was a driving force behind the "anti-sex worker' restrictions on the use of federal funds to foreign countries, apparently thought that sex trafficking in the USA is legit. Tobias abruptly resigned this weekend after he was asked about an upscale escort service allegedly involved in prostitution; in a comment reminiscent of Clinton's "I did not have sex with that woman", Tobias stated that there was 'no sex', only massage.

For more, click here.

Thursday, April 26, 2007

Supreme Court Decision: Read it and Weep

A very wise person suggested to me that the recent Supreme Court decision (Gonzales v. Carhart) demonstrates a disturbing trend: that the courts now feel empowered to impose their own moral view at the cost of women’s health. The implications are considerable. She suggested that we all read the recent decision and not solely rely on the media's interpretation. You can find the decision here.

Wednesday, April 25, 2007

Eat Until You're Beauti-Full

Too tired to workout at the gym? Prefer big macs to salads at lunch? Jealous of the size 0 model on magazine covers? Well then trade your jeans for pants with elastic waistbands, cancel your gym membership, supersize your order, and move to Mauritania.

In Mauritania, beauty still appears to be measured in pounds. Situated in northwest Africa, this country has traditionally encouraged and sometimes demanded that its women stay overweight. Certain households, particularly in more rural areas of the country, continue to force-feed their daughters at an early age (1). This ritual is referred to as gavage, and is the same term used to describe the practice of fattening geese (1). Many of the country's middle-aged women can recall repeatedly tolerating physical punishment when they refused to drink excessive quantities of camel milk (1).

Though these brutal feeding practices are not as common today, societal pressure remains. Husbands even threaten to divorce wives who exercise and lose too much weight (1). Since the country's ancestors often had difficulty foraging for food in the desert, obesity became a symbol for health (1). However, this cultural preference greatly jeopardizes the physical health of these largely overweight women. Though their love handles are admired, they are ultimately at a much higher risk for major health complications, such as Type II diabetes and heart disease (1). Even simple tasks become laborious for these obese women who are frequently short-winded (1).

Conscious of this health dilemma being perpetuated by tradition, Mauritania's government has turned to the media. Aimed at increasing public awareness, many television and radio advertisements now contain information on the consequences of overeating (1). Still, reversing popular attitudes is a slow process.

1. Callimachi, Rukmini. New views in desert culture on fat women. Seattle Post-Intelligencer. 16 April 2007.

Tuesday, April 24, 2007

Everything Conceivable - New Book

From the dust jacket: Skyrocketing infertility rates and the accompanying explosion in reproductive technology are revolutionizing the American family and changing the way we think about parenthood, childbirth, and life itself. In this riveting work of investigative reporting, Liza Mundy, an award-winning journalist for The Washington Post, captures the human narratives, as well as the science, behind what is today a controversial, multibillion-dollar industry, and examines how the huge social experiment that is assisted reproduction is transforming our most basic relationships and even our destiny as a species.

Based on in-depth reporting from across the nation and around the world, using riveting anecdotal material from doctors, families, and children—many of them now adults—conceived through in vitro fertilization, Mundy looks at the phenomena created by assisted reproduction and their ramifications. Never before in the history of humankind has it been possible for a woman to give birth to an infant who is genetically unrelated to her. Never before has it been possible for a woman to be the genetic parent of children to whom she has not given birth. Never before has the issue of choice had such kaleidoscopic implications. If you support reproductive freedom, does that mean you support everything being offered in the reproductive marketplace? Thawing frozen embryos and letting them expire? Selecting the sex of your baby? Conceiving triplets and “reducing” the pregnancy down to twins?

Everything Conceivable explores the personal impact on individuals using assisted reproduction to conceive, and the moral, ethical, and pragmatic decisions they make on their journey to parenthood. It looks at the vast social consequences: for hospital neonatal wards, for family structure, for schools, for our notion of genetic relatedness and whether it matters, for adoption; for our nation as a whole, and how we think about the earliest human life-forms.

The book explores questions of social justice: the ethics of buying or borrowing some part of the reproductive process, as with egg donation and surrogacy. It looks at entirely new family structures being created by families who have conceived using sperm donors, so that children may have half-siblings around the country with whom they are, or are not, in contact. And it looks toward the future, to the impact today’s technology may have on coming generations.

NOTE: WBP Founder Kathryn Hinsch will be interviewing author Liza Mundy on Wednesday, May 9th, 7:30pm at the Seattle Town Hall. Join us for the conversation!

The Virginia Tech Tragedy and Mental Health

Art Caplan writes a compelling column on MSNBC about how we need to fix a broken, abandoned and pathetic system of mental-health care:

By Arthur Caplan, Ph.D.

It is not just guns. In all my life I never thought I would write those words after a massacre involving a mass murder with a gun. But a week's worth of intense media coverage of the heinous murders of students and faculty at Virginia Tech and analyses focusing on guns by innumerable experts has left me furious.

I don't think the expert wisdom is even close to understanding what must be done to try and prevent this type of tragedy in the future. It is not just guns. We need to fix a broken, abandoned and pathetic system of mental-health care.

In the same month that Seung-Hui Cho killed and injured scores of people at Virginia Tech, a researcher at the University of Washington was shot to death in her office by a former boyfriend, who then killed himself. Rebecca Griego had gotten a restraining order against Jonathan Rowan. When he showed up at her office he fired five shots into Rebecca. A colleague at the university said it was a "psycho from her past."

In Mandeville, La., a man who had just had a restraining order issued against him by his estranged wife allegedly ambushed her and their three children. Police say James Magee chased his wife's gray Toyota Scion for several blocks, ramming it repeatedly until the car crashed into a tree. As Adrienne Magee tried to get out of the vehicle, James Magee allegedly stepped out of the truck and shot her in the head with a 12-gauge shotgun loaded with buckshot, killing her instantly. He then opened fire on his children as they tried to flee the vehicle, killing his 5-year-old son and striking his 7-year-old daughter in the chest, according to police.

Magee had never gotten any help for previous violent outbursts.

And in Queens, New York, a man killed his mother, a wheelchair-bound man and a home health care worker before shooting himself dead - just minutes after the mother called 911 pleading for help. The mother's surviving sister blamed police for failing to protect her sister from the "mentally ill" son. "My sister was scared!" Annetta Taylor screamed. "She thought this might happen!" Cops outside the house tried to calm her, but she continued. "I blame you!" she said. "She called and nobody would respond!"

The murdered mother, Sonia Taylor, had called police twice Monday during fights with her son Wade Dawkins. The police had been called to the home eight times since last May. During an incident this past October, Taylor told police her son, a drug abuser with no rap sheet, was throwing things around the house and acting violently.

The police brought him to a local hospital for an evaluation. He was quickly sent back to her house.

All of these killings involved not just guns, all involved killers who might have benefited from mental-health treatment. None got the help they needed.

The Virginia Tech murderer was - to be blunt - totally crazy. He fit the dreary profile all too familiar from the shootings at Columbine High School near Denver and the Nickel Mines School in Amish country near Lancaster, Penn. Cho was an angry outcast, preoccupied with thoughts of violence against those whom he saw as bullying, victimizing or just plain ignoring him. From the tapes he made of himself, it is obvious that he was in the grip of paranoia. He had profound social withdrawal, suicidal thinking, destructive fantasies and was a known stalker. He scared people. But he fell through the cracks of university bureaucracy and a hodgepodge mental-health system.

Report after report over the past decade have warned that most public mental-health systems have, to quote one, "all but disintegrated." Such systems, whether local, state or federal, are badly fragmented and ill-equipped to address our nation's mental health in a comprehensive manner.

The complete article is here.

Sunday, April 22, 2007

Rising Infant Mortality, Racial Disparities, and Access to Health Care

In a disturbing report in the NY Times this morning, infant mortality rates have in the Southern United States have risen. For one of the richest countries in the world, this is an embarrassment; the United States has the second worst newborn death rate in the modern world, and some of the factors contributing to number are poverty, lack of access to health care, racial disparities, cuts in social programs and a dearth of transportation:

"For decades, Mississippi and neighboring states with large black populations and expanses of enduring poverty made steady progress in reducing infant death. But, in what health experts call an ominous portent, progress has stalled and in recent years the death rate has risen in Mississippi and several other states.

The setbacks have raised questions about the impact of cuts in welfare and Medicaid and of poor access to doctors, and, many doctors say, the growing epidemics of obesity, diabetes and hypertension among potential mothers, some of whom tip the scales here at 300 to 400 pounds." To read on, click here.

Friday, April 20, 2007

A Secret Government Database?

Friend and colleague Roy Poses of the Healthcare Renewal Blog asked this question on an email listserve and gave my permission to re-post it:

One of our loyal list members alerted me to an aside in an ABC news story about the Virginia Tech mass murder:

The aside was, "some news accounts have suggested that Cho had a history of antidepressant use, but senior federal officials tell ABC News that they can find no record of such medication in the government's files. This does not completely rule out prescription drug use, including samples from a physician, drugs obtained through illegal Internet sources, or a gap in the federal database, but the sources say theirs is a reasonably complete search." [emphasis added]

This seems to suggest that there is the US government has a comprehensive database of prescriptions for individual patients, indexed by the patients, not anonymized. I had never heard of such a database, which, if it exists, would seem to pose major privacy and civil liberty concerns.

(This should not be confused with the databases known to be kept of prescriptions written, indexed by prescribers, but without identifying patient data. These have raised concerns, especially since their main use is by drug marketers, but they are not supposed to include any patient level data.)

The blogsphere has picked this up, here:, and see claims here: that the database was created due to a 2005 law.

And I just found this on seemingly in confirmation....

Of course, this part of the ABC could be erroneous, or a misinterpretation of some sort, i.e., maybe it was actually a DEA database of people convicted of drug offenses? But if it's not an error or misinterpretation, it surely raises many issues.

Does anybody know anything more about a broad government patient-level database that includes prescription information?

It would appear that this bears further investigation.

Thursday, April 19, 2007

Supreme Court Upholds Late-Term Abortion Ban

My observation has been that if there is anything that approaches a consensus in the US regarding abortion, it is that a late-term abortion is more morally problematic than an early term abortion. In a decision yesterday that reflects the ambivalent state of the nation with regards to abortion, the United Supreme Court upheld the 2003 Congressional legislation that banned a specific procedure, known medically as “intact dilation and extraction". While the ruling will have an impact on only a relatively small percentage of abortions, the decision will like have broader implications on abortion regulations in general.

The majority opinion, written by Justice Anthony M. Kennedy, makes note of the implication of abortion’s “ethical and moral concerns.” and indicates a change in the court’s balancing of the state vs. individual interests in the abortion debate.

For a more thorough reporting and analysis, check out the NY Times, Washington Post, and NPR reports on the decision.

Tuesday, April 17, 2007

The Blindness of the Abstinence Only Approach

Our friend and colleague, Art Caplan, posts a great column in MSNBC today about the abstinence only approach doesn't work:

"Is the Bush administration capable of allowing fact-based, scientifically proven evidence rather than ideology or blind faith to shape its public policies? When it comes to what to do about air pollution, endangered species, embryonic stem cell research, the disposal of farm waste, forest management or lead poisoning, the answer is apparently not.

Nowhere is this administration’s reliance on ideology and faith and willful ignorance of science more dangerous and harmful than when it comes to sex. The president and his people continue to be willing to let your kids get dangerous diseases and to tolerate tens of thousands of preventable abortions by ignoring the fact that abstinence-only education does not work.

In a just released major study ordered by Congress, independent researchers found that in four typical abstinence-only programs sampled from around the country there was absolutely no difference between the sexual activity of kids in these program and kids who were not. ."
The rest of the article can be read online here.

Monday, April 16, 2007

Reining in the Organ Market

In this opinion piece William Saletan documents the growing market of organ trafficking and offers a solution to reverse this troubling trend.

The key to reversing the organ market is to turn that equation on its head. Stop fighting capitalism, and start using it. What's driving the market is scarcity. Americans, Britons, Israelis, Japanese, and South Koreans are going abroad for organs mostly because too few of their
countrymen have agreed to donate organs when they die. Some have religious objections. Others are squeamish. Many figure that if they don't supply the organs, somebody else will.

They're right. Somebody else will supply the organs. But that somebody won't be a corpse. He'll be a fisherman or an out-of-work laborer who needs cash and can't find another way to get it. The middlemen will open him up, take his kidney, pay him a fraction of the proceeds, and abandon him, because follow-up care is just another expense. If he recovers well enough to keep working, he'll be lucky.

The surest way to stop him from selling his kidney is to make it worthless, by flooding the market with free organs. If you haven't filled out a donor card, do it now. Because if the dying can't get organs from the dead, they'll buy them from the living.

Read the rest of the article at Slate or the Washington Post.

World Bank figure accused of undermining health of women

This article from the Guardian sounds like possible plot from Dan Brown novel:

· Madagascan contraception targets deleted, critics say
· Managing director said to have links to Opus Dei

A key figure in the World Bank, said to have links to the Roman Catholic sect Opus Dei, was accused yesterday of undermining its commitment to the health of women by ordering the deletion of goals, targets and policies relating to family planning.

Juan José Daboub, the bank's managing director, ordered staff to remove all references to family planning from its country assistance programme document for Madagascar. Mr Daboub is the former finance minister of El Salvador and a member of the Arena party, which has close ties to the Catholic church.

The Guardian understands from sources close to the Africa region that specific targets relating to contraception were also deleted. The original draft committed the bank to work to increase contraception uptake from 14% as of 2004 to 20%. The final document contained no goal.

The British international development secretary, Hilary Benn, who has strongly backed efforts to improve the reproductive health of women in the developing world, said yesterday that he was very concerned. "If true, they [the reports] are extraordinary. This would be inconsistent with bank policy on reproductive health."

In the past, the World Bank has championed the sexual and reproductive rights of women, which are considered by most in international development as critical to their health, status and economic progress. There are 75m unplanned pregnancies around the world each year, a third of which end in unsafe abortions. The need for better services to enable women to protect their health has been thrown into sharp relief by the Aids epidemic.

For the rest of article, click here.

Sunday, April 15, 2007

Week in Review...

Some stories that have caught our interest over the past week:

NYTimes: The Search for the Female Equivalent of Viagra -- Even in the most sexually liberated and self-satisfied of nations, many people still yearn to burn more, to feel ready for bedding no matter what the clock says and to desire their partner of 23 years as much as they did when their love was brand new...

A large proportion of breast surgeons never refer their patients to a plastic surgeon for reconstruction, a new study reports.

Researchers surveyed 365 surgeons with 1,844 patients in Detroit and Los Angeles in 2002. Only 24 percent of surgeons referred more than three-quarters of their patients for plastic surgery, and 44 percent referred fewer than one-quarter.

Over all, fewer than 20 percent of breast cancer patients undergo breast reconstruction, according to background information in the article, which appeared online March 26 in the journal Cancer. To read on, click here.

Washington Post - Women Under-Treated for Ovarian Cancer: Ovarian cancer is one of the most lethal cancers women can get, yet one out of three U.S. patients diagnosed with the disease doesn't get the full, recommended surgical treatment, a new study finds.

"It's very concerning that we see such a large proportion of women with ovarian cancer not being treated up to what we would consider a minimal standard for surgery," said the study's lead author, Dr. Barbara A. Goff, director of the division of gynecologic oncology at the University of Washington, Seattle. For the rest of the article, click here.

Sex is the future for growing bodily tissues on scaffolding -- Stem cells, which have the ability to grow into different kinds of tissue, are being investigated for their potential to help sufferers of diseases and conditions such as diabetes and Parkinson's.

Now experts from the University of Pittsburgh in the US have found that female stem cells manage to regenerate skeletal muscle more effectively than male cells.

They believe their findings could also provide clues on the differences between men and women with regards to ageing and disease.

A Study published in the Journal of Cell Biology, is the first to report a difference between the sexes on the regenerative capabilities of muscle stem cells. To continue reading, click here.

Euronews: UK woman loses appeal over embryos -- A British woman has lost a legal battle to have children using frozen embryos fertilised by her former partner, who no longer wants her to have his baby.

The European Court of Human Rights' final court of appeal, the Grand Chamber, upheld an earlier rejection of Natallie Evans' submission that her human rights were infringed by British court rulings which said her former fiance Howard Johnston was entitled to block her use of the embryos.

The European court said there had been no violation of the right to life, the right to respect for private and family life enshrined in Article 8 of the European Convention on Human Rights, or of the prohibition of discrimination. To read on.

LA Times: Potential organ donor was wrongly declared brain-dead --The error raises concerns about the medical care of those who have promised their organs for transplants.

A man whose family agreed to donate his organs for transplant upon his death was wrongly declared brain-dead by two doctors at a Fresno hospital, records and interviews show.

Only after the man's 26-year-old daughter and a nurse became suspicious was a third doctor, a neurosurgeon, brought in. He determined that John Foster, 47, was not brain-dead, a condition that would have cleared the way for his organs to be removed, records of the Feb. 21 incident show.

"It kind of blew my mind," said the daughter, Melanie Sanchez, "like they were waiting like vultures, waiting for someone to die so they could scoop them up." Rest of the story here.

2007: A Face Odyssey -- An article about phobic attitudes towards aging and dying and how women are striving for an immortal-cyborg-android beauty.

Aging: Disease or Business Opportunity? For four days last December, America’s pleasure dome in the desert, Las Vegas, played host to a convention dedicated to the proposition that growing old is “a treatable medical condition.”

Wednesday, April 11, 2007

Texas Futile Care Law

There is a case going on in Texas right now dealing with the Texas Futile Care Law. The bill, signed in 1999 by then Governor George W. Bush, allows hospitals to end life-sustaining treatment to patients whose medical treatment is declared "medically futile." Read the entire law here: Texas Statutes Health & Safety Code, Chapter 166. Advance Directives (specifically Section 166.046)

From the Washington Post:

Since Dec. 28, baby Emilio Gonzales has spent his days in a pediatric intensive care unit, mostly asleep from the powerful drugs he is administered, and breathing with the help of a respirator. Children's Hospital here declared his case hopeless last month and gave his mother 10 days, as legally required, to find another facility to take the baby. That deadline, extended once already, was due to expire Wednesday, at which time the hospital was to shut off Emilio's respirator. Without the machine, Emilio would die within minutes or hours, hospital officials have said.

Gonzales and her lawyers are seeking a transfer for the child, diagnosed with a terminal neurometabolic disorder called Leigh's disease, to a hospital that will perform a tracheotomy and insert a feeding tube so that he can live out his life in the facility or at home with his mother. But Children's Hospital doctors have declared that continuing treatment is potentially painful and is prolonging the child's suffering.

Read the rest of the article here.

On Wednesday a Judge issued a temporary restraining order preventing the hospital from ending the life-sustaining treatment. A hearing is set for April 19th.

Tuesday, April 10, 2007

The Left Testicle Would Have Been Right


Most patients are nervous before undergoing a surgical procedure, however routine. High anxiety and the fear of unexpected outcomes are often more burdensome than the actual recovery process. Though our imaginations cause us to anticipate the worst-possible-scenario, rare medical errors can sometimes transform these worries into reality.

Benjamin Houghton, an Air Force veteran, received chemotherapy for metastatic testicular cancer over 10 years ago (1). Though he has been in remittance ever since, Houghton has experienced atrophy and considerable discomfort in his left testicle (1). In June, Houghton agreed to have his left testicle surgically removed at the Los Angeles VA Medical Center. In addition, he expected to have a vasectomy performed on his right testicle. His surgeon, a fifth year surgical resident, had Houghton sign an informed consent on the morning of his scheduled surgery (1). According to Houghton and his wife, the surgeon claimed that the form outlined the surgery details they had already discussed. Houghton, who was not wearing his glasses at the time, trusted that the consent was consistent with previous medical deliberations he had had with his surgeon (1).

Apparently, the form stated that Houghton would be having the right testicle removed, instead of the left, and that the vasectomy would be performed on the left testicle (1). Before being surgically anesthetized, Houghton was asked to indicate which testicle he was having removed. Contrary to typical surgery procedures, traditional markings were not made on the surgical site (1). This "wrong site surgery" led to the removal of Houghton's healthy testicle (1). Houghton will have to undergo additional surgery so that the left testicle can be removed. Without the benefits of testosterone, he is likely to experience sexual dysfunction, depression, increased susceptibility to weight gain, and an elevated risk of developing osteoporosis (1).

Houghton and his wife have filed a claim and are hoping to gain monetary compensation for this grave medical error (1). They are also hoping that their case will help rectify inadequate medical procedures that have accounted for these irreversible mistakes (1). Changes have already been implemented at the medical center where Houghton had his surgery. Why were these precautions not in place before? What if you were Houghton? What if you were Houghton's wife? How do you think this incident would adversely affect your family and quality of life?

This unfortunate case certainly stresses the importance of reading everything before you sign. It also exposes patients' vulnerabilities when their health is entrusted to a medical team. Occasional medical mistakes are inevitable because we are human, but an error of this magnitude should never happen!

1. Engel, Mary. "VA Patient Has Wrong Testicle Removed" Los Angeles Times. 3 April 2007.

The Odds of Dying an Undignified Death: One in Five So They Say

Did you ever stop to think how the last chapter in the book called Your Life may transpire? Are you fantasizing that your “final act” will be staged in your own comfortable bed under dim lighting, and surrounded by loved ones, sweet flowers, soft music, satin sheets, and on-demand medications? Or, perhaps you thought you would “phase out” with only the sandman and/or your guardian angel supervising your final moments on planet earth.

Well, you might want to prepare yourself for the harsh reality that your death or the deaths of those you hold dear may be less than dignified and more reminiscent of a documentary. According to a new book, A Social History of Dying, authored by Allan Kellehear, Professor of Sociology at the University of Bath the deaths of >50% of population will be managed by medical personnel following serious injury or ill health, with only a small proportion of persons dying suddenly and unexpectedly. As the author explains, people are significantly more likely to die a lonely and prolonged death in a long-term care facility or hospital preceded by multiple organ failure, pneumonia, or dementia.1,2 One in 5 persons are expected to die from deaths that would be considered “shameful” (ie, dying alone with dementia and without dignity) by individuals from previous generations. As the aging baby-boomer population increases and as average life-expectancy increases, it is probable that dying a less-then-dignified death will be more likely to transpire. In addition, advances in science and medicine and the increasing dementia epidemic have been implicated in delayed death.1,2

Unfortunately, it seems more likely that your final “act” will be staged under fluorescent lighting, in a hospital bed in the confines of a nursing home room shared with >1 bedridden strangers. Your “music” will be a PA system, your on-demand medications will be administered based on your nurse’s busy schedule, and the only “sweet flower” in the room may be the wilting, recycled carnation that was popped on your cafeteria lunch tray.

Trends have shown that the best way to deal with older persons in ailing health has been to develop more long-term care facilities. Yet the quality of healthcare at these facilities continues to be a debated subject. Major concerns with institutional care include lack of attention to cultural needs and cognitive function of their long-term care residents. Professor Kellehear cautions that many persons are unprepared and lack foresight on the realities of their own death, such as medical advances that delay the dying process. He predicts that suicide among elderly and terminally ill persons will increase in coming years and indicates that the largest age-related group of suicides exists for person aged >80 years. When it comes to taking their own life, elderly persons are less likely to provide warning and are more likely to successfully carry out suicide compared with other younger persons: 50% of persons aged >65 succeed in suicide versus 25% of younger persons. “The act of dying appears to be disintegrating” noted Professor Kellehear. Results from a survey of older persons revealed some of the reasons why older persons do not want to live to the ripe old age of 100. These included the refusal to face disability, pain, cognitive decline, lose bodily and social autonomy, and loss of dignity.1,2
While Professor Kellehear’s book is not considered academic by any means, he cites several salient yet controversial points. Some major takeaways that deserve greater consideration include the right to control the way in which we die, the quality of care of persons who are dying, and potential policies and ethical issues associated with the dying process.1,2

“I am not dead just yet” is the adage that comes to mind after reading more about Kellehear’s perspectives. Essentially, dying is a component of the living process and one that deserves greater thought, respect, and planning on the parts of ordinary citizens, medical personnel, organizations, as well as government.

1. One in five people will face a ‘shameful’ death-could it be you? Medical News Today Web site. Available at: Accessed April 2007.
2. Kellehear A. A Social History of Dying. Port Melbourne, VIC: Cambridge University Press; 2007. Available at: Accessed April 2007. [excerpt]

Monday, April 09, 2007

Happiness & Aging

This is a little off topic, but I came across it and wanted to share with everyone:

People with higher incomes today report greater happiness than those poorer. At the same time, people today are richer than earlier generations, but they're not happier than them. A new study by economists David Blanchflower of Dartmouth and Andrew Oswald of Warwick report how happiness evolves as people age, “while income and wealth tend to rise steadily over the life cycle, peaking around retirement, happiness follows a U-shaped age pattern.”

Between the years of 1974-2004, 45,000 Americans were asked to rate their happiness on a three-point scale:
1) Not too happy
2) Pretty happy
3) Very happy
The average happiness score in the US was a 2.2.

Between the years of 1975-1998, 400,000 Europeans (11 countries), were asked to rate their happiness on a four-point scale:
1) Not at all satisfied
2) Not very satisfied
3) Fairly satisfied
4) Very satisfied
The average happiness score in Europe was a 3.0.

Upon analysis of the data for both men and women in the two continents, the economists found that happiness starts off relatively high in early adulthood, then continues to drop until age 45, at which time it begins to rise into old age.

Over the last century, Americans have become less happy. The authors compared men born in the 1960s against men born in the 1920s and noted a tenfold difference in income. But lower income individuals born in the 1920s were happier than higher income individuals born in the 1960s. Here the European pattern diverges. Happiness falls for the birth years from 1900 to about 1950, and generations born on the continent since World War II have become happier. So, why does happiness start strong, dip with middle age, and then revive among the elderly? The authors speculate that people come to understand their strengths and weaknesses and "in mid-life quell the infeasible aspirations of their youth.”

So if money doesn’t buy happiness, what does? Does anything? If you look at our society, perhaps we are successful, but what are we sacrificing? Are we sacrificing quality time with our families, and what effect is that having on the values we teach or do not teach our children? Are we focusing on material possessions? What does this all say about aging? Should an increased effort be put into studies on improving ailments of the aged so they may live longer and more fulfilled lives – truly making these the golden years? The Alliance for Aging is spearheading research efforts on behalf of the aged. Their aim is to ‘advance science and enhance lives through a variety of activities and initiatives.’ If interested, please go to their website to see what you can do to improve the state of the aged in our country, after all, we will soon not be far behind…

Saturday, April 07, 2007

Emotionally Abandoned Alzheimer’s Patients

I think Alzheimer’s disease is becoming a bigger concern for most people in this country. As the years go by, there seems to be more media on the disease, as well as more awareness about its deteriorating effects. This New York Times article investigates the window of opportunity to enjoy life before Alzheimer’s makes daily life too difficult to enjoy, and how many people are emotionally abandoned by their families as their condition deteriorates.
Should people with early stage Alzheimer’s be treated differently than “regular” people? They still have feelings, but in many cases, Alzheimer’s patients are saying that their spouses do not talk to them like they did before their diagnosis, and it makes their fate that much more difficult. Typically, patients have 2-5 years left to enjoy before Alzheimer’s really takes over their lives. Some people may experience short term memory loss, but can have lengthy conversations. Other people may not be able to form sentences easily, but retain their memory. In any case, shouldn’t we try to treat these people as if they didn’t have a medical problem?
There are groups in place that create volunteer opportunities for Alzheimer’s patients. According to this article, and other studies, it is important to give people a sense of responsibility, as long as they can handle it (mentally and physically). Some patients are guest speakers at different venues, but leave the stage and can’t remember what they spoke about.
I can’t think of anything more frustrating than a family member, let alone a spouse, getting annoyed because I’m suffering from a disease that cannot be controlled. I think it’s best to enjoy everyday activities with loved ones while you still can, and hopefully they’ll remain by your side, but what if they don’t? Feeling emotionally abandoned when you know you won’t remember your family, your name, your address, or how to speak must be awful, and if I am ever diagnosed with Alzheimer’s, I would want all the support I could get.

Full article:

Friday, April 06, 2007

Are we hard-wired to believe in God?

Why do some of us feel more spiritual or religious than others? Call it science, or call it faith, or call it neurotheology, this is an interesting question posed in a article on CNN's website today:

"NEW YORK (CNN) -- "I just know God is with me. I can feel Him always," a young Haitian woman once told me.

"I've meditated and gone to another place I can't describe. Hours felt like mere minutes. It was an indescribable feeling of peace," recalled a CNN colleague.

"I've spoken in languages I've never learned. It was God speaking through me," confided a relative.

The accounts of intense religious and spiritual experiences are topics of fascination for people around the world. It's a mere glimpse into someone's faith and belief system. It's a hint at a person's intense connection with God, an omniscient being or higher plane. Most people would agree the experience of faith is immeasurable.

Dr. Andrew Newberg, neuroscientist and author of "Why We Believe What We Believe," wants to change all that. He's working on ways to track how the human brain processes religion and spirituality. It's all part of new field called neurotheology.

After spending his early medical career studying how the brain works in neurological and psychiatric conditions such as Alzheimer's and Parkinson's disease, depression and anxiety, Newberg took that brain-scanning technology and turned it toward the spiritual: Franciscan nuns, Tibetan Buddhists, and Pentecostal Christians speaking in tongues. His team members at the University of Pennsylvania were surprised by what they found.

"When we think of religious and spiritual beliefs and practices, we see a tremendous similarity across practices and across traditions."

The frontal lobe, the area right behind our foreheads, helps us focus our attention in prayer and meditation."

To read on, click here.

Sunday, April 01, 2007

The ABC's of Converging Technologies (otherwise known as NBIC)

N is for Nanoscience and nanotechnology (manipulation of matter on an atomic scale)
is for Biotechnology and biomedicine, including genetic engineering and transgenics
I is for Information technology, including computing and communications
C is for Cognitive science, including cognitive neuroscience, neurotechnology, and psychopharmaceuticals.

Put them all together and what do you get? The NBIC rubric from the National Science Foundation, which is studying the above converging technologies for the purpose of enhancing human performance. One example of converging nano-info is 'smart dust', which gathers information surreptitiously, and can be sent to sense tumour cells. Another example is the ‘lifelog’, a digital diary of everything and individual does. In nano-bio, there are implantable computers that send feedback on body function (including neural activities). A nano-bio-cogno convergence gives us the brain pacemaker, a neuroprosthetic device for restoring brain performance, and extending this to nano-bio-info-cogno, the full NBIC, produces neural interfaces for enhancing memory and the senses, and human technogenics (cyborgs).

My friend and colleague, Greg Wolbring, does a fantastic job of anticipating, monitoring, and contemplating what this all means at his blog Innovations Watch: The Choice is Yours. A sample of his entries:

I've bookmarked this page -- it is a 'must have' if you want to keep on top of the latest in converging technologies. And if you're interested in hearing about Augmented Cognition your can watch the video from the Spotless mind conference that we had blogged about earlier.