March 4, 2014
Lifesaving implants complicate end-of-life care
(The Boston Globe) – More than a decade has passed, but Nathan Goldstein, then a medical resident at Mount Sinai Hospital in New York City, still remembers it clearly. A man with terminal lung cancer had planned to die at home with hospice care. Instead, the man was lying on a stretcher in the busy emergency room. Every few minutes, his heart received a shock from his internal defibrillator, preventing his heart from stopping.
How can we reduce end-of-life health-care costs?
(The Wall Street Journal) – Balancing cost, care and quality of life near death remains a puzzle for policy makers, practitioners, and of course, patients and their families. With this difficult calculus in mind, we asked The Experts: How can we reduce end-of-life health-care costs? This discussion relates to the latest Health Care Report and formed the basis of a discussion on The Experts blog on Feb. 26 and 27.
March 3, 2014
Whose genome is it anyway? Doctors face dilemmas over risk knowledge
(U.S. News and World Report) – When you break your arm and get an X-ray, those results are mostly only significant to you – they don’t affect your brother, your sister, your parents or that distant cousin of yours in Alaska. But genetic testing is different, explains Dr. Mark Robson, clinic director of the Clinical Genetics Service at Memorial Sloan-Kettering Cancer Center in New York City. Targeted genetic tests – such as tests for Alzheimer’s disease, Huntington’s disease and certain types of cancer – yield results that can have dramatic and unpredictable consequences for family members. For doctors, deciding whom to test, when to return results and whom those results might impact is perhaps even more complex.
February 27, 2014
‘Stop medicating elderly and let them die naturally’
(The Telegraph) – Doctors should stop prescribing statins and blood pressure drugs to over 80s because they have little effect and many older people would rather be allowed to die naturally, a health expert has warned. More than two million people over 80 in Britain are currently prescribed pills to prevent strokes and heart attacks with many drugs causing debilitating side-effects. Dr Kit Byatt, a specialist in geriatric medicine at The County Hospital, Hereford, claims many older people ‘see death as the next natural event’ and do not want the burden of medication.
FDA weighs evidence on producing ’3-parent’ embryos
(Fox News) – U.S. medical advisers are considering whether there is scientific justification for allowing human studies of a controversial procedure known as “three-parent in vitro fertilization (IVF),” a technique supporters say could prevent horrific genetic defects but that critics believe could lead to designer babies. During two days of public hearings starting on Tuesday, scientists were scheduled to present their research to outside advisers to the U.S. Food and Drug Administration.
February 26, 2014
‘Death test’ predicts chance of healthy person dying within five years
(The Telegraph) – A ‘Death Test’ which predicts the chance of a healthy person dying from any medical condition in the next five years has been developed by scientists. Researchers said they were ‘astonished’ to discover that a simple blood test could predict if a person was likely to die – even if they were not ill. They found that the levels of four ‘biomarkers’ in the body, when taken together, indicated a general level of ‘frailty’. People whose biomarkers were out of kilter were five times more likely to die with five years of the blood test.
Science in court: Disease detectives
(Nature) – The method, which marries classic evolutionary-biology practices with modern sequencing technology, is increasingly being used in criminal and civil investigations, and for biodefence. A paper published this month, for example, describes how the technique allowed scientists to trace the likely origin of an anthrax-laced batch of heroin that has been killing users across Europe since 2009. But the intersection of this science with the legal system makes many uneasy, says Anne-Mieke Vandamme, an evolutionary geneticist at the University of Leuven in Belgium, who has worked on 19 criminal cases since 2002, mostly for the defence. Unlike DNA evidence, which is routinely used in legal settings around the world, the results of phylogenetic forensics are rarely definitive. “You can never prove guilt,” she says.
February 25, 2014
The secret to a bulletproof antidoping test?
(New York Times) – In the lab of Yannis Pitsiladis, a physiologist in Scotland, athletes spend their days injecting synthetic EPO, a popular performance-enhancing drug that tricks bone marrow into churning out more red blood cells, allowing athletes’ bodies to absorb more oxygen. Pitsiladis hasn’t gone rogue. He’s at the forefront of an effort to revolutionize the hunt for dopers in sports by scouring his subjects’ blood cells for a distinctive, long-lasting genetic “fingerprint” left by the drug.
Sequencing genes can pinpoint rare illnesses. Might it also help with other problems?
(Washington Post) – Born prematurely, Lillian Yuska struggled to feed, and she suffered from chronic gastrointestinal problems and repeated infections. After years of shuttling her from specialist to specialist, Lillian’s parents turned to cutting-edge technology: They had their daughter’s genetic code mapped. This genomic sequencing, which began when Lillian was 4, revealed that she had tricho-hepato-enteric syndrome-2, a condition caused by a gene mutation that disrupts gut function and immunity. Only six other children worldwide are known to have the condition.
A New Edition of Bioethics is Available
Bioethics (Volume 28, No. 3, March 2014) is now available online by subscription only.
- “2014 International Bioethics Forum Between UK and China and the Professional Development of Bioethics in China” by Li EN-Chang, et al.
- “Living Organ Procurement from the Mentally Incompetent: The Need for More Appropriate Guidelines” by Kristof Van Assche, et al.
- “Are Bans on Kidney Sales Unjustifiably Paternalistic?” by Erik Malmqvist
- “Equity Under the Knife: Justice and Evidence in Surgery” by Wendy Rogers, et al.
- “A Costly Separation Between Withdrawing and Withholding Treatment in Intensive Care” by Dominic Wilkinson and Julian Savulescu
- “Are Phase 1 Trials Therapeutic? Risk, Ethics, and Division of Labor” by James A. Anderson and Jonathan Kimmelman
- “The Nocebo Effect of Informed Consent” by Shlomo Cohen
February 24, 2014
Two year old boy to inherit 11 frozen embryos
(Harvard) – A new twist on frozen embryo litigation is now before a Dallas probate court facing what to do with 11 frozen embryos after the parents were murdered. They left no will and gave no instructions to the fertility clinic for disposition if they both died. Under the Texas intestacy statute the only heir is a two year old boy. The Master in Chancery appointed by the Probate Court has recommended that the embryos be maintained by the clinic until the two year old heir is 18, at which time he would acquire all rights to their disposition.
IVF treatment: Better, but not yet good enough
(Forbes) – On the occasion of the CDC’s yearly release of IVF clinic success rates, I remind myself and my old colleagues that we should always strive to do better. Every baby, whether conceived by in vitro fertilization or dropped by a stork down the chimney, is a miracle. As a reproductive endocrinologist, I had a unique opportunity to make small contributions to some of these miracles. But as I constantly reminded myself and my colleagues: the miracles are the babies, not the procedures. That is still true today. Assisted reproduction as it exists in the year 2014 is still a pretty primitive set of procedures and tools.
February 21, 2014
Thyroid cancer nearly triples; research blames “epidemic” on overdiagnosis of harmless tumors
(Associated Press) – A dramatic rise in thyroid cancer has resulted from overdiagnosis and treatment of tumors too small to ever cause harm, according to a study that found cases nearly tripled since 1975. The study is the latest to question whether all cancers need aggressive treatment. Other research has suggested that certain cancers of the prostate, breast and lung as well as thyroid grow so slowly that they will never become deadly, and that overzealous screening leads to overtreatment.
A New Edition of The New England Journal of Medicine is Available
The New England Journal of Medicine (Volume 370, No. 8, February 20, 2014) is now available online by subscription only.
- “Post-Acute Care Reform — Beyond the ACA” by D.C. Ackerly and D.C. Grabowski
- “Post-Acute Care — The Next Frontier for Controlling Medicare Spending” by R. Mechanic
- “The Hospital-Dependent Patient” by D.B. Reuben and M.E. Tinetti
- “Informed Consent, Comparative Effectiveness, and Learning Health Care” by R.R. Faden, et al.
- “Informed Consent for Pragmatic Trials — The Integrated Consent Model” by S.Y.H. Kim and F.G. Miller
Patient consent to research not always necessary, bioethicists say
(Newswise) – Under the right conditions, full informed consent is not ethically required for some types of health research, according to leading bioethics experts. The experts focus in particular on the comparison of common treatments in the February 20 issue of the New England Journal of Medicine (NEJM), arguing that in some cases a time-consuming consent process is not only unnecessary from the standpoint of protecting patients, but also potentially harmful to patients when it functions as an obstacle to gaining new knowledge that can improve the quality of the care patients receive.
February 20, 2014
The lies that doctors and patients tell
(New York Times) – The doctor-patient relationship is ideally an intimate partnership where information is exchanged openly and honestly. That is seldom the reality, however. Deception in the doctor-patient relationship is more common than we’d like to believe. Deception is a charged word. It encapsulates precisely what we dread most in a doctor-patient relationship, and yet it is there in medicine, and it often runs both ways.
February 19, 2014
Healthcare organizations under siege from cyberattacks, study says
(Los Angeles Times) Add this to the list of things to freak you out: Healthcare organizations of all kinds are being routinely attacked and compromised by increasingly sophisticated cyberattacks. A new study set to be officially released Wednesday found that networks and Internet-connected devices in places such as hospitals, insurance companies and pharmaceutical companies are under siege and in many cases have been infiltrated without their knowledge.
February 18, 2014
View on disability: Trials exclude vulnerable people
(Sci Dev Net) – Fisher’s solution is what she calls the ‘goodness-of-fit’ ethic, an approach she developed and which, she says, has gained approval among her colleagues. The idea is that researchers should adapt the way in which they obtain informed consent to the intellectual strengths and vulnerabilities of the individuals they are recruiting.
February 17, 2014
Media hype blood clot risk of birth control pills
(Nursing Times) – Combined hormonal contraceptives (or “the pill”) are in the news after letters were sent to doctors to tell them about the latest evidence on the risk of thromboembolism (blood clots) associated with combined contraceptives. Unfortunately, most of the UK media overhyped the potential risk in their reporting. The Mail’s panic-maximising implication that 1 million women could be at risk doesn’t reflect the reality that only around 12 women per 10,000 taking combined contraceptives are thought to be at risk of having a blood clot in any given year.
February 14, 2014
A drug-dealing robot that upends the pharmacy model
(Wired) – The technical backbone of PillPack is a suite of drug-dealing robots. A large, beige machine in PillPack’s New Hampshire office is filled with a cornucopia of curatives which are dispensed into the plastic packets. The strip of dose packs is then fed through another robot that reviews each plastic packet for quality control purposes before a team of pharmacists double check the prescriptions and send them off to patients.
February 12, 2014
Ancient genome stirs ethics debate
(Nature) – The remains of a young boy, ceremonially buried some 12,600 years ago in Montana, have revealed the ancestry of one of the earliest populations in the Americas, known as the Clovis culture. Published in this issue of Nature, the boy’s genome sequence shows that today’s indigenous groups spanning North and South America are all descended from a single population that trekked across the Bering land bridge from Asia. The analysis also points to an early split between the ancestors of the Clovis people and a second group, whose DNA lives on in populations in Canada and Greenland.