Medical Bloggers Cross Ethical Lines

Is the information age providing too much of a good thing in the world of healthcare?

According to a recent study published in the Journal of General Internal Medicine, some medical blogs have crossed ethical lines by violating individual patient privacy. The report calls on doctors to use responsible tone and content in sharing their narratives with online communities.

Blogs have become increasingly popular in recent years, providing places for commentary, news, and interaction as the Web has exploded as the world’s information portal (maybe it’s appropriate, then, that this is a blog about blogs). Medical blogs are especially popular, as people use the Internet to supplement their healthcare knowledge and share opinions on medical news. In that sense, the blogs make a significant contribution to the general public.

But should formal blogging standards exist for doctors, nurses, and other healthcare professionals? Dr. Robert Centor, a regular blogger himself, doesn’t think so. Centor believes that “rules are unnessesary” because the Internet provides a place for personal expression at an individual’s own risk. However, some blogs may have crossed the line: the JGIM study found that 17% of medical blogs contain enough information for patients to identify themselves or their doctors.

In response to the ethical issues surrounding medical blogs, a coalition of bloggers formed the Healthcare Blogger Code of Ethics, which attempts to maintain a high standard of integrity in healthcare information sharing. Bloggers may place organization’s seal of approval on their sites if they meet the standards of the code, while a “blogroll” on the group’s site lists the names of code-abiding blogs.

As information explodes across the Web, it’s important to keep in mind the ethical standards of the healthcare industry. Maybe the JGIM study is just what medical bloggers needed to keep ethical issues at the front of the boom enveloping all corners of the information superhighway.

Sharing Prescriptions

No Prescription? Have Some of Mine in The New York Times raised the issue of people sharing their prescription drugs with others. Reasons for sharing prescription drugs ranged from being on the same medication but not having it with them to sharing medication for pain or having similar health problems as the other person.

Another reason, not discussed in this article, that people share prescription drugs is cost. In an early post, I mentioned that my mother is currently in the Medicare prescription drug coverage doughnut hole. One way she deals with that is by borrowing medication. She and my husband are on the same prescription antidepressant--same brand, same dosage, etc. My husband, however, realized about a year ago that he never remembered to take the evening dose and seemed to be fine without it. So, over time, he ended up with a stockpile of that drug. So, when my mother mentioned her problem with having to pay out of pocket for the same drug, he started sharing his medication with her. It doesn't entirely solve her problem, but it does mean that she only has to get her prescription for that drug filled every other month.

Last month, my nephew and his girlfriend (both in their late teens and still in college) both came down with Strep throat. The girlfriend still has health insurance through her parents, so she went to urgent care and got a prescription for antibiotics. My nephew doesn't have health insurance. So, between them, they decided to share her antibiotics and recommended over-the-counter medications. Thankfully, they live with me and when I heard their plan, I explained why it wasn't a good idea. Taking half a course of antibiotics might result in neither of them fighting off the infection. So, I took my nephew to urgent care, paid out of pocket, and got him his own course of antibiotics.

And in my own experience, I've had multiple knee surgeries and have a friend who has also had knee surgery and a recent total knee replacement. Post-operatively, we've both been prescribed oxycodone for pain, which most doctors prescribe in very limited quanities because it can be addictive. Have we ever shared pain medication? Yes. After my friend's knee replacement, they sent her home with a handfull of paper prescriptions, including one for oxycodone. It took her partner several hours to get to the local pharmacy, do the paperwork, get the prescription refilled, and get back home. Meanwhile, my friend was in pain, serious pain. So, I shared my oxycodone with her--knowning that the same medication had been prescribed by her doctor but that she just didn't have it in hand yet made the decision a no brainer.

So yes, people do share prescription medications for lots of reasons--cost and need among them.

HPV Vaccine Use Controversial

A recent article in The New York Times, Researchers Question Wide Use of HPV Vaccines presented some of the issues still surrounding widespread use of vaccines for the prevention of the human papillomavirus (HPV).

One concern raised in this article was whether the vaccines are worth their high cost. This is an especially important question for developing countries and even women and girls in the United States with little or no health insurance or Medicare coverage. A complete series (3 shots) of the vaccine cost between $400 and $1000 per person depending on the country and charges for doctor's office visits. Vaccines for other diseases are relatively inexpensive and save money by preventing costly diseases; however, the HPV vaccines seem to actually be costing the healthcare system money. The HPV vaccines might only be truly cost effective if they protect girls from cervical cancer for an entire lifetime. Unfortunately, there hasn't been enough research to prove that yet. For girls with sufficient healthcare coverage, there's every reason to consider vaccination to reduce the risk of cervical cancer. However, the case is not so clear where funding is scarce. Should this $400 to $1000 per girl be spent on other medical treatments or prevention that have already been proven to prevent disease and save lives? Pap smear screening and treatment in developed countries has already reduced death rates from cervical cancer to very low levels. Should funds be spent on more screening and treatment instead of HPV vaccines in developing countries untl further data is available? Would that be a better use of such limited funds for healthcare? Perhaps, at least for now.

Safe Shooting?

Just five years after opening, the first legal safe injection site in North America finds itself in the crosshairs of the Canadian government.

Health Minister Tony Clement weighed in on the controversy last week, calling into question the ethics of physicians who support the harm-reduction facility. According to Clement, the “injection site undercuts the ethics of medical practice and sets a debilitating example for all physicians and nurses.”

At issue is Insite, which opened its doors in the Downtown Eastside section of Vancouver in 2003 under an exemption from federal drug laws. Clients use safe injection sites like Insite to inject their own drugs under the supervision of trained medical staff. The idea is to reduce harm to users and decrease other negative consequences of drug abuse.

Clement and the conservative Canadian government oppose Insite, citing the practice of “supervised overdoses” as unethical and claiming that the facility has done little to reduce drug overdose deaths. However, a government-appointed panel concluded otherwise in April, noting that Insite has saved money and lives and that most health officials want the service to continue.

Safe injection sites treat drug addiction as an illness rather than a crime. That distinction has stirred controversy in and around Vancouver, which went down a “drug-fueled spiral” in the years leading up to Insite’s opening. Opponents of Insite think drug users should be in rehab or behind bars, while supporters sharply criticize Clement and say the closing of the facility could result in the deaths of users.

Does Insite prevent the spread of disease and save lives? Or is it an unethical blemish on Canadian healthcare? Either way, the controversy isn’t going away anytime soon. Physicians, politicians, and drug users: stay tuned.

Quality vs. Quantity of Life

Reading the article The Artificial Heart: Not Just a Pump in Scientific American raised the issue of quality of life vs. quantity of life.

I knew that in the early 1980s an artificial heart, the Jarvik-7, had been successfully implanted into a man who would have died without the device beause of his own failing heart. What I hadn't realized before reading this article was what kind of quality of life Mr. Clark (the patient) had after receiving the artificial heart.

We all have this image in a heads, probably most from television shows, of a patients who undergoes a heart transplant and receives a donor heart, which gives him or her a second chance. The leave the hospital looking healthy and happy and go onto to live for 5, 10, 15 years, or more.

Unfortunately, this wasn't the case for Mr. Clark. He was never able to leave the hospital after the artifical heart was implanted. In fact, the compressor that powered the artificial heart was the size of a refrigerator and Mr. Clark was tethered to this compressor the entire time. During the 112 days that he survived after the surgery, he suffered convulsions, cognitive problems, kidney failure, and then died of massive organ failure. Because of the scientific and medical implications of this procedure, the press followed the story closely. The public watched Mr. Clark's progress and then his decline. His quality of life during this time was so poor that many Americans were turned against the idea of artificial hearts for the next decade.

While researchers would probably argue that every patient who undergoes a procedure such as this one furthers scientific and medical progress, what does it do for the patient himself? In the end, was it worth it to Mr. Clark? Would his quality of life at the end been better if he'd spent his final days with his family, rather than undergoing surgery and hooked up to so much medical equipment? Should researchers wait longer before performing such procedures on humans? At what point is the quantify of life worth the quality? Should a patient with terminal cancer be encouraged to try yet one more treatment, even if the chances of it improving their outcome are minimal, or should they go home and spend their final moments with their loved ones? These are sensitive issues and often best decided by the patients and families themselves.

Drug Ads vs. Scare Tactics

In The Wall Street Journal this week, there was an article titled Glaxo's HIV-Drug Ads Draw Critics that raised the notion that pharmaceutical companies might be using scare tactics to convince patients to stay on their current medications.

On the surface, this might not sound too bad. After all, scare tactics have been used in other health-related commercials. We all remember the screen with the frying pan and the cracked egg, and the voiceover that said, "This is your brain on drugs." Then there were ads in the 1980s and 1990s aimed at convincing teenagers of the dangers of having unprotected sex and contracting the human immunodeficiency virus (HIV).

However, the concern with these new ads, such as the ones from Glaxo featured in the article, is that they seem aimed more at convincing patients not to try new medications. For example, one Glaxo ad showed shark-infected waters and included the message, "Don't take a chance--stick with the HIV medicine that's working for you." Although the ads don't mention a specific medication by name, they do carry the Glaxo logo.

A patient's decisions about medical treatment should be an informed decision and ideally should be made after consultation with his or her own healthcare provider. The treatment regimen that might be right for one patient, might be totally wrong for another. As new treatment options are approved by the Food and Drug Administration and are made available to patients, they should be considered. Pharmaceutical companies shouldn't be trying to scare patients into staying on their own marketed drugs to avoid having them switch to a competitor's drugs. If the competitor's drugs are really better, then perhaps the pharmaceutical company tempted to run scare ads should focus more on their research and development and coming out with newer, better drugs of their own.

Many individuals are afraid to seek medical treatment, afraid to learn the truth about their condition, and afraid to hear the prognosis. They don't need to have more fear instilled in them about the actual treatment for their condition.

Access to Too Much Information

A recent article in The Wall Street Journal, Increase in Cases of Measles Tied to Fears Over Vaccine, reported a significant increase in the number of measles cases in the United States, the highest level in more than a decade. The increase appears to be associated with an increase in the number of patients refusing to having their children vaccinated.

For children attending state-supported public school, a clearly defined set of vaccinations must be completed and documentation provided before the child can be enrolled in school. However, for children who are home schooled, their parents can refuse vaccinations and there is no enforcement. Parents of children in public school can also seek an exemption to vaccination for religious reasons.

There have been 131 reported cases of measles so far this year; 122 of those children had not been vaccinated or their vaccination status was unknown. Although not perfect, the measles vaccine is considered to be highly effective at preventing measles.

Why are parents refusing to have their children vaccinated? Primarily due to fears of that autism is caused by measles shots, other childhood vaccinations, or a mercury-based preservative that used to be in most vaccines. There is no scientific evidence that autism is caused by any of these and in fact, the preservative has not been used in any vaccinations since 2001. However, news stories, law suits, and less official sources of information available on the internet have made parents aware that some fear a link between vaccination and autism. Some parents are making their decisions out of fear and possibly putting their children at risk. Of the 131 reported cases of measles this year, no children died, however, 15 of them did have to be hospitalized.

To counteract the potentially misleading information available online, pediatricians and the Centers for Disease Control and Prevention (CDC) are endeavoring to make more evidence-based information available to parents.

Should Healthcare Workers Control Access to Treatment

The Wall Street Journal recently published an article about proposed regulation to protect healthcare workers who oppose abortion, Rules Let Health Workers Deny Abortions.

How much protection do healthcare workers really need from women seeking medical treatment? The proposed new rules could potential cut off federal funding to states that force healthcare workers to perform, assist in, or refer patients to abortion services. It seems reasonable to expect that individuals who oppose abortion for moral or religious reasons should not be forced to perform them or even in assist in performing them. However, in my opinion, doctors and nurses should not be involved in denying medical care to a patient by refusing to refer them elsewhere. If they aren't willing to perform a procedure for personal reasons, then they should be willing to refer the patient to a different clinic or healthcare provider who will.

Opponents to the new regulation worry that the ambiguous wording would also enable healthcare providers to deny patient access to the morning-after pill and even some forms of birth control. Although supporters claim that the regulation does not affect the rights of patients to obtain any legal medical procedure, it's hard to deny that these changes would make it much more difficult for some patients to actually get the needed or desired medical treatment. Under the new rules, a woman presenting to the emergency room after being raped might not even be told about the availability of the morning-after pill, depending on the moral or religious beliefs of the healthcare providers treating her or the institution itself (such as Catholic hospitals). Isn't this tantamount to denying the patient access to appropriate and legal medical care?

Deaths of Babies Raise Questions in India

Are unethical clinical trials occurring at India’s top public hospital?

The All India Institute of Medical Sciences (AIIMS) is under fire after a report indicated that 49 babies died in clinical trials at the hospital between January 2006 and August 2008. The deaths were among 4,142 infants used in 42 clinical trials, mostly for Western drug companies, according to the Times of London.

Known for providing free and low-cost treatment to the poor, AIIMS has been ranked the best medical college and public hospital in India in recent years. The government-funded hospital treats approximately 3.5 million patients per year, “achieving mortality and infection rates comparable to the best facilities in the developed world,” according to a 2006 Newsweek article. The average inpatient fee is just $1 per day.

So how did AIIMS end up in the news? India has become the world’s hotspot for clinical trials because of its large population and low costs. Clinical trials cost just 40 to 60 percent of what they would in developed countries, according to some estimates. So, along with other developing nations, India scrambles to “catch Big Pharma’s eye” in an outsourcing boom that characterizes the international drug industry.

The infant deaths at AIIMS have sparked concerns that poor and illiterate parents don’t understand the risks associated with drug trials. Questions have been raised about whether informed consent, the cornerstone of human clinical trials, was properly obtained. Researchers at AIIMS say an internal ethics committee cleared the trials, but an investigation is underway.

However, a BBC report in 2006 revealed that some patients in Indian clinical trials did not realize they were part of experiments. The report indicated that patients signed consent forms without understanding the nature of the clinical trials or the risks involved with participation.

Investigations will shed light in the coming weeks on whether the clinical trials at AIIMS were unethical, but one thing is clear: obtaining proper informed consent should be just as important to researchers as jumping on the “outsourcing boom.” Families who walk into AIIMS with the hope of medical aid for their children shouldn’t expect to find themselves the victims of ethics violations.

When Are Doughnut Holes a Bad Thing?

A recent article in The Wall Street Journal titled Some Seniors Quit Taking Medicine When Medicare Doughnut Hole Hits discussed the affects on seniors of current Medicare drug coverage, or lack thereof.

You might be asking, "What does Medicare have to do with doughnut notes?" Well, Medicare beneficiaries receive prescription drug coverage up to $2400. However, after their costs for drugs exceed that amount, beneficiaries must pay for their prescription drugs out of their own pockets. There is not coverage again through Medicare until they've spent another $3850 for drugs. This gap is called the doughnut hole.

Many seniors are grappling with how to handle the way this gap in coverage affects their daily medications. Some pharmacies offer discounts to seniors on generic drugs, allowing them to fill some of their prescriptions during this gap interval for $5.00 per month. However, quite a few drugs don't fit in this category.

After a 40-year habit of smoking 3 packs of cigarettes per day, my mother developed deep vein thrombosis and had pulmonary embolism. Luckily, she survived; over 30% of individuals who experience PEs die. She quit smoking cold turkey while she was in the hospital; it's not like they gave her a choice. She was on oxygen 24 hours a day. To help with the withdrawal as well as her postdischarge recovery, her doctor prescribed Wellbutrin. She has been taking it twice-daily now for over 7 years. For her, it works well. She's never wanted to smoke again and it helps with depression as well. Unfortunately, there have been times that she has been switch to generics because of her healthcare coverage in order to save money. For her, the generics don't seem to be as effective; there are reports in the literature that this is true for other patients as well. Last year, my father retired and now my parents have Medicare prescription drug coverage and my mother's in the doughnut hole. She keeps threatening to stop taking the Wellbutrin because of the cost. Not good. It's a medication that she really needs. I keep encouraging her to continue taking it and help her out with the costs as much as I can. However, she's tempted to stop taking the medication altogether.

Many other seniors are facing the same dilemma. How beneficial is healthcare coverage which doesn't provide sufficient support for sick individuals to receive treatment on an ongoing basis?

Access to DNA Evidence

A recent article in The Washington Post titled Va. DNA Project Is in Uncharted Territory discussed the issues surrounding DNA testing for criminal cases from the past.

About three years ago, a $1.4 million project was launched by the State of Virginia to re-examine blood, semen, and saliva samples from approximately 400 rapes, murders, and other serious crimes from the 1970s and 1980s. The state is entering unchartered waters in terms of ethical and practical issues depending on the results of the DNA testing. The focus of the state's crime lab is the science of the DNA testing of samples. This project does not include determining guilt or innocence of the accused or wrongly convicted. That's being left up to the criminal justice system. Most of the convicts involved do not even know that this testing is being done.

This project raises a number of ethical issues. If evidence if found to implicate another individual, shouldn't the person convicted of the crime be informed? Shouldn't they be entitled to a new trial based on this evidence? Is it possible to rule out a suspect or someone convicted of a crime based on available evidence? Or does the investigation need to be reopened? Given the number of unsolved crimes, how much attention will these cases receive? If an individual was wrongly convicted and is found not guilty based on DNA evidence, what are their rights? Is a new trial required? Should they be pardoned automatically?

Cancer Drugs Prove Too Costly for UK Healthcare

Is saving or prolonging a life justified at any cost? The UK’s National Institute of Health and Clinical Excellence (NICE) has advised against it, causing quite a stir in the British Isles.

NICE recently recommended that four drug treatments for kidney cancer remain unavailable on the UK’s National Health Service (NHS), citing failure of the medications to meet cost-effectiveness criteria. The drugs, which include Sutent (sunitinib), Avastin (bevacizumab), Nexavar (sorafenib) and Torisel (temsirolimus), cost between £20,000 and £35,000 per patient per year. They were found by NICE to provide “significant gains” in survival.

NICE is the independent organization responsible for providing the NHS guidance on health issues. The NHS is the publicly funded healthcare system of the UK, providing most of the primary, inpatient, and long-term care in addition to opthamology and dentistry.

While NICE has been criticized for failing to approve the cancer drugs, its chief accused pharmaceutical companies of driving up the cost of medicince. Sir Michael Rawlins defended NICE’s decision on the drugs, arguing that drug companies enjoy expanding profit margins and are “out to sustain that, not least because their senior management’s earnings are related to the share price.”

Also coming to the defense of NICE is Mark Henderson, who put forth an argument for cancer drug rationing in the Times. Henderson notes that there simply isn’t enough money to provide every free, point-of-use medical service that people want.

Opponents of the drug recommendation, including leading cancer specialist Robert Hawkins, claim the decision is bad for patients. Families of patients also slammed the decision, saying the life-saving drugs should not be rejected on the basis of cost. In addition, one drug company has already threatened to withdraw its products from the NICE approval process because of the controversy.

The debate on drug cost is nothing new in the UK, and the issue is sure to keep healthcare in the British media spotlight. It also raises public healthcare questions in the United States, where healthcare reform will surely be on the agenda during the presidential campaign this fall.

Better Late Than Never

The American Medical Association has finally said, “We’re sorry.”

In a move to improve its relationship with minority physicians, the AMA issued a formal apology last month for its history of racial inequality toward African American doctors. In particular, the AMA apologized for excluding black physicians from its membership, for listing black doctors as “colored,” and for failing to speak against federal funding of segregated hospitals.

The AMA’s apology followed on the heels of a report published by a panel it convened to investigate the historical racial divide in organized medicine. According to the report, the AMA was “early and persistent in countenacing racial segregation” characterized by the open discrimination against black physicians. The report also concludes “the legacy of segregation, bias, and exclusion continues to adversely affect African American physicians and the patients they serve.”

The National Medical Association immediately accepted the apology, issuing a press release noting that the NMA “owes its very existence, in part, to these inequities which forced African American physicians to found their own membership organization.” Nelson L. Adams, president of the NMA, urged the AMA to join forces with his organization on several initiatives aimed at improving healthcare for all races.

The NMA was founded in 1895 in response to the AMA’s discrimination, but you don’t have to look back that far to see blatant segregation in the medical community. In fact, as Dawn Turner Rice wrote recently, 54 of Chicago’s 57 hospitals didn’t allow black physicians to have attending status until 1964.

Another important read: Harriet Washington, a member of the AMA-appointed panel that produced the report on the racial divide in medicine, wrote an essay for the New York Times on racial barriers in medicine. Washington examines the AMA’s “wrongs” throughout the twentieth century — including the organization’s failure to support the Civil Rights Act of 1964.

Washington ends her essay with a mind-boggling statistic. In 1910, 2.5% of doctors in the United States were African American. The same figure in 2008? Just 2.2%. It’s not exactly the progress one might expect over the course of a century, but maybe the AMA’s apology will prove to be a good first step.

Brain Death vs. Cardiac Death in Organ Donors

A recent article in The Washington Post titled Infant Heart Transplant Controversy Continues reports the results of recent heart transplant surgeries using hearts from donors who experienced cardiac death.

We're familiar with organ donation after a patient has been declared brain dead. However, organs can also be used for transplantation after a patient experiences cardiac death--after life support is withdrawn, the heart stops. The controversy lies in how long after the heart stops beating before it is permissible to begin harvesting organs, especially the heart itself. Previously, the Institute of Medicine had recommended waiting 5 minutes in case the heart were to restart on its own. However, it has been recently suggested that cardiac death might be irreversible after only 1 minute.

Surgeons at a Denver hospital have recently reported results from heart transplantation surgery in 3 infants where the time between the heart stopped and organ retrieval started was 3 minutes in one case and 75 seconds in the other two cases. By decreasing the amount of time that the organs are deprived of oxygen likely increases the success of the transplantation procedure.

Ethicists argue that if a heart is transplanted from one patient into another and resumes functioning, then it is not possible for the first patient to have suffered from irreversible loss of cardiac function. Others agrue that in the case of these patients, none of them would die as a result of removal of their vital organs who would not have otherwise died after withdrawal of life support.

How and when questions about organ donation are raised at issue as well? One patient's death should not be hastened in order to save the life of another. Ethically, health care providers should not raise the issue of organ donation with the family until the decision has been made to withdraw life support. With this decision made, if the family then consents to organ donation, then perhaps more lives can be saved by increasing the number of available donor organs.

Whose Rights Were Really Being Protected?

A recent article in the Wall Street Journal titled A Death in the Family tells the story of a son who murdered his mother after being discharged from a psychiatric hospital.

William Bruce had been committed to an inpatient psychiatric facility and diagnosed with paranonid schizophrenia after multiple incidents including attempting suicide, threatening two men with a loaded assault rifle, and assaulting both his mother and father. During his hospitalization, he refused to take medication and sought discharge from the facility by working with a government-funded patient advocacy group. According to the Wall Street Journal article, Bruce's medical records indicate that his doctor's thought he posed a threat to himself and to others if he was not medicated and treated for his psychiatric illness. The patient advocates fought for his right to remain psychotic and untreated, if that was his choice, and to be discharged. Unfortunately, after his court-ordered commitment term for assault ended, Bruce no longer met Maine's legal criteria for involutnary commitment, so he was released.

When Bruce was releasd, he returned home to live with his parents. Two months later, he murdered his mother by repeatedly striking her in the head with a hatchet while his father was at work. Bruce was found not criminally responsible by reason of insanity and committed indefinitely to the same psychiatric hospital where he'd been previously. Faced with the possibility of being restrained and medicated against his will, Bruce agreed to take a prescribed antipsychotic drug. Within a matter of weeks, his mental status had improved. Now, he says, "The advocates didn't protect me from myself unfortunately." At the time, he was just happy to have someone help him to get discharged from the hospital, but at that point he hadn't yet acknowledged that he had a mental illness and needed help. He went on to say, "There are times when people should be committed. Institutions can really help. Medicine can help."

Whose rights were the advocates trying to hard to protect? In addition to a patient's right to make their own decisions regarding medical treatment, patients also have the right to receive the appropriate treatment for their condition. According to superintendent at the psychiatric hospital where Bruce is committed, "...the advocates overstepped their bounds. William was relying on the people whose purpose it was to ensure his civil rights were being exercised, and unfortunately that interfered with his other right, which was to get medical care."

Now at least three lives have been ruined--William Bruce's, his mother's, and his father's, as well as other relatives and friends affected by his mother's death. If only Bruce had received the treatment that he needed during his first hospitalization, perhaps these life-altering events would never have happened.

Putting Kids’ Fears to Rest

It wasn’t exactly the summer vacation I planned before heading into fifth grade. A medical procedure revealed that I needed surgery, and I’d be in the hospital a few days. Of course, I was scared to death.

As a kid, I didn’t know much about surgery, but I did know the basics: people wearing masks cut you open. That’s exactly how I pictured it. A bunch of people would surround me, put me to sleep, and then cut into me.

Nothing really prepares a kid for that first trip to the hospital. The sights, sounds, and smells are all new, and in my case, I associated them all with surgery. What was that beep in the hallway? Why is that guy wearing a blue gown in the cafeteria? And, of course, there was the unknown. Would I feel anything? Will I wake up during surgery? How long would I be away from my family?

During my first trip to Milton S. Hershey Medical Center, I had most of these questions answered by a specialist in the Child Life Program. I remember thinking how much better I felt when she explained what surgery was, and how it wasn’t going to be the horror show I envisioned. We played games, talked about my procedure, and I soon felt comfortable in a place I previously dreaded.

A recent article in the Philadelphia Inquirer brought back these memories and others from my hospital experience. The article details the Child Life, Education, and Creative Arts unit at The Children’s Hospital of Philadelphia, and how young patients come to terms with their own treatments by acting out medical procedures on dolls.

One study cited by the Inquirer article shows that child life programs make a calculable difference. Among 100 hospitalized preschoolers in the 1998 study, blood pressure and pulse rates were lower in children who participated in puppet shows about their surgeries.

Although I don’t have a record of my blood pressure from my hospital stay, I’d guess it was much lower because of my child life specialist. By translating the “unkown” into something I understood, she helped put my fears to rest. The same story unfolds every day at hospitals across the country, helping kids realize that it’s not going to be as bad as they think.

Pens, Pizza, and Prescriptions: A New Era in Drug “Gifting”?

You’re waiting in the lobby of the doctor’s office with a brutal sore throat. In between painful sips of water that the office assistant kindly provided, you notice something strange: a sharply dressed person entering the office with what appears to be several grocery bags.

The cold medicine might be making you a bit dreary, but you’re not seeing things. In fact, you’ve just witnessed something patients see in waiting rooms across the country, one that helps to characterize the landscape of American healthcare: a gift-bearing drug company representative.

For years, drug reps have been showering physicians with pens, clocks, notepads, and a host of other gifts — including free meals and, in some cases, trips — to help market their products. However, recent legislation signed into law by Masssachusetts Governor Deval Patrick places limits on the types of gifts drug companies may provide health professionals. The new law requires companies to publicly disclose any gift worth more than $50 and bans high-end gifts such as sports tickets and free travel.

Massachusetts isn’t alone, however. Vermont and Minnesota already have state laws requiring the reporting of drug company payments to doctors.

The Massachusetts law comes on the heels of an industry-wide code of conduct adopted in July by PhRMA, set to take effect in January 2009. The code places a ban on “freebies” such as pens, mugs, and notepads. However, small meals — like free pizza during informational sessions — are still allowed.

Drug companies and biotech groups aren’t happy with the new legislation. John Hefferman, vice president of the Massachusetts Biotechnology Council, told Gov. Patrick that the law “could erode the state’s competitive edge…and has already created negative buzz in the life sciences industry.”

But do pens and notepads really make doctors prescribe certain drugs more often than others? Gwen Ifill tried to get to the heart of that question during a 2006 debate on the NewsHour with Jim Lehrer. As Dr. David Blumenthal asked during the debate, would drug companies spend money on freebies if they got no return?

The answer, according to The Prescription Project, is “no.” The organization recently published a report titled Why Small Gifts Matter, which found that industry interactions with drug studies led to increased prescription drug costs.

Maybe those grocery bags filled with pens, clocks, and notepads have an impact after all. It’s certainly an interesting ethical debate that raises conflict-of-interest questions. But whether or not more states join Massachusetts, Vermont, and Minnesota in reporting drug gifts, those pens and notepads may be history next year.

Are Standards of Conduct Needed for Physician Weblogs?

By Randy Hendrickson

Pharmalot recently reported a study (“Content of Weblogs Written by Health Professionals” by Tara Lagu et al) that shows that there are serious ethical problems associated with physician weblogs. Although weblogs have emerged as a vital new way to share experiences and provide a connection between health professionals and the public, they do not have the same standards of conduct as medical books, peer-reviewed journals, presentations at medical conferences, and other more traditional forms of medical communication.

Patient Privacy

Funded by the Robert Wood Johnson Foundation and published in the Journal of General Internal Medicine, this study found that a total of:

• 16.6% (45/271) of physician blogs contained information that allowed patients to identify either themselves or their doctor
• 42.1% (114/271) of the blogs described individual patients
• 15.9% (43/271) portrayed patients positively
• 17.7% (48/271) portrayed patients negatively
• 2.9% (8/271) showed patient radiographs with no other identifiable information
• 1.1% (3/271) of the blogs showed recognizable pictures of the patients

Product Endorsement

Explicit product promotions appeared in a total of 11.4% (31/271) of physician weblogs; however, none of the authors provided conflict of information, which is the rule for any legitimate form of medical publishing. Additionally, 29% of bloggers have been approached by public relations firms to endorse a product, and of those, 52% actually wrote a post endorsing that product. Lagu explains that “these endorsements are not advertisements that appear on the website; they are written into the blog narrative, often without any acknowledgment that they are paid promotions.”

According to Lagu, “the ease of use of medical weblogs disconnects blog content from the editorial process common to books, journals, and conventional broadcasts. For the most part, blog authors have few incentives to maintain their credibility and integrity or, in contrast, to compromise it for the sake of ratings or sales.” Most medical literature is subject to peer review; however, weblogs can be written by anyone with an internet connection, regardless of their qualifications.

Although the content of some weblogs shows a lack of respect for the physician-patient relationship, patient confidentiality, and appropriate management of conflict of interest, there has been no formal response from the medical community about the need for standards of conduct for weblog content.

The results of this study show that this new means of medical communication is only going to expand in the future. It is critical that “[p]hysician-leaders and medical educators consider curricular development and educational forums that address the challenges, opportunities, and responsibilities that medical blog authors face, and the place for this new medium with norms of the medical profession.”

A little Cuervo...

A little Cuervo Can Be Good for You

By Michael Leshinski

A little Cuervo in your life can actually help your liver instead of destroying it. No, I am not talking about the popular tequila maker, but rather about a molecular biologist who shares the same name. As reported by Wired magazine, Dr. Ana Cuervo is working on research that could possibly provide healthier livers to booze hounds in the future. Cuervo and her fellow researchers at Albert Einstein College of Medicine have been working with mice through genetic engineering. The altered mice are usually elderly, in mouse years, but have been altered so that their liver works as effectively as young mice (6 months old). The study focused on a protein found in the liver as well as other parts of the body. The protein collects cellular by-products, mainly appearing as damaged proteins, or garbage as they put it.

The group employs simple logic to back the research. If you take out the garbage properly, then the rest of the cell should work just fine. And it has been so far for these little furry test subjects. Besides the possibility for a healthier liver, the research could be breakthrough for Alzheimer’s disease, a disease also associated with the buildup of cellular by-products. But don’t start celebrating with the Cuervo shots just yet. The research being done is still in very early stages and the possible transformation into human medication has not even yet been thought discussed. Whether you’re a fan of consequence free alcohol consumption or someone who really cares about the advancement of research in these important issues, news can be welcomed by all.

Decriminalizing Disease

Decriminalizing Disease

By Michael Leshinski

A recent NY Times article reports on the 17^th annual AIDS conference that was held last week in Mexico. The topic of the article was the decriminalization of certain instances in which the HIV virus is passed from one individual to the other. First of all, I didn’t even know that it was a crime for one person to give AIDS to another person. Although, I have always wondered what would happen to an individual who purposely and successfully gave the HIV virus to another human being. It also makes me think, what about other serious disease states. Types of Hepatitis, for example, can be deadly. When you think about getting the HIV virus, (that leads to AIDS), intravenous drug use and unprotected sexual relations with an infected person are the main reasons for contracting the disease. What about Hepatitis B, which is able to pass through sharing saliva?

Imagine that you made enemies with a person who has Hepatitis B. You’re sitting at lunch and you get up to go to the bathroom. You inadvertently leave your soda bottle sitting at the table. Your nemesis unscrews the cap on your favorite soda and then proceeds to wipe his/her saliva all over the portion that would come directly in contact with your own mouth. This is the way you contract the deadly disease which eventually leads to your death. Is the person ultimately responsible for your death punishable by law? By death? Now this story is obviously made up and a bit far-fetched, but I believe that it is still possible. Think about lesser disease like the common cold. Would that be punishable by fine? Would there be a scale to determine the disease to the punishment? Think about it.

The End...or Just the Beginning

by Leane Scoz

I have to admit. When the weekly assignments were announced during the first class meeting of BW706 this semester, I was a bit in shock. You want me to do what? And post one every week? On the Internet? Where potentially hundreds to thousands of people are going to view it?

I was a blog virgin before this semester. I never gave much thought to blogging. I heard about it. I may have read an occasional entry while browsing the Web. But, I didn't catch the blog fever that all my friends were experiencing courtesy of MySpace. In fact, I am even guilty from time to time of poking fun at friends and their obsession for "the place for friends."

I realize now that I was probably in the minority and wonder why I had not caught the blog wave sooner. I think, at first, I was just not interested in that kind of thing. I am also guilty of using the excuse of not having enough time to waste on blogs I thought nobody would read anyway. However, when I was faced with posting my first blog this semester, I figured out the real reason...I was afraid.

Yes, I am currently in the MS Biomedical Writing program at the University of the Sciences in Philadelphia and a future job opportunity could lead to the potential of having works published that millions of people could read. But, I consider myself a private person. I take criticism, constructive or not, to heart. I do not like to be under scrutiny. And, blogging, I thought, would put me in a vulnerable position.

All of these feelings ended when I clicked "Publish Post" for the first time. I actually felt relieved. I was getting my thoughts on bioethical issues out for all to view. From comments posted, some people even agreed with what I was writing. Others did not...but that's okay because I was able to open my mind to other people's views.

I have also enjoyed reading classmates' posts. Their insight into other key bioethical issues has been uplifting and inspiring. I have also benefited from seeing their writing techniques, which are helping me polish some of my own.

As I prepare to click "Publish Post" for the final time this semester, I am leaving the BioEthics Cafe of Philadelphia with an open mind to the world of blogging. Don't get me wrong...you will probably not find me on the pages of MySpace.com anytime soon. But, you might catch an occasional blog by me on a controversial issue in the news.

Happy Blogging!

Because Women Need Lovin' Too

by Leane Scoz

Listen up, ladies! If you are currently taking antidepressants and experiencing sexual dysfunction, a new study may have the answer to your problem. And, it may have been right under your nose in the medicine cabinet of your male counterpart all along. Yes, Viagra®, the savior drug for men, may also be beneficial for women.

According to CBS Evening News medical correspondent, Dr. Jonathan LaPook, sexual dysfunction affects about half of patients on antidepressants (women more than men). A small study on premenopausal women found Viagra helped to achieve the big "O". However, according to the research report published recently in the Journal of the American Medical Association, it did not improve other sex aspects for women, such as desire or arousal.

Although the study shows promise as a treatment for female sexual dysfunction, Pfizer Inc. (the company that manufactures the little blue pill) currently has no plans to pursue FDA approval of Viagra® use for women. The results of the company's own research proved the drug to be safe but inconclusive in treating women, leading to the study's end in 2004.

When is it going to be the women's turn? Sexual dysfunction treatments for men have exploded onto the pharmaceutical market in recent years. The search for a helper for women leads little to be desired. If Viagra® has the potential of helping depressed women achieve an orgasm, it should be explored further. Depression alone is a serious medical condition. When the treatment for depression is coupled with sexual dysfunction, the situation often worsens. Everyone deserves to be happy and sexually satisfied in life and should not settle for anything less...men and women.

Pardon me, David Letterman

Pardon me, David Letterman

By Michael Leshinski

As a fan of late night talk shows in general, I cannot pledge loyalty to any one network or specific entertainer. Instead, I usually decide to watch a particular show based upon either the musical guest or movie star, in that specific order. In the event that nothing at least semi-amusing is scheduled, I find myself choosing the Late Show with David Letterman. I think everyone knows about his daily “Top Ten” lists, which in my opinion are often hit or miss. Nevertheless, I have been inspired to compile my own Top Ten List consisting of ten websites that I think are relevant in the world of bioethics. The first five websites include information about bioethics in general, government sponsored websites, and journals. The second five include some links to universities besides ours that also study bioethics. *Note: I would mention our blog and the Women’s Bioethics Blog, but we all obviously know them already.

1. http://bioethics.od.nih.gov/

2. http://www.bioethics.net

3. http://www.bioethics.gov/

4. http://www.cbhd.org/

5. http://www.bioethicsjournal.com/

6. http://www.bioethics.upenn.edu/

7. http://kennedyinstitute.georgetown.edu/

8. http://www.bioethics.iu.edu/

9. http://www.ahc.umn.edu/bioethics/

10. http://www.bioethics.lumc.edu/

Informed Consent Issues May Restrict Stem Cell Research

By Randy Hendrickson

According to a recent article in Nature, Stanford University has run into informed consent issues for their human embryonic stem cell lines, and these lines may be restricted for use in research because of ethical concerns. The women who donated the embryos for these stem cell lines did not give adequate informed consent for their use in research. Bioethicist Robert Streiffer, from the University of Wisconsin, obtained copies of the informed consent forms of the donors of the 21 lines that the NIH approved for federal research funding, and none of the forms met the guidelines that were set by an advisory committee of the US National Academy of Sciences (NAS) in 2005. These guidelines covered the types of experiments that could be conducted and proper treatment of the donors of the gametes and embryos. Streiffer’s review of the consent forms found that there were wide variations and discrepancies in the forms that were used. In many cases, the donors were in no way sufficiently informed.

Now, these stem cell lines were obtained before August 2001, when President George Bush mandated that only stem cell lines already in existence would be eligible for federal support. Story Landis, head of the NIH’s Stem Cell Task Force, stated that the NIH will not be taking any stem cell lines off its registry because these guidelines only came into existence in 2005. Landis claims that Streiffer’s analysis “deals with application of 2008 standards to cell lines that were put on the registry in 2001,” and that the registry lines meet the 2001 standards.

As a result of this conflict, “ethics oversight committees across the United States are questioning which lines should be permissible for research—hoping that another agency, such as the NIH or a state government, will make the decision for them.” Frank Sharples, director of the NAS advisory committee, stated that “the NAS will revisit the issue of which lines are acceptable at a meeting later this year.”

Bioethics Defense Fund

Bioethics Defense Fund

By Michael Leshinski

I was just experimenting with You Tube and I wondered if any new, uploaded videos dealing with bioethics existed. I typed it into the search box and to my surprise; a video posted within the previous week seemed to be worth a look. It was entitled “Bioethics Defense Fund”. I had never heard of it before so I decided to check it out. The video explains about their organization, but it has a bit of a political slant to it. Feel free to watch the video and also make comments.

Digital Mammograms

By: Jenny Walters

A recent article on Cnn.com entitled “Do digital mammograms make a difference?” by Linda Saether discussed the details involved in a digital mammogram.

Although digital sounds great, according to Dr. Carl D’Orsi, director of breast imaging at Emory Winship Cancer Institute in Atlanta, “So far we have not been able to obviate the need for compression.” Therefore, as Saether remarked: “The ‘smoosh’ factor lives on.”[1]

With this being said, there are many positives involved in digital mammograms:1

1. The dose of radiation exposure is lower than in traditional analog mammography.
2. Digital mammograms can be stored better and shared more easily because they are computer files.
3. The digital image allows for a great deal of picture enhancement. Dr. D’Orsi stated “We can change the brightness, we can change the contrast, we can invert the contrast, we can magnify it, and we can demagnify.”

The down side to digital mammograms is they cannot detect cancer much better than the older analog type could. However, Dr. D’Orsi stated: “It is better than film in really one particular area, and that’s the woman with dense breast…By dense breasts, we mean a woman who has a fair amount of glandular tissue, breast tissue, related to fatty tissue that’s always present in breast.” He went on to state, “Studies have shown that digital mammography does detect the findings better [in the above] scenario.”1

No matter whether you will be getting a digital mammogram or an analog mammogram, Saether remarked, the best advice to follow is that of your doctor’s “Just do it.”1

Pam Keel, an eight-year veteran mammographer, said: “There are a few things women can do to make this picture-taking session more productive. First…lay off the caffeine for a week prior to your mammogram…caffeine can wreak havoc on breasts—dense or not.” In addition, Keel advises women who are highly pain sensitive to “take something such as over-the-counter pain reliever [prior to the mammogram].”1

Although mammograms are not the most comfortable thing women must go through, they are an invaluable asset we have for early detection of breast cancer.

[1] Saether L. Do digital mammograms make a difference” July 2008. Available at: http://www.cnn.com/2008/HEALTH/07/24/hfh.digital.mammograms/index.html. Accessed on August 5, 2008.

Surgical Side Effects Decrease with Robotics

By: Jenny Walters

A recent article on Cnn.com entitled “Surgical side effects cut with robotics,” by Danielle Delloroto discussed the growing trend of robotic surgery.[1] Over the past four years, robotic surgery used to treat prostate cancer has increased from 10,000 in 2004 to 70,000 in 2008.

The advantages to using robots during surgery include fewer side effects and quicker recovery times. Such advantages have lead to the increased use of robotics for other surgeries, including hysterectomy, kidney cancer, and some heart procedures.1

According to Dr. Nikhil Shah, one benefit of robotic surgery is precision that far exceeds the human hand. Dr. Shah went on to state in prostatectomy: “the robot controlled scalpel works delicately around the nerves and blood vessels in the pelvic area, vastly reducing the risk of damage that can lead to incontinence or impotence.”1

Another clear advantage of robotic surgery in a prostatectomy is reduced blood loss. In a traditional prostatectomy, a 4 ½ inch incision is required. In robotic surgery patients have six dime-sized incisions in the abdomen and are often in the hospital for less than 24 hours.1

Dr. Shah stated, “Not everyone qualifies for robotic surgery…patients with excess abdominal fat and those with cancer that is not localized would not be the ideal candidate.” In addition, it is important to note, the surgery can cost up to $15,000 and is not always covered by insurance.1

Although robotic surgery is increasing in use, the American Urological Association (AUA) has not yet described the procedure as “the new gold standard of care.” According to AUA spokesperson Dr. J. Brantley Thrasher, chairman of urology at University of Kansas Medical Center: “The outcomes of robotics operations have been excellent…But to say we’ve seen a quantum leap in regards of one treatment being better than the other is premature.”1

Thrasher did acknowledge that robotics prostate surgery is the fastest growing surgical procedure. She also went on to state, robotic surgery is being driven by the consumer, “with patients requesting is like never before.”1

Overall, this article described what will be an increasing trend in all areas of surgery, not just for prostate cancer. My father recently underwent a prostatectomy. Unfortunately, he did not qualify for the robotic surgery because the cancer was not localized. Therefore, he had a lengthy recovery and had to miss 6 weeks of work.

It is important to remember what Dr. Shah said, robotic surgery is not for every patient. Although robotics surgery may sound quick and easy, there are risks and benefits involved in all types of surgery.

[1] Dellorto D. Surgical side effects cut with robotics. August 2008. Available at: http://www.cnn.com/2008/HEALTH/conditions/08/05/robotic.prostate.surgery/index.html. Accessed on August 5, 2008.

Cheaters Never Win

by Leane Scoz

The 2008 Summer Olympics is set to begin this Friday in Beijing, PRC. For the next two weeks, the world's greatest athletes will descend upon this ancient metropolis to showcase their talents. Well...the world's greatest athletes less the 37 disqualified for positive drug tests since April.

An article in USA Today reports that the anti-doping crackdown is expected to continue in the upcoming days as random tests are conducted at the athletes' village.

The only question that comes to mind is why?

Why do athletes use performance-enhancing drugs when they know the probability of getting caught is high?

Why does the number of athletes using performance-enhancing drugs continue to rise even when the consequences are known?

Why aren't athletes learning from past doping mistakes of fellow athletes?

If someone is a good enough athlete to qualify for the Olympics, why does he/she feel the need to use performance-enhancing drugs in the first place?

Why aren't doping athletes thinking about their status as a role model and what their status will become when they test positive?

Why wouldn't an athlete want to lose/win fairly than be branded a cheater for the rest of his/her life?

The Olympic games give the entire world a chance to come together for a brief moment in time for peace instead of war. They allow people the opportunity to cheer on and be proud of their countries and the great talent representing them. Why would anyone want to tarnish this event and shame themselves and their country by utilizing performance-enhancing drugs?

We’ll take only one baby please…

by Leane Scoz

In-vitro fertilization (IVF) is a procedure used to treat infertility when other methods of assisted reproductive technology have failed. A major risk of IVF is multiple births because a common practice of treatment is multiple embryo transfer to boost the pregnancy rate. Since IVF is sometimes a last resort for a woman to get pregnant, many couples welcome the idea of multiple births since they were having trouble having one baby, let alone several. However, others are not so keen on the idea.

Recently, a lesbian couple in Australia attempted to sue their obstetrician for failing to ensure that a single embryo was implanted in the birth mother. The couple, now the parents of 4-year-old twin daughters, were seeking medical negligence in the amount of $382,000. According to an article in USA Today, the claim was to cover the cost of raising one of the children, including private school fees.

The judge overseeing the case ruled against the couple, citing that the birth mother had actually acted negligently by failing to ensure the IVF clinic staff were aware that she no longer wanted to have multiple embryos implanted. The couple are considering an appeal but the case leaves many, including the state president of the Australian Medical Association, wondering why such a suit was ever brought before a court in the first place.

Yes, multiple births are accompanied with increased risk of pregnancy loss, complications, prematurity, neonatal morbidity, and the potential for long term damage. However, when IVF results in the birth of healthy babies, why mess with it? IVF is an investment that people can spend years thinking about before deciding on treatment. It is not cheap and most expenses are paid out of pocket by the couple. If a couple has devoted that much time and personal resources for IVF treatment, shouldn't they have enough sense to set aside adequate resources for the end result? Or in this case...results?

Your Very Own Personal Genome Project -- At What Cost?

By Randy Hendrickson

There’s an interesting article in Wired magazine (“How the Personal Genome Project Could Unlock the Mysteries of Life” by Thomas Goetz). The Personal Genome Project (PGP), a successor to the Human Genome Project, was launched by George Church, an expert in synthetic biology from Harvard Medical School. The first phase of the study began with 10 volunteers, but a second phase using 100,000 participants is scheduled to begin later in 2008. It is an attempt to map the genetic sequences in the DNA and determine how they are connected to genetic-based diseases such as cancer, heart disease, and diabetes. According to Church, “the PGP will bring personal genomics to fruition and our genomes will unfold before us like road maps: We will peruse our DNA like we plan a trip, scanning it for possible detours (a predisposition for disease) or historical markers (a compelling ancestry).”
Just this past spring, Church perfected the technology that could analyze millions of sequences at once. The Polonator G.007 not only accelerated the process, but it also reduced the costs involved. The goal is to sequence a human genome for as low as $1000 and make this technology a part of standard medical care.
One of the important ethical issues surrounding this project is how to obtain informed consent from the study participants. At the request of the Institutional Review Board at Harvard Medical School, the initial 10 volunteers were to be educated stakeholders in the field of personal genomics, because they would understand the ramifications of the study and would be able to give highly informed consent that the general public would not be able to give.
The next phase of the study, which will include 100,000 participants, is more complicated. To ensure that all the participants understand what is involved, an online educational system is being set-up, and participants will be tested to see how well they understand the intricacies of the study. The testing will also determine how much information is released to them.
In addition to informed consent, other important social, legal, and ethical questions still remain, namely, how privacy and fairness is ensured in the use of personal genetic information by employers, schools, insurance companies, the government, and people making clinical and reproductive decisions? If this information is misused, it is possible that a genetic underclass could be created.
Additional issues that must be considered include:
· balancing the need for personal privacy against the need for openness for scientific research;
· the potential impact of personal genomics on medicine, insurance, and employment;
· potential risks of misinterpretation and explicit misuse of personal genomic information; and
· legal and policy issues concerning ownership of this information.
According to Church, one of the goals of the PGP is to determine whether it is possible to protect personal genetic information. “Successfully protecting privacy will reassure the public, but if patients find the information is used against them, people may reject this technology.”

Compassionate Use

Compassionate Use

By Michael Leshinski

A recent news report and subsequent blog posting have sparked my interest in compassionate use waivers. I wanted to know more about the process. What exactly is compassionate use? I’ve provided some links below to help us better understand it.

http://www.research.ucsf.edu/chr/Guide/chrEmerUSE.asp

-This website from the University of California, San Francisco, will give you a detailed explanation of compassionate use as well as discuss some associated ethical issues.

http://www.pfizer.com/research/science_policy/compassionate_use_policy.jsp

-Take a look at this website to learn where some pharmaceutical giants stand on the issue of compassionate use waivers.

http://www.cancerworld.org/CancerWorld/getStaticModFile.aspx?id=1955

-Follow the link above to an article exposing many true life stories related to cancer and compassionate use. The article also discusses how the subject is treated in some European countries.

http://clinicaltrials.gov/ct2/show/NCT00718393

-From a clinical trials watch site, provided by the National Institutes of Health, the site tells about a clinical trial being conducted with patients on compassionate use basis.

http://www.nytimes.com/2008/07/17/business/17dystrophy.html?_r=1&scp=1&sq=compassionate%20use%20waiver&st=cse&oref=slogin

-The link above discusses a legal suit involving a drug company and a family of a sick boy who is being denied treatment for his illness.

Psychiatric Drugs: Not Just for Humans Any More

By Randy Hendrickson

Do animals have thoughts and feelings that are similar to our own? Do they experience anxiety, depression, or cognitive dysfunction? According to the New York Times ( “Pill-Popping Pets” July 13, 2008), pharmaceutical companies are now formulating human drugs for use in companion dogs and cats. These include behavior modification and lifestyle drugs to treat conditions such as cognitive dysfunction, separation anxiety, depression, mood and behavior disorders, and even obesity. One such drug, Clomicalm® (Novartis), is chemically identical to clomipramine (Anafranil®), the tricyclic antidepressant for humans, however, it was packaged with a picture of a happy, smiling yellow lab on the box. It is approved by the FDA for separation anxiety, but also prescribed off-label for canine compulsive disorders. Another drug, Anipryl® (Pfizer) is used to treat cognitive dysfunction and help the animal with memory loss. Similarly, Reconcile® (Eli Lilly), which is used for separation anxiety, is the same chemical compound as Prozac®, except it is beef flavored and chewable. Currently, most of the major pharmaceutical manufacturers have a companion animal division. It is a very lucrative income stream considering that $15 million was spent on behavior modification drugs in the United States in 2005 alone.

According to Melanie Berson from the FDA Center for Veterinary Medicine, “as people are seeing more complex and sophisticated drugs for themselves, they want the same quality for their pets.” There is a growing desire to use behavior-modifying medications in order to have more obedient pets and to control their dogs so they don’t act like dogs. “Owners want their pets to be more like little well-behaved children.”

But this issue is more complicated than merely wanting well-behaved, socially adjusted pets. Behavioral pharmacology advocates maintain that the combination of new drug therapies along with progressive training techniques can solve behavioral problems that in the past usually resulted in euthanasia. Aggression in dogs, for example, is a serious problem. It is the primary reason dogs are brought to clinics, taken to shelters, and often even euthanized. Treatment with psychoactive medications is a good alternative to putting down these animals. Dr. Nicholas Dodman from the Tufts University Animal Behavior Clinic explains, “Prozac, a selective-serotonin reuptake inhibitor (SSRI), prolongs the effects of that neurotransmitter to reduce impulsivity, stabilize moods and lower anxiety.”

Separation anxiety is also a troublesome problem for many dogs. At least 14% of all American dogs have separation anxiety, and it often results in destruction of the home, whining, frantic barking, inappropriate chewing, or sometimes even injury to itself. Dodman claims that although separation anxiety is believed to have genetic origins, the unnatural lives that people lead and subject their animals to trigger these problems. “A dog that lived on a farm and ran around chasing rabbits all day would be more prone to being stable than a dog living in an apartment in Manhattan.”

But is pharmacological treatment more for the health and well-being of the dog or for the convenience of owners? “A lot of ‘behavior problems’ are actually normal behaviors for the animal. Food guarding and aggression toward strangers boost a dog’s survival rate in the wild but don’t cut it in the living room.” Not everyone, however, believes that drugs are the solution to companion animal behavior problems. According to animal behaviorist Dr. Ian Dunbar, although pharmacologic aids may be helpful in some very extreme situations, most cases behavior modification alone is enough. “The rush to the medicine bottle for easily resolved problems . . . shows a disturbing parallel to the human approach to health care. We lead an unhealthy lifestyle and then rely on drugs to correct it.”

The use of psychiatric medicines in treating mood and behavior issues, however, is prompting new questions concerning what exactly separates mankind from animals. What does animal behavioral pharmacology teach us about not only animal minds, but also our own? Is it a coincidence that animal mental illnesses are mirroring those of humans? The causes of behavioral problems and mood disorders are similar for both pets and people—genetics and environment. “Whether cubicle- or cage-bound, we get too little exercise; we don’t hunt, run or play enough to produce naturally mood-elevating neurochemicals. . . . All of the behavioral issues that we have created in ourselves, we are now creating in our pets because they live in the same unhealthy environments that we do. That’s why there is a market for these drugs.”

Little Miss Sunshine Meet Little Miss Melanoma

by Leane Scoz

Awwww, summertime! Whether at the beach, the pool, the park, or backyard, you are bound to come in contact with Earth's big, round, yellow friend in the sky...the sun. But, the way the encounter is handled varies greatly from person to person.

Some people welcome the warm rays from the sun and choose to apply little or no sunscreen at all. Others are deathly afraid of the consequences of the powerful rays and head to the store for a floppy hat and SPF 60. Many others choose to have their cake and eat it too by applying a mid-range SPF in hopes of tanning instead of burning. However, new research should make everyone want to run toward the nearest shade.

According to a recent article in the Washington Post, government cancer statistics revealed the rate of new melanoma cases among younger women jumped 50 percent since 1980. The American Cancer Society reports about 62,000 melanoma cases are diagnosed each year in the United States, with more than 8,400 people dying from the disease. What has caused such a large increase?

National Cancer Institute researchers who led the analysis believe a number of risk factors have contributed to the rise in cases. Stronger rays from the sun are a direct result from the thinning ozone layer and increase in greenhouse gas emissions. People are spending a lot more time outdoors and are not protecting themselves against ultraviolet radiation. Young women are frequently engaging in indoor tanning (tanning bed) use in larger numbers. Researchers also noted that increased awareness, public education campaigns, and better diagnosis may have also played a role in the larger number of reported cases.

So, what's a pale-skinned gal to do? First, remember that ultraviolet radiation is dangerous and a carcinogen. Limit the amount of time spent in the sun. Always use sunscreen (SPF 15 or greater). Get your skin checked at least once a year. And, lastly feel good knowing that you will look much younger and wrinkle-free in your golden years than your sunbathing beauty counterparts who will have acquired leathery skin that matches their handbags and more wrinkles than a Shar-pei puppy.

Survey Results

Question #1: Is it OK to step on an ant?

3 answered yes
1 answered no
1 answered sometimes

Question #2: Is it OK to swat a fly?

3 answered yes
2 answered sometimes

Question #3: Is it OK to put down a dog?

1 answered yes
4 answered sometimes

Question #4: Is it OK to put down a human?

1 answered yes
1 answered no
3 answered sometimes

Question #5: Is it OK to abort the fetus before the third trimester?

1 answered yes
2 answered no
1 answered sometimes
1 answered undecided


This survey was anonymous, thanks for participating!

All Those Bugs at the Gym, Oh My!

By: Jenny Walters

A recent article on Cnn.com entitled Germ warfare moves to the gym by Linda Saether dealt with the ever increases germs that are present at gyms around the U.S.

According to Dr. Brian Adams, director of University of Cincinnati Sports Dermatology Clinic, “Gyms are great for fitness, but like fun in the sun, you just have to be careful.”[1]

The main microorganisms present at gyms include bacteria, fungi, and viruses. Germs are able to travel to and from many gym –goers’ due to the number of people who share equipment, exercise mats, lockers, and showers. In addition, the activities that gym-goers’ take part in also put them at risk.

Dr. Adams stated: “The first several layers of skin are like a castle wall protecting the athlete from outside marauders. Abrasions from mats and weigh equipment, blisters from constant rubbing while running or using weight equipment both help to break down the castle wall and allow microorganisms to enter the skin.”

Sweating is also another way that germs can enter the body at a gym. According to Dr. Adams: “Sweating super-hydrates the skin and makes the athletes more likely to develop blisters. Sweating by itself may alter the castle and allow penetration of the bugs.”

Bugs that can cause problems include fungi, which can cause athlete’s foot, to viruses that can cause herpes or potentially deadly infections known as MRSA, or methicillin-resistant staphylococcus aureus.

A first line of defense for the gym-goer is disinfectant. Before an individual uses any piece of equipment, he/she needs to wipe down the equipment with disinfectant wipes. The disinfectant wipes will kill any germs that were present on the gym equipment.

One gym-goer has her germ-fighting weapons all contained in her “ultrabreathable, pink, Nike backpack.” Her backpack contains a clean water bottle, plastic bags, workout gear, a clean towel, flip-flops for the shower, a fresh bag of wipes and “everyone’s weapon of choice, the don’t-leave-home-without-it pocket hand sanitizer.”

Due to news of MRSA spreading in gyms, germ fighting has been taken “up a notch.” Gyms today are offering hand sanitizers located throughout the gym and many other germ fighting products.

This article brings light to the age of being vigilant about germs. For me, a nurse a mother, I have the word vigilant about germs embedded into my brain. My husband thinks I go a little overboard, but I would rather be safe than worry about the germs my daughter has been exposed to throughout the day. However, as my pediatrician says, germs are everywhere and it’s good to be exposed to some now and than.

[1] Saether L. Germ warfare moves to the gym. July 2008. Available at: http://www.cnn.com/2008/HEALTH/07/10/hfh.fighting.germs/index.html. Accessed on July 18, 2008.