Who Gets Born?

The Bioethics Council of New Zealand has given its government a lot to think about.

The council issued a report in mid-June recommending that parents be given the right to choose the sex of their babies in pre-implantation genetic diagnosis (PGD). New legislation would replace a 2004 law that bans gender selection except as part of treatment for rare genetic diseases.

The report, appropriately titled “Who Gets Born?,” issues a series of recommendations to the government on pre-birth testing and the challenging developments in PGD. With the hope of producing “better, longer-lasting, and wiser policy decisions,” the council used public deliberation to frame ethical issues before making its recommendations.

In its summary, the council concluded that there are “insufficient cultural, ethical, and spiritual reasons to prohibit the use of PGD for sex selection for social reasons such as family balancing.”

Critics of the recommendation include the New Zealand Catholic Bioethics Centre, which issued an immediate response to the council’s report. Taking the position of all embryos being created equal, the Catholic Bioethics Centre asks: “What stops parents from using the technology for nothing more than parental desires? [We believe] in welcoming the children we are given rather than ordering them according to specifications.”

The gender selection debate might be a fresh topic in New Zealand, but it’s nothing new in the United States. In contrast to New Zealand, Australia, and the United Kingdom, there is no ban on sex selection in America. In fact, some foreign couples—those who can afford it, anyway—avoid national bans on sex selection by traveling to the U.S. for medical procedures.

As with other medical advancements, gender selection doesn’t float through the public consciousness without sparking a healthy dose of ethical debate. Is sex selection a dangerous path that leads to discrimination against “non-selected” individuals? Are parents using the technology to fulfill their own desires as opposed to respecting life? Or is sex selection an important individual right not to be regulated by government?

This summer, it’s up to the New Zealand government to decide.

Pharma and Philanthropy

By Randy Hendrickson

How do the major pharmaceutical companies compare in providing drugs, diagnostics, and vaccines to people in lower income countries? A new index (Access to Medicine Index) rates pharmaceutical companies in terms of how well they provide aid and outreach to poor, undeveloped countries with third world diseases such as AIDS, tuberculosis, or malaria. The 2008 Outcome Index ratings are based on data in 8 areas, including management, influence, R&D, patenting, capacity, pricing, donations, and philanthropy. The index examines issues such as:

How cheaply products are sold to third world countries;
Which drugs or vaccines are sent to which countries;
Whether generic versions of patented drugs are used;
How much is actually donated; and
What research is done in the areas of third world diseases.

The Access to Medicine Foundation, based in Haarlem, The Netherlands, “aims to advance access to health care (in the widest sense of the word) in developing countries and, in particular, to encourage the pharmaceutical industry to accept a bigger role regarding access to medicine in pre-industrialized countries.” Their motto is “Engaging Industry Through Transparency”.

The top 5 industry leaders that were identified by Access to Medicine Index are:

1. GlaxoSmithKline (UK)
2. Novo Nordisk (Denmark)
3. Merck & Co. (NJ, USA)
4. Novartis (Switzerland)
5. Sanofi-Aventis (France)

The pharmaceutical companies have been permitted to verify the data in the index, and the methodology and data analysis has been reviewed by an independent panel of experts.

For a complete listing and data breakdown, see The 2008 Index Outcomes at:
http://atmindex.org/index/2008.

There are Bugs in My Food

By: Jenny Walters

A recent report on National Public Radio (NPR) entitled “Getting the Goods on ‘Good Bacteria’” by Allison Aubrey and a recent article entitled “Eat Your Germs” by Sanjay Gupta, MD discussed the new trend of probiotics in yogurt.

“A probiotic is any substance containing live organisms that, when ingested, have a beneficial effect on the host by altering the body’s intestinal microflora.”[i] Probiotics are often referred to as the “good” bacteria and can be found in yogurt, kefirs, and in pill-form as dietary supplements. The “good” bacteria can include Lactobacillus reuteri, Lactobacillus rhamnosus, and Bifidus regularis.[ii]

The theory behind probiotics is, “certain strains of these living organisms – or good bacteria—can displace bad bacteria in the gut.”1 One trial dealing with the popular Activia yogurt split healthy volunteers into two groups: one ate Activia and the other ate an inactive form of Activia product with no love bacteria. At the end of the study, the volunteers who ate the Activia with live bacteria experienced a 21% decrease in colon transit time (meaning food passed more quickly out of their bodies).1

According to Dr. Gary Huffnagle: “In the digestive tract the bacteria help to regulate and restore peristalsis, the rhythmic motion of he intestine that pushes digested food through…Doesn’t matter if you are constipated or the opposite…these bacteria can help make you regular.”2

In addition to aiding in regularity, the “good” bacteria can also battle numerous forms of allergies, irritable bowel, and pediatric diarrhea.1,2 In a recent study, researchers gave Lactobacillus GG, sold under the brand name Culturelle or VSL-3, to pregnant women with a history of allergies and then to their infants. The study revealed babies who received Lactobacillus GG developed a significantly lower rate of allergic eczema than the control group that did not take the product.1 However, in other studies in children with well-managed Crohn’s disease, probiotics did not reduce gastrointestinal flare-ups.1

Currently, because probiotics are categorized as dietary supplements, the Food and Drug Administration (FDA) does not approve them.1 In addition, there are some people who should not take probiotics. According to Dr. Gupta, those with weakened immune systems and those who are critically ill should not ingest foods with live bacteria.2 Furthermore, probiotics can take some time to adjust to. If one suddenly began to ingest large amounts of probiotic products, there is a possibility of developing uncomfortable bloating.2

As Dr. Huffnagle reports: “You have just started a civil war in your intestines between good bacteria and bad bacteria….Fortunately the war is usually over in one to two weeks and the good guys win.”

Dr. Gupta suggests plain yogurt remains the best product for added bacteria because it has three things the bugs absolutely love: lactose, fat, and water. However, with more than $100 million in sales in Activia’s first year in the U.S. alone, the “good” bacteria idea seems to be paying off.2 Due to successful sales of Activia, other companies are beginning to market probiotic yogurt drinks, fortified beverages, and chocolate bars.

I am not yet sold on the idea of probiotics. Personally, I prefer to stick with plain old yogurt instead of the super infused bacteria yogurt.

[i] Aubrey A. Getting the good on ‘good bacteria.’ July 2006. Available at: http://www.npr.org/templates/story/story.php?storyId=5569230. Accessed on Jun 28, 2008.
[ii] Gupta S, M.D. Eat your germs. May 2008. Available at: http://www.time.com/time/specials/2007/article/0,28804,1703763_1703764_1725938,00.html. Accessed on June 28, 2008.

The lives of children in unstable nations

By: Jenny Walters

A recent article posted on CNN.com entitled Kids’ lives are nightmares in unstable nations, UNICEF reports, focused on the emerging number of child related crimes taking place in unstable nations, such as Haiti.

According to a recent United Nation’s Children’s Fund report: “More than 50 children have been abducted in Haiti since the beginning of the year, adding to a trend of kidnappings in countries affected by violence.”[1]

Children in countries, such as Central African Republic, Democratic Republic of Congo, and Iraq, which are affected by war, food shortages and poverty, have become targets for armed groups who see them as commodities. In Haiti, UNICEF and local officials report that kidnapped children are being rapped, tortured and murdered. Currently, the United Nations Stabilization Mission in Haiti is working with the national police force to try to put a stop to such crimes.

In the Dominican Republic as many as 2,000 children a year are trafficked, often with the parents’ support.1 Another 1,000 children are working as spies, messengers or soldiers for armed gangs in the Haitian capital of Port-au-Prince.

In Iraq, children have been recruited by militia and insurgent groups. “Girls are increasingly subject to murder, kidnapping and rape, or are being abducted and trafficked within or outside Iraq for sexual exploitation.”1

In the Central African Republic, armed gangs terrorize farms and communities, kidnapping children and holding them ransom.1 Souleimane Garga, in Paoua, told UNICEF, “Bandits broke into his home nearly two years ago and kidnapped his wife, newborn, baby, and two other children, after killing older family members including an uncle and a grandfather.” For two-years, two of his children were held in bush camps, as he was “financially broken” after paying to free his wife and newborn and could not pay the ransom for his other two children. Souleimane’s children are home now, but wake with nightmares and cries remembering what they endured in the bush camps.1

Earlier this month, following the murder of a 16-year-old hostage and the rapping and lynching of other hostages, including infants, a demonstration was held in Haiti’s capital. UNICEF’s Haiti representative stated: “There is no acceptable motive or rationale for these crimes, as there is no acceptable excuse that they should be allowed to continue with flagrant impunity.”1

In July 2006, UNICEF’s report on child soldiers in the nation, reported “as many as 30,000 children may be associated with armed forces or groups as fighters.”1 Of those children, “30 to 40 percent of children associated with armed forces are girls.”

After reading this report, I was almost in tears. The thought that children and families are put through such unimaginable acts, is both disturbing and unsettling. Yet, this type of cruelty takes place in all parts of the world on a daily basis. I look in my daughter’s eyes everyday and could not imagine my world without her.

[1] CNN.com. Kids’ lives are nightmares in unstable nations, UNICEF reports. Available at: http://edition.cnn.com/2008/WORLD/africa/06/21/unicef/index.html. Accessed on June 21, 2008.

Limb from Limb

Limb from Limb

By Michael Leshinski

A woman walks into a doctor’s office for the fourth time this month and tries to relax in the waiting room. She is early for the appointment and has plenty of time to wonder what her prognosis will be. Battling courageously against severe symptoms of insulin dependent diabetes (Type I), she even feels optimistic about what the doctor will say. However, no one has told her that the decisions to come would depend on her skin color and place of residence. According to the NY Times, a recent study comparing medical care to the patient’s race and place of residence has revealed some surprising results. If our patient happens to be African-American, then she is five times more likely to have a limb amputated than her Caucasian counterpart. Not only are African-Americans more likely to lose a limb, but they are also less likely to undergo the routine testing associated with diabetes. Does it mean that amputation is a better health option for different races of people? No. Or does this mean that the doctors taking care of black diabetes patients are racist? I don’t think so. The combination of the patient’s geography and skin color proved to have unequal care standards in different states throughout the country.

For example, rural areas of the United States like Nebraska and South Dakota have seen extremely high levels of patients relying on Medicare, which can possibly act as reason for sub-par patient treatment. In this instance, the substandard treatment given to our impoverished manifests itself as preventable and even unnecessary limb removal. Southern states, including Louisiana and Mississippi, have much higher rates of amputation than wealthier states such as Colorado. So our woman diabetes patient waiting in the doctor’s office better hope that she has good medical coverage, or she may be leaving there minus an appendage. Not only that, she should probably hope that she’s white and lives in a wealthier area. According to the Times’ article, national grants have been allocated in order to improve the level of care in the substandard areas of this country. Will it work? Let’s hope so.

1. http://www.nytimes.com/2008/06/05/health/research/05disparities.html?_r=1&adxnnl=1&oref=slogin&adxnnlx=1214587353-HiZLHIIwmewjdHWxb9Jhrg

2. http://www.census.gov/hhes/www/income/income06/statemhi2.html

No More Monkey Business

By Randy Hendrickson

Do the advancement of science and the possibility of finding new therapeutic options for disease justify “offending the dignity” of animals?

According to Nature (June 12, 2008; 453(7197):833), the local administrative court in Zurich, Switzerland recently banned several research experiments on macaque monkeys that were being conducted jointly by the University of Zurich and the Federal Institute of Technology Zurich (ETHZ). Macaques are the most widespread genus of primates and are found in northern Africa as well as parts of Asia. The brains of these monkeys are closely related to those of humans in structure, and they make an excellent research model for studying neurological function and dysfunction.

The aim of the experiments was to study how the cortex of the brain adapts to change. One experiment involved depriving the monkeys of water (or any other drinks) for long periods of time so that they would value the reward of apple juice more when they performed a task correctly. Another experiment required that the monkeys be sacrificed after the experiment in order to examine the microcircuitry of the cortex of the brain. These experiments were previously approved by the Swiss National Science Foundation; however, an external animal experimentation advisory board challenged the right to continue the research on the grounds that it would “offend the dignity” of the monkeys.

Swiss law mandates that the benefits to society must outweigh the burden to the animals. In addition, a new court interpretation of the law demands that there must be immediate benefits gained from the research. According to the court ruling, “society is unlikely to see the benefits of the research during the 3-year funding period approved, and thus the burden on the animals is not justified.”

Conversely, according to PETA, the British government automatically rubber stamps most animal research, even when the benefits are vague or intangible. The main difference between the Brits and the Swiss is that the Swiss require that the benefits be immediate, whereas the Brits only have to show that there may possibly be benefits further down the road. Unfortunately, this has led to more than 3 million animal experiments in Britain annually despite obvious scientific failings.

The Swiss researchers feel that the use of the “immediate benefit” requirement is completely unrealistic and will impede progress in preventing and treating neurologic conditions such as Parkinson’s and Alzheimer’s diseases. Both the University of Zurich and the Federal Institute of Technology Zurich are planning appeal the lower court’s decision in hopes that they can continue their research.

Daycare: The Strong Will Survive

By Leane Scoz

A recent article in Newsweek suggests that children who attend daycare are healthier than kids who do not by the time they enter kindergarten.

According to columnist, Claudia Kalb, more than 7 million children are enrolled in daycare. Everyone who has ever had a child in daycare knows that they and their child will probably contract a wide variety of illnesses within the first year of their child's attendance. The illnesses run the gamut, from the common cold and earaches to more sever infections such as RSV and the flu. With all of the pain and suffering parents and children have to endure, does the light really shine at the end of the tunnel after daycare?

Researchers at the University of California, Berkeley, say yes. An analysis of their studies revealed that daycare children have a 30 percent lower risk of developing childhood leukemia due to the increased exposure to infections. University of Arizona scientists carried out research over the last 10 years and found that although kids in daycare get twice as sick as their non-daycare counterparts, they have a third fewer illnesses by the time they enter elementary school. The research also showed that daycare children are less likely to develop asthma.

However, parents of children who do not attend daycare should not be discouraged. By the time children are teenagers, researchers report that no difference exists in either group of children because their immune systems catch up with each other.

The bottom line--allow the circle of illness to continue and do not worry too much about children in daycare. Everyone equals out in the long run.

On a lighter note...

On a lighter note…

By Michael Leshinski

Not kidding, the seemingly progressive Japanese government has begun the early stages of weight control for its population. The New York Times recently reported that a law requiring all individuals age 40 through 74 must have their waistlines measured during an annual doctor visit. Government officials hope that the recently instituted laws will help accomplish their goal of reducing the number of overweight citizens. Japan is also hoping to reduce the risk of weight related diseases such as diabetes and stroke. To enforce the law, the government has placed strict rules on many companies that provide health insurance to its workers. Employees of a company falling into the age bracket must all have their waistlines measured. The cutoff is 33.5 inches for men and 35.4 inches for women. If you fall above the respective cutoff lines, then it is your employer’s job to make you lose the weight. If they are unsuccessful, the government will impose strict fines that will presumably lead back to the employee and his/her imminent firing. Other citizens, such as retirees, are actually sent a summons letter by the local government to attend special checkups. Even the local government will be held accountable by the national government if they are unable to control the weight of their citizens.

I wonder if the famous Sumo wrestlers are subject to waistline measurement. If so, I wouldn’t want to be the guy who had to enforce those rules. Those with a waist size being greater than the national law will be recommended to undergo weight education in order to drop a few pounds. Violators have 3 months to lose weight or be forced to receive dieting guidance, and then even more education will be imposed after another failed “weigh-in”. The national average for American man’s waistline is 39 inches, almost 6 full inches above the new Japanese standard. I seriously doubt that these standards would fly in the USA. Isn’t it the right of citizens of a free nation to be as fat as they want? It may not be the best good idea, but who are they to choose? FYI the new word for fat in Japan is “metabo”, short for metabolic syndrome. Experts in Japan have coined this condition, characterizing it with similar symptoms as diabetes, including obesity and high levels of blood-sugar. One question remains for the Japanese citizens. Are we really being look after by our government, or have these laws been put in place for political reasons?

1. http://www.nytimes.com/2008/06/13/world/asia/13fat.html?_r=2&pagewanted=1&oref=slogin
2. win.niddk.nih.gov/publications/PDFs/hlthrisks1104.pdf - 04-15-2008

"These Are Early Days"

Stem cells, bioethics, and…vacations to Thailand?

Those were some of the hot topics last week at the Pennsylvania Convention Center, where the International Society for Stem Cell Research held its sixth annual meeting. The ISSCR kicked off the week with a public workshop and symposium highlighted by some of the world’s leading stem cell experts.

The workshop provided an overview of stem cell biology, which was particularly useful to me because I don’t have a background in science (there were many moments, however, when the discussion passed over my head at a much higher altitude).

Dr. Jonathan Epstein, co-director of the Institute for Regenerative Medicine at the University of Pennsylvania, provided a fascinating look at the potential of stem cells to help regenerate heart tissue. Our bodies can regenerate some organs, such as the liver—so why not hearts? Epstein presented a video showing functional heart tissue generated with stem cell technology. The new cells could be seen beating under the microscope, then continuing to beat in unison as they developed into a larger piece of tissue.

Below is a clip showing beating heart cells derived from human embryonic stem cells similar to the one Epstein presented:



For me, Epstein’s presentation magnified the potential of stem cell research. It was only one example of the latest research happening in the labs of researchers around the world. As Epstein was quick to point out, “these are early days.”

Some researchers can’t wait to tap into the potential. As a result, stem cell tourism has popped up in Thailand, China, India, and elsewhere around the globe. The ISSCR unveiled a set of guidelines to halt what its president, Dr. George Daley, calls “the snake oil we’ve seen in medical fraud for centuries.”

But what lies ahead? Dr. Jonathan Moreno, medical ethicist at the University of Pennsylvania, discussed the ethical issues surrounding stem cell research. The moral and metaphysical debate about the status of the human embryo has permeated the political arena over the last decade, and it is likely to continue with the election of a new American president in November. Moreno noted that both Barack Obama and John McCain support stem cell research but have yet to articulate the details and conditions of their policies.

Having made 140 trips to Capitol Hill to educate elected officials about stem cell research, Dr. John Gearhart often finds himself in the center of the political storm. Gearhart remembers his first trip to Congress vividly: “the first person I met asked what it felt like to kill the smallest Americans.” Amy Comstock Rick, president of the Coalition for the Advancement of Medical Research, is also no stranger to members of Congress. CAMR wants to reverse President Bush’s policy on stem cell research, and “will not stop until we get new legislation,” according to Rick.

Whether new legislation is imminent or not, the stem cell debate will no doubt remain heated at the nexus of politics and science.

Pro-Life Drugstores: A Trend for the Future?

By Randy Hendrickson

According to the Washington Post (“Pro-Life Drugstores Market Beliefs” June 16, 2008), no methods of birth control will be sold in DMC Pharmacy, based in Chantilly, Virginia. This faith-based pharmacy will open in August, however, no birth control pills, morning after pills, condoms, or any other forms of contraception will be available, even with a prescription. This may be the beginning of a new trend in pharmacies that are refusing to sell products that the health care providers (pharmacists in this case) find morally objectionable. “[S]uch methods can cause what amounts to an abortion, and contraceptives promote promiscuity, divorce, the spread of sexually transmitted diseases and other societal woes…. This allows a pharmacist who does not wish to be involved in stopping a human life in any way to practice in a way that feels comfortable.” Some pro-life pharmacies do not sell contraception products only, whereas others also refuse to sell tobacco, pornography, rolling papers, or other commodities that are deemed morally questionable. The patient has the option of going elsewhere to another pharmacy if she does not share this philosophy.

In traditional pharmacy practice, the legal and moral obligations have always involved ensuring that the proper medication ordered by the prescriber is properly delivered to the patient. Physicians, not pharmacists, hold the ultimate responsibility in making sure that the final treatment outcome is achieved. However, according to the American Association of Colleges of Pharmacy’s Commission to Implement Change in Pharmaceutical Care, the definition of ‘pharmaceutical care’ now focuses on “the pharmacists’ attitudes, behaviors, commitments, concerns, ethics, functions, knowledge, responsibilities, and skills on the provision of drug therapy with the goal of achieving definite outcomes towards the improvement of the quality of life for the patient.” How does provision of contraceptive products fit into this view of pharmaceutical care?

Bioethicists have mixed feelings about this issue. Some hold that the needs of the patients should come before the beliefs of the health care professional.

• Nancy Berlinger of the Hastings Center for Bioethics Research, claims that “if you are a health care professional, you are bound by professional obligations,” and you can’t refuse to do what is required by the profession.


• R. Alto Charo, a University of Wisconsin bioethicist, also fears that pro-life pharmacies may proliferate in the future, especially in rural areas, “creating a separate universe of pharmacies that puts women at a disadvantage.”

Others have differing views:

• Loren E. Lomasky, a bioethicist at University of Virginia, states that finding a niche market based on ethical beliefs and “product differentiation expressive of differing values is a very good thing for a free, pluralistic society."


• Similarly, Pharmacists for Life International, which is dedicated to the pro-life philosophy, supports the pharmacist’s right to refuse to fill prescriptions for birth control products.
  

Several other issues are also at stake. Many pro-life pharmacies do not have signs indicating that they will not dispense contraceptives. As a result, women who need the morning after pill may be wasting valuable time finding a pharmacy that will fill her prescription. This would also be a major concern for rape victims. There have also been reports of pharmacists who not only refuse to fill the prescription, but also refuse to return the prescription to the patient so that she could have it filled at another pharmacy. This, however, is extreme, but it has been reported.

A few states, including New Jersey, California, Illinois, and Washington, have laws that require pharmacies to fill all prescriptions for contraception products OR help women find other means to fill their prescriptions, such as recommending other available pharmacies. The state of Virginia, however, has no such restrictions and no intentions to adopt any such prohibitions.

Because of the societal issues that are constantly evolving, the ethics of pharmacy (and medicine in general) has changed tremendously over the past few years, and these changes make the need for an ethical framework more vital today than it has been in the past. Health care providers need to be cognizant of both the expanding ethical responsibilities as practitioners, but also the traditional moral obligations to patients. Hopefully a balance can be achieved that will benefit all involved.

Heaven on Earth for Researchers

by Leane Scoz

Most people have heard of the largest charity in the United States, the Bill and Melinda Gates Foundation, but few are probably familiar with the second largest, the Howard Hughes Medical Institute (HHMI). A recent news segment on the CBS show, 60 Minutes, profiled the charity. Located in Chevy Chase, Maryland, the non-profit medical research institute invests about $450 million per year in biomedical research.

Howard Hughes is remembered as an aviator, engineer, film producer/director, playboy, and bazaar billionaire who suffered from obsessive-compulsive disorder. However, few think of him as a founder of one of the nation's largest private medical research organization. The institute was founded in 1953 by Hughes for the purpose of basic medical research "to probe the genesis of life itself."

Initially, the institute was thought to be the refuge for Hughes' fortune since non-profit organizations are tax exempt. However, after Hughes' death in 1976 and several years of court proceedings to determine the fate of his fortune, the institute experienced incredible growth. Today, it employs more than 2,600 people throughout the country and has an endowment of $18.7 billion.

What makes this organization more appealing to medical researchers than government agencies, such as the NIH? According to the HHMI, the institute is guided by the principle of "people, not projects." It supports researchers who take risks, think about big problems, and explore things that they would not otherwise be able to do if they were federally funded. Researchers are not responsible for huge amounts of paperwork to defend their need for funding. Instead, they are encouraged to spend more time in the laboratory and follow their ideas through to fruition no matter how long it takes.

The institute spends about $1 million per year per investigator and currently funds over 300 investigators. Because the HHMI is a private institute, researchers are permitted to work on controversial topics such as stem cell research from human embryos, which federal grant holders are not permitted to do. Scientists can change the course of their study if they so choose, such as leading stem cell and diabetes researcher, Douglas A. Melton, Ph.D., who switched from frog development research to juvenile diabetes research after his two children were diagnosed with the disease.

At the time of conception, Hughes probably never imagined his organization to be funding research on society's biggest health concerns. Today, the HHMI supports research on subjects ranging from AIDS, diabetes, and cancer to climate effects on cholera and malaria. The research possibilities and funding seem endless.

“America’s Medicated Army:” The Future of our Soldiers and How they Cope with War?

By: Jenny Walters

In recent months, reports about rising suicide rates for our soldiers in Iraq and Afghanistan have been on the rise.

An article entitled, America’s Medicated Army, by Mark Thompson, focused on medicating our soldiers with antidepressants “to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan.”[1] According to the Army’s fifth Mental Health Advisory Team report, an anonymous survey of U.S. troops in fall 2007 revealed about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help cope with the stress of war. Unfortunately, due to the stigma surrounding antidepressant use and the need for mental help among soldiers, the above numbers are more than likely a vast underestimate of the actual number of medicated soldiers.1

The increase in the use of antidepressants and sleeping pills reflects the “heavy mental and psychological price being paid by soldiers fighting in Iraq and Afghanistan.”1 A recent Pentagon surveys suggests 70% of soldiers deployed to war zones manage to “bounce back to normalcy;” while 20% will suffer from “temporary stress injuries” and the remaining 10% are affected by “stress illnesses.” According to the Pentagon, stress injuries or illnesses begin with mild anxiety, irritability, difficulty sleeping, and growing feelings of apathy and pessimism. As the symptoms progress, they worsen to include panic, rage, uncontrolled shaking, and temporary paralysis. When the soldier returns home, escalating symptoms can further lead to broken marriages, suicides, and psychiatric breakdowns.1

In 2008, mental trauma has become so prevalent among soldiers in Afghanistan and Iraq, the Pentagon is now considering expanding the list of “qualifying wounds for a Purple Heart…to include posttraumatic stress disorders (PTSD).”1

The use of medications to cope with wartime stress has been debated for years among insiders in the service. According to a book entitle Combat Stress Injury: “No magic pill can erase the image of a best friend’s shattered body or assuage the guilt from having traded duty with him that day. Medication can, however, alleviate some debilitating and nearly intolerable symptoms of combat and operational stress injuries and help restore personnel to full functioning capacity.”1 Ultimately, medications keep the soldiers fighting and deployed, and save the Army money on training and deploying replacements.1

One military doctor remarked: “Boy it’s nice to have these drugs…so we can keep people deployed.” Whereas, professionals such as Dr. Frank Ochberg, a veteran psychiatrist and founding board member of the International Society for Traumatic Stress studies, doubts the use of medications stating: “Are we trying to bandage up what is essentially an insufficient fighting force?”1

As side effects of antidepressants become more prevalent, the Food and Drug Association (FDA) pushed for a “black box” warning stating “the drugs may increase the risk of suicide in children, adolescents…and went on to include young adults ages 18 to 24,” the average age of the military force fighting the war in Afghanistan and Iraq.1

As of May 29, 2007, 115 soldiers killed themselves last year, including 36 in Iraq and Afghanistan.1 This was the highest military suicide rate since 1980. According to Thompson: “Nearly 40% of Army suicide victims in 2006 and 2007 took psychotropic drugs-overwhelmingly, selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft.” The army reported the primary reason for the above suicides to be due to “failed relationships.” However many civilian experts “sense a link between suicides and prescription drug use.”1

As medicating U.S soldiers becomes more and more prevalent; it is important to understand some of the facts about what the soldiers are faced with on a day to day basis. According to a recent mental-health survey conducted by the U.S. Army: “while nearly two-thirds of the soldiers surveyed in Iraq in 2006 knew someone who had been killed or wounded, fewer than 15% knew for certain that they had actually killed a member of the enemy in return.” This “imbalance” leads soldiers to experience “a haunting mismatch in combat life….and contributes to feelings of intense fear, helplessness, or horror.”1

According to military psychiatrist, because our soldiers are faced with horrors we could not imagine, thousands are being driven to take antidepressants just to cope with day to day life of wartime in Iraq and Afghanistan.1

Thompson stated: “If troops do not get sufficient time away from combat…antidepressants and sleeping aids will be used to stretch an already taut force even tighter. Lawrence Korb, Pentagon personnel chief during the Reagan Administration went on to state: “This is what happens when you try to fight a long war with an army that wasn’t designed for a long war.”1

Marc Thompson’s article on the medicating of today’s Army was compelling, riveting, and disturbing. Ultimately, the U.S. Army appears to be medicating our young soldiers just to keep them sane enough so they can fight another day in Iraq and Afghanistan. What I don’t understand is: why aren’t we hearing more about this; how dose the Army justify this; and what will become of our young troops?

As stated above, the average age of our troops is 18 to 24. To many of us, the soldiers are just children. Many of these soldiers are coming home with immense amounts psychological trauma. However, instead of receiving combined therapy with counseling and, if required, medication; they are administered their monthly prescriptions for some “happy pills,” in hopes the medication will cover up and/or help to ease their pain.

Ethically, the Army’s concept of medicating our troops to keep them deployed and fighting longer does not work. What is happening in Iraq and Afghanistan is alarming. As we approach a new presidential term, I can only hope for a better future, and maybe, just maybe someone will step in and put an end to this travesty and bring our troops home.

[1] Thompson M. America’s Medicated Army. Time. June 2008. Available at: http://www.time.com/time/nation/article/0,8599,1811858,00.html. Accessed on Jun 08, 2008.

You're Fired!

By Randy Hendrickson

Patients have the option to fire their physicians, that is commonplace; but is it ethical for a physician to fire a patient? A recent NYT article ( “Showing the Patient the Door…Permanently” June 10, 2008 ) documents the experience of a physician (Rahul Parikh, MD) who refuses to see a pediatric patient because the mother of the patient was confrontational, accusatory, and very difficult to deal with. She accused the physician of taking her money, by recommending what she thought was unnecessary treatment. She refused to follow preventive care recommendations, and dealing with the mother was in fact interferring with the care the doctor was trying to provide to the son. Is this good enough reason to dismiss the patient? What are the ethical issues involved?

“Doctors cannot fire a patient in dire straits like severe pain, bleeding or a life-threatening situation. And of course, [they] cannot refuse to see patients because of their race, age, sexual orientation and so on. . . .” But could you fire a patient because of a difficult mother? There is a implicit compact between patient and physician. The physician provides care for a fee, and the patient follows the physician’s treatment recommendations. Patients who are unhappy with the care they receive are free to go elsewhere. Likewise, physicians also have the right to dismiss patients.

The most common reasons for a physician firing his/her patients is refusal or inability to pay, missing appointments, or not complying with treatment regimens. Of course, the physician should not leave the patient stranded without care, and the patient should be given reasonable notice of the discontinuation of service and viable options, such as other clinics or practices that would be suitable for the continuation of medical care.

In this case, the patient’s mother refused to comply with the recommendation for the patient to receive a tetanus booster shot. The physician claims that prevention is the cornerstone of his practice. “I’m a pediatrician — prevention is in my DNA. If I accepted her view, I’d be compromising my conscience and my professional ethics. I couldn’t do that.”

Sometimes a change may be best for both patient and physician alike.

Money for Results?

Money for Results?

By Michael Leshinski

Prestigious Harvard University Medical School was recently under the public microscope for some potentially unethical acts that were undertaken by a few of their esteemed psychiatrists. The NY Times reports that three well known doctors were found to be on the payroll of big pharma. While this it is not illegal to do types of work for pharmaceutical companies, such as consulting, it is illegal to falsely represent the amount of money given by these companies. In this case, the psychiatrists and hospital are both to blame for the misrepresentation. But there is a more important issue here. The payoffs from the pharmaceutical companies may actually be a conflict of interest. The research being done by Harvard Medical School at Massachusetts General Hospital deals with treating children with anti-psychotic drugs. It just so happens that these medical professionals are receiving payment from pharmaceutical companies that manufacture these drugs. The doctors are accused of designing studies that are bound to provide favorable outcomes for the drug in question. With positive results from the study, it is easy for the doctors to endorse these drugs and try to push their views on others in the field. After all, who wouldn’t listen to a couple of Harvard guys?

During the course of my blogs, I usually ask the readers thoughts on whether the reported topic is ethical or not. In this case, however, it is clear to see the shady dealings that are often present in the medical/pharmaceutical world. These individuals received more than $1 million over the course of seven years. What did they do to earn that money? Their job title was consultant. Did they consult the drug companies on how to correctly deposit the money into their bank accounts? The article reports a possibility of simple mistake made by the doctors in reporting their outside income. Whether or not that happened seems to be irrelevant compared to their situation. At their institution, the main research focuses on the treatment of children with anti-psychotic drugs. Meanwhile, their outside income is generated by a manufacturer of the same anti-psychotic drugs. Seems like a conflict of interest to me.

1. http://www.nytimes.com/2008/06/10/opinion/10tue2.html?_r=2&oref=slogin&oref=slogin

Do Prayer and Medicine Mix?

On June 10, 2008, the Washington Post published an article about faith and medicine (Doctors Can Be Doubters).

In the article, Dr. Manoj Jain discusses his own thoughts and experiences in trying to find a balance in combining spirituality and the practice of medicine. He also shares observations of what he has seen other doctors doing.

The issue that caught my attention was the notion of how to interact with patients with regard to religion or spirituality, especially if the doctor and the patient are not followers of the same religion. Of particular note, Dr. Jain mentions observing another physician praying with a patient before surgery and asking him whether he changes this practice for patients who are not Christian. Dr. Jain seemed to think that this doctor might only pray with patients that shared his religious beliefs. He noted that "Although studies show that 40 to 60 percent of hospitalized patients want their doctors to pray with them, fewer than 5 percent of doctors say they often or usually pray with patients."

This raises an ethical dilemma. Are all patients receiving the same treatment? Should prayer and meditation be integrated into medical practice? If so, shouldn't all patients be entitled to this type of attention from their doctor regardless of their religion? What if a research study showed that patients whose surgeons prayed with them before surgery had better outcomes? Would this become standard of care? Who would decide on the content of the prayer?

The Mexico Option

“If you drink this, you will die.”

Those were among the last words Shirley Justins says she spoke to her long-term partner, Graeme Wylie, in March 2006. Moments later, according to Justins, Wylie poured a lethal dose of Nembutal into a glass and drank it. The Australian died a short time later.

Justins told her story during a controversial trial before the Supreme Court in New South Wales in which she is accused of murdering the 71-year old Wylie, a former Qantas pilot. During testimony last week, Justins admitted to assisting Wylie commit suicide but denied being part of a murder plot. Caren Jenning, a friend of Justins who purchased the Nembutal in Mexico, is charged with being an accessory to murder.

The case is controversial for several reasons. Wylie suffered from Alzheimer’s disease, which led to the denial of his application for legal euthanasia in Switzerland. He also changed his will a week before his death, leaving nearly all of his $2.4 million estate to Justins, who rejected that she had a conflict of interest. In addition, Jenning admitted lying to police to avoid investigation into Wylie’s death.

The trial has also featured testimony from Australia’s top euthanasia advocate, Philip Nitschke. The founder of Exit International advised Wylie, Justins, and Jenning on possible methods of suicide in 2005. Nitschke taught them about euthanasia tourism, a thriving industry in Mexico that provides an opportunity to purchase Nembutal in pet shops under lax regulations. Some advocates call it “the Mexico option.”

Nembutal is popular among euthanasia campaigners because it causes painless death in humans in less than an hour. Veterinarians around the world use it to anesthetize and euthanize animals, but the drug is not readily available to the general public—except in Mexico.

Do humans have the right to a peaceful death? Nitschke and Jack Kevorkian think so. As the Australian courts determine the fates Justins and Jennings, advocates for euthanasia will continue to fight for the right to die on their own terms.

And they’ll go to pet shops in Tijuana to do it.

Tricking Kids

Tricking Kids

By Michael Leshinski

The New York Times recently reported about a start-up drug company that doesn’t actually sell drugs. While taking care of children, a young mother was faced with a “sick” child who presented not so believable symptoms. As many parents do, she thought of giving a simple pain reliever not to actually treat any pain, but just to stop the complaining. Instead, she had an idea. What if I could treat the child without actually giving medicine? The rest is history. She has since created Efficacy Brands, a company that recently launched a placebo to “cure” the common child age hypochondriac. The chewable tablet is not so cleverly called Obecalp, placebo spelled backwards, and a liquid form is also currently in development. Sale of Obecalp began this week on the Efficacy Brands website. Will it work? I am sure there are many parents out there that think this is a great idea. Give the kid a pill and hopefully they will stop complaining. What if it doesn’t work because the child is actually sick? The child will have to suffer from the illness while believing a recovery is on the way. What if it is serious? Will the usage of Obecalp cause the child to miss out on a potential doctor visit?

Since it is technically not a drug, Obecalp does not undergo regulation by the Food and Drug Administration. Instead, it will be sold as a dietary supplement with no specific intended treatment. The inventor of the placebo pill acts simply as the supplier, and relies on the parents’ judgment for the administration. A bit of theatrics enter the picture here as well. The parents have to believe that the pill will work in order to give it. Unless you are accustomed to tricking your child on a regular basis, this may be difficult. Although placebo pills have had success in the past, specifically among attention deficit disorder, there is no evidence that it will work on other disease states. According to proponents of placebo administration, its usage could possibly act as a counter for the over-prescription of drugs.

Imagine There's No Copyright Law

By Randy Hendrickson


In a recent copyright infringement case, Yoko Ono and the two sons of John Lennon (along with EMI Blackwood Music) sued Ben Stein (and Premise Media) for the unauthorized use of part of the song “Imagine” in his new movie “Expelled: No Intelligence Allowed”. The movie is a critique of free speech and how intelligent design proponents are treated in academic circles. The plaintiffs requested a preliminary injunction to stop future distribution and promotion of the film and sought financial damages. U.S. District Judge Sidney Stein, however, ruled in favor of the defendant on grounds of “fair use”. The film focused on an area of public interest, and the use of Lennon’s copyrighted lyrics was in fact a commentary on “the exercise of free speech and freedom of inquiry” as related to the role of religion in public life. Under copyright law, the use of copyrighted material is permissible for “criticism, comment, news reporting, teaching, scholarship, and research”.

Judge Stein (not related to Ben Stein) explains:

“They put the song to a different purpose, selected an excerpt containing the ideas they wished to critique, paired the music and lyrics with images that contrast with the song's utopian expression, and placed the excerpt in the context of a debate regarding the role of religion in the public life.”

Yoko Ono is expected to appeal the ruling. “It is a pity that this decision weakens the rights of all copyright owners.”

Media Coverage of Health Issues: Dangerous to Your Health?

By Randy Hendrickson

The Public Library of Science (PLoS) recently reported a study of the quality of media coverage of health issues, including treatments, tests, products, and procedures, in the United States. The study (“How Do U.S. Journalists Cover Treatments, Tests, Products, and Procedures: An Evaluation of 500 Stories” by Gary Schwitzer at the University of Minnesota School of Journalism) evaluated how U. S. journalists are reporting health issues. Over a two-year period, the study rated the accuracy, balance, and completeness of news stories from a variety of media. A rating instrument that included 10 criteria was used to evaluate each of the 500 news stories. These criteria look at how well each story:

1. Adequately discusses costs
2. Quantifies benefits
3. Adequately explains and quantifies potential harms
4. Compares the new idea with existing alternatives
5. Seeks out independent sources and discloses potential conflicts of interest
6. Avoids disease mongering
7. Reviews the study methodology or quality of evidence
8. Establishes the true novelty of the idea
9. Establishes the availability of the product or procedure
10. Appears not to rely solely on a news release

This study showed that “…journalists usually fail to discuss costs, the quality of evidence, the existence of alternative options, and the absolute magnitude of potential benefits and harms.” This raises the issue of the quality of the information that reaches consumers. Because this information can have a dramatic, and possibly harmful, effect on consumers, Schwitzer and colleagues are working with news organizations and editorial executives to make them aware of these problems and to correct the imbalanced view that is often portrayed. The results of each evaluation were emailed to the journalist who wrote the article or news segment. The shortcomings of the news stories were mainly attributed to a lack of time and space. Those journalists who had more time to research and write the articles and more airtime or space in which to publish them tended to produce stories that were more balanced and complete. “We hope that our evaluation of health news will lead news organizations—and all who engage in the dissemination of health news and information—to reevaluate their practices to better serve a more informed health consumer population.”

The Flu Shot: Great in 2008 or Unclear Like Last Year

By Leane Scoz

Every February, a Food and Drug Administration (FDA) Advisory Committee convenes to decide on the three influenza virus strains that will make up the influenza vaccine for that year. Their decision is based on global surveillance for influenza viruses and the emergence and spread of new strains. If they get it right, millions of people who receive the influenza vaccine for that year will be protected from the virus and can go on with their daily lives without interruption. If they get it wrong, the millions of people who took the time out of their busy lives to get themselves and children vaccinated will be at the same risk as people who chose not to get vaccinated. Last year, the Committee got it wrong.

When the Committee selects strains that match the circulating viruses well, the influenza vaccine reduces laboratory-confirmed influenza by approximately 70% to 90%. According to the CDC, the 2007 influenza vaccine was only 44% effective in preventing the influenza virus. A bad selection for one of the strains is to blame.

The poor success rate of the influenza vaccine last year led the Committee to select three new strains for the influenza vaccine this year. Normally, only one or two strains change each year. In fact, a three strain change has never occurred in the past. What does this mean for the 2008 influenza season?

Most manufacturers of the influenza vaccine were not anticipating a three strain change since it has never occurred in the past. They were probably all ramping up their supply of strains selected last year in hopes that one or more would have been selected again for the vaccine this year. When the FDA selected the three different strains this year on February 21, 2008, influenza vaccine manufacturers probably panicked at first and then kicked into high gear to ensure they will be able to produce as many vaccines as last year and get them to market as soon as possible to have an edge on competitors.

If vaccine production does not go as planned this year, will the country be faced with a shortage similar to the 2004 influenza season? Possibly, but a shortage is not likely to occur since multiple manufacturers now exist for the influenza vaccine compared to only two when the shortage occurred in 2004.

The success rate of this year’s influenza vaccine will not be known until early next year, however, people should not be discouraged from getting vaccinated Every year, influenza infects up to 20 percent of the U.S. population, causes the hospitalization of over 200,000 people, and is responsible for more than 36,000 deaths. If you add up the people at highest risk, more than 200 million people should be vaccinated each year. Manufacturers produced over 130 million doses of influenza vaccine last year, and more than 20 million were not used and had to be discarded. People do not take the influenza virus serious enough, and if the success of the vaccine is compromised each year, the pattern of not getting vaccinated will unfortunately continue.

Guest Authoring and Ghostwriting

In their April 16, 2008 issue, the Journal of the American Medical Association (JAMA) published an article titled Guest Authorship and Ghostwriting in Publications Related to Rofecoxib: A Case Study of Industry Documents from Rofecoxib Litigation based on documents discovered during lawsuits against Merck related to their brand-name drug Vioxx (rofecoxib).

Two of the major issues raised in this article are guest authoring and ghostwriting. These issues often go hand in hand.

Guest authoring occurs when an individual who does not meet authorship criteria is listed as a named author for an article. Many journals, including JAMA, follow the guidelines for authorship identified by the International Council of Medical Journal Editors (ICMJE). These authorship guidelines require that a named author be involved in the design of the study, conduct of the study or analysis of the data, and writing or substantively reviewing/revising the manuscript. Only those individuals meeting all three criteria should be listed as authors; anyone else who contributed to the manuscript should be listed appropriately in the acknowledgments section.

Ghostwriting occurs when an unacknowledged individual writes most or all of a manuscript, which is then submitted with other individuals as the named authors. The American Medical Writers Association (AMWA) has published a Position Statement on the Contribution of Medical Writers to Scientific Publications that recommends including a statement in the acknowledgments section to indicate when a medical writer or medical editor has provided assistance in writing or preparing a manuscript for submission to a journal as well as acknowledging the source of funding for these services. By including this information in the acknowledgments section, transparency is maintained. When this information is not included, then in effect the medical writer is acting as an unnamed ghostwriter for the named authors on behalf of the pharmaceutical company.

The recent JAMA article indicates that some of the rofecoxib manuscripts submitted for publication were written by Merck staff or by medical publishing companies on behalf of Merck. After the manuscript were drafted and a target journal chosen, then selected academic researchers or key opinion leaders were contacted about being named authors on these articles; this constitutes guest authoring. The recent JAMA also indicated that some manuscripts were written by staff at an external communications company at the request of the pharmaceutical company using paid medical writers; this constitutes ghostwriting.

From an ethical standpoint, it is more beneficial to the reader to know who was involved in designing and conducting a clinical study as well as who paid for it. When it comes to publishing the results, it is also important for the reader to know who analyzed the results and wrote the manuscript that result in the published article that they are reading. If a well-respected leader in a therapeutic area conducted an independent study, analyzed the results, and presented his conclusions in an article that was published in a scientific journal then readers would have a great deal of confidence in the information presented. On the other hand, if a pharmaceutical company designed and conducted a clinical study assessing the efficacy of one of their own products, had their staff statisticians analyze the data, and their internal medical writers or an external communications company write a manuscript, then readers might have less confidence in the presented material.

It is possible, however, that neither scenario is ideal. The thought leader could be so convinced that his hypothesis is true that he analyzes the data in such a way that skews the results. Or the staff at the pharmaceutical company could be striving to be as transparent, conscientious, and protective of patient health and well-being as is possible, rather than focusing only on their profits. The reality is likely somewhere in between. Transparency in terms of who did the work, who paid for it, and who is telling the scientific community about the results makes it more likely for individuals to have some trust in the presented data.

Named authors should have participated in the designing or conducting the study, analyzing the results, and writing or substantially revising the manuscript. Medical writers involved in preparing manuscripts should be acknowledged in the published article. Statisticians who analyzed the study data should also be acknowledged. The source of funding for the author, investigators, medical writers, and statisticians should also be included in the acknowledgments section.

Cervical Cancer Vaccine: Do we Need it?

By: Jenny Walters

As you watch television, you cannot go a day or even a couple hours without seeing the commercial for Gardasil, “the first ever cervical cancer vaccine.” Gardasil claims to stop cervical cancer before is starts.

The Gardasil vaccine is recommended for girls ages 11 to 12, but can be used in girls as young as 9. According to an article from the Mayo Clinic, written by Bobby Gostout, MD, and entitled Cervical cancer vaccine: Who needs is, how it works, Gardasil is the newest addition to the official childhood immunization schedule.[1]

Cervical cancer affects 10,000 women a year and leads to 4,000 deaths.1 In 2005, according to the World Health Organization, there were an estimated 500,000 new cases of cervical cancer. Cervical cancer is the leading cause of death in women, even with treatment.

Various strains of the human papillomavirus (HPV), are responsible for most cases of cervical cancer.1 HPV spreads through sexual contact. Gardasil specifically blocks two cancer-causing types of HPV: types 16 and 18. Gardasil also blocks types 6 and 11, which are associated with genital warts and mild Pap test abnormalities.

The Gardasil vaccine allows young girls immune system to become “activated before their likely to encounter HPV.” Vaccinating young girls also allows for higher antibody levels, which results in greater protection against cervical cancer.1

To see earlier positive effects of the Gardasil vaccine, the Center for Disease Control (CDC) recommends a “catch-up immunization for girls and women ages 13 to 26” be administered.1 Currently, the vaccine is not required for school enrollment, but may be in the future.1

Gardasil has been proven to be “remarkably safe.”1 Common side effects include: soreness at the injection site, low-grade fever or flu-like symptoms. There were no reports of clinical trial discontinuation due to serious side effects.

So what does this all mean? As a mother and wife, HPV is not a threat I worry about now. However, during nursing school, I had a class of about 18 girls. Of those 18 girls, almost every one of them had the HPV infection. It seemed as though each week I would hear of another student having an abnormal Pap test due to HPV.

HPV is non-discriminating, it can affect anyone. If the Gardasil vaccine can help block HPV infection, than maybe one day cervical cancer will no longer be the number one killer of women.

[1] Gostout B, MD. Cervical cancer vaccine: who needs it, how it works. Sep 2007. Available at: http://www.mayoclinic.com/health/cervical-cancer-vaccine/WO00120. Accessed on Jun 02, 2008.

Patients in Search of VIP Treatment

By: Jenny Walters

Most people have experienced “assembly line patient care.” The kind of patient care where you wait in an overcrowded office with 20-30 other patients; where you are seen an hour or later after your scheduled appointment by, a physician, but usually a physician assistant for all of a 5 minute visit; where you are lucky if the physician takes a minute, of that 5 minute appointment, to look up from his/her notes to make eye contact with you. If you haven’t experienced this type of patient care, consider yourself lucky….very lucky.

In an age of insurance company driven patient care, patients finds themselves in the “assembly line” situation more often than not. In fact, at times it may feel almost impossible to find a physician’s office that does not function on these premises.

A recent article in Time magazine, written by Jeninne Lee-St. John, entitled Giving Patient the VIP Treatment, focused on the new emergence of VIP treatment physician practices.[1] According to Lee-St.John, many patients are choosing to pay immense out-of-pocket premiums to obtain more personalized attention.

In the more than 1,000 “concierge, or boutique, practices” that are open today, physicians are limiting the number of patients they see so they can devote more time to each or them.1 Concierge practices accept insurance for routine tests and treatment, but charge patients additional fees for extras like: no waiting, longer office visits, and round-the-clock availability via e-mail or cell phone.1

Many concierge practices are primary care offices. However, OB/GYN physicians are now beginning to enter the new area of concierge practices. Elite Obstetrics and Gynecology, in Ft. Lauderdale is one such practice. Elite charges patients an additional $15,000 on top of insurance, “for VIP prenatal care that includes add-ons like a fetal ultrasound photo at every visit, private birthing classes, one massage per trimester, optional home doctor visits, physicians home and cell numbers, e-mail addresses, and the guarantee that your physician will be at the hospital for your full active labor and delivery.”1 Elite is able to make the guarantee that each physician will be available for each of their patients birth by accepting obstetric patients by due date, and accepting no more than four woman due per month.

Critics argue concierge practices are for the wealthy; and high quality healthcare should be available to all patients, not just those who can afford it. However, many of the concierge physicians report: “Most of our patients are normal people who just care a lot about their health.”1

Dr. Lanalee Araba Sam, a physician from Elite OB/GYN stated: “Women seem to spend more time picking a hairdresser than picking who’s going to take care of them for nine months and be responsible for the baby.” For woman who are deeply interested in their health, but who cannot afford Elite’s fees, Dr. Sam will sometimes offer her services at a discounted rate or for free.1

As we draw closer upon the next presidential election, we are overwhelmed with claims and promises of better health care and health care or all. It is impossible to say what changes we will really see with our new president. However, one thing is clear, the current health care system must change in order to better accommodate patients. Patients shouldn’t be forced to pay immense out-of-pocket fees to obtain high quality patient care; and patients shouldn’t feel like a number in assembly line. Instead, high quality patient care should be available to all. The question is ….How are we going to make that happen?

[1] Lee-St. John L. Giving patients the VIP treatment. Time. May 2008. Available at: http://www.time.com/time/health/article/0,8599,1779338,00.html. Accessed on June 1, 2008.

Old-Fashioned Science or Necessary Evil?

By Chris Karlesky

The international debate over animal testing got a shot in the arm last week when renowned primatologist Jane Goodall urged the European Union to find alternatives to experimentation on animals. Armed with 150,000 signatures and a lifetime of heralded research, Goodall called for the introduction of a Nobel Prize to reward research that avoids testing on live, sentient beings.

Goodall delivered her message as the EU prepares to update its 22-year old directive on animal testing. Scientists and animal rights campaigners also descended on Brussels to join the debate over how to proceed on the controversial issue.

Campaigning for animal rights is nothing new for Goodall (pictured), who founded the Jane Goodall Institute in 1977 to “advance the power of individuals to take informed and compassionate action to improve the environment for all living things.” Goodall also heads up Advocates for Animals, an animal rights organization in Edinburgh, Scotland.

It didn’t take long following Goodall’s call to action in Brussels for supporters of animal research to chime in. Colin Blakemore, professor of neuroscience at Oxford, argues that while strict controls should be required, animal experimentation is a necessary evil in the world of scientific research. Blakemore is no stranger to controversy; according to a 2003 article, he endured over a decade of attacks and abuse by animal rights campaigners for engaging in experiments that led to the deaths of newborn kittens.

The animal testing debate clearly raises important ethical questions (not to mention the blood pressure of its participants). Which procedures should be considered acceptable, and at what expense to the animals? How can we determine when animal suffering is “minimized?” Should animals be considered part of the polity?

Perhaps the most important question relates to the human mind. Goodall mentions that the “amazing human brain” should work to find new ways of testing that don’t involve animals. The brain’s capacity to reason gives humans an incredible gift—one filled with responsibility. As new methods of conducting scientific research evolve, the debate over that responsibility will define the future of animal experimentation.

Is One-A-Day One Too Many?

By Leane Scoz

"Train, say your prayers, and eat your vitamins."--Hulk Hogan

If vitamins are good enough for the Hulkster, they should be good enough for all of us. And, most Americans agree. Vitamin supplements are a multi-billion industry. With over a third of American adults consuming them on a regular basis, the risks and benefits should be well known.

However, recent reports reveal insufficient evidence to support the beneficial effects of multivitamins. In fact, an NIH panel review and Mayo Clinic article both report beta-carotene supplements actually increase the risk of lung cancer in smokers. Also, a Harvard Men's Health Watch suggests that high doses of multivitamins may raise prostate cancer risk. The study had limitations since it was not originally designed to support this assessment, however, it does raise the question on whether or not our daily "helpers" are really doing their jobs or causing us more harm than good.

The NIH and the Mayo Clinic articles suggest another negative aspect for multivitamins is that the products are not strictly regulated, which implies that the labels may not exactly include everything contained in the bottles. However, both agree that studies do exist to support the use of folic acid supplements for pregnant women to prevent neural tube birth defects, calcium and vitamin D supplements to protect the bones of postmenopausal women, and antioxidants and zinc supplements to slow the worsening of age-related macular degeneration.

Most Americans assume multivitamins are safe and effective since they are readily available on store shelves and marketed heavily in the media. And why shouldn't we feel this way? Vitamins are found in nature in the foods we eat everyday. Vitamin supplements make us feel healthier and believe we will prevent chronic diseases, colds, and flu. We are taught that vitamin deficiencies can be extremely dangerous and hazardous to our health. We do not think that too much of certain nutrients can be harmful.

As always, people need to make an educated decision when it comes to multivitamin use. They need to carefully assess their health, consult their physician, and weigh out the possible benefits and risks before determining if a multivitamin is right for them. Maybe, Hulk needs to amend his slogan to say, "...consider eating your vitamins."