Ethics: A Patient’s Right to Not Know

Ethics: A Patient’s Right to Not Know.

Excerpt

Writing in Science, the chair of the Presidential Commission for the Study of Bioethical Issues notes it is increasingly common for physicians and medical researchers to discover a disease that was not the original target of a medical test or screening.

Amy Guttman Ph.D. notes these surprise clinical test results are called incidental and secondary findings. Guttman explains the surprise discovery of an unexpected illness from screening and similar tests is called an ‘incidental’ finding. Guttman adds when clinicians deliberately seek to discover a second or third disease in addition to the primary target, these results are called ‘secondary’ findings.

Guttman, who is the president of the University of Pennsylvania, writes (and we quote): ‘Improved technologies are making incidental and secondary findings increasingly common. They are becoming a growing certainty in clinical practice as well as in the distinct contexts of research and direct-to-consumer testing’ (end of quote). For example, Guttman notes an array of unexpected clinical findings may be generated by new CT scans intended to detect lung cancer in heavy smokers. The increased screening will occur because of recent recommendations from the U.S. Preventive Services Task Force, which we discussed in last week’s podcast.

Guttman writes before CT scans or other medical tests, clinicians should alert patients about the possibility of surprise findings regardless whether screening deliberately seeks (or accidentally finds) new, unexpected illnesses.

http://www.jakebouma.com/i-have-hodgkin-lymphoma/

Guttman notes while some persons will ask a physician to tell them about whatever clinical tests discover, some patients do not want to learn about incidental or secondary findings.

As a result, the Presidential Bioethics Commission recommends physicians and medical practitioners need to know a patient’s health priorities and tolerance to manage surprising results prior to clinical testing. Guttman writes (and we quote) ‘A patient who does not wish to learn about information related to the primary purpose of the test should not undergo the test. If a patient wishes to opt out of receiving incidental or secondary findings that are clinically significant and actionable, then clinicians should exercise their discretion whether to proceed with testing’ (end of quote).

Guttman notes health care providers should explain both the risks and rewards of finding unexpected illnesses that can occur from a new generation of sophisticated clinical tests, such as human genome screenings. While false positive findings are among the risks, Guttman explains the rewards include the detection of diseases and illness that could be clinically actionable.

In terms of biomedical ethics, Guttman concludes (and we quote):’ In keeping with shared decision-making, clinicians live up to their highest calling when they discuss how they will handle incidental findings with their patients’ (end of quote). While the Presidential Bioethics Commission provides more specific recommendations in their report, their overall intent is to improve patient-provider disclosure and communication as well as help patients anticipate the possibility of unexpected findings from routine testing.

The Commission’s report is available at bioethics.gov.

Meanwhile, a link to a website that explains some of the ethical issues associated with patient and provider health decision making (from Beth Israel Medical Center) is available in the ‘specific conditions’ section of MedlinePlus.gov’s medical ethics health topic page.

Similarly, a link to a website that explains some of the ethical issues associated with patient and provider treatment decisions (also from Beth Israel Medical Center) can be found in the ‘specific conditions’ section of MedlinePlus.gov’s medical ethics health topic page.

MedlinePlus.gov’s medical ethics health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. You can sign up to receive updates about medical ethics as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s medical ethics health topic page type ‘medical ethics’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘medical ethics (National Library of Medicine).’ MedlinePlus.gov additionally contains a health topic page on talking with your doctor, which provides tips to enhance provider and patient communication.

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Dalai Lama: On Science and Emotional Health

 

Tenzin Gyatso, the fourteenth and current Dalai Lama, is the leader of the exiled Tibetan government in India. He was awarded the Nobel Peace Prize in 1989. Photographed during his visit in Cologno Monzese MI, Italy, on december 8th, 2007. (Photo credit: Wikipedia)

Dalai Lama: On Science and Emotional Health.

Excerpt

The Dalai Lama, the Nobel Peace Prize winner and exiled spiritual leader of Buddhism in Tibet, discussed his admiration for scientists and made some interesting remarks about emotional health during a recent speech at the National Institutes of Health.

The Dalai Lama was effusive in his praise for scientists. He said (and we quote): ‘I deeply admire my scientific friends’ (end of quote). The Dalai Lama pinpointed the open minded of scientists and what he described as a healthy skepticism about evidence and hyperbole. He also emphasized the capacity of scientists from around the world to work together and ignore differences in geography, race, ethnicity, gender, religion, and social class.

The Dalai Lama noted these traits set scientists apart and provided an international, professional role model.

However, the Dalai Lama also said he found some scientists were unhappy despite their gifts and intelligence. He briefly discussed the lack of inner peace among scientists with a sense of humor rather than admonishment. The Dalai Lama’s infectious laugh and self-deprecating humor delighted many NIH staff members who packed an auditorium to hear him.

The Dalia Lama’s discussion about emotional inner peace led to broader remarks about the impact of maternal affection in the life long health of children. The Dalai Lama explained he was pleased that scientific evidence seemed consistent with his personal, long-standing observation of the vital role of maternal love and sincerity in the development of a child’s brain and emotional health.

Similarly, the Dalai Lama noted that he had long observed a perceived link between maternal affection, attention, and sincerity for their children and the development of life long compassion for others. He encouraged behavioral and other scientists to further assess the extent of this relationship.

The Dalai Lama also was moved by a series of drawings from young patients at NIH’s Children’s Inn and underscored his appreciation for the artists. Similarly, he praised a project he saw at NIH’s Clinical Center that seeks to restore the ability to walk for young persons with Cerebral Palsy.

In response to a question from NIH Director Francis Collins M.D., the Dalai Lama confessed he sometimes gets frustrated and irritated – and even occasionally loses his temper. For example, he explained he became angry once during an interview when a New York Times columnist asked him four times to describe his probable legacy. Although the Dalai Lama noted he believed he answered the question the first time, the story revealed even renowned spiritual leaders sometimes can get cross. It also deftly reminded the audience there always is room for improvement in how we manage our lives and work.

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A Threat to Male Fertility – NYTimes.com

A Threat to Male Fertility – NYTimes.com.

 

“Phthalates belong to a group of industrial compounds known as endocrine disruptors because they interfere with the endocrine system, which governs the production and distribution of hormones in the body. The chemicals have been implicated in a range of health problems, including birth defects, cancers and diabetes.

But it is their effect on the human reproductive system that hasmost worried researchers. A growing body of work over the last two decades suggests that phthalates can rewire the male reproductive system, interfering with the operation of androgenic hormones, such as testosterone, that play key roles in male development. That mechanism, some experts believe, explains findings that link phthalate exposure to changes in everything from testicular development to sperm quality.”

“There are different kinds of phthalates complicating the picture; some seem to have a much larger effect than others. And these are far from the only factors, chemical and otherwise, that influence human fertility. Dr. Buck Louis’s group is looking at a broad range of industrial compounds, including heavy metals like lead and cadmium, that tend to accumulate in the body.

Phthalates, by contrast, tend to be metabolized within a few hours. Their impact would not be so profound if it were not that people are constantly exposed from multiple sources.

These include not only cosmetics and plastics, but also packaging, textiles, detergents and other household products. Phthalates are found in the tubing used in hospitals to deliver medications; in water flowing through PVC pipes; enteric coatings on pills, including some aspirin; materials used to create time-release capsules; and countless other products. In 2008, the government banned them in children’s toys, and the European Union is also moving forward on restrictions.

“The W.H.O. called them ‘pseudopersistent’ in one report,” Dr. Woodruff said, because continued exposure keeps phthalates in the body. But here’s the silver lining: the transient nature of these compounds also means that consumers can take fairly simple measures to reduce their phthalate levels.

One is to read the labels on cosmetics and other personal care products and to choose those without phthalates. Another is to be cautious with plastic food containers, and to avoid using them to heat food and drink, as the phthalates in them may get transferred to what you consume.

“These compounds leach from plastics,” Dr. Buck Louis said. “You can switch to glass for drinking. You can cook your frozen dinners on paper plates.”

Studies have shown that these kinds of actions do make a difference; experiments have found measurably lower levels within several days in people who make these changes.

“Lifestyle has an important place here,” said Dr. Buck Louis.”

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Hepatitis C Cure May Be Too Expensive for Prisoners – Stateline

Surely, as one of the wealthiest countries in the world, we can find a way to provide basic health care for all.
And this includes prisoners, they too are human beings.

 

Hepatitis C Cure May Be Too Expensive for Prisoners – Stateline.

If used widely, a new generation of antiviral drugs has the potential to wipe out the deadly hepatitis C virus in the United States. But the high price of the drugs might prevent their use in prisons, which house as many as one-third of those who are infected.

The drugs cost anywhere from about $65,000 to $170,000 for a single course of treatment—between three and nine times more than earlier treatments. Ronald Shansky, former medical director of the Illinois prison system and founder of the Society of Correctional Physicians, described that price as “extortionarily high, criminal.”

…

HIV Precedent
States and municipalities typically pay for prisoner health care out of their corrections budgets. When effective HIV treatments emerged in the late 1990s, those budgets grew to accommodate the cost of the drugs, said Edward Harrison, president of National Commission on Correctional Health Care, which sets standards for prisoner health care.

But the new hepatitis C medications present a much bigger challenge. “The prevalence of HCV [hepatitis C) is 10 times greater than HIV and the cost of treatment is probably 10 times greater than a year’s worth of treating HIV,” said Anne Spaulding of Emory University, one of the leading researchers on hepatitis C in prisons.

 

…

The new hepatitis C drugs and others in the pipeline could be the “straw that breaks the back of corrections” and force large-scale changes in penal systems. Already, as a result of a U.S. Supreme Court decision, California has had to reduce its prison population by tens of thousands because of inadequate health care. Spaulding said she can foresee the high costs of medicine could force cuts in prison populations across the United States.

Another possibility, she said, would be to create a different mechanism for paying for prison health care, perhaps by extending Medicaid to jail and prison populations.

One thing is clear: The goal of eradicating hepatitis C won’t be achieved unless the campaign involves prisons.

“Because of these new drugs, the conversation about eliminating hepatitis C is finally happening,” said Ninburg of the Hepatitis Education Project. “But if it’s going to be eliminated, we are going to have to address hep C in the correctional setting.”

Related articles

• Hepatitis C: Between a Rock and a Hard Place

A Health Strategy on the Reduction of Inequalities: Not a Utopian Fantasy

O.N.E.—One Nation’s Echo

          As social inequalities in health in the U.S. and international evidence continue to increase, disparities in income and wealth widened the gap making social class as a key determinant of population health. The gap is widening between upper-middle-class Americans and middle class Americans. Health and longevity are determined by the access of advances in medicine and disease prevention. These benefits are disproportionately delivered to individuals who have more education, connections, money, and good jobs. They are the ones in the best position to learn new information early, modify their behavior, take advantage of the latest treatments and have the cost covered by insurance. Since 1911, mortality statistics in Britain have consistently shown an inverse relation between measures of socio-economic status and mortality. While social class has been a less popular topic in the United States, this has been a trend in Europe since George III. Socio-economic…

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A vascular surgeon explains why he ditched statins for more meat and less sugar, lowering his cholesterol in the process

A Longitudinal Analysis of Electronic Cigarette Use and Smoking Cessation

Natural Products News and Updates

The latest Journal of American Medical Association published a longitudinal analysis evaluating the smoking cessation rates in close to 1600 current smokers using electronic cigarettes. The authors stated that the study did not achieve statistical power, but contributed to the building evidence that e-cigarettes do not increase smoking cessation rates, as often suggested by manufacturers. What is your experience with e-cigarettes – personally or with your patients? Would your current recommendations change after reading this survey?

For additional information, please see JAMA.

Image courtesy of [patrisyu]/FreeDigitalPhotos.net

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7 million premature deaths annually linked to air pollution

Full Text Reports...

7 million premature deaths annually linked to air pollution
Source: World Health Organization

In new estimates released today, WHO reports that in 2012 around 7 million people died – one in eight of total global deaths – as a result of air pollution exposure. This finding more than doubles previous estimates and confirms that air pollution is now the world’s largest single environmental health risk. Reducing air pollution could save millions of lives.

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Should we consider alcohol-related violence to be a social justice issue?

One Punch Too Many

Social justice is where the rights of every person in a community are considered in a fair and equitable manner. Consider these facts in relation to alcohol-related violence, when evaluating the relation of this issue to social justice:

• People who are younger, from lower socioeconomic areas, and of lower education status are more likely to use and abuse alcohol and be involved with violent behaviours; meaning these groups are particularly vulnerable to experiencing alcohol-related violence.
• Victims of alcohol-related violence are often young men, but men and women from all ages can be affected directly or indirectly, including children.
• The victims of alcohol-related violence can be killed by a single punch, often in unprovoked or unexpected attacks. Those that live often have expensive hospitalisations, severe morbidities and long recoveries.

For health, social justice revolves around four key ideas; access, equity, rights and participation. The statements above establish that there is inequality…

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Air pollution’s 2012 toll: 7 million

Science for the Future

Polluted air killed seven million human beings in 2012.

So concludes a new report from the World Health Organization, which also found that one-third of the deaths occurred in Asia.

Air pollution is now Earth’s most dangerous environmental threat to health, the WHO study says, and it accounts for one out of every eight deaths.

Emissions of pollution to the atmosphere raises the risk that individuals will suffer heart attacks, strokes, and cancer. About 40 percent of heart disease victims and about 40 percent of stroke victims die as a result of outdoor air pollution. Indoor air pollution, such as from smoke and soot, accounts for 34 percent of stroke deaths and 26 percent of ischemic heart disease fatalities.

Overall, WHO estimates that 4.3 million people died as a result of exposure to indoor air pollution, while 3.7 million individuals perished due to outdoor air pollution.

“Cleaning up the air…

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