Health and Medical News and Resources

General interest items edited by Janice Flahiff

Letting Doctors Make the Tough Decisions

Excerpt from the 11 August New York Times article

…..When it came to medical decisions, almost all the respondents wanted their doctors to offer choices and consider their opinions. But a majority of patients — two out of three — also preferred that their doctors make the final decisions regarding their medical care.

“The data says decisively that most patients don’t want to make these decisions on their own” said Dr. Farr A. Curlin, an associate professor of medicine at the University of Chicago and one of the authors of the study.

The challenges appear to arise not when the medical choices are obvious, but when the best option for a patient is uncertain. In these situations, when doctors pass the burden of decision-making to a patient or family, it can exacerbate an already stressful situation. “If a physician with all of his or her clinical experience is feeling that much uncertainty,” Dr. Curlin said, “imagine what kind of serious anxiety and confusion the patient and family may be feeling.”

Patients and their families also often don’t realize that their doctors may be grappling with their own set of worries. …

Read the entire New York Times article

August 13, 2011 Posted by | Health News Items, Psychology | , , , , , | Leave a comment

Academics ‘guest authoring’ ghostwritten medical journal articles should be charged with fraud, legal experts argue

From the 3 August 2011 Medical News Today article

ScienceDaily (Aug. 3, 2011) — Two University of Toronto Faculty of Law professors argue that academics who ‘lend’ their names, and receive substantial credit, as guest authors of medical and scientific articles ghostwritten by industry writers, should be charged with professional and academic misconduct and fraud, even if they contain factually correct information.

In an article published in PLoS Medicine, Professors Simon Stern and Trudo Lemmens argue “Guest authorship is a disturbing violation of academic integrity standards, which form the basis of scientific reliability.” In addition, “The false respectability afforded to claims of safety and effectiveness through the use of academic investigators risks undermining the integrity of biomedical research and patient care.”

In “Legal Remedies for Medical Ghostwriting: Imposing Fraud Liability on Guest Authors of Ghostwritten Articles,” Stern and Lemmens argue that since medical journals, academic institutions, and professional disciplinary bodies have not succeeded in enforcing effective sanctions, a more successful deterrence would be through the imposition of legal liability on the guest authors, “and may give rise to claims that could be pursued in a class action based on the Racketeer Influenced and Corrupt Organizations Act (RICO).”…

Read the entire news article
Journal Reference:
Simon Stern, Trudo Lemmens. Legal Remedies for Medical Ghostwriting: Imposing Fraud Liability on Guest Authors of Ghostwritten Articles. PLoS Medicine, 2011; 8 (8): e1001070 DOI: 10.1371/journal.pmed.1001070

August 8, 2011 Posted by | Medical and Health Research News | , , , , , , , , | Leave a comment

Animals Containing Human Material: Time To Review The Ethics Say UK Scientists

From the 22 July 2011 Medical News Today article

 

Implanting mice with human tumors to test new anti-cancer drugs, injecting rats with human stem cells to find out how the brain repairs itself after a stroke, inserting human genes into the DNA of goats to make a protein that treats human blood clotting disorders; these are some examples of how science uses “animals containing human material” (ACHM). While they are invaluable tools for biomedical research, their use raises serious ethical questions, and a new report released on Thursday from the UK’s Academy of Medical Sciences says it is time to revisit these questions, and recommends the UK government set up an expert body to oversee experiments that use animals containing human material.

The report’s authors say that although the vast majority of research that uses animals containing human material, or “ACHM”, does not raise new ethical or regulatory questions, they are concerned that some sensitive areas like exploring cognition and reproduction, and giving animals human-like physical characteristics, need to be controlled.[Flahiff’s emphasis]..

..An example of a key area they highlighted that concerns scientists and the public, is using ACHM in brain research. What if, inserting human cells into the brains of animals results in animals having human-like “cerebral” functions: to be capable of consciousness, awareness and show human-like behaviour, they ask?

Click here to read the entire news article

Click here to link to the above report (Animals Containing Human Materials)and related downloads 

July 22, 2011 Posted by | Medical and Health Research News | , , , , | Leave a comment

What can we do about death? Reinventing the American medical system

From the 31 May 2011 Eureka News Alert

(Garrison, NY) In a feature article in The New Republic,(subscription only, check your local public library for availability)  Daniel Callahan and Sherwin Nuland propose a radical reinvention of the American medical system requiring new ways of thinking about living, aging, and dying. They argue that a sustainable—and more humane— medical system in the U.S. will have to reprioritize to emphasize public health and prevention for the young, and care not cure for the elderly.

An interesting twist on their argument, which would aim to bring everyone’s life expectancy up to an average age of 80 years but give highest priority for medical treatment to those under 80, is that Callahan and Nuland are themselves 80 years old. Daniel Callahan, Ph.D., is cofounder and president emeritus of The Hastings Center and author most recently of Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System. Sherwin Nuland, M.D., is a retired Clinical Professor of Surgery at the Yale School of Medicine and author of How We Die and the Art of Aging. He is also a Hastings Center Fellow and Board member.

“The real problem is that we have medicine excessively driven by progress, which aims to rid us of death and disease and treats them as the targets of unlimited medical warfare,” said Callahan and Nuland. “That warfare, however, has come to look like the trench warfare of World War I: great human and economic cost for little progress. Neither infectious disease nor the chronic diseases of an aging society will soon be cured. Cancer, heart disease, stroke, and Alzheimer’s disease are our fate for the foreseeable future. Medicine and the public must adapt it to that reality, one that has mainly brought us lives that end poorly and expensively in old age.”

The article notes that the Affordable Care Act might ease the financial burden of this system, but not eliminate it. It reports, for example, that the cost of Alzheimer’s disease is projected to rise from $91 billion in 2005 to $189 billion in 2015, and to $1 trillion in 2025 – twice the cost of Medicare expenditures for all diseases now.

“We need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person,” the authors write. “An old age marked by disability, economic insecurity, and social isolation are also great evils.” They endorse a culture of care, not cure, for the elderly, with a stronger Social Security program and a Medicare program weighted toward primary care that supports preventative measures and independent living.

Callahan and Nuland point the way to a more sustainable path that reprioritizes the entire system. Among their recommendations:

  • improve medicine at the level of public health and primary care, while reducing its use for expensive high-tech end-of-life care;
  • shift resources for the elderly to greater economic and social security and away from more medical care;
  • subsidize the education of physicians, particularly those who go into primary care, and decrease medical subspecialization;
  • train physicians better to tell the truth to patients about the way excessively aggressive medicine can increase the likelihood of a poor death;
  • shift the emphasis in chronic disease to care rather than cure;
  • conduct a top-down, bottom-up, long-range study of the entire American system of health care, including the training of physicians, with a view toward reconstituting it along systematic lines that take science, humanistic concerns, economics, and social issues into account.

June 14, 2011 Posted by | Uncategorized | , , , , , , , , , , , | Leave a comment

US Department of Defense Patient Safety Program

The US Department of Defense Patient Safety Program was “was created [in 2001] to identify and report actual and potential problems in medical systems and processes and to implement effective actions to improve patient safety and health care quality throughout the MHS [Military Health System].

The Welcome Statement stresses that they “encourage a systems approach to creating a safer patient environment; engaging MHS leadership; promoting collaboration across all three services; and fostering trust, transparency, teamwork, and communication.”

The Home Page has a well organized Site Map with essential links, social media links, education/training links, and links to research and news items.

While many educational resources (as continuing education courses) are closed to the public, these educational items are freely available to all.  [Descriptions are from the Patient Safety Program Web Page]

Click here for more information about the Patient Safety Learning Center (PSLC).

  • Patient Falls Reduction Toolkit: Falls have been the number one harm event reported to the Department of Defense (DoD) Patient Safety Analysis Center (PSAC) since its inception. These tools are offered as guidance and are designed to assist you with creating an institutional awareness and response to patient falls – education, prevention, assessment, reassessment, intervention, and continuous improvement.Click here to access the Patient Falls Reduction Toolkit.

  • Professional Conduct Toolkit: The toolkit is designed for health professionals who may be serving in leadership roles or who are seeking resources for addressing behaviors that negatively impact patient safety and that disrupt the clinical work environment.

Click here to access the Professional Conduct Toolkit

  • Situation, Background, Assessment, Recommendation (SBAR) Toolkit: Evidence shows that use of a structured communication tool known as SBAR can improve information exchange among healthcare team members and reduce the rate of adverse events.

Click here to access the Situation, Background, Assessment, Recommendation (SBAR) Toolkit.

February 10, 2011 Posted by | Professional Health Care Resources | , , , , , , , | Leave a comment

Drug Maker Wrote Book Under 2 Doctors’ Names, Documents Say

Entire medical textbook written by pharmaceutical company …”a new level of chutzpah”

Excerpts from the November 2009 NY Times article

Two prominent authors of a 1999 book teaching family doctors how to treat psychiatric disorders provided acknowledgment in the preface for an “unrestricted educational grant” from a major pharmaceutical company.But the drug maker, then known as SmithKline Beecham, actually had much more involvement than the book described, newly disclosed documents show. The grant paid for a writing company to develop the outline and text for the two named authors, the documents show, and then the writing company said it planned to show three drafts directly to the pharmaceutical company for comments and “sign-off” and page proofs for “final approval.”

On a related note…Playing Doctor: How to Spin Pharmaceutical Research

An excerpt from this December 2010 Atlantic article

His first assignment was to produce scientific abstracts for studies of a newly approved antibiotic. Unfortunately, the antibiotic had a major weakness: it did not work against pneumococcus, one of the most common bugs a doctor will see. But this shortcoming was not something that the drug’s manufacturer— hich was funding the articles and abstracts—was keen to point out. So David and his fellow medical writers were told to avoid the topic.

December 1, 2010 Posted by | Health News Items | , , , , , | Leave a comment

Study Recommends Disclosure of Medical Mistakes That Affect Multiple Patients

From a Press Release by the Agency for Health Research and Qualtity (AHRQ)

Health care organizations should disclose medical mistakes that affect multiple patients even if patients were not harmed by the event, according to an AHRQ-funded research paper published in the September 2 issue of the New England Journal of Medicine. Medical mistakes that affect multiple patients, known as large-scale adverse events to researchers, are incidents or series of related incidents that harm or could potentially harm multiple patients. These events, which can include incompletely sterilized surgical equipment, poor laboratory quality control and equipment malfunctions, are often identified after care has been provided and can affect thousands of patients.

September 23, 2010 Posted by | Health News Items | , | Leave a comment

Notions of Personal ‘Sacrifice’ Help Docs Take Gifts From Industry

Study suggests drug/device companies can play to physicians’ need for ‘appreciation’

In recent years there has been a movement to impose guidelines and codes on the relationship between doctors and the drug/medical device industry. These standards run the gamut from not accepting free pens from drug companies to paid trips. However, gift giving is still going on according to a study appearing in the Sept. 15 issue of the Journal of the American Medical Association. The study focused on a survey to 301 resident US physicians.

If doctors are told that they’ve studied and worked hard to get where they are today, they find it easier to justify taking gifts from drug and medical-device companies, a new study finds…..

In the new study, conducted in 2009, Sah and her colleagues distributed three quality-of-life surveys to about 300 pediatric and family medicine resident physicians. Sah conducted the study while a doctoral candidate in the Tepper School of Business at Carnegie Mellon University in Pittsburgh.

The authors posed a series of questions to gauge opinions on industry gifting. Some questions touched upon the sacrifices doctors had made (sleep lost, hours worked, debt amassed) while pursuing a career. They also asked about the stagnant wages and high debts that can hamper many in the medical field.

The results: Although few physicians indicated that their working conditions were “bad,” doctors who were reminded of the sacrifices they had made to get to where they are now were much more likely to view receiving industry gifts as acceptable.

Specifically, about 48 percent of those who were reminded about the sacrifices they had made as doctors thought accepting gifts from industry was fine, vs. about 22 percent of those who were not reminded.

Most physicians, when asked directly, disagreed with the notion that “stagnant salaries and rising debt levels” would make accepting gifts from industry OK. And yet exposure to this notion during the study boosted the number of doctors who thought gift-taking was acceptable to more than 60 percent, the researchers noted.

September 16, 2010 Posted by | Health News Items | | 1 Comment

Two New MedlinePlus Items of Note

MedlinePlus is a goldmine of links to free and trusted health and medical Web sites.
It is sponsored by the US National Library of Medicine and the US National Institutes of Health.

—->Recently MedlinePlus has added a Medical Ethics page with links to overviews, news items, specific conditions, and news articles.

Additionally, a  good list of Medical Ethics Web sites from the College of the Holy Cross is available here.

—->MedlinePlus is undergoing a major Web site redesign. Check here for details and the opportunity to provide feedback.

May 26, 2010 Posted by | Consumer Health | , , , | Leave a comment

   

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