My lede:
For nearly two decades, the medical and legal consensus has been that it is permissable to withdraw life-sustaining artificial hydration and nutrition from adult patients in a persistent vegetative state. But should that standard apply to children, too?
Yes, it should, but only if their parents agree, according to a new position statement issued by the American Academy of Pediatrics’ Committee on Bioethics and published in the August Pediatrics.
The whole shebang.
My lede:
Federal authorities in July charged a Brooklyn, N.Y., man with conspiracy to violate the federal law banning buying or selling of human organs. If the allegations are true, it would be the first documented case of a black market for organs for transplant operating in the U.S., and experts said it could undermine public confidence in the country’s organ system.
A criminal complaint filed in the U.S. District Court of New Jersey alleges that Levy Izhak Rosenbaum asked an undercover FBI agent for $160,000 to line up an unrelated living kidney donor from Israel. The agent pretended to be a longtime secretary of a cooperating witness and in need of a kidney for an uncle waiting on a transplant list in the Philadelphia area.
“This kind of thing happens in Third World countries. There have been suggestions of it happening here, but I just never believed them,” said Joren C. Madsen, MD, DPhil, president of the American Society of Transplantation and director of the Massachusetts General Hospital Transplant Center.
The whole shebang.
My lede:
Pressure is mounting on Capitol Hill to reveal the financial relationships among doctors, drug companies and devicemakers through the Physician Payments Sunshine Act.
Six states already have enacted payment-disclosure laws or bans on gifts to doctors. Meanwhile, more medical centers are restricting doctors’ and students’ interactions with industry, as calls grow for medical societies and educators to turn down drugmakers’ dollars.
But now some doctors and physician organizations say the push to police financial relationships with industry has gone too far.
The whole shebang.
My lede:
Alzheimer’s disease is unpreventable and largely untreatable. Though genetic testing can tell patients if they have an elevated risk of developing the condition, the expert consensus has been that disclosing such information would distress patients while giving them no medical benefit.
That consensus may be wrong, according to a study in the July 16 New England Journal of Medicine.
The whole shebang.
My lede:
The board that administers New York’s stem cell research funding program recently approved using state money to pay women who donate fresh oocytes for an experimental technique called somatic cell nuclear transfer, also known as therapeutic cloning.
The policy makes New York the first American government body, state or federal, to use taxpayer dollars to do more than reimburse egg donors for direct expenses incurred in donating. Opponents of the move said it would encourage women to undertake a painful, sometimes risky procedure for speculative research.
The whole shebang.
My lede:
The Food and Drug Administration in January 2008 advised parents to avoid giving over-the-counter cough and cold medicines to children younger than 2 because potential overdosing risks outweigh the symptom-relieving benefits. But a new study found that many parents are confused by medication labels that say “infant” or display child-friendly graphics such as pictures of teddy bears.
The whole shebang.
My lede:
Apple Inc., maker of devices such as the iPod and the iPhone, is headquartered in Cupertino, Calif. The company’s CEO, Steve Jobs, lives in the area. Yet when Jobs needed a transplant to replace his liver, diseased by the spread of pancreatic cancer, the iconic Silicon Valley executive did not get his new organ at nearby Stanford University Medical Center — or anywhere else in California.
Instead, he traveled more than 2,000 miles to Methodist University Hospital Transplant Institute in Memphis, Tenn., where the wait list for a liver is about 80% shorter, according to data from the United Network for Organ Sharing. The median wait for a man Jobs’ age to receive a liver in the organ-allocation region where Memphis is located is 543 days — about a third the wait time of Jobs’ home California region.
The case highlights longstanding regional disparities in wait lists for life-saving transplants and has reignited debate over how a few well-to-do patients are able to register as potential recipients at distant centers to better their odds of getting an organ. These inequities in the nation’s organ-allocation system should be addressed, say transplant physicians and medical ethicists.
The whole shebang.
My lede:
Protecting patients from harm is medicine’s bedrock goal, but the resources required to do so have never come cheaply. With the recession taking its toll on the health sector, doctors and other medical professionals who have tackled problems ranging from hospital-acquired infections to patient falls find their efforts increasingly scrutinized on dollars-and-cents grounds.
Ninety percent of hospital CEOs have cut administrative expenses, staff and services amid the recession, according to a survey of more than 1,000 chief executives released in April by the American Hospital Assn. More than three-quarters said they cut capital spending and nearly half scaled back ongoing projects.
The moves come at a time when hospitals already are facing a changing payment landscape. For example, the Centers for Medicare & Medicaid Services and many private payers have cut or stopped paying for “never events,” such as wrong-site surgeries.
President Obama has proposed bundling payments for hospitalization and care 30 days postdischarge, penalizing hospitals with high one-month readmission rates. The administration says the move would save $8.4 billion and give hospitals more financial incentive to reduce the 20% 30-day readmission rate among Medicare patients.
Given all that, it was no surprise to hear phrases not frequently uttered in patient-safety circles — cost-benefit ratio, return on investment, cost effectiveness — flutter about the 2009 Patient Safety Congress convened in May. The annual event, organized by the Boston-based National Patient Safety Foundation, brought more than 1,200 doctors, nurses, pharmacists, patient-safety officers, risk managers and hospital executives to National Harbor, Md., across the Potomac River from the nation’s capital.
The whole shebang.
My lede:
Primary care doctors fail to inform patients of about one in 14 abnormal test results, according to a study of 5,434 medical records at 23 physician practices in the Midwest and on the West Coast.
Few practices have rules on how to manage test results and often leave the process to individual physicians, according to the study published in the June 22 Archives of Internal Medicine. Having electronic medical records was no guarantee of better test-results tracking.
The whole shebang.
My lede:
The controversy surrounding the medical care pop star Michael Jackson received before he died at age 50 in late June has drawn attention to the difficulties doctors face when caring for high-profile patients.
There is little ethical or clinical guidance for physicians that specifically addresses celebrity patients and how to ensure that their fame does not interfere with delivering the right medical care.
The whole shebang.
I mean, I always thought so, but now it’s been confirmed by an outside source.
The American Society of Business Publication Editors‘ Midwest-South Region handed out its annual “Azbee” awards last night and I was a winner. One of my articles from last year — “Oregon still stands alone: Ten years of physician-assisted suicide” — won the gold award in the feature article category.
Here are the first few grafs of the story, which ran months before Washington became the second state to legalize doctor-aided dying:
It was 10 springs ago that a Portland woman in her mid-80s sat to talk about her impending death. Doctors guessed the metastatic breast cancer wracking her body would kill her within two months. As the city shook off its winter slumber, the woman — whose identity is still a secret — anticipated her eternal rest.
“I’m looking forward to it,” she said in a recording later made available to reporters. “I can’t see myself living a few more months like this.”
Disease set her on the path toward death, but the woman was determined to choose when and how to take her final steps. For that, she needed a doctor’s help.
On a Tuesday in 1998, in the presence of her family, she became the first patient to commit suicide with a physician’s aid under Oregon’s Death With Dignity Act.
A physician prescribed a lethal dose of barbiturates. The woman washed down a mixture of the medication and syrup with a glass of brandy and died shortly thereafter.
Whether the path chosen was a victory for patient autonomy or an ethical tragedy depends upon one’s view of this wrenching issue. But what is clear — and what comes as a surprise given the predictions of supporters and opponents of physician-assisted suicide — is that it is a path still lightly traveled.
Through the end of last year, only 340 more Oregonians had chosen physician-assisted suicide. And after a decade, Oregon still stands as the lone state to legalize the practice.
There is no tidal wave of patients moving to Oregon to die, and there is no evidence of a slippery slope toward involuntary euthanasia there, as opponents once feared. At the same time, there is no sign that many states will rush to follow Oregon’s lead on physician-assisted suicide, as supporters still hope.
Though Oregon’s law remains seldom used and unduplicated, its impact on physicians, patients and the movement to improve end-of-life care cannot be overstated.
The whole shebang.
My lede:
The Food and Drug Administration is falling short in how stringently it evaluates medical devices before they are approved and how well it detects problems with the products once they hit the market, according to a Government Accountability Office report issued in June.
“These shortcomings … raise serious concerns about FDA’s regulation of medical devices,” concluded the GAO report.
The whole shebang.
My lede:
Dad needs a new kidney. His son, wanting nothing more than to return the gift of life his father gave him, gets tested to see whether he can donate a kidney. But the test reveals that he is not just a bad match, but also not biologically related to the man he believes is his father.
In such a situation, are physicians and other transplant professionals obliged to tell what they have learned about the paternity? If so, whom do they tell?
Although rare, wrongly attributed paternity is discovered during histocompatibility testing in 1% to 3% of all living kidney donations, according to a study of U.S. and Canadian transplant data published May 27 in the journal Transplantation.
The whole shebang.
kboreilly.com 
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