The lede:

A new California law requires physicians and health care organizations to provide terminally ill patients with “comprehensive information and counseling” about their legal end-of-life care options upon request.

The measure — known as the Terminal Patients’ Right to Know End-of-Life Options Act — says such patients have a right to be told about hospice care and advance directives, and their right to refuse life-sustaining treatment and to continue treatment while receiving palliative care. Patients also must be informed of their “right to comprehensive pain and symptom management at the end of life,” including “clinical treatments useful when a patient is actively dying.”

The law, which backers said is the first of its kind nationally, was supported by the California Medical Assn. after it was substantially changed. Gov. Arnold Schwarzenegger signed the bill Sept. 30; the law takes effect Jan. 1, 2009.

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The proportion of hospitals with palliative care programs has more than doubled since 2000 to 53% of all facilities with more than 50 beds, according to a study in the October Journal of Palliative Medicine.

But the prevalence of hospital-based palliative care varies widely by state, and about 310,000 seriously ill patients a year lack access to such specialized care, said R. Sean Morrison, MD, co-author of the study and an accompanying state-by-state report card.

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Oregon’s stand as the only U.S. state to provide terminally ill patients with legal access to physician-assisted suicide may come to an end Nov. 4.

Voters in Washington will consider a ballot measure, known as Initiative 1000, to enact a law similar to the one in Oregon. Under I-1000, access to doctor-ordered lethal doses of medication would be limited to adults who live in Washington and who are judged by two physicians to be mentally competent and likely to die of a terminal illness within six months.

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The lede:

The next president will be faced with the question of whether to overturn President Bush’s 2001 executive order banning federal research funding for new human embryonic stem cell lines.

Sens. Barack Obama (D, Ill.) and John McCain (R, Ariz.) have pledged to overturn Bush’s restrictions. But prominent supporters of embryonic stem cell research have raised concerns about what they see as mixed signals from the McCain campaign.

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The lede:

The U.S. transplantation system is approaching a tragic milestone. In late September, 99,728 people were on the United Network for Organ Sharing waiting list.

One waiting patient dies every 73 minutes. Three in four waiting patients need kidneys, with the average wait more than five years.

Yet transplant professionals in Iran — which has the world’s only legal, regulated system of kidney donor compensation — claim to have nearly eliminated that country’s waiting list. If their numbers were adjusted for the U.S. population, the kidney wait list would number 1,307.

Meanwhile, in Spain — which, by law, presumes organ donation after death unless the individual said otherwise while alive — the cadaveric organ procurement rate is 35% higher than ours. If the U.S. could do what Spain does with its presumed-consent law, the U.S. would net nearly 14,000 more organs a year.

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The lede:

It’s flu season. Again.

The good news is this year’s vaccine is in ample supply. But with it, comes a challenge. Physicians should not only seek to immunize as many patients as possible, but also their staff members — and themselves.

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The lede:

The Medical Tourism Assn. in July launched a program to identify medical travel agencies that follow industry best practices.

But the West Palm Beach, Fla.-based trade group’s initiative has drawn fire from hospital accreditation and physician certification organizations who say it could confuse patients seeking reassurance when considering surgery outside the United States.

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The lede:

Without brand-name drug samples to hand out, physicians are three times more likely to rescribe generic medications for their uninsured patients, according to a study in the Septmber Southern Medical Journal.

The study looked at prescribing habits of 70 doctors at a university-affiliated internal medicine practice in the nine months before and after an office move meant losing access to a secure place to store drug samples.

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The lede:

For the first time, physicians and patients can directly compare hospitals’ mortality outcomes for heart attack, heart failure and pneumonia care using the Dept. of Health and Human Services’ Hospital Compare Web site.

The risk-adjusted data on Medicare patients from 2005 to 2007 were unveiled in August and represent the first set of outcomes metrics made available in such detail on the site. Government officials and patient-safety advocates want the new information to help patients make medical decisions and spur hospitals and physicians to make systemic changes to lower their patient death rates.

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The lede:

To avoid leaving sponges or surgical instruments inside a patient after surgery, nurses count these items when a procedure begins and ends. While cases of retained foreign objects are rare — occurring once in every 5,000 surgeries — discrepancies in counts happen in 13% of surgeries, according to an August Annals of Surgery study.

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Lede:

Stem cell scientists in growing numbers say their work is being hampered by restrictions on the financial compensation that can be offered to women who donate oocytes for research.

“Why would a woman take 40 injections and go through everything else involved in oocyte donation in exchange for bus fare?” Dr. Wood asked. “It’s wrong to ask women to go through this process and not pay.”

Limits on compensation are making it hard to find women willing to undergo the time-consuming, often painful process of egg donation, which involves taking a regimen of hormone shots to stimulate oocyte production for surgical retrieval, said Samuel H. Wood, MD, PhD, who is CEO of Stemagen, a private embryonic stem cell research firm in La Jolla, Calif.

The biggest complaints have come in California, where voters in 2004 approved $3 billion to fund stem cell research. California accounts for more than half of federal, state and private U.S. spending in this area, according to an August 2007 study by the Rockefeller Institute of Government and the Alden March Bioethics Institute’s Federalism and Bioethics Initiative.

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The lede:

Primary care doctors say the greatest obstacle they face in prescribing opioids to treat chronic pain is scrutiny from regulators and law enforcement, according to a survey released earlier this year.

But that fear is misguided, says a study in the September issue of Pain Medicine, the journal of the American Academy of Pain Medicine.

Researchers reviewed nine years of medical board and local, state and federal law enforcement charges against doctors for improperly prescribing opioid analgesics. They found that 725 doctors were accused of criminal or administrative offenses from 1998 to 2006. The figure represents about one-tenth of 1% of practicing physicians, or one of every 954 doctors.

“The conclusion of our study is that there is risk [in prescribing opioids]; we’re not denying that,” said study co-author Myra Christopher. “But the risk is manageable and the risk has been exaggerated.”

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The lede:

Measles are coming back. The Centers for Disease Control and Prevention reported that measles outbreaks have reached a peak not seen since 1996. By late August, 131 cases had been confirmed in 16 states.

Almost half of the cases occurred in children who had not been vaccinated because their parents claimed religious or personal exemptions to vaccine mandates.

“This measles outbreak may be a warning shot,” said Paul A. Offit, MD, chief of the infectious diseases division at the Children’s Hospital of Philadelphia. “We now have communities that have a lack of herd immunity. That puts children at risk.”

Other physicians and public health experts are echoing Dr. Offit’s concern. They say states are making it too easy for parents to exempt their children from the vaccines required for school entry. As scientifically unfounded information about vaccine risks swirls around the Internet and among parents, experts say the exemption rate is bound to grow.

But others worry that toughening the opt-out process, or just talking about mandates, could lead to an even greater loss of public trust in the immunization system.

The whole shebang.