"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
More News from the Genetic Revolution: On Friday, an Italian infertility researcher suggested in a conference in the Middle East that he had created a human clone and that it was residing in a woman's womb somewhere in the world at about eight weeks gestation. Since giving that tantalizing tidbit, he's been mysteriously quiet. Meanwhile, our own Senate is set this week to consider making human cloning illegal.
No one knows if the Italian has succeeded in creating a human clone or if he was just indulging in some braggadacio, but his acknowledged attempts to do so should give us pause. We already know that human manipulation of the genesis of life can have unintended consequences. There are more complications among babies born of in vitro fertilization, than occur in those conceived naturally, and cloning involves far more manipulation of eggs and genetic material than in vitro fertilization does. Furthermore, we don't yet know what the long-term effects of this manipulation may have over the course of a lifetime. When Dolly the sheep was cloned, her genetic material was the same age as her donor's , meaning she was chromosomally older than her chronological age. This could have extensive ramifications for a human clone. It could mean a higher incidence of early cancer, Alzheimer's, Parkinson's, and other diseases of old age in a cloned person. If you are born with thirty-year old chromosomes, are you going to have the health risks of a fifty year old when you are twenty? No one knows.
It seems cruel to bring a life into this world knowing those possibilities exist, especially when there are other alternatives to treat infertility, including adoption. We are only now beginning to learn the effects of assisted reproduction on the offspring, both medically and psychologically. One can't help but suspect that the motive behind the Italian researcher's efforts is rooted in gaining glory and renown rather than altruism. He clearly could not have the best interests of his patients at heart to proceed with such an attempt. Scientific American published a review of cloning a few years ago that predicted just such an act by just such a man:
“One would hope that such research will be done openly in the U.S., Canada, Europe or Japan, where established government agencies exist to provide careful oversight of the implications of the studies for human subjects. Less desirably, but more probably, it might happen in clandestine fashion in some offshore laboratory where a couple desperate for a child has put their hopes in the hands of a researcher seeking instant renown.”
Well, the future is now. It's too early to tell if the Italian will be successful. Miscarriages are common in the first twelve weeks of pregnancy, and the clone may not be perfect enough to survive nature's process of elimination. There is no doubt, however, that he and others like him will try and try again until they achieve their goal, unless they are stopped. We know too little to fool around with life at this level. To think otherwise is sheer arrogance. posted by Sydney on
4/07/2002 01:03:00 PM
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Keep using the baby shampoo until they reach dating age.
I'm always skeptical about the supposed earlier puberty that girls are going through. Some people have tried to blame it on milk and the dairy industry, now the shampoo industry is getting hit with the blame. The thing is, we really don't have any good data on the rates of development in the past, so there is no good comparisons to back up the claim that girls are maturing faster. Also, development and growth depend on so many factors (nutrition, genetics, etc.) that it's almost impossible to finger one lone culprit among a diverse population. posted by Sydney on
4/07/2002 09:04:00 AM
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They're being forced to send their prescriptions in to a mail-order firm, AdvancePCS , instead of filling them at the pharmacy of their choice. The mail order firms can offer cheaper prices because they grab large volumes of customers by signing deals like this with insurance companies, employers, and unions. The trend is driving small, independent pharmacists out of business, and it's having it's effect on the chain stores, too. The disadvantage to the mail-order system, and it's a big one, is that there are no pharmacists for the patient to consult when there is a problem. I've had patients tell me the pill they got in the mail is a different color and shape than the one they received last time and they aren't sure if there was an error in the dispensing. I can't tell, either, since the color and shapes of pills vary by manufacturer. Only the pharmacy can tell if there was an error or just a change in supplier. When that happens at a local pharmacy the patient can take the pill back and check with the pharmacist. No such luck with the mail-order firms. Half the time you can't even get a person to answer the phone, only a prerecorded message that has no directions for "speaking to a pharmacist".
Mail order pharmacies like Advance PCS also use their captive audiences to practice big brother medicine in the guise of their “disease management” program. They send mailings out once a month suggesting changes in patient medications. When they were owned by Eli Lily it was always a request to change to a medication made by Eli Lily. Sometimes it wasn't even a request to change medicine, but one to initiate a medication. For instance, to start Evista for osteoporosis prevention because the patient was a woman over fifty. When that happened, I began disregarding them completely, and I still throw them away without reading them. I didn't realize until now that they are no longer owned by Eli Lily. I'll probably read the next one they send, but I doubt it will change my therapy. How could it? They haven't examined and talked over the treatment options with my patients, only I have. How can they presume to suggest that they know what's better for them? posted by Sydney on
4/07/2002 08:59:00 AM
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Saturday, April 06, 2002
Who's Prejudiced? The biographical information on the committee and staff behind the Institute of Medicine’s report on the inherent racism of physicians provides evidence that the people behind the report may be laboring under prejudices of their own. Here are some of the notables (italics are mine):
Martha N. Hill, Ph.D., Co-Vice Chair: Interim Dean, Professor, and Director, Center for Nursing Research, at Johns Hopkins University School of Nursing. Her research interests are hypertension and diabetes care and control in urban African American communities. “Her most recent work includes research on barriers to hypertension care and control, and dispelling myths about urban Black men and hypertension.”
Joseph R. Betancourt, M.D., MP.H., Senior Scientist, Institute for Health Policy and Director for Multicultural Education, Multicultural Affairs Office at Massachusetts General Hospital-Harvard Medical School. His “primary interests include cross-cultural medicine, minority recruitment into the health professions, and minority health/health policy research. ..and exploring root causes for racial/ethnic disparities in health”
M. Gregg Bloche, M.D., J.D., Professor of Law and Co-Director of the Georgetwon-Johns Hopkins Joint Program in Law and Public Health. “His recent and current scholarship addresses efficiency and fairness issues, the interplay between medical markets and the law, patients’ rights, and socio-economic and racial disparities in medical care.”
W. Michael Byrd, M.D., M.P.H., Senior Research Scientist and Instructor in the Divison of Public Health Practice at the Harvard School of Public Health, and Instructor in the Division of Public Health Practice at the Harvard School of Public Health, and Instructor and Staff Physician at Beth Israel Deaconess Hospital. “His work focuses on health policies that impact African American populations and other disadvantaged minorities. He also has expertise in the medical and public health history of African Americans.”
John F. Dovidio, M.A., Ph.D., Charles A. Dana Professor, Department of Psychology and Interim Provost and Dean of the Faculty at Colgate University. His research interests are “in stereotyping, prejudice, and discrimination; social power and nonverbal communication; and altruism and helping...[He] shared the 1985 and 1998 Gordon Allport Intergroup Relations Prize with Samuel L. Gaertner for their work on aversive racism and ways to reduce bias.”
Jose J. Escarce, M.D., Ph.D., , Senior Natural Scientist at RAND, and co-director of the Center for Research on Health Care Organization, Economics and Finance. He has “studied racial differences in the utilization of surgical procedures and diagnostic tests by elderly Medicare beneficiaries, and was lead investigator of a study of racial differences in medical care utilization among older persons...He was co-investigator of study that..[assessed] the impact of patient race and gender on physician decision making for patients with chest pain...[and] is currently working on several projects that address sociodemographic barriers to access in managed care.”
David R. Williams, Ph.D., M.P.H., Professor of Sociology and Senior Research Scientist at the Institute for Social Research at the University of Michigan.He is “interested in social and psychological factors that affect health and especially in the trends and the determinants of socioeconomic and racial differences in mental and physical health.”
Brian D. Smedley, Ph.D., Senior Program Officer in the Divison of Health Sciences Policy of the Institute of Medicine: He was Study Director for the Institute of Medicine report "The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved." He adds the following tidbit to his biographical information:
“On a personal note, Dr. Smedley would like to acknowledge his godfather, Dr. Charles H. Wright of Detroit, Michigan. Dr. Wright was an obstetrician whose tireless efforts to increase awareness of the rich history of African peoples and their descendents in America and throughout the world...”
Adrienne Y. Stith, Ph.D., Program Officer in the Division of Health Sciences Policy of the Institute of Medicine. She “worked in the areas of ethnic health disparities, mental health services for children in schools, and racial profiling.”
These committee members seem to have an overwhelming interest in racial discrimination, don’t they? Even if they didn’t bring to the table their own ideological biases, which is hard to believe, many of them have ongoing research projects that involve exploring the impact of race on medical care. This in itself is reason to suspect them of bias, since their research grants depend on keeping the public interest focused on racism as an issue.
Most amazingly, the report itself admits to its biases. In describing the committee's review of the literature, it says, on p. 492, (italics, again, are mine), that “..a finding of no racial or ethnic differences in patient outcomes (e.g. survival) despite disparate rates of treatment should not be interpreted as demonstrating that disparities in the use of medical intervention are inconsequential. In such instances, researchers should ask whether equivalent rates of intervention might be associated with better patient outcomes among minorities.” In other words, they should assume that things could be better than they are. Furthermore, they described the thirteen studies they reviewed in this way: “Two found no evidence of racial and ethnic disparities in care after adjustment for racial and ethnic differences in insurance status, comorbid factors, disease severity, and other potential confounds...Almost all studies found that adjustment for one or more confounding factors reduced the magnitude of unadjusted racial and ethnic differences in care. Among the five studies that collected data prospectively, however, all found racial and ethnic disparities remained” In other words, we’re going to ignore the studies that disagreed with our preconceived notions, even though they outnumber the ones that back us up.
This isn’t science, it’s fraud. It belies the mission statement of the Institute of Medicine, which is “to provide objective, timely, authoritative information and advice concerning health and science policy,” and sullies the reputation of the National Academy of Sciences to which the Institute belongs. The shame of it is that no one will have the courage to speak out against the report for fear of being labeled a racist.
I actually know someone who complains incessantly about the price of his diabetes medication but doesn't bat an eyelash at spending his hard-earned cash on this stuff. posted by Sydney on
4/06/2002 08:14:00 AM
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I’ve often witnessed this back-stabbing phenomenon among nurses in the hospital, and each time I do I say a silent prayer of thanks that the majority of my colleagues are men. posted by Sydney on
4/06/2002 08:11:00 AM
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More on the genetic revolution: NBC has an excellent write-up about the important differences genetic advances will make in our lives.
While cloning gets all the media attention, it's this sort of small treatment and diagnostic advances that will make the greatest difference in the future of medicine. Even if we decide as a society that cloning is ethical and worthwhile, it will never be something that is done routinely. Natural reproduction is so much more reliable and more fun that it's unlikely to ever be supplanted by cloning.
But being able to understand each person's genetic make-up and to use that information to provide treatment tailor-made to their body's blueprint is so exciting it gives me the shivers. We stand at the threshold of a new era of medicine, and one that will prove just as ground-breaking, and possibly moreso, than the era ushered in by microbiology advances at the beginning of the twentieth century. posted by Sydney on
4/06/2002 07:53:00 AM
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Sign seen in an independently-owned pharmacy:
DISCLAIMER:
Although we may be listed on your national drug plan
through our wholesaler network, we reserve the right to
reject any plan which we consider an insult to our
profession.
Kaiser sues Geneva Pharmacueticals for conspiring with Abbott Laboratories to keep generic Hytrin off the market.
The suit claims that Geneva paid Abbott $4.5 million dollars not to market its generic version of Hytrin, a drug used for prostate problems and high blood pressure. Three months worth of the generic version of Hytrin costs $18 , the brand name version sold by Geneva costs $137. Tsk. Tsk. posted by Sydney on
4/05/2002 06:12:00 AM
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I'm surprised that D.A. Henderson is dragging his feet on offering smallpox vaccine to everyone who wants it now that it's available. I attended a lecture of his, given before Sept. 11, about smallpox and bioterrorism that scared the bejeezus out of me. I say offer the vaccine to everyone and let each individual decide if it's worth the risk. posted by Sydney on
4/05/2002 06:11:00 AM
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Pakistani doctors go on strike: But they aren't striking over anything as mundane as consulting fees. They're on strike because they're being killed by Islamic extremists and the government doesn't seem to care. (NPR did a story on this a few weeks ago, too, but I lost the link) posted by Sydney on
4/05/2002 06:03:00 AM
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Celebrity Medical Watch:Yasir Arafat's Check-Ups. (Thanks to Best of The Web Today) Does anyone else think it odd that the physician who "regularly examines" Arafat is a neurologist? That tremor in his lip must be more than old age. It probably is Parkinson's or some other neurological disorder. posted by Sydney on
4/05/2002 06:03:00 AM
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Thursday, April 04, 2002
Derek Lowe waxes depressive about modern medicine in a post from yesterday. At least he starts out that way and then becomes wildly optimistic about its future. I have to disagree with his premise that we “have no wonderful therapies for much of anything.” We do. We may not be able to cure all cancers yet, but there are a lot that we can cure or prevent. Cervical cancer, for example, used to be a common killer of young women, but now death at its hands is virtually unheard of in developed (read affluent) countries thanks both to pap smears and successful treatments of its early precursors. We may not have medication that makes headaches disappear in seconds, but we do have medication that makes them disappear in minutes. Cuts may not heal in seconds, but it’s the rare person now who dies from tetanus or sepsis as a result of the cut. As for arthritis, Alzheimer’s, osteoporosis, and Parkinson’s, and even most cancers those are all diseases that are prevalent today solely because our life spans are longer, thanks in large part to the advancements we’ve made against infectious diseases and heart disease. Yes, it’s true that bacteria are growing resistant to our armamentarium, but we still beat them the vast majority of the time with antibiotics; and yes, it’s true that with the exception of HIV we have few effective anti-viral agents, but on the other hand we have few deadly and highly contagious viruses. The hemorrhagic viruses, though deadly, deplete their supply of hosts before spreading any further than a small geographic area. They are nothing compared to the scourges we have conquered. Polio is rare where it was once commonplace, smallpox has been irradicated except as a bioterrorist threat, and even lowly chickenpox has declined significantly in the past five years all thanks to immunizations. To be sure, there is much that we do not yet understand about our bodies and what ails them, but we are light years away from where we stood even fifty years ago.
And what does the future hold? Surely, there will be breakthroughs in treating many diseases that baffle us now, but old age isn’t one of those diseases. Old age and our ultimate mortality is as much due to wear and tear and the passage of time as it to disease. Everything must come to an end in this finite world, and our bodies are no exception. We will probably never be able to arrest or turn back that process, but we will continue to find ways to treat the symptoms and consequences of it; and the longer we live, the more of them there will be. It is there, I fear, that we will end up spending more and more money with each medical advancement, for old age and its consequences are a curse none of us can escape if we survive all the other perils of life. posted by Sydney on
4/04/2002 09:42:00 PM
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Evidence that it's affluence, not race that determines the quality of medical care. (And I bet it won’t show up on the front page of the NY Times) Addendum: It didn't. The story on
kissing cousins did instead (link requires registration)
When breast cancer outcomes were compared within the same socioeconomic class, all race distinctions disappeared. Cancer was diagnosed later in women of all races if they were poor. This is important. The nefarious report last week by the Institute of Medicine that racism was the cause of differences in health care needs to be shouted down. There are many people in this country who do not have access to good medical care, and they are from all races. Blaming racism for the disparity does nothing to solve the problem. It only inflames passions and distracts attention from the real cause. The Institute of Medicine could have acted responsibly and given an honest report about the root causes of medical inequality in our country, but they chose instead to let their own prejudices bias their report. This is doubly unfortunate since they are the body that advises Congress in medical matters. As the editorial in the Journal of the National Cancer Institute, which published the breast cancer study, so succinctly puts it:
“....finding the true reasons for the difference in medical outcome is important if we are to effectively reduce it....Rather than speaking in racial/ethnic terms of black and white populations, it is more appropriate to speak in socio-economic terms of the 'haves' and the 'have nots. This focus would rightfully bring other socio-economically deprived populations that include whites, Hispanics, Native Americans and Asians into the discussion." posted by Sydney on
4/04/2002 07:26:00 AM
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The Canadians brace themselves for drug advertising. They had better think twice before allowing it. Based on our experience here, they will see their drug costs sky-rocket enough to bankrupt their national health system. posted by Sydney on
4/04/2002 07:25:00 AM
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Here’s a study that shows when teenage mothers hand over their children to their own mothers to raise, the children end up with more behavior problems. This comes as no surprise. Having failed to raise their own children properly, why would they be any better at raising the next generation? Not willing to risk sounding judgemental, the author tries to lay the blame on the teenage mothers, but the data doesn't back this up. The children had more problems if they were raised by the grandmother regardless of whether or not their mothers had emotional problems, and kids raised by emotionally troubled mothers alone without grandma’s input, had fewer problems. I’ve noticed this in my own practice, too. The grandmothers more often than not end up interfering with the young mother’s decisions and eventually the young mom gives up and hands everything over to her mother. The successful ones are the ones who move out on their own and assume full responsibility for raising their child. posted by Sydney on
4/04/2002 07:24:00 AM
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Oh, brother. I can see it now, people of all sizes, fit and thin, will be badgering their doctors to write them a note for the IRS saying their health club memberships are medically necessary. posted by Sydney on
4/03/2002 06:26:00 AM
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Genetic Revolution II: Thanks to the results of the human genome project, researchers are discovering ways to use genetic information to tailor treatment for individual patients. In this case, they’ve identified genes that make patients susceptible to side effects of the anti-HIV drug abacavir. Identifying patients who carry the genes makes it possible to chose a different therapy for them and thus avoid serious side effects. In yet another breakthrough in this area, researchers have identified a gene that predicts if a woman’s cholesterol profile will improve with estrogen replacement therapy.
Forget cloning, that won’t impact medicine beyond a few elites who can afford the technology. It’s developments like this that represent the true promise of molecular genetics, and the one that will have the most bearing on the future of medicine. Imagine being able to tailor medical therapy to a patient’s unique genetic makeup. No more guessing and taking chances. We’re nowhere near that point yet, but make no mistake, this will be the wave of the future. posted by Sydney on
4/03/2002 06:22:00 AM
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What?! They let thousands of pharmacologically active herbs be sold as dietary supplements, yet eggs from vaccinated chickens are considered drugs? If antibodies from the vaccinated chickens actually show up in the chicken eggs (which I doubt), are they even biologically active after passing through the consumer's digestive system? The irony here is that the egg farmer got in trouble because she actually tried to test her product's effectiveness. If she had just sold them and made outrageous claims for their benefits she never would have come under fire. posted by Sydney on
4/02/2002 07:36:00 AM
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Should you have your kids checked out if they snore?
The American Academy of Pediatrics has issued a treatment guideline on childhood snoring that says “yes”, but the full report leaves one wondering why?
The guidelines were the result of a panel of physicians sitting down and reviewing 2067 articles on snoring and sleep apnea in children. (Well, they didn’t all sit down and review them, some of them were handed over to residents and fellows to do the hard work of digesting them.) They then combined the different data together, when they could, to come up with conclusions about snoring. A lot of the data was so divergent, however, that they couldn’t combine them. They can’t even agree on the prevalence of snoring in children. It could be anywhere from 3% to 12%. Treatment of snoring didn’t seem to make much difference. Grades improved from an average of 2.43 to 2.87 (not enough to make the honor roll), treatment “did not result in any statistically significant improvement in development or temperament,” and in some studies it did not make any difference in height, although treated children did gain weight. Furthermore, they can’t agree on how to diagnose problem snoring in children:
“One of the problems in evaluating various methods of diagnosing OSAS (obstructive sleep apnea syndrome) in children is that the gold standard, overnight PSG (polysomnogram, or sleep study), has not been well standardized in its performance or interpretation. Although recent consensus statements pertaining to standards and normative data should lessen this problem, the question of definition remains problematic.” (parenthetical statements are mine)
It’s not clear why the AAP decided to publish the recommendations when they are based on such weak data. It’s almost as if the panel did all that hard work then hated to admit it wasn’t worth the effort posted by Sydney on
4/02/2002 05:40:00 AM
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A Seattle nurse claims to have come up with a compound that alleviates the fatigue of MS. Her study involved only 27 patients: 22 took the drug, and 5 did not. They claim a 37% reduction in fatigue in the 22 who took the drug, but what does that mean when it's compared to a control group of only 5? Also, her compound includes caffeine which in itself is a stimulant, and thus could be responsible for the effect. Neurologists are rightly skeptical about the study and the drug. Meanwhile, the nurse sees it as an alignment of an "old boy's club" against her. Baloney. posted by Sydney on
4/02/2002 05:35:00 AM
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Does this really only happen in women? Aren't there an equal number of men out there who feel "tired, stressed, and eat too much"? Judging from my practice there are. They just can't blame "hormones" for the problem. Instead they blame their bosses, the economy, and their wives. Who knows if it was the sunlight, the exercise, or the vitamins, or all three that made them feel better? Can’t tell since they were all three combined, but it was probably the exercise and the sunlight. Nothing like fresh air and exercise to perk up a sagging soul. posted by Sydney on
4/02/2002 05:34:00 AM
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CORRECTION: Reader David Margolies correctly points out that I erred in a fundamental fact when commenting on Father Conway, the confessed pedophile priest who is on disability retirement. Father Conway was not caught in bed with a boy by a nun. The nun found the boy alone in the priest's bed. The Newsweek article doesn't elaborate on what Father Conway told his superiors, but he did leave the parish after the incident. I stand corrected, and I apologize for the error. posted by Sydney on
4/01/2002 07:08:00 PM
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SMALLPOX: The drug company Aventis, has agreed to donate their surplus smallpox vaccine to the government. Meanwhile, researchers have found that the vaccine is also effective if diluted. This means that suddenly, there is enough vaccine to offer it to everyone, and the Bush Administration is considering doing just that. (Interesting that it's the Department of Health and Human Services who is involved in this and not the CDC. Does this mean the Adminstration realizes the CDC has failed to adjust it's priorities post-September 11?)
Right now, the CDC policy is to vaccinate only those in the immediate area of an exposure in the event of a bioterror attack. This makes sense when the supply of vaccine is inadequate to vaccinate everyone. Now, however, it’s time to rethink that position. Here is a persuasive argument in favor of mass immunization. The vaccine is not without
risks. In fact, it is a riskier vaccine than we have grown accustomed to expect. Smallpox, however, is more deadly and more contagious than anything we’ve faced in modern times. One poorly defended smallpox attack, and we will never refer to AIDS as a plague again. The benefits of vaccinating the population would be well worth the risks. I know I would have my family immunized if given the chance.
