This is a special shout out to the doctors and scientists out there. Everything we do in our fields has repercussions, often unexpected ones. Because of this, we strive to practice ethically to help prevent or minimize negative repercussions.
This discussion comes up specifically as an epiphenomenon of the release of The Immortal Life of Henrietta Lacks (my full review can be found here.) How one reacts to this book would, I suppose, depend on your perspective. A neighbor of the Lacks's might react quite differently than a 22 year old doctoral student. And that's really the point.
This book should be required reading for young scientists and medical students. Ethical practice is important because it recognizes the fact that many negative outcomes are unexpected, and that we as physicians and scientists cannot always anticipate these negative outcomes.
It's good to see some of the comments appearing online about the book, even though many of these are from folks who haven't read it (it's being released on February 2nd). It's natural to become defensive when your beliefs are questioned. Some of the more interesting comments appeared at Ed Yong's place. To catch you up, HeLa is cell culture used in labs around the world. It was derived from a young woman named Henrietta Lacks, a woman dying of cervical cancer in a segregated hospital in 1950's America.
I have to say I completely disagree. Cell lines are derived from Humans on a regular basis, I use cells from a man who died from colon cancer and a young girl who had neuroblastoma. What exactly is the issue here? Would this fuss be made if she hadn't been black and poor? I doubt it.
Her cells were useful but they're not unique and why should her family get money for her cells when other families don't? I've read an article by the author of this book and it was self aggrandising overblown nonsense.
Trying to conflate the real racially motivated problems in the US with this type of cancer research is just insulting to everyone involved, in my opinion.
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It's a cold day here in
Lake Woebegone southeast Michigan. I'm looking out the kitchen window at the thermometer: +11 F, which is apparently the same -11 C. From my kitchen table, I can see the neighbors let out the dog, who seems unfazed by the cold. He's some sort of little fuzzy white dog and he's currently sniffing happily. It's not quite cold enough for the air to have that extra clarity you see when it gets really cold, but I'm still not rushing outside.
It's pretty cold upstairs. We probably need to replace more of the windows, and I'm not so sure about our insulation, so we were cozily nested deep under the covers, sleeping the way you do when the air is cold and the bed is warm. This is, until there was a little knock on the door, and suddenly a third body in the bed saying, "I'm hungry I'm bored can we play I'm hungry can I have waffles now how come you're not saying anything?"
So now I'm down at the kitchen table, watching the neighbor's dog sniff around the trees. I'm drinking and enjoying my coffee (I can quit any time, really), and waiting for my Irish oatmeal to finish cooking so that I can pour some Michigan maple syrup over it.
If you are not blessed to live in a part of the country that makes maple syrup, you need to go find some. I don't know what's in those other syrup bottles (OK, I do, I just don't like to think about it), but real maple syrup started out in a maple tree in the late winter/early spring when a Michigander pounded taps into his maples and hung buckets on them, collecting the sap (unless he has one of those fancy vacuum systems). He collected the buckets, poured them in a vat, and cooked it down, filtered it, and bottled it. Now I'm eating it.
At some point I'm going to head out into the cold and make my way to the hospital, but meanwhile, it's coffee and oatmeal time.
In other news, I've posted my review of The Immortal Life of Henrietta Lacks. I posted it over at another site because I'm experimenting with reaching out to other audiences. I already have one post about the book here, and I hope to post more, since this is one of the best medical history books I've read in a while.
Happy wintry Saturday!
"...It never was our guise
To slight the poor, or aught humane despise:
For Jove unfold our hospitable door,
'Tis Jove that sends the stranger and the poor..."
---Homer: The Odyssey, Translation by Alexander Pope
A few weeks ago, Drugmonkey wrote a piece
about perceptions of drug users. Specifically, the study looked at how mental health providers perceive people with substance use disorders depending on whether the patients were referred to being a "substance abuser" vs. having "a substance use disorder." These data revealed something interesting. Among the mental health professionals:
...those assigned the "substance abuser" term ... were significantly more in agreement with the notion that the character was personally culpable for his condition and more likely to agree that punitive measures be taken...
[they were more likely]...to convey internal causal attribution and personal culpability, a moral vs. medical
solution, suggesting the character has volitional control and might be viewed as a "perpetrator"who is willfully engaging in the behavior and thus more deserving of punishment.
I would not be surprised if these results were reproducible in primary care physicians. People with substance use disorders can be difficult to care for even before we layer on our own prejudices. Anecdotally speaking, substance abusers can be needy, stubborn, and narcissistic. They can behave inappropriately and show little respect for boundaries. These behaviors set off a whole set of reciprocal behaviors in providers. If a patient demands a narcotic medication, the reaction is often to become angry and say "no" without responding to the underlying pathology (not, that is, the pathology of the back pain, but the narcotic dependence).
This phenomenon has been documented
in various ways over the years but I've found little in recent literature examining physicians' attitudes toward people with substance use disorders. Today, though, I found an interesting article just published in the journal Addictive Behaviors
which looked specifically at doctors' attitudes toward prescribing opiates in patients with a history of substance abuse. The study's findings resonated with me, and I suspect they would with many doctors.
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I'm hard on hardware, apparently. My current computer, an hp tablet, is falling apart. I need to start thinking about replacement. Cost is the number one issue, so I was thinking about an Acer or a Dell Mini or similar product.
I use my computer all day, every day, for work and for writing. My hospital and my office use IT systems that requires Windows.
So, geeky folks, I need some suggestions. What have you folks found to be useful and economical?
Salmonella is lots of fun. Human infection usually involves fever, abdominal cramping, and diarrhea, which is often bloody. Salmonella infections are reasonably common, especially food-borne outbreaks. It's unknown exactly how many people in the U.S. suffer from salmonellosis each year since many probably never seek medical care or never have a stool culture done. The CDC gets approximately 40K reports of salmonella in the U.S. each year with about 400 deaths (the real case number is estimated to be closer to 1.4 million). Most of these cases are preventable.
There are two large outbreaks currently under investigation by the CDC. The first is a bit odd. It involves frogs.
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After learning of the British vicar who sent the cops after a blogger, I decided to read up a bit more about this guy.
Sizer is a Mideast activist. By "activist", I mean that he sees the State of Israel as an abomination. He has revisionist ideas about Middle East history which he feels was influenced by "the Zionist lobby". What's interesting is his condemnation of the insane rantings of the Evangelicals who want to see the Temple rebuilt in order to bring about the End Times. In fact, he seems to believe that it was misguided Christians who were responsible for the founding of the State of Israel:
In the Middle East, this is largely due to the influence of European Christians who, nearly 200 years ago, believed it was their destiny to assist the Jewish people in colonising Palestine. This movement which became known as Christian Zionism, gave rise not only to Zionism and the founding of the State of Israel, but also to the Palestinian Nakba and the Arab-Israeli conflict.
This is a horrid misreading of history. While there were certainly Christian and secular supporters for the founding of Israel, there was also religious and non-religious opposition. There are parts of the modern Evangelical movement that are strong supporters of Israel, but this support is predicated on the idea that when The End comes, the Jews are fucked.
Sizer emphasizes the human rights tragedy of the occupied territories, which is a good thing, but he does so in the context of his critique of "Christian Zionism" which he condescendingly reminds us is "bad for the Jews."
Religious arguments regarding Mideast Politics are fruitless and idiotic. There is real, secular human suffering on the ground. Tossing an additional religious match into the tinderbox is cruel. If you care about peace in the Middle East, fight for it politically, condemn the violence of the occupation and the terrorist tactics supported by hypocritical, self-serving Mideast dictatorships. Sizer's "anti-Zionist" rhetoric flirts closely with outright anti-semitism and ignores the fact that millions of Jewish Israelis are there already.
But the guy's a hypocrite anyway. He's a proud member of the Fellowship of Confessing Anglicans who profess belief in:
the unchangeable standard of Christian marriage between one man and one woman as the proper place for sexual intimacy and the basis of the family.
So the dude is all for equal rights when it suits his purposes. Nice.
I still don't have a good read on this Sizer guy. Is he a critic of Israel who has been vilified by extremists? Is he a critic of Israel who has strayed into frank anti-semitism? Is he just another religious wacko using superstition to justify his own hypocritical beliefs? Either way, anyone who calls the cops on a blogger for criticizing him is a no-goodnik in my book.
From my pal Arikia, I learned of a disturbing case in the UK. A blogger over there has been posting information about Stephen Sizer, an Anglican vicar and holocaust denier. The vicar apparently felt so threatened by the dissemination of his own ideas that he called the cops.
According to various news and blog reports, Sizer is cozy with terrorists and neo-fascists.
I don't know much about this guy, but he apparently is very active in anti-Israel activities that have blended into frankly anti-Jewish activities. He has apparently take his concern for the plight of Palestinians and thrown up his hands at the thought of a real peace. He has bought into the idea of a zero-sum game in the Middle East, and he has chosen his side in that game, denouncing other Christians who have shown "support" (meaning, apparently, acknowledgement) for Israel.
Well, Sizer, you can try to use your jack-booted, neo-fascist intimidation tactics in Yorkshire, but your past subjects over here won't put up with that kind of behavior. As far as I can tell, you, Sizer, are a thug, an anti-semite, and a hate-monger. You should be ashamed.
Oh, and where's the Anglican church in all this? Does he belong to them? If so, and if they haven't spoken up about him, then his views are their views.
In The Checklist Manifesto (Amazon, Borders, b&n), Dr. Atul Gawande expands on his previous writing about the work of Dr. Peter Pronovost. Pronovost developed a system to help reduce complications of hospital care, such as infected venous catheters. This system has been very successful. It is based on the idea that some tasks are simply too complex to be error-free. Medical care has become very successful, but also very complex, to the point where one person cannot possibly remember every step in some processes, even simple steps such as scrubbing in.
The simple and successful solution is to create checklists analogous to what pilots use. Even though each step in preparing to fly a plane or place a central line may be simple and easy to remember, there are so many of these steps that it's easy to drop one.
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Tragedy can bring out the best and the worst in humanity. The Haitian earthquake has seen an outpouring money (the most needed type of aid) and other emergency aid. A few days ago I pondered what sort of quackery would emerge to fill a need that doesn't exist.
Homeopaths responded, of course, and while clean water is always needed, clean water that comes with a fairy tale is not.
Every person that lands in Haiti to provide "aid" also brings a mouth to feed and a cloaca to empty, so every body who goes better have a lot of value to deliver. That's why the arrival of Scientology ministers in Port-au-Prince is doubly abominable.
And what are the Xenu-bots bringing with them? They did bring some doctors, but...
"We're trained as volunteer ministers, we use a process called 'assist' to follow the nervous system to reconnect the main points, to bring back communication," she said.
"When you get a sudden shock to a part of your body the energy gets stuck, so we re-establish communication within the body by touching people through their clothes, and asking people to feel the touch."
No. No, it does not. There is no "energy" to get "stuck", and as a doctor on the scene said, "I didn't know touching could heal gangrene." In fact, an influx of untrained volunteers could worsen infection, especially if they are moving from one patient to another touching them.
The people of Haiti have suffered terribly, and the suffering will continue for a long time. As long as our Marines are there, maybe they could kick these dangerous cultist idiots off the island.
It's funny because it's true.