HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Friday, March 14, 2008

Terrific Job Opportunity - Southern Illinois University School of Medicine

Assistant Professor in Health Law and Policy Department of Medical Humanities Southern Illinois University School of Medicine Springfield, Illinois

The Department of Medical Humanities at Southern Illinois University School of Medicine invites applications for a full-time, tenure-track faculty position at the assistant professor level in health law and policy. Located in the capital of Illinois, the Department is part of a School of Medicine with a dynamic and collaborative learning and research environment that is internationally known for its medical education innovations and dedication to problem-based learning.

Department faculty, through their teaching, research and service, draw upon expertise in such areas as health policy, law and medicine, ethics, psychosocial care, religious studies, and medical history and literature to foster dialog on health, health care and the human condition. In addition to contributing to the education of medical students, residents and physicians, the Department serves as the medical school home for one of the oldest and most robust M.D./J.D. dual-degree programs in the country. The Department seeks a candidate who can build upon a successful health law and policy program and develop individual and collaborative educational and research initiatives which would help increase understanding of health law and policy issues and improve the health of the people of central and southern Illinois and beyond. The successful candidate can anticipate a cross appointment to the SIU School of Law faculty, and may also have an opportunity for cross appointment at SIU’s Paul Simon Public Policy Institute. He or she would join the Department on or before late Summer/early Fall 2008.

Qualifications for the position include a Juris Doctor (J.D.) or equivalent legal degree from a nationally accredited law school, and additional graduate degree(s) in health policy, public policy (with a health focus), health care finance, health economics, public health, or a related field. Preference will be given to candidates with demonstrated experience teaching medical students, health professions students, or small group teaching in other higher education settings.

Southern Illinois University is an equal opportunity employer and will not discriminate against any person on the basis of race, religion, national origin or sex in violation of Title VII. This position is a security-sensitive position and will require a background investigation. Further details about the position, Department and School can be found at:

Applicants should mail or e-mail a CV and a letter with a detailed statement of interest and area(s) of expertise to: Ross D. Silverman, J.D., M.P.H., Associate Professor and Chair, Department of Medical Humanities, SIU School of Medicine, 913 N. Rutledge St., Room 1116, P.O. Box 19603, Springfield, IL 62794-9603, or Applications will be accepted until March 31, 2008, or until the position is filled.

March 14, 2008 | Permalink | Comments (0) | TrackBack (0)

Egyptian Organ Donors: Unfortunately It's All About the Money

The LATimes has an eye-opening and rather depressing piece on organ donors in Egypt. Jeffrey Fleishman and Noha El-Hennawy write,

He sits quietly at the corner cafe, a gold watch flickering on his wrist. If you need a liver, or want to sell a piece of yours, grab a chair and get acquainted with Mustafa Hamed, a 24-year-old ex-bus driver who fell unexpectedly into a life as a broker in human organs.  Hamed's 4-year-old son, Mohamed, was dying of cancer and needed an artery transplant that cost $5,000. The only savings Hamed had was what he fished from his pockets at the end of the day.  There was another way, one whispered about for those with nothing. A man could wager part of himself, slip into a hospital gown, and wake up with an incision above the gut.  Hamed sold a section of his liver for a bit more than the price of his son's operation. The boy died in surgery.   With his scar healing and his son buried, Hamed, whose knowledge of anatomy would perhaps fill a single page, decided that driving a bus was not the fate of the man he wanted to be. He brokered his first liver deal four months ago. He earned $900. Four more sales have followed.

"Things shouldn't be this way, but they are," he says. "I sold part of my liver to save my son. I had to do it. . . . You cut your body and sell your pieces. But some people who come to me aren't that desperate. They could find other solutions. Many men I see now want to sell their organs so they can afford to buy an apartment to get married. That doesn't seem desperate enough to me. I try to tell them: 'Be patient. You don't need to do this.' " . . . .

Similar tales echo around the globe. Human organs are brokered from Pakistan to China; kidney-theft rings have swept through villages in India. The poor in underdeveloped nations, such as Moldova and the Philippines, are offered "transplant tourism" packages that arrange for them to travel to another country and sell their organs to rich patients. It is a market of desperation and ingenuity in which doctors ask few questions and donors often end up ill, and sometimes dead. . . .
Donors and patients in Cairo know where to go. There are cafes near clinics and labs where the brokers sit, stirring tea and smoking, cellphones buzzing like insects on the tables.  Those needing organs are easy to spot. They carry X-rays and blood work charts under their arms. Some are ashen, some drawn; they need what they need quickly. They come from Upper Egypt and the Nile Delta, their purses and wallets bulky with borrowed money, and if they're lucky enough they'll be able to hire the Japanese transplant surgeon who flies in once a month.

"My doctor told me to come to this place," says an agricultural engineer from Upper Egypt who was shopping for a kidney near a lab in Cairo's Dokki neighborhood, where horse carts clatter and puffed bread cools in the breeze.  He will not give his name as he straightens his pressed tunic. "I'm 58 years old. I'm in renal failure and I have no children. I need a donor. Kidneys sell for between 20,000 and 40,000 pounds [about $3,600 to $7,300]. I'm bargaining, but I can't pay more than 30,000 pounds."

The donors face hardships of their own. . . .  "I have two choices: Pay my debts or go to jail," says Abdullah, a heavyset man in a sweater, who sits in a cafe hoping to negotiate part of his liver for 40,000 pounds. "I can't find any other solution. It's either the operation or I lose my freedom. . . . I started looking for ads where kidney patients look for donors, but I realized that the maximum amount of money I could get for a kidney is 20,000 pounds. Then in the same newspaper, I found an ad by a liver patient." . . . .

Mohamed Queita, a member of the Egyptian parliament and the ruling National Democratic Party, has been working for 12 years to pass a law to regulate organ transplants and stop an expanding black market that draws patients from across the Middle East and as far away as Europe.  "It's the worst kind of business in Egypt. It's worse than slavery," says Queita, who has no comprehensive statistics but notes that one Cairo clinic had a waiting list of 1,500 people willing to sell their organs. "I don't want the poor turned into spare parts for the rich. . . . People are coming from all over to buy organs in Egypt. They're mainly gulf Arabs. If you're a rich man from the gulf, you go to a private Egyptian hospital that has contacts with organ brokers. Serious cases of poverty in this country are causing an increase in the theft and sale of organs."

Queita's bill proposes that transplants be limited to family members or to donors who accept no money. The legislation has been stalled by disagreements between Islamic clerics and doctors. Physicians support the harvesting of organs from patients who are clinically brain-dead, but clerics regard the practice as haram (forbidden).

The issue is a strand in a legal and spiritual debate over the definition of death that dates to Pharaonic times. Most clerics agree with Queita that the selling of body parts violates Islamic law.

"But there's no punishment," the lawmaker says. "Nobody goes to jail."   . . . .

March 14, 2008 | Permalink | Comments (0) | TrackBack (0)

Diagnosis v. Treatment: Improving Health Care's Darshak Sanghavi has a brief article on a way to improve the quality of health care - have the doctor focus on the patient's treatment rather than on the diagnosis.  He writes,

. . . . The real trouble is that doctors—somewhat paradoxically—are simply not focused on actually treating disease.

A key indicator of this problem emerged last October, when a team of researchers led by Rita Mangione-Smith reviewed children's medical records from 12 major American cities and found that fewer than half of children got the correct medical care during doctor visits. The researchers asked basic questions such as these: Did doctors properly inform mothers to continue feeding infants who had diarrhea? Was HIV testing offered to all adolescents diagnosed with a sexually transmitted disease? Was a follow-up visit scheduled after a child's medication changed for chronic asthma? These were all simple things doctors should have been doing yet weren't. (A similar study of adult quality of care was published in 2003 with similar results.). . . .

There are at least two explanations. First, clinical training in primary care—including pediatrics, internal medicine, and family practice—excessively focuses on the diagnostic hunt rather than the more routine rounds of treatment that follow. It's tempting to think that most doctors are detectives nailing baffling diagnoses, like Hugh Laurie's character on House. In part, this view of medicine accounts for the success of Jerome Groopman's book How Doctors Think, which explores how wrong diagnoses occur. In almost every educational venue—from morning teaching sessions for residents to the weekly case conference featured in the New England Journal of Medicine—medical trainees spend hours learning about how to diagnose rare ailments. And then, abruptly, discussion ends, as though treatment were an afterthought.

The not-so-subtle subtext: Medicine is about the exciting search for a diagnosis, and any old doctor can write a prescription once the real work is done. This same bias pervades insurance rules. To be paid at the appropriate level, physicians must exhaustively document all sorts of irrelevant diagnostic data—such as a rectal exam in toddlers seen for a comprehensive asthma evaluation—rather than the rationale for the treatment they prescribe.

On a separate but related front, medical education today fixates on acquiring knowledge that is largely unrelated to patient care. Consider the college prerequisites to attend medical school (for example, physics and organic chemistry) and the morass of molecular biology, anatomy lessons, and pharmacology that follows and must be committed to memory. Of course, a general foundation is important. However, the sheer abundance crowds out an important—in fact, the only—skill that matters in treating a patient: how to critically appraise published clinical trials. Few doctors ever read them. In effect, medicine has become a priesthood of practitioners who never review or learn to interpret the Bible to minister to their flock; they instead rely on secondhand wisdom. Or, worse, on Google. . . . .

Even if perfect treatment guidelines were to appear magically, it takes a lot of work to teach doctors to follow them. Consider ear infections in children, which are vastly overtreated with powerful antibiotics. In 2000, a group of Boston researchers created an ambitious three-year program (using sociological methods used by missionaries to score religious converts) to educate local pediatricians about proper ear-infection treatment. They explained how to talk to patients, control symptoms without antibiotics, and create educational handouts for patients. They taught doctors what they should have learned in medical school and, as reported in Pediatrics this year, substantially cut antibiotic use. The only sticking point is that it all took a big investment of time and money.

Treatment neglect has big consequences beyond ear infections. Medical errors may claim almost 100,000 lives each year, often from basic skills like poor handwriting on prescriptions. In her book, Overtreated, Shannon Brownlee explains how ignoring treatment has led to odd discrepancies in medical care; for example, some towns in Vermont had tenfold higher rates of pediatric tonsillectomy than others, despite having the same kinds of patients.

Refocusing doctors on actual treatment, instead of pointy-headed diagnostic puzzles, will take serious effort. In the meantime, patients should ask a simple question: "Can you describe the evidence for my treatment?" For better or worse, the answer will tell you a lot about the care you're getting.

March 14, 2008 | Permalink | Comments (0) | TrackBack (0)

Wednesday, March 12, 2008

Health Care Reform in Chart Form

Ezra Klein brings us the easy-to-read chart version of various plans for health care reform to show how difficult or easy it may be to change our system and provide universal coverage.  He starts with our current system and then examines the Hacker Plan (Economic Policy Institute) and Healthy Americans Act (Sen. Wyden (D)) proprosals.  I have not attached the final two charts but they are available at Ezra Klein's website. 

. . . yesterday, I was working on an article comparing different roads to universal coverage, and looking particularly at the way they sell cost controls politically and implement them in the policy. Now, folks know that I think the single largest factor promoting cost control is integrating the system. So I dug into some of the various plans and tried to figure out how far they'd go towards bringing us under one roof. First, here's what private insurance system currently looks like:


Totally fractured. Remember, in particular, that the big blog of "employer sponsored insurance" is not one system, but hundreds, maybe thousands, of individual insurance systems, split up by region. A more accurate graph would break that into Blue Shield of California, Blue Cross in Massachusetts, etc. 

March 12, 2008 | Permalink | Comments (0) | TrackBack (0)

1 in 4 Teenage American Girls have STD

Yesterday the Centers for Disease Control and Prevention issued a report on sexually transmitted diseases among teenage girls.  Monifa Thomas for the Chicago Sun Times reports on study findings,

One in 4 teenage girls in the United States has at least one sexually transmitted disease, according to a first-of-its-kind study released Tuesday by the Centers for Disease Control and Prevention.  The trend is even worse among African-American girls: Nearly half have one or more STDs, compared with 20 percent of whites.

Human papillomavirus was the most common of the four diseases included in the study, affecting 18 percent of the girls studied. Chlamydia was a distant second at 4 percent, followed by trichomoniasis and genital herpes.   The data is based on a nationally representative sample of 838 young women who participated in the National Health and Nutrition Examination Survey in 2003 and 2004.

Teen health experts say the study, billed as the first to look at common STD rates among young girls, highlights the need for comprehensive sex education that goes beyond the abstinence-only message pushed by the federal government.  "It's a clear sign that something's wrong in terms of the way we teach sex education, the way we talk about it, and the message we send to youth," said Soo Ji Min, executive director of the Illinois Caucus for Adolescent Health. In addition, many teens don't get tested for sexually transmitted diseases because they don't think they're at risk, said Dr. John Douglas, director of the CDC's division of STD prevention.

Douglas said African-American girls are probably more vulnerable to STDs because of higher infection rates among blacks as a whole and less access to health care.  The numbers "[do] not mean African Americans are taking greater behavioral risks. In fact, research suggests the opposite," he said. The CDC says women between the ages of 11 and 26 should be vaccinated against HPV, which can lead to cervical cancer. Annual chlamydia screening is also recommended for women under 26. . . . .

The study did not address young males and STD rates.  NPR's Day to Day did a radio interview with Kevin Fenton of the CDC which discussed these number and the CDC report in general. 

March 12, 2008 | Permalink | Comments (0) | TrackBack (0)

Tuesday, March 11, 2008

Academic Perfomance Enhancements -

First, it was those baseball players named in the Mitchell Report - now it could be your law professor or any random college student who uses performance enhancing drugs.  This past weekend, the New York Times ran an article on the use of certain drugs among students and professors to enhance their scholarly performance - mainly it seems to allow individuals to spend more hours awake.  The New York Times article quotes Dr. Anjan Chatterjee who compares this drug use to cosmetic surgery and is concerned about future use of these drugs  -

Dr. Anjan Chatterjee, an associate professor of neurology at the University of Pennsylvania who foresaw this debate in a 2004 paper, argues that the history of cosmetic surgery — scorned initially as vain and unnatural but now mainstream as a form of self-improvement — is a guide to predicting the trajectory of cosmetic neurology, as he calls it.

People already use legal performance enhancers, he said, from high-octane cafe Americanos to the beta-blockers taken by musicians to ease stage fright, to antidepressants to improve mood. “So the question with all of these things is, Is this enhancement, or a matter of removing the cloud over our better selves?” he said. . . .

Along those same lines, the Neuroethics & Law Blog quotes from a student, Molly, who wrote about her use of Adderall.  The blog quotes Molly saying,

"It is difficult to know whether it is a drug itself or a drug culture that attracts certain people to certain substances. In the case of Adderall, I came for the culture and stayed for the drug. Nothing had ever tempted me before. As an adolescent girl, alcohol was closely allied with promiscuity, and I was a prude. Weed suggested foolishness and snacking, and I was foolish and hungry enough as it was. But then came college, and with it, Adderall—a drug associated with writing, thinking, and joyful, hermetic reading. Adderall Me and Ideal Me were nearly the same person, and I saw no reason not to dabble in my best self."

I don't like to think that I can only find my "deepest" self is by using a drug designed to help with ADHD - however, I do sometimes need my cup of coffee in the morning . . . .

March 11, 2008 | Permalink | Comments (0) | TrackBack (0)

What Patients' Want . . . . It's Pretty Costly

The Wall Street Journal's Health Blog's Theo Francis posts on a potential problem with health reform that was revealed in a recent Mayo Clinic on-line survey.  It is an interesting overview of what some Americans would like to see happen to health care and how some of their goals are contradictory.  Theo Francis writes,

Nine in 10 respondents said health-care costs are too high. But eight in 10 called it very or extremely important that patients should have “freedom of choice” to pick insurers, hospitals and doctors. Some 72% said no one should be denied coverage for pre-existing conditions, and 70% think care should be based on patients’ preferences and needs.

Some currently hot policy ideas got less full-throated — but still solid — support, including a federal health board modeled on the Federal Reserve, mandatory health insurance and encouraging patients to have a “medical home,” or one primary-care provider to coordinate treatment. Nearly two-thirds thought it “important” or “very/extremely important” that the federal government “play an important role in funding health-care.” . . . .

Oh, and the chance of anything actually happening? Just 17% think reform is likely in the next decade. Another 17% are on the fence. We’ll do the math for you: Two-thirds think it ain’t likely.

The online survey was conducted by Harris Interactive for Mayo during the third week of December. Participants included 1,018 U.S. residents, age 25 to 75. They were involved in making health-care decisions for their households.

You can see a presentation of the results here, part of a symposium on health policy the Mayo Clinic Health Policy Center is holding today.

March 11, 2008 | Permalink | Comments (0) | TrackBack (0)

Monday, March 10, 2008

Pfizer and the New England Journal of Medicine's Peer Review

The Independent (UK)  reports today on the decision of Pfizer to sue the New England Journal of Medicine to gain access to the names and comments of its anonymous peer reviewers.  Steven Connor writes,

A multinational drugs company is trying to force a medical science journal to reveal the confidential statements made by the journal's expert reviewers in a test case that could undermine one of the central tenets of the scientific process.

Pfizer, the manufacturer of the anti-impotency drug Viagra, is trying to force the New England Journal of Medicine (NEJM) to release the names and comments of its anonymous peer reviewers who judged a dozen studies into two of the company's pain-killing drugs.  Pfizer has issued a subpoena demanding that the journal release the identities and comments of its referees, who normally remain anonymous so that they will feel free to give their honest opinions.

A US district court judge is expected to rule this week on whether the drug company can force the NEJM to release the information, which some scientists claim would damage the confidential peer-review system that science uses to evaluate the merits of prepublication research.

Pfizer, which is based in New York, is being sued for damages allegedly caused by the drugs Celebrex and Bextra. . . . .   As part of its defence, Pfizer is seeking any additional information that may support its case. "Scientific journals such as NEJM may have received manuscripts that contain exonerating data for Celebrex and Bextra which would be relevant for Pfizer's causation defence," the company says in its motion.

But Donald Kennedy, the editor of the journal Science, said that this amounts to a fishing expedition. "If this motion succeeds, what journal will not then become an attractive target for a similar assault?" he wrote in a signed editorial. At stake is the public's interest in a fair system of evaluating and publishing scientific work.

The motion filed by Pfizer claims that the public has no interest in protecting the editorial process of a scientific journal.

March 10, 2008 | Permalink | Comments (0) | TrackBack (0)

Prescription Drugs in Your Water

The Associated Press reports the results of a recent test of our nation's drinking water and finds that small amounts of a variety of prescription drugs exist in our drinking water supplies.   CNN.Com reports,

A vast array of pharmaceuticals -- including antibiotics, anti-convulsants, mood stabilizers and sex hormones -- have been found in the drinking water supplies of at least 41 million Americans, an Associated Press investigation shows.  To be sure, the concentrations of these pharmaceuticals are tiny, measured in quantities of parts per billion or trillion, far below the levels of a medical dose. Also, utilities insist their water is safe.

But the presence of so many prescription drugs -- and over-the-counter medicines like acetaminophen and ibuprofen -- in so much of our drinking water is heightening worries among scientists of long-term consequences to human health.  In the course of a five-month inquiry, the AP discovered that drugs have been detected in the drinking water supplies of 24 major metropolitan areas -- from Southern California to Northern New Jersey, from Detroit, Michigan, to Louisville, Kentucky. . . .

How do the drugs get into the water?

People take pills. Their bodies absorb some of the medication, but the rest of it passes through and is flushed down the toilet. The wastewater is treated before it is discharged into reservoirs, rivers or lakes. Then, some of the water is cleansed again at drinking water treatment plants and piped to consumers. But most treatments do not remove all drug residue.

And while researchers do not yet understand the exact risks from decades of persistent exposure to random combinations of low levels of pharmaceuticals, recent studies -- which have gone virtually unnoticed by the general public -- have found alarming effects on human cells and wildlife. . . .

The federal government doesn't require any testing and hasn't set safety limits for drugs in water. . . .

Contamination is not confined to the United States. More than 100 different pharmaceuticals have been detected in lakes, rivers, reservoirs and streams throughout the world. Studies have detected pharmaceuticals in waters throughout Asia, Australia, Canada and Europe -- even in Swiss lakes and the North Sea.

In the United States, the problem isn't confined to surface waters. Pharmaceuticals also permeate aquifers deep underground, the source of 40 percent of the nation's water supply. Federal scientists who drew water in 24 states from aquifers near contaminant sources such as landfills and animal feed lots found minuscule levels of hormones, antibiotics and other drugs.

Perhaps it's because Americans have been taking drugs -- and flushing them unmetabolized or unused -- in growing amounts. Over the past five years, the number of U.S. drug prescriptions rose 12 percent to a record 3.7 billion, while nonprescription drug purchases held steady around 3.3 billion, according to IMS Health and The Nielsen Co. . . .

Veterinary drugs also play a role. Pets are now treated for a wide range of ailments -- sometimes with the same drugs as humans. The inflation-adjusted value of veterinary drugs rose by 8 percent, to $5.2 billion, over the past five years, according to an analysis of data from the Animal Health Institute.

Ask the pharmaceutical industry whether the contamination of water supplies is a problem, and officials will tell you no.  "Based on what we now know, I would say we find there's little or no risk from pharmaceuticals in the environment to human health," said microbiologist Thomas White, a consultant for the Pharmaceutical Research and Manufacturers of America.

But at a conference last summer, Mary Buzby -- director of environmental technology for drug maker Merck & Co. Inc. -- said: "There's no doubt about it, pharmaceuticals are being detected in the environment and there is genuine concern that these compounds, in the small concentrations that they're at, could be causing impacts to human health or to aquatic organisms."

Recent laboratory research has found that small amounts of medication have affected human embryonic kidney cells, human blood cells and human breast cancer cells. The cancer cells proliferated too quickly; the kidney cells grew too slowly; and the blood cells showed biological activity associated with inflammation. . . . .

Perhaps some new filtering devices for our drinking water supply are in order.   The CNN.Com site has a helpful map which shows what prescription drugs were found in water supplies in different states.  It is pretty interesting.

March 10, 2008 | Permalink | Comments (0) | TrackBack (0)