March 14, 2009
Million Women Study
The Guardian UK has an article about concerning the million women study being conducted by scientists at Oxford University. Sarah Boseley writes,
Oh, the lure of a glass of chilled white wine at the end of a hard day. Or a goblet of luscious red by a leaping fire on a winter's evening. Or a gin and tonic, poured over cracking ice and lemon. Can't you hear it calling as you tramp home, tired, head buzzing with the day? Well, maybe not any more - if you heeded the recent study which warned that even a small glass of wine a day increases a woman's risk of breast cancer.
In all likelihood, most women just shrugged and reached for the corkscrew. There are, after all, so many conflicting stories about what is good and bad for you these days. Unfortunately, this is not some easily dismissed, pie-in-the-sky trial involving a couple of hundred people. It is the Million Women Study, run by some very senior scientists at Oxford University. In research, size really does matter - and this is the biggest project of its kind on the planet. . .
The survey was started by Professor Valerie Beral, head of Oxford University's cancer epidemiology unit. When she began planning it in 1993, she quickly realised the study would have to be massive to answer the thorny and still controversial questions over HRT and possible links to cancers and other diseases. But enrolling a million women meant they would be able to tackle a lot of other issues too, and the answers are slowly coming in. And yes, she says, it is intended to provide a definitive blueprint for women's health, spotlighting all the issues from the pill, to alcohol, to diet, to childbearing, to the menopause. "That's what we plan to do, slowly and reliably over time," says Beral. "We're interested in not creating false stories, so it is totally reliable information - the sort of information that women want to know about their health." . . . .
With this much data, the scientists will be able to investigate a whole range of issues. Maybe those who enjoy painting or music in their spare time or who go to church are less stressed and happier than those with little social activity to report. And are those who say they eat five portions of fruit and vegetables a day really healthier? . . . .
Even so, Professor Sheila Bird of the MRC's biostatistics unit and the Royal Statistical Society, sounds a cautious note. Big in itself does not necessarily mean free of bias. One in four of the population in the age group signed up - but, she asks, "How different are the quarter who volunteered from the rest?" First they accepted breast screening and then they agreed to be part of the Million Women Study. Does that mean, for instance, that they are middle-class women more concerned about breast cancer?
Avoiding and then adjusting for any such bias, however, is at the heart of the work of the Oxford cancer epidemiology unit. And Walker points out that the Million Women Study is under constant scrutiny from the best scientists in this field - facing rigorous peer review, first to get funding from Cancer Research UK and the MRC, and then to get each scientific paper published as they are completed. The findings have all appeared in leading medical journals, such as the Lancet.
So what do the study's findings really mean for each of us as individuals? Should we all be following Beral's developing blueprint to the letter? The answer is, not necessarily. We may all run an increased risk of cancer if we drink, but how serious that is depends on how high or low a risk we had to start with. Walker puts it well: "What they are coming out with is risks across the population that they are studying. Each of us as individuals will have been born with a greater or lesser risk of a cancer because of the genes we have inherited and, on top of that, our lifestyle has to be factored in. "We may have only one vice and it may be drinking three glasses a night, but if we had 10 children before the age of 30, it is not going to make much difference. One needs the whole picture."
And each of us may have a different perspective on acceptable risk. As a herd, we have a 9.5% chance of getting breast cancer before we are 75. Drinking every day raises that risk to 10.6%. If we think we have no other major risk factors lurking, such as a mother or sister who died of the disease, but we believe a drink a day significantly improves our life, we might choose to go with the extra risk. The great thing about the Million Women Study is that it is giving us the information with which to make an informed choice . . . .
March 13, 2009
Congratulations to Professor Burris
The Temple University's Beasley School of Law website reports on the great news:
Temple University 's Beasley School of Law has been selected by the Robert Wood Johnson Foundation to manage a new $19 million national program that will fund interdisciplinary research exploring legal and regulatory solutions to pressing health challenges such as chronic diseases, and health emergencies including floods, bioterrorism and epidemics.
The Public Health Law Research program will operate under the direction of Temple Law professor Scott Burris, an internationally recognized authority on how law influences public health.
"The Public Health Law Research program brings long-needed funding and attention to the crucial role of law in public health," said Burris, who also co-directs Temple Law's new Center for Health Policy, Law and Practice. "Law can be a powerful tool for improving public health. Laws have contributed to reductions in smoking and they have increased use of seat belts." But, he explained, laws and law enforcement practices can also endanger health. . . .
A Temple Law faculty member since 1991, Burris is one of the founders of modern public health law and a pioneer in the use of empirical research in the discipline. He published the first law review article detailing the public health law issues raised by HIV/AIDS and led the effort to create the first comprehensive legal analysis of the epidemic. His work has been funded by the U.S. Centers for Disease Control and Prevention and the National Institutes of Health. He is currently working with the United Nations to reduce policy barriers to the treatment of pain and drug dependency.
Burris is also a senior associate at the Johns Hopkins Bloomberg School of Hygiene and Public Health, where he is associate director of the Center for Law and the Public's Health. Before joining the Temple Law faculty, Burris worked for the American Civil Liberties Union of Pennsylvania, where he represented people with HIV in cases addressing discrimination, privacy, and access to care in prison. He has played a leading role in developing privacy and confidentiality legislation in Pennsylvania. . . .
Sacrificing for Others
The Boston Globe has a feel-good story about Paul Levy, the CEO of Beth Israel Deaconess Medical Center. Kevin Cullen writes,
Paul Levy, the guy who runs Beth Israel Deaconess Medical Center, was standing in Sherman Auditorium the other day, before some of the very people to whom he might soon be sending pink slips. In the days before the meeting, Levy had been walking around the hospital, noticing little things. He stood at the nurses' stations, watching the transporters, the people who push the patients around in wheelchairs. He saw them talk to the patients, put them at ease, make them laugh. He saw that the people who push the wheelchairs were practicing medicine. . . .
And so Paul Levy had all this bouncing around his brain the other day when he stood in Sherman Auditorium. . . ."I want to run an idea by you that I think is important, and I'd like to get your reaction to it," Levy began. "I'd like to do what we can to protect the lower-wage earners - the transporters, the housekeepers, the food service people. A lot of these people work really hard, and I don't want to put an additional burden on them. "Now, if we protect these workers, it means the rest of us will have to make a bigger sacrifice," he continued. "It means that others will have to give up more of their salary or benefits."
He had barely gotten the words out of his mouth when Sherman Auditorium erupted in applause. Thunderous, heartfelt, sustained applause. . . .
The consensus was that the workers don't want anyone to get laid off and are willing to give up pay and benefits to make sure no one does. A nurse said her floor voted unanimously to forgo a 3 percent raise. A guy in finance who got laid off from his last job at a hospital in Rhode Island suggested working one less day a week. Another nurse said she was willing to give up some vacation and sick time. A respiratory therapist suggested eliminating bonuses. . . .
Paul Levy is onto something. People are worried about the next paycheck, because they're only a few paychecks away from not being able to pay the mortgage or the rent. But a lot of them realize that everybody's in the same boat and that their boat doesn't rise because someone else's sinks. Paul Levy is trying something revolutionary, radical, maybe even impossible: He is trying to convince the people who work for him that the E in CEO can sometimes stand for empathy.
March 12, 2009
Wisconsin Health Reform
Governor Jim Doyle, Governor of Wisconsin and co-host of an upcoming White House Forum on Health Reform, has an interesting post at the Huffingtonpost website discussing his state's health reform and how it may be a template for the one that President Obama should consider. He writes,
I applaud President Obama for having the courage to take on this crisis, even during these tough economic times. It is not only the right thing to do, it makes fiscal sense. Unless we reform this broken system we will continue to saddle our children and grandchildren with increasing debt. . . .
It is important that any meaningful attempt at reform includes measures to cut costs. But we must not forget the 46 million Americans who, today, lack access to basic health insurance. Even during this tight budget, there are paths available to Washington for universal health care access. All they need to do is examine what states like Wisconsin have done through our national leading BadgerCare Plus program.
While many states are cutting back on health care programs, here in Wisconsin we are moving forward, expanding access to health care at an unprecedented rate. In February 2008, we ensured that every child in our state has access to affordable health insurance. In July, we will provide 98 percent of our residents with health care coverage by expanding BadgerCare Plus to low income individuals that don't have dependent children. When it's complete, we'll have the second largest percentage of residents insured of any state. In both cases, we built upon existing successful programs. Simplification and cost-effectiveness drove our efforts.
Often, complex programs deter individuals from enrolling. In Wisconsin, we have cut bureaucracy and shortened our BadgerCare Plus application form to one page. We also now accept more than 30 percent of our applications online. In addition, we have shown creativity in controlling costs while expanding access. . . .
Here in Wisconsin, we have shown that the moral issue of health care -- the crisis of the uninsured -- is something we can successfully address. We look forward to working with federal policymakers to make basic, affordable health care a reality for all Americans.
Health Care Crisis: One Reporter's Up-Close Story on the Underinsured
Time Magazine runs a moving story by reporter Karen Tumulty about what she learned when her brother was diagnosed with severe kidney disease and suddenly learned that his health care coverage was not what he thought. She discusses her difficulties in figuring out why his short-term health insurance failed to provide coverage for his condition and how many people may not realize that they will not have coverage when they need it. She writes,
The unforeseen was exactly what turned up when Pat went in for a physical on Nov. 30, 2007, his first in five years. . . . That's when Pat, who is now 54, learned that his kidneys were failing.
The diagnosis was only the first shock. The second came a few weeks later, in an Aug. 5 letter from Pat's health-insurance company. For six years — since losing the last job he had that provided medical coverage — Pat had been faithfully paying premiums to Assurant Health, buying a series of six-month medical policies, one after the other, always hoping he would soon find a job that would include health coverage. Until that happened, "unexpected illnesses and accidents happen every day, and the resulting medical bills can be disastrous," Assurant's website warned. "Safeguard your financial future with Short Term Medical temporary insurance. It provides the peace of mind and health care access you need at a price you can afford."
Kidney failure would seem to be one of those disastrous "unexpected illnesses" that Pat thought he was insuring himself against. But apparently he was wrong. When my mother, panicked, called to tell me that the insurance company was refusing to pay Pat's claims, I told her not to worry; bureaucratic mix-up, I assumed. I said I'd take care of it, bringing to bear my 15 years of experience covering health policy, sitting through endless congressional hearings on the subject and even moderating a presidential candidates' forum on the issue. Confident of my abilities to sort this out or at least find the right person to fix the problem, I made some calls to the company. I got nowhere. That's when I realized that the national crisis I'd written so much about had just hit home. . . .
. . . . But Pat represents the shadow problem facing an additional 25 million people who spend more than 10% of their income on out-of-pocket medical costs. They are the underinsured, who may be all the more vulnerable because, until a health catastrophe hits, they're often blind to the danger they're in. In a 2005 Harvard University study of more than 1,700 bankruptcies across the country, researchers found that medical problems were behind half of them — and three-quarters of those bankrupt people actually had health insurance. As Elizabeth Warren, a Harvard Law professor who helped conduct the study, wrote in the Washington Post, "Nobody's safe ... A comfortable middle-class lifestyle? Good education? Decent job? No safeguards there. Most of the medically bankrupt were middle-class homeowners who had been to college and had responsible jobs — until illness struck."
Ms. Tumulty was also featured on Fresh Air earlier this week and a podcast of the story can be found here.
March 11, 2009
New FDA Commissioner: Dr. Margaret A. Hamburg
According to various press reports, the new FDA Commissioner will be Dr. Margaret A. Hamburg. Mark Gardiner of the New York Times reports,
President Obama intends to nominate Dr. Margaret A. Hamburg, a former New York City health commissioner, to lead the Food and Drug Administration, sidestepping a battle between drug safety advocates and the drug industry, people briefed on the decision said. . . .
Dr. Hamburg, 53, will succeed Dr. Andrew C. von Eschenbach, who led the beleaguered agency from 2005 until last January and often had to deflect critics who accused the Bush administration of letting politics play too forceful a role in science policy. . . .
The F.D.A. is arguably the most important public health agency in the country, but its budget has lagged far behind those of agencies like the Centers for Disease Control and Prevention. A growing list of scandals has led a bipartisan chorus on Capitol Hill to demand major changes and larger budgets, with some legislators advocating that the F.D.A. be split in two. . . .
Dr. Hamburg, who was appointed by Mayor David N. Dinkins as acting commissioner in 1991 and became commissioner the following year, was one of the few top officials asked to remain when Mayor Rudolph W. Giuliani took office in 1994. She was best known for developing a tuberculosis control program that produced sharp declines in the incidences of the disease in New York. Under her tenure, child immunization rates rose in the city. She left New York in 1997 to become assistant secretary for planning and evaluation at the federal Department of Health and Human Services, where she created a bioterrorism initiative and led planning for pandemic flu response . . .
Europeans Debate Castration For Sex Offenders
The New York Times reports on the European debate on sex offenders and castration and whether such a strong response actually reduces the incidence of repeat offenders. Dan Bilefsky writes,
Pavel . . . invited a 12-year-old neighbor home. Then he stabbed the boy repeatedly. His psychiatrist says Pavel derived his sexual pleasure from the violence.
More than 20 years have passed. Pavel, then 18, spent seven years in prison and five years in a psychiatric institution. During his last year in prison, he asked to be surgically castrated. Having his testicles removed, he said, was like draining the gasoline from a car hard-wired to crash. A large, dough-faced man, he is sterile and has forsaken marriage, romantic relationships and sex, he said. His life revolves around a Catholic charity, where he is a gardener. “I can finally live knowing that I am no harm to anybody,” he said during an interview at a McDonald’s here, as children played loudly nearby. “I am living a productive life. I want to tell people that there is help.” . . .
Whether castration can help rehabilitate violent sex offenders has come under new scrutiny after the Council of Europe’s anti-torture committee last month called surgical castration “invasive, irreversible and mutilating” and demanded that the Czech Republic stop offering the procedure to violent sex offenders. Other critics said that castration threatened to lead society down a dangerous road toward eugenics. . . .
Now, more countries in Europe are considering requiring or allowing chemical castration for violent sex offenders. There is intense debate over whose rights take precedence: those of sex offenders, who could be subjected to a punishment that many consider cruel, or those of society, which expects protection from sexual predators. . . .
Last year, the governor of Louisiana, Bobby Jindal, signed legislation requiring courts to order chemical castration for offenders convicted of certain sex crimes a second time. . . . Ales Butala, a Slovenian human rights lawyer who led the Council of Europe’s delegation to the Czech Republic, argued that surgical castration was unethical, because it was not medically necessary and deprived castrated men of the right to reproduce. He also challenged its effectiveness, saying that the council’s committee had discovered three cases of castrated Czech sex offenders who had gone on to commit violent crimes, including pedophilia and attempted murder. Although the procedure is voluntary, Mr. Butala said that he believed some offenders felt they had no choice. . . .
Several states, including Texas, Florida and California, now allow or mandate chemical castration for certain convicted sex offenders. Dr. Fred S. Berlin, founder of the Sexual Disorders Clinic at Johns Hopkins University, argued that chemical castration was less physically harmful than surgery and that it provided a safeguard, because a psychiatrist could inform the courts or police if the patient ordered to undergo treatment failed to show up. A surgically castrated patient, Dr. Berlin said, can order testosterone over the Internet.
For Hynek Blasko, the father of Jakub Simanek, neither form of castration is the answer. “These people must be under permanent detention where they can be monitored,” he said. “There has to be a difference between the rights of the victim and the perpetrator.”
March 10, 2009
Living in the Genetic Age - March 20, 2009
SAINT LOUIS UNIVERSITY SCHOOL OF LAW's 21st Annual Health Law Symposium - Living in the Genetic Age will take place on Friday, March 20, 2009 -- 8 a.m. to 4 p.m. William H. Kniep Courtroom. Brief Overview: Advances in genetic technology raise a broad range of legal, social and ethical concerns. Fear of genetic discrimination remains an issue, as evidenced by the Genetic Information Nondiscrimination Act of 2008 limiting the use of genetic information by employers and healthi nsurance providers. Other concerns include the meaning and uses of genetic knowledge in the face of uncertain choices; the significance of genetic information for ideas of self, family and community; and the challenges of genetic enhancement and personalized genomic medicine. This Symposium gathers leading experts and scholars from fields including law, medicine and anthropology to discuss these and other challenges of living in the genetic age. Details and registration: Call: Mary Ann Jauer (314) 977-3067 Click: law.slu.edu/genetics Write: firstname.lastname@example.org
SAINT LOUIS UNIVERSITY SCHOOL OF LAW's 21st Annual Health Law Symposium - Living in the Genetic Age will take place on Friday, March 20, 2009 -- 8 a.m. to 4 p.m. William H. Kniep Courtroom.
Brief Overview: Advances in genetic technology raise a broad range of legal, social and ethical concerns. Fear of genetic discrimination remains an issue, as evidenced by the Genetic Information Nondiscrimination Act of 2008 limiting the use of genetic information by employers and healthi nsurance providers. Other concerns include the meaning and uses of genetic knowledge in the face of uncertain choices; the significance of genetic information for ideas of self, family and community; and the challenges of genetic enhancement and personalized genomic medicine. This Symposium gathers leading experts and scholars from fields including law, medicine and anthropology to discuss these and other challenges of living in the genetic age.
Details and registration:
Call: Mary Ann Jauer (314) 977-3067
Diane Rehm Show on Stem Cell Executive Order
The Diane Rehm show today reviews the changes that the President's new Executive Order will bring and some of the controversy over the use of embryonic stem cells that remains.
10:00Federally Funded Stem Cell Research
President Obama has overturned Bush administration restrictions on federal funding for human embryonic stem cell research. A look at the new policy and its implications.
Dr. Harold Varmus, co-chairman of the White House Council on Science and Technology, president, Memorial Sloan-Kettering Cancer Center, former director of the National Institutes of Health, and the author of "The Art and Politics of Science".
Dr. John Gearhart, Director, Institute for Regenerative Medicine, at the University of Pennsylvania
Sheryl Gay Stolberg, White House correspondent, "The New York Times"
Richard Doerflinger, associate director, secretariat for pro-life activities for the U.S. Conference of Catholic Bishops