While doctors are divided over whether medical practices should be active on social media networks, Dr Jeff Livingston says that Facebook and Twitter are effective tools for educating patients and marketing his Texas OB-GYN practice.

Over the past two years, MacArthur OB/GYN has ventured into the world of social media, where doctors post news about their own practice and the medical world at large. Its Facebook page has almost 700 fans. “People are looking for information online,” he says. “I wanted them to look at our page.”

Many doctors have been deterred from social media by concerns over time and patient privacy.
"No matter how you parse it, doctors don't avoid the Internet and social media because they're simply Luddites," Westby Fisher, an Illinois cardiac electrophysiologist, wrote last month on his blog, Dr. Wes. "They avoid the Internet because they enjoy the benefits of anonymity, privacy, efficiency and legal protection that come with dropping off the grid."

Livingston says that these have not really been issues for his practice. In the two years since he launched the Macarthur Obgyn Facebook page, he has only had to remove content posted by others three times.  "What I'm watching for is that no private personal health information gets relayed via social media," says Livingston, who says he keeps a close watch on the page with his iPhone and iPad. ~USA Today, Jul 9

The UK’s first major study of a disease using stem cells that do not require the creation and destruction of embryos is being launched.

An Oxford University research team will use induced pluripotent stem (iPS) cells to examine Parkinson’s disease. iPS cells, first developed in 2007, are adult stem cells which are able to become any kind of cell in the human body.

These cells will then be used to grow the brain neurons that are killed by the disorder. When iPS cells were developed, scientists said they had potential to offer many of the benefits of embryonic stem cells without any of the ethical downsides.

The team at Oxford University is one of the first in the world to use IPS cells to implement a large-scale clinical investigation of a major disease. The iPS cells may enable researchers to produce limitless quantities of nerve cells for experimentation and for testing new drugs.
Skin cells will be taken from 1,000 patients with early stage Parkinson’s and turned into nerve cells carrying the disease.

"Parkinson's disease is the second most common neurodegenerative disease in the UK and is set to become increasingly common as we live longer," said Dr Richard Wade-Martins, head of the Oxford Parkinson's Disease Centre. "Once we have neurons from patients we can compare the functioning of cells taken from patients with the disease and those without to better understand why dopamine neurons die in patients with Parkinson's." ~ BBC News, Jul 13

Debate over the issue of foetal pain continues, as research by the Royal College of Obstetricians and Gynaecologists was disputed this week. A statement from a US lobby group, the Family Research Council statement contends that the RCOG used a “faulty definition of pain” by saying that foetuses under 24 weeks cannot experience it.  

A summary of the RCOG statement says that the foetus is unable to experience pain before 24 weeks because connections between the cortex (which plays an important role in consciousness) and the periphery (outer tissue of the brain) are not intact before this point in the pregnancy. The statement goes further, saying that these connections are “necessary for pain experience but not sufficient”, and that there is “increasing evidence that the fetus never experiences a state of true wakefulness in utero and is kept, by the presence of its chemical environment, in a continuous sleep-like unconsciousness or sedation.

An FRC blog entry described this as “politically timed and motivated”, and that the study could be used by pro-abortion activists in the US to argue against a new Nebraska law stating that an unborn baby feels pain at 20 weeks, outlawing abortion from that point on. The FRC report
states: “At 20-30 weeks, the human being has the highest number of pain receptors per square inch, more than any other time in development. Fibers which help to moderate pain do not begin to develop until 32-34 weeks, thus making the argument that babies feel pain more severely between 20-32 weeks.”

As BioEdge last week reported last weeks, the politicisation of science in the US remains a hot-button issue. The foetal pain debate is the latest chapter. ~ Family Research Council, Jun 24, Jul 12; Royal Council of Obstetricians and Gynaecologists, Jun 25

This sounds like a good plot for a spooky Twilight Zone episode – or an argument for scepticism about neuroscience determinism. A neuroscientist studying psychopaths and sociopaths finds that they tend to have low activity in the orbital cortex of the brain. It can’t do its job of inhibiting the amygdala, the part of the brain which regulates that id-type behaviors like rage, violence, eating, sex, and drinking. Like his own brain scan…

Then he learns that his family line contains at least eight murderers, including the famous Lizzie Borden (who took an axe and gave her father 40 whacks).

Then he examines family members for the MAO-A gene (monoamine oxidase A), nicknamed the “warrior gene” because it regulates the calming chemical serotonin in the brain. The neuroscientist discovers that he is the only one in his family without the low-aggression variant of the gene.

The light goes on -- deep organ music -- “I'm a born killer."

However, it’s not science fiction, but the real life story of Dr Jim Fallon, of the University of California-Irvine. Why isn’t he a killer, then? Dr Fallon speculates that brain patterns and genetic makeup are not enough: a childhood of abuse or violence is needed to top up the toxic mix.

This intriguing story attracted many scathing comments on the NPR website. One contended that the genes and the scans hadn’t lied at all: “it's intriguing to consider that in this case the gene for 'sociopathy,' led to tenure.” ~ NPR, June 29

 

End-of-life care is one of the key areas of contemporary bioethics. The Economist has just published a 40-page survey of how 40 mostly rich countries care for the dying. Its conclusions are summarised in an index which places Britain at the top with a score of 7.9 and India at the bottom, with 1.9.

This is not a matter of cultural bias, The Economist explains -- although Australia, New Zealand and Ireland rank 2, 3 and 4. “For all the health care system's faults, British doctors tend to be honest about prognoses, the mortally ill get plentiful pain killers and a well-established hospice movement cares for people near death. Countries such as Denmark and Finland rank lower because they concentrate more on preventing death than on helping people die without suffering pain, discomfort and distress.” ~ Economist, July 14

Even top-flight hospitals like UCLA Medical Center can improve the way they manage dying patients, according to a study in Archives of Internal Medicine.

Researchers found that the doctors were excellent at pain control, but did less well in discussing prognosis and goals of care with patients and families. Although they performed well in ordering comfort care, they did less well at follow-up to make sure the care was effective.
The head of the study, Dr Anne Walling, of the University of California Los Angeles, and her collaborators analysed the charts of 496 adults hospitalised at least three days before dying. The patients’ end-of-life care was assessed based on 13 quality indicators in three areas: eliciting goals of care, pain assessment and management, and assessment and management of dyspnea (difficulty in breathing).

Patients received recommended care for 70% of the quality indicators. Goals of care were addressed in a timely manner about half the time, pain assessments were performed 94% of the time, and pain treatments (95%) and dyspnea treatments (87%) were administered as recommended.

Follow-up for distressing symptoms, however, was not performed as well as initial assessments, and only 29% of patients whose ventilation tubes were removed before death were evaluated for dyspnea. "The findings suggest much room for improvement in treating patients dying in the hospital," the investigators concluded. ~Reuters, Jul 8

The Philippines Health Secretary appointed by the  new president, Benigno Aquino III, is a strong supporter of allowing Filipinos to sell kidneys to foreigners.

Enrique Ona, 71, is one of the country’s leading transplant surgeons. He was director of the National Kidney and Transplant Institute for 11 years, and the president of the Transplantation Society of the Philippines since 1989.

Shortly after joining the administration, Dr Ona announced that he was opposed to the total ban on organ transplants from Filipino donors to foreigners. He also said he was open to giving a gratuity package to donors, which could go as high as P150,000 Pesos (approximately US$3,200). A few days later he was forced to backtrack, saying that “the ban stays as of now”.

Under President Arroyo transplant tourism was restricted, but Dr Ona fought tooth and nail to liberalise organ donation. He wrote a letter in 2008 to his international critics in which he argued: “In our part of the world, transplantation is the only avenue of our people to escape certain death, and the use of living non-related donors is only one of the strategies we use… We are in the receiving line of the developed world’s problem in kidney donor shortage which cannot be solved by the blanket prohibition you [in the developed world] propose for us to adopt.”

Dr Ona’s proposal was opposed by Dr. Alberto Chua of the Philippine Society of Nephrology. "These establishments offer P150,000 in gratuity package for donors. If I was a tricycle driver who only earns P3,000 a month, maybe I would sell my own kidney to get that P150,000," he said.  ~  Philippine Star, July 7; abs-cbnNEWS.com, July 2;Gulf News, July 14 

This falls in the category of bioethical fantasy rather than bioethical argument, but it was published in the respected Journal of Medicine and Philosophy. Libertarian academic Walter Block, of Loyola University, in  New Orleans, has a radical solution to the stalemate over human embryonic stem cell research. On one side, he says, pro-choice activists argue that embryos are just biological material. On the other, pro-life activists regard it as fully human.

Dr Block cuts the Gordian knot with libertarian reasoning which draws upon the work of Murray Rothbard. Yes, the foetus is indisputably a child, he says, but children are the quasi-property of their parents, who are responsible for a valuable asset which they should not mistreat, but they can dispose of.

Hence the solution: foetuses belong to the researchers provided that no one else wants to claim them as their own and raise them:

“Will the demand on the part of potential adoptive parents outstrip the supply of fetuses that can be created in the laboratory? If so, then not a single one of them will be killed, and no research will take licitly place, under the legal regime we are now considering. Or, will the ability of the medical technicians to create fetuses in this way overwhelm the willingness of adoptive parents to bring them up? If so, then some fetuses will be saved, those who are adopted, and others will be used and/or destroyed in medical research, the ones that exceed the demand of adoptive parents.” 

Dr Block acknowledges that his solution is unlikely to be very popular. ~ Journal of Medicine and Philosophy, July 11

 

Lesbian couples and anonymous sperm donors seem to be going mainstream. Attracting rave reviews is “The Kids are All Right”, a comedy about a lesbian couple in Southern California whose two teenaged children contact their sperm donor dad. He shows up full of smiles and fecklessness and testosterone. In short, he spells Trouble for this normal suburban family. A.O. Scott, of the New York Times, describes it as a beautifully acted and highly original film. From the reviews, the theme seems to be that anonymity is the best policy. The personal life of the director, Lisa Cholodenko, mirrors the situation in the film, as she has a partner and their son’s biological father is an anonymous sperm donor.  

The controversy over President Obama’s healthcare package has flared up again with the appointment of a Harvard professor who will implement many of the reforms, including the expansion of Medicaid and controlling Medicare costs. Donald Berwick will become Administrator of the Centers for Medicare & Medicaid Services (CMS).

This is a significant appointment, as the CMS Administrator oversees a third of all health care spending in the United States, more than US$800 billion. Since Congress is in recess, the President was able to appoint Dr Berwick for one year without seeking Senate approval.

Obama’s political opponents warn that Dr Berwick will implement healthcare rationing and the socialisation of American medicine. They have trawled through interviews and articles to find evidence of this.

Last year, they found, Berwick said society makes decisions about rationing all the time, and that the "decision is not whether or not we will ration care -- the decision is whether we will ration with our eyes open. And right now, we are doing it blindly."

He also esteems the UK's National Institute for Health and Clinical Excellence (NICE), which he said had "developed very good and very disciplined, scientifically grounded, policy-connected models for the evaluation of medical treatments from which we ought to learn."

And his praise of the UK’s National Health Service was fulsome in 2008: “one of the truly astounding human endeavors of modern times… The NHS is a bridge – a towering bridge – between the rhetoric of justice and the fact of justice.”

However, a number of medical groups and healthcare organisations defended his “patient-centered” record. President Bush’s two former CMS administrators also defend the appointment. ~ ABC News, July 6