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What to Make of the Prostate Cancer Screening Studies
Tweet Share on Facebook March 23, 2009 Comment (11)By Bernadine Healy, M.D.
Two ongoing prostate screening studies, one in the United States and the other in Europe, provide an early peek at mortality information. The studies, discussed in the just released issue of The New England Journal of Medicine, have caused a storm of confusion, since they seem to conflict. Actually, the studies are complementary, both make a lot of sense, and they are certain to influence medical practice even before they are completed.
For background, U.S. health policymakers are concerned that too many people get screened with the prostate-specific antigen test, which can identify prostate cancer long before symptoms develop. For this slow-growing tumor, that can mean before it needs to be detected, leading to unnecessary treatment, side effects, and cost. Thus, many think PSAs should be reined in. In contrast, in Europe, where PSAs are not routinely available to screen healthy men for disease, prostate cancer mortality is higher, leading some to believe that the reins on the test should be loosened up.
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Comparative Effectiveness: Is Obama Really Calling for Rationing?
Tweet Share on Facebook March 18, 2009 Comment (27)By Bernadine Healy, M.D.
Patients and doctors, get ready for pop-ups, a feature of healthcare reform described by President Obama in his budget. His plan to cut medical costs and standardize quality of care envisions a national computerized medical record system tied to treatment guidelines based on "comparative effectiveness" studies of how well the treatments work. Suppose you're a teen with acne or a woman with heart failure. You're a chronic diabetic or a middle-aged man with erectile dysfunction. As your doctor types your information into his or her government-certified computer, user-friendly pop-ups provide alerts in real time of what is deemed to be the best option for care. This could be a dream if it cuts costs while reducing unnecessary and harmful care—or a nightmare if we fall into a trap of inappropriate rationing.
Getting all Americans into a certified national health computer system in the next five years would start with Medicare and Medicaid patients. Doctors and hospitals would get incentives starting in 2011 for using certified electronic records, followed in 2015 by financial penalties on those who are not with the program. Inevitably, private health insurers would be drawn into the system.
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Obama Lifts Stem Cell Ban but Opens Debate on Embryo Creation
Tweet Share on Facebook March 9, 2009 Comment (17)By Bernadine Healy, M.D.
You can still hear the popping of the champagne corks. President Obama, surrounded by an exuberant and celebratory crowd peppered with notables of all political persuasion, has lifted former President Bush's ban on federal funding of research on human embryos for stem cell work. But Obama's remarks left the door open for embryo research that involves more than the frozen embryos left over from in vitro fertilization that Congress and most of the public seem to support: After all, these would be discarded anyway. What's on the table now is whether scientists should be able to use federal dollars to create human embryos for the sole purpose of laboratory research, including harvesting their stem cells.
Embryo creation is already going on privately in stem cell research labs throughout the country. Since public money is not involved, however, there is limited information on its scope or success. Leftover IVF embryos from fertility treatments that couples donate for scientific use are not what they have been cracked up to be; they can be damaged, often don't grow, and are inadequately characterized in terms of disease susceptibility. Stem cells from a freshly created embryo will be healthier and give scientists more of a "designer" tool, but they come at a cost: Donated human eggs are not easy to come by, and those eggs are simply the starting point. An embryo still must be created by fertilization with sperm, or by cloning in a process called somatic cell nuclear transfer. And there is considerably more resistance from an ethical perspective.
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Why Embryonic Stem Cells Are Obsolete
Tweet Share on Facebook March 4, 2009 Comment (129)By Bernadine Healy, M.D.
Scientists may be growing impatient, but President Obama has been rightly taking his time in addressing a campaign promise to lift the ban on federal funding for research using new lines of stem cells to be taken from human embryos. Even for strong backers of embryonic stem cell research, the decision is no longer as self-evident as it was, because there is markedly diminished need for expanding these cell lines for either patient therapy or basic research. In fact, during the first six weeks of Obama's term, several events reinforced the notion that embryonic stem cells, once thought to hold the cure for Alzheimer's, Parkinson's, and diabetes, are obsolete. The most sobering: a report from Israel published in PLoS Medicine in late February that shows embryonic stem cells injected into patients can cause disabling if not deadly tumors.
The report describes a young boy with a fatal neuromuscular disease called ataxia telangiectasia, who was treated with embryonic stem cells. Within four years, he developed headaches and was found to have multiple tumors in his brain and spinal cord that genetically matched the female embryos used in his therapy.
