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The Vaccines-Autism War: Détente Needed
Tweet Share on Facebook April 14, 2009 Comment (110)By Bernadine Healy, M.D.
When Larry King used the word debate to describe his April 3 program on vaccines and autism, he might just as well have said war; the airways smoked as activist Jenny McCarthy, mother of a child diagnosed with autism who blames vaccines, and her partner, Jim Carrey, faced off with two distinguished pediatricians representing the American Academy of Pediatrics. McCarthy and Carrey and two colleagues from the autism advocacy group she founded, Generation Rescue, took the AAP to task for its unwillingness to give at all in the controversy over vaccine safety and, while holding up a vaccine ad in its journal, accused the group of shilling for vaccine manufacturers.
The academy's goal is to get every child in America—that's 4 million born per year—vaccinated fully and on time in order to avoid perilous consequences such as a recent deadly outbreak of hemophilus influenza that could have been prevented with the Hib vaccine. The pediatricians took umbrage at the criticism and insisted that vaccine safety issues have been resolved to the fullest. I was there in the crossfire, arguing as I have many times that, yes, vaccines are eminently safe—and parents are raising legitimate concerns, yet unanswered. This controversy might be resolved if we can focus on a few big questions, with an open mind.
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Surprise! Heart Muscle Can Replenish Itself
Tweet Share on Facebook April 3, 2009 Comment (9)By Bernadine Healy, M.D.
It's humbling to see medical dogma overturned, but that is exactly what happened when, contrary to deeply embedded thought, scientists led by Jonas Frisen from the Karolinska Institute in Stockholm reported in Science today that the heart can grow new muscle cells, and does so regularly, albeit slowly, in the course of a lifetime.
To cardiologists, this is a blockbuster discovery, since the heart has been pegged as a disadvantaged organ in terms of injury, healing, and repair. Susceptible to coronary blockages that can cut off blood and destroy major hunks of heart muscle at one time in a heart attack, the heart can only heal itself slowly, often leaving behind thinned and baggy scar tissue devoid of healthy, beating muscle. And the distortion and remodeling of the heart that comes with this muscle loss sets the patient up for cardiac failure, blood clots, and nasty heart rhythms. It was always assumed the heart could do no better. But that does not seem to be so.
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Should Obama Get a PSA Test? On Prostate Cancer Screening and Comparative Effectiveness
Tweet Share on Facebook April 2, 2009 Comment (15)By Bernadine Healy, M.D.
One of the most sobering pieces of information from a recent prostate cancer screening study—one of two studies released last month that involved the blood test for prostate-specific antigen—is that to save one life, more than 1,000 men would have to be screened and 48 treated. That's a lot of screening, expense, and potentially unnecessary treatment. Is it all worthwhile? As these PSA studies show, answering that question—the question at the heart of what medical researchers call comparative effectiveness—is not nearly as easy as we might wish. Yet comparative effectiveness is critical, not just in evaluating cancer screening tests but in achieving successful health reform.
The new prostate studies are relevant for patients trying to decide whether to get PSA screening. But they give neither a simple thumbs up nor thumbs down. That underscores the need for clinicians and patients to make many subtle judgments, based on the evidence available. For example, urologists have developed criteria to identify which prostate cancer patients could safely pursue watchful waiting, delaying treatment if not eliminating it altogether. But a one-size-fits-all approach to screening and treatment, which is a feature of socialized healthcare systems, does not always allow those nuanced judgments. Should we continue with the imperfect and keep plugging to make it better or suspend the good until the perfect arrives? These are not scientific decisions but ones of policy. They are sure to stir debate.
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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.
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Electronic Medical Records: Will Your Privacy Be Safe?
Tweet Share on Facebook February 17, 2009 Comment (75)By Bernadine Healy, M.D.
Doctors are supposed to be nosy. It's not just that they examine your naked body inside and out and record all its imperfections. Physicians are trained to peer into your life, past and present, and ask all sorts of sensitive, if not uncomfortable, questions. Have you ever used marijuana or cocaine? How about steroids? How many sexual partners? Ever had a sexually transmitted disease? An abortion? Had sex with the same sex? How much do you smoke or drink? Have you used Botox or had plastic surgery? Have you been depressed or been treated for mental illness? And how about your marriage—or marriages?
You get the gist; the experience is intrusive. But the doctor-patient relationship was never meant to be other than confidential and privileged and solely for the benefit of the patient. Patients expect it, or they would not be forthcoming. And doctors take the Hippocratic oath, pledging to hold sacred their patients' secrets. This pledge of confidentiality, however, is now challenged by a world where computers rule and health information falls into many hands. One might well ask whether medical privacy is just too outmoded a concept for today's information-hungry world.
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A Cardiologist's Red-Dress-Day Tribute to the Heart
Tweet Share on Facebook February 5, 2009 Comment (5)By Bernadine Healy, M.D.
As February is heart month, February 6 has been designated National Wear Red Day as a way to encourage all of us—men and women, young and old—to think about and pamper that wonderful, hardworking, four-chambered gift. The occasion prompted me to go back and reread a "valentine to the heart" I wrote for U.S. News several years ago, the gist of which I offer again here.
At some level, everyone is an expert on the heart, which has a mind of its own. It is prone to flutter in response to a kiss, skip a few beats in the klieg lights, brace itself in the face of treachery, and slow during slumber—except, of course, as it races and pounds during a nasty dream. And while in today's secular times the heart has lost much of the cachet it once had as the mansion of the soul, it has not lost its grip on us as a romantic symbol of life. We still speak of happy hearts, good hearts, heavy hearts, and brave hearts. We have all felt heartache and have even been heartsick. We've suffered when our heart's desires were not fulfilled and been bewildered by those who are heartless. Our own hearts rally for those who are the lionhearted, and we yearn along with the Tin Man in his desperation for a heart. We see goodness in the heartland and know instinctively that home is where the heart is.
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Legalize Marijuana? Obama Was Right to Say No
Tweet Share on Facebook February 4, 2009 Comment (1142)By Bernadine Healy, M.D.
Puff the Magic Dragon—in his naughtier incarnation—bit the dust when President Barack Obama recently made it clear that he is against legalizing marijuana. His message was delivered on his website, Change.gov, even before he placed his hand on the Lincoln Bible. Astonishingly, legalization of marijuana ranked as Priority No. 1 for the new administration among the thousands of possible actions voted upon on the website by the public. Yes, even above stem cell research, the war in Iraq, and Wall Street bailouts. Obama's prompt no to the query "Will you consider legalizing marijuana so that the government can regulate it, tax it, put age limits on it, and create millions of new jobs and create a billion-dollar industry right here in the U.S.?" dashed the hopes of many who thought our young, hip, new president—who long ago dabbled in the stuff and, by his own admission, inhaled—would come to marijuana's rescue.
