Thursday, February 28, 2013

From JAMA: A piece of my mind. Remarkably wise

 2013 Feb 20;309(7):669-70. doi: 10.1001/jama.2013.196.

A piece of my mind. Remarkably wise.


Department of Medicine, University of Minnesota Medical School, Minneapolis, USA.

As one walks through the brightly lit, drably painted corridors of a typical US teaching hospital around 10 o’clock in the morning on any day of the week, any week of the year, one finds himself or herself tossed about in a tumultuous sea of the English language. Most buffeting winds come from senior residents, droning from within their white coats as they present cases to senior physicians:
“Cardiovascular-wise, examination was unremarkable.”
“The patient is in no acute distress, vitals within normal limits.”

From the Indian Journal of Medical Ethics: Do we need notification of tuberculosis? A public health perspective

 2013 Jan-Mar;10(1):56-8.

Do we need notification of tuberculosis? A public health perspective.


Assistant Professor, Centre for Public Health, Tata Institute of Social Sciences, Sion-Trombay Road, Deonar, Mumbai 400 088 INDIA e-mail:


Several instances of tuberculosis (TB) resistant to most drugs were reported in Mumbai in January 2012. Eventually, the Government of India declared TB to be a notifiable disease. This paper looks at the utility of notification and the ethical issues posed by it from a public health practice perspective. The paper argues that notification of TB in the absence of regulation of diagnostic practices, rational use of anti-TB medicines and availability of diagnostic and treatment facilities for drug-resistant TB will pose more ethical problems rather than provide solutions by way of adequate and rational treatment to patients.

From U Colorado: Update on Treatment Strategies for Obesity

 2013 Feb 26. [Epub ahead of print]

Update on Treatment Strategies for Obesity.


Division of Endocrinology, Metabolism, and Diabetes, Anschutz Health and Wellness Center, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045.


Obesity is a disease that is defined as the accumulation of excessive amounts of body fat and is associated with increased risk of serious illness, disability, and death. In clinical practice, obesity is best assessed by calculating body mass index and measuring waist circumference. Treatment options are determined based on the body mass index, waist circumference, and adverse health consequences the patient is experiencing or is at an increased risk for facing in the future. Today, overweight and obesity impacts the majority of patients we treat in our clinical practices. Although endocrinologists are uniquely positioned to treat one of the major consequences of our current obesity epidemic, type 2 diabetes, we also need to be positioned and prepared to effectively treat one of its major causes-obesity. Type 2 diabetes and obesity are very much intertwined. Treatment of each disease affects the other. For these reasons, endocrinologists need to be experts in the treatment of obesity as well as diabetes. They should keep up with advances in obesity treatment including lifestyle, pharmaceutical, and surgical strategies. These strategies offer opportunities for improving the overall treatment for our obese patients today and will continue to improve and expand over the next decade.

Evaluating Animal Models: Some Taxonomic Worries

 2013 Feb 26. [Epub ahead of print]

Evaluating Animal Models: Some Taxonomic Worries.


Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, Australia.


The seminal 1993 article by LaFollette and Shanks "Animal Models in Biomedical Research: Some Epistemological Worries" introduced an influential taxonomy into the debate about the value of animal experimentation. The distinction they made between hypothetical and causal analog models served to highlight a concern regarding extrapolating results obtained in animal models to human subjects, which endures today. Although their taxonomy has made a significant contribution to the field, we maintain that it is flawed, and instead, we offer a new practice-oriented taxonomy of animal models as a means to allow philosophers, modelers, and other interested parties to discuss the epistemic merits and shortcomings, purpose, and predictive capacities of specific modeling practices.

Texas business leaders call for performance-based higher education funding (HT:DF)

Updated: 5:16 p.m. Wednesday, Feb. 27, 2013 | Posted: 5:12 p.m. Wednesday, Feb. 27, 2013

Business leaders call for performance-based higher education funding

American-Statesman Staff
Texas business leaders came out forcefully Wednesday in support of a proposal to link 10 percent of state funding for public colleges and universities to their graduation rates and other measures of student success.

Nothing less than the future workforce of the state is at stake, said Bill Hammond, president and CEO of the Texas Association of Business, the state’s largest business group.

“The future is now in terms of jobs,” said Justin Yancy, executive director of the Texas Business Leadership Council. “We need more post-secondary success.”

- See more at:

Former Penn admissions officer mocked applicant essays (HT:CF)

Former admissions officer mocked applicant essays

Nadirah Farah Foley's case raises questions about social media in admissions

· February 26, 2013, 8:24 pm

A former Penn admissions officer who had shared excerpts from applicants’ essays on her personal Facebook page is no longer employed by the University.
Near the end of 2012, Penn’s Office of Admissions was made aware of a series of online posts written by Nadirah Farah Foley — a 2011 Princeton University graduate who had been responsible for coordinating Penn admissions in Connecticut.
In the posts, which were made available through a collection of Facebook screenshots sent anonymously to Dean of Admissions Eric Furda and The Daily Pennsylvanian on Dec. 3, Foley mocked a number of student essays she had come across in her work.

Wednesday, February 27, 2013

Scientific Misconduct: Three Forms that Directly Harm Others as the Modus Operandi of Mill's Tyranny of the Prevailing Opinion

 2013 Feb 19. [Epub ahead of print]

Scientific Misconduct: Three Forms that Directly Harm Others as the Modus Operandi of Mill's Tyranny of the Prevailing Opinion.


Center for Logic and Philosophy of Science, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium,


Scientific misconduct is usually assumed to be self-serving. This paper, however, proposes to distinguish between two types of scientific misconduct: 'type one scientific misconduct' is self-serving and leads to falsely positive conclusions about one's own work, while 'type two scientific misconduct' is other-harming and leads to falsely negative conclusions about someone else's work. The focus is then on the latter type, and three known issues are identified as specific forms of such scientific misconduct: biased quality assessment, smear, and officially condoning scientific misconduct. These concern the improper ways how challenges of the prevailing opinion are thwarted in the modern world. The central issue is pseudoskepticism: uttering negative conclusions about someone else's work that are downright false. It is argued that this may be an emotional response, rather than a calculated strategic action. Recommendations for educative and punitive measures are given to prevent and to deal with these three forms of scientific misconduct.

From USC: The relationship between measures of obesity and incident heart failure

 2013 Jan 2. doi: 10.1002/oby.20298. [Epub ahead of print]

The relationship between measures of obesity and incident heart failure: The multi-ethnic study of atherosclerosis.


Department of Medicine, University of Southern California, Los Angeles, CA.



To evaluate the strength of association of body mass index (BMI) and waist circumference (WC) with incident heart failure (HF), exploring our associations by ethnicity and age.


We included 6,809 participants, aged 45-84 years, without clinical cardiovascular disease (2000-2002), from the Multi-Ethnic Study of Atherosclerosis. Cox-Proportional hazards models were used to examine associations of BMI and WC with incident HF. The predictive abilities of BMI and WC were compared using receiver operating characteristic curves.


Over a median follow-up of 7.6 years, there were 176 cases. BMI and WC were associated with incident HF in men [1.33 (1.10-1.61) and 1.38 (1.18-1.62) respectively] and women [1.70 (1.33-2.17) and 1.64 (1.29-2.08) respectively]. These associations became non-significant after adjusting for obesity-related conditions (hypertension, dysglycemia, hypercholesterolemia, left ventricular hypertrophy, kidney disease and inflammation). The associations of BMI and WC did not vary significantly by ethnicity or age-group, but were inverse in Hispanic men. The area under the curve for BMI and WC was 0.749 and 0.750, respectively, in men and 0.782 and 0.777, respectively, in women.


The association between obesity and incident HF is largely mediated by obesity-related conditions. BMI and WC have similar predictive abilities for incident HF.

Five ethical and clinical challenges psychiatrists may face when treating patients with borderline personality disorder who are or may become suicidal

 2013 Jan;10(1):14-9.

Five ethical and clinical challenges psychiatrists may face when treating patients with borderline personality disorder who are or may become suicidal.


Dr. Howe is Professor, Department of Psychiatry, Director, Programs in Medical Ethics, and Senior Scientist, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland.


This article discusses five core ethical and clinical questions psychiatrists should consider when they treat patients with borderline personality disorder who are or may be suicidal. These questions include whether psychiatrists should tell patients their diagnosis, what they should tell them about their suicide risk, whether they should be "always" available by phone, when they should hospitalize these patients involuntarily, and how they should respond after these patients have attempted suicide and return for further care. This discussion highlights the ethical components of these questions. Optimal ethical and clinical interventions, in most cases, overlap. Psychiatrists may accomplish the most clinically by sharing with these patients some of the above conflicts that they face and/or the rationales for doing what they will do. These interventions may maximize the autonomy patients with borderline personality disorder and at the same time be clinically optimal, increasing a sense of self-efficacy and patient-psychiatrist trust in the patients.

Some links to the life of C. Everett Koop, America's greatest Surgeon General, who died this week. Hero.

Telepsychiatry in India

 2013 Jan;55(1):3-11. doi: 10.4103/0019-5545.105499.

Telepsychiatry: Promise, potential, and challenges.


Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.


Despite the high prevalence and potentially disabling consequences of mental disorders, specialized mental health services are extremely deficient, leading to the so-called 'Mental Health Gap'. Moreover, the services are concentrated in the urban areas, further worsening the rural-urban and tertiary primary care divide. Strengthening of and expanding the existing human resources and infrastructure, and integrating mental health into primary care appear to be the two major solutions. However, both the strategies are riddled with logistic difficulties and have a long gestation period. In such a scenario, telepsychiatry or e-mental health, defined as the use of information and communication technology to provide or support psychiatric services across distances, appears to be a promising answer. Due to its enormous potential, a review of the existing literature becomes imperative. An extensive search of literature was carried out and has been presented to delineate the modes of communication, acceptability and satisfaction, reliability, outcomes, cost-effectiveness, and legal and ethical challenges related to telepsychiatry. Telepsychiatry has been applied for direct patient care (diagnosis and management), consultation, and training, education, and research purposes. Both real-time, live interaction (synchronous) and store-forward (asynchronous) types of technologies have been used for these purposes. A growing amount of literature shows that training, supervision, and consultation by specialists to primary care physicians through telepsychiatry has several advantages. In this background, we have further focused on the models of telepsychiatry best suited for India, considering that mental health care can be integrated into primary care and taken to the doorstep of patients in the community.

From the Bulletin of Health Policy and Law: A National Alzheimer’s Disease Plan

A National Alzheimer’s Disease PlanErika Orjales 

Abstract: The National Alzheimer’s Project Act has been signed into law. However, implementation may be challenging.
Keywords: Alzheimer’s Disease; treatment; national policy

Published: 10 January 2013
Cite as: Orjales E. A National Alzheimer’s Disease Plan. 
Bull Health L Policy. 2012;1(2).


Under the National Alzheimer’s Project Act (NAPA), the Department of Health and Human Services (HHS) directs the first national Plan, currently being drafted and titled The Draft National Plan (“Plan”). The Plan’s goal is to eradicate Alzheimer’s Disease by focusing on the following five main categories: (1) prevention and treatment, (2) health and long term care, (3) social resources for family and caregivers, (4) public awareness and (5) disease tracking mechanisms.1The Plan has evolved during quarterly conferences held by the Advisory Council of NAPA.2 In addition to the quarterly conferences, NAPA’s website has opened a forum for public comments regarding suggestions for draft revisions.3
As the number of AD cases continues to grow, caregivers are demanding more aggressive actions from the government to assist with care costs.
4 HHS has teamed up with various federal agencies to form an Interagency Group (Group).5 The Group will be gathering and coordinating information for submission to NAPA’s Advisory Council for review.6 Through the use of conferences and public forums, the Advisory Council will make recommendations as to the priorities HHS should take to fully implement NAPA.7 Through these means, NAPA intends the Plan to act as a platform to coordinate a comprehensive approach to diminish the burden of AD for the entire nation.8

Approach to Intraoperative Consultation for Donor Liver Biopsies

Approach to Intraoperative Consultation for Donor Liver Biopsies

Claire Melin Ronald Miick MD; Nancy A. Young MD; Jorge Ortiz MD; Manjula Balasubramanian MD
From the School of Medicine and Dentistry, University of Rochester, Rochester, New York (Ms Melin); and the Department of Pathology and Laboratory Medicine (Drs Miick, Young, and Balasubramanian) and the Division of Transplant, Department of Surgery (Dr Ortiz), Einstein Medical Center–Philadelphia, Philadelphia, Pennsylvania.
Context.— As demand for organs to treat end-stage liver disease increases, donor livers once deemed only marginally suitable for donation are being considered for transplantation. Pathologists are increasingly being asked to evaluate these livers for acceptability. This article provides guidelines for frozen section evaluation of livers for transplantation.
Objective.— This article concentrates on the histopathologic features of transplant suitability with appropriate clinicopathologic correlation for the practicing pathologist. Recommendations for proper handling and sampling of tissue are discussed. Relative and absolute contraindications as well as artifacts and benign conditions are emphasized.
Data Sources.— Sources include a compilation of the authors' experiences in academic and community liver transplantation centers. In addition, relevant medical literature was reviewed, as well as Web sites specializing in organ transplantation, such as Transplant Pathology Internet Services and the Organ Procurement and Transplantation Network.
Conclusions.— Malignancy and extensive necrosis in the liver are absolute contraindications to transplantation. Evaluation of macrosteatosis, fibrosis, hepatitis, and necrosis depends on the severity of disease and correlation with the clinical situation. Donor age of greater than 60 years does not preclude transplantation. Artifacts and benign conditions need to be understood to prevent wastage of precious organs and to ensure that an appropriate organ is provided for the recipient.

Cass Sunstein's It's For Your Own Good! (or, how I learned to stop worrying and love the nannystate)

It’s For Your Own Good!

MARCH 7, 2013

Cass R. Sunstein

Against Autonomy: Justifying Coercive Paternalism
by Sarah Conly 
Cambridge University Press, 206 pp., $95.00  

For coercive paternalism to be justified, Conly contends that four criteria must be met. First, the activity that paternalists seek to prevent must genuinely be opposed to people’s long-term ends as judged by people themselves. If people really love collecting comic books, stamps, or license plates, there is no occasion to intervene.
Second, coercive measures must be effective rather than futile. Prohibition didn’t work, and officials shouldn’t adopt strategies that fail. Third, the benefits must exceed the costs. To know whether they do, would-be paternalists must assess both material and psychological benefits and costs (including not only the frustration experienced by those who lose the power to choose but also the losses experienced by those who are coerced into something bad for them). Fourth, the measure in question must be more effective than the reasonable alternatives. If an educational campaign would have the benefits of a prohibition without the costs, then Conly favors the educational campaign.
Applying these criteria, Conly thinks that New York’s ban on trans fats is an excellent example of justifiable coercion. On the basis of the evidence as she understands it, the ban has been effective in conferring significant public health benefits, and those benefits greatly exceed its costs. Focused on the problem of obesity, Conly invokes similar points in support of regulations designed to reduce portion sizes.
She is far more ambivalent about Mayor Bloomberg’s effort to convince the US Department of Agriculture to authorize a ban on the use of food stamps to buy soda. She is not convinced that the health benefits would be significant, and she emphasizes that people really do enjoy drinking soda.

Standardized Synoptic Cancer Pathology Reports: So What and Who Cares?

Standardized Synoptic Cancer Pathology Reports: So What and Who Cares? A Population-Based Satisfaction Survey of 970 Pathologists, Surgeons, and Oncologists

Sara LankshearPhDJohn SrigleyMDThomas McGowanMDMarta YurcanMHScCarol SawkaMD
From the Cancer Information Program (Dr Lankshear and Ms Yurcan), the Programs of Laboratory Medicine (Dr Srigley) and Oncology (Dr McGowan), Trillium Health Partners, Mississauga, Ontario Canada, and Clinical Programs and Quality Initiatives (Dr Sawka).
Context.— Cancer Care Ontario implemented synoptic pathology reporting across Ontario, impacting the practice of pathologists, surgeons, and medical and radiation oncologists. The benefits of standardized synoptic pathology reporting include enhanced completeness and improved consistency in comparison with narrative reports, with reported challenges including increased workload and report turnaround time.
Objective.— To determine the impact of synoptic pathology reporting on physician satisfaction specific to practice and process.
Design.— A descriptive, cross-sectional design was utilized involving 970 clinicians across 27 hospitals. An 11-item survey was developed to obtain information regarding timeliness, completeness, clarity, and usability. Open-ended questions were also employed to obtain qualitative comments.
Results.— A 51% response rate was obtained, with descriptive statistics reporting that physicians perceive synoptic reports as significantly better than narrative reports. Correlation analysis revealed a moderately strong, positive relationship between respondents' perceptions of overall satisfaction with the level of information provided and perceptions of completeness for clinical decision making (r = 0.750, P < .001) and ease of finding information for clinical decision making (r = 0.663, P < .001). Dependent t tests showed a statistically significant difference in the satisfaction scores of pathologists and oncologists (t169 = 3.044, P = .003). Qualitative comments revealed technology-related issues as the most frequently cited factor impacting timeless of report completion.
Conclusion.— This study provides evidence of strong physician satisfaction with synoptic cancer pathology reporting as a clinical decision support tool in the diagnosis, prognosis, and treatment of cancer patients.

From Adam B at the Daily Kos: Five reasons why Section 5 of the Voting Rights Act is in grave danger (HT:SD)

Five reasons why Section 5 of the Voting Rights Act is in grave danger

byAdam B

"The Chief Justice, possibly our best bet to be the fifth vote, is skeptical about whether the current VRA formula reflects the states which are problematic"

"social engineering disguised as product engineering"

Is Smart Making Us Dumb?

A revolution in technology is allowing previously inanimate objects—from cars to trash cans to teapots—to talk back to us and even guide our behavior. But how much control are we willing to give up?

But many smart technologies are heading in another, more disturbing direction. A number of thinkers in Silicon Valley see these technologies as a way not just to give consumers new products that they want but to push them to behave better. Sometimes this will be a nudge; sometimes it will be a shove. But the central idea is clear: social engineering disguised as product engineering.

Tuesday, February 26, 2013

CPRIT "despite a moratorium...letting contract negotiations resume"

CPRIT board OK's contract talks on frozen grants

AUSTIN, Texas (AP) — The state's troubled $3 billion cancer-fighting agency has voted to move forward with frozen grants despite a moratorium still hanging over the Cancer Prevention and Research Institute of Texas.
The move adopted Monday stops short of actually funding nearly $183 million in approved awards. But board members approved letting contract negotiations resume so the deals will be ready when — and if — the moratorium is lifted.
Board member Barbara Canales says the agency is "going to offend somebody" by taking action with the moratorium still in place. But Canales says it's time for the board to show courage.

From Jacobs U-Bremen Germany: Social regulation of emotion: messy layers

 2013;4:51. doi: 10.3389/fpsyg.2013.00051. Epub 2013 Feb 15.

Social regulation of emotion: messy layers.


School of Humanities and Social Sciences, Jacobs University Bremen Bremen, Germany.


Emotions are evolved systems of intra- and interpersonal processes that are regulatory in nature, dealing mostly with issues of personal or social concern. They regulate social interaction and in extension, the social sphere. In turn, processes in the social sphere regulate emotions of individuals and groups. In other words, intrapersonal processes project in the interpersonal space, and inversely, interpersonal experiences deeply influence intrapersonal processes. Thus, I argue that the concepts of emotion generation and regulation should not be artificially separated. Similarly, interpersonal emotions should not be reduced to interacting systems of intraindividual processes. Instead, we can consider emotions at different social levels, ranging from dyads to large scale e-communities. The interaction between these levels is complex and does not only involve influences from one level to the next. In this sense the levels of emotion/regulation are messy and a challenge for empirical study. In this article, I discuss the concepts of emotions and regulation at different intra- and interpersonal levels. I extend the concept of auto-regulation of emotions (Kappas, 2008, 2011a,b) to social processes. Furthermore, I argue for the necessity of including mediated communication, particularly in cyberspace in contemporary models of emotion/regulation. Lastly, I suggest the use of concepts from systems dynamics and complex systems to tackle the challenge of the "messy layers."

Surviving and winning a professional negligence lawsuit


Surviving and winning a professional negligence lawsuit.


Orthopaedic Trauma Surgeon, Resurgens Orthopaedics, Atlanta, Georgia.


Being served with a medical negligence lawsuit usually is a traumatic event for an orthopaedic surgeon. The course of litigation is long and tedious, and the defendant physician must be well prepared for the experience. It is imperative that the physician contact his or her insurance carrier immediately after being served with the complaint because many legal actions are time dependent. The insurance company will assign an attorney to defend the physician, and an effective team will be needed to mount a powerful defense. The defendant physician's deposition is among the most important aspects of the entire process. Extensive preparation for the deposition will strengthen the defense; but the physician must remember that the lawsuit will not be won during the deposition. Because the testimony of expert witnesses often decides the outcome of the case, it is important for the physician to help the attorney identify the best potential witnesses. A thorough knowledge of the tactics that the plaintiff's attorney may use during cross-examination can help ensure that the truth is clearly portrayed. The American Academy of Orthopaedic Surgeons Professional Compliance Program is designed to ensure that all testimony in medical liability cases is fair and factual.

Parental smoking in the vicinity of children and tobacco control policies in the European region

 2013;8(2):e56783. doi: 10.1371/journal.pone.0056783. Epub 2013 Feb 20.

Parental smoking in the vicinity of children and tobacco control policies in the European region.


EHESP Rennes, Sorbonne Paris Cité, EA 4069 Université Paris Descartes, Paris, France.



To ascertain patterns of parental smoking in the vicinity of children in Eastern and Western Europe and their relation to Tobacco Control Scale (TCS) scores.


Data on parental smoking patterns were obtained from the School Child Mental Health Europe (SCMHE), a 2010 cross-sectional survey of 5141 school children aged 6 to 11 years and their parents in six countries: Germany, Netherlands, Lithuania, Romania, Bulgaria and Turkey ranked by TCS into three level categories toward tobacco control policies.


A slightly higher proportion of Eastern compared to Western European mothers (42.4 vs. 35.1%) were currently smoking in but the difference was not statistically significant after adjusting for maternal age and maternal educational attainment. About a fifth (19.3%) and a tenth (10.0%) of Eastern and Western European mothers, respectively, smoked in the vicinity of their children, and the difference was significant even after adjustment for potential confounders (p<0.001). Parents with the highest educational attainment were significantly less likely to smoke in the vicinity of their children than those with the lowest attainment. After control of these covariates lax tobacco control policies, compared to intermediate policies, were associated with a 50% increase in the likelihood of maternal smoking in the vicinity of children adjusted odds ratio (AOR) = 1.52 and 1.64. Among fathers, however, the relationship with paternal smoking and TCS seems more complex since strict policy increases the risk as well AOR = 1,40. Only one country, however belongs to the strict group.


Tobacco control policies seem to have influenced maternal smoking behaviors overall to a limited degree and smoking in the vicinity of children to a much greater degree. Children living in European countries with lax tobacco control policies are more likely to be exposed to second hand smoking from maternal and paternal smoking.