Feng Yin, Gang Han, Marilyn M. Bui, Julie Gibbs, Ian Martin, Lohini Sundharkrishnan, Lauren King, Christine Jabcuga, Lauren N. Stuart, and Lewis A. Hassell (2016) Educational Value of Digital Whole Slides Accompanying Published Online Pathology Journal Articles: A Multi-Institutional Study. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Educational Value of Digital Whole Slides Accompanying Published Online Pathology Journal Articles: A Multi-Institutional Study

Feng Yin , MD, PhD; Gang Han , PhD; Marilyn M. Bui , MD, PhD; Julie Gibbs , MD; Ian Martin , DO; Lohini Sundharkrishnan , MD;Lauren King , MD; Christine Jabcuga , MD; Lauren N. Stuart , MD, MBA; Lewis A. Hassell , MD

Reprints: Lewis A. Hassell, MD, Department of Pathology, University of Oklahoma Health Sciences Center, Presbyterian Tower, Lower Level, Pathology Suite, 700 NE 17th St, Oklahoma City, OK 73104 (email: Lewis-Hassell@ouhsc.edu).

Context.—Despitep pgreat interest in using whole slide imaging (WSI) in pathology practice and education, few pathology journals have published WSI pertinent to articles within their pages or as supplemental materials.

Objective.—To evaluate whether there is measurable added educational value of including WSI in publications.

Design.—Thirty-seven participants, 16 (43.3%), 15 (40.5%), and 6 (16.2%) junior pathology residents (postgraduate year 1–2), senior pathology residents (postgraduate year 3–4), and board-certified pathologists, respectively, read a sequence of 10 journal articles on a wide range of pathology topics. A randomized subgroup also reviewed the WSI published with the articles. Both groups completed a survey tool assessing recall of text-based content and of image-based material pertinent to the diseases but not present in the fixed published images.

Results.—The group examining WSI had higher performance scores in 72% of image-based questions (36 of 50 questions) as compared with the non-WSI group. As an internal study control, the WSI group had higher performance scores in only 40% of text-based questions (6 of 15 questions). The WSI group had significantly better performance than the non-WSI group for image-based questions compared with text-based questions (P < .05, Fisher exact test).

Conclusion.—Our study provides supporting evidence that WSI offers enhanced value to the learner beyond the text and fixed images selected by the author. We strongly encourage more journals to incorporate WSI into their publications.

Jackie Fox's The 10 Commandments of Breast Cancer

The 10 Commandments of Breast Cancer

in preparation for the Presidential election: An economics primer in two rounds

In preparation for the Presidential election: An economics primer in two rounds

ROUND ONE

ROUND TWO

Am J Obstet Gynecol. 2016 Apr 19. pii: S0002-9378(16)30059-X. doi: 10.1016/j.ajog.2016.04.018. [Epub ahead of print]

Midurethral Slings: Evidence-Based Medicine vs. The Medicolegal System.

Nager CW1.

Author information

• 1Department of Reproductive Medicine, UC San Diego School of Medicine. Electronic address: cnager@ucsd.edu.

Abstract

Midurethral slings are minimally invasive surgeries for stress urinary incontinence that use a trocar system to place a narrow ribbon of polypropylene mesh under the midurethra. The peer-reviewed scientific literature on these procedures is abundant and midurethral slings are the most well -studied incontinence procedure ever. Systematic reviews of the literature demonstrate that midurethral slings are safer, and more (or equally) effective as traditional procedures. The midurethral sling is the worldwide standard for the treatment of female stress urinary incontinence and over 3 million procedures have been performed. The FDA and international scientific review agencies have consistently differentiated transvaginal mesh for stress urinary incontinence from transvaginal mesh for prolapse. In the recruitment of patients to participate in the transvaginal mesh litigation, plaintiff lawyers have not made the distinction between stress urinary incontinence and prolapse procedures because s, more women have received midurethral slings than transvaginal mesh for prolapse by an order of magnitude. The litigation costs of defending their products have forced several companies that manufactured midurethral slings to leave the marketplace. It is not inconceivable that midurethral slings could become absent from the U.S. market. If that happens, then American women with stress urinary incontinence will be harmed because they will not have access in this country to the best and safest stress urinary incontinence surgical procedure ever developed. It may be time for the Institute of Medicine, or another comparable national agency to provide evidence-based recommendations on the midurethral sling.

Zombie allusions: They just keep on coming™: "...crying like a little baby."

11-year-old takes down burglar, thanks to his zombie target practice

POSTED 7:18 PM, APRIL 29, 2016, BY STOSCHLOG39

"Yeah," he laughs, "I play zombies for target practice." And he plays with real bullets.

So when Chris heard someone break into his house Wednesday morning, he got straight to business, grabbing a nine millimeter gun.

"I told him I was going to kill him and all that, with a gun, if he didn't get outta my house," Chris explains. But the robber didn't believe this tiny Terminator.

"I guess he didn't think it was a real gun because he didn't worry about it," Chris continues, "He just kept on walkin'."

In fact, he walked right out the door with a hamper full of stuff. But Li'l Chris wasn't havin' it.  He started shooting a dozen bullets. "I shot through a hamper that he was carrying. It was a full metal jacket bullet. It went straight through the back of him and his leg, and he started crying like a little baby."

Zombie allusions: They just keep on coming™: "... in COMMUNIST SOVIET RUSSIA AND/OR DEEPEST RED CHINA..."

Tyrannical Nashville Neighborhood Association Orders Man to Remove Zombie From Yard

By Ben Mathis-Lilley

"Grinstead says he will comply even though his agreement with the association doesn't appear to mention anything about lawn ornaments or zombie art masterpieces.

It's odd that the dateline and identifying details in WKRN's story say it happened in Nashville, Tennessee, USA, because I would have thought for sure such a thing could only take place in COMMUNIST SOVIET RUSSIA AND/OR DEEPEST RED CHINA.

For shame."

"For centuries, science communication has been widely perceived, irrespective of context, as a didactic enterprise."

Public Underst Sci. 2016 May;25(4):433-46. doi: 10.1177/0963662516629747.

In science communication, why does the idea of a public deficit always return?

Meyer G1.

Author information

• 1Copenhagen Business School, Denmark gme.dbp@cbs.dk gitte@gittemeyer.eu.

Abstract

For centuries, science communication has been widely perceived, irrespective of context, as a didactic enterprise. That understanding does not accommodate a political category of science communication, featuring citizens on an equal footing - some of them scientists - who share responsibility for public affairs and represent different points of view and ways of reasoning. That may harm, at the same time and for the same reasons, democratic knowledge societies as political entities and science as a body of knowledge and rational methodology. Scientists are discursively excluded from the public. The public is perceived in terms of knowledge deficiency. The latter perception has survived decades of critique, accompanied by attempts, along an everyman-as-scientist logic, to include all citizens in the scientific endeavour. But why should all be scientists? With respect to practical-political issues - as distinct from technical-scientific ones - the acknowledgement of the citizenship of scientists seems more relevant. Only, this would challenge the widespread understanding of science as an all-purpose problem solver and the consequent ideas of politics.

Rev Med Chir Soc Med Nat Iasi. 2016 Jan-Mar;120(1):15-22.

ETHICAL AND GENETIC ASPECTS REGARDING PRESYMPTOMATIC TESTING FOR NEURODEGENERATIVE DISEASES.

Cozaru GC, Aşchie M, Mitroi AF, Poinăreanu I, Gorduza EV.

Abstract

Neurodegenerative diseases, such as Alzheimer's dementia, Huntington's chorea, Parkinson's disease or spinocerebellar ataxia, manifests into adulthood with an insidious onset, slowly of progressive symptoms. All of these diseases are characterized by presimptomatic stages that preceded with many years of clinical debut. In Parkinson's disease, more than half of the dopaminergic neurons of the black substance are lost before the advent of motor characteristic manifestations. In Huntington's chorea, the progressive neurodegenerative disease could be diagnose prenatal and presymptomatic by analyse of the number of CAG repeats in exon 1 of the huntingtin gene. A similar mechanism represented by expansion of trinucleotide repeats during hereditary transmission from parents to children was identified in fragile X syndrome, spinocerebellar ataxia, spinal muscular and bulbar atrophy, or myotonic dystrophy. Presymptomatic diagnosis in all these progressive diseases raise many ethical issues, due to the psychological impact that can cause the prediction of a disease for which there is currently no curative treatment. Therefore, a positive result can produce serious psychological trauma and major changes in the lifestyle of the individual, instead, a negative result can bring joy and tranquillity. But the problem arises if presymptomatic testing in these neurodegenerative diseases brings greater benefits compared to the possible psychological damage, which can add the risk of stigmatization or discrimination.

NO: Would a sugar tax be better than a soda tax?

Would a sugar tax be better than a soda tax?

Some states have, however, tried to get more aggressive in regulating sugar. Seventeen states have a special tax they levy just on candy or snacks (the rationale for these feesactually began in the World War I era — not as a public health campaign, but as a way to raise war revenue by taxing consumption of a "luxury good.")

This approach ultimately runs into the same issue as a soda tax in that it misses a lot of the sugar in the world. A since-repealed "snack tax" in California, for example, applied to Milky Way candy bars — but not Milky Way ice cream.

Child obesity in US has grown unabated since 1999, study finds "...dims optimism prompted by research published two years ago..."

Child obesity in US has grown unabated since 1999, study finds 

The new study, published Monday in the journal Obesity, dims optimism prompted by research published two years ago, when a similar population-wide study found a large drop in obesity rates among toddlers (ages 2 to 5). The decline was hailed as the possible leading edge of a reversal in U.S. child obesity—a positive response to public health initiatives aimed at driving down the nation's girth.

The authors of the current study, researchers at Duke University, University of North Carolina and Wake Forest University, dashed even that small glimmer of hope. The reported decline, they wrote, “is not evident in our results, for girls or boys.”

- See more at: http://www.gazettextra.com/20160429/child_obesity_in_us_has_grown_unabated_since_1999_study_finds#sthash.acVzjSVF.dpuf

Fresno High adds breast-feeding room for teen moms

“We don’t know why, but it could be that at such a young age, it’s just easier for someone else to take care of the baby by giving them a bottle, or that they’re embarrassed or don’t know how it’s going to affect their bodies,” she said. “But I want to change that. It’s the most perfect nutrition for a baby.”

Read more here: http://www.fresnobee.com/news/local/education/article74787237.html#storylink=cpy

Arch Pathol Lab Med. 2016 Apr 15. [Epub ahead of print]

Biomarker Testing in Lung Carcinoma Cytology Specimens: A Perspective From Members of the Pulmonary Pathology Society.

Roy-Chowdhuri S, Aisner DL, Allen TC, Beasley MB, Borczuk A, Cagle PT, Capelozzi V, Dacic S, da Cunha Santos G, Hariri LP, Kerr KM, Lantuejoul S, Mino-Kenudson M, Moreira A, Raparia K, Rekhtman N, Sholl L, Thunnissen E, Tsao MS, Vivero M, Yatabe Y1.

Author information

• 1From the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology, University of Colorado Cancer Center, Denver (Dr Aisner); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Beasley); the Department of Pathology, Weill Cornell Medical College, New York (Drs Borczuk and Cagle); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Cagle); the Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil (Dr Capelozzi); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, University Health Network, Princess Margaret Cancer Centre, and the University of Toronto, Toronto, Ontario, Canada (Drs da Cunha Santos and Tsao); the Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, Aberdeen University Medical School, and Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom (Dr Kerr); the Department of Biopathology, Centre Léon Bérard, Lyon, and J Fourier University, Institut National de la Santé et de la Recherche Médicale-Institut Albert Bonniot, Grenoble, France (Dr Lantuejoul); the Department of Pathology, New York University, New York (Dr Moreira); the Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York (Dr Rekhtman); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston (Drs Sholl and Vivero); the Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands (Dr Thunnissen); and the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe).

Abstract

The advent of targeted therapy in lung cancer has heralded a paradigm shift in the practice of cytopathology with the need for accurately subtyping lung carcinoma, as well as providing adequate material for molecular studies, to help guide clinical and therapeutic decisions. The variety and versatility of cytologic-specimen preparations offer significant advantages to molecular testing; however, they frequently remain underused. Therefore, evaluating the utility and adequacy of cytologic specimens is critical, not only from a lung cancer diagnosis standpoint but also for the myriad ancillary studies that are necessary to provide appropriate clinical management. A large fraction of lung cancers are diagnosed by aspiration or exfoliative cytology specimens, and thus, optimizing strategies to triage and best use the tissue for diagnosis and biomarker studies forms a critical component of lung cancer management. This review focuses on the opportunities and challenges of using cytologic specimens for molecular diagnosis of lung cancer and the role of cytopathology in the molecular era.

Michael Misialek and me: Pathologists: You're On Social Media! So Now What?

Michael J. Misialek and Timothy Craig Allen (2016) You're On Social Media! So Now What?. Archives of Pathology & Laboratory Medicine: May 2016, Vol. 140, No. 5, pp. 393-393.

EDITORIAL

You're On Social Media! So Now What?

Michael J. Misialek , MD; Timothy Craig Allen , MD, JD

From the Department of Pathology, Newton-Wellesley Hospital, Newton, Massachusetts (Dr Misialek);

and the Department of Pathology, The University of Texas Medical Branch, Galveston (Dr Allen).

Reprints: Timothy Craig Allen, MD, JD, Department of Pathology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555 (email: tcallen@utmb.edu).

"Any health care 'reform' that intensifies government regulation or enlarges the role of insurance companies only makes a bad system worse."

JEFF JACOBY

Let the patient pay the piper, and the price of health care will fall

"Americans are forever being told that health care costs are out of control and that only sweeping government intervention can bring them back to earth. Obamacare was supposed to make medical plans more affordable, but premiums are higher than ever . Bernie Sanders campaigns on a platform of “Medicare for all” — single-payer socialized health care — yet any such system would inevitablylower the quality of care while raising prices still higher.

Any health care “reform” that intensifies government regulation or enlarges the role of insurance companies only makes a bad system worse. Like the woman described above, for most Americans, even their most routine and predictable medical costs must be routed through the maddening labyrinth of insurance procedures.

But nothing could be more counterproductive."

Surrey on...childhood obesity - five different viewpoints

"What can be done to tackle the problem and how can habits be changed for good? Should the schools, families or the government take the lead in implementing a solution? Are parents to blame and should it be up to ministers to tell us how and what we should be eating?"

The Last Theme Song -UNT's One O'Clock Lab Band

The Last Theme Song - One O'Clock Lab Band

Violence Vict. 2016 Apr 8. [Epub ahead of print]

Morality and Intimate Partner Violence: Do Men in Court-Mandated Psychological Treatment Hold a Sacred Moral Vision of the World and Themselves?

Vecina ML, Chacón JC.

Abstract

This article examines the characterization of men in a court-mandated treatment for violence against their partners as holding a sacred vision of the 5 moral foundations and of their own morality. This characterization is compatible with the assumption that a sacred moral world is easily threatened by reality and that may be associated to violent defensive actions. The results from latent class analyses reveal (a) a 4-class distribution depending exclusively on the intensity with which all participants (violent and nonviolent) tend to sacralize the actions proposed in the Moral Foundations Sacredness Scale and (b) a greater prevalence of the violent participants among the classes that are more prone to sacralize. They also show that they hold an inflated moral vision of themselves: They think they are much more moral than intelligent than others who have never been charged with criminal behavior (Muhammad Ali effect).

Strength training for older adults promotes longevity

"The researchers looked at data from the National Health Interview Survey (NHIS) where nine percent of participants reported meeting the twice-a-week guidelines for strength training. “That’s only a small fraction of the population, but it’s actually higher than we had anticipated,” Kraschnewski said.

The respondents were followed for 15 years through their death certificate data. The researchers found that those who partook in strength training at least twice a week had a 46 percent lower risk of death, 41 percent lower risk of cardiac death, and 19 percent lower risk of death by cancer."

Aca-awesome: AcoUstiKats - Amazed

AcoUstiKats - Amazed

Starts at 1:40

ObamaCare Suffers Three Major Blows In One Week

"ObamaCare rates will skyrocket next year, according to its former chief. Enrollment is tumbling this year. And a big insurer is quitting most exchanges. That’s what we learned in just the past few days."

Michael F. Press, Ivonne Villalobos, Angela Santiago, Roberta Guzman, Monica Cervantes, Armen Gasparyan, Anaamika Campeau,Yanling Ma, Denice D. Tsao-Wei, and Susan Groshen (2016) Assessing the New American Society of Clinical Oncology/College of American Pathologists Guidelines for HER2 Testing by Fluorescence In Situ Hybridization: Experience of an Academic Consultation Practice. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Assessing the New American Society of Clinical Oncology/College of American Pathologists Guidelines for HER2 Testing by Fluorescence In Situ Hybridization: Experience of an Academic Consultation Practice

Michael F. Press , MD, PhD; Ivonne Villalobos , MHA; Angela Santiago , BS; Roberta Guzman ; Monica Cervantes , BA; Armen Gasparyan ; Anaamika Campeau , BA; Yanling Ma , MD; Denice D. Tsao-Wei , MS; Susan Groshen , PhD

From the Departments of Pathology (Drs Press and Ma; Mss Villalobos, Santiago, Guzman, Cervantes, and Campeau; and Mr Gasparyan) and Preventive Medicine (Ms Tsao-Wei and Dr Groshen), Norris Comprehensive Cancer Center, University of Southern California, Los Angeles.

Reprints: Michael F. Press, MD, PhD, Department of Pathology, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, NOR5409, Los Angeles, CA 90033 (email: press@usc.edu).

Context.—Evaluation of HER2 gene amplification by fluorescence in situ hybridization (FISH) was changed by recent American Society of Clinical Oncology/College of American Pathologists (ASCO-CAP) guidelines.

Objective.—To determine frequencies and assess patterns of HER2 protein expression for each ASCO-CAP guideline FISH category among 7526 breast cancers accrued to our consultation practice.

Design.—We retrospectively reevaluated the HER2 FISH status of breast cancers in our consultation practice according to ASCO-CAP FISH guidelines, and documented HER2 protein levels in each category.

Results.—According to new guidelines, 17.7% of our consultation breast cancers were “ISH-positive” with HER2:CEP17 FISH ratios ≥2.0 and average HER2 gene copies per cell ≥4.0 (group 1); 0.4% were “ISH-positive” with ratios ≥2.0 and average copies <4.0 (group 2); 0.6% were “ISH-positive” with ratios <2.0 and average copies ≥6.0 (group 3); 4.6% were “ISH-equivocal” with ratios <2.0 and average copies ≥4.0 and <6.0 (group 4); and 76.7% were “ISH-negative” with ratios <2.0 and average copies <4.0 (group 5). However, only groups 1 (HER2 amplified) and 5 (HER2 not amplified) agreed with our previously reported status, and only these groups demonstrated the expected immunohistochemistry status, overexpression and low expression, respectively. Groups 2 and 4 breast cancers lacked overexpression, whereas group 3 was not significantly associated with either increased or decreased HER2 expression.

Conclusions.—Although the status of approximately 95% of our cases (groups 1 and 5) is not affected by the new guidelines, those of the other 5% (groups 2–4) conflict with previous HER2 gene amplification status and with HER2 status by immunohistochemistry.

"The problem with ­science is that so much of it simply isn’t."

SCIENTIFIC REGRESS

by William A. WilsonMay 2016

"The problem with ­science is that so much of it simply isn’t. Last summer, the Open Science Collaboration announced that it had tried to replicate one hundred published psychology experiments sampled from three of the most prestigious journals in the field. Scientific claims rest on the idea that experiments repeated under nearly identical conditions ought to yield approximately the same results, but until very recently, very few had bothered to check in a systematic way whether this was actually the case. The OSC was the biggest attempt yet to check a field’s results, and the most shocking. In many cases, they had used original experimental materials, and sometimes even performed the experiments under the guidance of the original researchers. Of the studies that had originally reported positive results, an astonishing 65 percent failed to show statistical significance on replication, and many of the remainder showed greatly reduced effect sizes."

Sinchita Roy-Chowdhuri, Dara L. Aisner, Timothy Craig Allen, Mary Beth Beasley, Alain Borczuk, Philip T. Cagle, Vera Capelozzi,Sanja Dacic, Gilda da Cunha Santos, Lida P. Hariri, Keith M. Kerr, Sylvie Lantuejoul, Mari Mino-Kenudson, Andre Moreira, Kirtee Raparia, Natasha Rekhtman, Lynette Sholl, Eric Thunnissen, Ming Sound Tsao, Marina Vivero, and Yasushi Yatabe (2016) Biomarker Testing in Lung Carcinoma Cytology Specimens: A Perspective From Members of the Pulmonary Pathology Society. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

Biomarker Testing in Lung Carcinoma Cytology Specimens: A Perspective From Members of the Pulmonary Pathology Society

Sinchita Roy-Chowdhuri , MD, PhD; Dara L. Aisner , MD; Timothy Craig Allen , MD, JD; Mary Beth Beasley , MD; Alain Borczuk ,MD; Philip T. Cagle , MD; Vera Capelozzi , MD, PhD; Sanja Dacic , MD, PhD; Gilda da Cunha Santos , MD, PhD; Lida P. Hariri , MD, PhD; Keith M. Kerr , BSc, MBChB, FRCPath, FRCPE; Sylvie Lantuejoul , MD, PhD; Mari Mino-Kenudson , MD; Andre Moreira ,MD, PhD; Kirtee Raparia , MD; Natasha Rekhtman , MD, PhD; Lynette Sholl , MD; Eric Thunnissen , MD, PhD; Ming Sound Tsao ,MD; Marina Vivero , MD; Yasushi Yatabe , MD, PhD

From the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri); the Department of Pathology, University of Colorado Cancer Center, Denver (Dr Aisner); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Beasley); the Department of Pathology, Weill Cornell Medical College, New York (Drs Borczuk and Cagle); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Cagle); the Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil (Dr Capelozzi); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Dacic); the Department of Pathology, University Health Network, Princess Margaret Cancer Centre, and the University of Toronto, Toronto, Ontario, Canada (Drs da Cunha Santos and Tsao); the Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, Boston (Drs Hariri and Mino-Kenudson); the Department of Pathology, Aberdeen University Medical School, and Aberdeen Royal Infirmary, Foresterhill, Aberdeen, Scotland, United Kingdom (Dr Kerr); the Department of Biopathology, Centre Léon Bérard, Lyon, and J Fourier University, Institut National de la Santé et de la Recherche Médicale-Institut Albert Bonniot, Grenoble, France (Dr Lantuejoul); the Department of Pathology, New York University, New York (Dr Moreira); the Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (Dr Raparia); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York (Dr Rekhtman); the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston (Drs Sholl and Vivero); the Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands (Dr Thunnissen); and the Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan (Dr Yatabe).

The advent of targeted therapy in lung cancer has heralded a paradigm shift in the practice of cytopathology with the need for accurately subtyping lung carcinoma, as well as providing adequate material for molecular studies, to help guide clinical and therapeutic decisions. The variety and versatility of cytologic-specimen preparations offer significant advantages to molecular testing; however, they frequently remain underused. Therefore, evaluating the utility and adequacy of cytologic specimens is critical, not only from a lung cancer diagnosis standpoint but also for the myriad ancillary studies that are necessary to provide appropriate clinical management. A large fraction of lung cancers are diagnosed by aspiration or exfoliative cytology specimens, and thus, optimizing strategies to triage and best use the tissue for diagnosis and biomarker studies forms a critical component of lung cancer management. This review focuses on the opportunities and challenges of using cytologic specimens for molecular diagnosis of lung cancer and the role of cytopathology in the molecular era.

"Chronic obesity comes with price ‘we are going to pay for ... one day’" "The long-term costs are staggering."

Chronic obesity comes with price ‘we are going to pay for ... one day’

"Richardson is right to point out the challenges that communities large or small face with a generation of young people getting larger all the time.

The long-term costs are staggering. We encourage government at every level, whether in city or country, to look at ways to promote healthier diets and lifestyles for the young.

Lower medical costs later will repay these investments a thousandfold."

Senator Says He May Back Bill Exposing Saudis to 9/11 Lawsuits

Senator Says He May Back Bill Exposing Saudis to 9/11 Lawsuits

By MARK MAZZETTI and JENNIFER STEINHAUERAPRIL 19, 2016

"Those cases, some of which have tried to hold members of the Saudi royal family and Saudi charities liable for what the plaintiffs allege was financial support for terrorism, have been largely stymied because of a 1976 law that gives foreign nations broad immunity from American lawsuits. The current legislation would amend the law, allowing for nations to be sued in American courts if they are found to have played any role in terrorist attacks that killed Americans on home soil."

HT:SD

State Pathology Societies Unite Urging Repeal of NY Ban on Pathologist Conferrals

State Pathology Societies Unite Urging Repeal of NY Ban on Pathologist Conferrals

In an April 13 resolution affirmed by 44 state pathology societies, pathologists nationwide called for New York State to repeal the regulation that prohibits pathologists from conferring with patients on laboratory and pathology test results.

"Pathologists in every other state in the United States are able to fully exercise our medical discretion in answering patient questions, without the dictate or constraint of state regulation, and conferring with patients based upon our medical judgment as physicians," the RESOLUTION STATED. "The New York regulation represents an unwarranted and deleterious intrusion into the physician practice of medicine by pathologists to the detriment of quality, patient care, and patient empowerment in understanding their diagnosis."

The CAP and New York State Society of Pathologists (NYSSPATH) have strongly advocated for the NYS Department of Health (DOH) to remove the outdated prohibition on discussions between patients and pathologists. Regulatory impediments to patient discussions with pathologists should be removed as pathologists are legally and ethically obligated to communicate with their patients, the CAP and NYSSPATH have said.

The DOH is meeting with stakeholders to decide whether to take any action to repeal or change the regulation. The NY Public Health Planning Council, following testimony by pathologists, set a deadline of July 2016 for the DOH to make a determination.

The state DOH has been conducting calls with external stakeholders to determine their respective positions on the issue. A DOH stakeholder call in February included Emily Volk, MD, FCAP, chair of the CAP Council on Government and Professional Affairs (CGPA), and Patrick Godbey, MD, FCAP, vice chair of the CGPA.

Recently, six national pathology organizations and the New York chapters of the AARP and the American College of Radiology (ACR) also have urged the DOH to repeal the prohibition.

Ann Intern Med. 2016 Apr 19;164(8):553-557. doi: 10.7326/M15-2642.

Judging the Past: How History Should Inform Bioethics.

Lerner BH, Caplan AL.

Abstract

Bioethics has become a common course of study in medical schools, other health professional schools, and graduate and undergraduate programs. An analysis of past ethical scandals, as well as the bioethics apparatus that emerged in response to them, is often central to the discussion of bioethical questions. This historical perspective on bioethics is invaluable and demonstrates how, for example, the infamous Tuskegee syphilis study was inherently racist and how other experiments exploited mentally disabled and other disadvantaged persons. However, such instruction can resemble so-called Whig history, in which a supposedly more enlightened mindset is seen as having replaced the "bad old days" of physicians behaving immorally. Bioethical discourse-both in the classroom and in practice-should be accompanied by efforts to historicize but not minimize pastethical transgressions. That is, bioethics needs to emphasize why and how such events occurred rather than merely condemning them with an air of moral superiority. Such instruction can reveal the complicated historical circumstances that led physician-researchers (some of whom were actually quite progressive in their thinking) to embark on projects that seem so unethical in hindsight. Such an approach is not meant to exonerate past transgressions but rather to explain them. In this manner, students and practitioners of bioethics can better appreciate how modern health professionals may be susceptible to the same types of pressures, misguided thinking, and conflicts of interest that sometimes led their predecessors astray.