"...today’s 19-year-old is as sedentary as a 60-year-old."

Pittsburgh Post-Gazette: Turn off the game, then get up and move

"A group of economists released a paper recently suggesting that young men are working fewer hours because they are spending so much time playing video games.

Video games might also help explain a study last month from Johns Hopkins University researchers who said today’s 19-year-old is as sedentary as a 60-year-old."

Democrats demand more 'nutrition education' in public schools to fight obesity

by Pete Kasperowicz | Jul 21, 2017, 1:20 PM 

"More than two dozen House Democrats proposed legislation Thursday that would require any school participating in the national school lunch program to teach students 50 hours of nutrition education per year."

"...drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014..."

Opioids and Obesity Driving Increased Death Rates for White Men, Not Despair

"Those reports claim “despair deaths” — by suicide, alcohol, and drugs — are on the rise among white Americans, particularly men, facing a lack of economic opportunity and an increase in chronic pain.

Instead, the new study from researchers at the University of Colorado at Boulder finds that drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available.

“We find little empirical support for the pain-and distress-based explanations for rising mortality in the U.S. white population,” said lead author Ryan Masters, an assistant professor of sociology at University of Colorado’s Institute of Behavioral Science. “Instead, recent mortality increases have likely been shaped by the U.S. opiate epidemic.”

Masters said metabolic diseases, including heart disease, obesity, and diabetes, also play a key role. After years of declining death rates for such diseases, thanks to new drugs and procedures, that progress has slowed for men and stalled for women, according to the study’s findings.

“When it comes to mortality, we are just starting to see the real health consequences of the obesity epidemic,” he said"

"The causative agent of Q fever, Coxiella burnetii, has the potential to be developed for use in biological warfare and it is classified as a bioterrorism threat agent by the Centers for Disease Control and Prevention (CDC) and as a category B select agent by the National Institute of Allergy and Infectious Diseases (NIAID)."

Epidemics. 2017 Jun 15. pii: S1755-4365(16)30048-2. doi: 10.1016/j.epidem.2017.06.001. [Epub ahead of print]

A human time dose response model for Q fever.

Heppell CW1, Egan JR2, Hall I3.

Author information

1

Public Health England, Porton, Wiltshire SP4 0JG, United Kingdom. Electronic address: Charles.Heppell@phe.gov.uk.

2

University of Southampton, Hampshire SO17 1BJ, United Kingdom. Electronic address: J.R.Egan@soton.ac.uk.

3

Public Health England, Porton, Wiltshire SP4 0JG, United Kingdom. Electronic address: Ian.Hall@phe.gov.uk.

Abstract

The causative agent of Q fever, Coxiella burnetii, has the potential to be developed for use in biological warfare and it is classified as a bioterrorism threat agent by the Centers for Disease Control and Prevention (CDC) and as a category B select agent by the National Institute of Allergy and Infectious Diseases (NIAID). In this paper we focus on the in-host properties that arise when an individual inhales a dose of C. burnetii and establish a human time-dose response model. We also propagate uncertainty throughout the model allowing us to robustly estimate key properties including the infectious dose and incubation period. Using human study data conducted in the 1950's we conclude that the dose required for a 50% probability of infection is about 15 organisms, and that one inhaled organism of C. burnetti can cause infection in 5% of the exposed population. In addition, we derive a low dose incubation period of 17.6 days and an extracellular doubling time of half a day. In conclusion this paper provides a framework for detailing the parameters and approaches that would be required for risk assessments associated with exposures to C. burnetii that might cause human infection.

Am J Public Health. 2017 Jul 20:e1-e5. doi: 10.2105/AJPH.2017.303900. [Epub ahead of print]

Minimum Age of Sale for Tobacco Products and Electronic Cigarettes: Ethical Acceptability of US "Tobacco 21 Laws".

Morain SR1, Malek J1.

Author information

1

Stephanie Rubino Morain and Janet Malek are with the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX.

Abstract

Several US jurisdictions have recently passed laws that raise the minimum age of sale for tobacco products and electronic cigarettes to 21 years (Tobacco 21 laws). Although these laws have been demonstrated to be an effective means to reduce youth smoking initiation, their passage and potential expansion have provoked controversy. Critics have objected to these laws, claiming that they unduly intrude on individual freedom and that they irrationally and paternalistically restrict the freedom of those aged 18 to 20 years, who were previously able to legally purchase tobacco products. We have examined the ethical acceptability of Tobacco 21 laws. First, we have described ethical support for such a restriction grounded in its public health benefit. We have then offered arguments that raise doubts about the soundness of critics' objections to these regulations and described an additional ethical justification arising from concern about preventing harm to others. On the basis of this analysis, we conclude that Tobacco 21 laws are ethically justifiable.

"Some of the advice is straight up harmful. A lot of health trends like detoxing, cleansing, cryotherapy, IV therapy, I think those things wouldn't exist but for celebrity endorsement."

SECOND OPINION | It's war! Debunkers take on actress Gwyneth Paltrow's GOOP and celebrity pseudoscience

War on GOOP breaks out into the open

By Kelly Crowe & CBC Health Unit, CBC News Posted: Jul 22, 2017 8:00 AM ET Last Updated: Jul 22, 2017 8:00 AM ET

"They just want to create noise, and the more noise, the better," he said. "They don't care if it's positive noise or negative noise. The jade vagina eggs are still going to sell out. And that's what history tells us."

Still, Caulfield believes the war on Goop is important.

"I think setting the scientific record straight matters. It may not change people's minds tomorrow, but ensuring the facts are out there will make a difference long term," he said.

"Some of the advice is straight up harmful. A lot of health trends like detoxing, cleansing, cryotherapy, IV therapy, I think those things wouldn't exist but for celebrity endorsement."

"Even on the matter of fitness, our population has become polarized. Large numbers have surrendered to obesity, while others seem willing to suffer hugely in pursuit of uber-fitness."

Americans polarized on exercise too

"Even on the matter of fitness, our population has become polarized. Large numbers have surrendered to obesity, while others seem willing to suffer hugely in pursuit of uber-fitness. So many of us, it seems, cannot enjoy good health in a relaxed way."

J Med Internet Res. 2017 Jul 18;19(7):e260. doi: 10.2196/jmir.8225.

Readability of Wikipedia Pages on Autoimmune Disorders: Systematic Quantitative Assessment.

Watad A1,2,3, Bragazzi NL4, Brigo F5, Sharif K1,2,3, Amital H1,2,3, McGonagle D6, Shoenfeld Y2,3, Adawi M7.

Author information

1

Department of Medicine B, Sheba Medical Centre, Tel Aviv, Israel.

2

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

3

Zabludowicz Center for Autoimmune Diseases, Sheba Medical Centre, Tel Aviv, Israel.

4

Department of Health Sciences, University of Genoa, Genoa, Italy.

5

Department of Neuroscience, University of Verona, Verona, Italy.

6

Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom.

7

Bar-Ilan Faculty of Medicine, Padeh and Ziv Hospitals, Zefat, Israel.

Abstract

BACKGROUND:

In the era of new information and communication technologies, the Internet is being increasingly accessed for health-related information. Indeed, recently published patient surveys of people with autoimmune disorders confirmed that the Internet was reported as one of the most important health information sources. Wikipedia, a free online encyclopedia launched in 2001, is generally one of the most visited websites worldwide and is often consulted for health-related information.

OBJECTIVE:

The main objective of this investigation was to quantitatively assess whether the Wikipedia pages related to autoimmune disorders can be easily accessed by patients and their families, in terms of readability.

METHODS:

We obtained and downloaded a list of autoimmune disorders from the American Autoimmune Related Diseases Association (AARDA) website. We analyzed Wikipedia articles for their overall level of readability with 6 different quantitative readability scales: (1) the Flesch Reading Ease, (2) the Gunning Fog Index, (3) the Coleman-Liau Index, (4) the Flesch-Kincaid Grade Level, (5) the Automated Readability Index (ARI), and (6) the Simple Measure of Gobbledygook (SMOG). Further, we investigated the correlation between readability and clinical, pathological, and epidemiological parameters. Moreover, each Wikipedia analysis was assessed according to its content, breaking down the readability indices by main topic of each part (namely, pathogenesis, treatment, diagnosis, and prognosis plus a section containing paragraphs not falling into any of the previous categories).

RESULTS:

We retrieved 134 diseases from the AARDA website. The Flesch Reading Ease yielded a mean score of 24.34 (SD 10.73), indicating that the sites were very difficult to read and best understood by university graduates, while mean Gunning Fog Index and ARI scores were 16.87 (SD 2.03) and 14.06 (SD 2.12), respectively. The Coleman-Liau Index and the Flesch-Kincaid Grade Level yielded mean scores of 14.48 (SD 1.57) and 14.86 (1.95), respectively, while the mean SMOG score was 15.38 (SD 1.37). All the readability indices confirmed that the sites were suitable for a university graduate reading level. We found no correlation between readability and clinical, pathological, and epidemiological parameters. Differences among the different sections of the Wikipedia pages were statistically significant.

CONCLUSIONS:

Wikipedia pages related to autoimmune disorders are characterized by a low level of readability. The onus is, therefore, on physicians and health authorities to improve the health literacy skills of patients and their families and to create, together with patients themselves, disease-specific readable sites, disseminating highly accessible health-related online information, in terms of both clarity and conciseness.

Ann Fam Med. 2017 Jul;15(4):375-378. doi: 10.1370/afm.2074.

Disenfranchised Grief and Physician Burnout.

Lathrop D1.

Author information

1

Independent Physicians, SC, Madison, Wisconsin info@independentdr.net.

Abstract

Over the span of their career, physicians experience changes to their professional role and professional identity. The process of continual adaptation in their work setting incurs losses. These losses can be ambiguous, cumulative, and may require grieving. Grief in the workplace is unsanctioned, and may contribute to physicians' experience of burnout (emotional exhaustion, depersonalization, low sense of achievement). Acknowledging loss, validating grief, and being prescient in dealing with physician burnout is essential.

Are people are more honest in public than in private? Interesting study results...

PLoS One. 2017 Jul 17;12(7):e0181682. doi: 10.1371/journal.pone.0181682. eCollection 2017.

Spot on for liars! How public scrutiny influences ethical behavior.

Ostermaier A1, Uhl M2.

Author information

1

TUM School of Management, Technische Universität München, Munich, Germany.

2

TUM School of Governance, Technische Universität München, Munich, Germany.

Abstract

We examine whether people are more honest in public than in private. In a laboratory experiment, we have subjects roll dice and report outcomes either in public or in private. Higher reports yield more money and lies cannot be detected. We also elicit subjects' ethical mindsets and their expectations about others' reports. We find that outcome-minded subjects lie less in public to conform with their expectations about others' reports. Ironically, these expectations are false. Rule-minded subjects, in turn, do not respond to public scrutiny. These findings challenge the common faith in public scrutiny to promote ethical behavior. While public scrutiny eventually increases honesty, this effect is contingent on people's mindsets and expectations.

Sci Eng Ethics. 2017 Jul 18. doi: 10.1007/s11948-017-9945-8. [Epub ahead of print]

The Scientific Self: Reclaiming Its Place in the History of Research Ethics.

Paul H1.

Author information

1

Institute for History, Leiden University, P.O. Box 9515, 2300 RA, Leiden, The Netherlands. h.j.paul@hum.leidenuniv.nl.

Abstract

How can the history of research ethics be expanded beyond the standard narrative of codification-a story that does not reach back beyond World War II-without becoming so broad as to lose all distinctiveness? This article proposes a history of research ethics focused on the "scientific self," that is, the role-specific identity of scientists as typically described in terms of skills, competencies, qualities, or dispositions. Drawing on three agenda-setting texts from nineteenth-century history, biology, and sociology, the article argues that the "revolutions" these books sought to unleash were, among other things, revolts against inherited conceptions of scientific selfhood. They tried to redefine the scientific self in their respective fields of inquiry by advocating particular catalogs of virtues or character traits. These ideals of selfhood, their contested nature notwithstanding, translated into practice in so far as they influenced hiring and selection policies and found their way into educational systems. The project of reclaiming the scientific self as an important subject of study in the history of research ethics is not an antiquarian pursuit, but related to an ethical question faced by scientists today: How are their scientific selves being shaped by funding schemes, research evaluation protocols, and academic hiring policies?

Attn: nannystate: "...what’s the point of living if you do so without joy?"

Can I Just Enjoy This Damn Diet Coke Without Being Health-Shamed?

"Here’s a freaking #lifehack for you: Enjoy a vice or two. Sure you can try to prolong your life by cutting out gluten or drinking coffee (or not drinking coffee), but life shouldn’t be about denying yourself, and what’s the point of living if you do so without joy? Diet Coke infuses my day with joy (and just enough caffeine) and I don’t understand why so many people wish to rob me of my joy. (Again, don’t say it because they’re concerned with my health; if people were really concerned about my health they wouldn’t like shenanigans such as this on Instagram.)"

Health Res Policy Syst. 2017 Jul 12;15(Suppl 1):52. doi: 10.1186/s12961-017-0208-6.

The change-makers of West Africa.

Godt S1, Mhatre S2, Schryer-Roy AM3.

Author information

1

Maternal and Child Health Program, International Development Research Centre, PO Box 62084, 00200, Nairobi, Kenya. sgodt@idrc.ca.

2

Open Society Foundation, New York, NY, 10019, United States of America.

3

Independent Consultant, PO Box 91, 00606, Nairobi, Kenya.

Abstract

West Africa was the focus of global attention during the Ebola virus disease outbreak, when systemic health system weaknesses compounded a serious emergency and complicated response efforts. Following the crisis, calls were made to strengthen health systems, but investments to date have fallen short of delivering the support needed to build strong health systems able to prevent and manage future outbreaks.In part, this reality serves to highlight the shortcomings of the solutions being repeatedly prioritised by external funders and experts, solutions that often fail to consider the wealth of West African evidence and actors actively working to strengthen the leadership and health systems needed to drive and sustainably improve national health outcomes. Unfortunately, this knowledge and experience are rarely heard in the global arena.This journal supplement is a contribution, although small, to changing this practice by putting the perspectives, experiences and knowledge of West Africans on the table. It presents findings from a series of research and capacity development projects in West Africa funded by the International Development Research Centre's Maternal and Child Health programme (formerly Governance for Equity in Health Systems).The evidence presented here centres around two key themes. First, the theme that context matters. The evidence shows how context can change the shape of externally imposed interventions or policies resulting in unintended outcomes. At the same time, it highlights evidence showing how innovative local actors are developing their own approaches, usually low-cost and embedded in the context, to bring about change. Second, the collection of articles discusses the critical need to overcome the existing fragmentation of expertise, knowledge and actors, and to build strong working relationships amongst all actors so they can effectively work together to identify priority issues that can realistically be addressed given the available windows of opportunity.Vibrant West African-led collaborations amongst researchers, decision-makers and civil society, which are effectively supported by national, regional and global funding, need to foster, strengthen and use locally-generated evidence to ensure that efforts to strengthen health systems and improve regional health outcomes are successful. The solutions are clearly not to be found in the 'travelling models' of standardised interventions.

Does exercise facilitate body weight control? The answer may depend on sex

"In a study conducted in rats, graduate student Rebecca Foright fed both male and female rats a high fat diet and then trained half of them to run on a treadmill. After a total of 10 weeks, there was a remarkable sex difference in response to the exercise training. Male rats who exercised ate less food and gained less weight than sedentary males. Exercising female rats did not reduce their food intake. At the end of the study they weighed the same as sedentary females. When this study was repeated in males fed a low fat diet, the research team found that the impact of exercise on body weight was evident even sooner than in the high fat diet fed male rats."

Artificial Sweeteners May Increase Your Risk For Obesity

"At the same time, the combined data from 30 observational studies involving more than 400,000 participants showed that artificial sweeteners are associated with obesity, high blood pressure, Type 2 diabetes and heart health problems."

Clin Geriatr Med. 2017 Aug;33(3):305-314. doi: 10.1016/j.cger.2017.02.003. Epub 2017 May 13.

Sarcopenia.

Woo J1.

Author information

1

Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, 9/F, Lui Che Woo Clinical Sciences Building, Shatin, New Territories, Hong Kong. Electronic address: jeanwoowong@cuhk.edu.hk.

Abstract

Sarcopenia refers to age-related muscle loss, defined using a combination of appendicular muscle mass, muscle strength, and physical performance measures. The pathogenesis depends on a balance between positive and negative regulators of muscle growth. Sarcopeniaincreases the risk for falls, fractures, dependency, use of hospital services, institutionalization, poor quality of life, and mortality. In clinical practice, brief screening tools, such as the 5-item SARC-F score, may be useful. Although pharmacologic treatments are actively being studied, the current mainstay consists of optimizing nutrition status, in particular protein and vitamin D status, and resistance exercises.

Econ Hum Biol. 2017 May 26;27(Pt A):126-136. doi: 10.1016/j.ehb.2017.05.007. [Epub ahead of print]

Heterogeneity in the long term health effects of warfare.

Akbulut-Yuksel M1, Yuksel M2.

Author information

1

Dalhousie University, IZA and HICN, Canada. Electronic address: mevlude@dal.ca.

2

Dalhousie University and IZA, Canada. Electronic address: mutlu@dal.ca.

Abstract

This paper estimates the long-term heterogeneous legacies of exposures to war in utero and during early childhood on height in adulthood. Using a novel dataset on the regional WWII destruction in Germany, combined with the German Socio-Economic Panel (SOEP), we find that individuals who experienced warfare in utero and during childhood are an average of 2cm shorter as adults, suggesting that the negative scarring effect of WWII dominated the positive effect coming from a selection. Among war survivors, children from less privileged families who resided in highly destroyed regions, particularly girls, suffered the greatest health consequences of warfare. Our analyses also show that wartime children who lost their parents during the war years are an average of 1.3cm shorter as adults. However, the father's conscription during WWII had no long-term effect on adult height.

Tim Mackey and Bryan Liang: After Amarin v FDA: What Will the Future Hold for Off-label Promotion Regulation?

Mayo Clin Proc. 2016 Jun;91(6):701-6. doi: 10.1016/j.mayocp.2016.02.024. Epub 2016 Apr 12.

After Amarin v FDA: What Will the Future Hold for Off-label Promotion Regulation?

Mackey TK1, Liang BA2.

Author information

1

Department of Anesthesiology, Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA; Joint Masters Program in Health Policy and Law, University of California, San Diego School of Medicine and California Western School of Law, San Diego, CA; Global Health Policy Institute, La Jolla, CA. Electronic address: tmackey@ucsd.edu.

2

Global Health Policy Institute, La Jolla, CA.

"On August 7, 2015, the US District Court in Amarin v FDA handed down a ruling that the US Food and Drug Administration (FDA) lacked the authority to prohibit nonmisleading forms of off-label speech.1 When a drug is approved by the FDA for a specific indication, licensed clinicians are nevertheless free to prescribe it for any clinical use they see fit. In fact, off-label drug use (ie, prescribing medications for a different disease or medical condition, different route of administration, and/or different dosage than that approved by the FDA) is relatively common, with a 2006 study estimating that 21% of commonly used drugs are prescribed off-label.2 Despite regular off-label use of prescription drugs (including high rates in certain patient populations and conditions such as pediatrics, cancer, and psychotic disorders), manufacturers are only allowed to engage in product promotion for the indication approved on the label.3 When manufacturers engage in promotion for any indication, dosage, or administration outside the FDA approval, they engage in illegal off-label promotion.4 However, the lines between illegal and permitted off-label promotion are now being blurred in the wake of the Amarin decision, which is likely to have a lasting impact on future drug promotion practices, regulatory and enforcement activities, and the role of the physician in patient care."

"Rising concerns about obesity, particularly in western markets, have also heralded the threat of a clampdown on marketing activity by snacking and confectionery companies."

Butterkist swallowed by Germans as KP adds popcorn to larder

"Popcorn brands now market themselves as healthier alternatives to potato crisps, reflecting consumers' growing appetite for foods containing lower quantities of sugar and salt.

Rising concerns about obesity, particularly in western markets, have also heralded the threat of a clampdown on marketing activity by snacking and confectionery companies."

O Canada: Is Canada's medical system pushing people abroad for treatment?

Is Canada's medical system pushing people abroad for treatment?

Fraser institute report claims wait times are to blame, but researcher says it's complicated

"Back when she spoke with a specialist about getting bariatric surgery to help her lose weight, he told her it would be years before she could get the procedure done. He told her she wasn't a good candidate for it because she was an emotional eater.

"He was very blunt and nasty about it," Walsh said. "I think he doesn't realize how close he had put me to suicide."

She says getting the operation done abroad was the best decision she has ever made."

"Nussbaum's primary concern is the demoralization of medicine as it becomes increasingly monetized; patients are reduced to body parts and reimbursement schedules."

Perspect Biol Med. 2016;59(4):576-580. doi: 10.1353/pbm.2016.0050.

Virtue Ethics in Monetized Medicine.

Frank AW.

Abstract

This review essay situates Abraham Nussbaum's The Finest Traditions of Our Calling (2016) within the contemporary genre of physician memoirs that shade into critiques of institutional medicine. Nussbaum's primary concern is the demoralization of medicine as it becomes increasingly monetized; patients are reduced to body parts and reimbursement schedules. He argues that physicians continue to have considerable choice in how they practice, despite institutional constraints. For bioethics, Nussbaum's advocacy of virtue ethics is notable. His book is a moving testimonial to contemporary problems, but also a manifesto for possibilities of change at the individual level.

"The United States is not among the top active states, ranking somewhere near the bottom of the list."

ACTIVITY INEQUALITY BETWEEN PEOPLE IS CORRELATED WITH HIGHER OR SMALLER OBESITY RATES

"They observed the average number of daily steps all over the world was 4,961. The United States is not among the top active states, ranking somewhere near the bottom of the list. It even scoredbelow the global average, with 4,774 steps taken per day.

Researchers were able to notice the phenomenon of activity inequality. Each country has some people who are always on the go, while others tend to be less physically active. If the gap between them is big, then the number of obese people is higher."

"...the public conversation for the legalisation of cannabis must include scientific evidence for its adverse effects."

Curr Drug Abuse Rev. 2017 Jul 12. doi: 10.2174/1874473710666170712113042. [Epub ahead of print]

Cannabis: an overview of its adverse acute and chronic effects and their implications.

Ford TC1, Hayley AC2, Downey LA3, Parrott AC4.

Author information

1

Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia. Australia.

2

Swinburne University, Melbourne, Australia. - Centre for Human Psychopharmacology Melbourne. Australia.

3

Swinburne University, Melbourne. Australia.

4

School of Human and Health Sciences, Swansea University, UK. - Department of Psychology Swansea. United Kingdom.

Abstract

In many communities, cannabis is perceived as a low-risk drug, leading to political lobbying to decriminalise its use. However, acute and chronic cannabis use has been shown to be harmful to several aspects of psychological and physical health, such as mood states, psychiatric outcomes, neurocognition, driving and general health. Furthermore, cannabis is highly addictive, and the adverse effects of withdrawal can lead to regular use. These in turn have adverse implications for public safety and health expenditure. Although the cannabinoid cannabidiol (CBD) has been shown to have positive health outcomes with its antioxidant, anticonvulsant, anti-inflammatory and neuroprotective properties, high-potency cannabis is particularly damaging due to its high tetrahydrocannabinol (THC), low CDB concentration. It is this high-potency substance that is readily available recreationally. While pharmaceutical initiatives continue to investigate the medical benefits of CDB, "medicinal cannabis" still contains damaging levels of THC. Altogether, we argue there is insufficient evidence to support the safety of cannabis and its subsequent legalisation for recreational use. Furthermore, its use for medicinal purposes should be done with care. We argue that the public conversation for the legalisation of cannabis must include scientific evidence for its adverse effects.

Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Two Pastors Sue Coca-Cola For Alleged Harm to African-American Community

Two Pastors Sue Coca-Cola For Alleged Harm to African-American Community

Citing purposeful advertising “deception” that “obscures” the connection between sugary soft drinks, obesity, and other ailments, the complaint alleges that Coca-Cola intentionally “misleads and deceives” consumers about the horrors of drinking their product.  Indeed, one of the pastors claims that “it is a matter of life and death in our communities.”

"Physicians also worry about how they may be [paid] for a virtual visit as compared to a real life doctor patient encounter in this current era of declining salaries and increased health care costs."

Digital Health Hope: Telemedicine and Increasing Access to Care

"While many physicians embrace technology as a way to improve patient care, there remains a significant skepticism among physicians when it comes to telemedicine. Many fear that much will be missed and misdiagnosis will be common in virtual visits. There is no possibility of physical exam during a telemedicine visit—one can only ask questions and observe what they see on the screen. Physicians also worry about how they may be reimbursed for a virtual visit as compared to a real life doctor patient encounter in this current era of declining salaries and increased health care costs. There is much debate among professional societies about what types of medical visits and for which types of medical problems are most appropriate for a virtual visit via telemedicine and guidelines are currently being created."

Prenat Diagn. 2017 Jul 10. doi: 10.1002/pd.5114. [Epub ahead of print]

Opening Pandora's box?: ethical issues in prenatal whole genome and exome sequencing.

Horn R1, Parker M1.

Author information

1

The Ethox Centre, University of Oxford, Oxford.

Abstract

OBJECTIVE:

The development of genomic approaches to prenatal testing such as whole genome and exome sequencing offers the potential for a better understanding of prenatal structural anomalies in the fetus and ultimately for improved patient care and more informed reproductive decision making. In addition to the scientific and clinical challenges of achieving this, the introduction of new reproductive technologies also presents a number of ethical problems. The successful and appropriate development and introduction of prenatal genomics into clinical practice requires these problems to be identified, understood and carefully analysed in the development of models of good ethicalpractice.

METHOD:

We conducted a critical review of the existing literature on ethical issues in prenatal genomics.

RESULTS:

We identified and discussed five areas of particular concern: valid consent, management and feed-back of information, responsibilities of health professionals, priority setting and resources, and duties towards the future child.

CONCLUSION:

There is a need for further discussion of the issues we have outlined here and we hope that this brief summary of ethicalarguments in the literature encourages researchers, clinicians, patients and scientists to engage in further discussion of these and other important issues raised by prenatal genomics.