Early specialist palliative care on quality of life for malignant pleural mesothelioma: a randomised controlled tria

Thorax. 2019 Jan 19. pii: thoraxjnl-2018-212380. doi: 10.1136/thoraxjnl-2018-212380. [Epub ahead of print]

Early specialist palliative care on quality of life for malignant pleural mesothelioma: a randomised controlled trial.

Brims F1,2, Gunatilake S3, Lawrie I4, Marshall L5, Fogg C6, Qi C7, Creech L8, Holtom N9, Killick S10, Yung B11, Cooper D12, Stadon L13, Cook P14, Fuller E15, Walther J16, Plunkett C17, Bates A18, Mackinlay C19, Tandon A20, Maskell NA21,22, Forbes K23, Rahman NM24, Gerry S25, Chauhan AJ26; RESPECT-Meso investigators.

Collaborators (13)

Author information

1

Respiratory Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.

2

Curtin Medical School, Curtin University, Perth, Western Australia, Australia.

3

Department of Respiratory Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, UK.

4

Department of Palliative Medicine, North Manchester General Hospital, Manchester, Manchester, UK.

5

Research and Innovation Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK.

6

School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.

7

Centre for Statistics in Medicine, University of Oxford, Oxford, UK.

8

University Hospital of South Manchester NHS Foundation Trust, Manchester, Manchester, UK.

9

Department of Palliative Care, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK.

10

Department of Palliative Care, Hampshire Hospitals NHS Foundation Trust, Winchester, Hampshire, UK.

11

Department of Respiratory Medicine, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, Essex, UK.

12

Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK.

13

North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK.

14

Department of Respiratory Medicine, County Durham and Darlington NHS Foundation Trust, Darlington, UK.

15

Department of Respiratory Medicine, South Tyneside NHS Foundation Trust, South Shields, South Tyneside, UK.

16

Haematology, Oncology and Palliative Care, Taunton and Somerset NHS Foundation Trust, Taunton, UK.

17

Department of Palliative Medicine, Mid Essex Hospital Services NHS Trust, Chelmsford, UK.

18

Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK.

19

Great Western Hospitals NHS Foundation Trust, Swindon, Swindon, UK.

20

Department of Palliative Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.

21

North Bristol Lung Centre, Southmead Hospital, Bristol, UK.

22

Academic Respiratory Unit, Department of Clinical Sciences, Bristol University, Bristol, UK.

23

Department of Palliative Medicine, Bristol University, Bristol, UK.

24

Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.

25

Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

26

Department of Respiratory, Queen Alexandra Hospital, Portsmouth, Hampshire, UK.

Abstract

PURPOSE:

Malignant pleural mesothelioma (MPM) has a high symptom burden and poor survival. Evidence from other cancer types suggests some benefit in health-related quality of life (HRQoL) with early specialist palliative care (SPC) integrated with oncological services, but the certainty of evidence is low.

METHODS:

We performed a multicentre, randomised, parallel group controlled trial comparing early referral to SPC versus standard care across 19 hospital sites in the UK and one large site in Western Australia. Participants had newly diagnosed MPM; main carers were additionally recruited.

INTERVENTION:

review by SPC within 3 weeks of allocation and every 4 weeks throughout the study. HRQoL was assessed at baseline and every 4 weeks with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30.

PRIMARY OUTCOME:

change in EORTC C30 Global Health Status 12 weeks after randomisation.

RESULTS:

Between April 2014 and October 2016, 174 participants were randomised. There was no significant between group difference in HRQoL score at 12 weeks (mean difference 1.8 (95% CI -4.9 to 8.5; p=0.59)). HRQoL did not differ at 24 weeks (mean difference -2.0 (95% CI -8.6 to 4.6; p=0.54)). There was no difference in depression/anxiety scores at 12 weeks or 24 weeks. In carers, there was no difference in HRQoL or mood at 12 weeks or 24 weeks, although there was a consistent preference for care, favouring the intervention arm.

CONCLUSION:

There is no role for routine referral to SPC soon after diagnosis of MPM for patients who are cared for in centres with good access to SPC when required.

This Is What Caused Millennials to Be so Different

It shaped Millennials and it's now shaping the behaviors of Generation Z and every other generation.

The word is...access.

As far back as they can remember, Millennials have had access to the world's information curated into a blank search box in the palm of their hand. Generation Z (the post-Millennial generation) now has access to this information (thank you, Alexa) at the tip of their tongue. The next generation after them will be able to access information at the tip of their brain.

Millennials were the first generation to feel the impact of access. Access caused Millennials to have different perspectives, expectations, and behaviors. Access changed how Millennials job search, learn, socialize, travel, communicate, build businesses, network, entertain themselves, sell, buy, and work.

Why do food cravings seem to get worse when you’re dieting? @utmbhealth

Why do food cravings seem to get worse when you’re dieting?

'The UTMB team took rats that had been on a 30-day low-fat diet and trained them to work for fatty treats by pressing a lever. In order to measure craving and motivation, the amount of times needed to press the lever to receive a treat was increased until the rat gave up trying. In half the rats, the researchers blocked the effects of a brain chemical called neuromedin U receptor 2 within a region of the brain that regulates food intake. The other half were the control group, and did not undergo this procedure.'

"...primary causes of physician burnout include utilization and interactions with electronic health records (EHR), lack of a supportive practice environment, the loss of autonomy, and poor work/life balance."

WMJ. 2018 Dec;117(5):194-200.

Physician Burnout in Wisconsin: An Alarming Trend Affecting Physician Wellness.

Hauer A1, Waukau HJ2, Welch P2.

Author information

1

Wisconsin Medical Society, Madison, Wisconsin, anne.hauer@wismed.org.

2

Wisconsin Medical Society, Madison, Wisconsin.

Abstract

Wisconsin physicians are experiencing burnout at levels that surpass national benchmarks. The Wisconsin Medical Society (Society), in conjunction with the American Medical Association (AMA), conducted a survey of 1,165 Wisconsin physicians to assess burnout and its contributing factors. The results indicate that primary causes of physician burnout include utilization and interactions with electronic health records (EHR), lack of a supportive practice environment, the loss of autonomy, and poor work/life balance. Addressing physician burnout in Wisconsin calls for significant efforts by all relevant stakeholders, including insurers, government entities, health care systems and their executive leadership, and physicians themselves, and will require improving physician interactions with the EHR, increasing the physician role in administrative decision-making, and maintaining the focus of health care on the patient. To lessen the impact of the key factors that lead to physician burnout, the Society plans to convene stakeholders to improve EHR functionality, develop and encourage physician leadership opportunities, create a Center for Physician Empowerment to unite stakeholders to lead systemic change through collective education and action, and pursue legislation to establish a Physician Health Program through the state government structure.

Dionne Warwick and The Spinners - Then Came You

J Med Ethics. 2019 Jan 21. pii: medethics-2018-105069. doi: 10.1136/medethics-2018-105069. [Epub ahead of print]

Internal morality of medicine and physician autonomy.

McAndrew S1.

Author information

1

Department of Philosophy, University at Buffalo, The State University of New York, Buffalo, New York, USA.

Abstract

Robert Veatch and others have questioned whether there are internal moral rules of medicine. This paper examines the legal regulatory model for governing professions as the autonomous exercise of professional skills and asks whether there is a theoretical basis for this model. Taking John Rawls's distinction between the justification of a practice and justification of the rules internal to the practice, this paper argues that the autonomous exercise of professional skills is justified so long as it benefits society. In opposition to Christopher Boorse, it is argued that medicine is pathocentric and that physicians exercise skills in treating pathologies. The autonomous treatment of pathologies is justified because non-interference with physicians will lead to greater treatment of pathologies and so benefit society. Finally, the analysis of medicine as the autonomous exercise of skills in treating pathologies yields the rule that physicians not be forced to cause pathologies.

Michelle Mello and colleagues: Effects Of A Communication-And-Resolution Program On Hospitals' Malpractice Claims And Costs

Health Aff (Millwood). 2018 Nov;37(11):1836-1844. doi: 10.1377/hlthaff.2018.0720.

Effects Of A Communication-And-Resolution Program On Hospitals' Malpractice Claims And Costs.

Kachalia A1, Sands K2, Niel MV3, Dodson S4, Roche S5, Novack V6, Yitshak-Sade M7, Folcarelli P8, Benjamin EM9, Woodward AC10, Mello MM11.

Author information

1

Allen Kachalia ( akachalia@bwh.harvard.edu ) is chief quality officer at Brigham Health, in Boston, Massachusetts.

2

Kenneth Sands is chief epidemiologist and chief patient safety officer at HCA Healthcare, in Nashville, Tennessee.

3

Melinda Van Niel is a project manager at Beth Israel Deaconess Medical Center for the Massachusetts Alliance for Communication and Resolution following Medical Injury, in Boston.

4

Suzanne Dodson, now retired, was project manager at Baystate Health, in Springfield, Massachusetts.

5

Stephanie Roche is a health care quality research analyst at Beth Israel Deaconess Medical Center.

6

Victor Novack is head of the Clinical Research Center at Soroka University Medical Center and a professor of medicine at the Faculty of Health Sciences, Ben-Gurion University of the Negev, in Beer Sheva, Israel.

7

Maayan Yitshak-Sade is a postdoctoral research fellow at the Harvard T. H. Chan School of Public Health, in Boston.

8

Patricia Folcarelli is vice president of health care quality at Beth Israel Deaconess Medical Center.

9

Evan M. Benjamin is chief medical officer of Ariadne Labs, Harvard T. H. Chan School of Public Health and Brigham and Women's Hospital.

10

Alan C. Woodward, an emergency medicine physician in Concord, Massachusetts, is past president and former chair of the Committee on Professional Liability of the Massachusetts Medical Society.

11

Michelle M. Mello is a professor of law at Stanford Law School and a professor of health research and policy at Stanford University School of Medicine, in California.

Abstract

To promote communication with patients after medical injuries and improve patient safety, numerous hospitals have implemented communication-and-resolution programs (CRPs). Through these programs, hospitals communicate transparently with patients after adverse events; investigate what happened and offer an explanation; and, when warranted, apologize, take responsibility, and proactively offer compensation. Despite growing consensus that CRPs are the right thing to do, concerns over liability risks remain. We evaluated the liability effects of CRP implementation at four Massachusetts hospitals by examining before-and-after trends in claims volume, cost, and time to resolution and comparing them to trends among nonimplementing peer institutions. CRP implementation was associated with improved trends in the rate of new claims and legal defense costs at some hospitals, but it did not significantly alter trends in other outcomes. None of the hospitals experienced worsening liability trends after CRP implementation, which suggests that transparency, apology, and proactive compensation can be pursued without adverse financial consequences.

Am J Bioeth. 2019 Jan;19(1):16-34. doi: 10.1080/15265161.2018.1544305.

Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008-2016.

DuBois JM1, Anderson EE2, Chibnall JT3, Mozersky J1, Walsh HA1.

Author information

1

a Washington University School of Medicine.

2

b Loyola University Chicago Stritch School of Medicine.

3

c Saint Louis University School of Medicine.

Abstract

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.

"Like the economic problems it always creates, another essential characteristic of socialism is this inability to accept blame for creating the problems." #ButSocialism

In Venezuela, socialism has succeeded the way it always does

"Unable or unwilling to accept responsibility for destroying his nation's economy, Maduro has periodically arrested and prosecuted business owners — store owners who failed to stock goods they could not obtain and bakers for failing to make bread at a loss. Like the economic problems it always creates, another essential characteristic of socialism is this inability to accept blame for creating the problems.

This is how South America's once-wealthiest nation, with greater proven oil reserves than Norway or Saudi Arabia, has been turned into a failed state. Its democracy has been subverted, its military and police corrupted, its money worthless, and its people unable to receive basic necessities. Venezuela used to produce exports, but its only export today is its people.

This is how socialism always works out everywhere it is tried. From that point of view, it has been a stunning success in Venezuela."

"The problems are well understood, the solutions harder to see. Good reporting is expensive, but readers don’t want to pay for it."

Does Journalism Have a Future?

In an era of social media and fake news, journalists who have survived the print plunge have new foes to face. By Jill Lepore

The problems are well understood, the solutions harder to see. Good reporting is expensive, but readers don’t want to pay for it. The donation-funded ProPublica, “an independent, nonprofit newsroom that produces investigative journalism with moral force,” employs more than seventy-five journalists. Good reporting is slow, good stories unfold, and most stories that need telling don’t involve the White House. The Correspondent, an English-language version of the Dutch Web site De Correspondent, is trying to “unbreak the news.” It won’t run ads. It won’t collect data (or, at least, not much). It won’t have subscribers. Like NPR, it will be free for everyone, supported by members, who pay what they can. “We want to radically change what news is about, how it is made, and how it is funded,” its founders state. Push-notifications-on news is bad for you, they say, “because it pays more attention to the sensational, exceptional, negative, recent, and incidental, thereby losing sight of the ordinary, usual, positive, historical, and systematic.” What will the Correspondent look like? It will stay above the fray. It might sometimes be funny. It’s slated to début sometime in 2019. Aside from the thing about ads, it sounds a lot like a magazine, when magazines came in the mail.

People with Too Much Belly Fat Also Have Smaller Brains

Your beer gut could be making your brain smaller, new research reveals.

By Lauren Vinopal

Jan 25 2019, 4:41 PM

"It’s important to note that researchers can’t say whether excess fat depletes grey brain matter directly, or whether people with less grey matter are more likely to overeat, or whether there’s a third, outside factor, that has not yet been considered. But even these preliminary findings could be a good motivator for men who recognize the need to deflate that spare tire."

Can Obesity Cause Depression?

Brain chemicals involved in both mood and weight gain often overlap, Smoller says. Hormones for weight metabolism and depression, including stress hormones, might be at play. These hormones, including cortisol, the so-called stress hormone, and leptin, which regulates body fat storage, “may be doing double duty,” he says.

From Adam Booth and Sinchita Roy-Chowdhuri: Becoming an Engaged Pathologist

Adam L. Booth and Sinchita Roy-Chowdhuri (2019) Becoming an Engaged Pathologist. Archives of Pathology & Laboratory Medicine: February 2019, Vol. 143, No. 2, pp. 149-150.

EDITORIAL

Becoming an Engaged Pathologist

Adam L. Booth, MD; Sinchita Roy-Chowdhuri, MD, PhD

From the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Booth); and the Division of Pathology and Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston (Dr Roy-Chowdhuri).

Corresponding author: Adam L. Booth, MD, Department of Pathology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555 (email: adbooth@utmb.edu).

Public health crisis of poor sleep deserves as much attention as obesity epidemic, brain researchers warn. #ReadyPlayerOne

Public health crisis of poor sleep deserves as much attention as obesity epidemic, brain researchers warn

The Dream of Diversity. "Although pathology currently has measurable diversity, it doesn’t reflect the community."

The Dream of Diversity

"...the number of weeks at No. 1 for albums of Broadway-originated material surpasses all the weeks at No. 1 of albums by the Beatles, [Frank] Sinatra, Elvis Presley, the Rolling Stones, and the Monkees combined.”

When Broadway Became Broadway

How the embrace of other media made New York’s theater district iconic

The centrality of the Broadway musical to postwar American popular culture cannot be exaggerated. Consider this statistic cited by Maslon: “Between 1945 and 1969—25 of the most fertile and febrile years in popular music—13 different original-cast albums hit No. 1 on the Billboard charts.…If one factors in the soundtrack albums directly derived from Broadway scores during those same decades (Oklahoma, West Side Story, etc.), the number of weeks at No. 1 for albums of Broadway-originated material surpasses all the weeks at No. 1 of albums by the Beatles, [Frank] Sinatra, Elvis Presley, the Rolling Stones, and the Monkees combined.”

"What is clear is that negative stereotypes about obese people at work persist."

Half of employers say they are less inclined to recruit obese candidates – it’s not OK

"What is clear is that negative stereotypes about obese people at work persist. They are often seen as lazy, lacking in self-discipline, less competent, less conscientious and unmotivated. Obese workers often have lower starting pay and less hiring success – 45% of employers say they are less inclined to recruit obese candidates. They are less likely to be regarded as able leaders or to have career potential, are more likely to experience bullying and harassment, and obese women are less likely to get customer-facing jobs."

Childhood obesity: “One of our biggest challenges is trying to engage parents to recognize where there is an issue."

Childhood obesity: Parents need to ‘step up to the mark’

Schools take on too much of the burden of tackling childhood obesity, a county councillor claims.
Cllr Clair Bell believes parents should be “stepping up to the mark” rather than relying on the state to reduce the weight of their children.
Around one in eight children were overweight when they started school in Kent last year.


..........................

“It isn’t the responsibility of the state to bring up people’s children when they are small.
“We can give them as much help and support as possible but we must not focus on teachers and schools all the time when they have enough to be doing anyway.”
Public health consultant Samantha Bennett said the council is looking into one-on-one consultations with parents when children begin to eat solid food.
However, she added it is often challenging to get parents involved and admit their child has a problem.
She said: “We struggle to get hold of parents and when we do speak to them, the actual uptake of the interventions that we offer are very low.
“One of our biggest challenges is trying to engage parents to recognise where there is an issue.
“Largely the feedback when school nurses make those conversations, is they don’t think there’s a problem.
“They don’t recognise there is an issue with their child or it’s something they need to deal with at this time.
“If you’ve got obese parents, they are much less likely to recognise an issue with their own child as being obese.”


Too little sleep tied to increased heart disease risk #ReadyPlayerOne

Too little sleep tied to increased heart disease risk

"Sleep, together with diet and physical activity, (is) one of the healthy habits that we need to adopt and maintain to keep our cardiovascular system healthy," said senior study author Jose Ordovas, a researcher at the CNIC in Madrid and director of nutrition and genomics at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston.

"Our results support the traditional belief that we should have about eight hours of good sleep per day," Ordovas said by email. "For those that for one reason or another cannot avoid poor sleep, the recommendation should be to be more proactive about controlling other lifestyle risk factors such as diet and exercise."

Tenet looks at offshoring more than 1,000 healthcare jobs

Tenet, one of the nation's major for-profit hospital operators, did not specify what areas of the organization would be affected. However, Mr. Rittenmeyer told The Dallas Morning News that Tenet will "look at aggressively" offshoring jobs "across the whole enterprise," which includes Conifer Health Solutions, the company's Frisco, Texas-based healthcare business services subsidiary.

Health time bomb on remote British island where 75 per cent of population are overweight

Last year St Helena’s Director of Health Services Akeem Ali set out the growing health problems that the islands was facing, saying he was concerned that the poor health of islanders would lead to blindness, limb amputation, cancer, heart attacks, stroke and early death.

Health experts are also concerned about the growing risk of kidney failure and liver disease on an island where it is virtually impossible to offer organ transplants.

Understanding Why Women With Obesity Don't Breastfeed

Prior research had found that obese women are less likely to start breastfeeding (82.2% vs 86.4%) and less likely to breastfeed for at least 6 months (44.4% vs 53.8% in a 2014 study).

As the number of women who are clinically obese rises, there are public health concerns that fewer newborns will be breastfed, and those that are will be breastfed for shorter intervals. Of note, breastfeeding aids in postpartum weight loss, which would be particularly important for this group. The researchers wanted to know which factors went into decisions to breastfeed or to quit breastfeeding.

Two themes emerged from the interviews: (1) “personal control over breastfeeding behavior,” and (2) “realistic expectations of the breastfeeding journey.”

THE GROOVE LINE - HEAT WAVE #DiscoLives

THE GROOVE LINE - HEAT WAVE

"...the sense that one is living a worthwhile life appears to be positively linked to just about every aspect of our lives, not just health."

The Power of Purpose and Meaning in Life

A new study reveals the pervasive effects of feeling that life is worthwhile.

A growing body of research has found that the feeling that one’s life has meaning is associated with a host of positive health outcomes. And now a new study of older adults published in Proceedings of the National Academy of Sciences goes even further by revealing that the sense that one is living a worthwhile life appears to be positively linked to just about every aspect of our lives, not just health. The new study also followed people over time and found that the more worthwhile they found their lives the more positive changes they experienced over the following four years.

“These associations seem quite pervasive, right across a whole spectrum of our experience,” says lead author Andrew Steptoe, a psychologist and epidemiologist at University College London who oversaw the study. “It’s not only related to health but to social functions, psychological and emotional experiences, economic prosperity, things like sleeping well and time spent doing different kinds of activities.”

Obesity in Childhood Adversely Impacts Lung Development

"We found that body composition trajectories from childhood to adolescence relate to lung function levels at 15 years and lung function growth rates from age 8 to 15 years. Specifically we found that:

– Higher levels of lean body mass relate to higher levels and growth rates of forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and forced expiratory flow at 25-75% of FVC (FEF25-75) in both sexes"

Stanford professor Marcus Cole appointed dean of Notre Dame Law School

“To me, law is the noblest profession in the world,” Cole said. “Lawyers save lives, protect rights and grease the wheels of the economy. It has been the great honor of my life to train lawyers, and I am humbled and honored to have the opportunity to help do so at one of the most important law schools in the world. As the needs of our society call for ethically and morally guided lawyers and leaders, Notre Dame will continue to answer that call.”

HT:SD

Long-term postpartum obesity may be due to reprogramming of maternal energy metabolism

“Excessive gestational weight gain increases the risk of long-term postpartum obesity,” said Shao, “and our study showed that pregnant mice consuming a high fat diet significantly increased white fat cell gain, which is characteristic in humans too.

“But these mice lost that weight gain soon after giving birth, only to become spontaneously obese a few months later. The data demonstrate that excessive gestational weight gain-induced postpartum obesity is not simply an extension of pregnancy-induced fat gain or fat retention, but rather a fundamental change in maternal metabolism that results in less energy expended and more weight added as the result.”

Obesity Linked to Dementia Risk

Gray matter atrophy tied to BMI and other obesity metrics

"Obesity was also related to smaller putamen, caudate, pallidal, and nucleus accumbens volumes, they wrote in Neurology. There were no significant differences in white matter brain volume."

Should obesity be labelled a disease?

Goddard said: “It is important to the health of the nation that we remove the stigma associated with obesity.

“It is not a lifestyle choice caused by individual greed, but a disease caused by health inequalities, genetic influences and social factors.”

But not everyone agrees. This morning on ‘Good Morning Britain’ the debate was ignited once again.

In a discussion about whether obesity should be labelled a disease weight loss expert Steve Miller said we have to get much stronger on fat: “We are normalising fat, now we’re saying it’s a disease. It is a great excuse to give people and it’s a dangerous thing to say,” he said.

“Don’t we need a bit of fat-shaming,” interjecting Piers Morgan. “We have the worst obesity rates in Europe. We have a lot of fat people with a lot of sedentary fat people and now the debate is moving away from come on get off the coach, get fit eat healthy, to lets find an excuse, lets label it a disease.”

T.S.O.P. (The Sound of Philadelphia) Extended Version #DiscoLives

T.S.O.P. (The Sound of Philadelphia) Extended Version 

"I have a lot of sympathy with the view that obesity is a society-wide problem, but classifying it as a disease is not the way to help." #ButTheNarrative

As someone who's overweight, I know that calling obesity a disease is not the way to help

"I have a lot of sympathy with the view that obesity is a society-wide problem, but classifying it as a disease is not the way to help."

"If Britain's waistlines have become bloated, so too, critics note, have the salaries of those who've watched those waistlines expand under their watch." #nannystate

Will ‘Frenzied Hectoring’ by British Food Nannies Never End?

British health officials are ready to tax tasty food out off shelves.

Baylen Linnekin | January 5, 2019

"The real victim has been our ability to choose what we want to drink for ourselves—all to satisfy the health zealots, while achieving nothing," he writes.

If Britain's waistlines have become bloated, so too, critics note, have the salaries of those who've watched those waistlines expand under their watch. The Nanny State Rich List 2018, a damning new report from the TaxPayers' Alliance, a British nonprofit watchdog, found hundreds of public health officials across the country earned six-figure salaries. That includes two leading health agency staffers who earned salaries in excess of more than $375,000 last year.

If it sounds to you like Great Britain is in the midst of a grand debate over food and the nanny state, you're right. But these debates are neither new nor uniquely British.

I've studied such policies for years and found evidence of their success to be lacking. Denmark repealed its ineffective fat tax. New York City's soda ban was overturned by a court. Minneapolis's plans to force corner stores to sell more fruits and vegetables backfired. Los Angeles's ban on new fast food restaurants in South Los Angeles failed to make people healthier.

Jerad M. Gardner and Timothy C. Allen (2019) Keep Calm and Tweet On: Legal and Ethical Considerations for Pathologists Using Social Media. Archives of Pathology & Laboratory Medicine: January 2019, Vol. 143, No. 1, pp. 75-80.

https://doi.org/10.5858/arpa.2018-0313-SA

SPECIAL ARTICLE

Keep Calm and Tweet On: Legal and Ethical Considerations for Pathologists Using Social Media

Jerad M. Gardner, MD; Timothy C. Allen, MD, JD

From the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and Department of Pathology, University of Mississippi Medical Center, Jackson (Dr Allen).

The authors have no relevant financial interest in the products or companies described in this article.

Corresponding author: Jerad M. Gardner, MD, Department of Pathology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 517, Little Rock, AR 72205 (email: JMGardnerMD@gmail.com; Twitter: @JMGardnerMD).

Recent privacy breaches by a major social media company have again raised questions from some pathologists regarding the legality and ethics of sharing pathology images on social media. The authors examined ethical principles as well as historic and legal precedents relevant to pathology medical photography. Taking and sharing photographs of pathology specimens is embedded into the culture of the specialty of pathology and has been for more than a century. In general, the pathologist who takes the photograph of a gross or microscopic specimen owns the copyright to that photograph. Patient consent is not legally or ethically required to take or use deidentified photographs of pathology specimens. Current US privacy laws (Health Insurance Portability and Accountability Act [HIPAA] of 1996) permit public sharing of deidentified pathology photographs without specific patient consent, even on social media. There is no case law of action taken against pathologists for sharing deidentified pathology images on social media or elsewhere. If there is any legal risk for pathologists or risk of patient harm in sharing pathology photographs, it is very small. The benefits of professional social media use for pathologists, patients, and society are numerous and well documented in the literature.

Drug screening and "non-physiologic specimens"

UMMC pathology prof’s assay helps uncover dubious specimens

"One reason clinical labs are interested in developing a new assay is in response to the opioid crisis, Kyle said. For pain management patients, health care providers want to make sure patients are using their medications as prescribed."