When should a doctor betray a patient's confidence? This week the Supreme Court of the State of Washington heard arguments on this question in a case that has profound implications for the doctor-patient relationship.
In the case, Volk v. DeMeerleer, a psychiatrist, Howard Ashby, was sued after a patient of his, Jan DeMeerleer, shot and killed an ex-girlfriend and her 9-year-old son before killing himself. (Mr. DeMeerleer also stabbed another son, who survived.) The estate of the victims, Rebecca and Phillip Schiering, took legal action, arguing that Dr. Ashby was liable because he had not warned the Schierings. A lower court ruled in Dr. Ashby's favor on the grounds that Mr. DeMeerleer, who had occasionally voiced homicidal fantasies, had made no specific threats toward the Schierings during his treatment.
But last November an appeals court reversed that judgment, asserting that doctors could be required to warn "all foreseeable victims" of potentially dangerous patients in their care. Whether the attack on the Schierings was foreseeable, the court said, should be decided by a jury.
Though the murder of innocents is obviously a tragedy, the Washington State Supreme Court should overturn the appeals court's decision. Not only does that judgment greatly expand the circumstances in which psychiatrists would be required to violate patients' confidentiality; those violations in the end would also not serve the purpose for which they were intended.
Throughout history, doctor-patient confidentiality has been a cornerstone of Western medical practice. The duty to keep patients' information private is written into the codes of ethics of medical organizations, and is even in the Hippocratic oath: "What I may see or hear in the course of treatment," it says, "I will keep to myself."
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http://www.nytimes.com/2015/11/19/opinion/protect-doctor-patient-confidentiality.html?
Saturday, November 21, 2015
Thursday, November 19, 2015
Federal privacy law lags far behind personal-health technologies - The Washington Post
Jacqueline Stokes spotted the home paternity test at her local drugstore in Florida and knew she had to try it. She had no doubts for her own family, but as a cybersecurity consultant with an interest in genetics, she couldn't resist the latest advance.
At home, she carefully followed the instructions, swabbing inside the mouths of her husband and her daughter, placing the samples in the pouch provided and mailing them to a lab.
Days later, Stokes went online to get the results. Part of the lab's Web site address caught her attention, and her professional instincts kicked in. By tweaking the URL slightly, a sprawling directory appeared that gave her access to the test results of some 6,000 other people.
The site was taken down after Stokes complained on Twitter. But when she contacted the Department of Health and Human Services about the seemingly obvious violation of patient privacy, she got a surprising response: Officials couldn't do anything about the breach.
More ...
https://www.washingtonpost.com/news/to-your-health/wp/2015/11/17/federal-privacy-law-lags-far-behind-personal-health-technologies/
At home, she carefully followed the instructions, swabbing inside the mouths of her husband and her daughter, placing the samples in the pouch provided and mailing them to a lab.
Days later, Stokes went online to get the results. Part of the lab's Web site address caught her attention, and her professional instincts kicked in. By tweaking the URL slightly, a sprawling directory appeared that gave her access to the test results of some 6,000 other people.
The site was taken down after Stokes complained on Twitter. But when she contacted the Department of Health and Human Services about the seemingly obvious violation of patient privacy, she got a surprising response: Officials couldn't do anything about the breach.
More ...
https://www.washingtonpost.com/news/to-your-health/wp/2015/11/17/federal-privacy-law-lags-far-behind-personal-health-technologies/
Wednesday, November 18, 2015
Single course of antibiotics can mess up the gut microbiome for a year | Ars Technica
In a battle against an infection, antibiotics can bring victory over enemy germs. Yet that war-winning aid can come with significant collateral damage; microbial allies and innocents are killed off, too. Such casualties may be unavoidable in some cases, but a lot of people take antibiotics when they're not necessary or appropriate. And the toll of antibiotics on a healthy microbiome can, in some places, be serious, a new study suggests.
In two randomized, placebo-controlled trials of healthy people, a single course of oral antibiotics altered the composition and diversity of the gut microbiome for months, and in some cases up to a year. Such shifts could clear the way for pathogens, including the deadly Clostridium difficile. Those community changes can also alter microbiome activities, including interacting with the immune system and helping with digestion. Overall, the data, published Tuesday in the journal mBio, suggests that antibiotics may have more side effects than previously thought—at least in the gut.
In the mouth, on the other hand, researchers found that microbial communities fared much better, rebounding in weeks after antibiotic treatments. The finding raises the question of why the oral microbiome is less disturbed by drugs. It could simply be because of the way that antibiotics, taken orally, circulate through the body. Or, it could imply that oral microbiomes are innately more resilient, a quality that would be useful to replicate in microbial communities all over the body.
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Using a weight-loss app? One created for millennials doesn't help much, study finds - The Orange County Register
Young American adults own smartphones at a higher rate than any other age group. And researchers from Duke University wanted to see if capitalizing on that smartphone usage with a low-cost weight-loss app might help the 35 percent of young adults in the U.S. who are overweight or obese.
If you're rooting for smartphones to solve all our health problems, you're not going to like what the researchers found. The smartphone app didn't help young adults lose any more weight than if they hadn't been using the app at all.
The study, published in the journal Obesity, looked at 365 young adults ages 18-35. A third of the participants used an Android app specifically created for the study, which not only tracked their calories, weight and exercise but also offered interactive features such as goal setting, games and social support.
Another third of the participants received six weekly personal coaching sessions, followed by monthly phone follow-ups. Plus, this personal coaching group was also encouraged to track their weight, calories and exercise via smartphone.
The last third of the participants were given three handouts on healthy eating and exercise – nothing else.
Researchers tracked the young adults' progress after six months, one year and two years. The personal coaching group had lost more weight than the other two groups after six months, but that lead vanished at the one- and two-year follow-ups.
As for the group using the smartphone app, their average weight loss was never more than the other two groups.
Lead author Dr. Laura Svetkey said she and her colleagues were both surprised and disappointed at the results.
"Given the seeming power of cellphone apps and frankly the popularity of these health and fitness apps in the commercial world, we thought this might be a really good strategy to provide effective intervention very broadly and potentially at low cost," said Svetkey, a professor of medicine at Duke University School of Medicine.
Yet, Svetkey says, it's difficult to get the same level of intensity in an app that you might get through personal coaching, and people have the tendency to stop using weight-loss apps after a while.
More ...
http://www.ocregister.com/articles/weight-692477-svetkey-app.html
If you're rooting for smartphones to solve all our health problems, you're not going to like what the researchers found. The smartphone app didn't help young adults lose any more weight than if they hadn't been using the app at all.
The study, published in the journal Obesity, looked at 365 young adults ages 18-35. A third of the participants used an Android app specifically created for the study, which not only tracked their calories, weight and exercise but also offered interactive features such as goal setting, games and social support.
Another third of the participants received six weekly personal coaching sessions, followed by monthly phone follow-ups. Plus, this personal coaching group was also encouraged to track their weight, calories and exercise via smartphone.
The last third of the participants were given three handouts on healthy eating and exercise – nothing else.
Researchers tracked the young adults' progress after six months, one year and two years. The personal coaching group had lost more weight than the other two groups after six months, but that lead vanished at the one- and two-year follow-ups.
As for the group using the smartphone app, their average weight loss was never more than the other two groups.
Lead author Dr. Laura Svetkey said she and her colleagues were both surprised and disappointed at the results.
"Given the seeming power of cellphone apps and frankly the popularity of these health and fitness apps in the commercial world, we thought this might be a really good strategy to provide effective intervention very broadly and potentially at low cost," said Svetkey, a professor of medicine at Duke University School of Medicine.
Yet, Svetkey says, it's difficult to get the same level of intensity in an app that you might get through personal coaching, and people have the tendency to stop using weight-loss apps after a while.
More ...
http://www.ocregister.com/articles/weight-692477-svetkey-app.html
NYTimes: Early Prostate Cancer Cases Fall Along With Screening
Fewer men are being screened for prostate cancer, and fewer early-stage cases are being detected, according to two studies published Tuesday in The Journal of the American Medical Association.
The number of cases has dropped not because the disease is becoming less common but because there is less effort to find it, the researchers said.
The declines in both screening and incidence "could have significant public health implications," the authors of one of the studies wrote, but they added that it was too soon to tell whether the changes would affect death rates from the disease.
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http://www.nytimes.com/2015/11/18/health/prostate-cancer-studies-find-declines-in-screening-and-early-detection.html?
The number of cases has dropped not because the disease is becoming less common but because there is less effort to find it, the researchers said.
The declines in both screening and incidence "could have significant public health implications," the authors of one of the studies wrote, but they added that it was too soon to tell whether the changes would affect death rates from the disease.
More ...
http://www.nytimes.com/2015/11/18/health/prostate-cancer-studies-find-declines-in-screening-and-early-detection.html?
Diary of a Food Tracker - The New York Times
Research shows that people who keep track of what they eat and weigh on a regular basis are more likely to succeed at losing weight and keeping it off. But as the food diary of Steve Lochner shows, food tracking and weight loss is far from simple.
In February of 2012, he weighed a high of 337 pounds. But then he started tracking his eating habits using the Lose It food tracking app. Soon he became a "Super Tracker," detailing virtually every bite of food — good and bad — that he ate over a three-year period, losing more than 100 pounds. Here's how he did it.
Tuesday, November 17, 2015
'War on drugs means millions are dying in pain' - CNN.com
Ruth Dreifuss is former President of Switzerland and Minister of Home Affairs. Anand Grover is former U.N. special rapporteur on the Right to Health, India. Michel Kazatchkine is former executive director of the Global Fund to fight AIDS, Tuberculosis and Malaria. The opinions expressed in this commentary are theirs.
Millions of people are dying in pain because of the repressive stance the world has taken on drugs. That's because states are obsessed by the fear that people will use controlled medicines such as morphine as recreational drugs, thereby neglecting their important medical uses.
Where you live determines whether you will be able to access to controlled medicines, particularly opiates, when confronting an acute terminal, chronic or painful illness. Ninety-two per cent of the world's morphine is consumed by only 17% of the world's population, primarily the United States and Europe. Seventy--five percent of the world's people in need do not have access to pain relieving medicine.
In other words, most of the global population, outside the affluent countries in the North, dying in pain, including from terminal cancers, do so in the absence of dignified palliative care.
This is a horrendous situation for millions of patients and families. Essential medicines such as morphine, taken for granted as the standard relief of severe pain in the global North, do not enjoy the same status in the global South. Quite the opposite. Chances are, if a person living in any developing country ends up with an illness associated with extreme and avoidable pain, they will endure the pain simply because their government has created obstacles to morphine use in hospitals.
More ...
http://www.cnn.com/2015/11/17/opinions/controlled-medicines-access-gcdp/
Millions of people are dying in pain because of the repressive stance the world has taken on drugs. That's because states are obsessed by the fear that people will use controlled medicines such as morphine as recreational drugs, thereby neglecting their important medical uses.
Where you live determines whether you will be able to access to controlled medicines, particularly opiates, when confronting an acute terminal, chronic or painful illness. Ninety-two per cent of the world's morphine is consumed by only 17% of the world's population, primarily the United States and Europe. Seventy--five percent of the world's people in need do not have access to pain relieving medicine.
In other words, most of the global population, outside the affluent countries in the North, dying in pain, including from terminal cancers, do so in the absence of dignified palliative care.
This is a horrendous situation for millions of patients and families. Essential medicines such as morphine, taken for granted as the standard relief of severe pain in the global North, do not enjoy the same status in the global South. Quite the opposite. Chances are, if a person living in any developing country ends up with an illness associated with extreme and avoidable pain, they will endure the pain simply because their government has created obstacles to morphine use in hospitals.
More ...
http://www.cnn.com/2015/11/17/opinions/controlled-medicines-access-gcdp/
Special Section: Wired Well - The New York Times
Once personal health technology meant little more than bathroom scales, thermometers and electric toothbrushes. Now, these devices and apps are everywhere: on our wrists, in our phones, the bedroom, the kitchen, even on our children and pets. In this special issue of Science Times, we explore the lives of newly wired consumers and the consequences, good and bad, that arise from our increasing reliance on trackers, monitors, guides and a vast array of other devices to better our health.
http://well.blogs.nytimes.com/2015/11/16/special-section-wired-well/?
http://well.blogs.nytimes.com/2015/11/16/special-section-wired-well/?
'Dangerously high' antibiotic resistance levels worldwide: WHO - Yahoo News
Antibiotic resistance, which can turn common ailments into killers, has reached dangerous levels globally, the World Health Organization warned Monday, saying widespread misunderstandings about the problem was fuelling the risk.
Antibiotic resistance happens when bugs become immune to existing drugs, allowing minor injuries and common infections to become deadly.
This happens naturally, but overuse and misuse of the drugs dramatically speeds up resistance, WHO said, voicing alarm at the results of a worldwide study showing that misconceptions about the threat are widespread, prompting dangerous behaviors.
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Sunday, November 15, 2015
Wary of Mainstream Medicine, Immigrants Seek Remedies From Home - The New York Times
On a recent afternoon, Ina Vandebroek was poking around the shelves of La 21 Division Botanica on the Grand Concourse in the Bronx. Its narrow aisles were crammed with thousands of votive candles, herbal potions and brightly colored plaster statues of saints.
Dr. Vandebroek, a Belgian-born ethnobotanist, paused to gaze at herb-infused oils. The vials had names like Amor Prohibido ("Forbidden Love"), for those in search of adventure, and Conquistador, for the timid — both of them big sellers. Bendicion de Dinero Al Hogar ("A Blessing for Money in the House"), which comes in a spray, is also popular. But Dr. Vandebroek was not there to jump-start a flagging love life or curry the favor of spirits. La 21 Division is a regular stop for her, a mile or so from her laboratory at the New York Botanical Garden, where she is the assistant curator of economic botany.
She is conducting a multiyear study of the folk remedies sold in New York's botanicas, more than 100 emporiums that offer products for all that ails the body, mind and soul to a clientele mainly consisting of Latino and Caribbean immigrants. She is compiling guides in English and Spanish describing the plants and their uses. Her goal is to promote "culturally effective and sensitive health care" for a community that is chronically underserved by mainstream medicine.
More ...
http://www.nytimes.com/2015/11/15/nyregion/wary-of-mainstream-medicine-immigrants-seek-remedies-from-home.html?
Dr. Vandebroek, a Belgian-born ethnobotanist, paused to gaze at herb-infused oils. The vials had names like Amor Prohibido ("Forbidden Love"), for those in search of adventure, and Conquistador, for the timid — both of them big sellers. Bendicion de Dinero Al Hogar ("A Blessing for Money in the House"), which comes in a spray, is also popular. But Dr. Vandebroek was not there to jump-start a flagging love life or curry the favor of spirits. La 21 Division is a regular stop for her, a mile or so from her laboratory at the New York Botanical Garden, where she is the assistant curator of economic botany.
She is conducting a multiyear study of the folk remedies sold in New York's botanicas, more than 100 emporiums that offer products for all that ails the body, mind and soul to a clientele mainly consisting of Latino and Caribbean immigrants. She is compiling guides in English and Spanish describing the plants and their uses. Her goal is to promote "culturally effective and sensitive health care" for a community that is chronically underserved by mainstream medicine.
More ...
http://www.nytimes.com/2015/11/15/nyregion/wary-of-mainstream-medicine-immigrants-seek-remedies-from-home.html?
When medical care is delivered in 15-minute doses, there’s not much time for caring - The Washington Post
I have 15 minutes. I'm generally not happy that, as an internist who works for a large medical group (most of us do now), I'm instructed to conform to this assigned length for visits with my patients. Being told to arrive at 2:45 p.m. makes it clear to patients that every doctor-hour is broken into quarters. But the pressure to keep to the time limit is felt primarily by the doctor, who must stick to the schedule or expect the 3 p.m. patient to come in unhappy about the wait.
A patient in any medical practice rightly wants the visit to take as long as is reasonably required. A healthy 25-year-old with a sore throat is thrilled to be out of my office in less than 10 minutes, after a focused exam and a culture. Most patients, though, don't present a single problem that can be addressed with a targeted answer. The 15-minute visit shortchanges those patients while frustrating the doctors who want to help make them well.
Marvin is thin, 6-foot-4, a 36-year-old commercial mortgage broker with a lineless, hard-to-read face. I've seen him once before, 11 months earlier, so this is considered a follow-up visit, half the length of a 30-minute first encounter.
There's a typical sequence to a 15-minute visit. In the opening phase, researchers who have studied primary-care interactions expect that I would "establish a cordial atmosphere" and "convey interest," and in fact I talk to Marvin about the Yankees' pitching problems. In the history section, I gather data with yes/no questions and tell-me-more-about-that follow-ups. "My back's acting up," Marvin says. Back pain is one of the 10 most common patient complaints in primary care and is almost never life-threatening. This shouldn't take very long if I'm clinically efficient and a clear communicator. Still, I try not to show that I am in a hurry. I do not wear a watch. Did your back pain begin after an injury? I ask. Have there been pain-free days? Are there certain positions or medications that have afforded relief? "It's been bad the past couple of months," Marvin says.
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https://www.washingtonpost.com/opinions/when-medical-care-is-delivered-in-15-minute-doses-theres-not-much-time-for-caring/2015/11/13/85ddba3a-818f-11e5-a7ca-6ab6ec20f839_story.html
A patient in any medical practice rightly wants the visit to take as long as is reasonably required. A healthy 25-year-old with a sore throat is thrilled to be out of my office in less than 10 minutes, after a focused exam and a culture. Most patients, though, don't present a single problem that can be addressed with a targeted answer. The 15-minute visit shortchanges those patients while frustrating the doctors who want to help make them well.
Marvin is thin, 6-foot-4, a 36-year-old commercial mortgage broker with a lineless, hard-to-read face. I've seen him once before, 11 months earlier, so this is considered a follow-up visit, half the length of a 30-minute first encounter.
There's a typical sequence to a 15-minute visit. In the opening phase, researchers who have studied primary-care interactions expect that I would "establish a cordial atmosphere" and "convey interest," and in fact I talk to Marvin about the Yankees' pitching problems. In the history section, I gather data with yes/no questions and tell-me-more-about-that follow-ups. "My back's acting up," Marvin says. Back pain is one of the 10 most common patient complaints in primary care and is almost never life-threatening. This shouldn't take very long if I'm clinically efficient and a clear communicator. Still, I try not to show that I am in a hurry. I do not wear a watch. Did your back pain begin after an injury? I ask. Have there been pain-free days? Are there certain positions or medications that have afforded relief? "It's been bad the past couple of months," Marvin says.
More ...
https://www.washingtonpost.com/opinions/when-medical-care-is-delivered-in-15-minute-doses-theres-not-much-time-for-caring/2015/11/13/85ddba3a-818f-11e5-a7ca-6ab6ec20f839_story.html
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