Promising New Legislation for Flint’s Water Crisis

Flint, Michigan has been suffering from a water emergency for over three years. Budget cuts in Michigan ended up affecting basic necessities, including drinking water. Bankole Thompson, a reporter for the Detroit News, is calling this “Michigan’s Katrina.” He says that the state has created this problem for itself by ignoring important findings regarding resident’s health over the past few years. Following the initial discovery of the lead crisis, the mayor, backed by the Department of Environmental Quality, discredited residents’ concerns and said that the water was up to standards (Fonger). However, the takeover by the EPA a year later would suggest otherwise (Davey). Studies done by Virginia Tech showed that there is, in fact, an increased level of lead in the water supply (Davey). Unfortunately, this research went ignored, and the residents’  pleas for clean water only intensified.

Overall, there has been a seemingly apathetic response from the local and state governments. Since the switch of the pipelines from Lake Huron to the Flint River, there have been reports of elevated levels of lead in children’s blood (Davey). In addition, there have been only limited warnings about the spreading of Legionnaire’s disease – a severe type of pneumonia that can be spread through contaminated water sources (Davey, Legionnaire’s Disease). Finally , there have been state level restrictions preventing the city from switching their water source back to Lake Huron until the pipeline is completed, leaving the locals of Flint desperate for relief (Davey).

After switching the water source to the Flint River, forgoing corrosion controls, failing to issue proper alerts, and ignoring research and alerts from researchers and medical professionals, Flint Michigan may finally be seeing some relief from a new piece of legislation passed in the Senate (Davenport). The Water Resources and Development Act is meant to aid poor communities, including Flint, that are affected by lead-contaminated water supplies (Davenport). Funding allocated by the new piece of legislation could help purify the water supply and get clean water to an increasing number of people (Davenport). There is much potential for this act to have positive effects on the water supply in Flint, however, whether or not the funding will come through is another issue altogether. The bill awaits deliberation in the House, where the amount of spending will be determined, should the bill be passed. But with a 95-3 vote in the Senate, the its prospects are looking good.

References:

Davenport, Coral. "Senate Approves Funding for Flint Water Crisis." The New York Times. The New York Times, 15 Sept. 2016. Web.

Davey, Monica, and Mitch Smith. "What Went Wrong in Flint." The New York Times. The New York Times, 03 Mar. 2016. Web.

Fonger, Ron. "City Adding More Lime to Flint River Water as Resident Complaints Pour in." MLive.com. Advance Digital, 12 June 2014. Web.

"Legionnaires' Disease." Encyclopedic Dictionary of Genetics, Genomics and Proteomics (2004): n. pag. CDC, 18 July 2016. Web.

Thompson, Bankole. "Thompson: Flint Crisis Is Michigan's Katrina." Detroit News. The Detroit News, 13 Jan. 2016. Web.

Blanket Bans in the NHS: Utilitarian Justice or Unfair Discrimination

       Post-Brexit healthcare from the UK’s National Health Service (NHS) has been under continuous burden as a nearly exponential demand in patients and a diminishing supply of resources persists. In the midst of consistent pressure to deliver quality care with limited funding and lingering debt from previous overspending, the NHS has not set national standards for reform. Just recently, and nearly two months post-Brexit, The Guardian covered a shocking decision made by a local, clinical commissioning group (CCG) within the broader NHS system to alleviate healthcare pressure using a blanket ban. From this point forward, all clinically obese persons, individuals with a BMI of 30 or over, will be denied elective surgeries for up to one year in the Vale of York CCG (1).

Does this decision exercise appropriate principles of justice in biomedical ethics? Furthermore, what are the consequences of these measures? One result is clear - the decision did not come without criticism. President of the Royal College of Surgeons (RCS), Dr. Clare Marx, heavily denounced the Vale of York’s action as one of the most precarious decisions made in the present-day NHS (1). Dr. Marx further stated that the RCS is not only in support of aiding clinically obese patients in their desire for speedy medical interventions, but also that “[delaying] patients’ access to what can be life-changing surgery for up to a year is wrong” (1). One NHS bariatric surgeon, Dr. Shaw Somers, described the Vale of York’s denial of elective surgery to clinically obese persons “like discriminating [against] a segment of the population on the basis of their colour or religious persuasion,” markedly because obesity is a medical illness (1).

           Despite clear contentions, the Vale of York stood by its decision. The CCG argued that its recent mandate was necessary for optimal healthcare services given the stringent availability of resources (1). The NHS maintains the decision because the CCG is still within its legal right to pursue such an approach. While the NHS emphasized that further review should be taken, an NHS spokesperson did advocate for the possible outcomes of the CCG’s move: “Reducing obesity and cutting smoking not only benefits patients but saves the NHS and taxpayers millions of pounds” (1). In the end, the driving factor for the Vale of York is to distribute the maximum amount of services for as many patients as possible within their limited capacity.

    Yet, will the end justify the means? According to Tom Beauchamp and James Childress’ Principles of Biomedical Ethics, conflicts in distributive justice and allocation of goods and services in times of scarcity is a healthcare issue that has transcended all generations and borders (2). Moreover, inequalities in healthcare access raise important questions about the justice of decisions made by policymakers for the public good. In the case of the Vale of York’s decision to deny elective surgeries to clinically obese persons, a strong utilitarian theory of justice was applied by the CCG. Beauchamp and Childress highlight the definition and purpose of utilitarian justice as a means to maximize net social utility and form healthcare policies that are based on cost-benefit or risk-benefit analysis (2).

    Utilitarian justice has major advantages for the Vale of York CCG in a post-Brexit NHS. One idea that utilitarian justice might not consider, however, is the fair-opportunity rule of Rawlsian theory. As an example of egalitarian thinking, the fair-opportunity rule stresses that individuals should not be denied social benefits because of undeserved, disadvantageous conditions for which they have no control (2). An enlightening view of this theory offered by Beauchamp and Childress says that the intrinsic properties given to individuals by the social and biological “lottery” of life cannot be discriminated against in “social allocations if people do not have a fair chance to acquire or overcome these properties” (2).

           Since obesity is a medical illness, which is linked to a myriad of genetic, environmental, economic, and societal influences, should the fair-opportunity rule not apply to the decision made by the Vale of York (3)? If the answer were yes, then the connection between denying clinically obese persons standard access to elective surgeries based on the condition of their illness would classify as an unfair discrimination. Some might argue that without a strong utilitarian mode of justice, then the already limited NHS resources and funding would plummet.

    In response, I pose another scenario in which other CCG’s across the NHS uphold decisions to deny access the healthcare options to clinically obese persons. When access to healthcare becomes increasingly scarce for those populations of patients, is the interest of the common good truly being served to its maximum capacity? If we allow blanket bans to prevent or give lower priority healthcare access to those with intrinsic, disadvantageous conditions for which they have no control, then who will face unfair discrimination next?   

References:  

1.   Beauchamp, Tom L., & Childress, James F. (2009). Principles of Biomedical Ethics. New York, NY: Oxford University Press.

2.   Rawlinson, Kevin, and Chris Johnson. (2016, Sept. 3). Decision to deny surgery to obese patients is like 'racial discrimination'. The Guardian.  Retrieved from https://www.theguardian.com/society/2016/sep/03/hospitals-to-cut-costs-by-denying-surgery-to-smokers-and-the-obese

3.   Why People Become Overweight. Harvard Health Publications. Retrieved from http://www.health.harvard.edu/staying-healthy/why-people-become-overweight  

Are Women’s General Practitioners Failing to be Heart Smart?

    Women are  affected by heart disease at higher rates than men not because they don’t care about their health but because they aren’t being tracked by their doctors at the same rate as males. The reason men's heart disease rates have decreased over the past thirty years is because the focus of Public health campaigns, marketing for heart disease care and prevention as well as doctors fail to focus on women.

    A study in the European Journal of Preventive Cardiology found that male General Practitioners, GP’s, are less likely than female GP’s to collect information on smoking, blood glucose and cholesterol from their female patients than their male patients.  Female GP's were found to have a higher rate of compliance with the recommended guidelines for heart disease tracking and were more apt to ask their female patients the pertinent questions so they would be able to track their patient's health.  The findings are from Europe but the results still hit close to home.  Women are not being tracked as well as men when it comes to heart disease.  They are also failing to respond to campaigns aimed at preventing and decreasing heart disease.

    The majority of women’s health issues focus on reproductive health.  While it is important to pay attention to reproductive health it fails to take into consideration whole health. The years when women are of child-bearing age estrogen is thought to protect women from heart disease.  During these years women should have active conversations with their Gynecologist and/or their GP about heart disease and prevention.  The patient/physician relationship should be built so conversations regarding heart health and lifestyle are held at every chance the physician has to see their patient.  Increasing awareness at a during the doctor’s visit will help increase the likelihood women will take preventative steps to increase their heart health before the protective effects of estrogen dissipate.

    The next step to heart health lies in marketing how a healthy lifestyle will prevent heart disease later in life.  The National Institutes of Health found heart disease is still the leading cause of death amongst women despite preventive measures put in place in the 1980’s.  Their findings showed males have reduced their rate of heart disease while women remain at the same incident level.  The message needs to change to connect with women if they want to see a decrease in women's heart disease rates by changing the way the messages are sent in campaigns. Women need to be shown as actively fighting heart disease, not being the caretakers of men who are fighting heart disease.  Campaigns should empower women to talk to their physician about heart health by connecting with women at a personal level.

    It is important to include women in the process of creating public health campaigns and advertising for heart health.  Heart disease is the number one killer for women in general, specifically for Caucasians and African American women, their needs, how they respond to information and the way the information is presented must be considered.  There is a need to be cognizant of how women, especially those with a high risk factor, respond to campaigns for heart disease prevention.

    A lack of information, education and preventative marketing for women leads to a lack of improvement in women's heart health.  Campaigns which focus on women, their risk and their need to tell their doctor their health habits need to be created.  Patients and Physicians need to work together to find a solution to the leading killer of women together not separately.  Through a joint effort awareness can be raised, health habits addressed and heart disease decreased.  

References: 

1. Delpech,Raphaëlle,Ringa,Virginie, Falcoff,Hector, & Rigal,Laurent.  ( 2016, June 21).  Primary prevention of cardiovascular disease: More patient gender-based differences in risk evaluation among male general practitioners.  European Journal of Preventive Cardiology.  Doi: 10.177/2047487316648476.  Retrieved from http://cpr.sagepub.com/content/early/2016/06/09/2047487316648476.full.

2. National Institutes of Health.  (2010,February 2).  Even With Heart Disease Awareness on the Rise, Prevention Remains Critically Important for American Women: The Heart Truth campaign urges women to take action.  (National Institutes of Health Publication).  Retrieved from https://www.nih.gov/news-events/news-releases/even-heart-disease-awareness-rise-prevention-remains-critically-important-american-women

The Ethical Dilemma of Unaccompanied Minors from Central America: Rage

The raging desert ravages the lost

Refugee, immigrant, exilee... tread on

Fathers, brothers, sisters, lovers what cost

Your children take to escape death at dawn

Week 3

The raging sunbeam ravages the boy

Elements relentless, inflict their strife

King Fear reigns, “Water? Gangs? You I’ll destroy.”

Heat exhaustion, pain, pleading God for his life

Week 4

Raging gangs ravage the calico crew

Bloody, battered, bandage Nameless wounds

Robbed, raped, resigned- no one is good nor true

wonder if their death waits in Nameless tombs

Week 5

The raging thirst ravages rambling bones

Terrible thirst, child saints stumble along

Sinking slowly to deep abyss, unknowns

Dehydration.. hallucination.. Mom?

Week 6

A raging illness ravages two dears

Faceless boys in the faceless group collapse

“Leave us to die”, too dry for bitter tears

Nameless dying carried on Nameless backs

Week 7

“America the free we see!” they cry

Quiet white sky rages Nameless behind

Yesterday the two were left to die

Look left. Patrol. Refugees are confined.

1 year

Raging guards ravage the despised detained

Isolated, cold, deplorable blocks

“Apply for asylum? In hell remain

‘America the free we see!’ now mocks”

1 year- alternate ending

The raging love ravages the home

Orphan boys lawlessly find some peace

Raging love, for lawlessness, atone

“Rest now.” Eyes closed. See Nameless boys deceased.

*Poem inspired by true events. The friend who inspired this poem lived out the alternate ending, but far too many live out the first.

Concerns Persist Over Organ Harvesting in China

Concerns are again being raised over China’s execution of prisoners in order to use their organs for transplant. In today’s economy, organs can fetch a high price; in 2014 the organs of a single human body, including the heart, lungs, liver, kidney, pancreas, and intestines, were valued at $689,9001. Including medication, a hospital stay, and other fees associated with surgery, an organ recipient may pay nearly $1.2 million1. Today, the price is likely even higher.

With such high value placed on organs and an aging population increasingly in need of transplants, China has struggled to find voluntary organ donors. For years, global health officials were wary of China’s high execution rate and its reputed connection to organ donation. According to Amnesty International, China’s rate of capital punishment is one of the highest in the world, with over 1,500 prisoners being executed in 2015. 2 With such high execution rates and limited information on who is executed and on what charge, it is widely accepted that China was killing two birds with one stone: execution of political prisoners serves to eliminate anti-communist ideology and provides a source of much-needed organs.

Along withthe prisoners being held on death row for heinous crimes, those up for execution include political prisoners and prisoners of conscience3. It is believed that these include members of the persecuted Falun Gong religious group and suspected anti-Communists 3. Upon entering prison, reports confirm 3 that prisoners are subjected to medical tests, and the results stored in a database. Once the need arises, the prisoners are executed and the necessary organs extracted, or in some cases, the extraction is done on live patients to ensure a fresh transplant.3

In 2005, after years of global suspicion, China publicly confessed that the organs of executed prisoners were being harvested for transplants, and in 2011, China’s transplant chief Dr. Huang Jiefu estimated that 65% of all transplanted organs in China came from executed prisoners. 4 This renewed global concern over possible human rights violations. Finally in 2015, after facing increasing international pressure, Chinese officials announced that organs would no longer be harvested from executed inmates.

With well over half of organ transplants coming from executed prisoners, nobody expected an easy transition from a corrupt system to a permanent, ethical means of organ transplantation. Donors are scarce in China, in part due to a very limited organ volunteer system and cultural belief that it is inappropriate to disfigure a deceased body. However, when a Canadian patient in need of a kidney made a trip to China this year and received an organ in three short days4, eyebrows were instantly raised. Clearly, China has a long road ahead if it ever hopes to shed its reputation for unethical organ harvesting.

References:

1  Hanson, Steven. “2014 U.S. organ and tissue transplant cost estimates and discussion.” Milliman, 30 Dec. 2014, http://www.milliman.com/uploadedFiles/insight/Research/

      health-rr/1938HDP_20141230.pdf

2

Perry, Juliet. “Amnesty report: Executions at their highest level in 25 years.” CNN, 6  April, 2016, http://www.cnn.com/2016/04/05/world/amnesty-2015-death-penalty-report/index.html

3

Robertson, Matthew. “China’s Former Security Chief Implicated In Organ Harvesting.” Epoch Times, 16 Mar. 2015, http://www.theepochtimes.com/n3/  1287014-chinas-state-sponsored-organ-crimes-find-scapegoat/

4 Merchant, Norman. “Does China Still Harvest Organs of Executed? Doctors Divided.” Stars and Stripes, 27 Aug. 2016, http://www.stripes.com/news/

    does-china-still-harves-organs-of-executed-doctors-divided-1.425833

Online Reviews & Healthcare Quality

Doctors are subject to evaluation on many levels. Physicians may be judged on availability, and bedside manner, in addition to their ability to ameliorate patients’ conditions. Interestingly, the reliability of a physician when it comes to addressing health problems does not necessarily correlate to high ratings by patients (Carroll). Patients, or the subset of them who write reviews, may consider other factors more important than outcome. Review websites for doctors are extremely popular with upwards of 33 publically available sites for this purpose. (Lopez) With this many options for publically available data on patient satisfaction it may be appropriate to ask how hospitals determine whether they are meeting customer expectations.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is commonly used as a data source when comparing patient satisfaction levels. This survey is aimed at gaining patients’ perspectives and allowing consumers a way to evaluate the hospitals available to them. This survey also has made a goal of increasing the standards for care (HCAHPS...). Hospitals with better reports, as put forward by patients, are expected to accrue business based on their higher satisfaction ratings and the possibility of a larger market share will push hospitals to improve their reviews. However, some patients may not see alternatives to the hospital they have been using even if they were unsatisfied with their interactions or experience there; and some hospitals may not see improving survey results as a significant way to access more of the market. The levels to which the HCAHPS survey reflects hospitals’ quality have been debated and some studies show that hospitals that perform well on the survey have high clinical standards, while others show quite the opposite (Carroll).

In turning to online reviews hospitals may gain new perspectives on patient satisfaction and, in turn, their own performance. By looking at Yelp reviews instead of HCAHPS data researchers found 12 more metrics that play into a patient’s satisfaction (Carroll). This isn’t saying that the HCAHPS data isn’t a useful way to examine hospitals but does suggest that the factors that influence a patient’s hospital experience are diverse and not fully accounted for in the survey data.

Does the prevalence of online reviews change where we go for care? Do we seek out hospitals and doctors who are held in high regard? A recent study has shown we do: “we find robust evidence across several different conditions and performance measures that higher quality hospitals have higher market shares and grow more over time.” (Chandra). With this in mind it becomes clear that at least some patients see choice in where they go for medical care and can make decisions based on satisfaction as customers. Where patients  are gaining the data needed to make such decisions should be investigated further; online reviews may prove to be influential in this regard.

References:  

Carroll, Aaron E. "How Yelp Reviews Can Help Improve Patient Care." The New York Times. The New York Times, 12 Sept. 2016. Web. 12 Sept. 2016.

Chandra, Amitabh, Amy Finkelstein, Adam Sacarny, and Chad Syverson. "Health Care Exceptionalism? Performance and Allocation in the US Health Care Sector." American Economic Review 106.8 (2016): 2110-144. Web.

López, Andrea, Alissa Detz, Neda Ratanawongsa, and Urmimala Sarkar. "What Patients Say About Their Doctors Online: A Qualitative Content Analysis."Journal of General Internal Medicine 27.6 (2012): 685-92. Web.

http://www.hcahpsonline.org Centers for Medicare & Medicaid Services, Baltimore, MD. Sept. 12, 2016.

Nasal flu vaccine no longer recommended

FluMist, the flu vaccine in the form of a nasal spray, is no longer recommended in the guidelines set forth by the American Association of Pediatrics (AAP) outlining preventative flu measures (Scutti, 2016). This form of the vaccine was found to be not nearly as protective as hoped, reducing the chance of getting the virus by only 3% as compared to no intervention in children 2-17 years in a study conducted by the Advisory Committee on Immunization Practices, part of the CDC (Fox, 2016). The injected vaccine is effective for two-thirds of that same population.

           The difference in protective capacity stems from the type of vaccine. The shot is an inactivated vaccine (Scutti, 2016) in which all the virus particles are no longer pathogenic. FluMist, on the other hand, is a live attenuated vaccine, meaning that a weakened form of the virus is present. The inactivated virus with all of its parts usually develops a more protective immune response than a live attenuated virus. Everyone over the age of six months is strongly advised to get the vaccine. This is particularly important for vulnerable populations such as health care providers, young children, seniors, and pregnant women.

           AstraZeneca, the maker of FluMist, disputed the CDC findings (Fox, 2016). The pharmaceutical giant cited European studies and a Canadian study that found their vaccine to be effective. However, because the guidelines set forth influence vaccine availability in the US, it is unlikely that AstraZeneca will be able to fight back at all this year.

           One potential outcome of this change is that some people may choose to opt out of getting the shot. This may put particular populations more at risk. In this case, with FluMist most often being used to vaccinate children, they are the ones most likely to be at risk. However, Dr. David Henderson, an OhioHealth pediatrics physician, doesn’t think parents who have a history of vaccination will let their kid go without getting the vaccine (Scutti, 2016).

References:

Fox, M. (September 6, 2016). Pediatricians give thumbs-down to FluMist flu vaccine. NBC News. Retrieved from

Harris, R. (September 6, 2016). Pediatricians Recommend Flu Vaccination, Just Not with The Spray. NPR.org. Retrieved from http://www.npr.org/sections/health-shots/2016/09/06/492829843/pediatricians-recommend-flu-vaccination-just-not-with-the-spray

Scutti, S. (September 6, 2016). Pediatricians update flu vaccine guidelines to remove FluMist. CNN. Retrieved from http://www.cnn.com/2016/09/06/health/flu-season-flumist-spray-shot/index.html

EpiPens: A Life-Saving Necessity or Luxurious Expense?

Millions of Americans suffer from life-threatening allergies, whether the antigen are peanuts, shellfish, or latex. The one line of defense these people possess in the instance that they suffer from an anaphylactic attack is the epinephrine auto-injector. Epinephrine, also known as adrenaline, acts as a bronchodilator and vasoconstrictor, effectively opening a patient’s airway and allowing adequate blood flow to the heart and lungs by diverting it from the extremities. There is no other medicine that has these same effects. It is becoming more and more difficult for Americans to procure this pharmaceutical because of its ever-increasing price. This has become such a concern that one individual opted not to use her EpiPen during an allergic reaction because of the cost to replace it.

Mylan, the company that produces the ubiquitous EpiPen, owns about 90% of the $1.3 billion U.S. auto-injector market and has increased its price of an EpiPen by 450% since 2004 (Iozzo).  In 2004, the price of an EpiPen was $150, but has since skyrocketed to over $600. That cost reflects one dosage, but Mylan only sells EpiPens in packages of two. The pharmaceutical giant argues that a backup auto-injector is necessary in case the first one malfunctions. Therefore, buying this life-saving medicine costs consumers about $1,200. The actual epinephrine only costs Mylan one dollar to produce; the astronomical price of the product is mainly due to the company’s proprietary pen injector. Only recently, after much public pressure, has Mylan offered a discounted price on their EpiPen. However, even with this discount the product still costs well over $1,000. As a result, many consumers have attempted other ways to treat their allergies. An alternative company named Adrenaclick has emerged in the auto-injector market with a much cheaper product, selling for $142. While this product is much more affordable, doctors are hesitant to recommend it because the steps to use this new product are drastically different from those of the EpiPen (Cha). Since the EpiPen has monopolized the market, using a different product with different injection procedures will take time and practice. Doctors do not want individuals taking time during an emergency to stop and read the directions on how to use this relatively new product. Additionally, individuals have begun to create their own concoctions of epinephrine and use that in place of an EpiPen. This latter trend greatly worries legislators, particularly Iowa Senator Charles E. Grassley: “I am concerned that the substantial price increase could limit access to a much-needed medication. It could also create an unsafe situation as people untrained in medical procedures are incentivized to make their own kits”. The alternatives to using EpiPens are not very well established, so many consumers are forced to pay the exorbitant amount to use Mylan’s product. Those who cannot afford an EpiPen are turning to very drastic and radical measures to protect themselves in case they suffer an allergic reaction.

Alyssa Rosenberg has suffered from a severe tree-nut allergy since she was a toddler. Because of this diagnosis, she has needed an EpiPen for practically her entire life. Alyssa has lived a very functional and fulfilling life, as many allergy-sufferers do. However, last spring she had to make a decision after unknowingly eating kale chips that were seasoned with cashew dust. She reasoned that she would not have to go to the hospital, so rather than using her EpiPen she made herself vomit. Rosenberg went on to say that her health insurance plan is very expansive and that she rarely has allergic attacks. The attack she had last spring was the first one she had had in about ten years. Even though all of this is true, she still believed that not using her EpiPen was the best thing to do when she had an allergic reaction. There are many individuals in the United States who have very poor health insurance programs and use their EpiPens several times a year. The cost of replacing EpiPens to them is most daunting, and must be mitigated so that people do not have to think twice about using their EpiPen in the appropriate situation.

Epinephrine injection is the only way to treat anaphylactic shock in a patient, and the EpiPen is the only credible product available to people suffering from anaphylaxis. Mylan has consistently raised the price of their EpiPen over the past twelve years, which has greatly reduced individuals’ ability to purchase the device. This inability to access an EpiPen has lead people to make radical and potentially-dangerous decisions about treating their allergic reactions.

References:

Cha, A. E. (2016). U.S. lawmakers demand investigation of $100 price hike of lifesaving EpiPens. The Washington Post. Retrieved from https://www.washingtonpost.com/news/to-your-health/wp/2016/08/23/u-s-lawmakers-demand-investigation-of-100-price-hike-of-life-saving-epipens/?tid=a_inl.

Iozzio, C. (2015). How one startup plans to end the EpiPen monopoly. Fortune. Retrieved from http://fortune.com/2015/07/21/epipen-alternative-medicine/.

Rosenberg, A. (2016). EpiPens are my armor against disaster. They shouldn’t be priced like a luxury. The Washington Post. Retrieved from       https://www.washingtonpost.com/news/to-your-health/wp/2016/08/25/epipens-are-my-armor-against-disaster-they-shouldnt-be-priced-like-a-luxur

Belgian Olympian Faces Final Challenge

        Olympians amaze and astound people across the globe with their unmatched athleticism, agility, and stamina. Olympians perform such jaw-dropping feats that oftentimes people question whether they are human.  However, they are every bit as human as you and me. Olympian Marieke Vervoot exemplifies this idea, for she currently faces the same challenge that thousands of individuals across the world face: ending one’s own life via euthanasia. Vervoot won gold in the 100-meter wheelchair sprint in 2012 and has recently competed in her final Paralympic Games in Rio de Janeiro. Citing that competing is her main passion in life, she has now requested to be euthanized. Many view her desire as inhumane and barbaric. While those people certainly have a valid argument, one must consider many different aspects of the individual’s life and evaluate the patient’s claim before dismissing it as unethical.

    Belgium has the most liberal euthanasia laws in the world. The practice was legalized for adults in 2003, a year in which 235 people were euthanized. In 2013, there were 1,816 cases of euthanasia and currently about 1 in 20 Belgian deaths are assisted suicides (Carle). In 2014, Belgium became the first country in the world to legalize euthanasia of children (with parents’ consent). In order to be eligible for euthanasia, a patient must exhibit chronic, debilitating, and incurable physical or mental pain. Most patients seeking euthanasia are diagnosed with terminal cancer, but people with psychological disorders and autism have also been euthanized. Belgium’s cultural acceptance of euthanasia and the policies created as a result of this mindset have allowed people like Vervoot to pursue a more dignified and peaceful way to end their lives.

           Marieke suffers from a degenerative disease that has impaired her vision and causes her great pain everyday. Her lone salvation is competing, saying, “sport is my only reason for living” (Cook). That is one thing her condition has not taken away from her: the ability to compete at a very high level. After these Olympics, Vervoot says that she will have nothing to live for, which is the primary reason she seeks to end her life. Dr. Wim Distelmans, a Belgian doctor on the vanguard of euthanasia, argues that the Vervoot’s prospect of being euthanized has actually extended her life. He explains, “The certainty that there is an emergency brake to stop the intolerable pain gives one peace. This mindset can extend one’s life”. Distelmans argues that euthanasia can bring clarity to someone whose life has been characterized by uncertainty and fear. By knowing that she is able to die on her own terms, Vervoot will be able to focus on all the positive aspects of her life rather than obsess over all of her interminable pain. As a result, she might find something so worthwhile, like competing, that will give her the motivation to live even longer.

           Dr. Ezekiel Emanuel led a study about patients’ feelings towards euthanasia and whether they would seriously consider it for themselves. His study found that those seriously considering euthanasia had the following common characteristics: depressive symptoms, substantial caregiving needs, and pain. Why is it ethical for a judge to force these people to feel such anguish every day for the rest of their lives? This question becomes especially pertinent when the patient has a neurodegenerative disorder, such as amyotrophic lateral sclerosis (ALS). Is it not better for people to die on their own terms, rather than dependent on a machine to keep them living for an extra year or two? For some patients, euthanasia provides a more dignified and humane way to die.

           There are millions of smart and talented individuals across the globe whose end-of-life experiences are plagued with machines breathing, eating, and speaking for them. After evaluating the costs of dying and the benefits of living, doctors, judges, and legislators must realize that sometimes it is ethical to die as a functioning human being rather than live with perpetual pain.

References:

Carle, Robert. “Give me Liberty and Give me Death: Belgium’s Brave new Euthanasia Regime”. The

    Witherspoon Institute: Public Discourse. Accessed 22 August 2016.

    <http://www.thepublicdiscourse.com/2015/09/15355/>.

Cook, Michael. “Gold medalist paralympian from Belgium seeks

           euthanasia”. Bioedge: bioethics news from around the world.

           Accessed 19 August 2016. <http://www.bioedge.org/bioethics/gold-medallist-

           paralympian-from-belgian-seeks-euthanasia/11956>.

“Current Law Regarding Euthanasia in Belgium”. Patients Rights Council. Accessed 22 August 2016.

    <http://www.patientsrightscouncil.org/site/belgium/>.

Emanuel, EJ, et. al. “Attitudes and Desires Related to Euthanasia and Physician-Assisted

           Suicide among Terminally Ill patients and their Caregivers”.  JAMA.  Accessed 19

           August 2016.

A New Approach to Combating the Zika Virus

The zika virus is currently of paramount concern to many health care officials in the United States, as there have been 29 cases of zika originating in the U.S. in the past several months (CDC). One area that has been particularly afflicted with the virus is southern Florida. As new cases emerge in Miami Beach, biotechnology companies have begun to propose that surrounding areas adopt a novel, yet preventative approach to fighting the zika virus. These companies argue that current methods to tackle zika are ineffective, but there are uncertainties regarding this new proposed method.

Zika can be transmitted multiple ways, but the most common is by mosquito bites. Other ways the virus can infect people are through intercourse, blood transfusions, and from a mother to fetus. The primary demographic that should be concerned about zika is pregnant women. Many adults rarely get sick enough from zika to go to the hospital and almost never die from the disease. However, the pathogen does pose a real threat to pregnant women because of the birth defects that it can cause. The main birth defect associated with zika is microcephaly, a condition in which a newborn’s head is smaller than normal. This abnormal shape is due to the brain’s insufficient growth either during pregnancy or after birth (CDC). The severity of microcephaly varies case by case, where the more severe instances of the condition can lead to many different learning disabilities and health conditions. Some of these include propensity to have seizures, intellectual disability, hearing loss, and vision loss. These negative effects of the virus are so pressing that public service workers in the Miami area are working overtime to ensure that all mosquitoes have been eradicated from the city streets.

Last Thursday there were reports that two new cases of zika had been diagnosed in Miami Beach. Public works crews are working around the clock to ensure that the tourism capital of southern Florida is completely without zika-carrying mosquitoes. They are using two different strategies to eradicate the disease, and are encouraging all residents of the Miami Beach area to do the same: drain and cover. Sanitation workers are working with pressure washers at temperatures of 250 degrees Fahrenheit to force all stagnant water into the sewer system while simultaneously killing any bacteria living in the water. Additionally, public health officials are urging residents drain any standing irrigation or rain water that can collect in trash cans, pool covers, gutters, etc. (Flechas). Mosquitoes need standing water to lay their eggs, but not a lot of it; mosquito larvae can hatch in as little as a teaspoon of water. This fact is the reason that eliminating all standing water in the area is of the utmost importance. The other approach that Miami workers are using to combat Zika is to cover any isolated areas where the virus may be. Workers are vacuuming up debris where mosquitoes may lay their eggs are throwing larvicide pellets into storm-water drains.  They also are requiring homeowners to cover up their doors, windows, porches, and patios with screens. People are also encouraged to wear clothing that does not expose their skin to potential mosquito bites. These are the current measures the Florida Department of Health is taking to protect its people from zika. There are certain biotechnology companies that are proposing more innovative measures to prevent this virus from spreading to other adjacent areas of the state.

Oxitec is a company that has genetically engineered mosquitoes designed to kill other ones carrying the zika virus. These synthetic mosquitos would mate with wild female ones and their offspring would die before adulthood. On August 5th, the Federal Drug Administration approved test trials of this new technology in the Florida Keys as a preventative measure. No cases of the zika virus have been reported in the Florida Keys at this time. Hadyn Perry, the CEO of Oxitec, advocates for the use of this technology to combat zika and cites its previous success. This same technology was employed in 2010 when there was a dengue outbreak in the Florida Keys, and it killed about 40% more mosquitos than the methods previously described. However, there had been opposition from local residents to use this technology, primarily because there is no current problem with zika in the Florida Keys and that there may be unpredictable side effects of this new technology (Allen). As such, this technology has not been used to date in the fight against zika, but its potential life-saving effects are very promising.

The zika virus is garnering all the attention among major healthcare officials in the United States, and for good reason. Its harmful effects on infant babies are very concerning, and must be dealt with. As such, Miami health officials have adopted a multi-faceted approach to battle the virus. However, more radical measures to fight this pathogen are on the horizon.

References:

Allen, Greg. “Florida Keys Opposition Stalls Tests of Genetically Altered Mosquitos”.

           NPR Shots: Health News from NPR. August 17, 2016. Accessed August 26, 2016.

           < http://www.npr.org/sections/health-shots/2016/08/17/490313999/opposition-in-

           florida-puts-tests-of-genetically-altered-mosquitoes-on-hold>.

CDC. “Overview: How Zika Spreads”. Center for Disease Control and Prevention.

           Accessed August 26, 2016. < http://www.cdc.gov/zika/about/overview.html>.

Flechas, Joey. “Miami Beach workers Sweep City for Zika Breeding Grounds”.

           Miami Herald: Healthcare. August 19, 2016. Accessed August 26, 2016.

           < http://www.miamiherald.com/news/health-care/article96637632.html>.

End HIV by 2020? Tell Us ‘How’

As someone who has dedicated her young life to learning how best to combat the HIV/AIDS epidemic, I am struck by articles wherein there is little thought given to the ‘how’ or ‘why’ we can fight HIV/AIDS. Instead, there is more focus on ‘what’ is needed or lacking in our armament. It seems to me that we are quick to judge ‘what’ is not working in the HIV intervention realm: treatments are failing, equipment lacks luster, drug stocks are insufficient. Yet there is little talk of ‘how’ to mitigate these challenges and ‘why’ such tribulations arise in the first place. It is about time that someone started talking about the ‘how’ and ‘why’ – maybe then we can rally behind the 90-90-90 Targets that I believe so deeply in.

Last week, BBC News published: “HIV effort let down by test shortages, says WHO,” wherein the writer discussed “gaps in provision” vis-à-vis rolling out HIV medications for global treatment. The article referenced the UNAIDS 90-90-90 Targets: by 2020, 90% of all people living with HIV should know their HIV status, 90% of those diagnosed should receive antiretroviral therapy, 90% of (these) treated patients should be virally suppressed. Viral suppression is a measure of inactivating the HI virus such that the probability of reinfection is mitigated. Within the article, one Vincent Habiyambere (Senior Procurement and Supply Management Office, World Health Organization) is quoted for claiming that “low and middle-income countries, including African countries where the HIV burden is high, are not geared up” for the fight against HIV/AIDS. Habiyambere implied that such countries lacked necessities to fight HIV such as staff training and properly installed equipment. Furthermore, laboratories and machines needed for testing and treatment were poorly maintained.

The article called for “strong leadership, resources, planning and management” as tools to implement and provide HIV services. Yet, there was little mention of ‘how’ to provide these tools in countries where most victims of HIV/AIDS are living below the poverty line.

Contrastingly, in her article “Are Young South Africans ignoring the Aids message?” (BBC News on 18th July 2016), Karen Allen described the plight of South Africans: “when the rest of the world was rolling out a drug called Nevirapine to reduce the chances of mothers transmitting the virus, South African leadership famously advised patients to use lemon and garlic, instead, to protect themselves.” Allen neglected to mention that the Nevirapine drug was sold for close to $100 per pill, especially since it was founded in 1996 and shortly approved by the FDA in the USA – a country far removed from South Africa in both distance and wealth at the time.

The drug embodied a luxury that most South African mothers could not afford. Hence the leadership turned to a more reasonable ‘home-remedy’ in garlic. While I openly admit this was likely less effective, I am reminded that this was at least presented a viable mode of action. Interestingly, we see that Allen honed in on the ‘what’ (lack of Nevirapine advocated in South Africa) while easily ignoring the ‘how’ and ‘why’ that I attempt to explore by means of the cost price of the drug.

Allen goes on to talk about a new plight in South Africa – the “sugar daddy syndrome.” She maintains that there are a number of young people who are newly infected with HIV due to intergenerational sex: sex across age groups. Needless to say the dim picture that Allen paints includes gender violence and inequality. While these are harsh realities in South Africa today, I believe that there is more achieved in highlighting the strides made against these social challenges instead of adding to the noise, which echoes their existence.

In the conclusion of her piece, Allen alludes to what I believe is the root of the epidemic that is crippling our nations - HIV stigma: “400 people die in South Africa every single day of HIV-related illnesses, either because they don’t seek help early on or default on their treatment.” The country is not alone given that more than “2 million adolescents” live with HIV globally (UNICEF 2016).

I am a graduate student who researches HIV/AIDS in South African urban townships. I believe HIV stigma embodies the ‘why’ surrounding HIV treatments specifically in terms of: why is treatment adherence so low, how do communities interact with HIV interventions. My work focuses on peer support and knowledge sharing for men at risk for and living with HIV/AIDS. I advocate that community members can provide the most knowledge when it comes to navigating streets rampant with treacherous HIV-stigma. As a result of this, I aim to facilitate and encourage platforms for knowledge sharing through peer interaction in ‘brave spaces’ that circumvent HIV stigma.

It seems to me that there are many discussions surrounding the ‘what’ when it comes to the world’s fights against HIV/AIDS. But if we are to win in this battle by 2020, we must begin brainstorming the ‘how’ and ‘why’ – before it is too late.

--

References:

Allen, Karen. Are Young South Africans Ignoring AIDS message. BBC News. http://www.bbc.com/news/world-africa-36795484. July 2016.

HIV Effort Let Down By Test Shortages, says WHO. BBC News. http://www.bbc.com/news/health-37168771. August 2016.

Lynch, Dominic. Higher Education’s ‘Safe Space’ is Now a Ridiculous ‘Brave Space’. Real Clear Education. http://www.realcleareducation.com/articles/2015/05/08/higher_educations_safe_space_is_now_a_ridiculous_brave_space_1195.html. May 2015.

Focused ultrasound now FDA approved

The University of Virginia recently led an international clinical trial determining the effectiveness of focused ultrasound on the treatment of essential tremors. Having an essential tremor can disrupt everyday life, making it difficult to write, feed oneself, and participate in many other daily activities. Of the 76 participants, those that received the experimental treatment reported dramatic improvement, whereas those that received the “sham” treatment showed no significant improvements. Some reported side-effects included numbness in the hands or face and gait disturbances, though most of these were temporary. The focused ultrasound device has been approved by the FDA but whether insurance companies will pay for the treatment and who will be eligible has yet to be finalized.

Painkillers are killing more Americans than any illegal drug. Here is Virginia’s response.

The Problem

Unintentional injuries and violence are among the leading causes of death, hospitalization, and disability in Virginia. Typical culprits on the top of that list are motor vehicle accidents, accidental gun deaths, and poisonings. In 2014, however, trends began to change.

For the first time in the state’s history, fatal drug overdose is now the number one method of unnatural death in the Commonwealth. It killed 986 people in 2014, eclipsing both motor vehicle-related fatalities and gun-related deaths.1

This new reality mimics trends in opioid and heroin addiction nationally. Also in 2014, more Americans died of drug overdoses than any other year on record, accounting for more than 47,000 total deaths.2 While a significant percentage of these deaths are a result of heroin overdoses, over half are related to opioid-based prescription painkillers, such as oxycodone, fentanyl, hydrocodone, or methadone.3

Oxycodone, fentanyl, and heroin are the most common painkillers seen on the streets today. Historically, oxycodone has been the number one prescribed drug to cause opioid overdose. However in recent years, fentanyl, which is up to 100 times more potent than morphine, has surpassed it.4

This is due to the fact that fentanyl is being illicitly produced instead of pharmaceutically produced. This illicit form of fentanyl is produced by international drug traffickers who import the drug into the United States and often mix it into heroin being sold. According to the Virginia Department of Health (VDH), by late 2013 and early 2014, some heroin being sold on the street was actually completely fentanyl, unbeknownst to the user.1

This illicitly produced fentanyl, especially fentanyl mixed with heroin, has been the biggest contributor to the significant increase in the number of fatal opioid overdoses in Virginia.

Source: Virginia Department of Health1

The Response

The rise of this epidemic has understandably caught the attention of policy leaders, law enforcement officials, and healthcare professionals alike. In typical government fashion, taskforces were formed, workgroups convened, and coalitions established.

Virginia Governor Terry McAuliffe created the Governor’s Task Force on Prescription Drug and Heroin Abuse in the beginning of 2015. The Task Force was directed to provide a range of policy recommendations, including how to: (1) raise public awareness about the misuse of prescription painkillers, (2) train health care providers on best practices for pain management, (3) identify treatment options and alternatives to incarceration for people with addiction, and (4) promote the safe storage and disposal of prescription drugs.3

The enforcement of these recommendations is currently underway across the state and many players are involved. State agencies, academics, law enforcement, and health care providers are forming partnerships and collaborating with each other in order to do their due diligence.

As an example, the Virginia Department of Medical Assistance Services (DMAS) worked with the Department of Behavioral Health and Developmental Services (DBHDS) to increase access to treatment for Virginia’s Medicaid members by increasing Medicaid reimbursement rates for addiction services.5

The new rates go into effect in April 2017 and increase some payments up to 400 percent. In preparation for the big change, DMAS, DBHDS, and VDH have also partnered together to host statewide trainings for medical providers, behavioral health providers, and administrative professionals. The trainings will raise awareness about the new reimbursement structure as well as educate providers on how to implement evidence-based addiction management services into their practice.

Medication addiction treatment, otherwise referred to as MAT, is one of these evidence-based treatments. MAT combines continuous behavioral counseling with anti-addiction medicines like buprenorphine or Suboxone in order to address the physical, mental, and social factors of addiction. Suboxone, which is a synthetic mix of buprenorphine and the overdose reversal drug naloxone,  suppresses opioid cravings, decreases withdrawal symptoms, and is proven to help addicts recover from their illness. A study conducted by the National Institute on Drug Abuse (NIDA) found that Suboxone reduced prescription painkiller abuse in nearly half of all participants.6

With the new payment incentives and increased education and trainings for MAT, Virginia will undeniably see an increase in the number of providers that offer fully comprehensive services. As a result, low income populations who are most disproportionately affected by the substance use epidemic will have improved access to community-based addiction treatments that promote full integration of physical health and traditional mental health services.

Counties are also working at the local level to carry out some of the Governor’s recommendations.  According to Loudoun Emergency Medical Services (EMS), in 2015 Loudoun County had a total of 35 suspected heroin overdoses and since January 2016, there have been 71 overdose incidents recorded, 30 of which appeared to involve an opiate.

Loudoun County Police Department drug drop off box

For years, local county and town law enforcement agencies have participated in biannual Drug Take Back Days. These events have resulted in disposal of almost 8,000 pounds of unneeded prescriptions, but the Loudoun County Health Council recognized the need for disposal locations that offered continuous access throughout the year.

Drug collection boxes provide a safe way for residents to dispose of prescription drugs without cost to them. The local Health Department sought and received a grant from the CVS Pharmacy and the Partnership for Drug-Free Kids to increase the number of drug drop off boxes from one to now five sprinkled throughout the county.  

The drug collection boxes give citizens the opportunity to remove as many unused or expired prescription drugs as possible and are another evidence-based approach to prevent further drug abuse and drug overdoses in the community.

Worry in Southwest

In light of the great work being done by these state and local agencies, there still remain some skeptics about the impact and effectiveness of medication assisted treatment for opioid addiction.

Despite the fact that Suboxone is not supposed to produce a narcotic high, users who snort or inject it, or combine it with benzodiazepines or alcohol, report being able to achieve similar euphoric effects of heroin or strong prescription painkillers.

In fact, towns in rural southwest Virginia describe Suboxone as a “menace” to their community.7 According to an article in the Culpepper Star Exponent, “Suboxone is the most-abused, most-sought-after street drug across that part of the state.” Law enforcement officials are increasingly concerned that people are using the drug to help feed their addictions instead of cure them.

However, experts believe it is likely that in southwest Virginia the availability of Suboxone has been perpetuated from cash clinics that don’t typically offer the comprehensive evidence-based treatment that addicts need to be successful. Behavioral counseling is an integral part of MAT and people abusing Suboxone may not be receiving the full spectrum of care, either due to access issues, financial barriers, psychosocial neglect, or a multitude of other reasons.  

While the dangers and abusive potential of Suboxone are indeed a reality for many people in the region, policymakers in Virginia and in Washington, DC remain strong proponents of MAT if executed correctly. President Obama’s 2017 proposed budget includes $1 million for expansion of MAT, and Virginia is expected to receive federal funding to match its $11 million dedicated to fighting the opiate epidemic.7

The access and availability of MAT will certainly increase as we move into the new year, and experts hope the situation in Southwest will not become the norm. Ideally, with boots on the ground and policy experts amidst, enforcement of the Task Force’s recommendations will curb the spread of this threatening epidemic in all areas of the Commonwealth.

References:

[1] Virginia Department of Health. (July 2016). Office of the Chief Medical Examiner Fatal Drug Overdose Quarterly Report, First Quarter 2016. Retrieved from http://www.vdh.virginia.gov/content/uploads/sites/18/2016/04/Quarterly-Drug-Death-Report-FINAL_July-2016.pdf

[2] Lopez, G. (June 2, 2016). The opioid painkiller and heroin epidemic. Retrieved from http://www.vox.com/2015/10/1/9433099/opioid-painkiller-heroin-epidemic

[3] Virginia Department of Health Professions. (April 6, 2015). Governor’s Task Force on Prescription Drug and Heroin Abuse Interim Report. Retrieved from https://www.dhp.virginia.gov/taskforce/minutes/20150512/TaskForceInterimReport05122015.pdf

[4] Center for Disease Control Health Advisory. (October 26, 2015).  Increases in Fentanyl Drug Confiscations and Fentanyl-related Overdose Fatalities. Retrieved from https://www.vdh.virginia.gov/OEMS/NewsFeatures/CDCHealthAdvisory-Fentanyl.pdf

[5] Department of Medical Assistance Services. (July 1, 2016). Virginia’s Addiction Treatment Services Delivery System Transformation Concept Paper: 1115 Waiver for Addiction Treatment Services. Retrieved from http://www.dmas.virginia.gov/Content_atchs/bh/VA%20Addiction%20Tx%20Services%20Concept%20Paper-FINAL-7-1-2016.pdf

[6] Partnership News Service. (November 9, 2011). Prescription Opioid Addiction Can Be Treated with Suboxone, Study Shows. Retrieved from http://www.drugfree.org/news-service/prescription-opioid-addiction-can-be-treated-with-suboxone-study-shows/

[7] Ramsey, J. (August 8, 2016). In SW Va., drug to help addicts attacked as part of the problem. Retrieved from http://www.dailyprogress.com/starexponent/news/in-sw-va-drug-to-help-addicts-attacked-as-part/article_d317f8f0-5dc2-11e6-868a-a7b72f83a47b.html.

A Right To Live: Unless You Produce Eggs or Milk

Early in my days of animal advocacy, newly cognizant of the abuse and exploitation of animals for human benefit, I made the decision to reject the consumption of all meat, adopting a vegetarian lifestyle, along with the philosophy to never again eat anything “with a mother or a face.” However, as my years of advocating for society’s rejection of animal meat progressed, I recognized my clear discomfort when faced with the realities of the animal agriculture industry. Eventually, I admitted the ovo-lacto-guilt I experienced was derived from my own subconscious awareness of the inconsistencies between my values and my lifestyle choices and of my daily decision to give in to this cognitive dissonance, all for the sake of ease and periodic chocolate chip pancakes.

Now, vegetarians, and subscribers of the traditional Western diet alike, often ask me why ethical vegans (who are against murdering animals) do not drink cow's milk or consume eggs, reasoning that "chickens lay eggs anyways" and "a cow doesn’t have to be killed for it to be milked." Without any further arguments, these points are entirely accurate. However, many vegetarians defend their meat-free diets with “right to life” reasoning, maintaining the right of an animal to live and not be killed. Unfortunately, in the context of a vegetarian diet, this principle overlooks the system in which animal products and by-products are manufactured.

The production of animal products and byproducts (such as eggs, milk, fur, meat, and feathers) for human consumption is a commercial industry. Just like any industry, the ultimate goal is profit- minimum input for maximum output. This is a well-known fact yet rarely is it considered at length. For animals (such as layer hens and dairy cows) raised for their byproducts, the reality is a system with nearly 200 years of technological innovations designed to benefit from every scrap of their body. Therefore, dairy cows are not raised solely for their milk, nor layer hens for their eggs.

Seventy percent of ground beef sold in the United States is made from dairy cows, whose bodies are worn from an average four years of intense milk production. The little-known slaughter linked to the dairy industry is the production of veal, often considered a byproduct industry. In order to avoid delays in milk production, baby cows are taken from their mothers within as little as days after birth. The males are condemned to an almost immediate slaughter, while the females are either slaughtered or entered into the dairy industry. By drinking cow's' milk and supporting the dairy industry, consumers permit and promote the slaughter of animals.

The egg industry is responsible for countless deaths as well, beginning with 260 million male chicks whose lives serve no purpose in egg production. For many “spent” layer hens, who do not qualify for protection under the Humane Slaughter Act, the slaughterhouse is also their designated end. However, due to a declining market for spent hens and therefore a decline in profits, many layer hens now face death by asphyxiation. Clearly, the consumption of eggs from the egg industry permits and promotes the slaughter of animals.

It has become impossible to isolate any one sector; animal agriculture of all species has become a single, interconnected industry. Even beyond the typical examples, byproducts of animal agriculture are integrated into the most unsuspecting industries: refined white sugar cane is manufactured with the bone char of cattle, tennis racket strings are created with animal intestines, some beers are even produced using the swim bladders of fish. However, animals commercially raised for their meat and animals raised for their by-products are equally subjected to an unnatural life supplanted with cruel, utilitarian treatment and their lives end the same as well: being corralled up the ramp to a slaughterhouse. Consumption of any animal product or byproduct permits and promotes the slaughter of all animals. There is truly no option for affirmers of the “right to life” belief other than committing to veganism.

By adopting a vegan lifestyle completely void of all animal products and byproducts one can discover a sense of security and legitimacy in the belief that all living beings should have an absolute right to life. Veganism is the only lifestyle which holds this belief in consonance with the awareness of the reality of animal agriculture. I wholeheartedly assert that one cannot justifiably renounce the consumption of animal meat on moral grounds, citing “right to life” reasoning, without the concurrent renunciation of all animal products.

*The question of whether or not animals deserve a right to life has been much contested. Philosophers, theologians, ethicists, farmers, vegans, and vegetarians alike have contemplated what it means to have a claim to life, citing the interests principle, free will, moral reciprocity, dominionism. However, this particular article does not address any of these contentions; I’m only arguing against the validity of maintaining both an existing belief in animals’ right to live and a continued support of the modern animal agriculture industry.

References: 

1. Joy, Melanie. Why We Love Dogs, Eat Pigs, and Wear Cows: An Introduction to Carnism: The Belief System That Enables Us to Eat Some Animals and Not Others. San Francisco: Conari Press, 2011.

2. "Veal: A Byproduct of the Cruel Dairy Industry." PETA. Accessed August 26, 2016. http://www.peta.org/issues/animals-used-for-food/animals-used-food-factsheets/veal-byproduct-cruel-dairy-industry/.

3. "Chickens." Farm Sanctuary. Accessed August 26, 2016. https://www.farmsanctuary.org/learn/factory-farming/chickens/.

A Privileged Conversation

It was day two at the Bioethics conference and the small breakout group’s conversation was swirling around me as people discussed the plight of the disabled when one word catches my attention: privilege.  The debate begins concerning who is the voice of, the leaders of, and the true representatives of the disabled.  Those who are considered the voice of or leaders of those who are disabled were accused of being privileged in this conversation.  They didn’t represent the disabled because they haven’t lived the lives of those who aren’t able to access the finest care and go to the best schools.  Then I begin to speak.

When I was born, the visible disabilities immediately defined who I am and in some ways who my mom was going to become.  My mother, divorced with two children, knew she had to take steps to ensure my health care needs would be met.  She sought answers regarding my care and began the process of taking me to doctors for consultations and surgeries.  Through all of this she found doctors who were nationally recognized and were able to meet my healthcare needs.  She worked full time as a teacher and took on several part time jobs to ensure I could have the best healthcare she could afford.  I was "privileged" because I had someone who sacrificed their comfort for my well- being.  I was "privileged" because I had doctors, who included me in my treatment plans; who listened to me.  This isn’t the type of privilege which would discount my ability to understand the needs of those who are disabled, but it could make me blind to the struggle of those who aren’t able to access this type of care.  

My voice is not loud, is not heard by many, and may never influence change, but my determination to advocate for those who cannot and do not know where to start is strong.  Working with those who struggle, those who are unaware of the care which exists in their community and providing comfort to those who find out their child will be disabled is a privilege.  It doesn’t come with money, tenure or talk shows but it does come with smiles, hugs and heartfelt thanks.  Privilege has many faces and while I believe those who have never experienced hardship should stop, step out of their comfort zone and live the life of those who are less fortunate before they legislate, write, and espouse what should and should not be in the world of disability, I also understand this is my "privileged" view.  

Faith in Kidneys

Disclaimer: All names and identifying information have been modified to protect the privacy of all individuals. The opinions expressed in these articles are the author's own and do not reflect the views of the University of Virginia.

Our world is not solely composed of “most-likely” situations. In the strange, curious, and at times inexplicable reality in which we live, the seemingly-impossible is sometimes synonymous with the achievable. Such was the case for Carter and his wife, Sarah.

What are the odds that either your parent, spouse, or child can be a fully compatible kidney donor to you? How about all three? It doesn’t take a quick Google search to realize that the chances of those three events happening together are not in your favor. However, that is exactly what happened to Sarah, whose battle with Henoch-Schönlein purpura (HSP) damaged her kidneys at the early age of ten years old. Usually, HSP, an autoimmune disease, is not serious in children and typically goes away over time. Again, typicality is never a guarantee.

Sarah received her first gift of life when she was thirteen, in the form of a kidney from her father. They had waited three years to operate because back then because doctors thought she needed to grow more in order to be closer to her father’s size; it was thought that this would increase the chances of surgical success. Because the first living organ donor kidney transplant occurred in 1960, the procedure during Sarah’s first transplant was drastically different from the one to which we are accustomed today. Fortunately, everything went well and Sarah was able to survive on her new kidney for twenty years.

Everything seemed fine until she became pregnant with her first child. Sarah’s HSP, the extra strain of pregnancy, and simultaneous battles with toxemia and diabetes led to the failure of the kidney that had helped her continue to live. It was time for Carter, the husband, to step in.

Twenty-one years ago, Carter donated one of his kidneys to his wife, with no hesitation in his mind. For him, the decision was automatic: “With my wife, there was absolutely no question about donating.” This second transplant went well, allowing Sarah to live for another twenty years. That should have been the end of the story, but then Sarah had a third kidney failure. While there were fifteen potential donors for another surgery, one stood out among the crowd: their son, also named Carter. He was just a child during his father’s transplant, too young to understand the situation in front of him. But now, Carter, a fully grown man, knew that as a blood relative he would be his mother’s best bet at life. It was his turn now.

This is an incredible story of a woman beating the odds, refusing to give up on life, and the three men who helped her along the way. They were willing and able to give her a piece of themselves to give her the gift of life. But the story doesn’t end there.

During his wife’s third surgery, Carter came across another opportunity to give, one that would take him into unchartered waters. Carter recounted the story in an interview with me: “I put up something on Facebook about it to my friends, and that on this certain day, I was going to be at a restaurant if anyone wanted to join me. 60 people showed up. One of them was a high school classmate, Kelly. Between 9th and 10th grade she got thrown off her horse and the injuries were so bad that she had to be homeschooled for the next 3 years. The pain medications that she was given ended up destroying her liver, and now she is in need of a liver transplant. I told her that if all tests worked out, I would give her part of my liver.”

As simply as Carter tried to portray the story, I knew that there was more to it than that. So I dug deeper, picking his brain on why he was willing to risk his health to help someone he barely knew.

Carter admitted that things were different this time around, especially now that the donor wasn’t his wife. “I know her name but I don’t really know her.” But Carter, now fifty-six years old, saw this as something that he was meant to do. “Something that was very important to me was that my son was raised. If my son was young, I wouldn’t be doing this. With any risk of something going wrong, I need to first and foremost be there for a child who is growing up. If something goes wrong, which is highly unlikely, then he’s an adult now. He’s twenty-seven. He’ll be okay.” Okay, that made sense. But was that the only thought that went through his head before making his decision?  I wanted to know more. There had to be more.

What is the difference between donating a kidney to a loved one and donating your liver to an almost-stranger? Through Carter, I discovered that the lack of familiarity, trust, and relationship between recipient and donor is made up for by one single word: faith. Carter not only believes, he knows that he is doing a good thing, and that realization is what helped him make the decision. “Jesus Christ, He gave everything for us, He died for us, suffering a terrible death. As a Christian, that’s what we should do: serve others. The bigger and the better that we can serve other people, the more we should. To me, that’s why I do it- When we preach Christianity, it should not be through talk, it should be through actions.”

Those were some bold words words that were definitely easier said than done. Listening to Carter as he sat across from me, I was afraid that I just wasn’t understanding. “So, let me get this straight. You were just in a restaurant, listening to her story, and somehow, God just told you that you should do this?” I asked him. His simple smile said it all: “I believe that at the end of the day, it’s all up to God’s plan. Sometimes our plan doesn’t line up with his, but with a little faith, you can make your plan, His plan.” A little bit of faith can go a long way. As a man of faith, Carter wanted to follow up his words with his actions, a principle that is reflected in the Bible: “You see that a person is justified by works and not by faith alone.” (James 2:24).

Some say that theology and faith have no place in an ever scientifically-driven world. This story says otherwise.

    Technically, the Bible does not explicitly state that part of being a good Christian means choosing to be an organ donor. However, the foundation of the religion itself is based upon the ideal of unconditional love. They believe that God showers love upon them and that it is their responsibility to spread that love across the world, regardless of race, religion, or gender. Christianity revolves around service to others: “Do not withhold good from those to whom it is due, when it is in your power to do it.” (Proverbs: 3:27). The act of carrying out this belief can be seen in various ways, including organ donation. Carter saw an opportunity to act on his faith and realized that it was indeed within his power to give part of his liver to a stranger.

    But stories like that of Carter are not limited to just those who are religious. While ethics and theology have much in common, they are not the same. Carter’s decision to donate was an ethical decision that was backed by faith. But faith is not the only catalyst that can lead people to donate. Christians such as Carter are not the only ones who can become altruistic organ donors. Put religion aside for a moment and think of something that all humans have inside: goodwill. Whether that be holding the door open for the person behind you, smiling at the barista at Starbucks, or offering part of your liver to a stranger, we all have the potential to do good. Becoming a living organ donor is possible for anyone, not just someone of faith.

Moreover, it is also within our power to become registered as deceased organ donors. What does that entail? Being registered means that upon death, a team of doctors can remove your organs and immediately use them to save the lives of people who are in critical condition. These organs are extremely precious and fragile, as there is a time limit for transplantation before oxygen deprivation renders them useless. In a broad sense, being an organ donor gives you the chance to continue to do good even after death.

Any topic of discussion concerning death is bound to be complicated. People deserve to know all of the information about both living and deceased organ donations. Some religions and cultures prefer not to touch the body once someone has died, while others find it quite acceptable, and even encourage it. Pope Francis has even described the act of organ donation as a “testimony of love for our neighbor.” Almost all religions respect the idea of the individual’s choice to donate or not. At the end of the day, this is a matter of agency, and what factors will influence your decision. However, despite these potential bioethical tensions, the simple fact remains that becoming an organ donor will undoubtedly serve to help someone in need.

    We have a drought of organ donors in America. At the same time, the need for organ donations continue to rise. According to U.S. Department of Health and Human Services, there are over 120,000 people who are waiting list candidates for organ donations. It’s easy to blame the government, to point fingers at a “broken system” that the government has failed to fix. It is much harder to realize that we as a society share the blame, too. It takes people to make the decision to be organ donors, people who choose to make act on their goodwill.

    Of course, the problem of the shortage of organs will not solved by the simple idea of good will alone. It will take educating the public, learning what being an organ donor means. It will require a government effort to properly regulate the distribution of organs to those who need it across the country. But most importantly, the solution lies in more individuals like Carter, who will act out of faith or goodwill, making a positive difference in the lives of others.

References:

http://www.americantransplantfoundation.org/about-transplant/facts-and-myths/

http://www.donorrecovery.org/2014/10/pope-francis-supports-organ-donation/

http://www.patheos.com/blogs/christiancrier/2015/09/12/is-organ-donation-a-sin-should-christians-donate-their-organs/
http://www.organtransplants.org/understanding/religion/

Racial Disparities in Opioid…Prescription?

An article published this past week through the Public Library of Science (PLOS ONE) provided an in-depth look at opioid prescription trends in emergency departments (Singhal, 2016). It has been well documented that minorities are less likely to be prescribed opioids by emergency rooms, with a major 2008 article by Pletcher et al providing some significant data on the subject (Pletcher, 2008). In an attempt to reassess the current literature and view the data through a new lens, Singhal and colleagues specifically looked at whether the opioids were administered in the emergency room or prescribed at discharge (Singhal, 2016). The distinction is a meaningful one, providing insight into provider-patient trust while potentially highlighting the presence of a systemic treatment bias against racial minorities.

Through the analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS) data collected from 2007-2012, the group found significant racial disparities in both administration and prescription of opioid medication for certain “non-definitive conditions,” including back pain and abdominal pain (Singhal, 2016). Odds ratios, which are statistical measures of an association between an exposure and an outcome, were computed. In this case, the exposure was race, the outcome opioid prescription. It was found that non-Hispanic blacks had 0.67 and 0.58 times the odds of receiving opioids at discharge and in the emergency department, respectively (Singhal, 2016). Both odds ratios were statistically significant, with P values less than 0.05. These ratios, along with the large sample sizes ranging from 3000-10,000 for the significant ailments, speak to the strength of the analysis.

These findings come on the tail of a recent social psychology report out of the University of Virginia by Hoffman et al. which exposed inherent bias against black patients by both laypeople and medical students (Hoffman, 2016). In the later experiment, 222 medical students were presented with patient scenarios and asked about their perception of patient pain, revealing that false beliefs about biological disparity between races led to a “racial bias in pain perception” (Hoffman, 2016). These two articles together highlight the need for further study of, and a focus on counteracting these pervasive biases. However, Singhal’s discussion also highlighted the complexity of assessing doctor-patient interaction and accurately representing the presence of minority bias via discrete data points.

One confounding variable that complicates this assessment is socioeconomic status. A recent New York Times article, which set out to review the Singhal article, points out that in many cases, racial disparity and low socioeconomic status are intertwined, complicating patient care, and the data corresponding to that care (Goodnough, 2016). Despite this confounder, though, the researchers interviewed for the article, including Raymond Tait, a pain researcher in St. Louis, are certain that race plays a role that should not be ignored.

Given this data, it appears as though further inquiry will be necessary to flesh out the problem more fully before meaningful interventions can be executed. The pain management field must self-assess while attempting to create metrics to more specifically explain clinical decision making. One of the major pitfalls of the Singhal paper was the acknowledgement that, even if there is bias, every patient presents differently, complicating the statistical analysis. Additionally, proper control of socioeconomic factors in analyzing racial disparity data should enhance the current picture of minority bias, and potentially point to opinions for intervention.

References: 

Goodnough, A. (2016, Aug). Finding Good Pain Treatment is Hard. If You’re Not White, It’s Even Harder. New York Times. Retrieved from http://www.nytimes.com/2016/08/10/us/how-race-plays-a-role-in-patients-pain-treatment.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=stream&module=stream_unit&version=latest&contentPlacement=3&pgtype=sectionfront&_r=1

Hoffman, KM, Trawalter, S, Axt, JR, and Oliver, MN (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. PNAS 2016 113 (16) 4296-4301. Retrived from http://www.pnas.org/content/113/16/4296.abstract

Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R (2008).Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008;299:70–78. Retrived from http://www.ncbi.nlm.nih.gov/pubmed/18167408

Singhal A, Tien Y-Y, Hsia RY (2016). Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse. PLoS ONE 11(8). Retrived from http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0159224

New test for risk of Alzheimer’s disease

            A new test has been developed to identify those at increased risk for Alzheimer’s disease (Science Bulletin, 2016). The biochip-based blood test was presented at the 68th AACC Annual Scientific Meeting & Clinical Expo in Philadelphia. The biochip, created by Randox Laboratories, will save patients both time and money by conducting multiple tests on the same blood sample and analyzing results in as little as three hours (Nichols, 2016). The biochips were also found to have the same accuracy as a standard DNA test.

            The gene for apolipoprotein is known to be a significant genetic risk factor for a multitude of neurodegenerative diseases, including dementia. Specifically, the E4 variant can increase a person’s risk for developing the disease 8-12 times when inherited from both parents. This new test detects the presence of the protein produced by this gene in a blood sample (Science Bulletin, 2016). According to research scientist Emma C. Harte, Ph.D, of Randox Laboratories, “pairing this test with medical and family history for risk of Alzheimer’s disease,” will greatly improve diagnostic ability as well as personalized medicine.

            Other tests for the disease have been less scientific. With cognitive decline comes progressive loss of senses, smell being the first to go. Researchers at the University of Florida found that those with a confirmed early-stage diagnosis of Alzheimer’s were able to smell a dollop of peanut butter with their right nostril, but not their left (Johnson, 2013). More recently, studies presented at the 2016 Alzheimer’s Association International Conference suggest that a poor score on an odor detection test correlated with subsequent memory loss (Borreli, 2016). These tests may be used in the future for an even cheaper and earlier test for Alzheimer’s disease.

(2016). New biochip-based blood test detects elevated risk for Alzheimer’s disease. Science Bulletin. Retrieved from http://sciencebulletin.org/archives/3971.html

Borreli, L. (July 27, 2016). Can't Smell Coffee? Maybe You Have Alzheimer's. Medical Daily. Retrieved from http://www.medicaldaily.com/alzheimers-disease-sniff-test-memory-decline-392885

Johnson, J. (October 9, 2013). Alzheimer's Test: Can You Smell Peanut Butter?. Newser. Retrieved from http://www.newser.com/story/175622/alzheimers-test-can-you-smell-peanut-butter.html

Nichols, H. (August 3, 2016). Alzheimer's: Biochip blood test detects disease risk. Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/312094.php

Loss of a Hero in Fertility

Mr. Frank Palopoli, the chemist who developed a drug to treat infertility and subfertility due to anovulatory tendencies died this past Saturday.  He was 94. The drug he helped into existence, Clomiphene citrate, which came to be marketed as Clomid, helps to induce ovulation. Due to it’s safe and effective ability to address infertility through the stimulation of natural hormone production it has been placed on the World Health Organization’s List of Essential Medicines, and remains the only ovulation inducer included. Though the drug was first developed in Palopoli’s lab in 1950 it was took 17 years to come to market, and remains in use today.

It has been shown that the use of clomiphene citrate, in women who experience anovulatory infertility, can increase the chances of pregnancy such that their fertility during treatment can be considered normal. This has allowed many people that previously would have been unable to conceive to do so either naturally or through in vitro fertilization or intrauterine insemination. Up to 80% of anovulatory infertility cases treated with this drug have been shown to be successfully addressed.

More recent research has examined clomiphene citrate as a possible treatment for hypogonadism, the loss of function in the gonads and subsequent decrease in testosterone levels, in men. This alternative use for the drug Mr. Palopoli played an integral role in developing, shows promise and may further extend the impact of his contributions to the collection of drugs used today.

The use of clomiphene citrate and other drugs that induce ovulation has the potential to over stimulate the release of eggs and cause an increase in the rate of multiple pregnancies. Because multiple pregnancies carry a greater risk for both the expectant mother and her children the use of Clomid has also been linked to the abortion debate and the ethics of pregnancy monitoring. The use of this and other fertility therapies remain an important topic in medical ethics.

The group of organic chemists he headed worked under the William S. Merrell Company and contributed to the development of several other agents including triparanol and tamoxifen (researched as possibilities for the treatment of high cholesterol and breast cancer respectively). Clomiphene citrate has now been used by millions of people worldwide.

References: 

Kousta, E. "Modern Use of Clomiphene Citrate in Induction of Ovulation." Human Reproduction Update 3.4 (1997): 359-65. Web.

Roberts, Sam. "Frank Palopoli, Who Aided Fertility With Clomid Drug, Dies at 94." The New York Times. The New York Times, 11 Aug. 2016. Web. 11 Aug. 2016.

Shabsigh, Ahmad, Young Kang, Ridwan Shabsign, Mark Gonzalez, Gary Liberson, Harry Fisch, and Erik Goluboff. "Clomiphene Citrate Effects on Testosterone/Estrogen Ratio in Male Hypogonadism." The Journal of Sexual Medicine 2.5 (2005): 716-21. Web.

"WHO Model Lists of Essential Medicines." World Health Organization. World Health Organization, 1 Apr. 2015. Web. 11 Aug. 2016.

Analyzing Illegal and Refugee Immigration from a Public Health Perspective

Immigration has been the topic of conversation across the political sphere as of late. The combination of the European migration crisis and the porous southern US border has brought about a fierce debate as to what should be done socially and economically with immigrants. However, one aspect of our nation’s refugee acceptance and illegal immigration issue that has not been discussed as frequently is the impact on public health.

The United States has worked for decades to eradicate some of the diseases that frequently plagued the general population. Through vaccination, new sanitation standards, and updates to dated public health practices, we have eliminated many of the diseases that are still prevalent in other nations. Unfortunately, it is possible that the massive amount of undocumented immigrants entering our country unscreened could cause a spike in previously nonexistent illnesses.

According to multiple reports released over the past few years, including one released on World Migrant Day, the number of tuberculosis, measles, whooping cough, mumps, scarlet fever, and bubonic plague cases has increased. Many healthcare professionals have made a direct link to illegal immigration. Below are a few of the statistics:

Tuberculosis: Up 1.7% in 2015 after 23 years of decline

Measles: 667 Cases in 2014 after eradication in 2000

Whooping Cough: 32,971 cases in 2014, 30 times the amount in 1976

Mumps: 688 cases in 2015, after a 99% decrease in prevalence in 1967

    All of these diseases have been linked to incoming refugees and undocumented immigrants through the southern border. Many of the camps that house illegal minors are plagued by disease. In 2014, former Congressman Phil Gingrey (R-GA) wrote a scathing letter to Congress about the lack of transparency regarding disease transmission among immigrants. He cited reports of Border Patrol agents contracting diseases from the children. One major news station even reports that tuberculosis is prevalent in multiple camps, citing anonymous reports from healthcare workers employed. Not only is this detrimental to health of Americans, but also the health of the immigrants.  

What is the Solution?

    A significant amount of regulation is required in order to halt the spread of these infectious diseases. Currently, refugees are not required to have any vaccines prior to entering the United States. This poses a massive risk to our public health, as the MMR vaccine was directly responsible for eradicating measles after it was required by law. With potential disease carriers entering the U.S. in large numbers, it is almost guaranteed that the public will encounter new illnesses more frequently than before. One of the first steps in preventing further outbreaks is to halt refugee migration and develop a comprehensive screening system for communicable diseases. Additionally, vaccination should be required for all refugees entering the country. The combination of these two processes would eliminate the threat that refugees currently pose to public health.

With respect to the southern border, the U.S. government needs to reduce the number of undocumented immigrants entering the country by a significant amount. There is no way to analyze the health of individuals who have entered and now remain in the country illegally. The only way to prevent diseases from coming up through the southern border is to cut down on illegal immigration.

    Our policy with regard to vaccination and screening significantly differs between migrants and refugees. Many vaccinations are required for United States immigration. This, combined with health screening, has resulted in an extremely small percentage of communicable diseases being brought into our country via legal immigration.

    In short, the massive importation of refugees and illegal aliens into the nation is a very real threat to public health. A comprehensive reform to our refugee health policies and border security is essential to prevent the reoccurrence of deadly communicable diseases. Let’s not decimate the hard work of public health workers before us in their successful efforts to eradicate these illnesses.

References:

“Guidelines for Evaluating and Updating Immunizations During the Domestic Medical Examination for Newly Arrived Refugees.” Centers for Disease Control. 11 June, 2015.

“Illegal Alien Minors Spreading TB, Dengue, Swine Flu.” Judicial Watch. 8 July, 2014.

“New Vaccination Criteria for U.S. Immigration.” Centers for Disease Control. 29 March, 2012.

“Six Diseases Return to US as Migration Advocates Celebrate ‘World Refugee Day.’” Breitbart. 19 June, 2016.