Doctors as interrogators

On the seventh anniversary of the Sept. 11 terrorist attacks on New York and Washington, the influential New England Journal of Medicine says the U.S. military continues to use doctors and psychiatrists when interrogating suspects -- a practice condemned by several medical groups.

"It undermines the notion of psychiatrists as healers, and undermines trust in the profession," Jonathan Marks, one of the authors of the study, told New Scientist.

Marks and co-author M. Gregg Bloche, both bioethicists and law professors, cite several documents released under the U.S. Freedom of Information Act in their article. The two found that five US army psychiatrists were trained between July 2006 and October 2007 to help with interrogations.

The American Psychiatric Association, the American Medical Association and the World Medical Association all have policies condemning the use of psychiatric advice in "softening up" detainees.

Hospital apartments, and political unrest

Bangkok Hospital Medical Centre is now offering full-service apartments for the families of medical tourist who travel to Thailand for medical help.

In the latest move to up the ante in the increasingly competitive market of international medical care, the hospital says the apartments -- complete with cooking facilities -- will make it easier for families to travel to Bangkok for treatment. Rates start at $77 (US) a night for a studio. The apartments are located within the hospital complex, making visitations easier.

Bangkok Hospital serves almost half the 1.2 million medical tourists who visit Thailand each year. It also offers complimentary visa extensions, should a patient's hospital stay extend longer than expected.

Meanwhile, Bangkok's other major international hospital, Bumrungrad, has posted a notice on its website in the wake or recent political turmoil there asking and answering the question, "Is it safe to travel to Bumrungrad now?" Their answer:

We believe it is. The recent political demonstrations are taking place in another section of the city and have not impacted our hospital’s operations nor access to our hospital from the airport or from nearby hotels. We agree with advisories issued by some embassies recommending that visitors to Bangkok avoid the areas where demonstrations are taking place. However, we know of none of our international patients who have been impacted by these demonstrations.

The fact that they felt the need to address the issue, however, shows one of the risks of medical tourism: it can involve travel to less-stable countries for care.

Babies abroad

France is revisiting its limits on in vitro fertilization, or IVF, in the wake of stories about a 59-year-old woman who sidestepped national regulations by going to Vietnam for the treatment.

She is expecting triplets.

IVF in France is only available to women 43 years old and younger. Unwilling to accept that, the woman went to Vietnam for the treatment. She is now being treated under France's medicare system at Cochin Hospital in Paris.

French bioethicists condemned the woman's actions.

"Certainly we are seeing a change in society where the age to get pregnant naturally is rising but everyone must understand that you cannot have a child at any age," said Sadek Beloucif, president of the ethics board of the l'Agence de la Biomédecine.

"This is important for the health of the mother and for the health of the baby."

Beloucif called for a standard age across Europe for providing IVF, saying Cypress and Ukraine are also popular destinations for older women wanting IVF.

France's bioethics laws are to be re-examined next year -- with IVF, surrogate mothers (currently banned in France) and gay rights among issues to be debated.

Organs from pigs

Scientists are trying to genetically modify pigs so they can be used as a source of organs for transplant to humans, Sunday Times of London reported yesterday in a column sure to raise the ire of animal rights activists, some religious groups and activists opposed to genetic modification.

"People needing a new heart or liver are waiting for someone else to die -- usually a violent death in a traffic accident. So my team at Hammersmith hospital in west London has been trying to modify pigs so their organs might save the lives of humans," fertility specialist Robert Winston writes.

"My colleague Carol Readhead, a scientist from California, and I hit on a drunken idea over a bottle of good burgundy a few years ago."

He dismisses stem cell research as too slow, saying it will take another "20 or 30 years" before scientists can culture organs from stem cells. Pigs, meanwhile, already have organs similar to those of humans, he says. "The key challenge is introducing the right genes into pigs," so the organs will not be rejected by the human patient.

He said his experiments are due to move to the U.S., saying getting approval for the research in Britain has been difficult.

Vatican death debate continues

It seems a debate is raging within the Vatican over the proper definition of death -- a debate that could put organ transplants at risk for millions of Catholics or anyone seeking a transplant at a Catholic hospital.

According to the Catholic Messenger newspaper and the online news service Lifesitenews, a front page editorial this week in the Vatican newspaper L'Osservatore Romano questioning brain death as the proper definition of death is only the tip of the iceberg.

In fact, they say, there are deep splits within the Vatican over the definition of death. And since brain death is the standard used in hospitals for harvesting organs for transplant, such questions could put transplants at risk.

The Catholic Church has long supported transplants, and it seems even the Pope carries an organ transplant card.

Vatican newspaper disputes when life ends

For the past 40 years, doctors and ethicists have accepted "brain death" as the official end of life.

But in a front-page editorial Vatican newspaper, L'Osservatore Romano, says the almost universally accepted definition established by Harvard doctors in August 1968, "contradicts Catholic doctrine," the Telegraph reports.

Prior the Harvard study, the absence of heart beat had been said to define death.

"The assumption of brain death is in contradiction with the concept of the person according to Catholic doctrine, and therefore in contradiction with the church's directive on persistent comas," the article signed by Lucetta Scaraffia, a bioethics expert, says.

Papal spokesman Padre Federico Lombardi said that the editorial was a personal opinion and not official Vatican policy, but called the article "interesting and authoritative." The Vatican's leading spokesman on health issues, Cardinal Javier Lozano, agreed "completely" with the article.

Scaraffia's editorial says the definition of brain death relies on medicine's understanding of the central nervous system, noting that understanding might change as a result of research currently under way.

Dental Tourists

The East European country of Hungary has sent a team of dentists to Britain -- complete with a mobile, blow-up dental office -- to drum up business for their country's fledgling dental tourism industry. With cutbacks in the British medicare system's dental plan pushing more into the private system, there seems to be plenty of demand.

The dentists use their make-shift inflatable examining room to assess the teeth of potential patients, who can then book a trip to Hungary to get any needed work done -- for about a third of the cost as in Britain.

In North America, Mexico is the primary destination for dental tourists.

Promoting medical tourism

Israel is hosting a group of German health officials this week in hopes of promoting their country as a destination for medical tourists. The three-day visit is meant to help make it easier for Germans to travel to Israel for care, but is also a step in the continuing mainstreaming of medical tourism -- once  exclusive to only the richest in society.

Meanwhile, India's smallest state seems to be feeling left out of the new phenomenon, even though the country is a leader in medical tourism. Goa plans to begin promoting medical tourism, as well as build amusement parks, golf courses and improve infrastructure.

No consensus on who gets care

Hospitals in Britain each seem to have their own ways of deciding who get access to the limited resources within the health care system, a new study in the Journal of Medical Ethics has found.

In surveying 22 people responsible for deciding who gets care at their local hospitals, the researchers found 14 different factors being used to decide which patients to treat, and which not. The top factors were cost effectiveness, clinical effectiveness, equality and total cost.

"No one reason was considered dominant," the report found.

Past Canadian Medical Association president Brian Day has identified access to health as one of the top emerging issues facing health care in this country, a point the study reiterates.

Several of those interviewed said societal or political directives and fear of litigation often distort the decision making process.

With financial pressures forcing health care providers to ration treatment, the researchers write that they launched the study to find out the sort of criteria is currently being used to make such decisions. After finding little consensus, they advocated better systems for developing such principles.

"Since we may not be able to construct principles that yield fair decisions ahead of time, we need a process that allows us to develop those reasons over time as we face real cases," the report says.

Ethicists in this country have argued for the same thing here.

Catching up

After a two-week hiatus, there's lots to catch up on in the field of medical ethics. But rather than try blogging on each issue, I will do a quick roundup. In no particular order, here's a few things that happened in the world the medical ethics in the past couple of weeks:

* Drug maker Merck & Co. came under criticism after it was revealed that the company had sponsored a clinical trial of its painkiller Vioxx in 1999 to support a marketing campaign. ``They went about this in a very analytic way, picking doctors who would be most influential, who will talk to other doctors and recommend Vioxx to them, and thus increase prescriptions in the area, planting the seeds of additional Vioxx use,'' Kevin Hill of Harvard Medical School and lead author of a study in the journal Annals of Internal Medicine, told Bloomberg. Merck, which pulled Vioxx from the market in 2004 after a study linked it to heart disease, denied the allegations. The drug maker has agreed to pay $4.85 billion (US) to settle patient claims that Vioxx, used by 84 million people worldwide, caused heart attacks or strokes.

* Wired magazine took a look at a looming issue once the US presidential election is over: the future of stem cell research funding south of the border. It's an issue this blog looked at recently, as well.

* The US secretary of veterans affairs apologized to the family of a 74-year-old vet who was denied medical treatment after he refused to take part in an Alzheimer's study. Joe Fitzgerald died of Creutzfeldt-Jakob disease - the human form of mad cow disease - less than a month after he was dismissed without diagnosis or treatment at James J. Peters VA Medical Center in the Bronx, The Washington Times reported. The paper also reported that the VA has come under criticism over its human-subject experiments amid allegations it failed to quickly notify participants in a smoking-cessation study about potentially dangerous side effects of a drug some participants were taking and an Arkansas veterans hospital uncovered rampant violations, including missing consent forms, secret HIV testing and failure to report more than 100 deaths of subjects participating in studies.

* A new book, Body Shopping, by Oxford ethicist Donna Dickenson looks at the world of medical research and commercialization of the human body. Australia and Dubai are looking to join the fast-growing medical tourism industry.

* Federal Health Minister Tony Clement questioned the medical ethics of doctors who support safe injection sites for addicts. The Canadian Medical Association says 79 per cent of Canadian doctors support such programs.

* The California Supreme Court ruled that doctors cannot deny treatment to homosexuals due to their own religious convictions. In Canada, meanwhile, the Ontario Medical Association is asking the College of Physicians and Surgeons of Ontario to change a draft policy that says doctors who deny treatment on moral or religious grounds might be contravening the Human Rights Code and committing professional misconduct.