Surgeon sued

The definition of informed consent for surgery may be expanded as a result of a law suit filed recently in the United States. In the future, doctors my need to tell patients if they have a financial stake in the treatment being given, beyond the usual fees for their medical services.

In fact, ethicists are saying they should disclose such information already.

The issue stems from a law suit filed by a Chicago woman who is suing a leading heart surgeon there after he implanted a device in her heart to repair a valve. The patient, 41-year-old Toni Vlahoulis, said she never would have agreed to the surgery had she known her doctor invented the device meant to keep her valve from leaking, and received royalties every time one is used.

The doctor -- Patrick McCarthy -- says he donates all the royalties to charity. The device, called a Myxo ETlogix ring, eventually had to be removed after causing an infection.

Dr. William Maisel, director of the non-profit Medical Device Safety Center at Boston's Beth Israel Deaconess Medical Center, said patients have a right to know when a doctor is using one of his own inventions.

"It's not hard to tell a patient, 'You may be receiving a device for which the physician receives royalties.' ... Then the patient may say, 'I'm not comfortable with that. Pick one of the other devices.'"

Donating the royalties changes nothing, Maisel said, since use of the device and research published as a result of its use would increase a doctor's status in the profession.

Psychedelic death

A top medical ethicist says hallucinogenic drugs such as ecstasy or "magic mushrooms" may help terminal patients and their families through their final, painful days.

Robin Mackenzie, director of medical law and ethics at the University of Kent, says studies are underway with terminal cancer patients into the ability of such drugs to ease the process of dying and encourage closer family bonding in the final hours.

"We have the technology to enhance the experience of dying. With neuroimaging [brain scans] we can measure the impact of different practices, such as meditation or drugs, which would allow us to orchestrate our dying, just as we choose the form of a funeral service."

A study at the University of Los Angeles is due to be completed in December and research is also taking place in Spain. Mackenzie was to discuss the research at a conference in London this week organized by Exit International, an Australian organization advocating voluntary euthanasia.

Mackenzie says she can understand why doctors might not want to be involved with handing out such drugs, but says many patients want such options.

"My research into the demedicalization of dying suggests that there is a groundswell of people wanting to exercise choices in dying beyond euthanasia and palliative care options. We are encouraged to manage our lives and managing our deaths could be part of that."

The dangers of medical tourism

Going abroad for a kidney transplant increases you chances of getting an infection or of the new organ being rejected by your body, a new study has found.

"Researchers from UCLA compared 33 patients who went to other countries to receive kidney transplants to 66 patients treated in the United States. They found that 30 per cent of medical tourists had kidney rejection compared with 12 per cent of those treated at UCLA."

As well, 27 per cent of medical tourism patients were hospitalized for infection after their surgery, compared with 9 per cent of U.S. patients. The tourists also reported higher rates of other complications.

The study is in the Clinical Journal of the American Society Nephrology.

UN reconsiders human cloning ban

It's only been three years since the United Nations banned all human cloning, and already it is reconsidering the measure in a move likely to reopen up the sensitive issue.

And will do so on the eve of the election in the United States -- a place where such issues quickly become political.

Two days of meetings begin Oct. 28 in Paris, where the UN Educational, Scientific and Cultural Organization (UNESCO) and the International Bioethics Committee are based. UNESCO director-general Koïchiro Matsuura said science is moving so fast it's time to revisit the issue.

"Recent technological developments and new prospects for the use of stem cells in the therapy of human diseases have once again raised the issue of adequacy of international regulations governing this research.”

A report from the committee last month said the previous motion was hampered because it didn't fully distinguish between reproductive and non-reproductive cloning. Many of those who voted against the motion or abstained primarily had a problem with reproductive cloning.

Under the motions to be examined later this month, reproductive cloning would still be banned, while human embryo and stem cell cloning would be allowed -- with international rules to be developed -- for research purposes.

Follow the money

Reporters love a juicy story, and ongoing revelations about top medical professionals and researchers getting millions of dollars in improper payments from pharmaceutical companies is the kind of scandal newspapers love.

Sometimes, however, reporters get caught up in the story, and may even be part of the problem. According to a study in the Journal of the American Medical Association, reporters working on medical discovery stories tend to do a bad job of telling readers about the money paid to the researchers.

"Of the 306 news articles about medication research identified,130 (42 per cent) ... did not report that the research had received company funding. Of the 277 of these articles reporting on medications with both generic and brand names, 186 (67 per cent) ... referred to the study medications by their brand names in at least half of the medication references."

Worse, it seems that reporters and their editors think they are doing a good job of reporting such potential conflicts of interest.

"Eighty-two of the 93 (88 per cent) newspaper editors who responded to our survey reported that articles from their publications always or often indicated when studies had received company funding (95 per cent), ... and 71 of 92 (77 per cent) responding editors also reported that articles from their publications always or often referred to medications by the generic names (95 per cent). ...However, only 3 of 92 newspapers (3 per cent) had written policies stating that company funding sources of medical studies be reported."

Merrill Goozner at the Center for Science in the Public Interest says the study shows that reporters have a lot of work to do.

"The Association of Health Care Journalists lists reporting the financing of research and conflicts of interest of researchers as its number one guideline for health care reporters. This latest survey shows that the word has yet to filter down to the majority of reporters out there."

Who lives, who dies

In the event of a pandemic, such as the widely expected bird flu pandemic, truck drivers, communications personnel and utility workers should rank with doctors, nurses and firefighters on the priority list of who gets saved, a new bioethics study argues.

Nancy Kass, deputy director of public health for the Johns Hopkins Berman Institute of Bioethics and lead author of the study in the journal of Biosecurity and Bioterrorism, says it is essential that a skeletal infrastructure remain intact at all times.

“When preparing for a severe pandemic flu it is crucial for leaders to recognize that if the public has limited or no access to food, water, sewage systems, fuel and communications, the secondary consequences may cause greater sickness death and social breakdown than the virus itself.”

Grocery store employees might also be given priority, the study says, since people will need food.

The report also calls on governments to inform the wealthy and the middle class to take responsibility for stockpiling their own food and supplies in preparation for a pandemic, so that public resources can be dedicated to helping those without the means to help themselves.

The study, available only with a subscription, details the role of ethics in medical planning.

"Considerations of ethics are important not simply because they remind us that, even in crisis, we must remain a civil society. Attention to ethics can also improve the likelihood of public health and medical success. Ethics helps us articulate goals, engage in respectful and inclusive discussion, minimize harm, and engage with each other fairly. Its contributions to planning and response efforts can help define priorities and increase public co-operation, both necessary for effective public health and government action in a crisis."

These same words, one might argue, could also apply to the looming crisis in medicare as more and more expensive drug treatments and an aging population force governments and doctors to confront the question of who gets basic medical treatment and who doesn't if medicare is to remain viable.

In other words, we may not need a pandemic before we start facing the tough issues addressed in this study.

Prime time ethics, part 2

Commenter Deana makes some very good points in her response to my last blog entry on medical ethics issues being used as a plot device in the Grey's Anatomy spin-off, Private Practice that deserve more discussion.

In fact, she cuts to the heart of the matter, raising the very issues that need to be debated broadly as medical advances raise more and more ethical issues -- which is why the Star launched this blog last spring. And Deana's comments certainly got me thinking.

"Doctors must absolutely stay out of the judging and moralizing business," Deana says in one of her many good points.

She may be right, and I suspect a lot of people would agree with her, but this is far from a simple matter. Many doctors, after all, got into medicine to help people and consider it part of their job to help patients and their families decide on the "right" treatment plan. Many patients expect that from doctors, as well.

Few can quibble with the desire to do the "right" thing, of course. The problem tends to be with defining what is right and what is wrong -- and who gets to decide. At a medical conference I covered to launch this blog last May, several delegates and speakers argued that such decisions should be up the the patient alone.

But for may others, such an approach is unethical because it downplays the expertise of the doctors in helping decide what is best. On the other hand, leaving such decisions to the doctor alone leaves the patient at the mercy of the doctor's own priorities or opinions.

Finding the balance is just one of the many challenges in medical ethics today. I certainly don't pretend to have any answers.

Deana questions if doctors "rushed off their feet" can really make the tough decisions. Another good point. Few in the medical ethics field think doctors should be left to make such decisions on the fly, which is why a wider societal discussion is needed.

There's a good chance, as Deana points out, that shows like Private Practice -- with their "fun, sexy, TV-worthy, low-cut blouse, look-what-this-small-boned-pretty-girl-also-does" approach, as Deana puts it -- will be fairly superficial in their approach to ethics story lines. I doubt I will be turning to it for many insights myself.

But it is interesting that medical ethics is considered by a major network to be a good plot device. It might just mean the needed broader discussion of these issues will happen.

So let's get it started.