Category Archives: Education

States target asthma care as number of patients grow

Share

Washington is one of the few states that has made the Asthma and Allergy Foundation of America honor roll of states that have adopted comprehensive public policies supporting people with asthma, food allergies, anaphylaxis risk and related allergic diseases in schools.

Illustration of the lungs in blueBy Michael Ollove
Stateline Staff Writer

April 16, 2014 

In a valley wedged between the Mississippi and Missouri rivers, St. Louis often finds itself beset by a stationary air mass that only a severe storm of some kind can dislodge.

St. Louis is also an industrial city with high humidity, so it’s no wonder it usually makes the list of worst places for asthmatics to live.

But the state has also pioneered advances in addressing asthma treatment and costs. Two years ago, the Missouri legislature became the first to allow schools to stock quick-relief asthma medications for emergencies.  Continue reading

Share

Some med schools shaving off a year of training

Share

Running medical studentBy Sandra G. Boodman
This KHN story was produced in collaboration with wapo

January 14, 2014 – For Travis Hill, it was an offer too good to refuse. Last year when the 30-year-old neuroscientist was admitted to a new program at New York University that would allow him to complete medical school in only three years and guarantee him a spot in its neurosurgery residency, he seized it. Continue reading

Share
Chain Saw

Sequester will force universities to scale back scientific research

Share

Chain SawBy Jim Malewitz
Stateline Staff Writer

Marian Alicea, an engineering student who is slated to graduate from college this spring, needs a doctorate degree to achieve her lofty career goal of becoming a White House environmental adviser with scientific expertise.

But the budget battle in Washington is complicating her plans for getting there.

In normal times Alicea, who attends Southern Polytechnic State University in Marietta, Ga., would likely be a shoo-in for a full research stipend. She is an honors student who has snagged several prestigious internships. And as a Latina she belongs to a minority group that is underrepresented among engineers.

But because of the sequester—the automatic federal budget cuts that went into effect March 1—some of the schools that want Alicea can’t offer her the financial aid she needs.

Federal agencies pour billions each year into university research, largely through grants that allow student researchers to pay their bills as they work.

With less federal money to spend, some Ph.D. programs are delaying admissions decisions, while others have already cut positions amid the uncertainty.

In 2011, federal money accounted for more than $40 billion of the $65 billion universities spent on research. At several large research universities, including Johns Hopkins, the University of Washington, the University of Pennsylvania and Harvard, federal dollars comprised 80 percent of research spending.

Research funding

Like most other federal agencies, the National Institutes of Health must cut 5 percent of its budget to comply with sequestration. Because NIH funnels about 85 percent of its budget to researchers, it is already scaling back some grants, according to director Francis Collins.

Meanwhile, the National Science Foundation, facing similar cuts, estimates it will give out about 1,000 fewer research grants and awards this year, affecting as many as 3,000 researchers.

Researchers and university officials worry the lost funding will slow or halt research on everything from cancer treatments to contaminated soil and water.

They also fear it will dissuade young scholars from pursuing scientific careers.

“It will be profoundly devastating for this generation of students,” said Michael Reid, head of the physiology department at the University of Kentucky’s College of Medicine.

Alicea was accepted into four of the dozen programs she applied to, but only two —Virginia Tech and Auburn — offered her financial help.

The other universities, Maryland and Illinois, said they could not guarantee her money because the sequester had muddled their budgets.

“Chilling effect”

Enrollment in graduate schools was already lagging amid growing concerns about student debt. Between 2010 and 2011, first-time U.S. enrollment across programs fell by 1.7 percent, following a decade of gains, according to a survey by the Council of Graduate Schools.

“This financial stress on institutions comes at a really tough time,” said Debra Stewart, the council’s president. “It has a chilling effect on what was already a chilly situation.”

For all university students, sequestration will mean higher fees on Stafford Loans and reduced payments from some grants, including federal work study.

Some educators worry that the prospect of amassing higher debt will scare students away, particularly as institutions hike tuition amid eroding state funding.

But the economic forecaster Moody’s expects universities as a whole to face only “minimal” immediate effects from sequestration as they turn to other revenues.

For graduate students in the sciences, the impact will be more dramatic. A lack of federal money prompted the University of Kentucky’s College of Medicine to admit about a third fewer students to its Ph.D. program in physiology, according to department head Reid.

“There were a number of qualified candidates we had to turn away,” he said.

Reid, who oversees a lab studying how chronic disease, such as cancer, speeds up muscle deterioration, said one of his lead doctoral students will lose his grant if sequestration continues, threatening to halt his education and dramatically slowing down the line of work.

If the politicians in Washington can craft a budget deal that replaces the sequester, Reid’s lab could immediately resume some of its stalled research, he said. But when it comes to genetically engineering mice, a process that can take years, it would likely have to start from scratch. When that type of research is halted, Reid said, “That’s it. You’re toast.”

A “grim fate”

Alicea has no qualms about taking the offer from Virginia Tech, but she is frustrated by her constricted choices and troubled by what it says about lawmakers’ support for the sciences.

Experts consider investment in those areas to be essential for the country’s economic competitiveness and ability to improve health and technology.

Consider Lucas Arzola, founder and head of Inserogen, a biotechnology startup that uses tobacco leaves to speed up the development of human and animal vaccines. He originally developed the technology as a Ph.D. student at the University of California-Davis, largely supported by federal grants.

If Congress doesn’t act, “how many graduate students will no longer have the support to make that next critical discovery?” Arzola said in a video testimony shortly before sequestration took effect.

Major drug, energy and engineering companies are increasingly relying on universities to build on their research and develop new products, said Robert Duncan, vice chancellor for research at the University of Missouri.

Duncan says sequestration “is terrible for U.S. competitiveness,” pointing to a 2010 National Academies of Sciences studythat showed the U.S. has begun to lag behind other countries in math and the sciences.

“In spite of the efforts of both those in government and the private sector, the outlook for America to compete for quality jobs has further deteriorated,” the authors concluded. They called for more spending on research and education.

Furthermore, many economists argue it is misguided to curb research spending to address the nation’s budget crisis, because several studies have shown such spending spurs economic activity far greater than what is invested.

Last fall, an analysis by the Information Technology and Innovation Foundation, a non-partisan think tank in Washington, estimated cuts to research and development funding under sequestration would reduce GDP by as much as $860 billion over nine years.

“If we want to see our still somewhat lagging economy pick up again, (investing in research) is one of the major ways to achieve it,” said Collins, the NIH head.

At NIH, the cuts follow a decade in which funding stayed static despite inflation, and could result in the elimination of as many as 20,500 U.S. research jobs, according to an analysis by United for Research, a coalition of research institutes and patient advocates.

“It is a paradoxical thing that we are both at a time of remarkable and almost unprecedented scientific opportunity,” Collins said, “and we‘re also at a time in the United States of unprecedented threat to the momentum of scientific progress.”

Stateline logo

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

Share
2013_Convention_Logo

In wake of Newtown shootings, school psychologists seek greater role in school mental health efforts

Share

By Julie Nikaitani
LocalHealthGuide 

School psychologists must be part of the conversation about school safety and mental health services, both nationally and at the local level, the leader of the National Association of School Psychologists (NASP) told the nearly 5,000 association members gathering in Seattle this week for the association’s annual conference.

Amy Smith

Amy Smith

Despite their broad training in psychology and their potential to play a larger role in promoting mental health and school safety, school psychologists are too often relegated to narrow educational testing roles, said Amy Smith, the association’s president.

In light of the December 14 shooting at Sandy Hook Elementary School in Newtown, Connecticut, school psychologists need to “turn up the volume” to address the issues raised by the tragedy that left 20 school children and six adults dead, Smith said. “We can help the decision makers and community members understand the wide range of activities that would be included within the continuum of mental health services, from prevention activities like promoting good mental health to providing interventions to students who need them along the way.”

A school psychologist, Mary Sherlach, was among those who died at Sandy Hook. Sherlach was a NASP member and an advocate for making mental health services an integral component of school-based services, Smith said.

To honor Sherlach, NASP has announced it will provide grants to members who are working to improve mental health services at their districts and schools. “Our hope is that we plant seeds of leadership on the issue of mental health services in the schools,” said Smith.

NASP’s Call to Action

Shortly after the Sandy Hook Elementary School shootings, the NASP called on Congress and the president to take action to:

  • Increase access to mental health services and supports in schools.
  • Develop safe and supportive schools.
  • Improve screening and threat assessment procedures to identify and meet the needs of individuals at risk for causing harm to themselves and others.
  • Reduce stigma around mental illness and to promote mental health on par with physical health.
  • Limit exposure to media violence among children, youth, and vulnerable populations.
  • Review current policies and legislation addressing access to firearms by those who have the potential to cause harm to themselves or others.

To learn more:

Enhanced by Zemanta
Share
residency-thumbnail

Shortage of residency positions making it difficult for physicians to complete their training.

Share

By Ankita Rao

Medical school students call this chart the “jaws of death.”

The graph from the Association of American Medical Colleges displays a yawning gap between the increasing number of med school grads looking for residencies and the number of residency slots available to them.

residency-500

Source: National Residency Match Program

“This is the only time in the history of the U.S. that we are going to see a decrease in practicing physicians,” said Dr. Atul Grover, chief public policy officer of the AAMC, who was speaking on a panel at the American Medical Association’s National Advocacy Conference on Tuesday in Washington, D.C.

Grover said that medical schools have responded to the physician shortage projected by the AMA by increasing admissions, but residency programs have not been able to follow suit.

Graduate medical education, from medical schools to residency programs, is partially subsidized by the government through Medicare, making it vulnerable to cuts to the federal program.

Medicare payments cover 21 percent of the cost incurred to train interns and residents, but teaching hospitals absorb the rest.

If the scheduled budget cuts from sequestration go into effect next month, some say the physician shortage in the U.S. could go from bad to worse because fewer doctors will complete residency, and thereby, their training.

“It’s a threat — having to go on with our training without knowing if we can complete our career,” said Amy Ho, a third year student at The University Of Texas Southwestern Medical Center in Dallas.

Ho, who was at the AMA conference, said she became involved with AMPAC, a bipartisan political action committee of the AMA to help figure out how to fix this problem.

She said her peers are now tailoring their careers to find the specialties and geographic locations that will result in better pay and lifestyle. But their strategy might not make up for those left without  residency positions on match day.

Thomas Ricketts, a professor of health policy and management at the University of North Carolina at Chapel Hill, said the budget cuts would negatively affect an aging population. He said state governments, health systems, communities and entrepreneurs should join Congress in encouraging medical education.

Meanwhile, the effort to train more physicians has found bipartisan support. Rep. Aaron Schock (R-Ill.) and Rep. Allyson Schwartz  (D-Pa.) introduced a bill to lift the 1997 legislation that capped the number of residency slots available. Their bill would create 15,000 new GME slots around the country.

But without a consensus, the jaws of death will clamp down sooner rather than later.

“We might not just cut supply here, we might cut quality,” Ricketts said.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Share
Physician and Nurse Pushing Gurney

The “best” hospital may not be the best place to learn how to be a doctor – study

Share

By Jenny Gold
KHN

Attention medical students: When selecting your residency program, there’s more than just geography and the hospital’s reputation to consider.

The nation’s 23 top academic medical centers also vary drastically in what researchers are calling “the intensity” of care they provide patients at the end of life, according to a new report from the Dartmouth Atlas Project.

And more intense care can translate into worse and more expensive care at the end of life, according to the authors.

The thinking is that physicians who train at hospitals with better and more efficient care will be better-prepared to become leaders in changing how health care is delivered in this country.

The authors call this phenomenon the “hidden training curriculum.”

“Learning how to use health care resources wisely, provide high-quality care, and incorporate patient preferences into a care plan is just as important as learning to work up a patient,” said Alicia True, report co-author and medical student at the Geisel School of Medicine at Dartmouth.

The report tracks variations in end of life care and chronic illness management, surgical procedures, and quality and patient experience using data from Medicare and published on the Hospital Compare website.

“Learning how to use health care resources wisely, provide high-quality care, and incorporate patient preferences into a care plan is just as important as learning to work up a patient.”

Take Johns Hopkins Hospital and Mount Sinai Medical Center, for example. They are both prestigious, but around 50 percent of patients at Johns Hopkins were enrolled in hospice in their last six months of life, compared to only 23 percent at Mount Sinai.

Residents at Mount Sinai “may therefore learn a higher threshold for referral of a patient to hospice or may decide to explore more aggressive treatment approaches first,” according to the report, while Hopkins residents “may be better trained in having discussions with patients about their preferences for end-of-life care.”

Patient safety training also varies widely. A patient at NYU Langone Medical Center is 47 times less likely to get an infection from a urinary catheter than a patient at the University of Michigan Health System.

“Medical students should be aware of the practice styles of residency programs they are considering ranking highly in the Residency Match,” report co-author True added.

The report, “What Kind of Physician Will You Be,” is intended as a guide for fourth-year medical students to help them select hospitals with the best practice patterns for training.

The selection is particularly important “for tomorrow’s doctors in order to practice successfully in the new environment created by health care reform,” the authors write.

“These variations in the way care is delivered are not trivial, as they may very well affect the future practice of medicine. During their residency training, young physicians learn by observing faculty, making decisions on how aggressively to treat chronically ill patients at the end of life, and whether to recommend surgery when other treatment options exist,” added Dr. John R. Lumpkin, director of the Health Care Group at the Robert Wood Johnson Foundation, which funds the Dartmouth Atlas Project.

The Dartmouth Atlas has been researching disparities in care using Medicare data to analyze trends about regional and local markets, but this is the first time they have applied the findings to residency training.

Dartmouth is working to get the word out to student medical groups and publications in the hopes that the report will help medical students make informed decisions when selecting their residency program.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Share
Doctor in white coat writes on clipboard

Patients who are allowed to read their doctor’s notes more likely to take their medicine – Harborview study finds

Share

By Jenny Gold

Doctors are required by federal law to provide patients with a copy of their medical notes upon request, but few patients ask and doctors generally don’t make the process easy.

When patients were offered online access, however, 90 percent read their doctors’ notes with some impressive results.

study published in the most recent of the Annals of Internal Medicine found that 60 to 78 percent of patients who read their visit notes reported that they were more likely to take their medications as prescribed.

And their doctors reported that sharing their notes actually strengthened relationships with patients.

The study included 105 primary care physicians and 13,564 of their patients at Beth Israel Deaconess Medical Center in Massachusetts, Geisinger Health System in Pennsylvania and Harborview Medical Center in Washington, who participated  in a project called OpenNotes, in which patients were given electronic access to their files.

Study authors Tom Delbanco and Jan Walker of Beth Israel said they were surprised and delighted to find that patients who viewed their medical notes were more likely to take their medicines correctly.

“Medication adherence is one of the greatest problems in health care,” said Delbanco, “yet flipping this switch seems to activate patients.”

As one patient explained, “having it written down, it’s almost like there’s another person telling you to take your meds.”

Patients also reported “an increased sense of control, greater understanding of their medical issues, improved recall of their plans for care, and better preparation for future visits,” the study authors write.

Despite concerns among participating physicians that sharing their notes would increase their workload, few of them reported longer visits or spent more time answering patients’ questions outside of visits.

One concern is that doctors may change the way they write their notes if their patients can read them. Since the same notes are shared with other doctors, this could have a clinical impact.

As an example of a minor change, some doctors reported using “body mass index” in place of “obesity” to avoid offending their patients.

Blunt language, however, seems to have motivated some patients. “In his notes, the doctor called me ‘mildly obese,” one patient commented. “This prompted my immediate enrollment in Weight Watchers and daily exercise. I didn’t think I had gained that much weight. I’m determined to reverse that comment by my next check-up.”

At the end of the experiment, nearly 99 percent of the participating patients wanted continued access to their visit notes. And all three participating hospital sites have decided to broaden patient access to their doctors’ notes.

“Our greatest hope is that this will become a standard of care,” said Walker. “We’re at a good time in history because more and more doctors and hospitals are getting electronic health records and putting up secure patient portals,” allowing many patients easy access to their records.

They add, however, that privacy implications could be enormous: 20 to 45 percent of patients reported that they shared their notes with others, including family and friends.

A patient could also choose to post their notes on Facebook or Twitter. “The patient-doctor relationship is confidential,” explained Delbanco, “but whether it’s private is now up to the patient.”
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Enhanced by Zemanta
Share
Books

Good Reads on the Web: From womb to tomb and other stories.

Share

By Shefali S. Kulkarni
KHN Reporter 

Every week, KHN reporter Shefali S. Kulkarni selects interesting reading from around the Web.

New York Magazine: A Life Worth Ending

Detail from a painting by Ambrogio Lorenzetti showing Temperance contemplating an hour glass.I will tell you, what I feel most intensely when I sit by my mother’s bed is a crushing sense of guilt for keeping her alive. Who can accept such suffering—who can so conscientiously facilitate it? … In 1990, there were slightly more than 3 million Americans over the age of 85. Now there are almost 6 million. By 2050 there will be 19 million—approaching 5 percent of the population. … By promoting longevity and technologically inhibiting death, we have created a new biological status held by an ever-growing part of the nation, a no-exit state that persists longer and longer, one that is nearly as remote from life as death, but which, unlike death, requires vast service, indentured servitude really, and resources. … The longer you live the longer it will take to die (Michael Wolff, 5/20).

CNN: Cost Of Children’s Health Care Hitting Families Harder

[Heather Bixler] was leaving her New York apartment with her 4-year-old daughter and infant son, who was in a baby carriage. … The doorman, perhaps just to play around, picked up the stroller and held it almost vertical. Sean, the baby, fell out. His head bashed against the marble stair. … Two years ago, the seizures started. So did the never-ending medical expenses. The Bixler family is just one example of how a child’s chronic illness can strain a family emotionally and financially — and children represent the fastest growing health care spending group in America, according to a new report (Elizabeth Landau, 5/21).

Time Magazine: Why Some Medical Students Are Learning Their Cadavers’ Names

At Indiana University Northwest, an IU branch campus located in Gary, Ind., anatomy professor Ernest Talarico instructs his medical students to probe beyond the nerves and muscles of the bodies lying on their examination tables and think of the cadavers as their “first patients.” … His students also typically exchange letters with family members to glean more information about their patients’ medical histories, hobbies and interests. … While Talarico has won praise from many of the individuals involved in the program, he’s also raised concerns among critics who question the ethics of his teaching technique (Dina Fine Maron, 5/17).

PBS NewsHour: Baby’s Tumor Means Surgery Before Birth

Before Cami was born, a huge tumor began growing from her lower body and injured her hips and internal organs. To save her life, doctors had to operate on Cami en utero, half her body still inside a special incision in her mother Tami Dobrinski’s womb. … Cami’s tumor, called a sacrococcygeal teratoma, is just one example of an uncommon category of tumors and cancerous growths that can occur in unborn children — a teratoma like hers occurs in only one in 35,000 infants. … hospitals that don’t specialize in fetal care are not always familiar with all the possible treatments for rare conditions (Monty Tayloe, 5/18).

ABC News: Truvada Helps Couple Cope With Reality of Love and HIV

Nick Literski, 45, and Wes Tibbett, 39, have been together for six years, and their bond is strong. But when Tibbett was diagnosed with HIV in 2009, it was a major blow to the Seattle couple. Tibbett became terrified of giving the virus to Literski. … According to the U.S. Center for Disease Control and Prevention, correct and consistent condom use greatly reduces the risk of HIV transmission. So does being in a monogamous, long-term relationship. But Tibbett and Literski still worried. Then both men started taking a daily pill, Truvada (Carrie Gainn, 5/21).


This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Share
Petri Dish

New bill would put taxpayer-funded science behind pay walls

Share

By Lena Groeger

Right now, if you want to read the published results of the biomedical research that your own tax dollars paid for, all you have to do is visit the digital archive of the National Institutes of Health.

There you’ll find thousands of articles on the latest discoveries in medicine and disease, all free of charge.

A new bill in Congress wants to make you pay for that, thank you very much.

The Research Works Act would prohibit the NIH from requiring scientists to submit their articles to the online database. Taxpayers would have to shell out $15 to $35 to get behind a publisher’s paid site to read the full research results. A Scientific American blog said it amounts to paying twice.

Two members of Congress — Reps. Darrell Issa, R-Calif., and Carolyn Maloney, D-N.Y. — introduced the bill. Rebecca Rosen ofThe Atlantic finds it curious that Issa, a well-known champion of the open Internet whose own website displays the words “keep the web #OPEN,” would back a bill that appears to be the polar opposite of open access.

As Michael Eisen, a University of California, Berkeley, biologist and open access supporter, notes, Maloney’s support seems no less mystifying since she represents “a liberal Democratic district in New York City that is home to many research institutions.”

Both Issa and Maloney have received campaign contributions from the Dutch companyElsevier, which calls itself the world’s leading publisher of scientific and medical information. According to MapLight, a website that tracks political cash, Elsevier and its senior executives last year made 31 contributions to House members totaling $29,500. Twelve contributions totaling $8,500 went to Maloney; Issa received two for a total of $2,000.

This isn’t the first effort by publishers to push Congress to roll back the NIH’s public access policy, which was enacted in 2008 and applauded by doctors, patients, librarians, teachers and students.

Under the policy, all research funded by the NIH was required to be made freely available to the public one year after publication on PubMed Central. (The NIH also runs PubMed, a biomedical research database that includes articles that aren’t federally funded and cost money to access.)

In 2009, as Eisen notes, the Association of American Publishers backed the Fair Copyright in Research Works Act. That bill never left committee, but this new bill is essentially a shorter version of the same thing (and was similarly praised by the AAP for forbidding “federal agencies from unauthorized free public dissemination of journal articles”).

Two arguments in favor of the bill crop up regularly:

  1. Publishers like Elsevier add value to every scientific journal article by overseeing the peer-review, editing and publishing process. Because of this contribution, they deserve exclusive rights to each article permanently, not merely one year after it has been published.Tom Reller, vice president for global corporate relations at Elsevier, comments here that Elsevier and other commercial and nonprofit publishers invest hundreds of millions of dollars each year in managing the publication of journal articles.”
  1. Publishing companies need this money to keep the industry going. As the AAP states: “At a time when job retention, U.S. exports, scholarly excellence, scientific integrity and digital copyright protection are all priorities, the Research Works Act ensures the sustainability of this industry.”

In the recent commotion over the bill (here’s a roundup of recent posts), the academic community has replied to both of these claims.

In response to the added value argument, Kevin Smith, scholarly communications officer at Duke University, argues that publishers don’t actually produce or add much themselves.

The work comes from academics and from the peer reviewers who volunteer their time to read and critique the work of their fellow academicsAccording to Eisen, although publishers might contribute a little something to the peer-review process (organization, supervision, etc.), this pales in comparison to the work done for free.

In response to the jobs and industry argument, Heather Morrison, a doctoral candidate at the Simon Fraser University School of Communication in Vancouver, B.C., points out that the top scientific, technical and medical publishers (Elsevier, Springer, Wiley, Informa) have seen profit margins of 30 percent to 35 percent in the last year.

Elsevier, part of a global multibillion-dollar information conglomerate with offices in New York City, publishes about 1,800 journals and last year made a profit of $1.1 billion.

The Economist makes the same point: The industry seems to be doing just fine. Furthermore, there is evidence that more jobs would come from open policies than from closed ones, says Peter Suber, an open access advocate at Harvard University.

In his response to a recent White House request for information on public access in research, Harvard Provost Alan Garber calls the current situation an “access crisis.”

He argues that public access is crucial to growing businesses, which need access to cutting-edge research to stimulate innovation, develop new products, improve existing ones, and create jobs.

“If the NIH policy is flawed,” writes Garber, “it is for allowing needlessly long delays before the public gains access to this body of publicly funded research, and for allowing needless restrictions on the public use and reuse of this research.”

Want to know more? Follow ProPublica on Facebook and Twitter, and get ProPublica headlines delivered by e-mail every day.

Share
Safe

Texting sex ed – NYTs

Share

The New York Times’s Jan Hoffman reports on efforts by health organizations and school districts to develop Web sites and texting services to provide teens with accurate information about sex.

Supporters of the initiatives say these new services allow students to get good information about sex anonymously. But there are also those who oppose these initiatives, writes Hoffman.

…proponents of abstinence-based sexual education argue that these digital services presume that sexual activity among teenagers is the norm, and do not spend enough time on alternatives.

“They are only focusing on the risk-reduction model,” said Valerie Huber, executive director of the National Abstinence Education Association, which hopes to kick off its online service for teenagers next year.

Those who run digital programs say they simply want teens to have accurate information, to help them make good decisions. Even though popular culture is saturated with sex, facts and advice can be hard to find.

To learn more:

Some of the services discussed:

 

Share
RNAi

RNAi explained: Animation by Ballard’s Arkitek Studios

Share

A video explaining RNA interference from Nature Reviews Genetics.

RNA interference (RNAi) is an important pathway that is used in many different organisms to regulate gene expression. This animation introduces the principles of RNAi involving small interfering RNAs (siRNAs) and microRNAs (miRNAs).

We take you on an audio-visual journey through the steps of gene expression and show you an up-to-date view of how RNAi can silence specific mRNAs in the cytoplasm.

Animation by Ballard-based Arkitek Studios.

To learn more:

Share
DO-IT

Free college prep for high-school students with disabilities

Share

By Sally James
UW Staff Writer

The University of Washington’s DO-IT Scholars program is inviting applications from Washington state high school sophomores and juniors with disabilities who are interested in preparing for college and challenging careers.

DO-IT, which stands for Disabilities, Opportunities, Internetworking and Technology, introduces high school students with disabilities to technology, peer support and work-based learning in an effort to help them be successful in a college environment.

Between 15 and 20 students are selected each year.

DO-IT is seeking students who:

  • Are high school sophomores or juniors.
  • Have an aptitude and interest in attending college.
  • Have a significant disability.
  • Want to meet other college-bound students with disabilities.

Selected applicants will travel to Seattle over three summers to take part in a one- or two-week program in which they participate in academic lectures and labs; live in residence halls; and practice skills that will help them become independent and successful in college.

Participants are loaned laptop computers, software and adaptive technology for long-term use in their homes and at school or work.

This technology enables them to continue to network online with peers, DO-IT staff and DO-IT mentors, many of whom are working professionals with disabilities.

At summer study sessions, students will learn about college selection, career options, technology and self-advocacy. Living in dormitories and navigating the campus also helps them get an early taste of college life.

Meals, housing and accommodation are covered. Primary funding for DO-IT is provided by the National Science Foundation, the State of Washington, and the U.S. Department of Education.

“Some young people with disabilities have expectations that are lower than they need to be,” said Sheryl Burgstahler, director of accessible technologies in UW Information Technology and founder and director of DO-IT. “We try to change that. Our focus is on the use of empowering technology and teaching students the skills they need to succeed in challenging careers.”

Students are encouraged to apply by January 10, 2012, but enrollment continues until all positions are filled. For more information or application materials, contact the DO-IT office at 206-685-3648 (V/TTY), or download forms at http://www.washington.edu/doit/Programs/scholar.html.

 

Share
Petri Dish

State’s life sciences sector grows despite recession

Share

Despite a recession, the number of jobs in Washington state’s life sciences sector rose 9 percent from 2007 through the first quarter of this year, according to a report released at the Washington Biotechnology & Biomedical Associations (WBBA) 2011 Governor’s Life Sciences Annual.

WBBA President Chris Rivera said the upbeat report on state’s life sciences industry was “conservative” — but added there were challenges that threatened the sector’s growth, including burdensome regulation and increased competition from competitors both here in the U.S. and abroad.

The report “Trends in Washing’s Life Sciences Industry 2007–2011”, which was prepared for WBBA by the Washington Research Council, found that the life sciences was now the fifth largest employment sector in the state, after transportation and equipment manufacturing, agriculture, software, and food and beverage manufacturing.

The sector, which does not include hospitals and other health services, employs 33,519 individuals directly, whose employment, in turn, supports as many as 57,000 other jobs indirectly for a total of nearly 91,000 overall, the report said.

In general, life science jobs are well paid, with an annual average wage of $77,490, compared to the state’s average private sector wage of $48,519 a year.

Overall, the sector adds $10.4 billion to the state’s gross domestic product of $340.5 billion in 2010.

Official portrait Washington State Gov. Chris Gregoire

Chris Gregoire

In her address to the conference, Gov. Christine Gregoire said collaboration has been the key to the success of the state’s life science sector.

“Our growing life sciences sector is built on three strong pillars: our educational institutions, our private businesses, and our nonprofit organizations,” she said, which “unlike many around the world are all working together.”

Gregoire cited a number of promising programs designed to support the sector, in particular small start ups, but warned that cuts to education due to the budget crisis threatened the sector.

“We cannot afford to continue to compromise our education system in this state and yet expect that we be on the cutting edge of the knowledge economy,” she said.

Speaker Highlight: Eli Lilly CEO John Leichleiter

Eli Lilly CEO John Leichleiter told the conference that while the U.S. Life sciences and biopharmaceutical sector was the “envy of the world” the sector is “facing today nothing short of a innovation crisis.”

Leichleiter blamed the high cost of research and development, burdensome regulation at home, and increased competition abroad, particularly from China and India.

Leichleiter noted that it now takes $1.3 billion to develop a new drug. At the same time, due to expiration of patents for a large number of top-selling drugs, the industry faces the loss of $150 billion in annual revenue. This means there will be less to invest in “next generation of medicines,” Leichleiter said.

These and other pressures are forcing a “wave of defensive consolidation” among “arge cap pharmaceutical companies, resulting in a “dwindling number of entities capable of taking a discovery to a medicine.”

At the same time,  China and India are “producing more scientists and engineers than we are and are intensely focussesing on developing their innovation capacity,” Leichleiter said.

Leichleiter proposed five policy remedies:

  1. Improve science and math literacty by improving K througn 12 education.
  2. Immigration reform that “allows and encourages top scientists to choose to work in the U.S.”
  3. Strong and sustained federal support for research: Medical research is a long process, he noted, “the funding must be consistent, predictable and sustained” in order to attract researchers and keep them engaged.
  4. Tax reform: Lowering corporate tax rates to the 20 to 25 percent range, more in line with the rates seen in competitor nations.
  5. Regulatory reform: Make drug approval quicker and more predictable and that better balances risks against potential benefits. “The pressure on regulators is to err on the side of avoiding risks, when some patients might accept those risks for the treatments potential benefit,” he said.

University of Washington President Michael Young echoed Gregoire’s and Leichleiter’sconcern about the effect state and federal budget cuts may have to the education system.

Young argued that there were three elements needed for a successful regional high-tech sector: an “innovative, imaginative business community that is willing to take risks”, a university that included “economic development in its mission,” and a supply of well-trained, “entrepreneurial students.”

That third leg was under threat due to budget cuts to public education, he warned.

WBBA also announced 2011 winners of their Innovation Award.

Seattle Genetics was recognized for its work on Adcetris (brentuximab vedotin), approved for the treatment of patients with relapsed Hodgkin lymphoma, and for the treatment of patients with relapsed systemic anaplastic large cell lymphoma.

Amgen was recognized for the FDA approval of Prolia (denosumab) for the treatment of postmenopausal women with osteoporosis at high risk for fractures, as a treatment to increase bone mass in women at high risk for fracture receiving adjuvant aromatase inhibitor therapy for breast cancer, and as a treatment to increase bone mass in men at high risk for fracture receiving androgen deprivation therapy for non-metastatic prostate cancer.

“Success in today’s economy is most directly tied to a region’s ability to grow, retain and attract human capital,” Young said.

Young argued that reason why the U.S. has been able to thrive as as the world economy have evolved from an economy based on first, agriculture, then industry, then services and now knowledge, was that it had an economic and regulatory environment that allowed businesses to adapt, a cutting-edge research infrastructure, and the “mechanisms for the best and the brightest to rise to the top,”

“The mechanisms that has allowed the best and the brightest to rise to the top have been the universities,” Young said, particularly the public universities, which educate the vast majority of America’s young.

To learn more:

Share
Salon Thumb

Do You Have a Duty to Participate in Medical Research?

Share

The Northwest Association for Biomedical Research launches a new series of community discussions tonight, Tuesday, Oct. 18 where you, your friends and your neighbors can discuss the latest advances in biological science and how they relate to society.

The conversations will usually begin with participants reading or viewing materials (e.g. short articles, media headlines, film clips), which will serve as “food for thought.”

A Bioethics 'Salon'

The discussions, guided by a facilitator, “will seek to explore the nuances of the social and ethical issues that pervade biomedical research and reflect on personal perspectives,” organizers say.

Every participant is valued not because they are experts in the field, but because they are curious, have meaningful life experience and are willing to explore topics with other open-minded individuals.

As for food: appetizers and beverages will be provided.

This discussion series is in partnership with 415 Westlake, Union, Kakao Coffee and Chocolate and the Institute of Translational Health Sciences. It is funded by the National Institutes of Health grant UL1RR025014

The events are free and open to all.

When:

  • Third Tuesday of each month: October 18th, November 15th, December 20th

Time:

  • Salons begin at 5:30pm and finish at 7pm

Where:

  • 415 Westlake, Seattle, WA at Kakao Coffee and Chocolate in the South Lake Union neighborhood

Eats:

  • NWABR hosted appetizers and beverages
Share
Your Medical Mind Thumb

Making up your ‘medical’ mind – Book Review

Share

By Jesse Gruman, Ph.D.
President and founder of the Center for Advancing Health 

Can we have “evidence-based” care and “shared decision making”? Are they in concert or in competition with one another?

Drs. Pamela Hartzband and Jerome Groopman, in essays published over the past few years, have argued that an impending collision between these two perspectives stands to decimate the responsiveness of U.S. health care and undermine patient autonomy.

In their new book, Your Medical Mind: How to Decide What is Right for You, the authors focus their attention on the patient experience in making treatment decisions and in the process, present a rich collection of stories and evidence that strengthen their argument that a crash is indeed imminent.

In Your Medical Mind, Hartzband and Groopman invite us, the public, to understand their concerns by unpacking how scientific evidence – and the lack thereof – plays an often limited and sometimes quite unexpected role in treatment decisions made by doctors and patients: “The effort to reduce medical decision making to numbers is ill-conceived and reductionist, overly simplifying a complex and vexing process that is fraught with conflict and emotion.”

The thesis of the book is that medical decisions are in part driven by established facts and evidence (some spotty and ambiguous), but that personal traits, fluctuating emotions, cognitive biases, health status, personal history and emerging situations also powerfully influence the treatment choices of patients.

To their credit, the authors do not exempt clinicians from being subject to these biases and conditions, but rather describe how sometimes clinician and patient characteristics conflict in shared decision making.

The authors recount stories of people making choices about a range of medical interventions.  They pull from the literatures of health psychology, behavioral medicine, health services research, behavioral economics and decision science to show the patterns through which personal, situational and contextual factors interact over time as these people wrestle with their choices.

There’s Omar with Hepatitis B who shares carefully with his wife all the details and considerations of treatment as his health declines while waiting for a liver transplant but who delegates to his clinicians decisions about his care prior to the transplant, asking his wife to follow their lead.

There’s Lisa, who took a natural approach to treating her lupus that she later abandoned when she decided to get surgery to correct a painful bone spur and ganglion cyst – and despite her efforts to gather information and make a choice that leads to the best outcome, the surgery is unsuccessful.

And many others.

The authors are good story-tellers and they stick with their subjects over time. The portrayal of the nuances of each individual’s choices – what influences them, how their physicians’ views affect their decisions – reflect the reality of many of us who take seriously our participation in decisions about our treatment.

Doing this is hard work.  Uncertainty about what the right choice is for a given individual can be excruciating, especially when that choice is different from the one our family or physician would make. The arduousness of the process may be the reason so many of us defer to the certainty of our physician’s choice.  We’d prefer not to acquire working knowledge of the complexity or feel the chilly uncertainty that close examination of our options entails. “When a person actively chooses a treatment and the outcome is poor, he or she can feel a deeper sense of self-blame and persistent regret.”

After reading about the deep, thoughtful and sometimes existential deliberations of these individuals, it is hard to imagine that we could be denied the option of participating fully in decisions about our treatment.

The reality is, however, that many of us are denied the kind of relationship with our doctors that allow for the exploration of benefits, risks, values, and preferences described in this book.  We don’t have health insurance.  Our insurance doesn’t cover our chosen treatment.  The FDA hasn’t approved the drug we think we need.  Our clinicians aren’t willing to engage: they don’t have time; they don’t get paid to do this; this is not how they were trained.

Your Medical Mind offers an orderly, well-sourced, approachable account of the challenges we and our clinicians face when we are truly engaged in making medical decisions together.

Your Medical Mind is not a how-to manual for making “good” medical decisions, despite its title.  If you want guidance on doing that, you’ll have to go to this article where you can see the interviewer try to get the authors to extract some snappy advice from the material they have presented.

If you are looking for the political and practical implications of a growing patient population that wants to actively deliberate about their treatment, you will be disappointed.  Just how can we avoid the impending collision between the blunt instruments of enforced evidence-focused quality improvement initiatives and the expectation that patients can and will engage meaningfully in decisions about our treatments? Perhaps the answers will be found in Hartzband and Groopman’s next book or essay.

Your Medical Mind offers an orderly, well-sourced, approachable account of the challenges we and our clinicians face when we are truly engaged in making medical decisions together.

If you are a person who wants to be involved in making decisions about your care, you will see yourself reflected in these stories – you may recognize patterns and learn about some of your own quirks.  But if you are an advocate for shared decision making, an enthusiast for patient “empowerment” or a clinician working to implement patient-centered care, this book is required reading.  It shows that implementing true shared decision making is not simple, it is not cheap and you can’t just supply a decision support tool and say you’ve done the job.  You need to know just how complicated this is, because in the absence of a practice and policy agenda supplied by Drs. Hartzband and Groopman, it’s up to you to propose one that will prevent the collision.

 

Related Links:

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

Share