Zocalo Public Square: How Doctors Die

Photo: Hanspeter Klasser

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. … He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible.

Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little (Dr. Ken Murray, 11/30).

Photo courtesy of Hanspeter Klasser

Health Affairs: An MS Patient Loses Trust When She Finds Out Her Doctor Is Paid By Drug Companies’

Last year, four years after showing initial symptoms of multiple sclerosis (MS), I walked out the door of one neurologist’s office and, after several months of searching, switched to a different doctor.

It was the final act in a series of events that had gradually eroded my trust in the first neurologist’s judgment, which I believe was colored by his financial relationships with drug companies who manufacture and market medicines for MS patients. … Given my background in medical ethics, I was familiar with the potential conflicts of interest that exist for physicians participating in clinical pharmaceutical trials.

Assuming that my neurologist was being compensated for running the trial, in addition to his earnings from seeing patients in his neurology practice, I’d asked him if that was the case, and he confirmed that it was (Maran Wolston, December 2011).

The New Republic: More Health Care Heresy From Newt

Newt Gingrich

Newt Gingrich’s past endorsement of an individual mandate has drawn fire from conservatives. But that’s not his only health care heresy.

In 2008, Gingrich made the case for another idea that became part of Obamacare and, in due time, the focus of right-wing attacks.

Worse still, at least from the standpoint of conservatives, he did so by writing an op-ed for The New York Times. Oh, and did I mention he had some help? Gingrich had a co-author: John Kerry, the Democratic senator and former presidential nominee. … they also acknowledged that ultimately the private sector couldn’t solve this problem on its own.

More action was necessary, they said, and that action had to come from government … That’s the problem for Gingrich when it comes to improving the delivery of health care. He isn’t crazy. But plenty of influential conservatives are (Jonathan Cohn, 12/13).

Photo by Gage Skidmore

Newsweek: Could This Be The End Of Cancer?

By all rights, Shari Baker should have said her final goodbyes years ago. In 2005, more than a year after three doctors dismissed a lump under her arm as a harmless cyst, she was diagnosed with stage IV (metastatic) breast cancer … In May 2006, she traveled to the University of Washington.

The (cancer) vaccine was injected into her upper arm; she got five more shots over the next five months. Today, with scans detecting no cancer anywhere, Baker seems to have beaten some extremely stiff odds. …

By “cancer vaccine,” scientists mean something that will stimulate the immune system to attack malignant cells (Sharon Begley, 12/12).

The Atlantic: The Top 10 Health Stories Of 2011

Photo by Jean Scheijen

Coffee is good for you. And coffee is bad for you. Cell phones cause cancer. And cell phones don’t cause cancer.

Like any other year in health, 2011 was one of conflicting studies. In the end, we’re not always sure how to act or what to drink or when to exercise, but we do know more about ourselves and the world we live in thanks to researchers everywhere and the work that they do.

However broad or specific their conclusions, however small or large their sample size, medical studies do contribute to our wellbeing simply by existing and, if nothing else, by making us think twice about the things we eat, say, and do on a daily basis (Nicholas Jackson, 12/14).

Photo courtesy of Jean Scheijen

The Daily Show: Ed Gillespie

Jon Stewart talks health care with Republican political strategist Ed Gillespie (12/8).

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.

“The public thinks everything we do is bad,” Grandin said.

Grandin, a professor of Animal Sciences at the Colorado State University who was diagnosed with autism as a child, has tried to use her experience as an autistic to better understand better how animals perceive the world.

As an autistic child she recalls often being overwhelmed by new sights and sounds and living with constant anxiety–feelings that she believes animals share when they are placed in new, frightening  situations.

Grandin’s work has been credited with promoting more humane treatment of both research animals and livestock, and in 2010 she was named one of the Time Magazines 100 World’s Most Influential People.

Dressed in her trademark black flowered cowboy shirt and sporting a red bandana, the tall, 63-year-old argued that the use of animals in medical research is justified provided that the research is worthwhile and that animals are treated humanely.

“If you are going to do something invasive and painful, you have to a good reason for doing it,” she said.

But laboratory and livestock animals must be treated with respect and care, she said. “We have to give them a life worth living.”

To do that, it is necessary to think about how the animals live in the wild, she said. “What is the the animal’s nature? In the wild, what does the animal do? What does the animal want?”

In the wild, for example, rats are prey and so they always want a place to hide, Grandin said. Being kept in a cage without out a place to hide is terrorizing.

Living a life of constant fear can cause greater suffering than the pain animals might feel from injections and other research procedures, she said.

The best way to tell if animals are well cared for watch their behavior, Grandin advised. A properly cared for laboratory animal will behave normally and will show no fear of its caretakers, Grandin said.

Animal rights

Despite her work for livestock industry, Grandin said she has “diplomatic relations” with many animal rights activists, who respect her work to improve conditions in stockyards and slaughterhouses.

But Grandin worries that the new generation of animal rights activists have become too extreme. Previous activists were “reformers”, she said, but the younger activists are radical “abolitionists.”

Readers: Do you agree that research on animals is justified? If not, what’s the alternative?

If so, under what conditions? Write your comment below.

The “atrocity films” posted online by animal rights activists showing cruelty in research laboratories do not reflect the conditions in most facilities, Grandin said.

To counteract those films, researchers must begin to use the Internet to “open the door to laboratories electronically” by uploading films that show the public what goes on in well run animal laboratories, how the animals are cared for and how they are used for research, Grandin said.

To learn more:

• Visit Temple Grandin’s website: www.templegrandin.com

By Dr. James Kublin

Today, December 1st, is World AIDS Day, and to mark the occasion the HIV Vaccine Trials Network, which is headquartered at Fred Hutchinson Cancer Research Center in Seattle, would like to debunk the top 10 myths about HIV vaccine research.

Myth No. 1: HIV vaccines can give people HIV.

HIV vaccines do not contain HIV and therefore a person cannot get HIV from the HIV vaccine. Some vaccines, like those for typhoid or polio, may contain a weak form of the virus they are protecting against, but this is not the case for HIV vaccines. Scientists make HIV vaccines so that they look like the real virus, but they do not contain any HIV. Think of it like a photocopy: It might look similar, but it isn’t the original. In the past 25 years more than 30,000 volunteers have taken part in HIV vaccine studies worldwide, and no one has been infected with HIV by any of the vaccines tested – because they do not contain HIV.

Myth No. 2: An HIV vaccine already exists.

There is no licensed vaccine against HIV or AIDS, but scientists are getting closer than ever before to developing an effective vaccine against HIV. In 2009, a large-scale vaccine study conducted in Thailand called RV144 showed that a vaccine combination could prevent about 32 percent of new infections. Researchers are starting to understand why this vaccine combination worked and how to improve upon it.

Researchers around the world continue to search for an HIV vaccine that is even more effective. Leading this effort is the HIV Vaccine Trials Network, the largest publicly funded group of HIV vaccine researchers in the world. The HVTN is an international effort to find a safe and effective vaccine to stop the spread of HIV. It is funded by the U. S. National Institutes of Health.

Myth No. 3: Joining an HIV-vaccine study is like being a guinea pig.

Unlike guinea pigs, people can say yes or no to participating in research. All study volunteers must go through a process called informed consent that ensures they understand all of the risks and benefits of being in a study, and those volunteers are reminded that they may leave a study at any time without losing rights or benefits. The HVTN takes great care in making sure people understand the study fully before they decide whether or not join. All HVTN research adheres to U.S. federal regulations on research, as well as the international standards for the countries in which it conducts research.

Myth No. 4: A person must be HIV positive to be in an HIV vaccine study.

Not so. While some research groups are conducting studies of vaccines that might be used in people who are already infected with HIV, the vaccines being tested by the HVTN are preventive vaccines. They must be tested on volunteers who are not infected with HIV.

Myth No. 5: Vaccine researchers want study participants to practice unsafe behaviors so they can see whether the vaccine really works.

Not true. The safety of study participants is the No. 1 priority of HIV vaccine researchers and study site staff. Trained counselors work with study participants to help them develop an individual plan on how to keep from contracting HIV. Participants also are given supplies such as condoms and lubricant as well as instructions on how to use them properly. HIV efficacy trials enroll thousands of participants over several years, and with even with the best counseling some participants will still become infected through their risky behavior. Changing human behavior is never easy; after all, many people still smoke, even though it is widely known that smoking is the major cause of lung cancer. An AIDS epidemic would not exist if prevention was as simple as counseling people to change their risky behavior.

Myth No. 6: Now that there are pills that can prevent HIV infection, an HIV vaccine is no longer necessary.

HIV-negative people who are at high risk can take antiretroviral medication daily to try to lower their chances of becoming infected if they are exposed to the virus. This type of therapy – called PrEP, short for PreExposure Prophylaxis – has been shown to be effective among those at high risk. However, it has not yet been recommended for widespread use. PrEP is unlikely to be an option for everyone because the pills are expensive and are not always covered by insurance, may cause side effects, and not everyone has access to them. Remembering to take a pill every day is also challenging for some people. The most effective way to eliminate a disease is by using an effective vaccine. It was a vaccine that eliminated small pox and has almost eliminated polio. Most likely it will be an HIV vaccine that eliminates HIV from the world. Vaccines are an effective, affordable and practical option.

Myth No. 7: An HIV vaccine is unnecessary because AIDS is easily treated and controlled, just like diabetes.

While treatment for AIDS has dramatically improved over the last 30 years, it is no substitute for prevention. Current HIV medications are very expensive, and there are also many side effects. Sometimes people develop drug resistance and have to change the regimen of pills they take. Access to these drugs for the uninsured in the U.S. and those in the developing world is also very limited.

Myth No. 8: The search for an HIV vaccine has been going on for a long time and it’s just not possible to find one that works.

The science of HIV-vaccine development is challenging, but scientific understanding continues to improve all the time. In just the past two years there have been promising results from the RV144 study in Thailand as well as exciting laboratory work, such as the discovery of new broadly neutralizing antibodies against HIV. HIV is a powerful opponent, but scientists are constantly learning from one another and using advanced technology to fight it. Science has come a long way in the 30 years since AIDS was discovered. In comparing preventive HIV vaccine work to other vaccine development, the time it has taken is not so surprising; the polio vaccine took 47 years to develop.

Myth No. 9: Vaccines cause autism and just aren’t safe.

This is not true. Numerous studies in the past decade have found this claim to be false. The British doctor who originally published the finding about vaccines and autism has since been found to have falsified his data. There is actually no link between childhood vaccination and autism. It is true that vaccines often have side effects, but those are typically temporary (like a sore arm, low fever, muscle aches and pains) and go away after a day or two. The value of protection to vaccinated individuals and to the public has made vaccines one of the top public health measures in history, second only to having a clean water supply.

Myth No. 10: People who aren’t at risk don’t need an HIV vaccine.

A person currently may not be at risk for HIV, but life situations can change along with disease risk. Such a vaccine also may be important for one’s children or other family members and friends. By being knowledgeable about preventive HIV vaccine research, a person can be part of the solution by educating friends and family about the importance of such research and debunking the myths that surround it. Even if a person is not at risk, he or she can be part of the effort to find a vaccine that will hopefully save the lives of millions of people worldwide.

To learn more or find out how to get involved in an HIV vaccine study, please visit www.hvtn.org

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.

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:

• Read the Washington Research Council’s report: Trends in Washingotn’s Life Sciences Industry 2007 – 2011

Temple Grandin, who was diagnosed with autism as a child but went on to obtain a Ph.D. in animal science, is noted for her work exploring the similarities between autistic consciousness and the thought processes of animals — research that has led to improvements in livestock handling to reduce animal stress.

Grandin’s research on pictorial thinking shared by animals and autistics alike has resulted in more than 400 scientific and lay publications, 6 books, and numerous awards.

In 2010, TIME Magazine listed Grandin as one of the 100 Most Influential People in the World.

Improving Animal Welfare

When:

Wednesday, November 30, 2011

4:00 – 5:45 PM

Where

Hogness Auditorium (A-420), Health Sciences Center, UW

Event is free and open to the public. A personal book signing will follow the lecture.