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Latest Posts

Medical Ethics And The “R” Word

[Recently] a short article in the New York Times, New Kidney Transplant Policy Would Favor Younger Patients, [drew] my attention to a very basic problem in medical ethics: Rationing.

According to the Washington Post coverage, the proposal comes from the United Network for Organ Sharing, a Richmond-based private non-profit group the federal government contracts for allocation of donated organs. From the Times piece:

Under the proposal, patients and kidneys would each be graded, and the healthiest and youngest 20 percent of patients and kidneys would be segregated into a separate pool so that the best kidneys would be given to patients with the longest life expectancies.

This all follows [the recent] front-page business story on the monetary value of life.

I have to admit, I’m glad to see these stories in the media. Any reasoned discussion of policy and reform requires frank talk on healthcare resources which, even in the best of economic times, are limited.

*This blog post was originally published at Medical Lessons*

Selling Human Organs For Transplantation: Medical Ethics In Handcuffs?

I have previously posted on the ethics of paying for organ donation. I find this notion to be ethically troubling, but I believe the issue deserves fair debate. In general, my belief is that a personal anecdote should not drive policy in medical ethics. There are many individual vignettes that are poignant and heartbreaking that tempt us to relax our ethical boundaries.

For example, permitting us to harvest organs from folks who are “not quite dead,” would save lives, but society’s rights outweigh this benefit, in my view. For similar reasons, I resist efforts to relax the definition of death in order to increase the reservoir of available organs. If death is redefined as a result of a search for truth, then the process is ethically permissible. Participants in these discussions would include medical professionals, theologians, ethicists, legal experts and ordinary people.

If a result of this process would be that there would be more organs available for transplantation, then I would be supportive. The distinction is that increasing organ supply would not be the primary objective. In other words, I reject the approach of, “Hey, we need more organs to save lives. Let’s roll back the definition of death to get there.”

Recently, two sisters who were serving life sentences in Mississippi for a crime related to armed robbery were released by Governor Haley Barbour. They were not pardoned, but their sentences were indefinitely suspended. A condition of their release was that one woman must agree to donate a kidney to her sister.

The women have always maintained their innocence, and supporters have argued that the verdict was wrong or disproportionate to the crime. I am not knowledgeable on the facts and offer no view on the whether the verdict and sentence were just. Read more »

*This blog post was originally published at MD Whistleblower*

Actual Living, Breathing Lungs On Stage At TEDMED 2010

Dr. Shaf Keshavjee, a thoracic surgeon and director of the Toronto Lung Transplant Program, showed the amazing miracle of modern lung transplantation at TEDMED 2010. Here’s his fascinating talk where an actual living, breathing set of porcine lungs were brought on stage for hands-on inspection by the audience:

Here’s a quick interview we were able to get with Dr. Keshavjee just after the talk: Read more »

*This blog post was originally published at Medgadget*

Medical Scam: High Heels, Short Skirts, And DNA Samples

Without having one myself, I am pretty familiar with bone marrow transplant as a potential curative and lifesaving approach. After all, it was invented in my hometown of Seattle and I’ve met Dr. Donall Thomas who won a Nobel prize for developing the approach. I have met people who have been given a new lease on life because of transplant, I’ve known people who have died when transplant did not work for them or complications overwhelmed them, and I know many doctors who are transplant experts.

I know how finding a perfect match can be hard — especially when the patient in need is part of an ethnic minority. And I have heard the horror stories of matched donors saying no to patients who would die if they didn’t receive a transplant from them.

Now comes a story from Massachusetts that’s almost as bad — not a story of sentencing people to death by not donating, but a story of defrauding our healthcare system and, in the process, undermining a legitimate nationwide effort to have more people registered as potential donors. Read more »

*This blog post was originally published at Andrew's Blog*

Can The Expiration Date Of Harvested Organs Be Extended?

Currently, once a donated organ has been harvested it only has a few hours on ice before it “expires.” Lengthening this time period would be an incredible breakthrough that would allow patients in a wider area to potentially receive a transplant and also it would reduce some of the insanity surrounding the time pressures of organ transplantation.

One proposed method of extending an organ’s shelf life is to alter the internal cell biology to allow cells to live longer at lower temperatures. The State University of New Jersey Rutgers-Camden just received a $385,419 grant from the NIH to study an enzyme system, AMP phosphatase, and how it can potentially create cold-tolerant Drosophila. The enzyme was originally identified in ice worms as the key enzyme that allows them to survive in glaciers. The researchers hope that if they are able to utilize this enzyme system to create a cold-tolerant fruit fly, then they would be able to apply that knowledge to donated organs. Read more »

*This blog post was originally published at Medgadget*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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