Inadequate pain treatment is an entrenched problem around the world, related to cultural, societal, religious, and political factors including, the authors believe, the acceptance of torture. Poorly controlled pain has many and potentially serious adverse effects, both physical and psychological, as well as "massive social and economic costs to society," says Dr Brennan.
Contributors to inadequate management include "opio-phobia and opio- ignorance": fear and ignorance of the strong pain medications classified as opioids-morphine and related drugs.
Although pain relief is clearly a core value of medical ethics, the legal foundation for a right to pain management is less clear. Some governments, including Australia and the state of California, explicitly define the right to adequate pain management, protect medical practitioners who treat pain in terminally ill patients, or have introduced requirements for pain management and education. ~ Newswise, Jun 26
Pharmaceutical companies are reeling from criticism in the US and Australia over claims that industry-funded medical education programs are "infomercials" which gloss over the weak points of their products. "Most of what doctors know about drugs comes from the industry, and that's not healthy," says Jerry Avorn, of Harvard Medical School. "Academic organisations lend their names to courses that are nothing more than infomercials." And Jerome P. Kassirer, of Tufts University, a former editor of the New England Journal of Medicine, says that "between a third and half of medical providers have a relationship with industry."
US politicians are listening to these allegations of a close and cosy partnership between Big Pharma and doctors. Twice this year Senate committees have examined the issue. In April, a Senate finance committee found that the Accreditation Council for Continuing Medical Education, the main accrediting body for education providers, did not scrutinise course materials for bias towards sponsors' products.
The Special Committee on Aging has also announced that it will propose a national registry of gifts and payments to doctors. Chairman Herb Kohl said, "It has been estimated that the drug industry spends US$19 billion annually on marketing to physicians in the form of gifts, lunches, drug samples and sponsorship of education programs... These gifts and payments can compromise physicians' medical judgment by putting their financial interest ahead of the welfare of their patients."
In Australia, too, the industry is taking a beating. The Australian Competition Tribunal recently ruled that the industry could only self-regulate if it forwarded complete information on perks given to doctors twice a year. "Absent any requirement for regular reporting and public disclosure... some companies will test the boundaries and offer inappropriate benefits to healthcare professionals." Public scrutiny is needed to ensure that the companies comply, it said.
Naturally, the pharmaceutical companies see things differently. Medicines Australia says that claims that inappropriate behaviour is widespread and rising are "simply untrue". A register of benefits from 8,000 educational meetings in Australia would be nearly meaningless. Its CEO, Ian Chalmers, insists that sponsored educational meetings are "a legitimate and fundamental part of our health system". ~ Australian, Jul 2; Sydney Morning Herald, Jun 30; Washington Post, Jun 27
WHAT'S LIFE ALL ABOUT?
Excitement about so-called "synthetic life" is growing as scientists reflect more on the implications of experiments which are aimed at creating artificial cells.
A group of eminent scientists gathered in Ilulissat, Greenland, has released a statement predicting a scientific revolution: "Fifty years from now, synthetic biology will be as pervasive and transformative as is electronics today. And as with that technology, the applications and impacts are impossible to predict in the field's nascent stages. Nevertheless, the decisions we make now will have enormous impact on the shape of this future."
The latest development to hit the headlines involves one of the Ilulissat signatories, J. Craig Venter, the colourful head of Synthetic Genomics. He reports in the journal Science that his team has transformed one species of microbe into another by transplanting DNA. "This is equivalent to changing a Macintosh computer into a PC by inserting a new piece of [PC] software," he explained. A senior editor of Science called the experiment "a landmark in biological engineering" -- although other scientists pointed out that Venter still doesn't understand how it works. In any case, this success takes him one step closer to his goal of creating an artificial chromosome.
The emergence of synthetic biology presents scientists with ethical and philosophical conundrums as well, the journal Nature points out. It argues that the idea of "creating life" is archaic and pre- Darwinian because "life" is a nearly meaningless concept. Synthetic biology also challenges "religious dogmas" about the embryo, says Nature, in the syntactically tortured conclusion to its editorial:
"If this view undermines the notion that a 'divine spark' abruptly gives value to a fertilised egg -- recognising as it does that the formation of a new being is gradual, contingent and precarious -- then the role of the term 'life' in that debate might acquire the ambiguity that it has always warranted." ~ Nature, Jun 27; Washington Post, Jun 29; Kavli Foundation, Jun 25
CAESAREANS RISING IN US
Caesarean section births are rising and rising in the United States -- and no one knows exactly why. In the 1940s, Caesareans were rare, but they now make up nearly one-third of the nation's births. In Puerto Rico, the rate is 47.7%.
The main reason seems to be caution. "In all the grey areas of clinical decision-making, obstetricians have moved to Caesareans. Mothers are more accepting, too," says Eugene Declercq, of Boston University's School of Public Health. Fear of lawsuits may be another factor, as parents often feel that Caesareans are safer. Many doctors now think that their patients have developed an extreme, almost unreasonable aversion to the smallest risk.
However, Caesareans also involve risk. This year two women died within two weeks in Pennsylvania after Caesareans. Recovery time is longer, and haemorrhage, infections, dangerous clots and rehospitalisations are more common. They also pose risks for future pregnancies. Planned Caesareans could even be contributing to the recent uptick in premature births. ~ philly.com, Jun 10
IN BRIEF: nurse murders; Nigeria; HFEA
Nurse murders: A Berlin nurse has been convicted of murdering five patients at a top hospital with drug overdoses. Irene Becker, 54, was sentenced to life imprisonment. Last November another German nurse was convicted of 12 murders, 15 manslaughters and one mercy killing in Germany's worst serial murder since World War II. ~ Newsday, Jun 29
Nigeria fights Pfizer: Drug company Pfizer has won the first round of a court battle over allegations that it conducted improper drug trials on Nigerian children in 1996. A court has refused to allow the government to add 85 new claims to an earlier 54. The government is suing for US$7 billion in damages. It claims that more than 50 children died from an experimental anti-meningitis drug. ~ BBC, Jun 26
Strongarm tactics fail: Britain's fertility regulator, the Human Fertilisation and Embryology Authority, has been forced to concede in a legal battle against a leading IVF clinic. In January the HFEA ordered a police raid on the premises of two clinics run by Dr Mohammed Taranissi. Now the HFEA is saddled with a bill of £1 million in legal costs. It appears that its search warrants were not legally watertight. ~ Independent, Jul 1
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Bungled car bombs in London and Glasgow on the weekend may have been organised by doctors. "We have to face the possibility that the health service has been used to get terrorists into Britain and launch attacks against us," a senior police source told the London Mirror. Investigators believe that a dozen doctors from the Middle East may have been involved. Of eight men under arrest on Tuesday in the UK, six were doctors or medical students.
Israeli doctors have successfully frozen eggs from cancer-stricken girls as young as five in order to allow them to become mothers in later life. Dr Ariel Revel, of Hadassah University hospital in Jerusalem, found that it was possible to extract eggs from girls below the age of puberty and cultivate them to maturity in the laboratory. The five-year-old had Wilm's tumour, a disease of the kidney, and two girls aged 8 and 10 had Ewing's sarcoma, a bone cancer.
Eighteen days after his wife instructed doctors to withdraw food and water, an Arizona man has awakened from a coma. Jesse Ramirez Jr, 36, had suffered brain injuries in an accident on May 30. Only few days later, on June 8, his wife Rebecca had his feeding tubes removed. However, his parents and his sister fought this decision in the courts and on June 13 he was reconnected. Now he is sitting up in a hospital bed, giving a thumb-up sign to visitors and giving hugs and kisses. His doctors had predicted that he would be blind and would remain in a permanent vegetative state.