Post-Hospital Syndrome: Are Hospitals to Blame?

Medical professionals are now seeing an increase in patients with post-hospital syndrome, described as a state of susceptibility that leads to a new affliction.  This is different than a relapse.  Patients are entering hospitals for particular ailments, but developing independent and unrelated illnesses after the initial reasons for hospitalization have been resolved.

Dr. Krumholz, a professor of medicine and public health at Yale School of Medicine says that in “many ways the hospital environment can be the opposite of healing.” He believes that because patients are often “deconditioned, in pain, malnourished, stressed with circadian disruptions” they become susceptible to new illnesses.

Dr. Krumholz (with the help of Dr. Desky, a professor of health policy at the University of Toronto) proposes an overhauling in hospital care as a solution to the problem. The doctors recommend more cheerful décor and preserving patients’ dignity by allowing them to remain in their own clothing.  The doctors gave harsh criticism to the “draconian unsavory diet” provided to patients and believe that eating well is critical for healing. Furthermore, the aggressive treatment provided by healthcare facilities to cure the problems that bring patients into the hospital, may be the very reason a patient will have to return.

Read more here.

Doctor Argues for Measured Paternalism

Dr. Sandeep Jauhar, a cardiologist, offers anecdotal evidence in support of his argument that even though autonomy is, and should be, medicine’s guiding principle, paternalism has its place. The principle of autonomy in medicine encompasses a patient’s right to direct care his or her care, and requires the doctor to fully inform the patient regarding medical treatment. Dr. Jauhar reflects on his early belief that autonomy was “an absolute good, an ethical imperative that trumped all others.” After some years practicing medicine, his belief has changed.

Dr. Jauhar has come to believe that “no ethic in medicine is absolute.” Though the consequences of a breach of trust between a physician and a patient are severe, the consequences of full disclosure can be adversarial to the doctor’s duty to select the best course of treatment for his or her patients. However, Dr. Jauhar states that if a doctor believes that a paternalistic approach is necessary to a patient’s care, a soft approach is most appropriate. He describes hard paternalism as “coercive,” while soft paternalism “involves negotiation.”

Read more here.

UPDATE: Man Forced to Undergo 3 Enemas and Colonoscopy by Police

David Eckert, from Hidalgo County, New Mexico, was subjected to numerous, highly invasive procedures, because police suspected him of hiding drugs in his rectum. Mr. Eckert had been convicted of methamphetamine possession in 2008, and the police suspected his continued involvement with drugs. However, the officers who searched both Mr. Eckert’s person and his vehicle, after pulling him over for a traffic violation, found neither drugs, nor weapons. One officer indicated that Mr. Eckert held himself in an “erect” position, and “kept his legs together,” which led the officers to assume that Mr. Eckert held drugs within him.

 After a local hospital refused forcibly to search Mr. Eckert, he was transported to the Gila Regional Medical Center (GRMC), 50 miles away. At GRMC, Mr. Eckert was subjected to two rectal exams, three enemas, forced bowel movements in front of officers and nurses, x-rays, and a colonoscopy performed under anesthesia. However, each search was fruitless. Mr. Eckert received a bill from the hospital for $6,000. Mr. Eckert filed suit against the hospital, and the parties settled for $1.6 million.

Read more here.

Antibiotics in Food Animals May Pose “High Risk” to Humans

The Natural Resources Defense Council (NRDC), an environmental advocacy group, has compiled a report on the safety of antibiotics used by American farmers to treat food animals. The report reflects the finding of Food and Drug Administration (FDA) scientists that 18 out of 30 antibiotics being given to the animals pose a “high risk” to human beings, by exposing them to antibiotic-resistant bacteria in the food supply. In addition, all 30 of the antibiotics studied, when used for non-therapeutic purposes (such as increasing an animal’s size), expose humans to antibiotic-resistant bacteria, and violate the FDA’s own safety guidelines on non-therapeutic use.

The NRDC claims that FDA efforts to “phase out” the administration of non-therapeutic drugs to food animals are not swift enough to protect the public. In December 2013, the FDA stated that it is taking action to promote “the judicious use of important antimicrobials to protect public health, while ensuring sick and at-risk animals receive the therapy they need.”

Read more here and here.

Shortage of Execution Drugs Creates 8th Amendment Dilemma

Pentobarbital was used, primarily, for the purpose of lethal injection in America. However, the principal manufacturer of pentobarbital, Hospira, Inc., halted its production of pentobarbital in 2011. As a result, states that allow the death penalty are experiencing a shortage of lethal injection chemicals. The shortage has caused states, such as Ohio, to modify their lethal injection protocols, which has led to new quandaries that implicate the 8th Amendment of the U.S. Constitution.

Counsel for the convicted murderer, Dennis McGuire of Ohio, argued recently on Mr. McGuire’s behalf in the U.S. District Court for the Southern District of Ohio.  McGuire’s counsel claimed that the new, untried drug substituted for pentobarbital could leave Mr. McGuire conscious and suffering from “air hunger,” thereby posing “a substantial risk of severe pain” which would violate the 8th Amendment’s prohibition against cruel and unusual punishment. However, the Court ruled that the defense did not offer sufficient evidence to support a finding that the new drug poses a substantial risk of severe pain, and did not delay the execution proceedings.

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Minorities Underrepresented in Federal Regulations on Human Subject Research

“Redressing Past Wrongs: Changing the Common Rule to Increase Minority Voices in Research” (forthcoming, American Journal of Public Health) states that the underrepresentation of minorities in human subject research is particularly alarming because many diseases are more prevalent in minority populations, irrespective of age, gender or income. The article suggests that minority underrepresentation reflects minorities’ mistrust of the government, due, in part, to cases of abuse of minorities in human subject research; and, minorities’ comparative lack of access to health care, leading to fewer opportunities for minorities to participate in research.

The article was co-written by Bill Rencher, the health access program director of the nonprofit, Georgia Watch, and Leslie Wolf, Professor of Law at Georgia State University, and it appears in a special issue on the Ethics of Human Subjects Research in Minority Populations. The authors suggest that federal regulations be changed to protect minority populations as they protect prisoners, children and pregnant women.

Read more here.

 

Many Autistic Children Treated with Multiple Mood-Altering Drugs

Dr. Anjali Jin, researcher at the Lewin Group, coauthored a new study that shows that many autistic children are prescribed multiple mood-altering drugs contemporaneously, and for extensive time periods. Though the researchers are not certain that doctors overprescribe these medications, they maintain that the risks of prescribing them may outweigh the benefits, because no one knows if these drugs actually treat the children’s autism. Other treatment options, such as behavioral therapy, can be effective. However, not every insurance plan will cover behavioral therapy, and behavioral therapy requires more time and effort on the part of the patient and the patient’s family.

 Read more here.

New Zealand Case Raises Questions Regarding Autonomy for Transgendered Children

In New Zealand, parents of a seven-year-old, who was born biologically female but identifies as male, have been criticized for their decision to consider allowing the child to begin using puberty blockers. The puberty blockers would make the child’s transition to becoming male easier later in life, and Claudia MacKay, president of Agender New Zealand, claims that the effects of the blockers are reversible. However, the head of the Philosophy Department at the University at Aukland, Tim Dare, questions whether a seven-year-old is capable of understanding the consequences of such a decision. He claims further that the parents should not make this decision alone, and should involve medical professionals. The parents are concerned that if the child is forced to go through puberty he could be psychologically damaged. Yet, some psychologists claim that gender confusion in children is common and some children grow out of it after puberty.

Read more here.

Parents Sue State Over Gender Reassignment Surgery

The parents of an adopted, eight year old child, who is identified only as “M.C.,” filed suit against the State of South Carolina recently. M.C. was born with both male and female reproductive organs.  While MC was in the state’s custody, the state arranged for gender-reassignment surgery (which included removal of the child’s male genital organs). MC was raised as a female. However, M.C. now identifies as male. The complaint alleges that the decision to remove M.C.’s male reproductive organs was never brought before a judge. The doctors and hospital involved filed a motion to dismiss.  Their motion was denied. The parents hope that the lawsuit will be a “wake-up call” for authorities in charge of children in state care.

Read more here.

Contaminated Equipment Potentially Exposed Patients to Fatal Brain Disease

Creutzfeldt-Jakob disease (CJD) is a fatal disorder that affects the central nervous system, and occurs in one out of one million people worldwide every year. CJD is commonly known as “mad-cow disease.” (Mad-cow disease is actually a variant form of CJD, associated with eating tainted beef.) In May of 2013, a patient who may have had CJD underwent brain surgery at Catholic Medical Center in Manchester, New Hampshire (NH). This patient is believed to have had the spontaneous form of CJD, which may occur without eating contaminated beef.

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