Ethics of giving a child a placebo

This article is from earlier this week, but I still wanted to point it out. The New York Times ran an article on the ethics of giving a child a placebo to soothe the little ills that don't require medication. The article is a pretty thorough examination of the ethics of placebo use in general, as well as the possibly implications of giving placebos to children. The makers of the children's placebo says that conceivably this product could reduce the over-prescribing of antibiotics for childhood ills. But the effectiveness of placebos is pretty unpredictable. And for placebos to be effective, there has to be a certain level of deception. Is that OK? Plus, is it OK to teach children that there is a pill for every ill? It seems that somewhere along the line, children have to learn the body is pretty resilient and that a skinned knee repairs itself.

It is an intriguing read. You can find the article here: http://www.nytimes.com/2008/05/27/health/27plac.html?ex=1369627200&en=93794384172e0a50&ei=5124&partner=permalink&exprod=permalink

When hostility melts

I really appreciated the Cases article in today's New York Times Health section by Dr. Godfrey Onime. He described the very personal reaction he had to a patient's family that initially greeted him with hostility, but later realized the quality of care he provided and asked him to the patient's new primary care doctor. He described how it is hard to not take the hostility personally when patient families are advocating for their patient. But the hostility can be forgotten when the family and doctor come to see eye-to-eye.

You can find the article here: http://www.nytimes.com/2008/05/27/health/views/27case.html?ex=1369540800&en=0831cbb37433c8b6&ei=5124&partner=permalink&exprod=permalink.

I especially appreciated this since sometimes I am greeted with harsh or short words when I am trying to get physicians to participate in our study to improve communication. Most of the time, the hostility isn't at me, per se, but just at how busy the day is and having to answer yet another phone call. But often times the hostility melts when they realize I am interrupting their busy day for a good cause. And who am I to stay annoyed with the doctor who was a little short with me, if he or she decides to enroll in our study? It's all a part of a day's work.

Unrealistic portrayals of clinical research

First, I hate to admit I even watch Grey's Anatomy. It's such a soap opera. But I have had to laugh in recent weeks about the portrayal of Meredith and Derek's clinical trial. First of all, Meredith has some epiphany, makes some discovery in text book and just decides she wants to do a clinical trial. Of course, first, she has to find an attending to sign off. But Derek signs on and next week they are enrolling their first patient. HA! In the real world, that's not all she has to do. I guess it just isn't sexy showing the months and years of laboratory research, institutional review board applications, grant applications and reapplications and the months of waiting for IRB approval, and then several rounds of amended applications.

And then in this week's episode, the chief of surgery approached Meredith and said the institutional review board, the national review board that oversees clinical trials, is concerned because she has had 11 deaths and she has one more chance before midnight to enroll and treat a patient. What is this, Cinderella? First of all, the institutional review board is local, not national. There would be someone breathing down her neck right at her hospital. And there are no "one more chances in clinical research." If an IRB thinks a trial is dangerous, they are not afraid to shut a trial down immediately. But in Meredith's world, she sneaks in two more patients, one of them lives, the trial continues, and she even gets her man in the end.

I know, I know, television dramas have always had an unrealistic view of the practice of medicine and the medical profession. These shows are about entertainment, not education. But I believe the writers are selling their viewers short by speeding through the research process. There certainly is great drama and story in the less flashy parts of research. But maybe that's just the researcher in me talking.

Advice from a cancer patient

Hamilton Jordon, the former White House chief of staff for Jimmy Carter died this week of cancer. He had four different types of cancer in his lifetime and was a strong advocate for patients empowering themselves and being active in their own health care. In his 2001 memoir, “No Such Thing as a Bad Day,'’ Jordan outlined his “Top 10 Tips for Cancer Patients.'’ The New York Times Health sections reprinted an interview from webMD. com on those 10 tips. You can find the article here: http://well.blogs.nytimes.com/2008/05/21/one-mans-advice-from-four-cancer-battles/.

Of course not everyone agrees about the advice, as seen by the commenters on the NYT article. Especially No. 10: "Your attitude and beliefs are your most powerful weapon against cancer." But there is something reassuring about a patient sharing what he or she has learned with another patient. Sharing in this way gives both patients a voice.

Conducting social research in a biomedical world

My job title is clinical research coordinator. I enjoy my work on a number of studies to improve physician-patient communication and I like to think I do it well. I maintain regulatory documents, obtain informed consents, enroll subjects and write institutional review board applications. Given my background, I am also involved in conducting literature reviews, writing grant applications and preparing article for publication.

I am preparing to take the Association for Clinical Research Professionals certification exam for clinical research coordinators http://www.acrpnet.org/MainMenuCategory/Certification/GetCertified.aspx. I am looking forward to taking the exam and obtaining this professional credential. But I am a little concerned. I meet all the qualifications for their definition of a clinical research coordinator (CRC), but as I reviewed the materials, I got a stark reminder of how, while the research we do about physicians and communication is valuable, it is completely foreign to the world of biomedical research.

It is not the first time I have encountered this. Most of the continuing education offerings for research professionals are geared toward the biomedical end of the spectrum. The IRBs are set up to handle all sorts of biomedical scenarios, but the questions can be difficult to answer when you are conducting a survey. And every once in a while, I encounter a doctor that we try to enroll in our study who thinks psychosocial research is "a waste of time."

But I know the research we do is valuable, even if occasionally overlooked in the biomedical world. The only reason this concerns me at all is that the certification exam I am preparing to take assumes all clinical research coordinators work on clinical drug trials. And while I have picked up some clinical trial knowledge in continuing education seminars, it is not my primary day-to-day work. So over the summer I will be giving myself a crash course in clinical drug trials, so that I will be prepared to take the exam. And hopefully this certification will be a valuable assets as I continue to pursue communication research in medical contexts.

Saying "I'm sorry"

The New York Times ran an article this week about an experiment at the University of Michigan Health System, loosening the typical restrictions on doctors to apologize to their patients for medical errors. Malpractice lawyers and hospital legal departments generally discourage doctors from admitting mistakes to patients for fear of legal repercussions. But some health systems such as the one the University of Michigan are starting to questions whether this practice causes more harm than good. And a policy of honesty may actually benefit the bottom line, as well as benefit the mutual physician-patient relationship.

I have always contended that the key to communication in any relationship - physician-patient, professional colleagues, intimate partners - is mutual respect and trust. You cannot have an effective communication relationship without trust. And a doctor who stonewalls and does not admit to a medical error erodes the delicate balance of trust between doctor and patient. That doctor cannot expect that patient to ever be honest about his or her symptoms, health problems, or questions. Not admitting to an error telegraphs to the patient that the physician doesn't trust the patient and that the patient can't and shouldn't trust the physician. But a physician who trusts the patient enough to admit his or her mistake tells the patient that the physician is human, but that the physician values and trust the patient enough to allow him or her to see that. And that's how you build an effective patient-physician relationship where both parties play an active role in the patient's health care. I can only hope that more research like what is going on in Michigan will show physicians and health systems that honesty be a wise health and legal policy.

You can see the New York Times article here: http://www.nytimes.com/2008/05/18/us/18apology.html?ex=1368936000&en=c9496b7eb97e3235&ei=5124&partner=permalink&exprod=permalink

5 mistakes women make at the doctor

CNN.com ran an article about the mistakes women make at the doctor. Most of the mistakes tend to revolve around communication. But the mistakes reveal the complexity of the physician-patient relationship. One mistake is that women don't question their doctors. But another stated mistake is that women tend to over-research and in the process get overwhelmed. So they don't ask enough questions but they over-prepare for questions they ultimately don't ask. The author also said that women tend to interpret their symptoms for their doctor rather than give just the facts. See, it's complicated. So you have to be deliberate in your preparation for talking to your doctor, but don't overdo it on the Internet research. And trust your intuition.

You can find the article here: http://www.cnn.com/2008/HEALTH/05/14/ep.women.mistakes/index.html.

a parent's perspective

Time has gotten away from me, but I didn't want to let too much time pass without at least pointing you to another article that looks at advancing health from the patient's perspective. But here it is the parent's perspective. The New York Times Health section today writes about a little girl with a rare tumor and the risky procedure to treat it. You can feel what I am sure is only a tiny portion of the gut-wrenching pain and anxiety the parents experienced. The article also offers a glimpse into the surgical room as well. Definitely worth the read.

You can find the article here: http://www.nytimes.com/2008/05/13/health/13tumo.html?ex=1368417600&en=fd49d2e9a128fb83&ei=5124&partner=permalink&exprod=permalink

Blog as therapy

CNN.com had an interesting article today about how blogging can act as a type of group therapy. While of course blogging can't replace face-to-face counseling, it can allow people a venue to interact with people who have faced similar problems. Patients are finding blogging as a valuable venue too, both as a way to sort out their own feelings and to gain perspective from others.

You can find the article here: http://www.cnn.com/2008/LIVING/personal/05/07/blog.therapy/index.html

Redefining disease

The New York Times published an interesting article today about the field of nosology, or disease classification. Scientists are redefining classifications of disease by examining the genetic underpinnings of disease.

The article is far from my area of knowledge or expertise, but it is interesting to read how knowledge about medicine and disease is constantly changing . You can find the article here: http://www.nytimes.com/2008/05/06/health/research/06dise.html?ex=1367812800&en=b4a1fb3e0b65b4c2&ei=5124&partner=permalink&exprod=permalink.

Slow medicine

The New York Times published an article today about "slow medicine," an approach that advocates less aggressive care at end-of-life.

Slow medicine ultimately advocates giving patients a greater voice in what treatments they pursue, or even decline, at end-of-life. But as some of those interviewed and the article and some commenters pointed out, contemporary medicine does not build in a lot of time for heart-to-heart discussions between patients and physicians. The typical default is to take medical action, even drastic action, first and ask questions later. The assumption is that a physician should always pursue every medical avenue for every patient. But this slow medicine movement points to the value of seeking the patient's perspective. Even if it means slowing down to do it.

You can find the article here: http://www.nytimes.com/2008/05/05/health/05slow.html?ex=1367726400&en=1b4e1a08fd8b7247&ei=5124&partner=permalink&exprod=permalink