As we herald the new decade, and leave 2010 behind, the year seemed devoid of blockbuster healthcare issues, but I subsequently changed my mind upon deeper review. Here’s my updated list:
1. The Gulf of Mexico Oil Spill – the sheer magnitude of this man-made disaster on the environment is mind-boggling. 5 million barrels of crude oil were spilled from April to July, causing permanent ecological damage to 1000 miles of coastline, adverse effects on the fishing and tourism industry, poisoning of the global food chain, not to mention the 11 lives lost during the explosion.
2. Haiti Double Whammy – the January earthquake resulted in a quarter million deaths with over 300,000 injured. Barely had the people recovered from the economic and health effects, when the spectre of cholera, never before seen in Haiti, appeared in October, causing over 3,300 deaths, as at end-December.
3. AIDS breakthrough – among the doom and gloom, AIDS treatment research made tremendous breakthrough in 2010. Among the good news:
- A new study in South Africa showed that a vaginal gel made using Gilead Sciences’s (GILD) AIDS drug, Viread, cut HIV infections by 39% in women.
- Men taking Gilead’s pill Truvada daily as a preventive measure reduced their risk of catching HIV by 44%.
- U.S. government scientists also discovered two potent human antibodies that can stop more than 90% of known global HIV strains from infecting human cells, thus giving hope for a vaccine to prevent AIDS.
4. The Battle of the Bulge – I had written in an earlier posting that practically all slimming pills have been banned due to safety reasons (see Where Have All The Slimming Pills Gone? Taking that obesity is a major healthcare issue worldwide, the pharma industry is racing to produce a safe diet pill which will produce a block-buster which will bring in untold profits. While the FDA rejected Arena’s lorcaserin and Vivus’s Qnexa, Orexigen Therapeutics’s Contrave had received a thumbs up.
5. CPR Change – for as long as many care to remember, CPR meant a combination of chest compressions and mouth-to-mouth breathing, the latter a common reason why bystanders were somewhat reluctant to get involved, In 2010, new guidelines were introduced where the so-called kiss of life was abolished. Read my post here.
6. Misleading Marketing by Cord Blood Banks – ABC News found the costs of private banking outweigh the potential benefits to many families.
In their marketing material, many private banking firms tout an impressive list of 70 to 80 diseases that purportedly are treated by stem cell transplants. But research has yet to prove that stem cells from cord blood work for all of the listed conditions. Private cord blood banks store blood on the possibility that in the future, there will be diseases that will affect the baby for which stem cells found in the cord blood can be used then to cure the disease.
- The Top 10 Health Care Stories of 2010 (dailyfinance.com)
- The BP Oil Spill’s Long-Term Threat to Bluefin Tuna (dailyfinance.com)
What do you do if an AIDS patient is dying but does not want the family members to know the diagnosis?
This was an ethical dilemma that I faced some time ago. This young man was admitted with pneumonia and expressly told the doctors not to disclose his illness to family and friends. As doctors, we were bound to uphold confidentiality. Should this be absolute at all costs, no matter what?
As was expected, his condition quickly deteriorated and he lapsed into coma. Close friends and relatives soon arrived at the hospital, each one enquiring on what was wrong.
Needless to say, a decision had to be made quickly enough on what to reveal or, more important, what not to reveal. We decided that, as the patient had nominated a next-of-kin, that this person would be the proxy for determining the future management and course of action. The patient had voluntarily nominated a person to make decisions on his behalf, so, by inference, this person should be told of his actual disease.
However, after much discussion, the medical team agreed that, as it was unlikely that the patient would survive another 24 hours, telling the next-of-kin was not going to affect decisions on management anyway. It would have been different if there were possibilities that treatment could realistically prolong his life; then the next-of-kin would have needed to be told of the diagnosis in order to obtain permission for the next course of action.
The patient eventually passed on a few hours later and relatives were told that he died of pneumonia due to an underlying cause for which the doctors were not under the liberty to disclose.
In this case, the duty to maintain doctor-patient confidentiality was maintained. This duty is not absolute always as pointed out above. Also, as AIDS is a notifiable disease, health authorities needed to be informed and further action necessary if there is a suggestion that the patient had infected others.