Stem cells, tissues and regenerative medicine

Excerpted from "Stem cells mimic human brain," Nature. August 28, 2013 -- With the right mix of nutrients and a little bit of coaxing, human stem cells derived from skin can assemble spontaneously into brain-like chunks of tissue. “It’s a seminal study to making a brain in a dish,” says Clive Svendsen, a neurobiologist at the University of California, Los Angeles, who was not involved in the study. “That’s phenomenal.” A fully formed artificial brain might still be years away, he notes, but the pea-sized neural clumps developed in this work could prove useful for researching human neurological diseases.

In the latest advance, scientists developed bigger and more complex neural-tissue clumps by first growing the stem cells on a synthetic gel that resembled natural connective tissues found in the brain and elsewhere in the body. Then they plopped the nascent clumps into a spinning bath to infuse the tissue with nutrients and oxygen.

“The big surprise was that it worked,” says study co-author Juergen Knoblich, a developmental biologist at the Institute of Molecular Biotechnology in Vienna. The blobs grew to resemble the brains of fetuses in the ninth week of development. Under a microscope, researchers saw discrete brain regions that seemed to interact with one another. But the overall arrangement of the different proto-brain areas varied randomly across tissue samples — amounting to no recognizable physiological structure.

“The entire structure is not like one brain,” says Knoblich, adding that normal brain maturation in an intact embryo is probably guided by growth signals from other parts of the body. The tissue balls also lacked blood vessels, which could be one reason that their size was limited to three to four millimeters in diameter, even after growing for 10 months or more.

Commentary

CMDA Member and Senior Fellow for Family Research Council David Prentice, PhD: “There have been numerous stories lately about using induced pluripotent stem (iPS) cells to form various tissues, including vascular endothelial cells for blood vessels, myocardial tissue for heart muscle regeneration and even brain tissue for study of normal and abnormal brain development.

“The iPS cells, because they are created from the patient’s own normal cells, could potentially provide tissues for personalized drug development or for transplant. There are still significant practical problems to overcome with iPS cells, including their penchant for growth, which may make them more suitable for laboratory study than for the clinic.

“But the ethics of the research is also significant. The iPS cell creation technique (for which Dr. Yamanaka won the Nobel Prize) does not rely on creation or destruction of human life—it does not use embryos, eggs or cloning techniques. Thus, it provides an ethical source of cells for study (as long as the molecular tools used for creation of the iPS cells are ethical, of course; i.e., not using aborted fetal tissue for DNA production, etc.). As more and more cellular and molecular techniques approach the clinic, this ethical consideration is very important if we are to maintain our stance for life. “Do no harm” applies not only to the patient treated, but to the origin of the treatment as well. We should reject any ethically-tainted treatments just as we would reject any bacterially-tainted or chemically-tainted drug or instrument.”

Resources
CMDA Ethics Statement on Stem Cell Research and UseScientific Demagoguery in the Stem Cell Wars by David Stevens, MD, MA (Ethics)

Using social media in clinical practice

Excerpted from "Docs Need to Get Up to Speed, Social Media Advocate Says," MedPage Today. August 15, 2013 -- Bertalan Mesko, MD, PhD, is counting on old media to convince more clinicians about the value of new media. The clinical genomics specialist has just published a handbook on social media in clinical practice -- and he hopes it will bring late adopters up to speed with their social-media-savvy colleagues, and even with some of their electronically empowered patients.

While "expert" patients voraciously pursue credible medical information and communities online, clinicians "usually lag behind," Mesko, who is based in Budapest, said in an email exchange with MedPage Today. Instead of disdaining this kind of behavior, doctors need to see themselves as a gatekeeper of vetted online information and activities, he said.

“Social media provides us with a lot of opportunities, but only if we know the potential limitations and security issues. Acquiring such knowledge takes years, and my goal with the handbook was to shorten this time significantly for those medical professionals who would like to become a bit more digital, but at the same time use these online tools in a secure way,” said Mesko in an online engagement via email.

“I think communication methods in real life and in the online world are the same. If medical professionals understand this and create a proper online presence, as well as give their patients a chance to communicate with them through certain online channels, the doctor-patient relationship can become more efficient by saving time for both parties. Using digital technologies, especially social media, is now an integral part of medical communication, and as more and more patients use these platforms, their physicians must be able to deal with this in an evidence-based manner,” said Mesko.

Commentary

CMDA Vice President and National Director of Campus & Community Ministries J. Scott Ries, MD: "Mention 'social media' during a conversation with one of your colleagues and observe the resulting reaction of the facial muscles. I predict you'll identify a subtle pupillary dilation, upturning of the corners of the mouth and an increase in pace of speech...or else you'll view a burrowing of the forehead creases, tightening of the lips and clenching of the jaw. When in past history has any other 'tool' ever evoked such emotional response from its users (or haters)?

"At its core, social media is indeed simply a tool—a forum to communicate, share ideas, explore information, engage conversation and create community. If you already embrace social media at some level, you won't be surprised to hear that I'm more likely to be contacted via Facebook than email by students, residents and even some doctors.

"If you find yourself beset with the clenched jaw, here are a few things that might help you dip your toe in the social media waters without catching a cold.

1. Recognize that social media does not equal Facebook. Not all of social media is Facebook. As social media expands, the relative amount of the landscape occupied by Facebook is diminishing. If Facebook seems daunting to you, choose another option to explore.
2. Peruse areas of CMDA’s social media engagement. CMDA is actively engaged with social media with both the current and upcoming generations of doctors.
3. Consider following just one blog, along with following their Twitter and/or Facebook posts. This will let you ease into the foray a bit without becoming overloaded.

For more practical insight into how to use social media, the benefits it can offer you and your practice and other information, check out Social Media in #Healthcare: Why You Should (Like) Social Media by Bill Reichart, MDiv.

"But won't social media consume any vestiges of time remaining in our overloaded schedules? Only if we let it. It's like when I was taking driver's ed as an inexperienced 15-year-old. In attempting to pass a slow moving truck, I was hesitant to exceed the speed limit. Seeing the approaching car, the instructor promptly pushed her 'instructor’s accelerator' to quickly get us by the truck, while calmly saying 'Control the car. Don't let the car control you.' So it is with social media. However you choose to engage, control it...don’t let it control you."

Resources
Social Media in #Healthcare: Why You Should (Like) Social Media by Bill Reichart, MDiv

CMDA's Social Media Pages

• Facebook
  
• CMDA Student Life Facebook
  
• Twitter
  
• YouTube

Hardwired for empathy

Excerpted from "Study finds that our brains are hardwired for empathy, friendship," Medical News Today. August 26, 2013 -- Perhaps one of the most defining features of humanity is our capacity for empathy - the ability to put ourselves in others' shoes. A new University of Virginia study strongly suggests that we are hardwired to empathize because we closely associate people who are close to us—friends, spouses, lovers—with our very selves.

"With familiarity, other people become part of ourselves," said James Coan, a psychology professor in U.Va.'s College of Arts & Sciences who used functional magnetic resonance imaging brain scans to find that people closely correlate people to whom they are attached to themselves. The study appears in the August issue of the journal Social Cognitive and Affective Neuroscience.

Researchers found that regions of the brain responsible for threat response displayed little activity in the cases of shock to a stranger. However, when the threat of shock was to a friend, the brain activity of the participant became essentially identical to the activity displayed under threat to the self. "The finding shows the brain's remarkable capacity to model self to others; that people close to us become a part of ourselves, and that is not just metaphor or poetry, it's very real. Literally we are under threat when a friend is under threat," Coan said.

This likely is the source of empathy, and part of the evolutionary process, Coan reasons. "A threat to ourselves is a threat to our resources," he said. "Threats can take things away from us. But when we develop friendships, people we can trust and rely on who in essence become we, then our resources are expanded, we gain. Your goal becomes my goal. It's a part of our survivability."

Commentary

CMDA Member and Executive Director of Lighthouse Network Karl Benzio, MD -- "Some Christians have a hard time accepting science, associating science with Darwin, thus getting flustered thinking most science contradicts the Bible. Others really struggle accepting psychological sciences, associating it with Freud or thinking that psychotherapy is man worshipping man, trying to solve problems without God, or looking for an excuse for or to normalize aberrant behavior.

“But science is just the study of: 1) What God made; 2) Understanding how He designed it to function; and 3) Learning how to maximally steward it for His glory and our abundant living. Obviously, I am partial, but God’s two most incredible creations are the human mind and free will (our psychological process which produces decisions).

“As our Creator, like any good developer of a product, God gave us an awesome instruction manual, called The Holy BIBLE (Best Instruction Book for Living Everyday). Throughout the Bible, God clearly teaches us His design for us to be in relationships from the beginning in the Garden of Eden through our ultimate union with Him in the life after this in Heaven. Mark 12:30, the Greatest Commandment, instructs us to love God with all our heart, soul, mind and strength, but then to love others and ourselves (in healthy and Godly ways).

“This study reveals science about the circuitry God created for us to accomplish His command to engage in healthy and caring relationships. The missing piece science has a hard time quantifying, though, is the spiritual sphere, that spiritual part of man that is unique for each of us. Our spirit allows a special connection to God and a special connection to others. Unfortunately, Satan is always attacking our mind, but as we manage life the way the Bible instructs, circuitry for empathy, forgiveness and agape love grow as we carry out the Greatest Commandment and develop the mind of Christ.

“So engage the awesome science of our mind as it helps us understand how God designed us, but more importantly, how to steward our mind to glorify Him and live life abundantly. How you manage every minute is your decision, so choose well.”

Resources
“Cleaning Up” Marital Communication by William Curtrer, MD, and Sandra Glahn, ThM
Summer 2012 edition of Today’s Christian Doctor

Morning-after pill conscientious objection ends in job loss

From Freedom2Care blog by CMA VP for Govt. Relations Jonathan Imbody, Aug. 8, 2013:

Tolerance. Diversity. Broad-mindedness. Those are the words.

Bullying. Discriminating. Compelling. Those are the deeds.

The contradictory words and deeds often come from one and the same individuals--and in a case I learned about today, companies. Turns out the words of tolerance, diversity and broad-mindedness only apply to those who comply with the dogma and submit to the will of the speakers.

Here’s an email I received this morning from a pharmacist member of the Christian Medical Association:

"Subject: Forced to resign over mandate to sell the morning after pill.

"Just to let you know that Rite-Aid corporation came out with a stricter policy on July 5, 2013 that requires all employees to accommodate the sale of the morning-after pill to all comers, of either gender and of any age. I tendered my resignation within the hour, it was accepted, and my last work day is July 20th. I realize that I am an 'at will' employee and I do not expect any recourse. Just for your information to add me to the list of those quitting pharmacy solely because of the policy change. Keep up the good work. The battle rages. The Lord is able to supply our needs."

Remember that even the Obama administration health department opposed the unlimited sale of the morning-after pill, citing health concerns. So presumably, even the radically pro-abortion Secretary of Health and Human Services, Kathleen Sebelius, is not radical enough to work at Rite Aid.


Unfortunately, Secretary Sebelius and President Obama trashed the only federal regulation protecting healthcare professionals from discrimination and firings for reasons of conscience. They and other abortion advocates also can't seem to muster enough liberality to support the tolerant, diversity-respecting and broad-minded principles of the Healthcare Conscience Rights Act (S 1204 and HR 940).

While the regulation and the law apply specifically to government-funded programs, each can help establish an environment of true respect for conscience, tolerance and diversity that will protect health care professionals nationwide. Until then, pharmacists, obstetricians and family docs who still adhere to the Hippocratic oath and faith tenets remain subject to job loss, discrimination and ostracism for their life-affirming views.

Lawsuits challenge contraceptives mandate

Excerpted from "Critics of contraception mandate vow Supreme Court appeal," The Hill, Aug. 14, 2013 - Critics of the contraception mandate in President Obama’s healthcare law said they will appeal to the Supreme Court after a federal appeals court declined to re-hear their case Wednesday.
Alliance for Defending Freedom, one of the organizations challenging the contraception mandate in the courts, said it will ask the Supreme Court to consider whether the mandate is unconstitutional.

“Every American, including family business owners, should be free to live and do business according to their faith," Alliance for Defending Freedom said in a statement vowing to appeal to the Supreme Court.

Resources

Visit the CMDA Freedom2Care website for news, resources, legal analysis and commentary.

Take Action:
Before taking action in professional situations involving conscientious objection, contact one of the conscience rights specialist attorneys we work with. They typically provide their services on a pro bono basis, working for non-profit organizations dedicated to preserving religious liberty and advancing respect for life. Visit our Freedom2Care webpage on discrimination to learn more.

Urge your senators to support conscience rights - S.1204

Urge your Rep. to protect conscience rights - HR 940

Tax reform drive threatens deductions and charity

Excerpted from "Taming the tax code beast," Washington Post column by George F. Will, August 09, 2013 - “Colleagues,” said the June 27 letter to 98 U.S. senators, “now it is your turn.” The letter’s authors are Max Baucus (D-Mont.) and Orrin Hatch (R-Utah), the chairman and ranking Republican, respectively, on the tax-writing Finance Committee. From their combined 71 years on Capitol Hill they know that their colleagues will tiptoe gingerly, if at all, onto the hazardous terrain of tax reform.

Together with Chairman Dave Camp (R-Mich.) of the House Ways and Means Committee, Baucus and Hatch propose a “blank slate” approach, erasing all deductions and credits — currently worth more than $1 trillion a year — and requiring legislators to justify reviving them. Hence the Baucus-Hatch letter, in response to which almost 70 senators sent more than 1,000 pages of suggestions. Although some often were short on specificity, the submissions were given encrypted identification numbers and locked in a safe, as befits dangerous documents.

Baucus still hopes to bring Congress to an “all join hands and jump together” moment, “a tipping point where there is a sense of inevitability.”

Commentary

CMA VP for Govt. Relations Jonathan Imbody: In his column, George Will neglects to note that when Committee leaders put every tax deduction on the table, they opened the door to misdirected assaults on charity. I have been meeting on the Hill this month with U.S. senators (Thune, Hatch and Wyden) and staff on the Senate Finance Committee and the powerful House Ways and Means Committee to convince them not to tax money that people give away to charities. Doing so only transfers money from the hands of citizens and cost-effective charities to the government--and we know how well that works.

Faith-based organizations would get hit hardest under any of the current schemes secretly floated by Members of Congress. Cutting the charitable gift tax deduction would decrease giving and cut an estimated $140 billion in charitable services to needy Americans. Since the government would have to take up the cost for lost social services, any tax revenue gained from cutting deductions would be more than lost to new program costs. The result would be a deeper deficit, bigger government and less efficient and effective care.

Yet the prospect of targeting the charitable gift tax deduction has become alarmingly clear in my meetings with senators and staff. One of the most insidious cuts under consideration would eliminate deductions for gifts to charities such as universities, the arts and churches, which in the opinion of some do not provide sufficient tangible services to be deemed a "public benefit."

The 100-year-old tax deduction for gifts given "exclusively for religious, charitable, scientific or educational purposes" enforces the First Amendment's proscription against government infringement of the free exercise of religion. Imagine the IRS determining which churches and faith-based charities merit approval for tax deductions. Congress should take aim at real tax reform while protecting charity and those who depend on it. Charity is not a loophole; it's a lifeline.

Take Action:

Visit the Freedom2Care website now to learn more and take action on this issue that impacts your charitable tax deductions, charities and, most importantly, the millions of individuals served at home and abroad through American charities.

Use this easy form now to tell your legislators to protect your gift tax deduction, charities and, most importantly, those they serve!

Links

To keep up with public policy:

• Website: www.Freedom2Care.org
• Legislative action center: http://f2c.capwiz.com/f2c/home/
• Blog: http://freedom2care.blogspot.com/
• Twitter: @Freedom2care

Ethics of Placebo Treatments

Excerpted from “Patients’ attitudes about the use of placebo treatments: telephone survey,” British Medical Journal. July 2, 2013 -- Several recent surveys of physicians have documented their use of placebo treatments in clinical practice. In a recent U.S. survey of internists and rheumatologists, half reported that they have prescribed placebo treatments, defined as treatments “whose benefits derive from positive patient expectations rather than from the physiologic or pharmacologic mechanism of the treatment itself.” These placebo treatments included active agents such as vitamins or analgesics that a physician prescribed to promote positive placebo effects rather than specific pharmacologic or physiologic effects.
The prescription of placebo treatments as part of medical care is ethically controversial. Their use has been criticized because the practice is thought to involve deception, thereby violating patient autonomy, because of concerns about the compatibility of placebo treatments with evidence-based medicine, and because the risks introduced by some placebo treatments outweigh the possible benefits of their use, as in the case of prescribing antibiotics for viral infection. U.S. clinical practice guidelines prohibit the use of placebo treatments without a patient’s knowledge, citing concerns about undermining trust and compromising the patient-physician relationship. Despite these concerns, some have argued that use of placebo treatments can be justified when they are effective, at least in certain cases.

The perspectives of U.S. patients have been missing in the debate over the use of placebo treatments in clinical practice. To probe the attitudes of U.S. patients regarding placebo treatments, a survey was conducted of adult members of a large Northern California health plan. The survey utilized a carefully constructed definition of “placebo treatments,” used a combination of general questions and detailed scenarios, and included a large and demographically diverse sample of patients. The data shows that patients are open to the idea of placebo treatments. Most (50 to 84 percent) judged it acceptable for doctors to recommend placebo treatments under conditions that varied according to the doctor’s level of certainty about the benefits of the treatment, the purpose of the treatment (for example, to address a patient’s need to receive a treatment) and the transparency with which the treatment was described to patients. Fewer than a quarter stated that it was never acceptable for doctors to recommend placebo treatments. In addition, many respondents indicated a willingness to try placebo treatments in different scenarios. This is generally compatible with trends reported in previous patient surveys in other countries regarding willingness to try placebo treatments.

Commentary

CMDA Member and Ethics Lecturer at Dublin City University, Ireland Dónal P. O’Mathúna, PhD: “The placebo effect is often viewed negatively, as something to be eliminated in medical research or as a way to explain how ‘inert’ interventions have effects. More recently, placebos have been declared unethical, a deceptive violation of patient autonomy. The American Medical Association holds that placebos should be prescribed only if patients agree to their use.
“The BMJ study defined the placebo effect as patients getting better after a treatment because they expected improvement, not because of the treatment itself. It found that most patients are open to placebos, but concerned about the deceptive element. The findings highlight the importance of honesty and trust in medical practice.

Many believe placebos only work if patients do not know they are taking them. In the BMJ survey, two-thirds would try a placebo for moderate stomach pain or chronic abdominal pain, if told they were given a placebo. A recent randomized controlled trial found that irritable bowel syndrome patients, fully informed about being given an inert placebo, had significantly better outcomes than those given no treatment (Kaptchuk et al. PLoS ONE 2010;5(12):e15591). The placebo included a supportive interaction with patients given a clear rationale for how placebos might be beneficial.

Research into the placebo effect provides evidence that ethics matter, and that patients want open and honest interactions with their physicians. These studies support the non-deceptive use of placebos. Our mind, body and spirit are intricately interwoven. How we relate to others makes a difference.

Resources
Alternative Medicine: The Christian Handbook by Dónal O’Mathúna, PhD and Walt Larimore, MD
CMDA Ethics Statement on Human Research Ethics
Bioethics Ireland