Bioethics Might Take Medical Ethics' Place

Dr. Edmund Pellegrino says that medical ethicist and bioethics should be working together for the good of patients. Dr. Pellegrino, Professor Emeritus of Medicine and Medical Ethics at the Center for Clinical Medical Ethics at Georgetown University Medical Center, spoke at Duquesne University about medical ethics' relationship with bioethics. Medical ethics is the system of ethics that is applied to physicians and patient care, while bioethics is interdisciplinary and focus on the question that arise from bio-science.

Pellegrino says that bioethics was formed out of three main events, the first being the cultural shift that began in the 1960s away from previously trusted authority figures. He says that this distrust that happened around the time of the Watergate scandal caused the second event, a mistrust of physicians and medical ethics.

The third event was an acceptance of multiculturalism. "And that's all fine, but then again it began to confuse one cultural set of values with the right rules and this fed into the idea of individual determination. 'What's right and wrong is what I say it is, what I say it is, what I believe. And don't tell me anything different and don't argue with me."

Dr. Pellegrino stresses that instead of just accepting the values that one already has, there needs to be discourse and public examination of whether those are right or not. He says that without examination of whether things are actually beneficial to society or a patient there can be no true progress.

Pellegrino says that he sees two possible futures for bioethics. One is where bioethics take the place of Medical ethics. "No matter how highly organized we can be, not matter how technical we can be, how scientific we can be. The human condition of being will and wanting to be helped, cured if possible, at least relieved of pain and suffering will be universal. Don't leave that to this vague notion of bioethics. I'm asking you to leave it to physicians."

The second future would be one which he most likes, one where bioethics and medical ethics can work together. He says that the aim of both types needs to be figuring out how to best look at the human condition of being ill and working in the best interest of people.

Safe Drug Disposal

On April 30th "Drug Take Back Day" will be in effect throughout the Pittsburgh region and across the nation. The Pennsylvania Resources Council (PRC) and Highmark Blue Cross Blue Shield will sponsor an event at The Mall at Robinson to dispose of prescription drugs instead of flushing or throwing them away. David Mazza, Western Regional Director for the PRC says there is no limit to what prescriptions can be brought.

"Everything from pills ointments and creams. We are also accepting both controlled and non-controlled substances. So, when we talk about controlled substances we are talking about prescription pharmaceuticals things like Vicodin, Oxycontin, Demerol, so any of the narcotic-type prescription medications. All of those will be accepted."

He also notes that flushing medications is dangerous because the wastewater system is not meant to digest prescription compounds, meaning that they could end up in the water system. Also, throwing them in the trash can make it easier for the drugs to get into the wrong hands, or damage the environment by being in a land fill. Since prescription drug abuse is more of a recent epidemic, Mazza says that there is no safe way to dispose of medications other than attending semi-annual Drug Take Back event. From the event, dropped-off medications will safely be incinerated.

Mazza says that individuals can drive-through, but suggests blacking-out personal and doctor information on the label before dropping the medications off at the event.

Mazza says that there are 133 collection sites in Western Pennsylvania. To find a site near you, visit www.dea.gov

Professor Develops Revolutionary Cancer Drug

Dr. Aleem Gangjee and his team at Duquesne University have received a $2.8 million, five-year grant from the National Institutes of Health to continue studying cancer-fighting compounds that target specific cancer cells and leave normal cells alone. The distinguished professor of medicinal chemistry at Duquesne created the drug to target a specific transport system that 20 to 30 percent of all cancer cells feature. Gangjee’s compounds carry drugs inside the tumor using the specific PCFT transporters. The drugs then cut off the DNA-synthesis machinery, killing the cell. Because the compounds use the specific transporter that is unique to cancer cells, healthy normal cells are unharmed. Gangjee says his compound acts as a sort of Trojan Horse. “The tumor cell doesn’t suspect that it’s taking up a fraudulent vitamin if you will, and once it gets inside the tumor cell is just blocks up the entire DNA-synthetic machinery,” he says. Gangjee’s drugs work on about a quarter of all cancers but works extremely well on some specific types of cancer cells. “There is some percentage in the 20 or 30 percent of tumors that do indeed express [the transport system]. The most prevalent kind that express this are ovarian cancer cells. Almost 90 to 95 percent of all ovarian cancer cells over-express this transport system,” he says. So far, there have been no side effects from the lab trials on mice. Gangjee hopes that the years of research following the discovery of this transport system in 2006 will lead to a clinical human trial by the time the grant runs up. “We’re sufficiently along in our preliminary studies that we are hoping at the end of this five years we should have a candidate hopefully ready for clinical trials,” he says.

UPMC Performs Less-invasive Aortic Valve Replacement

UPMC surgeons performed the first round of procedures that replaces patent's aortic heart valve without having to perform open heart surgery. The hospital is one of 40 hospitals nation-wide participating in the Medtronic CoreValve® Clinical Trial evaluating a non-surgical procedure as an alternate to open-heart surgery for aortic stenosis patients. The procedure requires doctors to channel a catheter through a small opening in the femoral artery to reach the patent's heart, then the CoreValve is guided to the aortic valve where it self-expands to replace the diseased valve.

William Anderson, director of Interventional Cardiology at UPMC, says that this procedure is different than other methods. "The gold standard of therapy for aortic valve replacement is to do it through open heart surgery, and that's an operation that we've done for a long time and we're very familiar with. The disadvantage to it is that it is maximally invasive and it has a relatively long recuperation period."

Anderson says that the procedure has yet to show whether or not t will be a commercial success. He says that there are two other valve replacements being made available commercially relatively soon and we should see in the next 12 months if either is successful.

Aortic stenosis prevents the heart's aortic valve from properly opening which leads to less healthy blood flow from the aorta to the rest of the body. Approximately 300,000 people suffer from aortic stenosis worldwide, one third being deemed too high risk for open heart surgery.

The CorevValve System will be available commercially until the end of its clinical trial and approval of the FDA.

Study Finds Arthritis Patients Suffer From Poor Sleep

A recent study performed by the University of Pittsburgh School of Nursing found that those affected by Rheumatoid Arthritis often experience very poor sleep quality which can translate to increased symptoms and poor life quality.

The study used a sleep questionnaire to identify problems in the subject’s sleep and of 162 people tested, it found that 61 percent experience “poor sleep” according to the Pittsburgh Sleep Quality Index. Thirty-three percent reported experiencing disturbing pain in their sleep at least three times a week.

Dr. Faith Luyster a research assistant professor for Pitt’s School of Nursing says a lot can be achieved if these subjects could sleep more peacefully.

“By improving their sleep it’s going to impact a lot of daytime symptoms and impairments that they have,” Dr. Luyster says. “In our study we found that poor sleep was associated with limitations and being able to do daily activities and social activities.”

The study identified two possible solutions to solving the poor sleep quality of the subjects tested. According to Dr. Luyster, behavior changes can lead to better sleep.

“Having a consistent bedtime and wake-time is important, avoiding caffeine, alcohol and vigorous exercise before they fall asleep, and creating as comfortable a sleeping environment that they can.”

Dr. Luyster also identified the importance of using the bed only for sleep and sex and avoiding watching TV or doing work in bed. Another solution offered by the study is the use of prescription medications to improve sleep.

Smart Phone App May Save Lives

A new smart phone application that connects first responders to doctors at the West Penn Allegheny Health System and also links to life flight helicopters and Google Maps is the first of its kind in the U.S.

Jeffrey Polana, Director of Pre-Hospital Operations at Alle-Kiski Medical Center, worked on the app with a German friend. There is a triage system to help emergency personnel determine what the patient is experiencing and, for example, get an EKG to a doctor in 15 seconds. The closest hospital to treat the specific problem is identified and driving directions given.

There is a pre-alert function that sends coordinates from an accident scene to a helicopter dispatch center, according to Polana, that can save up to ten minutes in getting a patient to the hospital. Saving time can save lives, says Polana.

Anyone can download the app free through the Apple Store and use some of the functions, but approval is needed to contact West Penn Allegheny Health System doctors or a dispatch center. There have already been 500 downloads and 140 approvals in the Pittsburgh area, says Polana.

Pitt Researcher Creates Database for Pregnancy Complications

Dr. James Watson, a researcher at the University of Pittsburgh, is spearheading a project to research prevention and treatment for preeclampsia along with creating a database for future studies. “We’re trying to bring together groups of individuals who have data and biological samples that have studied preeclampsia in the past with the idea that we can maybe pull sources to answer questions pretty quicky,” Watson says. The database method has been successful in other research, including cancer and heart disease. Watson is the senior advisor to PRE-EMPT or PRE-Eclampsia Monitoring, Prevention, and Treatment, a group that is funded by the Bill and Melinda Gates Foundation through a $7 million grant over four years. His goal is to create a research database filled with blood, urine, and other biological samples from ethnically diverse women across the globe. This database will facilitate the first goal of finding a specific marker of the disease, but can also be used in future pregnancy research. “We’re hoping that we can move pretty quickly. It’s our initial goal to find something along the line of a predictor,” Watson says. Preeclampsia is a pregnancy complication that involves high blood pressure in the mother and affects five to ten percent of pregnancies. It is the second leading cause of maternal death worldwide.

State House Passes Bill to Protect Students With Allergies

Parents of children with food allergies can begin to feel a peace of mind as a bill that would force school districts to create a policy allowing children to carry epinephrine medication awaits the governor's signature. Passing the bill on a bipartisan vote of 180-19, the House was persuaded by the dangers of an allergic reaction without medication.

Bill sponsor Matthew Smith, a Democrat from Allegheny County, says it’s essential for children to be able to self-medicate themselves after an allergic reaction.

“It can strike a child at any moment and it’s imperative that they have these EpiPens on their person at the time they suffer from the food allergy attack. It will help prevent them from going into anaphylactic shock.”

If a child has an allergic reaction to something they ate, often nut-based, the child has only a few seconds to medicate themselves. Students are currently prohibited from carrying epinephrine medication such as EpiPen injectors in school and this legislation would allow those medications to be carried on the person at all times.

Smith says the bill is as much about ensuring peace of mind for parents as it is about the protection of students.

”It gives the parents the peace of mind that if their son or daughter has a food allergy they’ll have the EpiPen on their person at school to administer the medication that literally needs to be administered in a matter of seconds,” Smith says.

Concerns about the maturity of students carrying the medication and their knowledge of how to use it were considered in the legislation and the bill includes safeguards to ensure that the child knows how to use it along with physician and parental consent.

Medical Authority Speaks Out on Misdiagnosis

The Pennsylvania Patient Safety Authority says diagnostic errors in medicine range from 4-50% depending on discipline, and cause twice as many ‘adverse effects’ as medication errors. But the Authority says misdiagnosis receives far less attention than medication errors.

Diagnostic errors include missed, late, or false diagnoses. Pennsylvania Patient Safety Authority Clinical Director Dr. John Clarke says some medical disciplines are less affected by misdiagnosis than others.

“In pathology, dermatology, radiology, you’re usually making the diagnosis on what you’re seeing. The history counts less than the observation,” says Clarke. “For the rest of the specialties, you’re depending on the history, the observation, and often on other things such as the cardiologist listening to the chest.”

Clarke says though they don’t always result in harm to the patient, diagnostic errors are some of the most common grounds for medical malpractice claims.

He says doctors can reduce errors by simply listening more closely and making sure to understand the patient, while patients should be sure to give as much medical history as possible, even if it seems irrelevant.

Clarke says the new health care law will also help combat misdiagnoses by encouraging electronic health records for use by both doctors and patients.

ACHD Calls for Reserve Medical Volunteers

Volunteers are needed for the local Regional Medical Reserve Corps, an emergency response group covering 13 counties in southwestern Pennsylvania.

Allegheny County Health Department spokesman Dave Zazac says the Reserve Corps is called up in times of medical emergency, like any natural or man-made disaster.

“For instance, if indeed we had an oil spill up here as opposed to down in the Gulf; if we go back to Hurricane Ivan, whenever there was flooding in certain sections of the county; other really wet-weather events perhaps at this time of year.”

You don’t need to be a doctor or a nurse to apply – Zazac says the Health Department would also need non-medical personnel to help contain crowds and provide clerical support. He says the Health Department provides free training online and in classrooms.

Reserve Corps chief Ed Schwartz says in emergency conditions, the state or federal government would cover any liability if a medical error should occur.

Southwestern Pennsylvania’s Region 13 chapter currently has 485 members. To apply, call the Health Department at 412-578-8349 or visit their website.

Study Finds Major Geographic Differences in Medicare Drug Spending

The study, published in the New England Journal of Medicine finds that some regions in the U.S. spend twice as much as others on drugs under Medicare. Dr. Yuting Zhang is a professor of Heath Economics at the University of Pittsburgh and is the lead author of the report. She also found little correlation between spending on drugs and spending on other medical services like hospitalizations and visits to the doctor. Zhang sees the study as an important tool for health care reform and bringing down medical costs. She says eventually they can use the data to learn why some places are inefficient with their spending and how to emulate best practices from other areas that keep their costs low while maintaining quality patient care. Researchers divided the country into 306 hospital-referral regions and controlled for geographic differences in cost, demographics, insurance and overall health. Manhattan New York spends the most on drugs under Medicare at $2,973 annually per beneficiary, the Hudson Florida area spends the least per beneficiary at $1,854 per year. Out of the 306 regions Johnstown Pennsylvania was ranked the 15th highest spender on drugs, but came in at 242 in overall medical spending. Pittsburgh ranked 59 and 61 respectively. Zhang says they will conduct follow-up studies focused on doctors' prescribing practices and a comparison of the prescription of generic and brand name drugs.

DNA Repair Proteins Tracked While Working at Pitt

A group of researchers at the University of Pittsburgh say they have made a breakthrough in understanding how damaged DNA is repaired. PhD. Bennett Van Houten is with the University of Pittsburgh Cancer Institute and the lead author of the paper published in today’s issue of Molecular Cell. Van Houten says they attached “quantum dots” to DNA-Repair proteins in an effort to watch them work. The dots shine brightly when exposed to light and this allowed the researchers to track their movement along strands of DNA that had been unraveled and stretched around a bead. In a normal cell the proteins search out damaged sections of DNA and then call in other proteins to make repairs. Van Houten says they went into the research wondering how the relatively small numbers of these special protein molecules were able to check so much DNA. Some theorized that the proteins would make random hops around the DNA strand while others believed the protein would slide up and down the DNA. Critics of the jumping theory said it was too inefficient but critics of sliding noted that DNA in a cell is crumpled up into a ball and the slider’s path would be blocked from time to time. Van Houten says what they found was that both methods are used. The proteins slide down the DNA for about seven seconds and then hop to another area of the strand. With the DNA on the surface of a bead and the quantum dots attached Van Houten and his team were able to get video of the movement.

All cells have these proteins and if they stop working the cells cannot survive. Van Houten says, “Everyone is constantly bombarded with environmental toxins that inflict small errors in the DNA code, so a rapid repair system is essential to maintain the integrity of the sequences for proper cell function.” Now that they have a better understanding of the movement of these repair proteins, Van Houten says scientists can start to use the knowledge to begin new efforts to prevent cancer and make cancer drugs more effective.

Technology to Detect Dementia, Infirmity in Seniors

Researchers from Carnegie Mellon, the University of Pittsburgh and Presbyterian SeniorCare will use unobtrusive sensors embedded in everyday objects to detect physical impairment or the onset of dementia in seniors.

Sensors will evaluate a person's ability to take medicine, use the telephone and prepare meals, says CMU Associate Professor Anind Dey.

If it takes longer and longer to open the right compartment in a pillbox or if medications are not taken correctly, Dey says sensors will report the problem--usually long before the people themselves seek help. Intervention, whether pharmacological or behavioral, will then be possible before damage is done or institutionalization is necessary.

The research team here, one of five in the country funded by the Robert Wood Johnson Foundation, will recruit 30 to 50 seniors who have osteoarthritis and are at risk of dementia.

Tuesday is World AIDS Day

At a news conference tomorrow morning, Mayor Luke Ravenstahl and AIDS activists in Pittsburgh will remind people there is still a problem right here in Allegheny County.

Kathi Boyle, Executive Director of the Pittsburgh AIDS Task Force says 93 new cases were diagnosed last year, but 25% of people with HIV don't know they are positive. Those who don’t know they have HIV are responsible for 70% of new infections each year, according to the Centers for Disease Control, so it’s important for everyone to be tested.

Free, confidential testing is always available at the AIDS Task Force in East Liberty and other locations. Tomorrow, the Allegheny County Health Department mobile testing unit will be at 4th and Grant Steet from 10 to 5. Boyle says both UPMC and Allegheny General offer free treatment and medications that are either free or at a reduced rate.

With early treatment, Boyle says people with HIV can live long lives.

Pitt Group Helps Vets With Facial Injuries

Researchers at the University of Pittsburgh School of medicine have picked up $1.6 million to perfect a fat grafting technique that the team hopes will help wounded soldiers return to a more normal life. Associate professor of surgery J. Peter Rubin is the head of the team awarded the Department of Defense grant. The doctors will use new regenerative tissue technologies and new medical instruments to transfer fat from one part of the patient’s body to his or her face. Rubin says, “As many as 26 percent of wounded soldiers suffer some kind of facial injury, which can have a huge impact on quality of life. While we can reconstruct bony structures very well, it is the surrounding soft tissues that give people a recognizable face. This project will investigate how soft tissue grafting can more precisely restore facial form and improve the lives of our wounded soldiers.” Rubin says the wounds received in combat are often very destructive involving shrapnel and burns. Rubin says the underlying tissue is often very scared and the work is done in “tight spots.” That leads to the need for new techniques and interments. About 20 patients will be treated in Pittsburgh under this grant. Doctors at military hospitals will then be taught the techniques and eventually offer the reconstructive work to more veterans. The first surgeries will be performed in January. The team of doctors doing the work includes a psychiatrist to help the patients with the transition and measure the impact the injuries and the new surgeries have on returning vets.

Nano Cups Filled in Pitt Lab

Researchers at the University of Pittsburgh have created “cups” that are only a few nanometers wide that researchers hope will someday help fight disease. Graduate student and researcher Douglas Kauffman says the “cups” are less than 1-100,000 of the width of a human hair. In the lab those cups were filled with an indicator substance, which makes Kauffman believe they can eventually be used as a sort of medical Trojan Horse. For example, the nano-cups could be filled with a cancer-fighting drug and coated with a substance that will seek out the cancer cells. Once the cups are in the cells they can “pour out” the medicine. Kauffman says if done right, the same coating that makes the cups seek out a cancer cell could make it pass through organs that could be damaged by either the drug or the device. The findings were published in this month’s edition of “Advanced Materials.” Kauffman says the University of Pittsburgh lab will next work on coating the cups and perfecting the release mechanism.

PHC4 Extended Through 2014

The Pennsylvania Health Care Cost Containment Council got a five-year extension through 2014 last week. In signing the legislation, Governor Ed Rendell credited the council's reports with lowering the state's mortality rate, thereby saving 49,000 lives and $1.7 billion over the last twelve years.

A PHC4 report on hospital-acquired infections led to an infection prevention law that has lowered the infection rate in Pennsylvania by 8%, and Pennsylvania is the first of only four states issuing report cards on physicians performing cardiac surgery.

Communications Director Joe Martin says PHC4 will continue the groundbreaking reporting that's made it the national standard and look for new ways to help consumers and providers achieve the best quality at the best possible cost.

Breastfeeding Lowers Women Health Risks, Study Shows

A study conducted by University of Pittsburgh researchers shows the more women breastfeed, the lower their risk for heart attacks and strokes. According to the study, women who breastfed their babies for more than a year were ten percent less likely to suffer heart disease, than women who had never breastfed.Dr. Eleanor Schwarz, Assist Professor of Medicine at the university says it likely has to do with the natural process of recovery from pregnancy. She hopes policies can be changed to promote breastfeeding among women including changes in public breastfeeding policy and maternity leave for working mothers.

Pitt Receives Grant to Train Foreign Scientists in Combating HIV

Researchers at Pitt have received a 5-year, $2.8 million grant from the National Institutes of Health's Fogarty International Center to train researchers and scientists in countries hit hard by the HIV/AIDS epidemic. A new center will open in Mozambique, while existing centers in Brazil and India will be updated.

Principal Investigator Lee Harrison says on reason they chose Mozambique is because one in every three pregnant women has HIV there. "And there are very few trained scientists to help study and control the epidemic there," says Harrison. He says students from both of the country's medical schools appear to be promising candidates for HIV education. However, for the time being, pupils will be trained only in the basics of AIDS research. Many scientists that Pitt trained in Brazil in the past 10 years will also help to train new researchers in Mozambique; both countries share the same language, Portugese.

In India, says Harrison, the grant funds will be used to bolster the research on new laboratory equipment that could help in the fight against AIDS and HIV.

Heart Association Lobbies for Health in Harrisburg

The American Heart/Stroke Association lobbied in Harrisburg Tuesday to promote awareness and improve health throughout Pennsylvania. According to their statistics, heart diseases claims one victim every 34 seconds and killed over 43,000 Pennsylvanians in 2006. State Senator Christine Tartagalione of Philadelphia says women have to realize their risk for heart disease is just as great as the risk for men. The Heart Association projects heart disease and stroke will cost the nation $475.3 billion in medical expenses and lost productivity in 2009.