Could brain surgery cure obesity ?

The number of people in the western world who are obese is now reaching dangerous levels. Some researchers are already calling it a pandemic. What so many physicians/researchers are trying to figure out are the reasons behind such a large percentage of the population being so over-weight. Many blame the eating habits-which consists mostly of fast food and over-processed foods. Still, another part of the reason might be a genetic defect that these individuals possess which makes it harder to loose the weight once they put it on. For people who wish to loose a few pounds for the summer, a diet of eating properly and exercising will result in a slimmer waist line. However, for those individuals who are morbidly obese often times need more help than just dieting to loose this large amount of weight.

A common choice for these individuals has become gastric bypass surgery, where the individuals stomach is shrinked to an extremely small size so that they cannot hold a large amount of food. For many, the results from this surgery have been astonishing. Everywhere in the media, there are examples of people who have lost 150-300 lbs from undergoing gastric bypass surgery. However, there are still some individuals who consider the risks of the operation far to large and seek other forms of treatment to loose the weight. Still, there are those who have underwent this type of surgery without receiving the results they desired.

Just recently, physicians have begun implanting electrodes into the brain to curb their cravings for food. Neurosurgeons from West Virginia University Hospital found electrical signals sent to an area in the brain, called the hypothalamus, which controls eating, can curb hunger in the obese. This surgery is the result of a three year, U.S. governmental trial and is now available to 20% of the population who have tried diets and surgery such as gastric bypass without loosing a significant portion of the weight. There has already been 2 successful surgeries in which both patients are satisfied with the amount of weight that they have been loosing. As a result, physicians are planning on more of these surgeries in the future.

With this surgery being so radial from all the other weight-loss treatments, many are challenging its usefulness in the medical field. Many critics have problems with physicians manipulating the patients brain to suppress these hunger triggers sent to the stomach. Through this surgery, the patient looses the control to determine when they are full or not, which is one of the main reasons behind them becoming obese in the first place. Instead of addressing their issues with food, the surgery is more or less just hiding these issues. Meanwhile, other critics are concerned with the high amount of risk associated with this surgery. There are already surgeries like this one in which surgeons use electrodes in the brain to help control Parkinson's or Obsessive Compulsive Disorder. However, critics consider these diseases much more complicated and difficult to treat than obesity. Taking such a large risk-under going brain surgery to curb an appetite, seems a little obtrusive when there are numerous other treatments available for these individuals. Despite what the critics state, the choice to have this surgery performed is ultimately the decision of the individual.

http://www.express.co.uk/posts/view/113367/Brain-surgery-could-be-cure-for-obesity

How private is your medical record ?

During the past week, it has been impossible not to catch some of the coverage surrounding the recent deaths of many public figures including Farrah Fawcett, Billy Mayes and Michael Jackson. Specifically, the death of Michael Jackson was such an unexpected, shocking event that many people are now looking into the medical charts to determine if there was a medical reason behind his early passing. Everything surrounding his death has become such a huge, public media circus from his will, his children, and his financial status at the time of his passing. The prescriptions that he was taking and his physical condition during the past few weeks and months has all been released to the media already. Everyday, more information is being revealed surrounding Jackson's medical health. However, should there be a limit to the amount of medical information that is released to the media surrounding these public figures ? How private are the medical records for these public figures ?

In an article from Fox News titled, Celebrity Medical Records Hacked: Are You at Risk ?, the release of medical records of Maria Shriver, Farrah Fawcett, and George Clooney were all snooped through by employees of the hospital. In April of 2008, the medical records of 30 high-profile patients, including Maria Shriver had their confidential records breached at UCLA medical center. The woman behind the Shriver case, Lawanda J. Jackson was also responsible for improperly looking at 61 patients' medical records before she resigned in May 2007. However, it is not just celebrities whose medical records are being looked at without the patient's consent.

Dr. Deborah Peel, founder and chairwoman of Patient Privacy Rights, a non-profit advocacy group, stated that "essentially, all medical records are up for sale to large corporations, research facilities and drug companies." She goes on to say that "by signing a Health Insurance Portability and Accountability Act consent form, you not only are giving your doctor and insurance company access to your medical record, but you may be giving them permission to sell your information as well." Linda Sanches, senior advisor for HIPAA Privacy Outreach states that "The privacy rule requires health care providers to give patients a notice of privacy practices to provide them with important information on how their health information may be used and disclosed, as well as what their rights are with respect to their information and how the individual can exercise these rights." Many consumers are not aware of every right that is included when they sign the HIPAA statement at physician offices. Bottom line, patient's need to be fully aware of what they are signing when they enter doctor offices. In the Shriver case, clearly this type of action was not warranted by the patient. However, the HIPAA privacy rule allows more than just the physician and patient to review the medical records, which is something very few people are aware of.

http://www.foxnews.com/story/0,2933,348988,00.html

Is there ethics on tv ?

During the summer, I am able to catch up on some TV shows that I was too busy to watch during the school year. From my opinion, television shows today can be classified into 3 main categories; reality shows, cop shows and medical shows. That seems to be the bulk of the shows airing today. Recently, my friend and I were sitting around watching Greys Anatomy. Although the show is highly entertaining (and somewhat addicting), the actions of the characters are very questionable, especially if they are trying to portray what really happens in a hospital. While I was watching it, the characters were intimately involved with each other and would discuss it while they were on the clock and some of their relations with the patients were far from ethical. Although this show is a medical drama and not a documentary, the public is still going to base some of their opinions of the medical field from what they see in these types of shows. As an example, one day on Oprah, Dr. Oz was dispelling the truth on if a certain injury that was shown on Greys Anatomy could actually happen in real life. This goes to show that people do believe some of what they see on these medical dramas because the content of it is so close to reality.

In an article that I found on The Healthcare Traveler, it discusses the ethcial actions of Jackie Peyton, the leading role in Nurse Jackie-a new show that began airing in mid-June on Showtime. On the show, a few of Jackie's behavioral traits that are upsetting the nursing community include her drug addiction, in-hospital sexual activities with a pharmacist who provides her with the drugs, and forging a patient's signature, just to name a few. These actions are so upsetting for some nursing associations that some are calling for action. Tina Gerardi, MS, RN, CAE, who is the cheif executive officer for the New York State Nurses Association is requesting a disclaimer to be shown before the airing of Nurse Jackie. She suggested that the disclaimer should note that "registered nurses practice according to a strict Code of Ethics that guides their interactions with patients and colleagues. Nurses are the professionals most trusted by the public because of their committment to the highest quality of patient care. The following program is not intended to denigrate the nursing profession in any way, but rather to explore the human element of a single, fictional character." Showtime's vice president of coporate public relations, Stuart Zakim, denied her request. Now, the American Nurses Association has prompted a "call for action," asking for all of its members to send complaint letters to Showtime. The AMA is concerned that the show will "erode the highly valued trust of patients who rely on the expertise of nurses in healthcare situations." As of yet, nothing has been changed or added to the show.

I agree that some of these medical dramas show healthcare professionals in a bad light. However, these portrayls are solely based on an entertainment factor. I doubt that any television network is purposely trying to portray all nurses with an addiction problem like Nurse Jackie, for example. The problem that I see is that there seems to be a grey area with medical entertainment and actual reality. Since these shows, like ER and Greys Anatomy, are using medical terminology and showing real operations, many people seem to blend the fiction with reality. Along with this is the behavior of the characters on the shows. If the viewers believe that the operations are real, will they also believe that nurses are less important, since that it they way they are often shown on these television shows? At what point should these dramas be allowed to show the health profession in a bad light before being forced to tame it down some or offer a disclaimer at the beginning of the show, as suggested by the New York State Nurses Association ?

http://healthcaretraveler.modernmedicine.com/healthcaretraveler/New+Healthcare+Travelers+Can+Use/ArticleStandard/Article/detail/606919

Changes in Health Insurance

There has been a lot of talk recently regarding the health plan that President Obama has been working so closely on. Although the plan is still in the beginning phases of being developed, some of the suggestions and discussions have been very interesting to read about and follow along. In an article I found in the New York Times, it discusses some of the problems that have been brought up between the private insurance and a government-administered health insurance plan. Much of the opposition for this plan lies with the democrats weary of the costs associated with the new plan. Also, many are concerned that a govenmental plan will force private insurance out of business. In response to this, President Obama stated that it is "not logical" that a public plan would undermine the private insurance market. He goes on to state that "We have not drawn lines in the sand other than that reform has to control costs and that it has to provide relief to people who don't have health insurance or are underinsured."

However, with a governmental health plan, many members of Congress believe that it will ultimately increase costs and push private insurance out of the market. "Regardless of how it is structured, a government plan would use its built in advantages to take over the health insurance market," from Karen M. Ignagni, president of America's Health Insurance Plans.

The financing of this health policy also concerns many in Congress. When President Obama first presented this health care proposal, the price tag totaled $1 trillion over 10 years. However, this price has now reached $1.6 trillion over 10 years. Part of this increase is based on the part of the plan which states that employers who do not offer "affordable" coverage to employees would have to help pay the cost of such benefits for their low-income workers. Under this, employers would have to pay half the cost of providing Medicaid for any of their low-income employees in that program. Senator Orrin G. Hatch (R) stated that the proposal "would be a disaster, because it would create a disincentive for employers to hire lower-income people on Medicaid." With everything that has been written about this proposal, I still believe that there has not been enough solid information given to be in support or opposition of this bill, personally. Everything that has been written about have been very broad and vague. Just like President Obama stated, "Those are the broad parameters that we've discussed." I do believe that the American healthcare needs to be reformed, however I do not know if it is prepared and can be successful based on the broad proposals that have been presented thus far. I will be actively following this story, patiently awaiting further information.

http://www.nytimes.com/2009/06/24/health/policy/24health.html?ref=health

Sick ? Take a Z-pack

I have been a student at UCF since my freshman year. So for well over 4 years, I have called UCF my home. Although I try to lead a healthy lifestyle, living on a college campus means that everyone is exposed to various germs/illnesses throughout the year. As a result, I have found myself at the UCF health clinic on a number of occassions with various illnesses. However, I seem to always be prescribed a Z-pack, regardless of my illness.

Just recently, my friend Brittany had been sick for a few days. She was hesitant to go to the health clinic because she knew what medication would be prescribed for her. All of her friends, including myself, all had a little bet going to see if the physician would prescribe a z-pack to her. This was not her first time taking a z-pack and we all knew it would not be her last either ! Sure enough, after her appointment she called me to say that I was right, the UCF health clinic had yet again prescribed a z-pack to her.

Speaking from personal experience, there has only been one occassion that I went to the health clinic and was not prescribed a z-pack... and that was because I had pink eye. I have been to the health clinic at least 7 times over the years and every single time I have either walked out with a z-pack or nothing at all. Regardless of my symptoms, the z-pack seems to be the miracle/cure-all drug to the UCF physicians and I'm not the only one who feels the same way. Its almost a running joke among students on campus that the second you step into the health clinic, you are walking out with a z-pack. The main problem that I personally have with the z-pack is that it is ineffective ! Every time I go to the health clinic, I say that it is going to be my last time because I am always given a z-pack (like clock work), and when I finish the pack, I still have symptoms ! Every time ! Normally I end up browsing the walls at CVS, purchasing any medication that has my symptoms listed on the box and after a few days I begin to feel better. I'm beginning to believe that rest and time, not medication, is what ultimately cures my illness. The health clinic has turned me into a skeptic for all prescriptions.


I do not know the reasons behind the frequency of prescribing the z-pack to everyone at the health clinic. Perhaps the makers of z-pack have a deal with the UCF health clinic. Or the populairty of the z-pack has consumers requesting it more often. However, I believe that physicians have become lazy and prescribe the z-pack since it is the most adaptive medication for various symptoms. Instead of taking the time and getting to the root of the problem with the patient, these physicians are just writing the prescription and moving on to their next patient. If this is the case, with physicians being over-worked and lazy, should the physicians or the health clinic be held at fault ? Would it really take that much effort and time to move away from this practice and to actually listent to a patient's symptoms and prescribe them medication that is tailored to their illness ? I believe that the health clinic is falling short of their potential. Since it is hopefully their goal to keep the campus healthy, I would hope that they wouldn't want to have students hesitant to go to the health clinic because they know that they will be prescribed the z-pack. The health clinic needs to change the way in which they deal with student's health issues, rather than having students see it as a joke to go to the health clinic.

Is 66 too old to have a baby ?

With all the media attention being given to Jon & Kate plus their eight children, I decided to read over some other various news articles dealing with fertility treatments. One particular article that caught my attention comes from the UK, announcing that a 66 year old woman is 8 months pregnant, expecting her first child. The article states that Mrs. Adeney is a very wealthy and healthy divorcee and is elated to be expecting her first child. She conceived the child through IVF treatments in Ukraine, since most British clinics will not offer services to women over 50. She is not alone in her old age pregnancy. In 2007, Mrs. Tollefson, 56 gave birth to her first child with her 46 year old husband with the help of IVF treatments from a Russian fertility clinic. Three years ago, Patricia Rashbrook, 62, from Sussex, gave birth to a son with the help of a donor egg from Russia. This case attracted much media attention since this was the first child for her husband while she already had 3 grown-up children.

As many critics have pointed out, Mrs. Adeney will be 79 by the time the child reaches its teens years and well into her 80s when the child is in college. On a blog site, many mothers have expressed their view points on her as well, calling it an "act of breathtaking selfishness" and stressing the need for a "cut-off point" in the age that a woman can become pregnant.

Meanwhile, others are quick to point out the double standard that exists between men and women when expecting a child. When BBC reporter, Jonathan Dimbleby had a child at the age of 64, everyone sent well wishes his way. Even over in America, Donald Trump and David Lettermen are among a few of the famous fathers who had children later in life, without much critizism given to them. What many people don't consider is that life expenctancy for women is always much longer than it is for men. Today, a women's life expenctancy is 85, while it is 82 for men.

Dr. Lockwood, a physician that has been following Mrs. Adeney case, stated that because IVF treatments for older patients rely on donor eggs taken from younger women, almost all of the dangers associated with older motherhood-such as down's syndrome and other foetal abnormalities-are not present. She believes that childbirth is not difficult if the woman is fit and healthy and does not have any underlying health problems. The most challenging part of pregnancy for older women is the psychological aspect of each case. Why is the woman not content with being an aunt or god-mother to children of friend's and relatives? Regardless of the reasons behind the woman wanting to become a mother later on in life, society will still place judgements on each specific case.

http://www.telegraph.co.uk/health/women_shealth/5335947/Is-66-too-old-to-have-a-baby.html

Managed Care

Ever since President Obama took office, health care reform as been a leading topic of reform. The rising cost of health care along with many individuals being dropped from their employer-sponsored health insurance has all lead to the high number of individuals who are uninsured today. Once an individual or family looses their employer-sponsored health insurance, it becomes extremely difficult to find another health plan that provides the right amount of coverage for the right price.

In an aritcle I found in the Managed Care Magazine, four individual views are provided regarding the ethics of managed care. One particular question that was posed to internists asking if they would deliberatley manipulate or misrepresent information they give to an insurance company to provide more care to their patients. The results found that 58% would to obtain coverage for a cardiac bypass, 56% would to revascularize a blocked artery in the leg, and 48% would if a patient was denied intravenous pain medication. Another seperate survey found that approximately 39% of physicians said that they had misrepresented information that went to an insurance company to benefit a patient within the past year.

If the physicians alter the information they provide to insurance companies to help the patient, is this still unethical? Many see this as just cost-shifting. The research done on chart-based data is distored by miscoding anyways.

Everyone knows that managed care has made it extremely difficult for patients to receive any type of treatment beyond the bare minimum. If an additional procedure is ordered, many times the managed care company will not cover it, leaving the patient to pay out of pocket for it. Instead of having patients go through all the paper work and trouble associated with receiving additional test, these physicians have taken it upon themselves to find a way for insurance to allow these additional tests that do benefit the health of the patient. Since the ultimate goal of physicians is to improve the health of their patients, these physicians are infact, fulfilling their goal, but at the expense of who ? I personally believe that if practices such as these continue to happen, total reform of our health care system will never be possible. Yes, managed care definitely needs to change the way in which they conduct their services, but physicians also cannot continue to misrepresent information to managed care companies or else the system will fall back into their old habits.

Welcome to my Blog !

This blog was established as part of the healthcare ethics class that I am currently enrolled in. I am very eager to begin this class because I believe that a physicians and other healthcare professional's ethics or a lack thereof will ultimately determine their professional success. With the needs of patients continually changing and evolving, the ethical issues that are brought to a physicians attention are also changing from one day to the next. I have found many websites that outline the ethical challenges facing the health care industry today. I have listed a few of these sites below for you to review.

http://www.healthcare-ethics.org/

http://www.ethics.va.gov/

http://www.csmc.edu/5387.html