Recent Newspaper & Online Columns by Kate Scannell MD

"There's no rap song about health care disparities"

June 11, 2013

Tags: rap song, health care disparities, health disparitites, Michael LeNoir, National Medical Association, Kate Scannell, Department of Health and Human Services, National Healthcare Disparities Report

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 06/08/2013

As a writer, I wish I could claim the title of this column as my own. But it rightly belongs to Dr. Michael A. LeNoir, an Oakland physician who is trying to educate patients and policymakers about approaching remedies for health disparities "from the bottom up, instead of the top down."

A "health disparity" usually refers to a higher burden of disease, disability, or mortality experienced by one subpopulation in comparison to another. In the U.S., health disparities are common, and they often reflect population differences characterized by race, ethnicity, gender, age or socioeconomic status.

For example, African-American men and women are more likely to die of heart disease and strokes than white people experiencing the same diseases. A recent study showed among preschool children hospitalized with asthma, 21 percent of white children were prescribed medications to prevent future hospitalizations, compared to only 2 percent of Hispanic and 7 percent of black children.

The troubling fact is that health disparities are many, widespread, long-standing and persistent. And studies rather consistently show that gaining access to a health care system does not necessarily ensure that patients will receive higher quality care. Racial and ethnic health disparities often persist even when insurance status is comparable -- a sobering acknowledgment as we approach near-universal coverage anticipated under the Affordable Care Act. (more…)

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Shedding light on the investigation on mortal loneliness

July 8, 2012

Tags: loneliness, mortality, elderly, UCSF, Breaking out of Bedlam, Leslie Larson, Archives of Inetrnal Medicine, Kate Scannell

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 07/06/2012

Cora Sledge soberly recalled all the useless prayers she had offered up throughout her 80 years of hardscrabble living. Without a hint of self-pity, she recounted: "I used to pray to keep my ma and daddy safe, but that was no use. I prayed for gifts at Christmas and to win the school prize. I prayed to be slim, so no one would make fun of me. That didn't happen, either. I asked Jesus to protect my kids. Look what happened."

Yet somehow, despite all the tragedy that had seeped into her long life through small holes in her big prayers, Cora remained hopeful about her uncertain future. But her hopes now focused more internally, and her prayers reshaped around her longing to escape the assisted-living facility in which her children had abandoned her. She asked for her heart to be healed, all the while it stayed open and "ready to love." She explained, "I pray now like I did when I was a little girl -- not needing to understand. I ask for simple things. Let me not hurt. Let me not be hungry, or cold. Please keep my loneliness at bay."

I finished reading about Cora Sledge in Berkeley novelist Leslie Larson's moving (and comical) novel "Breaking Out of Bedlam" the same day that UC San Francisco researchers reported finding statistical associations between loneliness and an increased risk of dying among elderly people. (more…)

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The top 10 medical stories of 2011

December 25, 2011

Tags: top ten 2011, top ten medical stories, iMedicine, Kate Scannell, top ten health stories 2011


By Dr. Kate Scannell, Syndicated columnist
First published in print: 12/25/2011

The top 10 medical stories chosen for 2011 are distinguished for their broad reach into people's lives. I look to the new year with hope that 2012's list contains much good health news for us.

Drug shortage: Our nationwide prescription drug shortage worsened this year, compromising some patients' health while also revealing systemic problems with pharmaceutical production and regulation. At least 250 drug shortages were reported, with hospitals facing worrisome scarcity of lifesaving medications including chemotherapies, heart drugs and antibiotics. An executive order signed in October by President Obama broadened the Food and Drug Administration's authority to expand its reporting of potential drug shortages, expedite regulatory reviews and monitor for opportunistic price-gouging on sales of scarce drugs. Still, the FDA cannot require pharmaceutical companies to resume or increase drug supplies -- and pharmaceutical companies are not legally obligated to do so.

Celebs help: Celebrities can influence societal views about health and disease. They can share the spotlight with public health issues to make them more visible to millions of people. The death of 27-year-old singer Amy Winehouse in July sadly illuminated the health hazards of excessive drinking. In November, the involuntary manslaughter conviction of Michael Jackson's physician cast a dark light on prescription drug abuse. When former first lady Betty Ford died in July, we were reminded about the power of one person's voice to speak truth to silence in changing how people viewed illnesses such as cancers and addictions. (more…)

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Good riddance to the old food pyramid -- and other food news

June 13, 2011

Tags: MyPlate, food pyramid, nutrition, food safety, Ronald MacDonald, seafood regulation, Kate Scannell, antibiotic resistance

A mummy from the pyramidal catacombs ?

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 06/11/2011

FOOD AND health and safety issues cooked up more news within the last two weeks than Lindsay Lohan and Oprah Winfrey combined! Is the public appetite changing?

A toppled pyramid, fishy fish, killer bacteria stalking European food supplies, Ronald MacDonald's job threatened and the FDA taking heat on the back burner . . . how to digest it all?

Let's begin with the dismantling of the 2005 food pyramid --that charming but baffling icon developed by the U.S. Department of Agriculture (USDA) that was supposed to somehow guide us toward healthier nutritional habits. But few Americans could crack the mysterious code of the old-world pyramid and its six unlabeled columns, all the while our nation's obesity and diabetes epidemics swiftly expanded.

Americans puzzled over the nutritional significance of the staircase -- or escalator? -- appended to the pyramid. They were distracted by the disarticulated humanoid figure that loitered on it. Was it a mummy emerging from the pyramidal catacombs? Was its disarticulation merely metaphor for the entire icon's failure to articulate a coherent message about good nutrition? Why was it running away from "the five food groups" jumbled at the pyramid's base -- especially if they were supposed to be good for us? Sadly, in the wake of the food pyramid's recent dismantling, we may never find out. (more…)

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Fourth-grade class gives its prescriptions to doctors for better health care

May 30, 2011

Tags: childrens' opinions health care and doctors, fourth graders views about doctors and health care, Kate Scannell

Ms. Lainey Alderman and some members of her fourth grade class at John Swett Elementary School in Martinez.

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 05/28/2011

LAST WEEK, I visited Lainey Aldermen's fourth grade class at John Swett Elementary School in Martinez with two related goals in mind. The first was to demonstrate how writing could be fun and exciting, how it could lead to adventures and experiences in bigger worlds that existed "off the page." My second objective was to gain a better understanding of what young people think about doctors and health care -- their important perspectives are virtually absent from mainstream polls and surveys.

My overarching plan was to merge both goals by teaching the students how to write a structured essay, and asking them to focus it on their experiences with doctors or hospitals. I told them I would include their opinions in this newspaper column, hoping to provide them a concrete experience of witnessing their words being carried beyond the classroom into a larger public conversation.

And, of course, I learned many amazing things during my visit. (more…)

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At the heart of Clinical Practice Guidelines -- at what price?

April 3, 2011

Tags: Clinical Practice Guidelines, Physicians, Conflicts of Interest, Kate Scannell, CPGs and GPS

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 04/02/2011

BY NOW, most of us know what a "GPS" is -- at least those of us who tend to get lost and require a "global positioning system" to navigate us toward our desired destination. But how many of us are familiar with the "CPGs" our doctors use to navigate our medical care?

A CPG is a "Clinical Practice Guideline," and it functions like a GPS for doctors and patients. For example, when a medical decision must be made for a diabetic patient, the doctor might consult a "CPG for diabetes" to select a course of management among several options. Depending on that course, the CPG could navigate doctors toward ordering certain tests or prescribing particular medications.

CPGs are created by a hodgepodge of private and public organizations that share some interest in the focus of the CPG. So, for example, the American Diabetes Association creates CPGs regarding diabetes management. The Academy of Ambulatory Foot and Ankle Surgery issues guidelines concerning ingrown toenails. More than 1,000 CPGs exist, spanning a vast array of medical disorders including heart disease, arthritis, thyroid problems, high blood pressure and various cancers.

Ideally, organizations volunteering to create guidelines do us a favor, because it is impossible for most doctors to keep up with the thousands of new research findings published each year in medical journals. We doctors tend to welcome CPGs that are written by groups of professionals who have expertly reviewed, analyzed, distilled, synthesized and translated complex research findings into useful clinical practice recommendations.

It's important to understand about CPGs because doctors frequently rely upon them to determine what happens to you when you're sick. (more…)

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How Elizabeth Taylor Saved My Patient

March 27, 2011

Tags: AIDS, Elizabeth Taylor, early HIV epidemic, in memorium, Kate Scannell

By Dr. Kate Scannell
First Published: March 24, 2011

My 20-year old patient had been suffering a slow, painful death expected to occur within the next few days. Alone in his drab room on a county hospital’s AIDS ward in California in the mid-1980s, he had been praying to see his father and mother one final time. He fantasized about them rushing into the hospital, assembling around his deathbed, holding his hands and easing his transition from this world.

He had last seen his parents several years before at the family homestead in the rural south. Standing on the front porch where he had been exiled moments after admitting his homosexuality, he saw his father’s angry face behind the slamming screen door, his mother’s piercing stare through the front window.

But, in the end, he carried those final imagesof his parents to his grave. Neither of them had responded to his pleas for a bedside visit, accepted offers of airfare to California gifted by an AIDS advocacy group, or taken opportunities to speak with their son by phone.

And yet, days before he died, he had the experience of “being saved” by Elizabeth Taylor. He had seen her on television, witnessed her embrace of a gay man with AIDS, and heard her unflinching support for AIDS research to seek cures for people who suffered with HIV infections.

Without first-hand experience of the early AIDS epidemic, it may be difficult now to appreciate Elizabeth Taylor’s heroism back then. (more…)

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Sports on the Brain -- Assessing the Damages

March 20, 2011

Tags: sports-related concussion, head injury, dementia, sports, Kate Scannell, chronic traumatic encephalopaty, CTE

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 03/20/2011

I AM IN DETROIT visiting family, and I’ve got sports on the brain.

Last night, we watched a local news report about former Red Wing hockey star Bob Probert who died last July at age 45 with a bad heart and battered brain. His celebrity on the ice rink had derived as much from his skill with his fists as with his stick.

Earlier this month, Probert’s brain was examined and found to exhibit “chronic traumatic encephalopathy” or “CTE” – a degenerative brain disease originally noted in boxers and, more recently, football players. Caused by repetitive or severe head trauma, CTE can manifest as dementia, memory loss, depression, aggression, and suicidal behavior. According to his wife, Probert had displayed problems with short-term memory and a quick temper.

During a commercial break, one of my sisters commented upon the increasing violence she’d witnessed during her own sons’ school sports activities. “But the parents are often worse than their kids,” she said. (more…)

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Breast cancer surgery, another paradigm shift in medicine

February 20, 2011

Tags: breast cancer, surgery, medical mythology, axillary lymph node dissection, paradigm shift in medicine, Kate Scannell

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 02/20/2011

FOR YEARS, I've been writing a book about medical practices that were later found to be wrongheaded, useless or dangerous. It's been a sobering and unsettling project, causing me to question the scientific foundation of my profession a few too many times.

But I am trying to how we doctors sometimes get it all so very wrong. How under our watch, enormous myths can sneak unnoticed into our clinical textbooks and remain there for decades.How our doctorly habits or routines sometimes bypass critical scrutiny and seamlessly morph into "standard medical practice." I am searching for instructive clues to these discomforting mysteries, keeping patients in center vision, hoping to help resolve what I can.

Preparing for this book, I have been collecting medical journal articles whose solid research findings blew some piece of conventional medical dogma out of the water and into oblivion. My collection is housed within a file cabinet labeled "Oops!" that expands at an ever-increasing rate. And today I added to that collection a study from last week's Journal of the American Medical Association (JAMA) that upends thinking about a type of breast cancer surgery routinely performed on tens of thousands of women each year. (more…)

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Food for thought -- What eats at us

February 6, 2011

Tags: food safety, food regulation, coherent logic, healthy eating, Kate Scannell, food marketing, USDA, FDA, diet pillls

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 02/06/2011

READING FOUR newspapers over breakfast each morning may turn out to be the most effective weight-loss regime in history. Simultaneously digesting the daily news about our food supply's safety and quality, our nation's expanding obesity epidemic, and the pharmaceutical industry's efforts to capitalize on the latter can generate significant appetite suppression.

Last week delivered a remarkable serving of health-related food news. After spreading it all out on the table for the purpose of writing this column . . . well, it left me feeling unsatisfied and hungry for something not on the menu: a coherent logic about healthy eating. (more…)

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The excruciating mystery of health care reform: Mrs. Winchester explains it all

January 23, 2011

Tags: Health Reform Repeal, Affordable Care Act, repeal, Winchester Mystery House, Kate Scannell, understanding the Affordable Care Act

By Dr. Kate Scannell, Syndicated Columnist
First Published in Print: 01/23/2011

IF THE ongoing ... ongoing ... and ongoing debates about repealing the Obama administration's new health care law causes you to feel weary or disoriented, a quick visit to "The Winchester Mystery House" could set you straight. This popular tourist attraction in San Jose is just the ticket for an invigorating education about the American health care system. It can make anyone feel more confident about surviving the deadening clamor of the current disputes.

The first thing to appreciate about the Winchester Mystery House is that it continues to stand despite its original owner's obsession with constant architectural renovations. Legend claims that Mrs. Winchester conducted nightly séances to divine home-remodeling tips that would allow her to elude and confuse "bad spirits." Her compulsive need for self-protection meant constant and unwieldy revisions to her home.

Consequently, at one point the Winchester home contained at least 500 separate rooms of varied shapes and sizes. Stairways that bluntly ended at ceilings. Chimneys that ascended short of the roof. Doors that opened to nowhere. As the home's official website describes: "The miles of twisting hallways are made even more intriguing by secret passageways in the walls. Mrs. Winchester traveled through her house in a roundabout fashion, supposedly to confuse any mischievous ghosts that might be following her."

We are kin to Mrs. Winchester as we continuously amass disconnected health care policies under one old roof and choose to think of our ramshackle construction as a unitary "system."

We never get the foundation right because we always listen to the loudest political spirits of the day and take their piecemeal advice. We pass innumerable health care laws and regulations that are so mind-boggling and labyrinthine to navigate, that we often give up the ghost trying. Meanwhile, as individuals and as a nation, we pay a hefty premium for the thrill of it all.

In other words, the Winchester Mystery House looks a lot like our American health care system.

But the Winchester house uniquely offers visitors the opportunity to experience chaos and structural anarchy without suffering apoplectic fits. In fact, (more…)

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How the new health care law may affect the unliving

January 9, 2011

Tags: Health care reform, end of life counseling, Medicare, unliving, death, politicization of death, advance care planning, zombies, Kate Scannell

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 01/09/2011

LAST WEEK, the Obama administration removed a provision from the new health care law that would have encouraged opportunities for patients to consult with doctors about life and death concerns. Under the provision, Medicare would have reimbursed physicians for time spent with patients who wanted to discuss end-of-life treatment and voluntary advance care planning during their annual wellness visits.

Thank goodness -- and Sarah Palin -- that the Obama administration had the timidity to withdraw such a ridiculous provision. Really, why would any mortal being ever want to talk about ... being mortal? Why would anyone ever want to document their own preferences to guide their future medical care when they became unable to speak for themselves?

Besides, whoever heard of a dead person complaining about the insurers and medical personnel who took charge of their health care during their final hours or months within an ICU?

Clearly, it is better to allow our dying process to arrive as one big surprise party for all concerned. (more…)

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The top 10 medical stories of 2010

December 26, 2010

Tags: Top ten medical stories of 2010, top health stories of 2010, swine flu, whooping cough, synthetic life, concussions, FDA, food safety, frozen embros, Avandia, bed bugs, AIDS, health care reform, Kate Scannell

By Dr. Kate Scannell, Syndicated columnist
First Published in Print: 12/26/2010

WHILE THE past year regaled us with a wealth of medical stories, the government's health care reform legislation took center stage. Meanwhile, the swine flu virus whimpered, but a killer bacterium left us with a whooping cough. Scientists created the world's first synthetic organism inside a Petri dish, while old-world bed bugs crawled into our mattresses. A baby was born from a fertilized human egg that had been frozen for two decades, and, following yet another Salmonella epidemic traced to tainted poultry, the FDA finally cracked down on the egg industry.

The swine flu whimpered
The swine flu hogged media attention, panicked millions of people and consumed considerable public health resources. Its causative virus -- H1N1 -- spread throughout the world like a hog on ice, ultimately proving to be much less formidable than experts had predicted. In the bitter end, critics claimed that the World Health Organization (WHO) had exaggerated the danger, fanning public fears about the scarcity of antiviral medications and life-saving medical interventions. An editorial in the British Medical Journal claimed that some experts advising the WHO about the pandemic had financial ties to drug companies that manufactured antivirals and vaccines. Still, the threat of a global pandemic forced governments and health care systems to plan collaboratively for a more coordinated and efficient emergency response to the next public health crisis.

The cough that whooped California
For six decades, whooping cough -- formally known as "pertussis" -- had been rather quiet on the Western front. But in July the CDC reported that six California infants had died from the infection. (more…)

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Back to the AIDS front

December 18, 2010

Tags: AIDS, HIV, epidemic, Lady Gaga, Alicia Keys, breakthrough, hope, Kate Scannell

By Dr Kate Scannell, Syndicated columnist
First Published in Print: 12/12/2010

LAST WEEK, Lady Gaga, Jennifer Hudson, and Justin Timberlake threatened to "kill " themselves -- that is, on social media like Facebook and Twitter. They vowed to remain "digitally dead" and unavailable for contact until fans resurrected them through a collective million-dollar donation to Alicia Keys' campaign for AIDS relief in Africa and India.

Coming of age as a doctor during the early AIDS epidemic, I was happy to learn about this high-profile effort and its eventual success. But I was particularly gratified because the mainstream news media barely bothered to notice it.

Less than 30 years ago, during the dark pre-digital 1980s, there were no major stars to shine a public light on AIDS and its causative virus, HIV. Celebrities, fearing actual career deaths by association with AIDS, stayed behind the curtain even as the epidemic exacted a devastating human toll on the artistic community.

Most of the known early AIDS patients were young gay men who suffered the social stigma of homosexuality while facing death within months of their diagnoses. Many were contemptuously regarded as plague-bearers, as toxic creatures intent on spreading a frightening and lethal infection throughout decent society. It took 500 HIV deaths before "AIDS" landed on the front page of the New York Times, and 12,000 fatalities before President Ronald Reagan first mentioned "AIDS" in public.

When the epidemic began, we were light years away from compassionate public embrace of people suffering HIV/AIDS.
But now the stars align differently, and famous singers passionately voice support for people afflicted with a once-unspeakable disease. AIDS can command center stage before an attentive and caring public.

This thundering cultural transformation was once completely unimaginable for many socially outcast AIDS patients who were burdened with the hopelessness of the '80s throughout their dying. In my memoir about doctoring during that era, I conclude the book's introduction with the dying wish of a hopeful 22-year-old patient in 1986 -- to live another 10 years, mainly to witness the world arriving at a compassionate understanding of AIDS.

How thunderstruck he would be today to see Lady Gaga "killing herself" on behalf of people with AIDS. (more…)

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Doctoring with the Stars! A Modest Proposal

December 3, 2010

Tags: doctoring with the stars, primary care, physician shortage, House, Grey's Anatomy, Private Practice, Kate Scannell, Bay Area News Group

By Dr. Kate Scannell, Syndicated columnist, Bay Area News Group
First Published in Print: 11/28/10

THE 11TH season finale of "Dancing with the Stars" drew 24 million viewers last Monday night. I was one of them.

I watched the show, exhausted after a particularly grueling day at work. And though I had punched the proverbial clock, still, like many physicians, I continued to view the spectacle of the world through a doctor's lenses.

So I worried about Jennifer Grey's spine and cringed whenever her neck extended. I wished for Bristol Palin an experience of joy residing in the gift of an agile, healthy body -- resilient to the thorny body politic impinging upon it. And I was grateful for Kyle Massey's intrepid exuberance -- I've witnessed no better public health promotion for exercise and physical fitness.

The show was peppered with advertisements reminding us to stay tuned for the upcoming debut of its latest offshoot, "Skating with the Stars." And while I did not warm to that particular concept, I was inspired to think about a different spinoff with a medical twist.

Already, besides skating and dancing with experienced professionals, "the stars" are also singing with the pros. They are shaking and baking with celebrity chefs. Pitching business startups to Donald Trump. Everywhere, the stars are lined up -- literally and figuratively -- to illuminate how anything is possible, how any profession can be mastered within weeks of trying. So it seemed natural to wonder -- why not "Doctoring with the Stars!"?

There are so many good reasons to launch a show featuring pairs of stars and doctors who compete to provide the best quality medical care to patients in the current health care system. For example, "Doctoring with the Stars!" would provide a much-needed reality-check against the public's skewed view of doctors. Through documentary-type coverage of the stars during their monthlong training to become physicians, the public would see what genuine footwork was required of real doctors engaged in actual dances with life and death.

Even I am sometimes confused by media portrayals of doctors. After watching just a few episodes of "Private Practice" I once showed up at work in high-heels and a Chanel white coat, expecting to sit with colleagues all day around the break-room table until our one shared patient-of-the-day showed up and interrupted the fun. One day, I began shouting out inaccurate diagnoses and ordering every imaginable diagnostic test for patients simply because "House" had made that seem not only right, but also righteous. And after season four of "Grey's Anatomy" -- well, let's say I realized that not all doctors need to experience delusional psychotic breaks or personality transplants within the course of their careers.

Besides, if "Doctoring with the Stars!" succeeded in transforming waning stars into shining new careers as doctors, it could help alleviate our country's physician workforce shortage. Already, within the next 15 years, we expect to face at least a 125,000 physician shortfall. (more…)

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CT scans: Radiating hope and concern about cancer

November 25, 2010

Tags: CT scans, lung cancer, screening, Kate Scannell

By Kate Scannell, Syndicated columnist, Bay Area News Group
First Published in Print: 11/14/2010

LAST WEEK'S news radiated hope that smokers' lung cancer mortality rates might be decreased through serial CT scanning -- as it also radiated concerns about the safety of CT scanning in general.

Last week, researchers from the National Cancer Institute proclaimed that the lung cancer death rate for smokers could be lowered by 20 percent if smokers underwent regular CT screening to detect early evidence of cancer. (more…)

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The Immortal Life of Henrietta Lacks, by Rebecca Skloot -- Book Review

November 17, 2010

Tags: The Immortal Life of Henrietta Lacks, Rebecca Skloot, Book Review, Journal of Legal Medicine, Kate Scannell

Crown Publishers, New York, NY, 2010, 369 pages, $26.00.
Pre-Print copy for the Journal of Legal Medicine
Reviewed by Kate Scannell, M.D., F.A.C.P.*
ENCOUNTERING HENRIETTA LACKS
Journalist Rebecca Skloot’s new book is a gripping read that embodies all abstractions about research ethics in a compelling tale about Henrietta Lacks – a woman whose microscopic cancerous cells shook the world’s medical establishment in 1951. (more…)

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The Nobel Prize in Medicine: Fertile past, pregnant future

October 19, 2010

Tags: Nobel Prize Medicine 2010, IVF, controversy, Robert Edwards, Kate Scannell, pregnant future, fertile past

By Kate Scannell, MD, Contributing columnist Bay Area News Group
PUBLISHED IN PRINT 10/16/2010

ROBERT EDWARDS thought he was "doing God's work" when he began his research in the 1950s. But critics charged that he was actually trying to play the boss himself.

Still, this British biologist dreamed about helping infertile couples who dreamed about having children. If successful conception wasn't possible for those couples "in vivo," he would strive to make conception happen outside their bodies "in vitro" -- with the help of science to coax that process along. (more…)

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"Eggribusiness" and food safety regulation - Salmonella in the scramble

September 23, 2010

Tags: eggribusiness, egg safety, Salmonella, Kate Scannell, food safety

By Kate Scannell MD, Contributing columnist Bay Area News Group
PUBLISHED IN PRINT 09/18/2010

YOU RISK upsetting readers whenever you express strong opinions within medical columns. Writing about controversial health care issues predictably ruffles a few feathers. But "laying it all out" for public deliberation is a primary objective of op-ed writing, and this week's column shell make no eggs-ception.

So here goes. Simply put: I am opposed to the presence of disease-causing salmonella within eggs meant for human consumption. (more…)

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Who really owns your spleen?

September 19, 2010

Tags: biobanks, ethics, consent, tissue storage, Tony Bennett, Kate Scannell, Henrietta Lacks

By Kate Scannell MD, Contributing columnist Bay Area News Group
PUBLISHED IN PRINT 08/08/2010

BELIEVE IT or not, parts of your own body might not always belong to you.

Tony Bennett may have famously -- and figuratively -- left his heart in San Francisco. But with much less fanfare -- and, quite literally -- people routinely leave behind parts of their organs and tissues in hundreds of cities across the country every single day.

They leave biopsies of skin, breast, liver, prostate, bone marrow -- you name it -- to doctors, hospitals, and diagnostic centers. Sections of their colons, lungs, and limbs are removed during surgeries, sent to labs for pathologic examination, and ... then what? (more…)

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Alzheimer's dementia -- and our epidemic of pre-diseases

September 10, 2010

Tags: Alzheimer's, dementia, pre-diseases, epidemic, Kate Scannell, Woody Allen, Prozac nation, Marlboror Man, pre-Prozac state

By Kate Scannell MD, Contributing columnist Bay Area News Group
PUBLISHED IN PRINT 08/22/2010

SO MANY news reports about Alzheimer's dementia flooded the media within the last few weeks that it's hard to remember them all.

Where to begin? That question not only prompts topics for this column, it also presents a fundamental question about the most appropriate time to begin diagnosing someone with Alzheimer's. Can a diagnosis of dementia ever be made too soon in a person's life?

In this regard, we learned about two new tools that might diagnose people with Alzheimer's earlier than was previously possible. (Way earlier.)

Traditionally, physicians diagnose dementia only after a person develops three conditions: impaired memory; a deficiency in at least one other intellectual capacity (like recognizing familiar objects or performing familiar tasks); and, as a result of those impairments, the inability to continue functioning within the world of his own making -- at home, at work, among friends.

But our two new tools -- a certain type of brain scan (a PET scan) and a spinal fluid test -- aim to detect Alzheimer's before a person even demonstrates any evidence of memory or functional impairment.

Instead, these tests look for evidence of "amyloid" buildup in the brain -- what many scientists consider to be the cause or precursor of Alzheimer's. The new tests establish, in essence, a pathological condition of "pre-dementia Alzheimer's" in an otherwise healthy person.

Diagnosing "pre-diseases" -- like "pre-diabetes" or "pre-hypertension" -- has become an increasingly common practice in our medical culture. Ironically, this tendency continues to expand all the while that millions of Americans find it increasingly difficult to access and afford health care for established, de-facto illnesses.

And, it should be noted, this trend also enlarges the already sizable pool of people with "pre-existing conditions" -- or, I suppose, "pre-pre-existing conditions" -- who will surely do battle with insurance companies in hopes of securing health coverage.

The pre-disease bandwagon additionally offers pharmaceutical companies the promise of a great ride. As prospectors used to claim during the old Gold Rush era, "There's opportunity in them thar' ills." Speculating on pre-illnesses raises opportunities to encourage medication intake earlier in patients' (or pre-patients') lives, and to develop new and extended drug markets.

And on a cultural level, every time we diagnostically label millions of healthy people with a "pre-disease," we progressively pathologize the human condition. In the U.S., the so-called national character has come to resemble Woody Allen more than the Marlboro man (without his cigarette pack). If we are not ill, we should expect to be so and to suffer the attendant anxiety. We may have entered "Prozac Nation" a decade ago, but now we squarely reside within a pre-Prozac state. (more…)

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