Healthcare NBIC

Top Healthcare Conversations of 2008

Many of the great healthcare thinkers and bloggers wrapped up 2008 with end-of-year considerations of the important developments in their fields, and some looked ahead with predictions for 2009. Here are the January 1, 2009 Health Memes from around the web:

Personal Genomics in 2008: the Year in Review  Genetic Future

From 2008 to 2009  ScienceRoll

Finding Venture Capital In 2009 Will Be Tough  Pharmalot

2009 Stem Cell Trendsetters in Neurology and Psychiatry  Brain Waves

The Future of Pharma  Health Beat

The Year in Bioethics: The Highs and Lows of 2008  Bioethics Forum

2008 in Review: Ethnicity Strikes Back  Dienekes' Anthropology Blog

HIT Predictions for 2009 on iHealthBeat  Health Populi

Best of Nanomedicine in 2008  Nanomedicinecenter.com

2009: Predictions Across the Web  ReadWriteWeb

Social Media Trends 2009, TrendsSpotting  ReadWriteWeb

Top 30 Brain Health and Fitness Articles of 2008  SharpBrains

Top 10 In 2008  Health Affairs Blog

Not Exactly Rocket Science Review of 2008 [Not Exactly Rocket Science]  ScienceBlogs Channel : Life Science

Top Health Search Engines of 2008 [Highlight HEALTH]  The Highlight HEALTH Network

The Year in Biomedicine  Technology Review Feed - Biomedicine Top Stories

Health and Health Care in 2009 -- a Year of Managing Risks and Wild Cards  The Health Care Blog

(See the final week of 2008 on the December 29 archive page.)

The "Ashley Treatment": Hard Choices for Life Enhancement

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"I think most people, when they hear of this, would say this is just plain wrong," Brosco said. "But it is a complicated story, and when you get into this issue, you can understand the difficulties.

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That's Miami pediatrician Jeffrey Brosco talking about the case of "Ashley," a nine-year-old girl with static encephalopathy, severe brain damage that leaves her bedridden, unable to roll over or sit up by herself, fed by a tube. Her parents say she hasn't shown material in mental ability since she was three months old. They call her a "Pillow Angel" because she tends to stay where they put her -- and because they love her deeply.

What makes the story complicated is the treatment Ashley's parents designed for her, in consultation with doctors and ethicists at Seattle Children's Hospital and Regional Medical Center. In July 2004, they removed her uterus so she wouldn't mentruate or have cramps; they removed her early breast buds so she wouldn't have fully developed breasts; they administered high dose estrogen therapy to attenuate growth; and they removed her appendix to avoid a potential appendicitis that she wou;dn't be able to tell anyone about. The result is that she will remain 4 ft 4 in tall and about 75 lbs for the rest of her life, making life more comfortable for her and making it easier for her parents to care for her at home.

Ashley's doctors Daniel Gunther and Douglas Diekema broke the story in an article in the AMA journal Archives of Pediatric and Adolescent Medicine titled Attenuating Growth in Children With Profound Developmental Disability: A New Approach to an Old Dilemma. In the same issue, an editorial by Dr,  Jeffrey Brosco (quoted above) and Dr. Chris Freudtner  explored the ethical dilemma and asked four questions: Will it work? Is it unacceptably unnatural? Could it be misused?  And -- tellingly -- does it detract from the argument for more spending on home health care?

An on-line Reuters story and MSNBC message board ignited the debate, and yesterday a syndicated LA Times story by Sam Howe Verhovek expanded the discussion on-line, in print and finally on TV (after the g-d pre-roll ad).

Life enhancement innovations like cosmetic neurology, 20-15 LASIK, non-therapeutic abortion, body modification and other elective surgeries are an inevitable part of medical care in a free society. Enhancing the life of your child should be included in that list. Ashley's parents have published a heart  rending anonymous blog of supreme, clear-eyed love and honesty called The Ashley Treatment. They describe how they came to the decision, explain the details in-depth, and try to cope with some of the knee-jerk vilification they've received since the story got out. To them, it was an easy decision: they wanted their daughter to be happy. In the process, they've advanced an important discussion in healthcare immeasurably.

Enhancement Amok: Barry Bonds' Choices

The notion that the patient knows what's good for him gets kicked in the head with the chilling story of baseball's Barry Bonds and his long-time affair with drugs to improve his game. A Sports Illustrated  excerpt from the new book Game of Shadows by Mark Fainaru-Wada and Lance Williams (see video interview) describes the Bonds regimen and the coterie of semi-medical experts pushing him drugs:

In addition to growth hormone and testosterone, doping calendars showed that Bonds used insulin along with steroids; the drug's anabolic effect was significant, especially when used in conjunction with growth hormone. He also popped Mexican beans, fast-acting steroids thought to clear the user's system within a few days. The label of the container read, "Andriol. Undecanoato de testosterone" -- in English: testosterone decanoate. Early in the 2001 season, the calendars indicated Bonds tried trenbolone, a steroid created to improve the muscle quality of beef cattle. Within the year it would be the chemical foundation for a new formulation of the Clear, the undetectable steroid Conte obtained from an Illinois chemist, Patrick Arnold.

The SI.com web package presents the issue from all angles, describing how athletes and their facilitators lied, cheated and broke the law while chasing record book glory, fan acclaim and multi-million dollar paychecks.

Cosmetic Neurology: "Are Better Brains Better?"

If you could take a pill to run faster or jump higher, would you?  How about a drug to keep you sharp when you're up all night? Or a treatment to make you feel happier or deal with a bad memory? Of course, we have all that now, but steroids. blood doping, amphetamines, cocaine, whiskey and anti-depressants are illegal, expensive or tightly controlled, mostly because of nasty side effects like fatal addiction.

University of Pennsylvania neuroscientist Anjan Chatterjee (at right) wrote a paper last year for Neurology titled Cosmetic neurology: The controversy over enhancing movement, mentation, and mood.  [PDF]

Chatterjee describes how medicines created to cure neurological disease might someday be applied to neurological enhancements. "Are better brains better?" he asks, and discusses the possibilities for medically improving things like movement, memory, attention and mood. "Would you give your child a medication with minimal side effects half an hour before piano lessons if it meant that they learned to play more expertly? ... Would you take a medicine that selectively dampened memories that are deeply disturbing? Slightly disturbing?"


And if we could, does that mean we should? (Doesn't it really mean we will?) The Chatterjee paper contains an excellent discussion of inevitability, ethics, justice and the role of the physician as cognitive science, but it seems to me that "elective neurology" might be a more accurate term.

LASIK's Unfair Advantage?

Slate's William Saletan recently asked the question "If steroids are cheating, why isn't LASIK?"  Performance-enhancing drugs are generally viewed as unsportsmanlike, and last Spring's Congressional inflammation on baseball's use of steroids was notable for its posturing and zero-tolerance attitudes. But Saletan reports on athletes like Tiger Woods who get laser eye surgery that gives them better than 20/20 vision; Woods ended up with 20/15, meaning he can see at a distance of 20 feet what someone with normal vision sees at 16 feet, an obvious advantage on the course. Saletan notes that after LASIK, Tiger "won seven of his next 10 events."

Testimonials and videos on the LASIK.com web site describe how pro athletes improved their scores and standings once they were LASIK-enhanced, and the pitch to amateur athletes to be just like their heroes is explicit. Like Direct-to-Consumer pharma marketing, like Medical Tourism, like Viagra et al., innovations in marketing and medicine keep ratcheting up consumer expectations of health and well-being.