Yesterday

Radiant mother, bespeckled with sweat

Will vaginally deliver, barring no threat

“Through my blood proudly come to your start

I’ll always love you, till death do us part”

One hour pushing, doctors mention

C section

Two hours of pushing, doctors threaten

C section

C section

Three hours. Mamma has strength. Baby is fine.

C section

C section

C section

Risk for infection demands dissection

“Time is what we need”, nurse disagrees

Mom cries, “my body is not my own”

Doctor’s decisions aren’t crafted to please

Of course.

She was trained to say no.

Avoid death and lawsuits; a quid pro quo.

Meds, curtain, disconnect mind from torso.

Surgeons stained satin, splatter bleached floor

Uterus outside chest, refugee in a war

of knives and sutures. Baby’s once home

bloody, battered, bandaged. Glory dethroned.

Same moment

Frozen in time, beautifully grotesque

Mother holds baby girl close to her chest

Tired baby sleeps on tired moms warm breast

Father, tear stained cheeks sing ineffable bliss

Heart full, gives his little angel a kiss

Radiant mother, bespeckled with sweat

Has delivered despite some grave threat

“Through my blood you’ve proudly come to your start

And I will love you, till death do us part

Cesarean sections in the United States have risen to 50 percent in the past two decades. We continue to have the highest risk of maternal and neonatal mortality in developed countries.

Osterman, Michelle, and Joyce Martin. "Trends in Low-risk Cesarean Delivery in the United States, 1990–2013." National Vital Statistics Reports 63, no. 6 (November 5, 2014): 1-16. Accessed October 23, 2016. http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_06.pdf.

Should Religion Play a Greater Role in Bioethics?

A perennial theme in bioethics has been whether, and to what extent, religion ought to play a role.  Recently, Timothy Murphy has gone so far as to propose an “irreligious bioethics,” built upon a “disregard for religion or even a degree of hostility” (Murphy, 2012, 3).  A common critique against positions such as Murphy’s is that they attempt to achieve an irreligious, ametphysical, view from nowhere, which is now widely regarded to be a fiction.  I call this the argument from inevitable presuppositions (AIP).  Consider the following passages:

“All moral theories come with traditions just as convoluted and troubling as those one might find in a religion […] We encourage Murphy to examine the possibility that the irreligion he espouses is just as much a cultural artifact as shamanism” (Crane & Putney, 2012, 29)

“[T]he ideal of secular medicine as a realm of reason and therefore as untroubled by deep metaphysical and moral disagreements is a fantasy” (Biggar, 2015, 1)

“No philosopher, politician or humanist marches into the contest armed only with the sharp sword of reason, stripped naked of the costume of any moral culture” (Cahill & Callahan, 1990, 14)

The AIP consists in making the charge that the liberal, scientific, naturalistic viewpoint taken up by Murphy and others is just as full of presuppositions and metaphysical troubles as any other tradition.  The attempt to obtain a more rational perspective by which to judge religion as irrational is impossible.  Charles Camosy makes the point this way:

Consider that secular utilitarian traditions are defined by their authoritative, faith-based and transcendent answers to the following kinds of questions. What is that about which we should be ultimately concerned? Maximizing good consequences. How are we to determine what counts as good consequences? Some will say “pleasure over pain”; others will talk about preferences satisfied over preferences thwarted”; still others “happiness over unhappiness.” How do we aggregate consequences? “One counts as one and none more than one.” But who counts as one? Do future or potential persons count? […] Answers to these (and many other) big questions are derived from the authoritative, transcendental, faith-based, first principles of traditions like hedonistic and preference utilitarianism (Camosy, 2012, 14).

    Timothy Murphy has responded to these “tu quoque” replies by arguing that the difference between religious and nonreligious standards is that the presuppositions of religious standards are “accessible only by logically prior commitments to certain theological claims” (Murphy, 2012, 7).  Murphy contrasts the Vatican’s view excluding gay marriage on the grounds that marriage between a man and woman is “something wisely and providently instituted by God the Creator with a view to carrying out his loving plan in human beings” (Faith, 2009) to an argument that claims “same-sex marriage is a threat to the psychological well-being of children.”  Murphy’s claim is that whether same-sex marriage is a threat to the psychological well-being of children is a claim that can be “analyzed and evaluated without any prior assumptions that are logically inaccessible by all” (Murphy, 2012, 7).  

This is precisely the claim murphy’s detractors will not allow him to get away with, as “well-being” is always tied up with “prior assumptions” that may very well be logically inaccessible to others.  Because the concept of well-being must be grounded in thick commitments of some kind - utilitarian, deontological, virtue ethic, naturalistic, etc -what seems like a relatively innocuous concept like “well-being” is always already deeply entangled in metaphysical, “logically prior” assumptions.  Because of this, I have decided to take a different approach than arguing that some metaphysical claims are more metaphysical than others.  Rather, I aim to show that the particular metaphysical claims of standard theism are incompatible with the AIP.  Standard theism is the conception of God as a personal, omniscient, omnibenevolent, omnipotent, creator, transcendent being (Peterson, 2013, 10).  It seems one could posit the AIP or standard theism, but not both.    

    The AIP can be read as leading to epistemic relativism. The relativistic reading sees no way to adjudicate between various sets of presuppositions.  All reasoning proceeds from fundamental moral-metaphysical claims, what one comes to believe as rational will be relative to the presuppositions from which one begins. Reason cannot get behind one’s presuppositions to determine which set of presuppositions is the correct or rationally superior set. Chris Durante claims that the best one can hope for in terms of being “rational” on this view is a mindfulness of the presuppositions and limitations of one’s view” (Durante, 2012, 20).  

    Aside from the traditional philosophical problems that haunt relativism, I think there is a special kind of incompatibility between relativism and belief in standard theism.  If God exists and issues moral commandments that he wants us to know, then he would not have created a world where we are forced to accept a set of presuppositions without any means to rationally adjudicate among them.  Why an omnibenevolent, omnipotent God would have created a world where we have no basis for choosing one set of assumptions over another remains a mystery.  How could we be blamed for selecting the “wrong” starting assumptions and for never coming to know the correct moral commandments which he has issued?  The epistemic reality described by a relativistic reading of the AIP is incompatible with the notion of a God that created the world with specific moral principles by which he wants us to live.  If God has important truths he wants us to know, then we should expect a better way of knowing than what epistemic relativism provides.  

     In sum, there may be good reasons for religious belief to have greater influence in bioethics, but the AIP is a problematic strategy for reaching that conclusion—as it describes humanity in an epistemic situation incompatible with the God of standard theism.  

References:

Biggar, N. (2015). Why religion deserves a place in secular medicine. Journal Of Medical Ethics, 41(3), 229-233. doi:10.1136/medethics-2013-101776

Cahill, L. S., & Callahan, D. (1990). Can theology have a role in `public' bioethical discourse? Hastings Center Report, 20(4), 10.

Camosy, C. C. (2012). The Role of Normative Traditions in Bioethics. American Journal of Bioethics, 12(12), 13-15. doi:10.1080/15265161.2012.725349

Crane, J. K., & Putney, S. B. (2012). Exorcising Doubts About Religious Bioethics. American Journal of Bioethics, 12(12), 28-30. doi:10.1080/15265161.2012.719274

Durante, C. (2012). Extending the Hermeneutics of Suspicion Beyond Irreligiosity. American Journal of Bioethics, 12(12), 19-20. doi:10.1080/15265161.2012.719276

Faith, C. f. t. D. o. t. (2009, September 3, 2016). Instruction dignitas personae on certain bioethical questions.   Retrieved from http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20081208_dignitas-personae_en.html

Murphy, T. F. (2012). In Defense of Irreligious Bioethics. American Journal of Bioethics, 12(12), 3-10. doi:10.1080/15265161.2012.719262

Peterson, M. L. (2013). Reason and religious belief : an introduction to the philosophy of religion: New York : Oxford University Press, [2013] 5th ed.

The Catch-22 of the Inexperienced Therapist

The reality of training to be a mental health professional is that the only way to truly develop competence is to actually see patients. Though I was tempted to try to hide in case studies and role plays forever, focusing only on what I would do so as to never risk messing up, I discovered quickly that this was not an option. As an MSW (Master of Social Work) student in New York City, my peers and I were thrown into the city’s highest need, lowest resource communities a mere two weeks into our educational experience. Armed with little more than naive optimism, I set out to learn how to be a clinical social worker.

How was it determined which people would be the victims of my well-intentioned but clumsy first efforts at conducting therapy sessions? The anxious aspect of my personality hoped it would only be those with relatively straightforward problems with clear solutions so that the potential havoc I could wreak would be minimized. Alas, the realities of the city in which I live and the system within which I work would allow no such thing to happen.

In my experience, NYC is a city where the extremes of wealth and poverty coexist, but do not comingle. The way I see it, there are two siloed mental health systems here: one that serves the rich and one that serves everybody else. For those with money, the options are limitless. Therapists and psychiatrists who do not take insurance abound in this city, some charging upward of $500 for a 15 to 45-minute single session. Excellent at what they do I’m sure, but entirely inaccessible for most. On the other end of the spectrum lies the public mental health system, a constellation of public hospitals and community-based clinics scattered throughout the city. It is in these places where those who cannot pay as much are seen. This includes individuals whose mental health difficulties are often caused or compounded by a multitude of psychosocial stressors.  

Though these two systems aim to provide similar types of services, the scales are heavily weighted against one. The public mental health system is understaffed and overburdened, and as such it is in its settings that social work interns like myself often find themselves. In my case, it was an outpatient mental health clinic in Manhattan’s East Village that served as my own personal psychotherapy training ground.

My eight months at this clinic were a sort of mental and emotional bootcamp in which I was asked to do things I had never done before on a daily basis. When I arrived I had never conducted a therapy session in my life. About a month later I had a full caseload of individuals, couples, and families to manage, and was considered the primary therapist for every one of them. These were not the uncomplicated cases of my dreams. While I thought my superiors would hand-select relatively straightforward cases, the reality was far from this. . Rather, I saw a broad swath of mental health diagnoses, including depression, anxiety, bipolar, and schizoaffective disorders, that were inextricably interwoven with homelessness, unemployment, financial instability, immigration-related concerns, legal issues, and trauma.

Therapy is not an experience for the faint of heart. It demands brutal honesty and total vulnerability. Therapists pry into the most intimate aspects of their patients’ lives, not to be nosey, but rather because it is the only way for us to understand how we can help. The single most fitting word I can think of to describe my patients is brave. It takes a tremendous amount of courage for an individual to open up in therapy, and I am consistently humbled by the willingness with which my patients engage this task. But therapy is a transaction - in exchange for their honesty and openness, patients engaging in therapy have the right to expect that they will be greeted with expertise and knowledge of how to help them work through their problems. But what happens when this expertise is absent?

Graduate school taught me a lot of things, but one thing it did not teach me was how to do my job. I caught on quickly that my classes aimed to broaden my knowledge base and teach me a way of conceptualizing the problems I encountered in a manner consistent with the dictates of my discipline. They did not, however, teach me much in the way of how to concretely intervene in my client’s lives in order to facilitate positive growth and change. This is not meant to be a criticism of my graduate education. I fully recognize that only so much can be imparted in two years, and that the priority is to build a strong foundation that can be furthered through post-graduate employment experience.

But the fact remains that the crux of my job as a therapist is to help people produce the changes they wish to see in their lives. And when I began my internship at that outpatient mental health clinic, I had very little idea of how to actually go about doing that. Because of this I often couldn’t help but think of my patients as casualties of my own inexperience, and be bothered by the feeling that they deserved better than what I could offer. Further, because of the nature of the mental health system, the people with whom I worked were often high-need and low-functioning. Namely, they were individuals and families who could have benefited greatly from the care of an experienced, specialized mental health professional, yet who found that kind of professional unreachable due to financial and practical constraints. In short, I, or a similarly inexperienced therapist in training, was their only option.

I once read an article about starting therapy and was struck by the suggestions that it contained. Though I agreed with every one of them, I couldn’t help but notice what a privileged perspective it reflected. It essentially encouraged readers to shop around for a therapist until the person found  a good fit for the individual’s personality and goals. This is absolutely the ideal situation, but one that is unattainable for many. The individuals and families who visited the clinic in which I worked were not given a choice as to which therapist they would see. They were assigned a therapist based on whoever had availability in their schedule. If it happened that the patient did not like that therapist or their style, there was very little, and oftentimes no, flexibility for a change to be made. And so it goes that in so many cases the individuals with the greatest needs end up matched to the therapists who are least equipped to meet them.

I worked my way through that internship hoping that what I lacked in experience I made up for in kindness and presence with my patients. I rationalized that any interaction with a caring person who has the desire to help is therapeutic, and that the only way I could be more helpful to future patients was to invest in my present patients, learning from them and from my mistakes. I still believe these things to be true, but continue to be troubled by the ethics of providing “therapy” when the only thing that qualifies you to do so is your participation in a graduate program. We have to learn somehow, but is it really right to keep patients with entrenched difficulties that impede their ability to live meaningful lives in therapy that may be unproductive, ineffective, or aimless simply for our learning purposes?

The pattern I often see is therapists working in community-based, public mental health care at the beginning of their careers when energy and zeal are high and the need to accumulate clinical hours for licensure purposes is paramount. But working within this disorganized and fragmented system that so often fails to meet the needs of its consumers is frustrating, discouraging, and ultimately exhausting. To avoid total burn out, many practitioners transition into private practice once they have acquired the necessary expertise to do so. Yet the clientele that fills the caseload of a private practitioner tends to look quite different from that which predominates at a public hospital or community health clinic, often higher functioning, better educated, and with greater access to resources. And that is how the cycle perpetuates, how the people with the highest needs find themselves working with the mental health professionals who have the least experience to draw upon in order to meet them.

Though now a full-fledged, licensed mental health professional, I still consider myself an inexperienced therapist, and I continue to come up against this dilemma in my practice. I frequently encounter cases that are unlike anything I have worked with before, and feel a bit lost as I attempt to put together a treatment plan that I can only hope will work. I dream of a world in which the public mental health system is more functional such that a greater number of skillful, accomplished professionals are incentivized to continue to work within it. Until that time, I will work to make my peace with the fact that sometimes, for any number of reasons, I am all that people have. And though it may be imperfect, I am optimistic that the something we burgeoning therapists can offer in terms of mental health support is a whole lot better than nothing.

The Not-so-Sweet Truth About our Health

The Journal of the American Medical Association (JAMA)  published documents on Monday, September 12th, 2016, revealing how the sugar industry misguided the American public’s understanding of the role of sugar in heart disease.

In 1965, the Sugar Research Foundation (SRF) funded research to study the dietary causes of Coronary Heart Disease (CHD). This study identified fat and cholesterol as the dietary causes of CHD, successfully casting doubt about the harms of sucrose on heart health.1 The SRF-funded study then targeted previous research that showed possible links between sugar consumption and heart disease. They attempted to discredit the previous research for their use of epidemiological and animal studies by labeling them as “limiting” and saying that this kind of research was not relevant to humans. In this same review, however, the same researchers referenced literature that linked saturated fat to heart problems, without critiquing the study for using the same methods.3 At the time of this publication, there was no disclosure on who funded the research because it was not a requirement for the SRF-funded research to do so until the 1980s.2 I find it to be questionable that a study funded by the sugar industry itself was able to discredit the evidence that sugar did indeed have an effect on overall health. It is only now, in more recent years, that public health sectors have been able to bring attention to the fact that low fat diets with large amounts of sugar are not really aiding, but instead impeding, our health.

           However, this is not the only instance of large industries and companies paying off researchers to guide evidence in a favorable direction. Last year, The New York Times published an article unveiling how Coca-Cola gave millions of dollars to downplay the link between sugary drinks and obesity.2 In June, the Associated Press reported that candy makers had been funding studies stating that children who eat candy have a tendency to weigh less than children who do not eat candy. One of the scientists that was paid in the original SRF-funded study went on to become the head of nutrition for the United States Department of Agriculture. He then went on to assist in the drafting of the forerunner of the federal government’s dietary guidelines.2 While I do not mean to discredit any valuable work that he may have contributed to the field of health, I would like to draw attention to the fact that it’s not always clear that published research is intended to improve the health of the public; sometimes, the motive may be more politically and economically driven. Studies that are given media attention are not always those with our health in mind as the primary target.

           Indeed, my intention in writing this piece is to share that we cannot always trust that what we are being told is true evidence. Politics and money sometimes also play a role in an area that should be strictly limited to science. We should not live in paranoia that we are being lied to about what should be common knowledge on the topic of our shared health, but sometimes research has not be conducted in the most ethical of ways. As a result of some of the research studies discussed above, as well as other societal factors, we have seen an immense increase in the rates of obesity, diabetes, and heart disease. About 80% of the 600,000 food products sold in the United States contain added sugars. The average woman should consume a max of about 25 grams of sugar a day while the average man should consume a max of 38 grams a day. But the majority of us are well over this limit. As a nation, we cannot afford to take this kind of risk when it comes to the  health of the public. Money, on many different levels, should not be the determinant of our collective well-being.

References:

1. MBA, Cristin E. Kearns DDS. "Sugar Industry and Coronary Heart Disease Research." :  A Historical Analysis of Internal Industry Documents. 2016. Accessed September 16, 2016. http://archinte.jamanetwork.com/article.aspx?articleid=2548255.

2. 2. O'connor, Anahad. "How the Sugar Industry Shifted Blame to Fat." The New York Times. 2016. Accessed September 16, 2016. http://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-fat.html?_r=0.

3. 3. Sifferlin, Alexandra. "How the Sugar Industry Shaped Heart Disease Research." Time. Accessed September 16, 2016. http://time.com/4485710/sugar-industry-heart-disease-research/?xid=homepage.

Beyond Euthanasia

Jerika Bolen, a 14 year old from Wisconsin who suffers from type 2 spinal muscular atrophy, made headlines in July when she made the decision to end her life this fall by pulling the plug on her life-sustaining ventilator.1 The disease causes her constant pain and erodes all of her muscular ability. It is also fatal by mid to late adolescence, and she had been told that her pain would only increase in the years to come before ending in an inevitable death.1 Rather than endure this suffering, Jerika believes that a life after death would grant her freedom from her current pain. “I have been realizing I’m going to get to walk and not have this pain anymore and not have to, like, live this really crappy life” she said.1

In addition to ethical implications stemming from Jerika’s age, her decision also opens up a larger discussion on end-of-life decisions outside of euthanasia. Euthanasia is often a heated ethical issue, and Americans are deeply divided over it. Polls show that about half, 53%, of Americans believe that it is morally acceptable,2 and it is currently legal in only five states. However, conversations about end-of-life decisions rarely widen outside of euthanasia (physician-assisted suicide), to include ones like Jerika’s, which is a refusal of medical services that results in death.

Despite euthanasia’s high-profile nature, terminally ill patients have long chosen to end their lives by means other than lethal drugs. Some make decisions similar to Jerika’s, removing themselves from life-sustaining devices, while others choose palliative sedation, in which patients are medically sedated until death. Sometimes patients request that food and water be withheld during sedation, causing death by dehydration.  

Perhaps discussion mainly focuses on euthanasia because it is more direct than other life-ending measures: the action to take lethal drugs is clear, and death comes quickly. Those who choose palliative sedation slip away in a matter of days, and there are no legal complications: no one is required to accept food or water, and death is inevitable if they choose to refuse it. The core issue, however, remains the same: in what case, if any, do terminally ill patients have the right to choose death?

Proponents of euthanasia claim that it is a more humane alternative to sedation. Though sedative drugs can be used to make a patient more comfortable, no one can be sure of how much a patient is able to feel while under their influence. An underlying principle is also at stake: proponents believe that a painless and intentional death should be available to those who feel that this world has caused them unbearable suffering.

On the other hand, proponents of palliative sedation  view it as a more natural means of death. Sedation is a path often chosen when death is near, and sedation is simply a means of reducing discomfort and ushering in its arrival. It also does not carry the same risk of abuse, as is only available in truly terminal cases. Proponents argue that sedation upholds the principle of preserving life until it is no longer possible. Advocates of both means however, believe in a merciful answer to suffering at the end of life.  

Jerika’s choice to end her life was one made under heartbreaking conditions, and one that will not easily be forgotten. It was not, however, without its share of public controversy and legal complications that must have added to her already-heavy burden. For her sake, and for others like her, it is the responsibility of society to continue dialogue that leads to ethical and legal decisions about what constitutes a compassionate end to life. This means opening up conversations to take a wide look at options beyond the often-discussed euthanasia to include palliative sedation, refusal of medical services, pain management, and other methods of easing suffering at the end of life. In doing this, we take a step towards securing a more just end for ourselves and those around us.

References:

1 May, Ashley. “Q&A: What you should know about right to die.” USA Today, 8 Sep. 2015, http://www.usatoday.com/story/news/nation-now/2016/09/07/q-what-you-should-know-right-die/89959838/.

2 Swift, Art. “Euthanasia Still Acceptable to Solid Majority in U.S.” Gallup Polls, 24 June, 2016, http://www.gallup.com/poll/193082/euthanasia-acceptable-solid-majority.aspx?g_source=CATEGORY_HEALTHCARE&g_medium=topic&g_campaign=tiles.

Hillary’s Health: Is it Time for More Transparency in the Health of Our Presidential Candidates?

    The health of presidential candidates has been the topic of conversation on both sides of the political spectrum, as of late. Hillary Clinton (D) has been under intense scrutiny ever since her syncopal episode at a 9/11 memorial ceremony. Ms. Clinton was rushed into her private vehicle and taken to her daughter’s nearby apartment. Later, a campaign spokesperson revealed that Ms. Clinton had been diagnosed with pneumonia, two days prior. This incident, combined with recent coughing fits, has raised the eyes of the public as to the overall health of the Democratic presidential candidate.

    There have been popular conspiracy theories for years regarding the health of Hillary Clinton. I do not plan discussing or even acknowledging these assertions. Rather, I believe it is more important to discuss a change in current political traditions.  Presidential candidates should provide some form of confirmation by a group of physicians demonstrating that they are physically and mentally fit to serve as President of the United States.

    Obviously, amending laws to make this proposition mandatory is incredibly involved and generally unlikely. However, this change can still result from a shift in the social standard, if the candidates are pressed by the people and media.

    Why is this important from a bioethical standpoint? A sudden illness displayed to the public should not be the incident that prompts a release of medical records. The personal health of a presidential candidate is equally important as his policies. Trade negotiations, international crises, and other aspects of foreign policy suffer when a president is physically or mentally unfit to meet with other world leaders. At home, the sudden death or incapacitation of a president would rock the American political structure to its core.

As an American citizen, it seems almost morally wrong to elect a president who may fall into the aforementioned health category. I recognize that every citizen has a right to his privacy, and HIPPA laws do not allow healthcare workers to share private information regarding a patient’s health. However, Hillary Clinton’s recent medical episodes have prompted the need for change. All major presidential candidates should be assessed by a group of doctors in order to confirm that the candidate is fit to serve. An unhealthy candidate’s condition could worsen throughout the election cycle considering the intensity of the campaign trail, risking the safety of the candidate themself. The findings of these professional assessments should be released to the public for the sake of the people, the candidate, and the country.

Promising New Legislation for Flint’s Water Crisis

Flint, Michigan has been suffering from a water emergency for over three years. Budget cuts in Michigan ended up affecting basic necessities, including drinking water. Bankole Thompson, a reporter for the Detroit News, is calling this “Michigan’s Katrina.” He says that the state has created this problem for itself by ignoring important findings regarding resident’s health over the past few years. Following the initial discovery of the lead crisis, the mayor, backed by the Department of Environmental Quality, discredited residents’ concerns and said that the water was up to standards (Fonger). However, the takeover by the EPA a year later would suggest otherwise (Davey). Studies done by Virginia Tech showed that there is, in fact, an increased level of lead in the water supply (Davey). Unfortunately, this research went ignored, and the residents’  pleas for clean water only intensified.

Overall, there has been a seemingly apathetic response from the local and state governments. Since the switch of the pipelines from Lake Huron to the Flint River, there have been reports of elevated levels of lead in children’s blood (Davey). In addition, there have been only limited warnings about the spreading of Legionnaire’s disease – a severe type of pneumonia that can be spread through contaminated water sources (Davey, Legionnaire’s Disease). Finally , there have been state level restrictions preventing the city from switching their water source back to Lake Huron until the pipeline is completed, leaving the locals of Flint desperate for relief (Davey).

After switching the water source to the Flint River, forgoing corrosion controls, failing to issue proper alerts, and ignoring research and alerts from researchers and medical professionals, Flint Michigan may finally be seeing some relief from a new piece of legislation passed in the Senate (Davenport). The Water Resources and Development Act is meant to aid poor communities, including Flint, that are affected by lead-contaminated water supplies (Davenport). Funding allocated by the new piece of legislation could help purify the water supply and get clean water to an increasing number of people (Davenport). There is much potential for this act to have positive effects on the water supply in Flint, however, whether or not the funding will come through is another issue altogether. The bill awaits deliberation in the House, where the amount of spending will be determined, should the bill be passed. But with a 95-3 vote in the Senate, the its prospects are looking good.

References:

Davenport, Coral. "Senate Approves Funding for Flint Water Crisis." The New York Times. The New York Times, 15 Sept. 2016. Web.

Davey, Monica, and Mitch Smith. "What Went Wrong in Flint." The New York Times. The New York Times, 03 Mar. 2016. Web.

Fonger, Ron. "City Adding More Lime to Flint River Water as Resident Complaints Pour in." MLive.com. Advance Digital, 12 June 2014. Web.

"Legionnaires' Disease." Encyclopedic Dictionary of Genetics, Genomics and Proteomics (2004): n. pag. CDC, 18 July 2016. Web.

Thompson, Bankole. "Thompson: Flint Crisis Is Michigan's Katrina." Detroit News. The Detroit News, 13 Jan. 2016. Web.

EpiPens: A Life-Saving Necessity or Luxurious Expense?

Millions of Americans suffer from life-threatening allergies, whether the antigen are peanuts, shellfish, or latex. The one line of defense these people possess in the instance that they suffer from an anaphylactic attack is the epinephrine auto-injector. Epinephrine, also known as adrenaline, acts as a bronchodilator and vasoconstrictor, effectively opening a patient’s airway and allowing adequate blood flow to the heart and lungs by diverting it from the extremities. There is no other medicine that has these same effects. It is becoming more and more difficult for Americans to procure this pharmaceutical because of its ever-increasing price. This has become such a concern that one individual opted not to use her EpiPen during an allergic reaction because of the cost to replace it.

Mylan, the company that produces the ubiquitous EpiPen, owns about 90% of the $1.3 billion U.S. auto-injector market and has increased its price of an EpiPen by 450% since 2004 (Iozzo).  In 2004, the price of an EpiPen was $150, but has since skyrocketed to over $600. That cost reflects one dosage, but Mylan only sells EpiPens in packages of two. The pharmaceutical giant argues that a backup auto-injector is necessary in case the first one malfunctions. Therefore, buying this life-saving medicine costs consumers about $1,200. The actual epinephrine only costs Mylan one dollar to produce; the astronomical price of the product is mainly due to the company’s proprietary pen injector. Only recently, after much public pressure, has Mylan offered a discounted price on their EpiPen. However, even with this discount the product still costs well over $1,000. As a result, many consumers have attempted other ways to treat their allergies. An alternative company named Adrenaclick has emerged in the auto-injector market with a much cheaper product, selling for $142. While this product is much more affordable, doctors are hesitant to recommend it because the steps to use this new product are drastically different from those of the EpiPen (Cha). Since the EpiPen has monopolized the market, using a different product with different injection procedures will take time and practice. Doctors do not want individuals taking time during an emergency to stop and read the directions on how to use this relatively new product. Additionally, individuals have begun to create their own concoctions of epinephrine and use that in place of an EpiPen. This latter trend greatly worries legislators, particularly Iowa Senator Charles E. Grassley: “I am concerned that the substantial price increase could limit access to a much-needed medication. It could also create an unsafe situation as people untrained in medical procedures are incentivized to make their own kits”. The alternatives to using EpiPens are not very well established, so many consumers are forced to pay the exorbitant amount to use Mylan’s product. Those who cannot afford an EpiPen are turning to very drastic and radical measures to protect themselves in case they suffer an allergic reaction.

Alyssa Rosenberg has suffered from a severe tree-nut allergy since she was a toddler. Because of this diagnosis, she has needed an EpiPen for practically her entire life. Alyssa has lived a very functional and fulfilling life, as many allergy-sufferers do. However, last spring she had to make a decision after unknowingly eating kale chips that were seasoned with cashew dust. She reasoned that she would not have to go to the hospital, so rather than using her EpiPen she made herself vomit. Rosenberg went on to say that her health insurance plan is very expansive and that she rarely has allergic attacks. The attack she had last spring was the first one she had had in about ten years. Even though all of this is true, she still believed that not using her EpiPen was the best thing to do when she had an allergic reaction. There are many individuals in the United States who have very poor health insurance programs and use their EpiPens several times a year. The cost of replacing EpiPens to them is most daunting, and must be mitigated so that people do not have to think twice about using their EpiPen in the appropriate situation.

Epinephrine injection is the only way to treat anaphylactic shock in a patient, and the EpiPen is the only credible product available to people suffering from anaphylaxis. Mylan has consistently raised the price of their EpiPen over the past twelve years, which has greatly reduced individuals’ ability to purchase the device. This inability to access an EpiPen has lead people to make radical and potentially-dangerous decisions about treating their allergic reactions.

References:

Cha, A. E. (2016). U.S. lawmakers demand investigation of $100 price hike of lifesaving EpiPens. The Washington Post. Retrieved from https://www.washingtonpost.com/news/to-your-health/wp/2016/08/23/u-s-lawmakers-demand-investigation-of-100-price-hike-of-life-saving-epipens/?tid=a_inl.

Iozzio, C. (2015). How one startup plans to end the EpiPen monopoly. Fortune. Retrieved from http://fortune.com/2015/07/21/epipen-alternative-medicine/.

Rosenberg, A. (2016). EpiPens are my armor against disaster. They shouldn’t be priced like a luxury. The Washington Post. Retrieved from       https://www.washingtonpost.com/news/to-your-health/wp/2016/08/25/epipens-are-my-armor-against-disaster-they-shouldnt-be-priced-like-a-luxur

A New Approach to Combating the Zika Virus

The zika virus is currently of paramount concern to many health care officials in the United States, as there have been 29 cases of zika originating in the U.S. in the past several months (CDC). One area that has been particularly afflicted with the virus is southern Florida. As new cases emerge in Miami Beach, biotechnology companies have begun to propose that surrounding areas adopt a novel, yet preventative approach to fighting the zika virus. These companies argue that current methods to tackle zika are ineffective, but there are uncertainties regarding this new proposed method.

Zika can be transmitted multiple ways, but the most common is by mosquito bites. Other ways the virus can infect people are through intercourse, blood transfusions, and from a mother to fetus. The primary demographic that should be concerned about zika is pregnant women. Many adults rarely get sick enough from zika to go to the hospital and almost never die from the disease. However, the pathogen does pose a real threat to pregnant women because of the birth defects that it can cause. The main birth defect associated with zika is microcephaly, a condition in which a newborn’s head is smaller than normal. This abnormal shape is due to the brain’s insufficient growth either during pregnancy or after birth (CDC). The severity of microcephaly varies case by case, where the more severe instances of the condition can lead to many different learning disabilities and health conditions. Some of these include propensity to have seizures, intellectual disability, hearing loss, and vision loss. These negative effects of the virus are so pressing that public service workers in the Miami area are working overtime to ensure that all mosquitoes have been eradicated from the city streets.

Last Thursday there were reports that two new cases of zika had been diagnosed in Miami Beach. Public works crews are working around the clock to ensure that the tourism capital of southern Florida is completely without zika-carrying mosquitoes. They are using two different strategies to eradicate the disease, and are encouraging all residents of the Miami Beach area to do the same: drain and cover. Sanitation workers are working with pressure washers at temperatures of 250 degrees Fahrenheit to force all stagnant water into the sewer system while simultaneously killing any bacteria living in the water. Additionally, public health officials are urging residents drain any standing irrigation or rain water that can collect in trash cans, pool covers, gutters, etc. (Flechas). Mosquitoes need standing water to lay their eggs, but not a lot of it; mosquito larvae can hatch in as little as a teaspoon of water. This fact is the reason that eliminating all standing water in the area is of the utmost importance. The other approach that Miami workers are using to combat Zika is to cover any isolated areas where the virus may be. Workers are vacuuming up debris where mosquitoes may lay their eggs are throwing larvicide pellets into storm-water drains.  They also are requiring homeowners to cover up their doors, windows, porches, and patios with screens. People are also encouraged to wear clothing that does not expose their skin to potential mosquito bites. These are the current measures the Florida Department of Health is taking to protect its people from zika. There are certain biotechnology companies that are proposing more innovative measures to prevent this virus from spreading to other adjacent areas of the state.

Oxitec is a company that has genetically engineered mosquitoes designed to kill other ones carrying the zika virus. These synthetic mosquitos would mate with wild female ones and their offspring would die before adulthood. On August 5th, the Federal Drug Administration approved test trials of this new technology in the Florida Keys as a preventative measure. No cases of the zika virus have been reported in the Florida Keys at this time. Hadyn Perry, the CEO of Oxitec, advocates for the use of this technology to combat zika and cites its previous success. This same technology was employed in 2010 when there was a dengue outbreak in the Florida Keys, and it killed about 40% more mosquitos than the methods previously described. However, there had been opposition from local residents to use this technology, primarily because there is no current problem with zika in the Florida Keys and that there may be unpredictable side effects of this new technology (Allen). As such, this technology has not been used to date in the fight against zika, but its potential life-saving effects are very promising.

The zika virus is garnering all the attention among major healthcare officials in the United States, and for good reason. Its harmful effects on infant babies are very concerning, and must be dealt with. As such, Miami health officials have adopted a multi-faceted approach to battle the virus. However, more radical measures to fight this pathogen are on the horizon.

References:

Allen, Greg. “Florida Keys Opposition Stalls Tests of Genetically Altered Mosquitos”.

           NPR Shots: Health News from NPR. August 17, 2016. Accessed August 26, 2016.

           < http://www.npr.org/sections/health-shots/2016/08/17/490313999/opposition-in-

           florida-puts-tests-of-genetically-altered-mosquitoes-on-hold>.

CDC. “Overview: How Zika Spreads”. Center for Disease Control and Prevention.

           Accessed August 26, 2016. < http://www.cdc.gov/zika/about/overview.html>.

Flechas, Joey. “Miami Beach workers Sweep City for Zika Breeding Grounds”.

           Miami Herald: Healthcare. August 19, 2016. Accessed August 26, 2016.

           < http://www.miamiherald.com/news/health-care/article96637632.html>.

Focused ultrasound now FDA approved

The University of Virginia recently led an international clinical trial determining the effectiveness of focused ultrasound on the treatment of essential tremors. Having an essential tremor can disrupt everyday life, making it difficult to write, feed oneself, and participate in many other daily activities. Of the 76 participants, those that received the experimental treatment reported dramatic improvement, whereas those that received the “sham” treatment showed no significant improvements. Some reported side-effects included numbness in the hands or face and gait disturbances, though most of these were temporary. The focused ultrasound device has been approved by the FDA but whether insurance companies will pay for the treatment and who will be eligible has yet to be finalized.