Thursday, January 7, 2010

Pseudoscience: Opioids, Contraception, Abortion and Cancer.

It's a great day for ideologically motivated pseudoscience!

From BeliefNet, a new study that, against all odds, establishes a link between contraception, abortion and cancer.

And from the super GeriPal, a debunking look at the swelling but false meme that opioids like morphine cause cancer growth.

Why is it important to not leap to the conclusion that opioids cause cancer growth? Two recent examples come to mind: hormone replacement therapy for post-menopausal women and vitamin E. Early retrospective studies (in humans, not mice) seemed to demonstrate that hormone replacement therapy led to reduced mortality. Unfortunately, large prospective cohort studies showed the opposite to be true! When researchers went back to re-examine the earlier studies, they found those earlier studies failed to account for important baseline differences in women: those who were healthier were more likely to take hormone replacement therapy, and therefore had better health outcomes that were attributed to the drug. Similarly, there was a great deal of excitement about vitamin E, including bizillions of laboratory studies that showed plausible mechanisms by which vitamin E could reduce heart attacks (antioxidant properties, etc). Again, large studies showed the opposite: people who do not take vitamin E live longer and have fewer heart attacks than people who do take vitamin E. In both the case of hormone replacement therapy and vitamin E, patients were taking the drug and health care providers were recommending treatment based on early evidence. And people died.


As Christian Sinclair (of Pallimed) noticed, if you Google search "morphine cancer" the fourth hit is "Pain drug morphine may accelerate cancer growth | Reuters." Think of all of our patients and caregivers who, seeking information, are clicking on that link.
Let's set the record straight.

The world is full of suppositions and pseudoscience that is meant to support an ideology - the media plays sucker again and again. Got your own examples? Post them in comments!

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Palliative Care Best Practices Study.

7thSpace posts a study that looks at the universality of best care practices among palliative care givers and finds there is no there there.

Methods: The official documents by the most representative health organisations committed to the definition of policies and guidelines for palliative and end-of-life care had been considered. The documents were analysed through a framework of the components of end-of-life care derived from literature, which was composed of 4 main "areas"and of 12 "sub-areas".

Results: Overall, 34 organizations were identified, 7 international organisations, and 27 organisations operating on the national level in four different countries (Australia, Canada, UK and United States).

Up to 56 documents were selected and analysed. Most of them (38) are position statements.

Relevant quotations from the documents were presented by "areas"and "sub-areas". In general, the "sub-areas"of symptoms control as well as those referring to relational and social issues are more widely covered by the documents than the "sub-areas"related to "preparation"and to "existential condition".

Indeed, the consistency of end-of-life choices with the patient's wishes, as well as completion and meaningfulness at the end of life is given only a minor relevance.

Conclusions: An integrated model of the best palliative care practice is generally lacking in the documents. It might be argued that the lack of a fixed and coherent model is due to the relevance of unavoidable context issues in palliative care, such as specific cultural settings, patient-centred variables, and family specificity.

The implication is that palliative care staff have continuously to adapt their model of caring to the specific needs and values of each patient, more than applying a fixed, although maybe comprehensive, care model.

Is the need to tailor care to each patient a bad thing or a viable thing? However exhausting and difficult such practice is, is it a result of the nature of the profession or is it an issue of palliative care's burgeoning development? And how is this lack of ethical best practice guidelines like or unlike the care guidelines other medical doctors operate under?

I would love to know what hospice and palliative practitioners have to say!

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"Stories at Sunset" From Hospice of Michigan.

From PRNewswire, an awareness campaign from Hospice of Michigan to better familiarize the public with end of life care and hospice experiences:

Hospice of Michigan, one of Michigan's leading providers of hospice and palliative care, will engage the public in a 52-week awareness campaign about end-of-life issues called "Stories at Sunset." The campaign, which begins the first week of January 2010, will draw upon the true stories of husbands, wives, sons, daughters, sisters and brothers who have helped loved ones at the end of life. It also will feature first-hand stories from Hospice of Michigan nurses, doctors, social workers, volunteers and donors.

The stories will be aired on radio stations in Southeast Michigan - one story each week for 52 weeks, and on the Hospice of Michigan website:

Hospice of Michigan President and CEO Dottie Deremo said, "We think "Stories at Sunset" is a powerful way to shed light on end-of-life experiences, and help dispel some of the fear that people feel when people they love are dying. We know from 30 years of providing hospice care that families are often transformed by their hospice experiences, and are comforted by talking about them."

Though hospice care has been available in Michigan for 30 years, it is still not widely understood. Only 30 percent of eligible patients access hospice services at the end of life.

Hospice of Michigan has been providing service in Michigan for 30 years. Here are some things you should know about hospice care:

  • Hospice care is a widely-accepted health-care service that is regulated by the state and federal government.
  • Hospice provides a holistic approach to care that includes addressing the emotional, physical, and social needs of the patient and their loved ones.
  • Hospice supports family members and loved ones through the experience and helps them cope with grief afterwards.
  • Hospice care is paid for by Medicare, Medicaid, and most private insurance companies.

"During the "Stories at Sunset" campaign, we will share a new story each week. We hope people will come to our website -- -- each week to hear the stories, or tune in to the radio station in their community that is airing them," continues Deremo. "At some point in each of our lives, we will lose people we love. The universal themes of these stories connect us to each other and help us realize that though our experiences are unique, we are not alone."

About Hospice of Michigan:

Hospice of Michigan is a non-profit organization that provides comprehensive comfort care to people living with a terminal illness and support to their families. The organization serves more than 900 people every day in 56 counties in Michigan. Patients and families may request hospice care for themselves or their loved ones, or they can ask their health care provider to refer them. Hospice of Michigan can be reached 24-hours-a-day at 888-247-5701. Visit Hospice of Michigan online at

Stories at Sunset logo in high-res .jpeg:

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Texas Baptists Break from Denominational Doctrine.

Wilkyjr has a post at Talk2Action about the Southern Baptist of Texas continuing the break from traditional Baptist support of separation of church and state. Their agenda looks more theocratic than democratic. Here's a clip:

Ledbetter wants churches to get government funds for church outreach programs. When Civil Rights issues come into play on this charitable choice program, Gary wants government to look the other way. He thus believes tax money can be used to win converts and indoctrinate potential converts. He also demands that the government cannot have any strings attached in hiring practices with the use of government money. The convention seemed to like the idea of Rick Warren, a Baptist preacher, interviewing potential Presidential candidates. The interview of candidates by Warren was used by the Fundamentalist paper to attack Obama. The paper's candidate comparison carried only one issue, abortion. The position on abortion was determined to be the overriding moral issue in the 2008 campaign.

When church state separation groups grew concerned that the Bush administration was claiming to allow discrimination in hiring with the use of tax money, Fundamentalist Baptists became defensive. The "L" word was thrown at those who didn't like this new Bush policy. They were dismissed as just "liberals". The taking of any government money foir church programs is a radical departure from Baptist heritage. With such paths traveled ture Baptists must wonder if the name "Baptist" even fits here.

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What is Disability?

As I ponder the end of life care landscape on a daily basis, I've come across the many opponents to aid in dying. Disability advocates, in many cases, have worked with "pro-life" groups in order to protest what they call the vulnerability of the disabled when aid in dying is legalized, as was just done in Montana.

This argument co-opts the "pro-life" position that aid in dying (or assisted suicide or euthanasia) is a slippery slope and holds up nations like the Netherlands, where aid in dying is legal, as example.

There are a thousand ways to parse the statistics but the statistics in the US - and the way that aid in dying has been legalized, regulated, and practiced here - do not bear out the accusations.

But the slippery slope argument makes me wonder, What is Disability? Is it frailty at the end of life? Physical or mental challenges present from birth like blindness or Downs Syndrom? Or physical challenges encountered later in life like spinal cord injuries? Brain death (as the Schindler family, Terri Schiavo's parents and siblings contest)?

Until we have a more detailed understanding of what disability is we will be left to struggle with the argument of who has the right to determine their own choices, who is "vulnerable" and what dignity or quality of life mean.

VSA Arts is running a project that asks people around the world to submit postcards that explore the definition of disability. I look forward to what they receive.

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Stupak's Fight.

Jodi Kantor has an article today at NYT about Bart Stupak and his efforts to restrict women's coverage in the health care bill:

“It’s not the end of the world if it goes down,” he said over dinner.He did not sound downbeat about the prospect of being blamed for blocking the long-sought goal ofPresident Obama and a chain of presidents and legislators before him. “Then you get the message,” he continued. “Fix the abortion language and bring the bill back.”

Mr. Stupak says his stand is a straightforward matter of Roman Catholic faith, but it also seems like the result of a long, slow burn. As dinner progressed, the congressman described years of feeling ignored, slighted or marginalized by his party for his anti-abortion views.

“We’re members without a party,” he said. “Democrats are mad at you, and Republicans don’t trust you.”

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Workplace Discrimination Charges Reach New High.

From an Equal Employment Opportunity Commission release yesterday:

The FY 2009 data show that private sector job bias charges (which include those filed against state and local governments) alleging discrimination based on disability, religion and/or national origin hit record highs. The number of charges alleging age-based discrimination reached the second-highest level ever. Continuing a decade-long trend, the most frequently filed charges with the EEOC in FY 2009 were charges alleging discrimination based on race (36%), retaliation (36%), and sex-based discrimination (30%). Multiple types of discrimination may be alleged in a single charge filing.

The near-historic level of total discrimination charge filings may be due to multiple factors, including greater accessibility of the EEOC to the public, economic conditions, increased diversity and demographic shifts in the labor force, employees’ greater awareness of their rights under the law, and changes to the agency’s intake practices that cut down on the steps needed for an individual to file a charge.

The back-up statistics are here and break the filings down into categories.

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PalliMed Grand Rounds Summary of Blogging.

Christian Sinclair has a new summary of recent palliative and hospice blogging - and tweeting. Catch it here.

Most helpful is a list of active palliative and hospice blogs. Find it here.

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