Why does acid reflux get worse after treatment?

Chronic acid reflux can be annoying and uncomfortable. Many times, when people are struggling with chronic acid reflux their healthcare provider prescribes them with a proton pump inhibitor, a proton pump inhibitor stops gastric acid secretion into the stomach and is commonly taken in combination with a protectant like sucralfate to in case there is damage done to the esophagus tissue or stomach lining (ulcer) which will coat theses part of the body to prevent and heal damage. Short term use of PPIs is the most effect and safe, but many people experience something called “rebound acid hypersecretion" which is an sudden increase in acid reflux and indigestion right after they finishing taking a PPI. It was found that the increase acid production was quicker than before they had taken the PPI and the release enterochromaffin-like cells had begun which also cause more acid production by releasing histamine.

Acid reflux and gastroesophageal reflux disease are very common problems for many people, but I choose to talk about how acid reflux can get worse after the most common treatment, which is PPI use, because I think the acid reflux is a lot more difficult to treat than people realize. When you look up treatments for acid reflux you will see articles saying to try multiple different diets, cleanses, apple cider vinegar, take medication, don’t take medication and it can be confusing how why is the most effective way. The reading I read suggests not abruptly stopping PPI and slowly decrease the amount you take to prevent rebound acid hypersecretion, but I think that more research would be helpful to see ways to treat acid reflux. 

I think this can show a valuable need for change in the experimental planning and publishing. I think when complex conditions and diseases like acid reflux are researched it can lead to a wide array of possible solutions because some treatments can work well on certain people or under certain circumstances. But I noticed that many times when information is published, it can be spread and lead people to misunderstanding how to treat and understand their own disease or condition. The best thing for people to do is to talk to their doctor about their specific illness and symptoms and there be more control over how information is published so that people are encouraged to talk to their doctor before becoming confused. In terms of research, more time should be put into test the effects of abruptly stopping a drug to prevent people from suffering from worsening symptoms. 

Citation: https://www.medsafe.govt.nz/profs/PUArticles/June2019/Proton-pump-inhibitors-and-rebound-acid-hypersecretion.htm

Antidepressants for IBS?

One of the most common gastrointestinal disorders is irritable bowel syndrome, which causes recurrent cramping, abdominal pain, bloating, gas, and diarrhea or constipation, or both. IBS is related to abnormal motility (too fast causing diarrhea or too slow causing constipation), visceral hypersensitivity which is increased sensitivity in the nerves in the GI tract which leads to discomfort and cramping. Lastly, it also shows poor brain-gut function where the brain is overly responsive to the pain signals coming from the GI tract and is worsened when an individual is experiencing stress. Antidepressants like SSRIs (selective serotonin reuptake inhibitors) and SNRIs (Serotonin-Norepinephrine reuptake inhibitors) have been shown to help with the brain and spinal cord function properly and help reduce visceral hypersensitivity. 

What is not talked about though is that there is a lot of strain on the people who have IBS, not feeling well all the time can make it difficult to not be worried and stressed. Being worried and stressed worsens the symptoms and creates a very difficult cycle for someone to be stuck in. These drugs can help reduce depression and anxiety symptoms and help people feel better. 

 

I wanted to talk about this since I learned that SNRI’s have a been effective in reducing the symptoms of IBS which was interesting, and I wanted to know what the physiology was behind it. I think IBS is an illness that is complex and can be caused by multiple different things, and it seems like every person with IBS has different experiences. I do find it very interesting to see stress has a big role on digestion and a decrease in norepinephrine can lead to improvement in symptoms, which I think shows how dependent all of the different systems in the body are on each other and sometimes the solution to one system starts somewhere else. 

In terms of how this can relate to ethics in science, I think it can show how experimental design can be altered to broaden how we think and measure the human body, for example recently more research is being done on how the microbiome effects the immune system, mental illness, and even likelihood of developing cancer. It is very interesting, and many people may assume that the bacteria in our intestines have very little to do with mental health, but according to new studies that is not true. I think experimental designs in physiology is moving towards being more wholestic when it comes to looking at small part of the body or dieases which I think will lead to more effective and unique research. 

Citation: https://www.med.unc.edu/ibs/wp-content/uploads/sites/450/2017/10/IBS-and-Antidepressants.pdf

Starbucks for Kids

I grew up in a family of coffee drinkers. As a child, I spent tons of time in local coffee shops or going on frequent Starbucks runs with my parents. I started drinking espresso in middle school and this became a daily habit when I was in high school. What  kind of effects can caffeine consumption have on a developing body? The idea that caffeine stunts a child's growth has been debunked, because coffee consumption does not cause osteoporosis (Harvard Health Publishing, 2020). Additionally, bone growth cannot be reversed, so teens will not shrink once they start regularly drinking coffee. Many people shrink due to compression fractures from osteoporosis or the compression of disks above and below spinal bones, but this has not been linked to coffee consumption (2020). Some studies have linked coffee consumption to reduced liver disease, arrhythmia, Alzheimer's disease, and Parkinson’s disease (2020). With linked health benefits and no impact on bone growth, coffee seems to be a very beneficial stimulant for humans. However, caffeine tolerance in children is much lower than adults. Coffee and caffeinated beverages produced are commonly targeted towards adults, who typically tolerate high caffeine levels better. Children drinking coffee or caffeinated beverages can face health risks and potential reduced cognitive function (Perlman, Ph.D., 2021). The Department of Biomedical Engineering at the National University of Singapore conducted a study that demonstrated an association between children who regularly consumed large amounts of caffeine and lower scores of cognitive function than their non-caffeinated counterparts (2021). The categories included, cognitive flexibility, processing speed, episodic memory, working memory, inhibitory control, reading decoding, and comprehension. An important note is association is not equivalent to causation, so it is unfair to assume high consumption levels of caffeine lead to impeded cognitive abilities.  

More research is being conducted on the impacts of coffee on child development and how this would impact the person through adulthood (McVay, 2020). For now, there is very limited research on the impacts of coffee and high doses of caffeine on children. Caffeine can disrupt sleep patterns and reduce sleep quality, which can be damaging for a child because quality sleep during adolescents is crucial for brain and body development (Lodato, 2013). Is it right to buy your children Starbucks beverages and highly caffeinated energy drinks? Everything can be done in moderation, and without significant data supporting detrimental effects to child development, it’s the parents decision. 

References:

Harvard Health Publishing. (2020, January 7). Can coffee really stunt your growth?Harvard Health. Retrieved November 29, 2021, from https://www.health.harvard.edu/staying-healthy/can-coffee-really-stunt-your-growth.

Lodato, F., Araújo, J., Barros, H., Lopes, C., Agodi, A., Barchitta, M., & Ramos, E. (2013, August 1). Caffeine intake reduces sleep duration in adolescents. Nutrition Research. Retrieved November 29, 2021, from https://www.sciencedirect.com/science/article/abs/pii/S0271531713001528. 

McVay, E. (2020, February 19). Is coffee bad for kids?Is Coffee Bad for Kids? - Johns Hopkins All Children's Hospital. Retrieved November 29, 2021, from https://www.hopkinsallchildrens.org/ACH-News/General-News/Is-Coffee-Bad-for-Kids. 

Perlman, W. R. (2021, May 28). Childhood caffeine exposure may negatively affect cognitive functioning. National Institute on Drug Abuse. Retrieved November 29, 2021, from https://www.drugabuse.gov/news-events/nida-notes/2021/04/childhood-caffeine-exposure-may-negatively-affect-cognitive-functioning. 

Microbiota passed through breast milk

Gut microbiota play an important role in human development. The flourishing group of symbiotic bacteria plays a crucial role in digestion, immune health, and homeostasis (Harvard, 2020). The microbiota is crucial for child brain development through the gut-brain axis (Ihekweau M.D. et. al., 2018). A child’s microbiota development begins in utero and further develops during the birthing process (2018). The first year of life is a pivotal time period for microbiome development because this when gut microbiota diversifies, and this development will impact the person through adulthood (Ma, 2020). A mother’s gut microbiota can be passed through breast milk and can heavily influence the infant's microbiota (Fehr, 2020). Breast milk is rich in vitamins, minerals, amino acids, and good bacteria. Prebiotic human milk oligosaccharides found in breast milk supports the development of the microbiota in an infant (2020). Microbiota passed through breast milk can also have an effect on a child’s allergy and disease risk (Van Den Elsen et. al., 2019).

It is well known that breastfeeding and formula provide an infant with exposure to microbiota and equivalent nutritional benefits (Bhandari, 2018). This makes both feeding methods adequate and acceptable forms of nutrition. Formula provides an infant with a different set of bacteria that is less abundantly found in breast milk, and vice versa (2018). It is currently unclear if the mode of breastfeeding has an impact on an infant’s gut microbiota. Nursing and pumping methods have been compared to determine if the infant’s microbiota differed. One study found that pumping breast milk may reduce the amount of shared microbiota between the mother and infant (Fehr, 2020). Additionally, a common source of microbes an infant receives comes through direct skin contact with the mother (2020).

Many women have strong opinions on how a mother should feed their child. If a primary source of transferring microbes is through skin contact, the infant is likely exposed to beneficial microbes through general nurturing. With so many uncertainties surrounding how gut microbiota is passed from mother to a child, it is unfair to judge or control a woman’s choice for feeding mode, whether that is through nursing, pumping, or formula. 

References: 

Bhandari, T. (2018, December 27). Breast milk, formula nurture similarities, differences in gut microbes. Washington University School of Medicine in St. Louis. Retrieved November 29, 2021, from https://medicine.wustl.edu/news/infant-formula-breast-milk-nurture-similarities-differences-in-gut-microbes/. 

Fehr, K., Moossavi, S., Sbihi, H., Boutin, R. C. T., Bode, L., Robertson, B., Yonemitsu, C., Field, C. J., Becker, A. B., Mandhane, P. J., Sears, M. R., Khafipour, E., Moraes, T. J., Subbarao, P., Finlay, B. B., Turvey, S. E., & Azad, M. B. (2020, July 10). Breastmilk feeding practices are associated with the co-occurrence of bacteria in mothers' milk and the infant gut: The child cohort study. Cell Host & Microbe. Retrieved November 29, 2021, from https://www.sciencedirect.com/science/article/pii/S1931312820303504?via%3Dihub#bib30. 

Harvard. (2020, May 1). The microbiome. The Nutrition Source. Retrieved November 29, 2021, from https://www.hsph.harvard.edu/nutritionsource/microbiome/. 

Ihekweazu, F. D., & Versalovic, J. (2018, August 21). Development of the pediatric gut microbiome: Impact on health and disease. The American Journal of the Medical Sciences. Retrieved November 29, 2021, from https://www.sciencedirect.com/science/article/pii/S0002962918303021. 

Ma, J., Li, Z., Zhang, W., Zhang, C., Zhang, Y., Mei, H., Zhuo, N., Wang, H., Wang, L., & Wu, D. (2020, September 25). Comparison of gut microbiota in exclusively breast-fed and formula-fed babies: A study of 91 term infants. Nature News. Retrieved November 29, 2021, from https://www.nature.com/articles/s41598-020-72635-x. 

Van Den Elsen, L. W. J., Garssen, J., Burcelin, R., & Verhasselt, V. (2019, February 27). Shaping the gut microbiota by breastfeeding: The gateway to allergy prevention?Frontiers in Pediatrics. Retrieved November 29, 2021, from https://www.frontiersin.org/articles/10.3389/fped.2019.00047/full.

Are school lunches healthy?

    A book I read called Food Fix touches on how schools provide meals for many of their students, but that is not enough as it is unhealthy in many cases. Diet impacts human health, so when there are specific nutrient inadequacies, especially during childhood, it can affect brain development and have lifelong health consequences. For example, school lunches can contribute to unhealthy meals for children because so many children rely on them for the nutrition they need, but they are loaded with sugar, salt, processed card, and industrial fats. Some companies lobby for bills that count tomato paste as a vegetable, making pizza count as a vegetable. It was surprising that there was such a bill because pizza should not compare to something nutritional and the use of " smart food" in schools, which is junk food marketed to be "reduced fats" or healthier, which are not. Healthy food should be accessible to every child, especially to poorer neighborhoods that truly depend on them.

    An article I can across focused on breakfast and how it is disproportionately prevalent among school-aged urban minority youth, which harms academic achievement by affecting cognition. On an average day, about 46% of children participating in free or reduced-price lunch also participated in the School Breakfast Program for which they were also eligible. Since there is a link between eating breakfast and academic achievement, children should eat breakfast. Research has identified the molecular and cellular processes by which dietary behavior influences neuronal activity and synaptic plasticity. The study found that availability of the School Breakfast Program (vs. no program) improved children's nutrient intakes: children were less likely to be deficient in serum levels of vitamin C, vitamin E, and folate, more likely to meet recommendations for intakes of fiber, potassium, and iron, have overall better dietary quality and consume fewer calories from fat while not consuming more overall calories (Basch, 2011).

Basch CE. Breakfast and the achievement gap among urban minority youth. J Sch Health. 2011 Oct;81(10):635-40. doi: 10.1111/j.1746-1561.2011.00638.x. PMID: 21923876.

HYMAN, M. A. R. K. (2022). Food fix: How to save our health, our economy, our communities, and our planet--one bite at a time. LITTLE BROWN SPARK.

Anti-diabetic drugs can treat Secondary Amenorrhea

Secondary Amenorrhea is when a woman does not have a period for more than three months. There are multiple reasons why a woman would experience secondary amenorrhea including polycystic ovarian syndrome, being overweight or underweight, hypothyroidism, increased stress, and hormonal imbalances. The hormone most responsible for menstruation is estrogen, a woman may have secondary amenorrhea when she is not producing enough estrogen or has high amounts of testosterone that interfere with the production of estrogen. There are many ways to treat secondary amenorrhea and the most common are birth control and lifestyle changes. While birth control is effective and helpful for many women it can be inappropriate for women who’s secondary amenorrhea more complex. Surprisingly, Metformin, an anti-diabetic drug that can decrease the body’s blood sugar and decrease insulin resistance has been found to increase ovulation, regulate periods, and increase fertility because it also reduces androgens like testosterone in the body which rebalances the hormones. It also helps with weight loss and prevents weight gain which is very helpful for those who have secondary amenorrhea due to being overweight. Personally, knowing people who have experienced having PCOS and secondary amenorrhea, it is very interesting to see how an anti-diabetic drug plays a role in menstruation. Someone I know described not being able to get a period as a suffocating feeling, they constantly felt as if they were bloated or full and felt uncomfortable. When taking birth control for this issue, they felt no different if not worse during the time they had to take the pills and when their period began, they felt better but it was only temporary. This person was also struggling with weight and diet issues. When they talked to their doctor, they were prescribed metformin, and it changed the way they felt. They lost weight after a few months of taking it, they have a consistent period, and no longer feel bloated and full. They feel significantly better now and have been able to manage their diet and PCOS. This raises questions about the effects of the diets and metabolism with how hormones are released in the body and how that creates symptoms and moods. This showed me that periods are a lot more complex than hormone levels.

In general, looking into different drugs used for women’s reproductive system I found that research on the female anatomy has been narrow or difficult to have a straight answer on. I think part of the reason some solution to women’s health issues is slow in progress compared to other issues. In terms of data collection in the scientific field and in historical context, issues like secondary Amenorrhea should not only have better research advancement and better understanding.

 Citations:

1.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712235/

2.  https://nyulangone.org/conditions/polycystic-ovary-syndrome-in-adults/treatments/medication-for-polycystic-ovary-syndrome-in-adults

Bone Loss in Menopause Starts Earlier Than You Think!

 Menopause is defined as the 12 month period after a women has her last menstrual period. The time leading up to menopause (perimenopause) can last for a total of four to eight years, but varies with each individual. During this time, a woman's ovarian function begins to decline, decreasing the amount of hormone released and increasing bone loss. 

A study aimed to specify the amount of bone density loss during menopause, found that the decline in bone mineral density began before the final menstrual period (FMP). The authors divided the FSH levels of menopause into categories, with four different requirements. Stage 1,2,3, and 4, depending on the amount of FSH present. In Lumbar Spinal regions, the bone loss was measured in relation to the FSH levels and stages. In stage one (7 years before the FMP), 17% of bone was lost, in stage two (7-2 year before FMP), 44% of bone was lost. In the last two FSH stages, from 2 years until FMP to 6 years after FMP, bone loss increased exponentially. 

When comparing BMI, the study found that obeseity protected women from bone loss during perimenopuse, as compared to non-obese women who lost more bone mass. The authors predicted this difference was due to estradiol (a hormone that can reverse symptoms of menopause) and other hormones in adipose tissue around the body. 

Bone loss in women experiencing menopause is extensive. This loss in bone density can increase risk of osteoporosis, fractures or other injuries. Recent findings have increased the hope for treatment of post-menopausal osteoporosis. Researchers at Tokyo Medical University believe that Sema3A (a protein secreted by osteocytes) could reverse this problem. They found that drop off of estrogen levels caused a decrease in Sema3A. Sema3A is important for maintaining bone and bone density, without this protein, osteocytes begin to die and bones deteriorate. This could be an important finding for treatments and prevention of menopausal osteoporosis.

How does estrogen protect bones? Unraveling a pathway to menopausal bone loss. (2019, April 11). Women's Health Weekly, 425. https://link.gale.com/apps/doc/A581549939/ITBC?u=regis&sid=ebsco&xid=418eeb7f

Sowers, M. R., Zheng, H., Jannausch, M. L., McConnell, D., Nan, B., Harlow, S., & Randolph, J. F., Jr (2010). Amount of bone loss in relation to time around the final menstrual period and follicle-stimulating hormone staging of the transmenopause. The Journal of clinical endocrinology and metabolism, 95(5), 2155–2162. https://doi.org/10.1210/jc.2009-0659

Where Do We Draw the Line?: Psychiatric Patient Autonomy

    My sophomore year I took two classes called “Philosophy of Mental Health” and “Drugs and Society”, in which we discussed an important ethical issue of patient autonomy and their right to refuse treatment. An interesting story in one of the required readings was about a college boy who experienced a psychotic break and broke into a family’s home to take a bath. After the police detained him and he was eventually brought to the hospital, the boy refused all treatment and demanded to leave despite the doctor and his parents pleading for him to get the help he obviously needed. Ultimately, he was allowed to leave unmedicated and untreated (although the boy was sued later on for trespassing). As college students we rarely experience or hear of stories like this, but it made me question what lines and regulations should allow doctors to virtuously overrule patients that refuse treatment they need? What would I have done if I was the doctor?

    While the majority of psychiatrists hold their patient’s wellbeing at the highest of their priorities, an ethics dilemma that has been at the forefront of psychiatric care for years is the need of boundaries and framework to override patient autonomy if intervention is deemed necessary. Primarily, a patient’s diagnosis or mental incapacity is usually relied on as justification for these decisions, but this is an obvious violation of rights for people with mental disabilities if the foundation of these claims is not supported. So, what ultimately decides these two criteria for overriding patient autonomy? For the diagnostic lens, many people have considered physiologic biomarkers and epistemic irrationality as indicators. However, these measures are not always reliable as epistemic irrationality is commonly used hastily to diagnose untreated patients despite the possibility of mental disorder and epistemic irrationality being exclusively mutual from each other. Biomarkers similarly are not always constant across every mental disorder. Therefore, biomarkers and epistemic irrationality cannot be means of reason for intervention in the health of psychiatric patients. 

    Currently, the mental incapacity criteria for intervention is the favored approach as it focuses on decision-making capabilities of the individual and incorporates the patients’ autonomy into the equation. The only challenge with this is where to draw the line and how to baseline mental incapacity, as neurodiversity creates an uneven playing field for defining “normal” and “rational” thought/behavior. A better model that has been proposed (and I believe to be fairer) is defining mental incapacity by statistical normality, although there are holes that are left uncovered as well. Ultimately, this issue remains open-ended, which I fear a ”silver bullet” model will never be found as there are only advantages and disadvantages for every proposed solution to get people the treatment they need while keeping their autonomy intact. 

 

Craigie, J., & Bortolotti, L. (2015). Rationality, diagnosis, and patient autonomy in psychiatry. In 

J. Z. Sadler, W. (C. W. . van Staden, & K. W. M. Fulford (Eds.), The Oxford handbook of psychiatric ethics., Vol. 1. (pp. 387–404). Oxford University Press.

Is gene therapy the future?

 

Should one use a study drug?

            Have you ever questioned your ability to finish everything at top quality in time? Have you ever complained to your friends about your workload? If so, then chances are someone has suggested you take some sort of study drug to help you focus or work more efficiently. Various forms of study drugs have been taken by students to increase academic performance for years. In Australia, university faculty responses have been rather lax and more focused on student health instead of a potential integrity violation (Dunn et al., 2020). According to Dunn et al. (2020), the university setting may promote the use of study drugs to meet requirements and deadlines by increasing study stamina and focus.

Dunn et al. (2020) surveyed 14 faculty members, institutional department heads or support roles. During this study, the researchers questioned if the faculty knew study drugs were being used and if they would deem it as cheating. Their consensus indicated knowledge of study drug usage however, many argued that they would not deem usage as cheating. With this in mind, is study drug a problem that should be considered cheating? Should it be discouraged, or individuals penalized for usage?

Personally, I lean more to the “as long as they learn the material” viewpoint. Sure, one can argue that such drug usage provides an unfair advantage in an already tilted education system. In that regard, the counterpoint is that study drugs also offer a benefit to those who are “impaired” (i.e. diagnosed with ADHD and its variants or LD). What makes a study drug less acceptable than caffeine? Almost every student I know has consumed exorbitant amounts of caffeine in their study sessions around finals or midterms. Mazanov et al. (2013) surveyed almost 1800 students in which about 86% used caffeine to enhance study performance. Is caffeine abuse worse than Adderall? Similarly, other drugs such as SSRI, SNRI, anti-anxiety medication and psychostimulants have seen increased usage over the years (Morris et al., 2021). Should all focus psychoactive drugs be barred? Should those students be denied their prescriptions in the case of fairness? The threat of abuse with study drugs is real and should be addressed in another blog. But if a student learns the material, should they be looked down upon or disciplinary action be taken if an individual is taking a study drug?

 

Dunn, M., Dawson, P., Bearman, M., & Tai, J. (2020). ‘I’d struggle to see it as cheating’: The policy and regulatory environments of study drug use at universities. Higher Education Research & Development, 40(2), 234–246. https://doi.org/10.1080/07294360.2020.1738351

Mazanov, J., Dunn, M., Connor, J., & Fielding, M.-L. (2013). Substance use to enhance academic performance among Australian university students. Performance Enhancement & Health, 2(3), 110–118. doi: 10.1016/j.peh.2013.08.017

Morris, M. R., Hoeflich, C. C., Nutley, S., Ellingrod, V. L., Riba, M. B., & Striley, C. W. (2021). Use of psychiatric medication by college students: A decade of data. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 41(4), 350. https://doi-org.dml.regis.edu/10.1002/phar.2513

Aortic Stenosis Treatment for Cancer Patients

Aortic stenosis is caused by a buildup of calcium deposits in the heart valve. Excessive buildup can cause narrowing of the heart valve, a decrease in blood pressure, and can lead to heart failure (Lopez-Jimenez, M.D., 2021). The most effective treatment for this disease is surgical valve replacement. However, this procedure poses great risk to a patient with active cancer in the area. The complications that could incur from undergoing this procedure would likely lead to infections and excessive bleeding (Bendary, et. al., 2020). Other treatments, such as angiotensin-converting enzyme inhibitors and beta blockers, have been used but patients typically die within a few years because the treatments are too conservative (Kornowski, Landes 2018). The aortic valve replacement procedure is intrusive, exposing the cancer patient to high-risk complications, on the other hand, medications have been found to be not aggressive enough, leading to death of the patient. 

An alternative treatment method has been tested, called TAVR. This is a transcatheter aortic valve replacement treatment, which is less intrusive than an open-heart valve replacement (Henry Ford Health System Staff, 2019). A cancer patient would be an ideal person to receive this type of treatment because of reduced intrusiveness of the procedure. The use of this treatment on cancer patients has yet to be deemed safe and reliable (Marmagkiolis et. al., 2021). After surgery, cancer patients undergoing this type of treatment have been found to have a worse 1-year prognosis when compared to their non-cancer counterparts (Landes, 2019) A study published by the Journal of the American College of Cardiology states that cancer patients have a decreased long-term life expectancy compared to their non-cancer counterparts after undergoing this procedure (Lind, et. al., 2020). Without understanding the effectiveness, safety, and reliability of this treatment, is it ethical for cancer patients to have this procedure? Is there enough evidence supporting the long-term benefits of this procedure to allow cancer patients to face potential risks? 

References: 

Bendary, A., Ramzy, A., Bendary, M., & Salem, M. (2020, March 11). Transcatheter aortic valve replacement in patients with severe aortic stenosis and active cancer: A systematic review and meta-analysis. US National Library of Medicine National Institutes of Health . Retrieved November 29, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7066604/. 

Henry Ford Health System Staff. (2019, August 26). Less invasive aortic valve procedure approved for low-risk patients. Henry Ford LiveWell. Retrieved November 29, 2021, from https://www.henryford.com/blog/2019/08/less-invasive-aortic-valve-procedure-approved-low-risk-patients. 

Kornowski, R., & Landes, U. (2018, April 20). The double jeopardy of aortic stenosis in cancer patients . Academic.oup.com. Retrieved November 29, 2021, from https://academic.oup.com/ehjqcco/article/4/3/150/4979550. 

Landes, U., Iakobishvili, Z., & Vronsky, D. (2019, January 9). TAVR in cancer patients with severe AS. American College of Cardiology. Retrieved November 29, 2021, from https://www.acc.org/latest-in-cardiology/journal-scans/2019/01/09/14/19/transcatheter-aortic-valve-replacement-in-oncology-patients. 

Lind, A., Totzeck, M., Mahabadi, A. A., Jánosi, R. A., Gabry, M. E., Ruhparwar, A., Mrotzek, S. M., Hinrichs, L., Akdeniz, M., Rassaf, T., Mincu, R. I., C.E., D. S., Al., E., D., C., G.C., J., M., T., C., F., S.H., A., W.K., H., … B.R., L. (2020, December 2). Impact of cancer in patients undergoing transcatheter aortic valve replacement: A Single-Center Study. JACC. Retrieved November 29, 2021, from https://www.jacc.org/doi/10.1016/j.jaccao.2020.11.008. 

Lopez-Jimenez, F. (2021, February 19). Aortic calcification: an early sign of heart valve problems?Mayo Clinic. Retrieved November 29, 2021, from https://www.mayoclinic.org/diseases-conditions/aortic-stenosis/expert-answers/aortic-valve-calcification/faq-20058525. 

Marmagkiolis, K., Monlezun, D. J., Cilingiroglu, M., Grines, C., Herrmann, J., Toutouzas, K. P., Ates, I., & Iliescu, C. (2021, August 4). TAVR in cancer patients: Comprehensive review, meta-analysis, and meta-regression. Frontiers in Cardiovascular Medicine. Retrieved November 29, 2021, from https://www.frontiersin.org/articles/10.3389/fcvm.2021.641268/full. 

Insurance: Putting a Price on Life

Having grown up in the United States, I find it to be an inconceivable notion that healthcare could ever be free to everyone. On the contrary, the United Kingdom has a universal healthcare system called the National Health Service that provides free healthcare to all its citizens. Each citizen contributes to the National Health Service budget under general taxation. There are many benefits to issuing universal healthcare: 

1. The first benefit falls under the biomedical ethics of justice. Universal healthcare means that every person has access to healthcare regardless of their economic or social status. They will be given treatments according to their health issue and not what they can afford to pay for. 

2. The second benefit falls under the biomedical ethics of beneficence. Universal healthcare can provide multiple avenues for treatment. A patient will be supplied with all the information regarding the different treatments available.  

According to the 2011 CDC Health Disparities and Inequality Report, better health outcomes were strongly correlated with those who had insurance coverage. Insurance coverage should not be the determining factor for a patient’s quality of life. Physicians swear the Hippocratic Oath “to treat the ill to the best of one’s ability.” However, how can we provide the utmost care to a patient if we are limited to what insurance companies will pay for? As a physician, we should only focus on the care of the whole person and not have to look up an insurance company’s policy for coverage rate on a procedure or medication.  

Not only is insurance coverage variable in terms of its coverage for visits to the physician’s office, but there is also a disparity in coverage for life saving medication such as insulin. Insulin has been rising in cost and it is all due to pharmaceutical politics and the inability of insurance companies to compensate. Why is it that patients with diabetes should have to choose between their medication and daily necessities? Healthcare is an indisputable asset that should be entitled to each citizen as free and fully funded. That way, physicians can provide the best treatment to improve a patient’s quality of care.   

 

References:  

 

Roosa Tikkanen, Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., Wharton, G. A. (n.d.). England. Home, from https://www.commonwealthfund.org/international-health-policy-center/countries/england.