Younger, healthier patients would be more likely than older, sicker ones to get the best kidneys if a new proposal by UNOS, the US’ organ transplant network is accepted. The proposal would supersede an existing first-come, first-served policy. It is designed to match-up the life expectancies of patients with the expected functional life of donated organs.

According to the proposal by the United Network for Organ Sharing, recipients and donor organs will be graded. The top 20% of patients and kidneys—based on age and health—will be placed in separate pools such that patients with the longest life expectancies will receive the best kidneys. The other 80% will be assigned to a separate a pool from which UNOS will match recipients and donors such that the age difference between the two is no greater than 15 years. For example, a 60 year-old person could only receive a kidney from donors who are between the ages of 45 and 75.

“Right now, if you’re 77 years old and you’re offered an 18-year-old’s kidney, you get it,” Richard Formica, a member of the UNOS  panel that penned the new proposal said in an interview. “You’ll die with that kidney still functioning…a 30-year-old could have gotten that kidney and lived with it to see his kids graduate college.”

The new proposal would affect the 90,000 or so people that are currently on waiting lists for donor kidneys. In 2009, 10,442 kidney transplants were performed using organs from deceased individuals. An additional 6,387 procedures involved live donors who typically specify the recipient. Nearly 5,000 people die while waiting for a kidney transplant.

Many transplant surgeons and medical ethicists support the proposal. Arthur Caplan, a leading bioethicist at the University of Pennsylvania reflected this sentiment as follows: “If it’s a choice between saving grandpa or granddaughter, I think you save granddaughter first.” (more…)

More than 70% of all medical devices that have been recalled by the FDA for safety concerns were not subjected to rigorous clinical testing before the agency approved them, according to a new study.

The study authors were Diana Zuckerman and Paul Brown from the National Research Center for Women and Families, a consumer group, and Steven Nissen, a cardiologist at Cleveland Clinic.

The authors reported that overall, the FDA recalled 113 medical devices between 2005 and 2009. Of these, 21 had been approved on the basis of rigorous clinical trial data. Eighty others had been approved under a less stringent, expedited approval process known as 510K, in which a device maker needs only to show that its new product is substantially similar to one already on the market. An additional 8 devices were exempt from FDA regulations, and 4 more were either counterfeit or classified as “other.”

Devices approved using the 510K approval process included mechanical ventilators, insulin infusion pumps, artificial hips and knees, and external cardiac defibrillators. The more rigorous process is typically reserved for life-supporting devices like implanted cardiac defibrillators. In the latter process, device makers must sponsor trials designed to prove their products are safe and effective.

Last summer, the FDA announced it was implementing some steps to “strengthen” the 510K process, but it deferred on a complete overhau pending the release of a report on the matter by the Institute of Medicine. The report is due later this year. (more…)

Federal courts have ruled that it is a violation of the US Constitution’s Establishment Clause to teach creationism—including its modern-day derivative, intelligent design—in public schools. Nevertheless, a recent national survey has confirmed that the practice is widespread in our country.

In the survey, Penn State political scientists Eric Plutzer and Michael Berkman queried more than 900 public school biology teachers from around the country.

The researchers found that only 28% of respondents consistently adhered to the recommendations of the National Research Council in presenting scientific evidence for evolution and explaining that the concept is a fundamental, unifying theme of biology. An appalling 13% of respondents taught and solely advocated for creationism. These teachers were spread throughout the country; they were not particularly more likely to be found in the South or West, as many people believe.

The remaining group, referred to by the scientists as “the cautious 60%,” ducked the controversy by failing to endorse evolution or its non-science-based alternatives. Some in this group explained they taught evolution primarily because the subject matter appeared on state exams. They told students it wasn’t necessary to “believe” it. Others taught the concept as it applied to molecular biology and genetics, but not specifically to the evolution and differentiation of species.

More public school students take biology than any other science course, according to the authors. For nearly 25% of them, biology is the only science course they take in high school.

“Students are being cheated out of a rich science education,” Plutzer said in an interview. “We think the ‘cautious 60%’ represent a group of educators who, if they were better trained in science in general and in evolution in particular, would be more confident in their ability to explain controversial topics to their students, to parents, and to school board members.” (more…)

In developed nations, human life expectancy has increased steadily for over a century. One of the few negative consequences of this trend has been a marked increase in the prevalence of Alzheimer’s disease, an age-related untreatable condition that has driven enormous health spending on a national scale and wrecked the finances of millions of families in the US alone. Now, with the oldest Baby Boomers just reaching age 65, Alzheimer’s disease seems destined to become a true national health crisis.

Two of the most vexing problems with this nasty disease are determining who has it and diagnosing it early enough (so scientists can understand how it progresses and someday, intervene to either cure it or halt its progression).

With current technology, the only way to accurately diagnose Alzheimer’s disease is at autopsy. Special tests of the deceased’s brain reveal the sine qua non of Alzheimer’s disease: amyloid plaques.

But last week, 2 studies appearing in JAMA provided rays of hope in this otherwise dismal state of affairs. We review them both below:

Brain Scan Detects Plaques
In the first study, scientists injected a radioactive dye known as Flobetapir F 18 into the blood of elderly volunteers, and then used PET scans to image their brains.  Florbetapir F 18 had been designed by Christopher Clark and colleagues at Avid Radiopharmaceuticals to bind to amyloid proteins—which are the main constituents of amyloid plaques—and thus make them visible in vivo using the PET scan.

The PET scans correctly identified amyloid plaques in 97% of the volunteers that actually had them, as proven at autopsy. In addition, PET scans performed after the dye had been injected into young, healthy volunteers revealed no plaques.

Scientists believe the Florbetapir F 18 PET scans could be helpful as a means to exclude the diagnosis of Alzheimer’s. If no plaques are found in a patient with symptoms of dementia, physicians would be compelled to consider other causes of the symptom complex. The PET scans could also potentially be used to test drugs designed to remove amyloid from the brain.

A Blood Test for Alzheimer’s
The second study showed that blood levels of amyloid protein, as detected by a new blood test, were correlated with memory problems.

The study was directed by Kristine Yaffe at UCSF. Her group recruited 997 elderly volunteers and followed them with memory tests and amyloid blood tests for 9 years. (more…)

Humans are the only living things that cry when they are overcome with emotion. Why do we do this?

A study by Noam Sobel and colleagues at the Weizmann Institute provide part of the answer, at least as it relates to women. The scientists showed that when men get a whiff of women’s tears, they experience a temporary, generalized loss of libido and a dip in testosterone. Really.

(And you thought that red, runny nose was the turn-off, didn’t you?)

Scientists have known for decades that the chemical composition of “emotional tears” differs from tears shed due to simple irritation. But now, it appears that some of the chemicals contained in the former are actually pheromones; biological substances that create behavioral changes in others who are exposed to them. Such chemicals were known to exist in urine in anogenital gland secretions (dont ask), but not in tears.

Sobel’s team began its study by posting ads on Israeli college campus bulletin boards in which they sought volunteers who cried easily. Seventy-one people responded. All but one were women. From that group, the scientists identified 6 who were, like, seriously profuse criers and who could return to their labs every other day.

The scientists then asked each one to select a movie that was guaranteed to make them break down, to watch it in private, and to collect their tears in a vial. For the controls, Sobel’s group trickled a saline solution down the same women’s cheeks and collected that.

Sobel’s group subsequently asked male volunteers to sniff the contents of the 2 vials and ran a battery of psychological and physiological tests to measure their responses.

The men could not distinguish the odorless, colorless liquids, but boy oh boy did their responses differ! In one study, men rated women in photos as less sexually attractive after sniffing “emotional tears” than after they sniffed the saline solution. In another study, men watched scenes from a sad movie after sniffing either the real stuff or saline. They were equally sad regardless of which mixture they sniffed, but the tear-sniffers had lower sexual arousal and lower testosterone levels. (more…)

Traditionally, people get blood tests when a doctor recommends them. This usually happens at the conclusion of an office visit. Nowadays however, people have begun deciding for themselves which lab tests to get and when to get them.

Folks have different reasons for making such independent decisions. Some want to keep track of cholesterol or hemoglobin A1C levels. Others want to assure their blood will screen negative for drugs prior to a job search, test for the presence of a disease like hepatitis C or AIDS, or obtain a chemistry panel that provides a broad picture of their overall health. The biggest reason for consumer-directed lab testing however, is an economic one. Uninsured people, and those with high-deductible insurance plans find it cheaper to do-it-themselves, since it avoids the cost of an office visit.

The savings can add up. A lipid profile (including cholesterol levels) obtained from an online lab testing company costs about $40. A hemoglobin A1C test usually runs a bit less. A visit to the doctor’s office typically costs $150 or more.

Although hundreds of tests can be obtained in this manner, the most commonly sought-after tests are lipid profiles, C-reactive protein (a new measure of cardiac risk), liver and kidney function tests, vitamin D levels, and hormone levels including estrogens and testosterone.

Consumers have plenty of ways to get lab tests done on their own. Many simple tests are available at drugstore clinics and health fairs, for example. Those interested in tracking their cholesterol levels over time can purchase either single-use devices for about $15 or reusable devices, usually for under $100.

The real growth in the do-it-yourself lab market however, involves online testing services such as HealthOne, Direct Laboratory Services, Health One, Personalabs and PrivateMD Labs.

According to one report, people spent nearly $20 million for lab tests through companies like these last year, and annual growth of 15-20% is expected in the next few years (although these projections may seriously underestimate demand if newer, lab-on-a-chip technology continues to develop. This technology promises to cut waiting times for lab test results from several days to less than 30 minutes, a feature that will surely capture the imagination of health consumers). (more…)

A living will is a legal document that enables you to specify your preferences about end-of-life care at a time when you are clear of mind and perfectly able to do so. The document usually covers things like whether you want breathing machines and tube feedings to be used to prolong your life if you have a terminal illness, whether you want providers to attempt resuscitation in the event you are terminally ill and stop breathing, and so on.

The living will avoids confusion because your family members and caregivers will know how you feel about such situations even if you can’t express your feelings at the time they actually happen.

The Case For Living Wills: The vast majority of health care providers, especially those who frequently care for patients with terminal illness, feel quite strongly that their patients should complete a living will, no matter how uncomfortable that process may be.

Numerous scientific studies support this position. For example, in an April 2010 study in the New England Journal of Medicine, scientists found that nearly 30% of all elderly Americans did in fact encounter situations near the end of their lives when these documents would have helped assure they received the care they wanted.

Shortly before that study was published, a  separate study showed that advance care planning improved “end-of-life care and patient and family satisfaction, and reduced stress, anxiety and depression in surviving relatives.”

And before that one appeared, a third one revealed that “end-of-life discussions between doctor and patient helped ensure that one got the care one wanted,” and therefore “protected patient autonomy.”

Recent Political History of the Living Will: These and other studies support the Obama administration’s longstanding efforts to pay physicians for time spent helping Medicare patients develop living wills and other forms of advance directives.

During the epic health reform debate of 2009-2010, House Democrats attempted to include provisions authorizing such payments in the evolving legislation. However, the effort fell prey to scurrilous attacks by Sarah Palin, House Minority leader John Boehner and others. Memorably, Palin said the provisions allowed the government to create “death panels,” of all things. For his part, Boehner claimed the provisions would “start us down a treacherous path toward government-encouraged euthanasia.” (more…)

Many people struggle to stay focused nowadays, amid a deluge of cluttered inboxes, electronic distractions, city noise and overloaded schedules. There’s no doubt this challenge is real and quite prevalent, but when some of us claim the challenge is caused by attention deficit hyperactivity disorder (ADHD), that’s a bit much.

ADHD is not a metaphor for modern life, but—as Perri Klass pointed out in an excellent essay for the New York Times—a bona fide, if perhaps over-diagnosed, disorder with specific and increasingly well understood neurological and genetic underpinnings.

As is the case with most medical conditions, ADHD is associated with a broad spectrum of symptoms and disease severity. Typical manifestations in boys are hyperactivity and impulsiveness, whereas girls with the condition tend to be inattentive. Gender differences may explain why girls are diagnosed with ADHD less frequently than boys; it’s possible to be inattentive and unable to focus at school and yet still be well behaved. That’s not usually the case with boys.

Imaging studies of kids with ADHD consistently reveal lower-than-normal activity in the frontal lobes of the brain, areas that help govern sensory input and decide things to focus on. On the neurochemical side of things, it looks like defects in dopamine-mediated circuits that transmit information toward and away from the frontal lobes are involved.

Diminished transmission of neuronal impulses across these pathways probably explains why stimulants like Ritalin and Adderall work in kids that appear to be overstimulated to begin with.

And in a fatal blow to the myth that ADHD is precipitated by an overly multi-tasked society, scientists have shown that the condition has strong genetic underpinnings. In fact, if one identical twin has ADHD, the risk that his twin will have it as well is nearly 80%. Among fraternal twins (that is, twins who do not have the same genotype) the risk is 20-30%, which is equal to that for any siblings.

Further pursuing the genetic etiology of ADHD, Maximilian Muenke and colleagues at the National Human Genome Research Institute showed that a particular gene, LPHN3, was linked to the condition and predicted a positive response to treatment with stimulants.

“In the long run we will be able to develop personalized medicine for a child with ADHD,” Muenke told the Times. “This child will have a very specific treatment, whether this treatment is behavioral treatment alone or medication,” he added, specifying that the medication will eventually be selected based on specific characteristics of each patient.

Throughout recorded history, men and women—particularly the latter—have sought ways to enhance their appearance. Egyptians used eye shadow and painted their faces. So did the Greeks and Romans. Tattoos and body piercings have been used by people in many cultures for centuries. The goals of these efforts include finding a suitable mate, increasing self-confidence and signaling wealth or power.

But as women slowly gain equal footing in the workplace, it’s appropriate to ask whether such efforts have a positive impact on their careers. Recently, economists Bradley Ruffle and Ze’ev Shtudiner examined one aspect of this matter by designing a study to assess the impact of physical attractiveness on success during a job search.

Their study revealed that good looks help men who are looking to secure a job interview, but they have a negative impact on women who are after the same thing.

To reach these conclusions, the scientists distributed 5,000 résumés to 2,600 Israeli employers that had advertised job openings. They sent 2 nearly identical résumés to each employer; one contained a photograph of the job-seeker, and the other did not. In some cases, the photo showed an attractive person; in others, the photo showed a plain-looking person.

Judgments about the attractiveness of the people in the photos were made by men and women that were not affiliated with the investigators. The photos included pictures of people with apparently mixed ethnic backgrounds to remove any possible effects of racial bias.

The employers reached-out to request an interview from 14.5% of the job candidates, overall. Among the male candidates, 13.7% with plain-looking photos, and 19.9% with attractive photos  were contacted to set-up an interview. Only 9.2% of those whose resumes contained no photo were called-in.

The results were strikingly different for women, in whom 16.6% who didn’t send a photo were invited for an interview, as compared with 13.6% of those who had submitted a plain-looking photo and 12.8% of those who had submitted an attractive-looking photo.

Interestingly, none of these differences was noted when employment agencies were responsible for deciding who would be interviewed. The differences were present only when the applications were sent directly to the hiring company.

A post-study analysis revealed that in companies that did their own hiring, young, typically single women were responsible for screening those resumes. When questioned by the scientists, these company-based screeners indicated that when a man included a photo, it showed confidence and helped assure that the candidate was “presentable.” When a woman did the same, the screeners perceived it negatively; the woman was “attempting to market herself via her appearance.”

The economists concluded that company-based personnel responsible for hiring new staff appear to discriminate against attractive women and that “female jealousy” was the most likely explanation for this.

“Our results show that beauty distorts the hiring process,” the researchers wrote. “Suitably qualified attractive women and plain men and women may be eliminated early on from the selection process.”

The write-up appears on the Social Science Research Network.

Flush from their big win in the midterms, the Boehners are vowing to repeal and replace the Big O’s health reform law. They pose a legitimate threat, but an even larger one lies in the courts, where suits challenging the constitutionality of the law have been popping up like fireflies on a late August night.

In Virginia for example, Republican-appointed Federal District Court Judge Henry Hudson has indicated that the Individual Mandate—a key provision of the law that has been challenged in a suit filed in his court by the state’s Republican Attorney General—might not pass his sniff test.

Hudson said he’d rule on the matter this month. If he deems the provision to be unconstitutional, he might (it’s unlikely, but he might) enjoin the law altogether until higher courts rule on the matter. Holy Kazakhstan, Batman!

An official at Camp Obama, who spoke with the New York Times under the condition that his name not be WikiLeaked, acknowledged that Hudson’s thumbs appear to be pointing downward, indeed.

“He’s asked a number of questions that express skepticism…we have been trying to think through that set of questions,” the official told the Times.

There’s no doubt, by the way, that the Individual Mandate is a foundational element of the Big O’s law. Without the mandate, millions won’t purchase health insurance until they get sick (you’d do that too, right?). That behavior blows-up the risk-pool; it prevents insurers from spreading the costs of caring for the few who are sick onto the many who are healthy, which is how insurance works in the first place.

A thumbs-down by Hudson would do a lot more than that, of course. It would confuse the bejesus out of the public, throw a wrench into the plans of providers and insurers who are already behind in organizing themselves to implement the law, create bureaucratic chaos in several government agencies involved with its implementation, and light-up the court system like a pinball machine.

So the $64,000 question is, “Can the Feds require citizens to buy health insurance?”  Judge Hudson gets to throw out the ceremonial first pitch when it comes to answering the question, but ultimately this baby is going to the Supremes. Bet on that! And it’ll take a 2-year sojourn through the Appellate process before it ever reaches 1st and East Capitol.

If there is a kernel of good news in this mess, it’s that Judge Hudson probably won’t enjoin the whole deal, even if he rules against the Mandate. No Federal District Judge this side of Deion “Prime Time” Sanders would have the hubris! And assuming Hudson doesn’t throw out the baby with the bathwater, the immediate impact of his snub would be minimal, since the Mandate provision doesn’t kick-in until 2014 anyway.

In that case, all we have to worry about is those other 2 dozen fireflies lighting up the summer sky.