Following reports that Pope Benedict XVI stated that condoms increase the problem of HIV/AIDS, many government and public health officials condemned the Pope’s comments. The Development Minister in the Netherlands, for one, called them “extremely harmful”. In Paris, the Pope's comments spurred a clash between those who agree with and those who oppose his view on condoms. And yesterday, about a dozen different pro-condom groups waited in St. Peter’s square for the Pope’s return to the Vatican.

While the responses to the Pope’s comment covered by the mainstream media were overwhelmingly negative, some government officials, including two deputies from France, defended the Pope. According to Jacques Remiller, deputy-mayor of Vienne, France, the media only partially reported the Pope’s words, which made the words lose their meaning. Remiller argued that while condoms are effective when used properly, they will not solve behavioral problems such as rape that can lead to the spread of HIV.

So what did the Pope really mean?

We might not find out, as it seems as though the Vatican might have retroactively softened the Pope’s words. News sources such as the Catholic News Service had reported the quote as follows: “One cannot overcome the problem with the distribution of condoms. On the contrary, they increase the problem.” However, according to the Catholic News Service, the version of the sentence published later by the Vatican translated as follows: “One cannot resolve the problem with the distribution of condoms. On the contrary, there is a risk of increasing the problem.”

Photo by Trec Lit

Posted by Kirsten Dorans at 04:36 PM | Permalink | Comments (2)

Pretty busy week over at the JAMA offices. First came the report that one of its editors had called a whistleblower a "nobody and a nothing", report that was accompanied by a pretty long series of comments from outraged readers.

Then came the journal's decision to modify its policy on conflicts of interest. Crucially, the new policy states that "The person bringing the allegation will be specifically informed that he/she should not reveal this information to third parties or the media while the investigation is under way, will be informed about progress of the investigation, upon request, as appropriate, and will be notified when the investigation is completed."

Ha! I'm sure that those New York Times and Wall Street Journal reporters will be delighted to hold on to their stories before breaking the news that a fresh conflict-of-interest case has come to light. I'm also sure that next time you discover an unreported conflict, you will first inform the journal and wait as long as needed for it to take remedial action, instead of bringing the conflict to the attention of the author's institution or funding body -- what authority do these other people have, anyway?

Not surprisingly, several media outlets have already put their own spin on the way they are reporting this policy change, and they don't seem impressed by it.

No-one would deny that JAMA has been a leader in raising awareness about conflicts of interest, discussing them perhaps to the point of eliciting a certain desensitization -- is anyone surprised when the journal expresses, yet again, the view that conflicts of interest should not be tolerated? Alas, despite its track record, the events of the past week undermine the credibility of the journal's position on this front.

To my mind, the way in which this whole controversy has escalated is related, in no small measure, to the overzealous way in which JAMA has always decried conflicts of interest. In other words, the tough line that JAMA has taken against conflicts of interest makes the journal much more susceptible to embarrassment when one emerges. Or as the saying goes, the higher they climb, the harder they fall. The latest policy change would seem to be saying that it's always possible to climb a little higher.

Photo by SparkyLeigh via Flickr

Posted by Juan Carlos Lopez at 02:17 PM | Permalink | Comments (0)

In an effort to explore the potential of personalized medicine, journalist David Duncan underwent hundreds of medical tests. He has now written a book, "Experimental Man: What One Man's Body Reveals About His Future, Your Health and Our Toxic World", describing his journey. From genetic tests aimed at uncovering his risks for over 37 diseases to detailed blood tests taken to help determine his chances of having a heart attack, it seems doctors tested and analyzed just about every part of Duncan’s body that they could.

One question Duncan asks in his book is whether, in the future, doctors will focus more on testing the healthy to try to keep them healthy, rather than treating those who are already ill. While doctors already do use family history and diagnostic tests to determine people’s risks for specific diseases, Duncan contemplates how new technologies and comprehensive genomic analyses might one day be routinely used to predict a broader range of illnesses.

However, even if advanced tests could provide a better pictur of our future health, with listed test prices of up to $40,000 much of the world's population would likely not benefit from such tests. Costs aside, how much would a person want to know about his or her risk of future illnesses, especially about an untreatable illness? And is it possible to undergo one test too many?

Photo by 91RS

Posted by Kirsten Dorans at 12:14 PM | Permalink | Comments (0)

A big Monday morning announcement is sure to set off a wave of celebration in labs across the US: President Barack Obama today signed an executive order overturning the restrictions on federal funding for embryonic stem cell research that had been put into place during the Bush Administration. Obama has reportedly asked the US National Institutes of Health (NIH) to draft new guidelines for stem cell research with the next four months.

But as scientists race to figure out how to take advantage of the new opportunities, they will also have to bear in mind that obstacles lie ahead. Specifically, experts worry that the Dickey-Wicker Amendment will be used to create a barrier to embryonic stem cell research. What do you see as the impact of today's announcement?

Photo by Marcn

Posted by Roxanne Khamsi at 12:01 PM | Permalink | Comments (2)

Hoping to prevent something along the lines of the birth of octoplets from happening in Georgia, state legislators proposed a bill that would cap the number of embryos created for any given round of in-vitro fertilization. The new rules would limit this to two embryos per cycle for a woman 39 years old or younger and three embryos for a woman above that age. In a press release, the president of Georgia Right to Life said the bill’s purpose is to “help reduce the attendant harm that could come to the mother and her children through the creation and implantation of more embryos than is medically recommended.”

In addition to limiting the number of embryos fertilized per cycle, an article in Slate.com explained how the bill, if passed, would give embryos legal rights, thus blocking certain types of stem cell research in the state. The Georgia legislation will probably not be voted on this year, but lawmakers there will likely reconsider the issue next year.

The proposed legislation does not take past IVF failures into account, unlike the joint guidelines previously issued by the Society for Assisted Reproductive Medicine and the American Society for Reproductive Medicine. So in addition to limiting biomedical research, the legislation would also promote an oversimplified approach to reproductive medicine that would likely harm more women than it would help. What do you think about the proposed bill?

Photo by Kaibara87

Posted by Kirsten Dorans at 03:15 PM | Permalink | Comments (1)

This article in the newspaper El Mundo, which reports on a paper published in 2008 in the American Journal or Psychiatry, definitely caught my imagination.

The authors of the paper in question, entitled "Compulsive hoarding: OCD symptom, distinct clinical syndrome, or both?" studied a group of people with the strong drive to gather stuff to the point of making their houses uninhabitable, as exemplified by the picture below, credited to Boston University and published in El Mundo.

Does this look familiar to you?

The question they asked was whether compulsive hoarding is a disease in its own right or a symptom of obsessive-compulsive disorder (OCD). The conclusion was that it is a disease in and of itself, and that "These findings have implications for the classification of OCD and compulsive hoarding in the next edition of DSM", perhaps getting its own entry in the legendary diagnostic manual.

I don't mean to criticize these authors' research, which, in fact, builds on an extensive literature on compulsive hoarding. I nevertheless find it somewhat disappointing that psychiatry carries on having this distinct fascination with taxonomy, which, regardless of its diagnostic use and validity, does very little to help us understand the underlying biology of disease and come up with new therapeutic approaches to treat the disorders of the mind.

In other words, is it realistic to think that we'll help people who hoard compulsively (assuming that we buy into the idea that this is really a disease, something that I'm not sure everyone will subscribe to) by categorizing their condition separately from OCD? Is it really a big advance to say to a patient "You don't have OCD; you only have compulsive hoarding"? It may provide comfort to some patients but, at the end of the day, I'd argue that it makes little difference.

What I'm trying to say is that, at a time in which the concept of endophenotypes is beginning to gain traction as a new way to parcel psychiatric diseases, it would be a shame if we don't seize the opportunity to start thinking about endophenotypes as features of a mental disease that have a specific, experimentally approachable biological foundation, instead of coming up with endophenotypes that are as unapproachable as the original disease or, even worse, coming up with new diseases altogether.

As for the DSM-IV, I get the feeling that it has come to the end of its useful life. Work is underway on the DSM-V, publication of which is scheduled for May 2012. Although it would be nice to think that the new edition will represent a break from the past, pushing the current boundaries of the discipline, I'm not so optimistic about it. Instead, I strongly suspect that we will see a much larger, encyclopedic book, with extensive discussion about many more conditions and diagnoses, many of which would be quite esoteric -- a lot of heat, but very little light. So, even though the field of psychiatry is in more dire need to get its house in order than some of those compulsive hoarders, I don't see it happening between now and 2012.

Posted by Juan Carlos Lopez at 04:41 PM | Permalink | Comments (1)

Senator Charles Grassley is not the only one working to reveal financial ties between doctors and pharmaceutical companies. In November, a group of more than 200 students and faculty at Harvard Medical School asked the administration to expand the school’s conflict-of-interest policies. Students had already convinced the school to require professors and lecturers to disclose relevant financial ties to pharmaceutical companies when discussing drugs in class. In November, the group asked that professors at the teaching hospitals and institutes affiliated with Harvard also disclose their ties to industry. Today, The New York Times reported that a 19-member committee organized by the school’s dean will meet to re-evaluate these policies on 5 March.

In addition to the students' demands, Harvard is facing external sources of pressure. In 2008 The American Medical Student Association, which grades medical schools on how well they track and curtail industry interaction with faculty and students, gave Harvard an F. Unlike schools such as the University of Pittsburgh Medical Center and Mount Sinai School of Medicine, who received A’s, Harvard does not currently ban faculty from accepting personal gifts from pharmaceutical companies. We’ll have to wait to see if Harvard makes substantial policy changes and whether more medical schools follow suit.

Photo by jenn_jenn

Posted by Kirsten Dorans at 02:00 PM | Permalink | Comments (1)