The pharmacogenomics, which costs ₹5,000, guides doctors in prescribing medicines suitable for a person. The image is used for representative purposes only.
| Photo Credit: GETTY IMAGES

I sit on an ethics review committee at the Albany Med Health System in New York state, where doctors and nurses frequently bring us fraught questions.

Consider a typical case: A 6-month-old child has suffered a severe brain injury following cardiac arrest. A tracheostomy, ventilator and feeding tube are the only treatments keeping him alive. These intensive treatments might prolong the child’s life, but he is unlikely to survive. However, the mother – citing her faith in a miracle – wants to keep the child on life support. The clinical team is distressed – they feel they’re only prolonging the child’s dying process.

Often the question the medical team struggles with is this: Are we obligated to continue life-supporting treatments?

Bioethics, a modern academic field that helps resolve such fraught dilemmas, evolved in its early decades through debates over several landmark cases in the 1970s to the 1990s. The early cases helped establish the right of patients and their families to refuse treatments.

But some of the most ethically challenging cases, in both pediatric and adult medicine, now present the opposite dilemma: Doctors want to stop aggressive treatments, but families insist on continuing them. This situation can often lead to moral distress for doctors – especially at a time when trust in providers is falling.

Consequences of lack of trust

For the family, withdrawing or withholding life-sustaining treatments from a dying loved one, even if doctors advise that the treatment is unlikely to succeed or benefit the patient, can be overwhelming and painful. Studies show that their stress can be at the same level as people who have just survived house fires or similar catastrophes.

While making such high-stakes decisions, families need to be able to trust their doctor’s information; they need to be able to believe that their recommendations come from genuine empathy to serve only the patient’s interests. This is why prominent bioethicists have long emphasized trustworthiness as a central virtue of good clinicians.

However, the public’s trust in medical leaders has been on a precipitous decline in recent decades. Historical polling data and surveys show that trust in physicians is lower in the U.S. than in most industrialized countries. A recent survey from Sanofi, a pharmaceutical company, found that mistrust of the medical system is even worse among low-income and minority Americans, who experience discrimination and persistent barriers to care. The COVID-19 pandemic further accelerated the public’s lack of trust.

In the clinic, mistrust can create an untenable situation. Families can feel isolated, lacking support or expertise they can trust. For clinicians, the situation can lead to burnout, affecting quality and access to care as well as health care costs. According to the National Academy of Medicine, “The opportunity to attend to and ease suffering is the reason why many clinicians enter the healing professions.” When doctors see their patients suffer for avoidable reasons, such as mistrust, they often suffer as well.

At a time of low trust, families can be especially reluctant to take advice to end aggressive treatment, which makes the situation worse for everyone.

Ethics of the dilemma

Physicians are not ethically obligated to provide treatments that are of no benefit to the patient, or may even be harmful, even if the family requests them. But it can often be very difficult to say definitively what treatments are beneficial or harmful, as each of those can be characterized differently based on the goals of treatment. In other words, many critical decisions depend on judgment calls.

Consider again the typical case of the 6-month-old child mentioned above who had suffered severe brain injury and was not expected to survive. The clinicians told the ethics review committee that even if the child were to miraculously survive, he would never be able to communicate or reach any “normal” milestones. The child’s mother, however, insisted on keeping him alive. So, the committee had to recommend continuing life support to respect the parent’s right to decide.

Physicians inform, recommend and engage in shared decision-making with families to help clarify their values and preferences. But if there’s mistrust, the process can quickly break down, resulting in misunderstandings and conflicts about the patient’s best interests and making a difficult situation more distressing.

Moral distress

When clinicians feel unable to provide what they believe to be the best care for patients, it can result in what bioethicists call “moral distress.” The term was coined in 1984 in nursing ethics to describe the experience of nurses who were forced to provide treatments that they felt were inappropriate. It is now widely invoked in health care.

Numerous studies have shown that levels of moral distress among clinicians are high, with 58% of pediatric and neonatal intensive care clinicians in a study experiencing significant moral distress. While these studies have identified various sources of moral distress, having to provide aggressive life support despite feeling that it’s not in the patient’s interest is consistently among the most frequent and intense.

Watching a patient suffer feels like a dereliction of duty to many health care workers. But as long as they are appropriately respecting the patient’s right to decide – or a parent’s, in the case of a minor – they are not violating their professional duty, as my colleagues and I argued in a recent paper. Doctors sometimes express their distress as a feeling of guilt, of “having blood on their hands,” but, we argue, they are not guilty of any wrongdoing. In most cases, the distress shows that they’re not indifferent to what the decision may mean for the patient.

Clinicians, however, need more support. Persistent moral distresses that go unaddressed can lead to burnout, which may cause clinicians to leave their practice. In a large American Medical Association survey, 35.7% of physicians in 2022-23 expressed an intent to leave their practice within two years.

But with the right support, we also argued, feelings of moral distress can be an opportunity to reflect on what they can control in the circumstance. It can also be a time to find ways to improve the care doctors provide, including communication and building trust. Institutions can help by strengthening ethics consultation services and providing training and support for managing complex cases.

Difficult and distressing decisions, such as the case of the 6-month-old child, are ubiquitous in health care. Patients, their families and clinicians need to be able to trust each other to sustain high-quality care.

Daniel T. Kim is an Assistant Professor of Bioethics, Albany Medical College.This article is republished from The Conversation.

A laboratory technician prepares COVID-19 patient samples for semi-automatic testing at Northwell Health Labs, Wednesday, March 11, 2020, in Lake Success, N.Y.
| Photo Credit: AP

Five years since Covid-19 started upending the world, the virus is still infecting and killing people across the globe — though at far lower levels than at the height of the pandemic.

Here is the current state of the play.

Still with us

Around 777 million Covid cases and more than seven million deaths have been officially recorded since the first infections emerged in December 2019, according to the World Health Organization (WHO).

However, the true toll is believed to be far higher.

The pandemic also crippled health systems, crashed economies and sent the populations of many countries into lockdown.

In the second half of 2022, infection and death rates tumbled due to growing immunity from vaccinations or prior infection. The virus also mutated to become less severe.

In May 2023, the WHO declared the emergency phase of the pandemic was over.

Since then, the virus seems to have gradually become endemic, according to experts, with occasional resurgences similar to the flu — although less seasonal.

It has also largely receded from the public eye.

“The world wants to forget this pathogen that is still with us, and I think people want to put Covid in the past as if it’s over — and in many respects pretend it didn’t happen — because it has been so traumatic,” WHO pandemic preparedness director Maria Van Kerkhove said last month.

From October to November last year, there were more than 3,000 deaths from Covid across 27 countries, according to the WHO.

More than 95 percent of official Covid deaths were recorded between 2020 and 2022.

Variants

Since the Omicron variant emerged in November 2021, a succession of its subvariants have been replacing each other as the dominant strain around the world.

At the moment, the Omicron variant KP.3.1.1 is the most common.

The rising XEC is the only “variant under monitoring” by the WHO, though the United Nations agency rates its global health risk as low.

None of the successive Omicron subvariants have been noticeably more severe than others, although some experts warn it is not out of the question that future strains could be more transmissible or deadly.

Vaccines and treatments

Vaccines were developed against Covid in record time and they proved a powerful weapon against the virus, with more than 13.6 billion doses administered worldwide so far.

However rich countries bought up a large portion of the early doses, creating unequal distribution across the world.

Booster shots updated for the JN.1 Omicron subvariant are still recommended in some nations, particularly for at-risk groups such as the elderly.

However, the WHO has said most people — including the elderly — have not kept up with their booster shots.

Even among healthcare workers, the booster uptake rate was below one percent in 2024, according to the WHO.

Long Covid

Millions of people have been affected by long Covid, a still little-understood condition that lasts months after the initial infection.

Common symptoms include tiredness, brain fog and shortness of breath.

About six percent of people infected by coronavirus develop long Covid, the WHO said last month, adding that the condition “continues to pose a substantial burden on health systems”.

Much about long Covid remains unknown. There are no tests or treatments. Multiple Covid infections seem to increase the chance of getting the condition.

Future pandemics?

Scientists have warned that another pandemic will strike sooner or later, urging the world to learn the lessons of Covid and prepare for next time.

Attention has recently focussed on bird flu (H5N1), particularly after the United States reported on Monday the first human death from the virus.

The patient in Louisiana had underlying medical conditions and contracted H5N1 after being exposed to infected birds, US health authorities said, emphasising there was no evidence of person-to-person transmission.

Since late 2021, the WHO’s member states have been negotiating a world-first treaty on pandemic prevention, preparedness and response.

However, an agreement has remained elusive ahead of a May deadline, with a key faultline lying between Western nations and poorer countries wary of being sidelined when the next pandemic occurs.

The Covid pandemic also saw a massive increase in scepticism and misinformation about vaccines.

Experts have warned about the prospect of having vaccine sceptic and conspiracy theorist Robert F. Kennedy Jr. — US President-elect Donald Trump’s pick for health secretary — in charge of the US response to a possible pandemic threat over the next four years.

Indian Council of Medical Research (ICMR) has announced a new initiative called First in the World Challenge. File
| Photo Credit: AP

Aimed at encouraging Indian scientists to come up with innovative ideas for finding solutions to difficult health problems, the Indian Council of Medical Research (ICMR) has announced a new initiative called “First in the World Challenge”.

The Council, which is the apex body in India for the formulation, coordination and promotion of biomedical research and is one of the oldest medical research bodies in the world, said that the scheme proposes to foster novel, out of the box, futuristic ideas, new knowledge generation, discovery / development of breakthrough health technologies (vaccines, drugs/ therapeutics, diagnostics, interventions etc.), which has never been thought, tested or tried in the world till date.

“The proposal must have bold research ideas with significant wide-ranging impact and if successful should have potential ‘first of its kind’ biomedical and technological innovations for better health outcomes in the global context,’’ said the Council in its order.

It added that proposals aiming for ‘incremental knowledge’ or ‘process innovation’ will not be funded through this scheme.

The announcement adds that this is a high risk, high reward initiative where the odds of success may be variable.

“But ICMR considers it worth taking the risk to achieve something which no one in the world has ever done before. This program believes in taking big chances for big rewards. Every attempt may not work out, but the successes will bring about a huge revolution in biomedical science,’’ it noted.

The proposals can be submitted by an individual or by a team of researchers (either from a single institute or from multiple institutes). The selection committee will be formed by experts of high repute, innovators, policy makers, scientists with outstanding record of conducting and nurturing research and innovation in the biomedical domain.

Individuals diagnosed with severe Covid-19 infections during the initial wave of the pandemic may face twice the risk of experiencing heart attacks and strokes, according to a new study. The research, published this week in the journal Arteriosclerosis, Thrombosis, and Vascular Biology and backed by the National Institutes of Health, revealed that the increased risk could persist for as long as three years.

The study found that those who have ever contracted Covid-19 are twice as likely to experience heart attacks, strokes, and mortality compared to those who have never been infected. Furthermore, for those who were hospitalised due to the virus, the risk increases to four times higher.

According to Dr Hooman Allayee, the study’s principal investigator, the cardiovascular threats posed by severe Covid-19 are comparable to those associated with type 2 diabetes. “Cardiovascular mortality trends from 2010 to 2019 were steadily declining. Then, all of a sudden, between 2020 and 2022, ten years of progress were completely wiped out because of Covid-19,” ABC News quoted Dr Allayee as saying.

The findings particularly underscore the risks associated with different blood types, revealing that individuals with blood types A, B, and AB are more vulnerable to increased cardiovascular complications from Covid-19, whereas those with type O blood exhibit a lower risk.

The research utilized data from the UK Biobank, which predominantly includes older, wealthier, and mostly white participants. However, similar studies in other demographics have yielded comparable results, according to Dr Allayee.

Emphasising the critical role of vaccinations, Dr Allayee stated, “No matter what vaccine you received, just six months after the vaccination or booster, the chance of heart attack and stroke decreased. But immunity wanes over time, which is why you need boosters.”

Individuals who have had severe Covid-19, particularly those requiring hospitalisation, are urged to consult their healthcare providers about the potential long-term health implications of the virus. “It’s not going away, so we have to start talking about it. Stay on top of your vaccinations and boosters and get regular check-ups,” Dr Allayee advised.

In South Korea and China, office workers are increasingly turning to intravenous (IV) drips to combat fatigue and regain energy, according to a report from MYNews. This practice, known as intravenous nutrient therapy (IVNT), involves a blend of liquid vitamins and saline administered directly into the body.

Initially used for treating cancer, joint health, and growth disorders, IVNT has now found its way into aesthetic medicine, according to a June report from Medical Aesthetics News, a South Korean publication focused on the beauty industry.

The cost of nutrient drips at a clinic in Seoul ranges from 25,000 to 60,000 won (approximately Rs 1,500 to Rs 3,600) per session, lasting about 40 minutes. The clinic recommends a weekly infusion for optimal results.

Another clinic in Seoul lists the Cinderella, garlic, and placenta drips as the most sought-after options among clients. The Cinderella drip, rich in antioxidants like alpha-lipoic acid and Vitamin C, promises to reduce oxidative stress and slow the ageing process.

The garlic drip, which contains Vitamin B1, has a garlicky taste and is believed to help alleviate fatigue, particularly for patients suffering from insomnia. The placenta drip, made from various components of the placenta, including amino acids, aims to enhance skin elasticity in middle-aged women.

A survey by South Korea’s Asian Daily found that over half of young people feel mentally and physically drained due to success-related pressures.

Health professionals, however, advise caution regarding IVNT. “Intravenous nutrient infusions bypass the body’s filter system, raising the risk of serious reactions like phlebitis,” warned Deng Guifang, a nutritionist at Huazhong University of Science and Technology Xiehe Shenzhen Hospital. She recommends focusing on gut-based nutrition and maintaining a balanced diet for better health.

A man poses with an Apple iPhone 12 in a mobile phone store in Nantes, France, September 13, 2023.
| Photo Credit: Reuters

A systematic review into the potential health effects from radio wave exposure has shown mobile phones are not linked to brain cancer. The review was commissioned by the World Health Organization and is published today in the journal Environment International.

Mobile phones are often held against the head during use. And they emit radio waves, a type of non-ionising radiation. These two factors are largely why the idea mobile phones might cause brain cancer emerged in the first place.

The possibility that mobile phones might cause cancer has been a long-standing concern. Mobile phones – and wireless tech more broadly – are a major part of our daily lives. So it’s been vital for science to address the safety of radio wave exposure from these devices.

Over the years, the scientific consensus has remained strong – there’s no association between mobile phone radio waves and brain cancer, or health more generally.

Radiation as a possible carcinogen

Despite the consensus, occasional research studies have been published that suggested the possibility of harm.

In 2011, the International Agency for Research on Cancer (IARC) classified radio wave exposure as a possible carcinogen to humans. The meaning of this classification was largely misunderstood and led to some increase in concern.

IARC is part of the World Health Organization. Its classification of radio waves as a possible carcinogen was largely based on limited evidence from human observational studies. Also known as epidemiological studies, they observe the rate of disease and how it may be caused in human populations.

Observational studies are the best tool researchers have to investigate long-term health effects in humans, but the results can often be biased.

The IARC classification relied on previous observational studies where people with brain cancer reported they used a mobile phone more than they actually did. One example of this is known as the INTERPHONE study.

This new systematic review of human observational studies is based on a much larger data set compared to what the IARC examined in 2011.

It includes more recent and more comprehensive studies. This means we can now be more confident that exposure to radio waves from mobile phones or wireless technologies is not associated with an increased risk of brain cancer.

No association

The new review forms part of a series of systematic reviews commissioned by the World Health Organization to look more closely at possible health effects associated with exposure to radio waves.

This systematic review provides the strongest evidence to date that radio waves from wireless technologies are not a hazard to human health.

It is the most comprehensive review on this topic – it considered more than 5,000 studies, of which 63, published between 1994 and 2022, were included in the final analysis. The main reason studies were excluded was that they were not actually relevant; this is very normal with search results from systematic reviews.

No association between mobile phone use and brain cancer, or any other head or neck cancer, was found.

There was also no association with cancer if a person used a mobile phone for ten or more years (prolonged use). How often they used it – either based on the number of calls or the time spent on the phone – also didn’t make a difference.

Importantly, these findings align with previous research. It shows that, although the use of wireless technologies has massively increased in the past few decades, there has been no rise in the incidence of brain cancers.

A good thing

Overall, the results are very reassuring. They mean that our national and international safety limits are protective. Mobile phones emit low-level radio waves below these safety limits, and there is no evidence exposure to these has an impact on human health.

Despite this, it is important that research continues. Technology is developing at a rapid pace. With this development comes the use of radio waves in different ways using different frequencies. It is therefore essential that science continues to ensure radio wave exposure from these technologies remains safe.

The challenge we now face is making sure this new research counteracts the persistent misconceptions and misinformation out there regarding mobile phones and brain cancer.

There remains no evidence of any established health effects from exposures related to mobile phones, and that is a good thing.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Plastic is in our clothes, cars, mobile phones, water bottles and food containers. But recent research adds to growing concerns about the impact of tiny plastic fragments on our health.

A study from the United States has, for the first time, found microplastics in human brains. The study, which has yet to be independently verified by other scientists, has been described in the media as scary, shocking and alarming.

But what exactly are microplastics? What do they mean for our health? Should we be concerned?

What are microplastics? Can you see them?

We often consider plastic items to be indestructible. But plastic breaks down into smaller particles. Definitions vary but generally microplastics are smaller than five millimetres.

This makes some too small to be seen with the naked eye. So, many of the images the media uses to illustrate articles about microplastics are misleading, as some show much larger, clearly visible pieces.

Microplastics have been reported in many sources of drinking water and everyday food items. This means we are constantly exposed to them in our diet.

Such widespread, chronic (long-term) exposure makes this a serious concern for human health. While research investigating the potential risk microplastics pose to our health is limited, it is growing.

How about this latest study?

The study looked at concentrations of microplastics in 51 samples from men and women set aside from routine autopsies in Albuquerque, New Mexico. Samples were from the liver, kidney and brain.

These tiny particles are difficult to study due to their size, even with a high-powered microscope. So rather than trying to see them, researchers are beginning to use complex instruments that identify the chemical composition of microplastics in a sample. This is the technique used in this study.

The researchers were surprised to find up to 30 times more microplastics in brain samples than in the liver and kidney.

They hypothesised this could be due to high blood flow to the brain (carrying plastic particles with it). Alternatively, the liver and kidneys might be better suited to dealing with external toxins and particles. We also know the brain does not undergo the same amount of cellular renewal as other organs in the body, which could make the plastics linger here.

The researchers also found the amount of plastics in brain samples increased by about 50% between 2016 and 2024. This may reflect the rise in environmental plastic pollution and increased human exposure.

The microplastics found in this study were mostly composed of polyethylene. This is the most commonly produced plastic in the world and is used for many everyday products, such as bottle caps and plastic bags.

This is the first time microplastics have been found in human brains, which is important. However, this study is a “pre-print”, so other independent microplastics researchers haven’t yet reviewed or validated the study.

How do microplastics end up in the brain?

Microplastics typically enter the body through contaminated food and water. This can disrupt the gut microbiome (the community of microbes in your gut) and cause inflammation. This leads to effects in the whole body via the immune system and the complex, two-way communication system between the gut and the brain. This so-called gut-brain axis is implicated in many aspects of health and disease.

We can also breathe in airborne microplastics. Once these particles are in the gut or lungs, they can move into the bloodstream and then travel around the body into various organs.

Studies have found microplastics in human faeces, joints, livers, reproductive organs, blood, vessels and hearts.

Microplastics also migrate to the brains of wild fish. In mouse studies, ingested microplastics are absorbed from the gut into the blood and can enter the brain, becoming lodged in other organs along the way.

To get into brain tissue, microplastics must cross the blood-brain-barrier, an intricate layer of cells that is supposed to keep things in the blood from entering the brain.

Although concerning, this is not surprising, as microplastics must cross similar cell barriers to enter the urine, testes and placenta, where they have already been found in humans.

Is this a health concern?

We don’t yet know the effects of microplastics in the human brain. Some laboratory experiments suggest microplastics increase brain inflammation and cell damage, alter gene expression and change brain structure.

Aside from the effects of the microplastic particles themselves, microplastics might also pose risks if they carry environmental toxins or bacteria into and around the body.

Various plastic chemicals could also leach out of the microplastics into the body. These include the famous hormone-disrupting chemicals known as BPAs.

But microplastics and their effects are difficult to study. In addition to their small size, there are so many different types of plastics in the environment. More than 13,000 different chemicals have been identified in plastic products, with more being developed every year.

Microplastics are also weathered by the environment and digestive processes, and this is hard to reproduce in the lab.

A goal of our research is to understand how these factors change the way microplastics behave in the body. We plan to investigate if improving the integrity of the gut barrier through diet or probiotics can prevent the uptake of microplastics from the gut into the bloodstream. This may effectively stop the particles from circulating around the body and lodging into organs.

How do I minimise my exposure?

Microplastics are widespread in the environment, and it’s difficult to avoid exposure. We are just beginning to understand how microplastics can affect our health.

Until we have more scientific evidence, the best thing we can do is reduce our exposure to plastics where we can and produce less plastic waste, so less ends up in the environment.

An easy place to start is to avoid foods and drinks packaged in single-use plastic or reheated in plastic containers. We can also minimise exposure to synthetic fibres in our home and clothing.

This article is republished from The Conversation under a Creative Commons license. Read the original article.