Incidental medical test findings: Not incidental

Incidental medical test findings: Not incidental

The doctor says to a patient with a broken collarbone, “We did the MRI scan of the torso, including the shoulder, and yes you have a multiple fracture and torn ligaments. We also discovered something else. You have lung cancer.” Two immediate points: This sort of incidental finding – looking for one medical condition and discovering another unrelated condition – is far more common than the public or even the medical community realized. It also presents doctors with a new, growing and often perplexing ethical challenge.

A recent report, Anticipate and Communicate, issued by the U.S. Presidential Commission for the Study of Bioethical Issues panel on incidental findings, puts the situation in a broader and more pressing context than previously understood. The advent of the many scanning and testing devices, from X-ray to MRI (and fMRI), to cat-scans (CT), blood assay machines, and genome sequencing devices has inevitably increased the possibility of finding indications of other – unexpected – medical problems.

These ‘incidental findings’ are not rare. For example, 30%-43% of abdominal CT scans result in incidental findings. About 10% of brain scans reveal unexpected physical problems. The commission found that incidental findings are so common that patients should be routinely advised of the possibility and warned, if that’s the word, about the difficulty of interpreting such unexpected results.

The warning indicates that incidental findings are not always correct or beneficial. In fact, they pose an important challenge to the ethics of the medical profession. While discovery of incidental findings can be lifesaving, they can also cause unnecessary worry and expense. This puts doctors in the position of trying to decide which, if any, incidental findings are valid and can (or should be) revealed to the patient. Some examples help make this clear. In addition, visit dentists stone harbor nj to learn more about medical dentistry services.

Since by definition an incidental finding is not what doctors expected, or were looking for, when they occur it is almost inevitable that doctors order follow-up tests. This is an additional expense, of course, but in worst-case scenarios can even do harm.

For example, an elderly patient suffers a mild heart attack and after scans of the heart and upper body, doctors discover a suspicious spot on a lung. A biopsy is ordered, which determines the spot is harmless (nothing more than an old scar), but the biopsy itself causes the lung to collapse, triggering a cardiac arrest.

Then there is always the possibility of an incidental finding in a medical-ethical gray area. For example, a young athlete complains of severe headaches after a concussion, so the doctor orders a brain scan. The concussion seems to have caused no physical problem, but the radiologist spots a tumor.

This discovery could be lifesaving. It could be a tumor of a type that remains benign. But, what if the tumor is malignant, inoperable and incurable? At what level of diagnosis does the physician feel compelled to discuss the results with a patient?

There are also situations where a patient expresses a desire not to hear about certain negative results, such as a former cancer patient not wanting to hear about the incidental finding of a cancer return. Normally doctors will honor that request even though they believe it is medically wrong.

A new area of great ethical concern is the result of recently available personal genome sequencing marketed as ‘direct to customer’ medicine. Reading of genomes for potentially disease causing genes is still in a very early stage of development – most of it in research.

Interpretation of genomes is, not to put too fine a point on it, suspect. When the consumer is directly responsible for the results, and not a doctor or other supporting medical personnel, what happens if the results show an unexpected parental lineage (“Not my father!”) or even a chromosomal sex that is different from a person’s accepted sex?

There are many cases where a doctor may order a genome analysis looking for a suspected inherited medical condition or susceptibility, such as for breast cancer, and discover from the sequence that the patient has other genes or markers for hereditable diseases. Is the doctor responsible for informing the patient of all the other possible hereditable diseases?

The problem is that, so far, the existence of certain gene patterns mostly correlate with a particular disease, but it’s unknown whether they actually cause the disease. There are so many confounding factors, such as the environment and personal health habits, that simply having a particular gene or genetic marker does not mean a person will develop a disease, only that they have a genetic makeup that is known to be present for people who develop the disease.

The problems of incidental findings are a perplexing mix of ‘good news, bad news.’ It’s good news that new technologies in scanning and medical testing can reveal so much. It’s bad news in that, at least for now, interpretation of the results are sometimes indeterminate, questionable, or just plain wrong.

TAGS: incidental findings, medical diagnosis, scanning tests, direct to customer, genome sequencing, medical ethics

Clinical Trial Finds Nanotube Sensor Can Monitor Cancer or Diabetes

Nanotube sensorNanotechnology in Medicine

Most everybody knows about a litmus test, strips of paper impregnated with dyes that turn red in the presence of acid and blue if there is a base (alkaline). It’s a kind of chemical sensor. There are many kinds of chemicals that can similarly act like a sensor, detecting the presence of other chemicals.

Some of them would work in the human body, detecting glucose (blood sugar) for example, but the problem has always been using them in a way that is effective to read but not harmful. In short, most biochemical sensors have a delivery problem.

Part of the nanotechnology revolution was the development of nanoparticles, small shapes mostly of carbon that are no more than 1/100,000th of the thickness of human hair, i.e. about 1 nanometer in size. Carbon nanotubes are the most common type of nanoparticle, and as the word “tube” indicates, these are incredibly tiny rods with hollow centers.

Using Nanotubes as a Biomarker

It occurred very early on to researchers that it might be possible to put something in the tubes – medicine, for example – and use the tubes to deliver the medicine to very small, very targeted locations in the body. Continue Reading

Clinical Trial Finds Links Between Inflammation Response and Autism

Autism clinical trial using whipwormsClinical Trial Research on Links Between Inflammation and Autism

Inflammations, such as a fever or the reddish hot area around an infection, are normal responses of the immune system. In fact, inflammation is such a common defense mechanism that some of its effects sort of slipped off the research radar.

Until recently (the last five years or less), this was the case for researching links between inflammation and autism (or more accurately, autism spectrum disorder). These days the inflammation-autism link is a busy area, including some research that may seem ‘far out’ until you look at the details. One such research track uses worms, whipworms (Trichuris suis ova) to be exact.

Using Whipworms to Research Autism

Obviously, question #1 is, “What do whipworms have to do with autism?!” Like so many things in science, the answer isn’t about surface appearances but about something the worms do in the human body. They suppress the immune system, specifically the inflammatory response. Continue Reading

Clinical Trial Shows Stelara Improves Psoriatic Arthritis

Clinical Trial Tests Stelara for Psoriatic Arthritis Relief

Clinical Trials for Stelara Two recent Phase III clinical trials, sponsored by Janssen Biotech, Inc. demonstrated that the drug Stelara (ustekinumab) is able to partially block joint damage and relieve symptoms caused by psoriatic arthritis for up to two years.

What is Psoriasis and Psoriatic Arthritis?

As the name indicates, psoriatic arthritis, there is a link to psoriasis. About 15% of people who have psoriasis, a disease that causes the immune system to attack the skin, will develop psoriatic arthritis. The condition can be very serious, leading to permanent damage of  joints such as knees and knuckles.

At best, psoriasis and psoriatic arthritis are debilitating and painful (like the rheumatoid arthritis, which is treated with methotrexate for RA). For mild cases, treatment has often consisted of taking NSAIDS (ibuprofen, naproxen), but the trend is to use antirheumatic drugs at an earlier stage. Continue Reading

New Clinical Trials Searches for Evidence of Benefit from Animal Assisted Therapy

What is an Emotional Support Animal?

Animal assisted therapy for cancer patients.

Animal assisted therapy has shown benefits for cancer patients and those with mental health conditions.

How’s your ESA doing? It’s a good bet you didn’t know your family’s pet(s) could also be “Emotional Support Animals.”

Here’s another related acronym, “animal assisted therapy (AAT).” This is a growing field of research and practice in the use of animals for psychological therapy.

It’s not difficult to understand the underlying beliefs about how animals can have a healthy effect on the human psyche – just hold a warm, fuzzy and purring kitten for a while.

However, when it comes to psychology, medicine, and the benefits for people with mental illness, animal assisted therapy can be more fuzzy than warm.

The Benefits of Animal Assisted Therapy

While human beings have known for centuries that relationships with animals could be beneficial, there’s a really big step from the benefits of a pet and the use of an animal to treat a serious mental condition such as PTSD, depression or autism. Continue Reading

Successful Clinical Trial for Breast Cancer: Herceptin + Emtansine

 Herceptin + Emtansine One of the most promising approaches to treat breast cancer is to target the tumor cells directly, through the use of T-DM1. If you’re considering undergoing a breast augmentation procedure, it is extremely important to do your research and ask your plastic surgeon the proper questions. This targeted therapy has two related advantages – it focuses the treatment on the cancer itself, and it reduces the side effects caused by collateral damage from the treatment.

As a prime example of how this can work are the results of a recently completed Phase III trial of the drug T-DM1.  

It’s a combination of the targeted drug trastuzumab (the “T” in T-DM1), better known by the brand name Herceptin, and a very powerful chemotherapy drug called emtansine (the “DM1″ part). The drug is designed to work when Herceptin alone no longer can keep the cancer in check.

Nearly 1,000 people with advanced breast cancer were involved in the three-year trial. All of them were diagnosed with an aggressive form of cancer distinguished by elevated levels of a specific protein, the human epidermal growth factor – 2 (HER-2). This protein promotes the growth of cancer cells and is found in about 20 percent of invasive breast cancers.

The drug T-DM1 (Herceptin + Emtansine) relies on the effect of trastuzumab, an antibody (immune system protein) that binds to the HER-2 protein and interferes with its ability to spur cancer cell growth. Trastuzumab is commonly prescribed as an added treatment with chemotherapy. Continue Reading

ePill: Edible Sensors That Talk to Phones

Edible Sensors That Talk to Phones Monitoring of your medicine intake will soon be easier if the FDA approves the new ePill, or edible sensor, from Proteus Digital Health.

The title of this article is not misleading or even exaggerated. Described technically, this is about an ingestible sensor that transmits information from a stomach to a phone app. That’s right, you eat the sensors, which are about the size of a grain of sand, and they communicate to a device worn on the belly, which communicates to a telephone.

The manufacturer of these Edible Sensors, opting health, sought and received U.S. Food and Drug Administration (FDA) approval for their new technology. Here’s how it works:

The tiny sensor devices are typically embedded in a pill. Once the pill reaches the stomach, the covering dissolves and releases the sensors. The acid found in the stomach powers the Edible Sensors when it converts chemically to energy.

This is very much like the ‘potato battery’ you might have seen in a science class, where a couple of needles stuck in a wet potato can power a light bulb.

In addition to new staff, glass bongs here and tobacco groups are moving from a straightforward manufacturing process to one heavily reliant on expensive research and development. You can also visit MigVapor alternative ecigarettes online for more.

In this case, the Edible Sensors are coated with a layer of magnesium and a layer of copper, which when exposed to the liquid in the stomach, produce electricity. Continue Reading

New Clinical Trial Study Develops a Better, Faster TB Treatment

Better, Faster TB TreatmentResults of a recent TB clinical study suggests a faster, more effective drug treatment for tuberculosis is very close to realization.

A Phase II clinical trial study, published in the UK journal The Lancet, and conducted in South Africa, demonstrated an effective new combination of drugs that killed more than 99 percent of the patient’s tuberculosis bacteria within two weeks. The speed and effectiveness suggest the new regimen could improve upon existing TB treatments for not only general TB, but also drug resistant and TB/HIV co-infected patients.

Historically tuberculosis (often shortened to TB for tubercle bacillus) was a major killer that, while never eradicated, by the 1950’s seemed to be less of a health threat. Modern antibiotic TB treatments and health practices generally reduced the incidence of tuberculosis to the status of a minor disease.

That changed during the 1980s, as strains of TB appeared that were resistant to traditional antibiotics. By the 1990s, the World Health Organization again labeled TB a global health emergency.   Continue Reading

Interview with the Women of Teal Blog: Fighting Ovarian Cancer

Fighting Ovarian CancerThe American Cancer Society estimates that 22,280 women in the US will be diagnosed with Ovarian Cancer, and 15,500 of those cases will be fatal. To raise awareness of ovarian cancer, we interviewed Dee, author of the blog Women of Teal. She is an ovarian cancer survivor, fighter, and advocate. She kindly shared her story and clinical trial experiences with JCT.

I am a wife and mother. After working as an engineer, college program coordinator, and computer teacher I did not think the focus of my life would change yet again. But in 2005, after being diagnosed with Ovarian Cancer I became a cancer survivor and research advocate.

I attended the Lance Armstrong Foundation’s Survivor Summits, became a member of my state’s Cancer Control Plan workgroup and joined a number of ovarian cancer advocacy organizations, serving on the Board of the Kaleidoscope of Hope Foundation for three years. In 2007, I began writing my blog, Women of Teal, in order to share what I have learned on this journey with others and to raise awareness of the disease, its treatments and the need for more research.

1. Would you please share with our readers how you were first diagnosed with ovarian cancer, and at what stage it was at?

I visited The Center for Cosmetic & Reconstructive Gynecology, my gynecologist for my annual exam and mentioned to her an odd pain I was having on my left side. I thought I might have just pulled a muscle. She thought we should investigate further and sent me for a transvaginal ultrasound.

The day after I had the ultrasound I was in the ER in terrible pain. The ER physician contacted the radiologist and my gynecologist, and I was scheduled the next day for an MRI. Continue Reading

Stress Illness: Its More Common Than You Think

Stress IllnessStress illness, otherwise known as Psychophysiologic Disorder or PPD, may not be a household word, but the conditions that result from it are all too common. We feature a leading expert in the field of PPD, Dr. David D. Clarke, in our JCT interview series. He was kind enough to shed some light on what PPD is and how it affects an estimated five to ten million people in the United States.

Dr. Clarke is the President of the Psychophysiologic Disorders Association (PPDA) in the U.S., and his biography and stellar qualifications follow the interview.

Dr. Clarke, could you please define the term “Stress Illness?”

The term “stress illness” describes an illness that is not linked to any disease of an organ or structure in the body, but one that diagnostic tests can’t explain. Often, people have physical symptoms that cause them discomfort or pain, but tests run by their doctor don’t show a cause for the symptoms.

Most of these patients are actually suffering from symptoms and illness caused by stress, which can be unrecognized or not readily apparent, hence the term “stress illness”, otherwise known as PPD.

How does it differ from the regular stress we experience every day?

Everyone experiences stress, but there are two main differences between regular stress and stress illness. To lessen your stress on your baby’s heartbeat you can use baby heartbeat monitor and feel secured. For a stress-free dental care for your teeth just go to headaches and tooth decay. The first is the degree and high level of stress which is producing physical symptoms such as stomach upset, headaches, and body pain on a regular basis. The second is that the person is not aware of the magnitude of the stress they are coping with because they have been living with it consistently. Continue Reading

Clinical Trial Shows Drug Ready for New Type 2 Diabetes Treatment

Type 2 Diabetes TreatmentA new drug, Trajenta, has been proven to work for type 2 diabetes treatment after a lengthy but successful clinical trial process.

An extended clinical trial of the drug linagliptin (Trajenta), conducted for a group of over 2,000 patients from 32 countries with type 2 diabetes, confirmed the drug as safe and effective for lowering and maintaining blood sugar levels for up to 102 weeks.

Fundamentally, all forms of diabetes are a condition where a person has high blood sugar, which means there’s too much sugar (glucose) in the blood for the body to process normally. The effects of this condition begin with the three classic symptoms of hyperglycemia, frequent urination, increased thirst, and increased hunger.

If untreated, diabetes can produce many serious long-term complications including cardiovascular disease (heart disease), kidney disease (renal failure), damage to the eyes (retinopathy), damage to the nerves (neuropathy) and in severe incidents, diabetic coma.

With modern type 2 diabetes treatment, diabetes is rarely fatal in its own right, but it is a major contributor to many other illnesses, many of which are fatal.

The key component in diabetes is insulin. Insulin is a hormone produced by the pancreas and its job is to regulate the blood sugar level of the body. In a way it acts like a stimulant to the liver, muscle and fat tissue to take glucose (blood sugar) from the blood and either metabolize (use) it or store it as fat. Lack or failure of insulin to do this job is the cause of diabetes.

Of the three major types of diabetes, type 2 is by far the most common – and becoming more common in the every part of the world where poor diet and health habits are the norm. Unlike type 1 diabetes, where there is little or no production of insulin, doctors characterize type 2 diabetes by sometimes-low insulin production and almost always a reduced sensitivity to insulin.

That is, various organs, notably the liver and muscles, no longer respond to insulin normally. They fail to either metabolize or store the glucose, which results in an increased glucose level in the blood.

Continue Reading

New Research Shows How UV Light Causes Skin Cancer

How does UV light causes cancer?According to Diane Walder, MD, 90% of skin cancers are linked to UV light from the sun, but discovering how UV light causes cancer is the key to new treatments.

All cancers are bad, but melanomas, loosely known as skin cancers, are among the worst. In fact, only three percent of skin cancers are melanoma, but they account for more than 75% of skin cancer deaths.  If caught early, melanoma is usually highly treatable. Caught late, after it metastasizes, it is usually fatal.

Doctors have known for decades there is a link between exposure to the sun, specifically ultraviolet (UV) light, and melanoma. You may have heard about not getting too much sun, using sun-blocker to protect your skin and avoid spending much time in a tanning booth and assist to a Skin Care in Phoenix to check and treat your skin in case of damage.

The big question for research and a potential step for better melanoma treatment or even a cure was how does UV light cause the cancer?  

The key to the approach taken by researchers at the Broad Institute of M.I.T. and Harvard (USA) and the University of Texas MD Anderson Cancer Center, builds upon the knowledge that melanoma tumors are full of cells with genetic damage caused by UV exposure, mostly caused by sunlight.

As with many cancers, genetic mutations often link to the uncontrolled growth of cancer cells. The question with melanoma is which mutations drive this cancer? Continue Reading