Doctors “Bending” Ethical Norms to Best Serve Their Patients who can’t Bend their Joints

Rheumatic diseases, such as rheumatoid arthritis and lupus, are a common cause of disability. they affect all sectors of the population, diminish quality of life and have a significant social impact.

Yet, despite the benefits of early treatment and effective therapies, access to rheumatologic services may be difficult, involving long wait times, even difficulties finding providers.

C. Ronald MacKenzie, MD, a rheumatologist at Hospital for Special Surgery in New York City conducted a survey among rheumatologists entitled “Bending’ Ethical Norms to Serve Patients’ Interests:Tensions in Medical Professionalism,” to examine the medical, moral and ethical dilemmas doctors face when trying to do what’s best for their patients in the current health care environment.

The study was published in the October issue of the journal Arthritis and Rheumatism. “When people receive a diagnosis, the cost of effective treatment may render it unaffordable for many,” says Dr. MacKenzie. “While an optimal or fair system would mitigate these impediments to care, our survey of the American College of Rheumatology members suggests that this is often not the case. In fact, physicians report they frequently find themselves in situations of ethical conflict in an effort to best serve their patients.”

The survey consisted of 14 closed-ended and two open-ended questions and was sent to 5,500 members of the American College of Rheumatology.

Physicians reported ways in which they see themselves as ‘bending’ ethical standards and presented justifications for doing so. Examples included ‘embellishment’ of symptoms to help patients obtain prior authorization from insurance companies; stretching the truth to obtain diagnostic tests and necessary medications and or physical therapy.

“The delivery of medical care takes place in a particular social context, and when this context includes conditions that are unfair, healthcare practitioners may be forced to struggle with ethical conflicts, making trade-offs that may go unrecognized or are not adequately discussed.”

Medicine is not merely the scientifically based treatment and care of illness. It also involves ethical issues of right and wrong. In some cases, tough ethical dilemmas force doctors and other health care providers to make difficult decisions, all while upholding the Hippocratic oath to which all doctors are bound.

In today’s health care world, where the number of health care options can be great, medical ethics is of particular concern.Awareness of this problem and its consequences is only the first step in finding solutions to the challenges that physicians face.

Fixing the system in which physicians feel they have to ‘bend’ ethical norms and compromise ethical principles in order to provide the care their patients need, is clearly what’s so desperately needed.

 

 

 

 

 

 

Stiffness, Swelling and the Sticky Issue of Sugary Soda

Those of us of a certain age, probably know all about osteoarthritis, the “wear and tear” disease in which joint cartilage is lost. Losing cartilage from your knee is similar to having the shock absorbers go on your car.  It leads to pain, stiffness and other symptoms.

According to a large 2007 study, nearly 20% of women and 15% of men over the age of 45 have  symptoms of knee osteoarthritis.

Until now, many experts thought disease progression was inevitable. I’m pretty sure that’s what my knee surgeon thinks. One such clue: he always says “when I see you again” rather than “if I see you again” at the end of every visit.

Now, for men at least, this may be about to change. A new study of more than 2,000 with osteoarthritis of the knee showed that disease progression in men is linked to consumption of sugary soda.

Researchers reviewed the records of 2,149 men and women with confirmed osteoarthritis of the knee.

All filled out dietary questionnaires that asked how many soft drinks, not including sugar-free beverages, they drank on average each week.

Every year for four years, the researchers tracked their osteoarthritis progression by measuring the space between the joints. The more cartilage that is lost, the less the space. Body Mass Index (BMI) was also measured.

After taking into account BMI and other risk factors, men who drank five or more soft drinks a week had twice as much narrowing of joint space compared with men who did not drink sugary soda.

“Our main finding is that the more sugary soda men drink, the greater the risk that knee osteoarthritis will get worse,” says researcher Bing Lu, MD, DrPh. Lu is assistant professor of medicine at Harvard Medical School and associate biostatistician at Brigham and Women’s Hospital in Boston.

If you’re thinking something along the lines of ‘Duh! Tell me something new. Soda=calories=weight gain= risk factor for osteoarthritis, think again.

Much to the researchers’ surprise, the link between knee osteoarthritis progression and sugary soft drinks could not solely be explained by weight.  When the men were divided into obese and non-obese, the link between sugary drinks and worse knee damage held true only in the non-obese men, suggesting that soft drinks worsen knee osteoarthritis independently of the wear and tear on the joints caused by carrying around excess weight.

So what’s a man who enjoys soda to do?  According to Lu the answer is simple. “just don’t drink it!”

Another expert says that’s going too far. “As with everything, enjoy soda in moderation. If you are a man with knee osteoarthritis and are drinking a lot of soda, this might be a reason to curb back,” says American College of Rheumatology spokesman Scott Zashin, MD.

He argues that the study doesn’t prove cause and effect and needs to be repeated before any recommendations to patients can be made, he says.

Furthermore he advises, that in patients with osteoarthritis of the knee, every excess pound of weight is 4 extra pounds of dead weight on the knee joint.

And it’s not only Zashin who’s speaking out. The American Beverage Association (ABA), has also taken issue with the findings.

In a statement, the ABA writes: “The authors’ ‘novel  findings’ – as they call them – suggest only a possible association of soft drink consumption with osteoarthritis in knees, which they state cannot be proven without further testing. Consequently, this presentation fails to establish that drinking soft drinks causes any negative health outcomes or even that they are linked to negative health outcomes.”

Lu however is defending his work. He claims that certain ingredients in soda, including phosphoric acid, caffeine, as well as coloring and sweetening agents may affect absorption of calcium and overall bone health.

He even has an explanation as to why the link between soda and disease progression could not be established in women. “It could be due to sex hormones. For example, estrogen has been associated with cartilage degeneration. Further research is needed to understand the pathways.”

Although the jury is still out on this issue, it seems cutting back, or cutting out soda may not be a bad idea.

Could or would you give up your cola?  Let us know!