December Analytical Posting

http://www.medscape.com/viewarticle/856197

Skin cancer has been recently on the rise, especially among young people. Just today, the FDA released new guidelines regarding the use of tanning beds. Specifically, the guidelines would prevent anyone under the age of 18 from using high-powered UV sunlamps. In addition, anyone over the age of 18 will be required to sign a waiver every 6 months that says that they understand that using these lamps has health risks that include burns and skin cancers. According to Dr. Peiris of the FDA’s Center for Devices and Radiological Health, tanning lamps give off ultraviolet radiation that’s 10-15 times stronger than the midday sun. Skin damage from UV radiation is cumulative. In other words, it adds up over the course of one’s lifetime, which implies that the concentrated doses of radiation that are delivered by tanning beds are especially dangerous to children and teens.

These guidelines come approximately 1 year after the FDA reclassified tanning beds from lower risk to moderate risk devices. These very moderate risk devices were subsequently banned from anyone that was either under 18, had open wounds or injuries, or had a family history of skin cancer. The FDA also required that anyone that was regularly using tanning beds should get regular checkups for skin cancer. Although this reclassification initiated the suspicions regarding tanning beds, it was only a month later that the surgeon general publicly singled out tanning beds as a cause of disease.

Understandably, the Indoor Tanning Association (ITA) has been very public about its belief that the decision to use tanning beds should be a personal one, even despite the risks. Of course, it is easy to see the profit incentives driven behind this statement, since teens are the industry’s biggest customers. Nevertheless, 13 states as well as the district of columbia have banned indoor tanning for minors, and 23 other states have requires tanning booth operators to adhere to time limits set by sunlamp manufacturers. While restricting access continues to be the main priority, the FDA also has made suggestions to make tanning beds safer, including improving labeling and eye safety.

Personally, I feel that the tanning bed debate speaks to a broader dilemma within healthcare – that regarding the autonomy of the patient in making individual health choices. It’s been well established that tanning beds pose significant health risks, but does this mean that it is appropriate to restrict access? A similar argument could be made regarding the relationship between smoking and lung cancer and alcohol and drunk driving. The risk is well-defined in these cases, but nothing prohibits Americans from being able to engage in these risky acts. Should tanning beds be treated differently? Given the precedents that have been set, I’m not so sure.

 

 

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Discussion Post

Following up on Dr. Guseva’s end of life care lecture, what is your opinion of the example set by Massachusetts and Oregon on end of life care policies?

Final Process Reflection

This class has been extremely enjoyable from the start. I’ve thoroughly enjoyed the lectures and discussions alike, finding them to be vastly informative while at the same time unbelievably interesting. I believe that the sociology of healthcare is a phenomenally deep and intellectually stimulating subject that will become increasingly relevant as the non-medical determinants of health become emphasized in the new age of healthcare. The discussions complemented the lectures extremely well and helped facilitate the learning through debates and engaging class-wide conversations. The most fascinating aspects of the course, to me, came during the second unit, wherein we learned about some of the social determinants of health as well as the element of social construction and medicalization in healthcare. I think these topics comprise the meat of healthcare sociology, addressing the ways in which sociological tendencies and patterns often dictate trends within healthcare. I think that with the passage of the Affordable Care Act, the issue of health disparities has become so important to long-term healthcare solutions. As a result, analyzing the sociological determinants of health, including socioeconomic status, race, and other demographics, is extremely valuable in thinking of these solutions. After all, the extension of insurance coverage is meant to target these very health disparities. Fittingly, Sociology of Healthcare at BU is taken mainly by students interested in pursuing careers in healthcare. This class has and continues to provide tomorrow’s healthcare professionals with a broad, liberal-arts based outlook on the nature of patient care that can only serve to enhance the quality of care delivered.

November Analytical Post Kunal Khurana

http://www.reuters.com/article/2015/12/01/us-usa-gene-editing-idUSKBN0TK33F20151201

Several US Scientists and activists have called for a global ban on editing genes of human embryos. The scientists mainly come from the Center for Genetics and Society, while the activists come from Friends of the Earth. Specifically, the CRIPR/CAS9 technology will one day allow scientists to prevent heritable diseases. Scientists and activists are concerned about the potential for parents to pay for genetic enhancements like greater intelligence or athletic ability. Gene-editing techniques can be used to alter both reproductive and non-reproductive cells.

When such techniques are applied to reproductive cells, it’s called germ-line editing. Interestingly, the White House released a ban in May on germ line editing, pending further study of the ethical issues. The US National Academy of Sciences teamed up with its counter-parts in China and the United Kingdom to produce the latest report. This report in particular has not only highlighted the issue of gene editing in human embryos, but also infuses the issue with a level of political and moral urgency.

Opponents of the technique don’t seem to have ulterior or selfish motives. One of the key developers of the CRISPR technique called for a voluntary research ban on the use of the technology for germ-line editing, reflecting fears about safety and eugenics. Despite the call for this voluntary research ban, a group of Chinese scientists carried out the very first experiment to alter the DNA of human embryos. The experiment was polarizing for the scientific community, in that some scientists were in favor of the Chinese group and others opposed them.

Personally, I disagree with the ban. I think human embryonic research of all sorts should be absolutely encouraged. Genetically modifying embryos, provided that we retain the embryos within the confines of the laboratory, is going to yield valuable scientific information. I would advocate this research even if the embryos were to be harmed as a result. After all, the embryos aren’t true human beings and therefore shouldn’t deserve the same legal or moral rights. Eliminating the possibility of obtaining vital scientific information for the purpose of political correctness, to me, is silly.

 

October Analytical Post Kunal Khurana

Posted earlier, but realized it didn’t go through again……

https://www.washingtonpost.com/national/health-science/a-group-of-middle-aged-american-whites-is-dying-at-a-startling-rate/2015/11/02/47a63098-8172-11e5-8ba6-cec48b74b2a7_story.html

Studies have suggested that a significant proportion of white middle-aged Americans have been experiencing a steadily increasing mortality rate since 1999. The group is specifically described by white men and women aged 45-54 with less than a college education. Not only are they dying at a faster rate, they are reporting elevated levels of physical pain and psychological distress. Higher drug overdoses and alcohol use is also reported.

The most likely causes for the rising mortality rate include legal and illegal drugs, alcohol, and suicide. These results are particularly surprising, because no other large demographic group in an advanced nation has experienced an increasing mortality rate except for Russian men after the collapse of the Soviet Union. Most of the individuals in this cohort are heading towards retirement and therefore will be eligible for Medicare very soon. This sicker population will therefore place a greater economic burden on federal programs as well a greater demand for doctors. Thus, the question is not only of how to pay for it but also how to meet the increasing healthcare needs of this population. This can only mean more problems for an already strained system. The other alarming aspect of this situation is that, since lack of college education is the defining factor of this cohort, the effects may not go away. After all, nearly half the population contains only a high school diploma or dropped out of high school.

Researchers are particularly interested by the fact that the effects applied exclusively to whites and not blacks, even though the former enjoy certain societal advantages. Socioeconomic circumstances like low education, low incomes, and race all supposedly work against African-Americans, but this isn’t reflected in the mortality data collected in the study. This is very surprising to me personally, because there are thousands of studies that establish poorer health quality in African-Americans. I’ve seen these health disparities first-hand in the DC Area while working with George Washington University’s Rodham Institute. Thus, it is difficult for me to rationalize the idea that white Americans are exclusively experiencing these rising mortality rates. It must mean that, although African Americans suffer from poor health, their situation is improving, while that of white Americans isn’t.

Discussion Question Kunal Khurana

In discussion, we briefly alluded to this but didn’t discuss in detail, and it could be a great followup in the next discussion.

If a man who is below the poverty line regularly purchases cigarettes despite knowing the risks, does he still deserve health-related aid from the federal government? This can be in the context of both health insurance and broader social policy.