Biomedical subjects
Publications and source records attributed to N B Cummings.
Perhaps one measure of wisdom is our willingness to listen to the tales of that man of a different color on our left and that woman of a different color on our right as we walk together toward life's inevitable crises.
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The association of cancer and death in laypeoples' thinking has resulted in discussions of cancer diagnoses often being held sub rosa. Open acceptance of a diagnosis of cancer cannot only help to dispel associated fears but also can serve to educate other persons to recognize that cancers can be cured. Open discussion of diagnoses of breast cancer by well-known public figures increasingly has focused media attention on related issues. Numerous ethical issues applicable to breast cancer (and to other chronic and/or cancer diagnoses) include: informed consent; education of relatives, friends, and public; patients' comfort in discussion of their diagnoses and treatment; access to care; and allocation of scarce resources. Genuine informed consent involves discussions of all relevant medical issues with the patient so that she understands the ramifications of the diagnoses, treatment, risks, and benefits of undergoing or of refusing treatment; and enables the patient to make a reasoned autonomous decision. Sufficient time must be allowed for development of this understanding because all persons, but especially apprehensive patients, tend to be selective in their hearing of explanations: to hear what they are afraid to hear, what they want to hear, and what they are prepared to hear. Limitations of funding for health care raise further questions about access to needed treatment. The concerns of the NIH Office of Research on Women's Health and of the Women's Health Initiative include breast cancer, as do those of the populace at large.
The US Public Health Service (USPHS) and the National Institutes of Health (NIH) have a major commitment to women's health issues and to women's health research. "To assess the problems of women's health in the context of the lives women in America lead today," the Assistant Secretary for Health, USPHS, appointed a task force whose report published in 1985 identified issues, listed 15 recommendations, and served as a guide for the establishment of groups within each agency to implement the recommendations according to their appropriate responsibilities. NIH established an Advisory Committee on Women's Health Issues which assessed NIH involvement in women's health research, made recommendations for implementation or expansion of this research, including a recommendation that women be included in clinical trails or their exclusion be justified. An Office of Research on Women's Health was created. The NIH announced a Women's Health Initiative (WHI) in the spring of 1991, which will address three of the leading health problems for women: cardiovascular disease, breast and colon cancer, and osteoporosis. The WHI will provide an integrated, multidisciplinary approach through clinical trials, observational studies, and community trials. Clinical trials will evaluate hormone replacement therapy, calcium/vitamin D, and dietary modification of fat/fiber. Community trials will implement known interventions for relevant risk factors. Presented here are USPHS response to the mandate to address women's health issues; data from the US National Center for Health Statistics about the incidence and prevalence of diseases and risk factors in women; details about the WHI clinical trial; and aspects of the WHI applicable to the field of nutrition.
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Developments in medical care over the past five to six decades have provided remarkable life-sustaining technologies (LST) that have contributed to prolongation of the life span of patients, as well as to a general increase in health and well-being. End-stage renal disease (ESRD) treatment is a prototype of these LST treatments and of the issues surrounding provision of chronic/catastrophic care. This remarkable progress has been accompanied by ethical dilemmas that include allocation of scarce resources, and initiation and termination of care with LST. Consideration of these ethical dilemmas are especially poignant for the elderly, because they raise "hard choices" and there are no easy answers to these ethical dilemmas.
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To provide an approximate estimate of the need for academic faculty in renal research, 1200 questionnaires were mailed to most departments in all medical schools in the United States. There were 627 completed questionnaires returned from 99 divisions of nephrology, 79 divisions or departments of urology, and 67 divisions of pediatric nephrology or departments of pediatrics in 120 medical schools. Analysis of the responses revealed that in these three departments there are 1057 faculty members engaged in teaching and research related to the kidney and urinary tract, and 131 current vacancies. The responses suggest that from 1979 to 1984 another 483 faculty members will be required to fill projected vacancies in the foregoing three clinical departments, making the total needed 614.
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