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INAUGURAL NUHS SCIENTIFIC & INNOVATION SUMMIT CHAMPIONS PREDICTIVE, PRECISE AND PERSONALISED CARE

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Innovation Summit

From digital twin technology to leveraging AI in tackling obesity, the NUHS Scientific & Innovation Summit is a congregation of the brightest minds in cutting-edge medicine – with patients’ utmost care at heart

SINGAPORE, Aug. 3, 2024 /PRNewswire/ — Hepatocellular carcinoma (HCC) is one of the most lethal cancers, but Mr Ang Chin Chay, 70, was in the dark about his dire condition, until he experienced a bout of fever following a vacation to Vietnam. He quickly sought medical attention for what turned out to be a Hepatitis A infection, transmitted through contaminated food he had consumed overseas.

NUHS Scientific Innovation Summit 2024
Themed “Tomorrow’s Health Today – Predictive, Precise and Personalised”, the NUHS Scientific and Innovation Summit 2024 showcases innovations that aim to improve health outcomes for patients and the population at large. The opening was officiated by Guest of Honour Prof Tan Chorh Chuan, Permanent Secretary for National Research and Development, and Public Sector Science and Technology Policy and Plans Office, Prime Minister’s Office (middle; seventh from left).

It was a fortuitous encounter, as routine tests revealed abnormal liver function results. Mr Ang subsequently underwent scans, which uncovered HCC, a largely asymptomatic cancer in its early stages. This was unexpected as Mr Ang was known to have fatty liver, but not cirrhosis, the most advanced form of liver scarring.

“Patients with fatty liver – but without cirrhosis – are not routinely recommended to undergo liver cancer screening,” Dr Huang explained. “But in reality, we have discovered that nearly 40 percent of HCC cases related to fatty liver occur in the absence of cirrhosis.”

Mr Ang’s prognosis would have been poor if his condition had not been detected early, as patients who are diagnosed at a late stage have an overall five-year survival rate of less than 20 percent.

Improving the screening process for patients like Mr Ang through non-invasive tests and advanced imaging is the crux of Dr Huang’s work that he will be presenting at the NUHS Scientific & Innovation Summit, on 3 August 2024.

“We aim to risk stratify people with fatty liver into those who have a high risk of liver cancer and those who do not, and to pre-emptively develop better ways to identify these people early so that they can receive some form of curative treatment,” Dr. Huang explained.

Personalising care with the digital twin

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Another project pushing the frontiers of medicine with digital innovations, is the Digital Twin programme led by Dr Gao Yujia, Assistant Group Chief Technology Officer, National University Health System.

The digital twin, which is based on imaging and other data from a patient’s own tests, is a virtual 3D anatomical replica of a patient’s organs, like the liver. The digital twin will allow clinicians to transform what is usually a static scan image (such as an MRI scan), into a dynamic model that precisely recreates the shape and structural behaviour of the organ it replicates, enabling enhanced pre-surgery planning and more accurate intra-operative navigation.

Together with Holomedicine, which is a mixed reality (MR) based technology, this represents a significant leap forward in the surgeons’ ability to predict how organs will behave during a surgery, and predict how internal structures will move and change as the surgery is being performed. 

“Holomedicine leverages mixed reality to interact with virtual objects superimposed onto the real world, allowing for unparalleled accuracy in pre-surgical planning,” explained Dr Gao, who will be presenting his work in mixed reality technology at the NUHS Scientific & Innovation Summit.

With this near-pinpoint precision, surgeons can minimise the risk of injuring other structures, thereby reducing potential complications and operating time, ultimately improving the patient’s overall recovery outcomes.

Innovation Summit: Tackling diseases with precision

Dr Anand Jeyasekharan, a senior consultant at the Department of Haematology-Oncology in the National University Cancer Institute, Singapore (NCIS), likens the human body’s reaction to cancer cells, to an intense battle between two warring armies.

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It was a battle that became personal in 2023 for Mr Soegianto Nagaria, Dr Jeyasekharan’s patient. He had a large tumour in his liver excised by surgeons in Taiwan. Initially thought to be liver cancer, the reports indicated it to be a Stage 4 diffuse large B-cell lymphoma instead. The situation worsened when the doctors discovered the presence of a second lymphoma in his bone marrow.

Diagnosing and treating two concurrent cancers presented significant challenges, requiring precise and coordinated medical intervention. It was important to know if the two cancers were related, as the treatment would be very different if they were.

Upon recommendations by his cousins, who are doctors, Mr Nagaria decided to continue the rest of his treatment at NCIS, under Dr Jeyasekharan’s care.

Mr Nagaria flew to Singapore in September 2023, and underwent a molecular profiling under an NUHS programme for precision oncology (IMAC – integrated molecular analysis of cancer) to get his tumour sequenced. Following the sequencing, the NCIS team discovered that the two lymphomas were not related and drew up the vital treatment plans, providing life-saving ammunition in the cancer battle.

Mr Nagaria completed multiple rounds of chemotherapy over six months, and is now on close monitoring while in remission.

Besides sequencing, which Mr Nagaria underwent, Dr Jeyasekharan is developing a new tool in his arsenal of weapons against deadly cancers – spatial phenotyping, where advanced imaging equipment is used to analyse cancer with high molecular detail.

Spatial phenotyping represents the next frontier of cancer research, and is especially useful for solid tumours. “We are trying to draw [battle] maps of cancer at a high resolution and in great detail, in order to understand how to fight it,” Dr Jeyasekharan explained. “Spatial phentoyping’s ability to dive deep into molecular detail allows us to be more precise in diagnostics, treatment and care.”

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With cancer being a leading cause of death globally, spatial phenotyping can mean a world of difference for patients afflicted with cancer. “We are never happy with just delivering standard treatment, because standard treatment simply isn’t good enough,” Dr Jeyasekharan said. “Some people get cured, some people don’t – we are trying to understand what we can do to improve the chances of curing more people.”

For A/Prof Su Xinyi, who is a senior consultant with the Department of Ophthalmology at NUH, precision medicine may be the key to restoring the vision of patients suffering from currently untreatable and blinding retinal diseases. “Every patient with retinal disease has a unique gene mutation, so the treatment that we provide is tailored specifically to the mutations that they have,” A/Prof Su explained.

Besides gene therapy, A/Prof Su also explores innovations in cell therapy, which are last options for patients with end-stage age-related macular degeneration (AMD) – the third leading cause of blindness globally. In AMD, retinal pigment epithelium (RPE) cells in the retina degenerate with age. By growing these cells in a petri dish, and then injecting them into the eye, they can replace lost cells and help patients regain vision.

While this method of treatment is not new, what makes it unique is the source of cells A/Prof Su uses in its development – cells derived from the umbilical cord. By doing so, this greatly reduces the chance of rejection or the need to use immunosuppressants.

Predicting risk factors, a step ahead

Predictive care affords patients and clinicians the precious gift of time, in preventing the onset, or minimising the severity, of diseases. For Dr Jocelyn Chew, who is an assistant professor at the NUS Alice Lee Centre for Nursing Studies and Yong Loo Lin School of Medicine (NUS Medicine), adopting a predictive approach to tackling a person’s dietary triggers can curb overeating and obesity.

Dr Chew has been working on an app called the Eating Trigger-Response Inhibition Program (eTRIP), which is designed to help patients identify moments where they are prone to overeating. These include emotional eating, or even ingrained habits such as over-ordering during family gatherings.

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eTRIP will be used in tandem with Adipoview, an AI-based dashboard that Dr Chew has created with the team from the NUHS Group Chief Technology Office. Adipoview will gather patient data throughout NUHS to generate insights, such as the diagnosis rate of obesity and treatment rate, to proactively predict who may need further support.

At the Innovation Summit

More than 60 clinician-scientists will be presenting their work at the NUHS Scientific & Innovation Summit, which will be graced by guest-of-honour Professor Tan Chorh Chuan, Permanent Secretary for National Research and Development as well as for Public Sector Science and Technology Policy and Plans Office, Prime Minister’s Office.

Themed “Tomorrow’s Health Today – Predictive, Precise and Personalised”, the summit will bring together over 500 international and local healthcare experts, opinion leaders and scientists to shape the future of healthcare.

Over the past decade, the NUHS academic health system has secured more than $1 billion in competitive grants (cumulative from FY2011 to FY2021). These funds have fuelled scientific innovations in predictive, precise and personalised care, ensuring improved health outcomes for patients now and in the future.

About National University Health System

The National University Health System (NUHS) is an integrated Academic Health System and Regional Health System in Singapore that delivers value-driven, innovative, and sustainable healthcare.

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As Singapore’s only academic health system, we are uniquely positioned to draw on the academic, research and creative capabilities residing within the National University of Singapore (NUS). This collaboration allows us to develop solutions for existing and emerging health and healthcare needs of the Singapore population.

We also work in close collaboration with community hospitals, general practitioners, family medicine clinics, nursing homes and other community and social partners to provide integrated care to the wider community.

With member institutions ranging from community hospitals to academic centres, NUHS creates synergies as a fully integrated cluster to provide seamless care, develop solutions for Singapore’s healthcare challenges and nurture the next generation of healthcare professionals.

National University Health System (NUHS) 

https://prnmedia.prnewswire.com/news-releases/inaugural-nuhs-scientific–innovation-summit-champions-predictive-precise-and-personalised-care-302213837.html

SOURCE National University Health System (NUHS)

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Food and Beverage

Seed oils are toxic, says Robert F. Kennedy Jr. – but it’s not so simple

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Seed oils have become a mainstay of the American diet. d3sign/Moment via Getty Images

Mary J. Scourboutakos, University of Toronto

Robert F. Kennedy Jr., who is expected to clear the final hurdles in his confirmation as President Donald Trump’s health secretary, and a host of health influencers have proclaimed that widely used cooking oils such as canola oil and soybean oil are toxic.

T-shirts sold by his “Make America Healthy Again” campaign now include the slogan, “make frying oil tallow again” – a reference to the traditional use of rendered beef fat for cooking.

Seed oils have become a mainstay of the American diet because unlike beef tallow, which is comprised of saturated fats that increase cholesterol levels, seed oils contain unsaturated fats that can decrease cholesterol levels. In theory, that means they should reduce the risk of heart disease.

But research shows that different seed oils have varying effects on risk for heart disease. Furthermore, seed oils have also been shown to increase risk for migraines. This is likely due to their high levels of omega-6 fatty acids. These fats can increase inflammation, a heightened and potentially harmful state of immune system activation.

As a family physician with a Ph.D. in nutrition, I translate the latest nutrition science into dietary recommendations for my patients. When it comes to seed oils, the research shows that their health effects are more nuanced than headlines and social media posts suggest.

How seed oils infiltrated the American diet

Seed oils — often confusingly referred to as “vegetable oils” — are, as the name implies, oils extracted from the seeds of plants. This is unlike olive oil and coconut oil, which are derived from fruits. People decrying their widespread use often refer to the “hateful eight” top seed oil offenders: canola, corn, soybean, cottonseed, grapeseed, sunflower, safflower and rice bran oil.

These oils entered the human diet at unprecedented levels after the invention of the mechanical screw press in 1888 enabled the extraction of oil from seeds in quantities that were never before possible.

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Between 1909 and 1999, U.S. consumption of soybean oil increased 1,000 times. This shift fundamentally changed our biological makeup. Due to increased seed oil intake, in the past 50 years the concentration of omega-6 fatty acids that Americans carry around in their fatty tissue has increased by 136%

https://datawrapper.dwcdn.net/rFwW9/1

Evaluating the omega-6 to omega-3 fatty acid ratio

Omega-6 and omega-3 fatty acids are essential nutrients that control inflammation. While omega-6s tend to produce molecules that boost it, omega-3s tend to produce molecules that tone it down. Until recently, people generally ate equal amounts of omega-6 and omega-3 fatty acids. However, over the past century, this ratio has changed. Today, people consume 15 times more omega-6s than omega-3s, partly due to increased consumption of seed oils.

In theory, seed oils can cause health problems because they contain a high absolute amount of omega-6 fatty acids, as well as a high omega-6 to omega-3 ratio. Studies have linked an increased omega-6 to omega-3 ratio to a wide range of conditions, including mood disorders, knee pain, back pain, menstrual pain and even preterm birth. Omega-6 fatty acids have also been implicated in the processes that drive colon cancer.

However, the absolute omega-6 level and the omega-6 to omega-3 ratio in different seed oils vary tremendously. For example, safflower oil and sunflower oil have ratios of 125:1 and 91:1. Corn oil’s ratio is 50:1. Meanwhile, soybean oil and canola oil have lower ratios, at 8:1 and 2:1, respectively.

Scientists have used genetic modification to create seed oils like high oleic acid canola oil that have a lower omega-6 to 3 ratio. However, the health benefit of these bioengineered oils is still being studied.

The upshot on inflammation and health risks

Part of the controversy surrounding seed oils is that studies investigating their inflammatory effect have yielded mixed results. One meta-analysis synthesizing the effects of seed oils on 11 inflammatory markers largely showed no effects – with the exception of one inflammatory signal, which was significantly elevated in people with the highest omega-6 intakes.

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To complicate things further, genetics also plays a role in seed oils’ inflammatory potential. People of African, Indigenous and Latino descent tend to metabolize omega-6 fatty acids faster, which can increase the inflammatory effect of consuming seed oils. Scientists still don’t fully understand how genetics and other factors may influence the health effects of these oils.

A small bottle of soybean oil beside a bowl of soybeans, on a wooden table
Soybean oil is the most highly purchased oil in the United States. fcafotodigital via Getty Images

The effect of different seed oils on cardiovascular risk

A review of seven randomized controlled trials showed that the effect of seed oils on risk of heart attacks varies depending on the type of seed oil.

This was corroborated by data resurrected from tapes dug up in the basement of a researcher who in the 1970s conducted the largest and most rigorously executed dietary trial to date investigating the replacement of saturated fat with seed oils. In that work, replacing saturated fats such as beef tallow with seed oils always lowers cholesterol, but it does not always lower risk of death from heart disease.

Taken together, these studies show that when saturated fats such as beef tallow are replaced with seed oils that have lower omega-6 to omega-3 ratios, such as soybean oil, the risk of heart attacks and death from heart disease falls. However, when saturated fats are replaced with seed oils with a higher omega-6 to omega-3 ratio, such as corn oil, risk of death from heart disease rises.

Interestingly, the most highly purchased seed oil in the United States is soybean oil, which has a more favorable omega-6 to 3 ratio of 8:1 – and studies show that it does lower the risk of heart disease.

However, seed oils with less favorable ratios, such as corn oil and safflower oil, can be found in countless processed foods, including potato chips, frozen dinners and packaged desserts. Nevertheless, other aspects of these foods, in addition to their seed oil content, also make them unhealthy.

The case for migraines – and beyond

A rigorous randomized controlled trial – the gold standard for clinical evidence – showed that diets high in omega-3 fatty acids and low in omega-6 fatty acids, hence low in seed oils, significantly reduced the risk of migraines

In the study, people who stepped up their consumption of omega-3 fatty acids by eating fatty fish such as salmon experienced an average of two fewer migraines per month than usual, even if they did not change their omega-6 consumption. However, if they reduced their omega-6 intake by switching out corn oil for olive oil, while simultaneously increasing their omega-3 intake, they experienced four fewer migraines per month.

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That’s a noteworthy difference, considering that the latest migraine medications reduce migraine frequency by approximately two days per month, compared to a placebo. Thus, for migraine sufferers — 1 in 6 Americans — decreasing seed oils, along with increasing omega-3 intake, may be even more effective than currently available medications.

Overall, the drastic way in which omega-6 fatty acids have entered the food supply and fundamentally changed our biological composition makes this an important area of study. But the question of whether seed oils are good or bad is not black and white. There is no basis to conclude that Americans would be healthier if we started frying everything in beef tallow again, but there is an argument for a more careful consideration of the nuance surrounding these oils and their potential effects.

Mary J. Scourboutakos, Adjunct Lecturer in Family and Community Medicine, University of Toronto

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


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Lifestyle

Is it COVID-19? Flu? At-home rapid tests could help you and your doctor decide on a treatment plan

At-home rapid tests for COVID-19 and influenza are becoming available, allowing simultaneous diagnosis, which aids timely and effective treatment and improves patient outcomes.

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Over-the-counter multiplex tests for more than one illness may soon come to a pharmacy near you. Paco Burgada/iStock via Getty Images

Julie Sullivan, Emory University and Wilbur Lam, Georgia Institute of Technology

A scratchy, sore throat, a relentless fever, a pounding head and a nasty cough – these symptoms all scream upper respiratory illness. But which one?

Many of the viruses that cause upper respiratory infections such as influenza A or B and the virus that causes COVID-19 all employ similar tactics. They target the same areas in your body – primarily the upper and lower airways – and this shared battleground triggers a similar response from your immune system. Overlapping symptoms – fever, cough, fatigue, aches and pains – make it difficult to determine what may be the underlying cause.

Now, at-home rapid tests can simultaneously determine whether someone has COVID-19 or the flu. Thanks in part to the National Institutes of Health’s Rapid Acceleration of Diagnostics, or RADx, program, the Food and Drug Administration has provided emergency use authorization for seven at-home rapid tests that can distinguish between COVID-19, influenza A and influenza B.

Our team in Atlanta – composed of biomedical engineers, clinicians and researchers at Emory University, Children’s Healthcare of Atlanta and Georgia Institute of Technology – is part of the RADx Test Verification Core. We closely collaborate with other institutions and agencies to determine whether and how well COVID-19 and influenza diagnostics work, effectively testing the tests. Our center has worked with almost every COVID and flu diagnostic on the market, and our data helped inform the instructions you might see in many of the home test kits on the market.

While no test is perfect, to now be able to test for certain viruses at home when symptoms begin can help patients and their doctors come up with appropriate care plans sooner.

A new era of at-home tests

Traditionally, identifying the virus causing upper respiratory illness symptoms required going to a clinic or hospital for a trained medical professional to collect a nasopharyngeal sample. This involves inserting a long, fiber-tipped swab that looks like a skinny Q-tip into one of your nostrils and all the way to the back of your nose and throat to collect virus-containing secretions. The sample is then typically sent to a lab for analysis, which could take hours to days for results.

Person inserting cotton swab into test tube for a rapid test
The COVID-19 pandemic made over-the-counter tests for respiratory illnesses commonplace. DuKai/Moment via Getty Images

Thanks to the COVID-19 pandemic, the possibility of using over-the-counter tests to diagnose respiratory illnesses at home became a reality. These tests used a much gentler and less invasive nasal swab and could also be done by anyone, anytime and in their own home. However, these tests were designed to diagnose only COVID-19 and could not distinguish between other types of illnesses.

Since then, researchers have developed over-the-counter multiplex tests that can screen for more than one respiratory infection at once. In 2023, Pfizer’s Lucira test became the first at-home diagnostic test for both COVID-19 and influenza to gain emergency use authorization.

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What are multiplex rapid tests?

There are two primary forms of at-home COVID-19 and COVID-19/flu combination tests: molecular tests such as PCR that detect genetic material from the virus, and antigen tests – commonly referred to as rapid tests – that detect proteins called antigens from the virus.

The majority of over-the-counter COVID-19 and COVID-19/flu tests on the market are antigen tests. They detect the presence of antigens in your nasal secretions that act as a biological signature for a specific virus. If viral antigens are present, that means you’re likely infected. https://www.youtube.com/embed/s45GMoZaHFE?wmode=transparent&start=0 Respiratory illnesses such as flu, COVID-19 and RSV can be hard to tell apart.

To detect these antigens, rapid tests have paper-like strips coated with specially engineered antibodies that function like a molecular Velcro, sticking only to a specific antigen. Scientists design and manufacture specialized strips to recognize specific viral antigens, like those belonging to influenza A, influenza B or the virus that causes COVID-19.

The antibodies for these viral targets are placed on the strip, and when someone’s nasal sample has viral proteins that are applied to the test strip, a line will appear for that virus in particular.

Advancing rapid antigen tests

Like all technologies, rapid antigen tests have limitations.

Compared with lab-based PCR tests that can detect the presence of small amounts of pathogen by amplifying them, antigen tests are typically less sensitive than PCR and could miss an infection in some cases.

All at-home COVID-19 and COVID-19/flu antigen tests are authorized for repeat use. This means if someone is experiencing symptoms – or has been exposed to someone with COVID-19 but is not experiencing symptoms – and has a negative result for their first test, they should retest 48 hours later.

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Another limitation to rapid antigen tests is that currently they are designed to test only for COVID-19, influenza A and influenza B. Currently available over-the-counter tests aren’t able to detect illnesses from pathogens that look like these viruses and cause similar symptoms, such as adenovirus or strep.

Because multiplex texts can detect several different viruses, they can also produce findings that are more complex to interpret than tests for single viruses. This may increase the risk of a patient incorrectly interpreting their results, misreading one infection for another.

Researchers are actively developing even more sophisticated tests that are more sensitive and can simultaneously screen for a wider range of viruses or even bacterial infections. Scientists are also examining the potential of using saliva samples in tests for bacterial or viral infections.

Additionally, scientists are exploring integrating multiplex tests with smartphones for rapid at-home diagnosis and reporting to health care providers. This may increase the accessibility of these tests for people with vision impairment, low dexterity or other challenges with conducting and interpreting at-home tests.

Faster and more accurate diagnoses lead to more targeted and effective treatment plans, potentially reducing unnecessary antibiotic use and improving patient outcomes. The ability to rapidly identify and track outbreaks can also empower public health officials to better mitigate the spread of infectious diseases.

Julie Sullivan, Chief Operating Officer of RADx Tech, Emory University and Wilbur Lam, Chief Innovation Officer, Children’s Healthcare of Atlanta Pediatric Technology Center; Professor of Biomedical Engineering, Georgia Institute of Technology

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

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The Bridge

What the ‘moral distress’ of doctors tells us about eroding trust in health care

The article discusses the ethical dilemmas faced by healthcare providers when families demand life-sustaining treatments for patients unlikely to benefit, highlighting moral distress and trust issues.

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Daniel T. Kim, Albany Medical College

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.

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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. https://www.youtube.com/embed/MY4e4l-eAFk?wmode=transparent&start=0 Moral distress in health care.

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.

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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, Assistant Professor of Bioethics, Albany Medical College

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

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