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Unlike many other areas in health care, the practice of oncology presents unique challenges that make assessing and improving value especially complex. First, patients and professionals feel a well-justified sense of urgency to treat for cure, and if cure is not possible, to extend life and reduce the burden of disease. Second, treatments are often both life sparing and highly toxic. Third, distinctive payment structures for cancer medicines are intertwined with practice. Fourth, providers often face tremendous pressure to apply the newest technologies to patients who fail to respond to established treatments, even when the evidence supporting those technologies is incomplete or uncertain, and providers may be reluctant to stop toxic treatments and move to palliation, even at the end of life. Finally, the newest and most novel treatments in oncology are among the most costly in medicine. This volume summarizes the results of a workshop that addressed these issues from multiple perspectives, including those of patients and patient advocates, providers, insurers, health care researchers, federal agencies, and industry. Its broad goal was to describe value in oncology in a complete and nuanced way, to better inform decisions regarding developing, evaluating, prescribing, and paying for cancer therapeutics.
This book is open access under a CC-BY licence. Cancer is perhaps the modern world's most feared disease. Yet, we know relatively little about this malady's history before the nineteenth century. This book provides the first in-depth examination of perceptions of cancerous disease in early modern England. Looking to drama, poetry and polemic as well as medical texts and personal accounts, it contends that early modern people possessed an understanding of cancer which remains recognizable to us today. Many of the ways in which medical practitioners and lay people imagined cancer – as a 'woman's disease' or a 'beast' inside the body – remain strikingly familiar, and they helped to make this disease a byword for treachery and cruelty in discussions of religion, culture and politics. Equally, cancer treatments were among the era's most radical medical and surgical procedures. From buttered frog ointments to agonizing and dangerous surgeries, they raised abiding questions about the nature of disease and the proper role of the medical practitioner.
Navigating the tumultuous waters of cancer treatment and decision making is difficult for all patients. It is also difficult for doctors and other medical personnel. This books deals with a variety of emotion-related and ethics issues that form much of the basis of the world of cancer related medicine: the responsibilities of the physician relative to truth, full disclosure, patient autonomy, death and dying, physician assisted suicide, and suicide in general among cancer patients. These and many other matters are discussed using real stories from the author’s extensive personal career in working with cancer patients and their families. This is not a book on treating cancer, but instead is a work that seeks to stimulate a dialog about these issues as well as the spiritual aspects of hope and other factors relating to the plight of cancer patients and their families. Written for health care professionals and cancer victims and their families alike, the core of the book centers around questions of medical ethics, doctor-patient relationships, decision making during cancer treatment (from medical and patient points of view). Given the emotional commitment and energy level required to work with cancer patients in a moral and ethical manner, medical students and residents will ask themselves: do I really want to be a cancer physician? Can I handle the ups and downs of treating people who may (or may not) be destined to fight and lose the battle against this strong nemesis? How will I answer the tough questions regarding medical approaches to cancer? How will I respond to patients who indicate a desire to commit suicide or request my help in doing so? What can I tell families whose loved one is choosing treatments that will not help and will deteriorate his quality of life? Basing his responses on the Oath of Hippocrates, the author illustrates how adaptable this oath actually is when considering the secular society in which we function. The Cancer Experience instructs doctors, medical students, and health care workers involved in cancer care on the proper role of medicine, the role of the doctor, and the opportunities for connecting with patients as they help them make decisions regarding treatment and end of life issues. It helps patients understand the issues facing doctors as they assist them, care for them, and try to maintain both close personal relationships but enough emotional and professional distance in order to protect themselves from the stress and strain when medicine fails and patients must face the hardest choices. Here the author promotes a return to traditional medical values that promote closer doctor-patient relationships in an effort to promote trust, civility, and partnership.
Cancer care today often provides state-of-the-science biomedical treatment, but fails to address the psychological and social (psychosocial) problems associated with the illness. This failure can compromise the effectiveness of health care and thereby adversely affect the health of cancer patients. Psychological and social problems created or exacerbated by cancer-including depression and other emotional problems; lack of information or skills needed to manage the illness; lack of transportation or other resources; and disruptions in work, school, and family life-cause additional suffering, weaken adherence to prescribed treatments, and threaten patients' return to health. Today, it is not possible to deliver high-quality cancer care without using existing approaches, tools, and resources to address patients' psychosocial health needs. All patients with cancer and their families should expect and receive cancer care that ensures the provision of appropriate psychosocial health services. Cancer Care for the Whole Patient recommends actions that oncology providers, health policy makers, educators, health insurers, health planners, researchers and research sponsors, and consumer advocates should undertake to ensure that this standard is met.
Some people suffer from chronic, debilitating disorders for which no conventional treatment brings relief. Can marijuana ease their symptoms? Would it be breaking the law to turn to marijuana as a medication? There are few sources of objective, scientifically sound advice for people in this situation. Most books about marijuana and medicine attempt to promote the views of advocates or opponents. To fill the gap between these extremes, authors Alison Mack and Janet Joy have extracted critical findings from a recent Institute of Medicine study on this important issue, interpreting them for a general audience. Marijuana As Medicine? provides patientsâ€"as well as the people who care for themâ€"with a foundation for making decisions about their own health care. This empowering volume examines several key points, including: Whether marijuana can relieve a variety of symptoms, including pain, muscle spasticity, nausea, and appetite loss. The dangers of smoking marijuana, as well as the effects of its active chemical components on the immune system and on psychological health. The potential use of marijuana-based medications on symptoms of AIDS, cancer, multiple sclerosis, and several other specific disorders, in comparison with existing treatments. Marijuana As Medicine? introduces readers to the active compounds in marijuana. These include the principal ingredient in Marinol, a legal medication. The authors also discuss the prospects for developing other drugs derived from marijuana's active ingredients. In addition to providing an up-to-date review of the science behind the medical marijuana debate, Mack and Joy also answer common questions about the legal status of marijuana, explaining the conflict between state and federal law regarding its medical use. Intended primarily as an aid to patients and caregivers, this book objectively presents critical information so that it can be used to make responsible health care decisions. Marijuana As Medicine? will also be a valuable resource for policymakers, health care providers, patient counselors, medical faculty and studentsâ€"in short, anyone who wants to learn more about this important issue.
#1 NEW YORK TIMES BESTSELLER • “The story of modern medicine and bioethics—and, indeed, race relations—is refracted beautifully, and movingly.”—Entertainment Weekly NOW A MAJOR MOTION PICTURE FROM HBO® STARRING OPRAH WINFREY AND ROSE BYRNE • ONE OF THE “MOST INFLUENTIAL” (CNN), “DEFINING” (LITHUB), AND “BEST” (THE PHILADELPHIA INQUIRER) BOOKS OF THE DECADE • ONE OF ESSENCE’S 50 MOST IMPACTFUL BLACK BOOKS OF THE PAST 50 YEARS • WINNER OF THE CHICAGO TRIBUNE HEARTLAND PRIZE FOR NONFICTION NAMED ONE OF THE BEST BOOKS OF THE YEAR BY The New York Times Book Review • Entertainment Weekly • O: The Oprah Magazine • NPR • Financial Times • New York • Independent (U.K.) • Times (U.K.) • Publishers Weekly • Library Journal • Kirkus Reviews • Booklist • Globe and Mail Her name was Henrietta Lacks, but scientists know her as HeLa. She was a poor Southern tobacco farmer who worked the same land as her slave ancestors, yet her cells—taken without her knowledge—became one of the most important tools in medicine: The first “immortal” human cells grown in culture, which are still alive today, though she has been dead for more than sixty years. HeLa cells were vital for developing the polio vaccine; uncovered secrets of cancer, viruses, and the atom bomb’s effects; helped lead to important advances like in vitro fertilization, cloning, and gene mapping; and have been bought and sold by the billions. Yet Henrietta Lacks remains virtually unknown, buried in an unmarked grave. Henrietta’s family did not learn of her “immortality” until more than twenty years after her death, when scientists investigating HeLa began using her husband and children in research without informed consent. And though the cells had launched a multimillion-dollar industry that sells human biological materials, her family never saw any of the profits. As Rebecca Skloot so brilliantly shows, the story of the Lacks family—past and present—is inextricably connected to the dark history of experimentation on African Americans, the birth of bioethics, and the legal battles over whether we control the stuff we are made of. Over the decade it took to uncover this story, Rebecca became enmeshed in the lives of the Lacks family—especially Henrietta’s daughter Deborah. Deborah was consumed with questions: Had scientists cloned her mother? Had they killed her to harvest her cells? And if her mother was so important to medicine, why couldn’t her children afford health insurance? Intimate in feeling, astonishing in scope, and impossible to put down, The Immortal Life of Henrietta Lacks captures the beauty and drama of scientific discovery, as well as its human consequences.
Countless medical researchers over the past century have been occupied by the search for a cure of cancer. So far, they have developed and implemented a wide range of treatment techniques, including surgery, chemo- and radiotherapy, antiangiogenic drugs, small molecule inhibitors, and oncolytic viruses. However, patterns of these treatments' effectiveness remain largely unclear, and a better understanding of how cancer therapies work has become a key research goal. Cancer Treatment in Silico provides the first in-depth study of approaching this understanding by modeling cancer treatments, both mathematically and through computer simulations. The main goal of this book is to help expose students and researchers to in silico methods of studying cancer. It is intended for both the applied mathematics and experimental oncology communities, as mathematical models are playing an increasingly important role to supplement laboratory biology in the fight against cancer. Written at a level that generally requires little technical background, the work will be a valuable resource for scientists and students alike.
Budgets of governments and private insurances are limited. Not all drugs and services that appear beneficial to patients or physicians can be covered. Is there a core set of benefits that everyone should be entitled to? If so, how should this set be determined? Are fair decisions just impossible, if we know from the outset than not all needs can be met? While early work in bioethics has focused on clinical issues and a narrow set of principles, in recent years there has been a marked shift towards addressing broader population-level issues, requiring consideration of more demanding theories in philosophy, political science, and economics. At the heart of bioethics' new orientation is the goal of clarity on a complex set of questions in rationing and resource allocation. Rationing and Resource Allocation in Healthcare: Essential Readings provides key excerpts from seminal and pertinent texts and case studies about these topics, contextualized by original introductions. The volume is divided into three broad sections: Conceptual Distinctions and Ethical Theory; Rationing; and Resource Allocation. Containing the most important and classic articles surrounding the theoretical and practical issues related to rationing and how to allocate scare medical resources, this collection aims to assist and inform those who wish to be a part of bioethics' 21st century shift including practitioners and policy-makers, and students and scholars in the health sciences, philosophy, law, and medical ethics.
What should happen when doctors and parents disagree about what would be best for a child? When should courts become involved? Should life support be stopped against parents' wishes? The case of Charlie Gard, reached global attention in 2017. It led to widespread debate about the ethics of disagreements between doctors and parents, about the place of the law in such disputes, and about the variation in approach between different parts of the world. In this book, medical ethicists Dominic Wilkinson and Julian Savulescu critically examine the ethical questions at the heart of disputes about medical treatment for children. They use the Gard case as a springboard to a wider discussion about the rights of parents, the harms of treatment, and the vital issue of limited resources. They discuss other prominent UK and international cases of disagreement and conflict. From opposite sides of the debate Wilkinson and Savulescu provocatively outline the strongest arguments in favour of and against treatment. They analyse some of the distinctive and challenging features of treatment disputes in the 21st century and argue that disagreement about controversial ethical questions is both inevitable and desirable. They outline a series of lessons from the Gard case and propose a radical new 'dissensus' framework for future cases of disagreement. - This new book critically examines the core ethical questions at the heart of disputes about medical treatment for children. - The contents review prominent cases of disagreement from the UK and internationally and analyse some of the distinctive and challenging features around treatment disputes in the 21st century. - The book proposes a radical new framework for future cases of disagreement around the care of gravely ill people.
Alternatives in Cancer Therapy offers help for all patients coping with cancer. The therapies discussed in this book are primarily non-toxic, have few, if any, side effects, and tend to strengthen the immune system. They can be used as supplemental regimens that help maximize the effectiveness of traditional therapies such as surgery, radiation, and chemotherapy. Patients have a right to know all of their treatment options, and Dr. Ross Pelton presents dozens of choices, including: * Shark Cartilage * Gerson Therapy * Mistletoe * Isoprinosine * Laetrile * Selenium * Beta-Carotene * Hydrogen Peroxide * Vitamins C and E * The Hoxsey Treatment Non-traditional therapies can enhance the quality of life, and improve overall health while treating the disease. Alternatives in Cancer Therapy provides information on the research, efficacy, potential side effects, and availability of each treatment.