Saturday, February 26, 2011

Changing Who Gets a Kidney

The nonprofit that oversees how human kidneys are distributed to people in need of a transplant is trying to change the distribution rules. Their goal is to maximize the number of years of life that a donated kidney can provide by changing how recipients are chosen.

The United Network for Organ Sharing (UNOS), which oversees organ donations from cadavers (not living donors), currently distributes kidneys based on who has been on the waiting list the longest. This process favors older patients over younger ones. A new UNOS plan that is currently open for public comment would prioritize kidney recipients based on two factors: the recipient's potential lifespan post-transplant (used when distributing the healthiest available kidneys), and whether the recipient's age is within 15 years of the donor.

These changes would most likely benefit patients who are younger than 50 years old more than the current system does. Recipients ages 50 and older would probably be less likely to receive a kidney under the proposed plan than under the current plan. Details about the plan are available online in the UNOS report "Concepts for Kidney Allocation."

In response to accusations of age discrimination, the report points out that since 1990, the percentage of potential recipients between ages 18 and 49 who have received a transplant has decreased, while the percentage of potential recipients ages 50 and older who received a transplant increased. The new plan was proposed to make the distribution system more fair.

Over 80,000 Americans are on the waiting list for a kidney, according to the National Kidney Foundation, and there are not enough kidneys available for everyone in need. The question is how to manage the valuable resource of a donated kidney.

A Washington Post article by Rob Stein about the proposed changes raises the larger question of how to ration limited health care resources. University of Pennsylvania bioethicist Arthur C. Caplan told Stein that the UNOS proposal "could have implications for other decisions about how to allocate scarce medical resources, such as expensive cancer drugs and ventilators during hurricanes and other emergencies."

Caplan explained, "We don't want to talk about rationing much in America. It's become taboo in any health-care discussion. But kidneys reminds us there are situations where you have to talk about rationing. You have no choice."

The UNOS report is grappling with a very complex topic, and it is the product of almost six years of work. I'm impressed by its attempt to analyze and improve an established system for kidney distribution. Academically, the topic is fascinating: what criteria do you use to make decisions about medical ethics?

But I have also interviewed kidney recipients, and those still on the waiting list, for stories I have written. I can't forget that there are so many individuals whose chances for a healthy or extended life are directly affected by UNOS policies; whatever UNOS decides, there will be winners and losers.

Sunday, February 20, 2011

Lessons From Bacteria

The American Academy of Microbiology just released a Microbes & Oil Spills FAQ that explains how microbes can help clean up oil spills such as the 2010 spill in the Gulf of Mexico. The microbes that can consume and break down different types of oil are mostly bacteria and fungi.

The FAQ proved once again the amazing versatility of bacteria, a topic I've blogged about before. Bacteria native to the area of the spill, who draw their energy from consuming and breaking down oil, reproduce to increase their numbers when more oil is present in the water, and slow reproduction when less oil is present.

The FAQ pointed out that the oil leaked in a spill can outpace the microbes' ability to respond to it, and microbes can't always break down oil components easily or quickly. But the microbes' ability to remove some oil from the water and to expand and contract their numbers in response to what's in the water is impressive.

Although bacteria can spontaneously help mitigate the environmental impact of an oil spill, however, we can't control how they will respond to an environment that we create. Our overuse of antibiotics, for example, has contributed to the rise of antibiotic-resistant bacterial superbugs.

A CBC study of bacteria in raw chicken, reported on the Association of Health Care Journalists' Covering Health blog, found antibiotic-resistant bacteria in all the samples tested. Why? Because the chicken farmers gave large amounts of unnecessary antibiotics to healthy chickens so that they would grow larger.

Bacteria have survived because they are adaptable; I hope that one day we can plan better for both the advantages and the disadvantages of this ability.

Monday, February 14, 2011

Gourmets, Guilt, and Parenthood

I'm probably not a real foodie, because I used to live just a few blocks away from Alice Waters' Chez Panisse in Berkeley and I never actually ate there. Chez Panisse advocates humanely, locally, and sustainably-produced meat, fruits, and vegetables. As the restaurant's website explains for the uninitiated,
Since 1971, Chez Panisse has invited diners to partake of the immediacy and excitement of vegetables just out of the garden, fruit right off the branch, and fish straight out of the sea. In doing so, Chez Panisse has established a network of nearby suppliers who, like the restaurant, are striving for both environmental harmony and delicious flavor.

I thought about the time I spent in Berkeley when I read B. R. Myers' "The Moral Crusade Against Foodies" published in The Atlantic online. In the essay, he equates the foodie quest for the perfect food or meal not with morality and environmental harmony but with with gluttony. "The Catholic Church's criticism [of gluttony] has always been directed against an inordinate preoccupation with food - against foodie-ism, in other words," Myers writes.

Those with personal or religious (or medical?) restrictions on what they eat are laughed at by foodies, Myers writes:
In the involuted world of gourmet morals, constancy is rudeness. One must never spoil a dinner party for mere religious or ethical reasons. [Michael] Pollan says he sides with the French in regarding 'any personal dietary prohibition as bad manners.'... guests have a greater obligation to please their host... than vice versa.
The obesity epidemic clearly demonstrates that you are what you eat. But for some people, what you eat also reflects your class, income, and general merit. And those are more important factors for them than health.

Meanwhile, a study came out in the journal Child Development that found that 8 to 12 year old children of working mothers tend to have higher BMIs than those whose mothers don't work, particularly the older children in the study.

"The longer a mom's employment - whether she's toiling at a regular 9-to-5 job or works irregular hours - the more likely her child is to gain more weight than is healthy," wrote Kathleen Doheny in a WebMD article about the study. Working mothers might have heavier children because they spend less time planning and cooking healthy meals at home than mothers who don't work.

"This is a not a reason for moms to feel guilty," said the study's lead researcher Taryn Morrissey unreassuringly. After all, anything that makes mothers feel guilty, worried, or horrified usually gets media attention (Tiger Mom, anyone?), and this study has received a lot of press.

A mother who overthinks food because she wants to define herself and her class by what she feeds her children might be amoral and shallow. A working mother who does not spend enough time thinking about and planning what she feeds her children might be making her kids overweight and contributing to the obesity epidemic. The middle ground, where feeding the family is a function of budget, time, and effort (and where this task is not assigned immutably to the woman in the family), is a quiet, perhaps dull place. But that's where most of us live.

Sunday, February 6, 2011

The Feds Clarify Healthy Eating

I know I'm not the only person who didn't like the My Pyramid healthy eating guide published in 2005 by the U.S. Department of Agriculture (USDA). The graphic features a stick figure climbing a pyramid made up of what looks like slices of pumpkin, lime, cherry, lemon, blueberry, and huckleberry pie. I don't think that's what the USDA meant to convey.

In late January, though, the USDA and the U.S. Department of Health and Human Services (HHS) got a few things right with their new (2010) Dietary Guidelines for Americans. The guidelines are reviewed and updated every five years. This latest update focuses more clearly on combating the rising rates of obesity and chronic disease among Americans.

The updated guidelines encourage Americans to pay attention to the amount of calories they consume and the amount of exercise they get. The guidelines also encourage replacing unhealthy foods with more nutrient-rich foods at each meal. Specifically, Americans should limit the amount of sodium, saturated fatty acids, dietary cholesterol, trans fatty acids, solid fats, added sugars, refined grains, and alcohol they consume. They should eat more fruits, vegetables, whole grains, fat-free or low-fat dairy and soy products, low-fat proteins, and seafood.

The new recommendations also stress eating a wider variety of healthy foods. For example, Americans should eat more red, orange, and dark-green vegetables, and eat a wider range of proteins (such as beans, nuts, and seeds). I think that a lack of variety - or perhaps simply a lack of imagination - is one of the greatest flaws of the typical American diet, which seems to be built on the four pillars of chicken, cheese, bread, and soda.

To help you start eating better, the February issue of Real Simple has an article on "The 30 Healthiest Foods." These foods include whole-grain pasta, barley, almonds, kale, avocados, sweet potatoes, oranges, and pumpkin. I recently made Real Simple's nutrient-rich recipe for spinach salad with salmon, barley, and oranges, which was very good, and a nice start for a healthier year.