Maria Silveira, MD, MPH, is the lead author on an article in the New England Journal of Medicine (April 1, 2010) on end-of-life decision making. Silveira and her colleagues found in a large-scale study that more than a quarter of the elderly lacked decision-making capacity as they approached death. Those who had advance directives were very likely to get the care that they wanted. Co-authors on the study are Kenneth Langa, MD, PhD, and Scott Y.H. Kim, MD, PhD. Read a press release about the article here.

Reshma Jagsi, MD, DPhil, is the lead author on a new study showing that breast cancer patients who have had mastectomies and need radiation are less likely to receive these treatments than patients who have had lumpectomies. The article appears in the Journal of Clinical Oncology (online March 29, 2010). Additional authors are Paul Abrahamse, Sarah T. Hawley, Jennifer J. Griggs, Steven J. Katz, Monica Morrow, John J. Graff, and Ann S. Hamilton. Read a press release about the research here.

Brian Zikmund-Fisher, PhD, is the senior author on a study led by Donna M. Zulman, MD, that reveals about a third of doctors and their patients with diabetes do not agree on which of the patient's health conditions is most important. In the study, 38% of physicians (compared to 18% of patients) ranked hypertension as the most important condition. Patients were more likely to prioritize symptoms such as pain and depression. Read the article, in the Journal of General Internal Medicine, here. Read a press release about the article here.

The vast majority of oncologists (84%) say that they consider costs to the patient when recommending cancer treatments. But fewer than half of oncologists frequently discuss cost issues with their patients. These are some of the results of a national survey conducted by Peter Neuman, ScD (Tufts Medical Center) and CBDSM's Peter A. Ubel, MD, funded by the California HealthCare Foundation. Results were published in the January 2010 Health Affairs. Ubel comments: "Oncologists understand, from up close, that cancer diagnoses and treatment leave many people bankrupt. They want to do what is medically right for their patients, but they are struggling to figure out what, at the same time, is economically right for them." Read the article here.

Oxford University Press has published Evaluation of Capacity to Consent to Treatment and Research, by CBDSM's Scott Kim, MD, PhD. The book is part of the series Best Practices in Forensic Mental Health Assessment. For further information about this volume, click here.

CBDSM's Reshma Jagsi, MD, DPhil, is the lead author on a study published in the Annals of Internal Medicine showing that women are less likely than men to receive major funding for scientific research. The study also found that only a quarter of all researchers (men and women) who received major early-career awards received further federal funding within five years. Additional authors are Amy Motomura, Kent Griffith, and Soumya Rangarajan. Read a press release about the article here.

Brian Zikmund-Fisher, PhD, is one of three speakers in a recent public health webcast on strategies for conveying the health risks of the H1N1 virus. Zikmund-Fisher is an assistant professor at the University of Michigan School of Public Health and CBDSM. To view the webcast, click here.

Several CBDSM faculty contributed to an article by lead author Monica Morrow, MD, that appeared recently in the Journal of the American Medical Association. The authors investigated the concern that mastectomy is overused in the US. In surveying 1,984 patients, they found that 75% had breast-conserving surgery as their initial surgical therapy. Of these, 38% required additional surgery. Although breast-conserving surgery was recommended by surgeons and attempted in the majority of patients evaluated, the mastectomy rate was affected by surgeon recommendation, patient decision, and failure of breast-conserving surgery. CBDSM faculty contributing to this article were Reshma Jagsi, MD, DPhil; Amy K. Alderman, MD; Jennifer J. Griggs, MD, MPH; and Sarah T. Hawley, PhD. Other authors included Ann A. Hamilton, PhD; John J. Graff, PhD; and Steven J. Katz, MD, MPH. Read the article at http://jama.ama-assn.org/content/vol302/issue14/index.dtl.

CBDSM's Ray DeVries, PhD, along with Mark Pearlman, MD (UM professor of obstetrics and gynecology), and UM doctoral student Ann V. Bell recently published an op-ed column in the New York Times. They discuss the delayed diagnosis of breast cancer and how it is the most common and the second most costly medical claim against American doctors. Read the full article: NY Times

A study by Beth Tarini, MD, has found that more than three-quarters of parents would be willing to permit use of their newborn's blood screening sample for research if their permission were obtained in advance. However, more than half of the parents said they would be "very unwilling" to permit this use of blood samples unless they were given a chance to grant or deny permission. For a discussion of this important article, go to http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=1217

Reshma Jagsi, MD, DPhil, has found that 29% of cancer research published in high-impact journals disclosed a conflict of interest, including industry funding of the study or a study author who was an industry employee. "Given the frequency we observed for conflicts of interest and the fact that conflicts were associated with study outcomes, I would suggest that merely disclosing conflicts is probably not enough. It's becoming increasingly clear that we need to look more at how we can disentangle cancer research from industry ties," comments Jagsi. The study, which has received wide media attention, was published in the journal Cancer, online at  http://www3.interscience.wiley.com/journal/122381054/abstract?CRETRY=1&SRETRY=0 

Additional authors are Nathan Sheets, Aleksandra Jankovic, Amy R. Motomura, Sudha Amarnath, and Peter A. Ubel.

Be sure to post a comment at peterubel.com, the blog of CBDSM's director, Peter A. Ubel, MD. Dr. Ubel's commentaries range across science, policy, health, well-being, and ethics. Topics include bankruptcy, behavior, and building; nuances, nature, and neighborhoods; soccer, satire, and scientocracy.

19% of women who should receive radiation after mastectomy are not getting this treatment, according to new research results now online in the journal Cancer. CBDSM's Reshma Jagsi, MD, DPhil, is the lead author on this study, which found that the most common reason that women in this high-risk group cited for not considering the treatment was that their doctors did not recommend it. See more information at the University of Michigan Health System Newsroom.

For human-subjects research, maximum regulation does not mean maximum protection. Stop regulating minimal risk research, say Scott Kim, Peter Ubel and Raymond De Vries in their new commentary in Nature.

http://www.nature.com/nature/journal/v457/n7229/pdf/457534a.pdf

Free Market Madness: Why Human Nature Is at Odds with Economics--and Why It Matters is the third book by CBDSM's Peter Ubel, MD. Dr. Ubel explains that our free-market economy is based on the assumption that we always act in our own self-interest. But, using his understanding of psychology and behavior, he then shows that humans are not always rational, and he argues that in some cases government must regulate markets for our own health and well-being. Dr. Ubel's vivid stories bring his message home to anyone interested in improving the way American society works. This publication of Harvard Business Press can be ordered at amazon.com, borders.com, or barnesandnoble.com.

Caring for an ailing spouse may prolong your life. Stephanie Brown explains her research in a vodcast, featured on the University of Michigan website:  http://www.ns.umich.edu/podcast/vodcast.php. This vodcast was, appropriately, the university's home page lead for the week of Thanksgiving.

A study by CBDSM researchers Michael Volk, MD, and Peter Ubel, MD, has found that the Model for End-stage Liver Disease (MELD) organ allocation system has changed how high-risk organs are used--patients lower on the waiting list are receiving more high-risk or poor-quality organs, which has reduced post-transplant survival rates.  Dr. Volk and his colleagues are interested in finding ways to provide better decision making tools for patients who need organ transplants.
To read more about this study, please visit http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=807
Their findings are published in the November issue of Gastroenterology (Vol. 135, No. 5)