ABC's 'Private Practice' explores bioethics

Date: 9/30/2008 10:26 AM

By SANDY COHEN
AP Entertainment Writer

LOS ANGELES (AP) _ On a massive sound stage at Hollywood's Raleigh Studios, a woman is dying of ovarian cancer. One doctor wants to treat her traditionally, by removing her uterus and ovaries. Another wants the patient to participate in a clinical trail that might preserve her ability to have children, but could have serious side effects.

On a different day, an obstetrician is conflicted about whether to deliver a premature baby she believes was conceived solely because the umbilical-cord blood could save the family's older, dying child. Another doctor struggles to do what's right when his teenage patient — who has HIV but doesn't know it — confides that he plans to have sex for the first time.

Bioethical questions like these come up weekly on ABC's "Private Practice," the "Grey's Anatomy" spin-off that begins its second season Wednesday.

"We're telling stories ... that will provide a lot of moral debate among our doctors and maybe debate at home when you watch," said series creator Shonda Rhimes.

The issues they face cause plenty of drama for the doctors at the Oceanside Wellness Group, where Kate Walsh's character, Addison Montgomery, came to work after leaving "Grey's" Seattle Grace Hospital.

"They're all viable conflicts ... grounded in these medical stories," Walsh said. "It's topical but not so procedural that it's not a Shonda Rhimes show. You still have all the great dialogue and characters and stories and romance."

Like "Grey's Anatomy," ''Private Practice" features an ensemble cast of doctors whose personal lives are often far messier than their professional ones. They have affairs with one another and struggle with love as they overcome tough medical challenges and the financial realities of keeping their medical co-op alive.

The bioethical issues raised are based on real medical cases and community concerns, said researcher and writer Elizabeth Klaviter.

"We look at the things that have ourselves and our family members and friends buzzing — the issues that people are talking about in terms of right or wrong and the laws, ethics and social morays that are put on us in terms of how we conduct ourselves," said Klaviter, who also researches cases for "Grey's Anatomy."

"Doctors disagree," she said. "We're looking for cases where there are different courses of action or treatment."

This season, the doctors at Oceanside Wellness will have to decide what rights prostitutes have to medical care and whether to treat a sex offender at their child-friendly practice. They also engage in an abortion debate that surprised actor Tim Daly, who plays Dr. Pete Wilder.

"I never thought we'd be doing something like that on Disney," which owns ABC, he said. "It was just these characters discussing their opinions and they didn't agree and they were passionate about it, just like in the real world."

Daly and his castmates credit Rhimes and the show's writers for using the forum of a prime-time drama to inspire viewers to consider current bioethical issues.

"If you can make anybody think in this day and age, and entertain them at the same time, that's a dream come true," said KaDee Strickland, who plays Dr. Charlotte King, a physician at a rival hospital.

Making bioethics a theme of the show is "seductive," Walsh said, because it deepens the characters while raising important issues for viewers to ponder. Though she said it was a risk for her to leave "Grey's," she feels she landed in a good place.

"It was a risk but it wasn't like sex-without-a-condom risk. It was an offer I couldn't refuse," she said. "I'm hugely grateful that it did really well last fall... It's really a testament to Shonda and her gift for being able to tap into the culture and the big collective consciousness of what people really relate to."

History proves that viewers respond to medical shows: "We may never end up in a courtroom or never end up arrested, but sooner or later everybody's going to come through the doors of a doctor's office," Rhimes said. Exploring bioethics adds a new dimension to the already-beloved genre.

"It's something more and more doctors are facing these days," Rhimes said. "It's just a very different way of looking at medicine that I don't think we normally think about — the ethics of what you're doing."

ABC is owned by The Walt Disney Co.

Copyright 2008 The Associated Press.

Baby deaths shock Turkey

Date: 9/26/2008 8:01 AM

By SUZAN FRASER
Associated Press Writer

ANKARA, Turkey (AP) _ Outside the Zekai Tahir Burak maternity hospital stands a bronze statue of a mother nursing a baby with an inscription from the Prophet Mohammed: "Paradise lies at the feet of the mother."

In July, the Ankara facility became the scene of any parent's hell: A total of 27 newborns died here within two weeks, most of them from infection.

Now Turkey is reeling from a similar tragedy at another hospital, this time in the western city of Izmir, where 13 premature babies died last weekend within 24 hours, apparently from tainted IV treatment.

The deaths at two of the nation's most modern maternity hospitals go to the heart of Turkey's uncertain status as a country energetically seeking to modernize in its bid to join the European Union — but held back by problems associated with the developing world.

The scandals have exposed a shortfall in the number of specialized neonatal units dealing with premature and high-risk babies as well as a shortage of qualified staff in a country of 70 million.

Most hospitals lack specialized premature birth units, and high-risk or premature babies are often transferred to larger hospitals in cities such Istanbul, Ankara or Izmir. The transfer and high concentration of newborns in the same place increases the risk of infections, experts say.

"There just isn't the facility that allows a premature baby to survive in the hospital that it was born in," said Bedriye Yorgun, who heads the Ankara-based Health and Social Services Workers' Union, which advocates improved health services. "When the babies are transferred, there is a higher chance of exposure to infection and of spreading an infection."

The government has acknowledged a shortage and has said it plans to increase the number of neonatal wards nationwide from the current 156 to 200 by 2010. It has also admitted to a shortage of more than 400 specialized doctors and thousands of nurses.

After the first deaths at the capital's Zekai Tahir Burak maternity hospital, a team of government-appointed doctors said a staff shortage had increased the risk of infection.

Dr. Fahri Ovali, one of the doctors, told reporters: "There were four high-risk babies for every nurse."

The Izmir tragedy caused a renewed explosion of outrage in this country where children are cherished and people will often stop to show affection to other people's kids.

"Such shame does not exist elsewhere in the world," read a headline in Bugun newspaper. "13 mothers' arms left empty," said Aksam newspaper.

A preliminary investigation concluded that the infants died of a bacterial infection spread by IV treatment. Further investigation is under way to see how the bacteria got mixed with the intravenous solution used to treat the infants at Izmir's Tepecik hospital. The bodies of three of the babies, who were buried immediately after their deaths, were exhumed to help with the investigation.

Izmir health department head Mehmet Ozkan said the hospital believed the babies were not neglected. After the 13 deaths, the unit was placed under quarantine and no new babies have been admitted.

Some of the families have filed complaints against the hospital accusing its directors of negligence. A local prosecutor has also launched a criminal investigation into the deaths, while the main opposition party has called for a parliamentary debate on the deaths.

A chief obstetrician at Etlik Zubeyde Hanim hospital said a government decree forcing hospitals not to turn away any patients was to blame.

"If there are no spare incubators and you are forced to admit more and more babies, what do you do? You have to put two babies into the same incubator, which increases the possibility of infections," he said. He spoke on condition of anonymity because of the sensitivity of the issue and because as a state-employee, he is not authorized to speak to journalists.

Yorgun, who heads the health workers' union agreed.

"The government is telling the people that no one will be turned away from hospitals, but it is not creating the conditions to allow doctors to treat everyone," she said.

Copyright 2008 The Associated Press.

More parents ponder cancer gene tests for kids

Date: 9/21/2008 5:48 PM

By MARILYNN MARCHIONE
AP Medical Writer

CHICAGO (AP) _ Women are going for breast cancer gene testing in record numbers, forcing more parents to face a tough question: Should we test the kids?

About 100,000 tests for breast cancer gene mutations were done last year, double the number in 2005. The trend may grow even more because of widening insurance coverage and a new law banning genetic discrimination.

Medical experts advise against such testing before age 25, saying that little can be done to prevent or screen for breast or ovarian cancer until then, so the knowledge would only cause needless worry.

However, new studies and interviews by The Associated Press show that many people who have BRCA gene mutations — and even more of their offspring — disagree. Cornell University freshman Jenna Stoller is one.

"I'm the kind of person that, like my mom, am more comfortable knowing something about myself than not knowing," said Stoller, who tested positive earlier this year, shortly after her 18th birthday. Her mother made her wait five years after revealing her own positive test result, even though Jenna wanted to be tested at age 13.

"I remember thinking on my 17th birthday that I had another year to wait till I could make the decision for myself," she said.

Research also shows there can be benefits to at least talking about testing and inherited cancer risks with teens. It led some to quit smoking, one study found. Others, like Stoller, were advised to limit alcohol and avoid birth control pills, which can raise the risk of breast cancer though they also lower the risk of ovarian cancer.

A decade after BRCA testing began, researchers are just starting to discover the many effects that someone's positive test can have on other family members. A big issue is whether it is ethical or good to test minors.

"I've seen a fair number of parents in clinic who have really struggled with this question," said Dr. Angela Bradbury, a breast cancer specialist at Fox Chase Cancer Center in Philadelphia who has led several studies on the topic.

Myriad Genetics Inc., based in Salt Lake City, sells the only BRCA gene test, which costs up to $3,000.

Men can also carry a BRCA mutation, and if either parent does, a child has a 50-50 chance of inheriting it. The mutations are most common in people of eastern European Jewish descent.

Women with a faulty gene have a three to seven times greater risk of developing breast cancer and a higher risk of ovarian cancer. Men have more risk of prostate, pancreatic and other types of cancer.

To lower risk, women can consider anti-estrogen drugs or having their breasts or ovaries removed. But these drastic measures are not advised for very young women. Even mammograms are not advised till age 25, because cancer is rare before then.

So the American Society of Clinical Oncology and other groups say that when the risk of childhood cancer is low and nothing can be done to lower it, children should not be given gene tests.

"The rule is, do no harm — test only if you can offer something that will help," said Mary-Claire King, the University of Washington scientist who in 1990 discovered the first breast cancer predisposition gene, BRCA-1.

"The life of a young girl is complicated enough already. There is nothing about it that needs to change" if she carries one of these genes, King said.

But some parents are testing girls before they even have breasts, let alone cancer risk. One woman had her 4-year-old daughter tested, said Sue Friedman, executive director of FORCE: Facing Our Risk of Cancer Empowered, a Tampa-based support group for people with BRCA genes.

Another woman tested two very young children several years ago at Baptist Health South Florida in Miami.

"We wanted to know — it's as simple as that," she said. "Kids are born with all kinds of defects that parents have to make decisions about. I just think this is one of those things," said the woman, who spoke on condition of anonymity because of privacy concerns for her children.

Rae Wruble, a nurse and genetics adviser at Baptist Health, said this woman was the only one in more than 900 she has counseled who chose to test very young children. Wruble said she always tells patients that cancer groups recommend against testing minors and why. But she admitted: "If I had young children, I would have tested them because that's just the kind of person I am — I would want to know."

Most parents do not peek inside their child's gene toolbox, Friedman said. "It does deny the actual patient informed consent."

"I feel very strongly that people should not test their children, but children should make their own decision," said Jill Stoller, a New Jersey pediatrician who is the mother of Jenna, the Cornell student.

Jenna had hours of counseling before doctors agreed that for her, testing was the right choice. However, Jennifer Scalia Wilbur, a counselor at Women and Infants Hospital in Providence, R.I., told of a 19-year-old who had testing without counseling and now wants to remove her breasts and not have children.

"It was extremely distressing" to talk with her now and try to correct her overly dire outlook, she said.

At a meeting of the oncology society in June, Bradbury reported on a survey she did of 163 adult BRCA gene carriers in the Chicago area. About half supported testing minors in some or all circumstances. A previous survey she led of 53 gene carriers and 22 of their offspring (ages 18 to 25) found about the same degree of support. Most sons and daughters favored testing minors.

Another of her studies, recently published in the American Journal of Medical Genetics, explored how sons and daughters ages 18 to 25 were affected by learning that a parent had tested positive.

Some effects were good — five of the seven smokers said they were motivated to quit.

Most said the knowledge had no big negative effect, but six of the 22 said they felt frightened or disturbed.

"I was shocked, scared. I wondered if I was going to get the gene and realized I could pass it to my (future) kids. I would feel like it was my fault if they got cancer," one daughter said in the survey.

Two sons said the knowledge might change their plans to have children. Five daughters and two sons had already gone for gene testing, and nearly all of the rest said they planned to be tested.

Wanting to test minors can be a knee-jerk response that changes after counseling. Tammy LeVasseur of North Attleboro, Mass., at first thought she wanted all three of her daughters to be tested after she learned of her own positive result in July.

She later decided to encourage testing for her two oldest daughters, ages 26 and 28, who had already finished having children, but not for Jessica, who just turned 17.

"I want to wait until I'm in my 20s," Jessica LeVasseur said. "They wouldn't do anything about it. There's no reason to worry now. I'd rather just be able to finish my teenage years without worrying about that."

___

On the Net:

National Cancer Institute: http://www.cancer.gov/cancertopics/factsheet/risk/brca

FORCE support group: http://www.facingourrisk.org/index.php

Copyright 2008 The Associated Press.

Doctors: infection led to Turkish newborn deaths

Date: 9/22/2008 2:18 PM

By SUZAN FRASER
Associated Press Writer

ANKARA, Turkey (AP) _ An infection spread by IV treatment led to the weekend deaths of 13 premature newborns at a hospital in western Turkey, a doctor investigating the deaths told the private Dogan news agency Monday.

The deaths drove the number of babies killed by infections in Turkey to at least 40 in three months.

In July, more than 27 newborns died of an infection at a hospital for high-risk births in the capital, Ankara. Government-appointed doctors investigating the deaths said a staff shortage had increased the risk of infection.

Recep Ozturk, a doctor at Istanbul's Cerrahpasa University Hospital, said preliminary results indicated that IV-spread infection caused the latest deaths at Izmir's Tepecik hospital Saturday and early Sunday, Dogan reported. Ozturk, who spoke on behalf of the group of doctors investigating the case, said the infection appeared to be spread by intravenous solution, Dogan reported.

A local prosecutor was investigating whether neglect may have been a factor.

Izmir health department head Mehmet Ozkan said the hospital believed the babies were not neglected. Tepecik hospital was caring for 41 newborns overnight Saturday. After the 13 deaths, the unit was placed under quarantine and no new babies have been admitted. The hospital has 30 incubators and can accommodate 45 infants.

The bodies of three babies buried over the weekend were being exhumed to help with the investigation, the state-run Anatolia news agency reported.

Hospitals in small towns in Turkey generally lack specialized premature birth units, and high-risk or premature babies are often taken to larger hospitals in cities such Istanbul, Ankara or Izmir.

Health workers unions say, however, that the larger hospitals are often understaffed or ill-equipped to care for large numbers of newborns.

"These unfortunate deaths are very saddening," Prime Minister Recep Tayyip Erdogan said. "There may have been neglect, this will become clear after the investigation."

"Premature births constitute a high risk, and this may have played a part, too," he said.

Turkey's infant mortality rate is relatively high, at 23.66 in 1,000 in 2005, compared with that of its EU-member neighbor Greece, where 3.8 newborns out of 1,000 died the same year, according to the Organization for Economic Co-operation and Development.

Copyright 2008 The Associated Press.