Publisher Health

The debate over aid in dying still rages in the language that medicine and the media use to describe the practice.In rural Iowa, Peg Sandeen recalls, living with AIDS meant living under the cloud of your neighbors’ judgment. After her husband, John, fell ill in 1992, the rumors began swirling. The couple had almost learned to live with the stigma when things took a turn for the worse.In 1993, ravaged by his disease and running out of options, John wanted to make one final decision: to die on his own terms, with the help of life-ending medication. But at the time, there was no way to convey to his doctors what he wanted. As the debate over assisted dying raged in far-off Oregon, the headlines offered up only loaded words: murder, euthanasia, suicide.John was adamant that what he wanted was not suicide. He loved his life: his wife, who had married him even though he had asked her to leave when he learned he was H.I.V. positive; their 2-year-old daughter, Hannah; and playing Neil Young songs on guitar, a pleasure that was rapidly being taken from him as his faculties slipped away.“This was not a man who wanted to commit suicide, at all,” said Ms. Sandeen, now the chief executive of Death With Dignity, a group that supports aid-in-dying laws across the country. To her, the word only added more judgment to the homophobia and AIDS phobia that they — and others who found themselves in a similar position — were facing.John had expressed to his wife his wish to die on his own terms. But, to her knowledge, he never spoke about it with his physicians. At the time, it felt impossible to bring it up as simply a medical question, not a moral one.“Even if the answer was, ‘No, we can’t offer that,’ that would have made such a difference,” she said. “We were just facing so much stigma that even to have the ability to have this end-of-life care conversation would have just been remarkable.”John succumbed to the virus on Dec. 9, 1993, less than a year before the Death With Dignity Act passed narrowly in Oregon. Since its enactment in 1997, more than 3,700 Oregonians have taken measures permitted by the law, which allows patients with a terminal illness and the approval of two doctors to receive life-ending medication. The practice is now legal in 10 U.S. states and Washington, D.C.With this shift has come new language. Like the Sandeens, many health advocates and medical professionals insist that a terminally ill patient taking medication to hasten the end is doing something fundamentally different from suicide. The term “medical aid in dying,” they say, is meant to emphasize that someone with a terminal diagnosis is not choosing whether but how to die.“There is a significant, a meaningful difference between someone seeking to end their life because they have a mental illness, and someone seeking to end their life who is going to die in the very near future anyway,” said Dr. Matthew Wynia, director of the University of Colorado’s Center for Bioethics and Humanities.In the 1990s, advocates were facing an uphill battle for support. Two assisted-dying bills, in California and Washington, had failed, and the advocates now faced an opposition campaign that mischaracterized the practice as doctor-prescribed death. “At the time, the issue very badly needed to be rebranded and repositioned,” said Eli Stutsman, a lawyer and a main author of the Death With Dignity Act. “And that’s what we did.”The text of the law, however, only defined the practice by what it was not: mercy killing, homicide, suicide or euthanasia. (In the United States, euthanasia means that a physician actively administers the life-ending substance. That practice has never been legal in the United States, although it is in Canada.)New terms soon became inevitable. Barbara Coombs Lee, an author of the law and president at the time of the advocacy group Compassion and Choices, remembers a meeting in 2004 where her group discussed which terminology to use going forward. The impetus “was probably another frustrated conversation about another interminable interview with a reporter who insisted on calling it suicide,” she said.A phrase like “medical aid in dying,” they concluded, would reassure patients that they were taking part in a process that was regulated and medically sanctioned. “Medicine has that legitimating power, like it or not,” says Anita Hannig, an anthropologist at Brandeis University and author of the book “The Day I Die: The Untold Story of Assisted Dying in America.” “That really removes a lot of the stigma.”By contrast, words like “suicide” could have a devastating effect on patients and their families, as Dr. Hannig learned in her research. Grieving relatives might be left feeling shamed, isolated or unsupported by strangers or acquaintances who assumed that the loved one had “suicided.” Dying patients often hid their true wishes from their doctors, because they feared judgment or struggled to reconcile their personal views on suicide.Unlike an older term, “physician aid in dying,” “medical aid in dying” also centered on the patient. “This is not a decision the physician’s making — this is not even a suggestion the physician is making,” said Ms. Coombs Lee, who has worked as an emergency-room nurse and a physician assistant. “The physician’s role is really secondary.”An equally important consideration was how the phrase would be taken up by the medical community. Doctors in Oregon were already practicing aid in dying and publishing research on it. But without agreed-upon terms, they either defaulted to “assisted suicide” (generally used by opponents of the law) or “death with dignity” (the term chosen by advocates for the name of the law). A more neutral phrase, one that doctors could use with each other and in their research, was needed.Not all organizations today agree that “medical aid in dying” is neutral. The Associated Press Stylebook still advises referring to “physician-assisted suicide,” noting that “aid in dying” is a term used by advocacy groups. The American Medical Association also uses this language: In 2019, a report from the association’s Council on Ethical and Judicial Affairs concluded that “despite its negative connotations, the term ‘physician assisted suicide’ describes the practice with the greatest precision. Most importantly, it clearly distinguishes the practice from euthanasia.”Medical language has long shaped — and reshaped — how we understand death. Dr. Hannig noted that the concept of brain death did not exist until 1968. Until then, a patient whose brain activity had ceased but whose heart was still beating was still legally alive. One consequence was that any doctor removing the patient’s organs for transplant would have been committing a crime — a serious concern for a profession that is notoriously fearful of lawsuits.In 1968, a Harvard Medical School committee came to the conclusion that “irreversible coma,” now known as brain death, should be considered a new criterion for death. This new definition — a legal one, rather than a biological one — has paved the way for organ transplantation around the world. “Before the definition of death was changed, those physicians would be called murderers,” Dr. Hannig said. “Now you have a totally new definition of death.”Of course, doctors have always assisted patients who sought a better end. But in the past, it was usually in secret and under the shroud of euphemism.“Back in the day, before the laws were passed, it was known as a wink and a nod,” said Dr. David Grube, a retired family physician in Oregon who began prescribing life-ending medications after one of his terminally ill patient violently took his own life. He knew doctors in the 1970s and ’80s who prescribed sleeping pills to terminally ill patients and let on that combining them with alcohol would lead to a peaceful death.For a brief time after the Death With Dignity law was passed, some doctors used the word “hastening” to emphasize that the patient was already dying and that the physician was merely nudging along an unavoidable fate. That term did not catch on, in part because hospices did not like to advertise that they were shortening lives, and patients did not like hearing that hospice care might lead to their “hastening.”In the absence of other language, the name of the law itself became the preferred term. The phrase allowed patients to open conversations with their physicians without feeling as though they were raising a taboo subject, and doctors understood immediately what was meant. The name has stuck: Even in his retirement, Dr. Grube gets calls from patients asking to talk about “death with dignity.”Yet in some ways, Dr. Grube believes the use of the word “dignity” was unfortunate. To him, the crucial point is not the kind of death a patient chooses, but that the patient has a choice. “You can have a dignified death when you pull out all the stops and it doesn’t work,” he said. “If that’s what you want, it’s dignified. Dignity is defined by the patient.”To him, that means avoiding language that heaps judgment on people who are already suffering. “There’s no place for shaming language in end-of-life,” Dr. Grube said. “It shouldn’t be there.”

Published35 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Philippa RoxbyHealth reporterA study of former rugby players’ brains has found that those who played for longer were more likely to develop a degenerative brain disease.Out of 31 donated brains analysed, 21 had evidence of a condition linked to repeated head injuries and concussion.Nearly two-thirds of those affected by chronic traumatic encephalopathy (CTE) played at amateur level.The researchers say their findings back up calls to reduce head impacts in all sports. CTE is a brain condition thought to be caused by repeated head injuries and blows to the head. It slowly gets worse over time and leads to dementia.People who regularly play contact sports such as football, boxing, rugby and American football have a higher chance of developing it, post-mortem studies have shown.More than 300 former football, rugby league and rugby union players in the UK are taking legal action over brain injuries they claim they suffered during their careers.Shaking and twistingIn this study, led by the University of Glasgow, scientists analysed the brains of 23 amateur and eight professional rugby players which had been donated for medical research.With an average playing career of 18 years, 68% of the brains had traces of the brain condition CTE.Thirteen of the affected brains belonged to club players, not professionals.And the study calculated that with each extra year of rugby played, there was a 14% increase in the risk of developing CTE.”It’s the shaking and twisting and rotating of the head thousands of times over decades that’s likely to cause deep damage in the brain,” says Prof Willie Stewart, lead study author from the University of Glasgow.He compares a head impact in rugby to “a spinning bowl of porridge” where the brain is the wobbly porridge in the middle.World Rugby recently said that elite women would wear smart mouthguards, which can measure head movements, in an effort to manage concussion from January 2024.Prof Stewart said reducing head impacts in rugby games and in training was what was needed, but the sport was currently not doing enough to address the problem.The ex-players’ brains in the study were donated to three brain banks – in Glasgow, at the Australian Sports Brain Bank in Sydney and at the Boston University School of Medicine.With an average age of 60 when they died, most of the former players in the study played rugby before it became professional in 1995.More on this storyBrain disease found in female athlete for first timePublished4 JulyBrain injury legal claims group grows to 378 ex-playersPublished4 April’I feel like a phoney’ – Thompson on dementiaPublished5 October 2022New research finds link between head impacts & CTEPublished27 July 2022Players suing governing bodies over brain damagePublished25 July 2022Heading ban for under-12s to be trialled by FAPublished18 July 2022

Harnessing new advances in genomic surveillance technology could help detect the rise of deadly ‘superbugs’ and slow their evolution and spread, improving global health outcomes, a new Australian study suggests.
Antimicrobial resistance occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to the medicines and chemicals we use to kill them. These ‘superbugs’ make infections harder to treat and increase the risk of disease spread, severe illness and death.
Without significant intervention, global annual deaths involving antimicrobial resistance are estimated to reach 10 million by 2050, with low and middle-income countries bearing the highest burden.
The new study, Genomic surveillance for antimicrobial resistance — a One Health perspective, published in Nature Reviews Genetics, highlights the need for a multifaceted ‘One Health’ approach to the surveillance of antimicrobial resistance in the environment.
The research was led by Distinguished Professor Steven Djordjevic from the Australian Institute for Microbiology and Infection at the University of Technology Sydney, together with researchers from the University of Melbourne and the University of South Australia.
“Antimicrobial resistance is a complex and global threat requiring large-scale, co-ordinated and cross-disciplinary collaboration to tackle,” said Professor Djordjevic.
“Understanding the evolution, emergence and spread of antimicrobial resistance within and between humans, animals, plants and natural environments is critical in mitigating the colossal impacts associated with this phenomenon.”
The use of genomic tracing during the Covid-19 pandemic has provided insight into the potential of genomic technologies to monitor the development and spread of antimicrobial genes and mutations.

A research team from the UC Davis Comprehensive Cancer Center has identified a crucial epitope (a protein section that can activate the larger protein) on the CD95 receptor that can cause cells to die. This new ability to trigger programmed cell death could open the door for improved cancer treatments. The findings were published Oct. 14 in the Nature journal Cell Death & Differentiation.
CD95 receptors, also known as Fas, are called death receptors. These protein receptors reside on cell membranes. When activated, they release a signal that causes the cells to self-destruct.
Modulating Fas may also extend the benefits of chimeric antigen receptor (CAR) T-cell therapy to solid tumors like ovarian cancer.
“We have found the most critical epitope for cytotoxic Fas signaling, as well as CAR T-cell bystander anti-tumor function,” said Jogender Tushir-Singh, an associate professor in the Department of Medical Microbiology and Immunology and senior author of the study.
“Previous efforts to target this receptor have been unsuccessful. But now that we’ve identified this epitope, there could be a therapeutic path forward to target Fas in tumors,” Tushir-Singh said.
Finding better cancer therapies
Cancer is generally managed with surgery, chemotherapy and radiotherapy. These treatments may work initially, but in some cases, therapy-resistant cancers often return. Immunotherapies, such as CAR T-cell-based immune therapies and immune checkpoint receptor molecule activating antibodies, have shown tremendous promise to break this cycle. But they only help an extremely small number of patients, especially in solid tumors such as ovarian, triple-negative breast cancer, lung and pancreas.

An international team of researchers has provided valuable insights into the brain’s noradrenaline (NA) system, which has been a longtime target for medications to treat attention-deficit/hyperactivity disorder, depression, and anxiety.
Equally important beyond the findings is the groundbreaking methodology that the researchers developed to record real-time chemical activity from standard clinical electrodes which are routinely implanted for epilepsy monitoring.
Published online in the journal Current Biology on Monday (Oct. 23), the research not only provides new insights into the brain’s chemistry, which could have implications for a wide array of medical conditions, it also highlights a remarkable new capacity to acquire data from the living human brain.
“Our group is describing the first ‘fast’ neurochemistry recorded by voltammetry from conscious humans,” said Read Montague, co-corresponding and senior author of the study, the VTC Vernon Mountcastle research professor at Virginia Tech, and director of the Center for Human Neuroscience Research and the Human Neuroimaging Laboratory of the Fralin Biomedical Research Institute at VTC. “This is a big step forward and the methodological approach was implemented completely in humans — after more than 11 years of extensive development.”
About the method
Voltammetry techniques for making real-time electrochemical readings in rodents and other laboratory models have yielded deep insights into brain function for about 30 years, but there was no clear path to use the techniques in humans, because they require electrodes to be inserted into the brain.
“Instead, we focused on what’s already being used in patients for medical procedures,” said Montague, who is also a professor in the Department of Physics at the Virginia Tech College of Science and in the Department of Psychiatry and Behavioral Medicine at the Virginia Tech Carilion School of Medicine. “When are surgeons already putting a wire in someone’s brain? And could we design a method to piggyback on that?”
The team’s initial approaches required the insertion of exclusive carbon-fiber electrodes designed at the Fralin Biomedical Research Institute into awake patients receiving deep brain stimulation surgery for Parkinson’s disease or other disorders.

A team of University of Waterloo researchers has created smart, advanced materials that will be the building blocks for a future generation of soft medical microrobots.
These tiny robots have the potential to conduct medical procedures, such as biopsy, and cell and tissue transport, in a minimally invasive fashion. They can move through confined and flooded environments, like the human body, and deliver delicate and light cargo, such as cells or tissues, to a target position.
The tiny soft robots are a maximum of one centimetre long and are bio-compatible and non-toxic. The robots are made of advanced hydrogel composites that include sustainable cellulose nanoparticles derived from plants.
This research, led by Hamed Shahsavan, a professor in the Department of Chemical Engineering, portrays a holistic approach to the design, synthesis, fabrication, and manipulation of microrobots. The hydrogel used in this work changes its shape when exposed to external chemical stimulation. The ability to orient cellulose nanoparticles at will enables researchers to program such shape-change, which is crucial for the fabrication of functional soft robots.
“In my research group, we are bridging the old and new,” said Shahsavan, director of the Smart Materials for Advanced Robotic Technologies (SMART-Lab). “We introduce emerging microrobots by leveraging traditional soft matter like hydrogels, liquid crystals, and colloids.”
The other unique component of this advanced smart material is that it is self-healing, which allows for programming a wide range in the shape of the robots. Researchers can cut the material and paste it back together without using glue or other adhesives to form different shapes for different procedures.
The material can be further modified with a magnetism that facilitates the movement of soft robots through the human body. As proof of concept of how the robot would maneuver through the body, the tiny robot was moved through a maze by researchers controlling its movement using a magnetic field.
“Chemical engineers play a critical role in pushing the frontiers of medical microrobotics research,” Shahsavan said. “Interestingly, tackling the many grand challenges in microrobotics requires the skillset and knowledge chemical engineers possess, including heat and mass transfer, fluid mechanics, reaction engineering, polymers, soft matter science, and biochemical systems. So, we are uniquely positioned to introduce innovative avenues in this emerging field.”
The next step in this research is to scale the robot down to submillimeter scales.
Shahsavan’s research group collaborated with Waterloo’s Tizazu Mekonnen, a professor from the Department of Chemical Engineering, Professor Shirley Tang, Associate Dean of Science (Research), and Amirreza Aghakhani, a professor from the University of Stuttgart in Germany.

Scientists from the University of Southampton and La Jolla Institute for Immunology (LJI), in California, have uncovered a group of immune cells that may drive severe asthma. These cells gather in the lungs and appear to cause the most harm in men who develop asthma in later life.
“If you are male and you develop asthma after age 40, there’s a high chance this T cell population is in your lungs,” says LJI Research Assistant Professor Gregory Seumois, who co-led the study with LJI Professor Pandurangan Vijayanand.
The new research, published in MED, suggests asthma patients with these cells in their lungs may be more likely to have hard-to-treat, and potentially fatal, asthma attacks. Normally a doctor would give an asthma patient a general therapy to dampen their immune response, but these cells don’t respond to treatment.
The scientists uncovered these T cells, called ‘cytotoxic CD4+ tissue-resident memory T cells’, thanks to volunteers enrolled in the NHS clinic-based WATCH study. It follows hundreds of asthma patients of different ages, sexes, and disease severities. By following patients over many years, and analysing their immune cell populations, researchers are making new connections between asthma symptoms and immune cell activity.
“Once you understand the role of cells like these T cells better, you can start to develop treatments that target those cells,” says WATCH study director Dr Ramesh Kurukulaaratchy, Associate Professor at the University of Southampton and researcher at the NIHR Southampton Biomedical Research Centre.
Scientists now hope to learn more about these cells and their role in asthma development in order to develop personalised therapies for asthma patients.
How harmful T cells drive asthma
The T cells are called “memory” cells because they react to molecules that the body has previously fought off. They help protect the body from viruses and bacteria, but the same T cell memory is a big problem for asthma patients. Their misguided T cells see harmless molecules, such as pollen, and produce a dangerous inflammatory response.

In a randomized controlled clinical trial of adults with moderate-to-severe depression, those who participated in heated yoga sessions experienced significantly greater reductions in depressive symptoms compared with a control group.
The results of the trial, which was led by investigators at Massachusetts General Hospital (MGH), a founding member of Mass General Brigham (MGB), and was published in the Journal of Clinical Psychiatry, indicate that heated yoga could be a viable treatment option for patients with depression.
In the eight-week trial, 80 participants were randomized into two groups: one that received 90-minute sessions of Bikram yoga practiced in a 105°F room and a second group that was placed on a waitlist (waitlist participants completed the yoga intervention after their waitlist period). A total of 33 participants in the yoga group and 32 in the waitlist group were included in the analysis.
Participants in the intervention group were prescribed at least two yoga classes per week, but overall, they attended an average of 10.3 classes over eight weeks.
After eight weeks, yoga participants had a significantly greater reduction in depressive symptoms than waitlisted participants, as assessed through what’s known as the clinician-rated Inventory of Depressive Symptomatology (IDS-CR) scale.
Also, investigators observed that 59.3% of yoga participants had a 50% or greater decrease in symptoms, compared with 6.3% of waitlist participants. Moreover, 44% in the yoga arm achieved such low IDS-CR scores that their depression was considered in remission, compared with 6.3% in the waitlist arm.
Depressive symptoms were reduced even in participants who received only half of the prescribed yoga “dose,” suggesting that heated yoga sessions just once a week could be beneficial.

Scientists at UNSW Sydney have created a new material that could change the way human tissue can be grown in the lab and used in medical procedures.
The new material belongs to a family of substances called hydrogels, the essence of life’s ‘squishy’ substances found in all living things, such as cartilage in animals and in plants like seaweed. The properties of hydrogels make them very useful in biomedical research because they can mimic human tissue, allowing cells to grow in a laboratory.
There are also human-made hydrogels that are used in a broad range of commodity products ranging from food and cosmetics to contact lenses and absorbent materials, and more recently in medical research to seal wounds and replace damaged tissue. While they might function adequately as space fillers that encourage tissue growth, synthetic hydrogels fall short in recreating the complex properties of real human tissue.
But in a research paper published today in Nature Communications, scientists from UNSW describe how a new lab-made hydrogel behaves like natural tissue, with a number of surprising qualities that have implications for medical, food and manufacturing technology.
Associate Professor Kris Kilian from UNSW’s School of Materials Science & Engineering and School of Chemistry says the hydrogel material is made from very simple, short peptides, which are the building blocks of proteins.
“The material is bioactive, which means that encapsulated cells behave as if they are living in natural tissue,” A/Prof. Kilian says.
“At the same time, the material is antimicrobial, meaning that it will prevent bacterial infections. This combination lands it in the sweet spot for materials that might be useful in medicine. The material is also self-healing, which means that it will reform after being squished, fractured, or after being expelled from a syringe. This makes it ideal for 3D bioprinting, or as an injectable material for medicine.”
Surprise discovery in lockdown