Law

Withholding life support: In Britain, in 2 separate cases, parents have locked horns with doctors. Parents want to continue all medical therapy including life support for their babies while doctors are unwilling, considering the poor long term outcome. One child has Trisomy 18 (Edwards’s syndrome) and the other is a severely handicapped child who was born 3 months preterm. Finally, doctors caring for them appealed to the court that artificial ventilation would not be in their best interests. In both cases judges have voted in favor of following doctors’ judgment and avoiding ventilation. In one of the judgments the judge has counseled the parents that "It is the duty of the mother for the sake of the baby … to reduce areas of conflict to a minimum and listen to what is proposed by those who have a great deal of medical and nursing experience." Improving medical care has fathered complex ethical issues (BMJ 30 October 2004; 329: 995).

Journal watch

Different strokes: The Public Library of Science ( PLoS) has launched a medical journal with a difference. Here the author pays to get his article published. The PLoS Journal of medicine will be available online free to readers (http://medicine.plosjournals.org). This monthly journal has also refused all advertising by pharmaceutical companies. The chief editor Victoria Barbour professes a desire to publish papers of worldwide significance and to reach readers in the developing world who would not otherwise have easy access to subscription journals. Authors will have to budget in a $1500 cost of paper publication while collecting funds for their study. Things are really looking up for the consumer even in the medical fraternity (BMJ 30 October 2004; 329: 996)

Technology

Chip on the shoulder: In the not too distant future scanning all our patients for a microchip implanted under their skin may be routine, like taking a pulse rate. The FDA has recently approved an implantable radiofrequency identification device for patients. This tiny chip will have a 16 digit number which can be used to access patient’s records on a secure database via encrypted internet access. This will be hugely useful in patients with long complicated medical histories or when multiple specialties are involved. The idea has been plagiarized from "Home Again" chips which are been used to identify lost pets and cattle for the past 30 years. About a 1000 people have already been implanted and in Mexico it is used by staff in high security areas. Is it the next step in the evolution of the humanoid or are we regressing backward as mere "branded cattle" (BMJ 6 November 2004; 329: 1064).

Nutrition

Repercussions of soy based milk: A year ago several babies in Israel who were fed soy based infant milks made in Germany, started developing peculiar neurological deficits. Two of them went into encephalopathy and died. Urgent investigations revealed that the milk was deficient in thiamine and some babies were saved after parenteral thiamine administration. Today 9 still have neurological deficits and 30 odd are under careful follow up. The milk manufacturer Humana claims it stopped adding synthetic thiamine on the belief that soy had sufficient natural thiamine. The financial compensation will be anywhere between $15 million and $25 million. Is the rampant use of soy milk for the faintest suspicion of cow milk allergy acceptable? Shouldn’t baby foods be considered "sensitive products" that need regular sampling and testing like drugs? Milk is the eternal passion of the pediatrician and will remain the eternal problem (BMJ 13 November 2004; 329: 1128).

Gouri Rao Passi,
Consultant,
Department of Pediatrics,
Choithram Hospital & Research Center,
Indore, India.
E-mail: [email protected]