Nearly one-third of US adults know someone who’s died of drug overdose

Survey also finds ‘overdose loss’ bolsters recognition of addiction as an important policy issue that spans party lines

JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH

Losing a loved one to drug overdose has been a common experience for many Americans in recent years, crossing political and socioeconomic divides and boosting the perceived importance of the overdose crisis as a policy issue, according to a new survey led by researchers at the Johns Hopkins Bloomberg School of Public Health.

A nationally representative survey of more than 2,300 Americans, fielded in spring 2023, suggests that 32 percent of the U.S. adult population, or an estimated 82.7 million individuals, has lost someone they know to a fatal drug overdose. For nearly one-fifth of survey respondents—18.9 percent, representing an estimated 48.9 million adults—the person they knew who died of overdose was a family member or close friend.

The rates of reported loss due to overdose did not differ significantly by political party affiliation, but those who experienced overdose loss were more likely to view addiction as an extremely or very important policy issue.

The study will be published online May 31 in JAMA Health Forum.

“The drug overdose crisis is a national tragedy,” says Alene Kennedy-Hendricks, PhD, assistant professor in the Department of Health Policy and Management at the Bloomberg School, who led the analysis. “Although large numbers of U.S. adults are bereaved due to overdose, they may not be as visible as other groups who have lost loved ones to less stigmatized health issues. Movements to build support for policy change to overcome the devastating toll of the overdose crisis should consider the role of this community.”

Over one million Americans have died from drug overdoses since the late 1990s, including more than 100,000 per year in the last few years, according to the Centers for Disease Control and Prevention. Last year, overdose deaths declined slightly for the first time in five years, decreasing three percent from 2022, according to preliminary data from the CDC’s National Center for Health Statistics. At about 108,000 estimated deaths, the CDC 2023 preliminary numbers remain near historic highs. 

The overdose crisis has evolved over several phases, beginning with prescription opioids such as oxycodone playing a key role, followed by heroin and, more recently, powerful synthetic opioids like illicitly manufactured fentanyl and polysubstance use. Opioids can suppress breathing as a side effect, and the unpredictability of the illicit drug supply and the potency of fentanyl have dramatically increased the risk of overdose.

While the survey questions did not specifically identify opioids, the majority of overdose deaths over the last two decades have been opioid-related.

The overdose crisis has not only impacted its direct victims but also their relatives, friends, and acquaintances. Kennedy-Hendricks and her colleagues at the Bloomberg School’s Center for Mental Health and Addiction Policy set up the study to help illuminate this wider impact, which otherwise has been little studied.

The paper was co-written with colleagues from Boston University School of Public Health, the University of Minnesota, and the de Beaumont Foundation. The study’s senior author is Sandro Galea, MD, DrPH, MPH, dean of Boston University School of Public Health. 

The survey is part of the CLIMB (COVID-19 and Life Stressors Impact on Mental Health and Well-being) study. Led by Catherine Ettman, PhD, an assistant professor in the Bloomberg School’s Department of Health Policy and Management, the CLIMB study has surveyed a nationally representative sample of adult Americans annually since 2020. For this overdose loss study, questions to participants from March 28 to April 17, 2023—CLIMB Wave 4—included “Do you personally know anyone who has died from a drug overdose?” A total of 2,326 participants responded to the question. Participants answering “yes” were then asked “Who do you know that has died from a drug overdose?”  

Overdose losses were reported across all income groups. Forty percent of lower-income respondents (defined as annual household incomes less than $30,000) reported overdose loss. Over one-quarter—26 percent—of respondents in the $100,000 and higher annual household income category reported an overdose loss.

The rate of reported overdose loss was not significantly different across self-described Republicans, Democrats, and Independents, adding to the picture of a far-reaching phenomenon.

The data suggested a high level of endorsement across all groups—greater than 60 percent, even among those reporting no overdose loss—that addiction is an extremely or very important policy issue. Respondents who reported overdose loss had 37 percent greater odds of viewing addiction as a very or extremely important policy priority. 

“This study contributes new evidence that the addiction crisis and the losses that come with it are common across Americans, but the burden is greater among those who are more economically precarious,” says Ettman. “Addressing addiction can be a unifying theme in increasingly divided times.”

The researchers plan to follow up with further studies in future CLIMB survey waves, looking at associations between overdose loss and other social variables such as trust in institutions.

“The Scale of Personal Loss Incurred by the Drug Overdose Crisis in the U.S.” was co-authored by Alene Kennedy-Hendricks, Catherine Ettman, Sarah Gollust, Sachini Bandara, Salma Abdalla, Brian Castrucci, and Sandro Galea.

CLIMB Study Wave 4 was funded by a grant from the de Beaumont Foundation.

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BU study finds policy makers’ use of in-hospital mortality as a sepsis quality metric may unfairly penalize safety-net hospitals

BOSTON UNIVERSITY SCHOOL OF MEDICINE

(Boston)—Sepsis is a leading cause of death and disability and a key target of state and federal quality measures for hospitals. In-hospital mortality of patients with sepsis is frequently measured for benchmarking, both by researchers and policymakers. For example, in New York, sepsis regulations mandate reporting of risk-adjusted in-hospital mortality, and hospitals with lower or higher than expected in-hospital mortality rates are publicly identified as high or low performers. Safety net hospitals (which face unique challenges, including fewer resources to care for a disproportionately high share of underinsured and high-risk patients) have been reported in prior studies to have higher risk-adjusted in-hospital mortality among patients with sepsis than non-safety-net hospitals.

However, among critically ill patients, in-hospital mortality may not adequately reflect short-term mortality fairly across all hospitals. In-hospital mortality is influenced by other variables, including hospital transfer practices, which shift the attribution of short-term death from the hospital to other sites. Safety-net hospitals may have different access or ability to transfer patients compared to non-safety-net hospitals.

In a new study, researchers at Boston University Chobanian & Avedisian School of Medicine found that safety net hospitals do have higher in-hospital mortality than non-safety net hospitals, but their 30-day mortality – an unbiased measure of short-term mortality – is actually not different.

 

“While the differences in mortality rates are numerically small, the difference in outcome metrics is enough to significantly affect hospital rankings. Current or future state and federal quality measures that use in-hospital mortality as a quality metric may unfairly penalize safety-net hospitals,” explained corresponding author Anica Law, MD, MS, assistant professor of medicine at the school.

The researchers performed a retrospective analysis of patients with sepsis who were aged 66 and older and were admitted to an intensive care unit between January 1, 2011, through December 31, 2019, at both safety and non-safety net hospitals.

“Although in-hospital mortality is often selected as an outcome measure because of its availability in claims databases and hospital medical records without need for post-hospitalization follow-up, the 30-day measure is important to accurately understand true short-term mortality rates,” said Law, who also is a pulmonologist and critical care physician at Boston Medical Center.

According to the researchers, the difference appears to be due partly to the fact that non-safety net hospitals discharge more patients to hospice, which shifts attribution of short-term mortality away from the index hospitalization. “When post-hospitalization data is incorporated, as is done in 30-day mortality analysis, you get a more accurate picture of who is actually dying in the short-term, and see that there no longer a difference between safety and non-safety net hospitals.” The Centers for Medicare and Medicaid Services (CMS) has already legislated a process measure that assesses whether hospitals are performing key sepsis care steps efficiently, including initiating antibiotics. CMS is currently considering rolling out a national sepsis outcome measure; it is not yet known if CMS will be measuring in-hospital mortality or 30-day mortality.

These findings appear online in JAMA Network Open.    

Funding for this study was provided by the National Institute of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) K23HL153482, National Center for Advancing Translational Sciences (NCATS) 1KL2TR001411, the Doris Duke Charitable Foundation, the Boston University Evans Junior Faculty Merit Award, and the Boston University Chobanian & Avedisian School of Medicine Department of Medicine Career Investment Award.

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JOURNAL

JAMA Network Open

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

In-Hospital vs 30-Day Sepsis Mortality at US Safety-Net and Non–Safety-Net Hospitals

ARTICLE PUBLICATION DATE

31-May-2024

 

Stem cells shed new light on how the human embryo forms

UNIVERSITY OF EXETER

A new study using stem cell-based models has shed new light on how the human embryo begins to develop, which could one day benefit the development of fertility treatment.

The study led by at the University of Exeter Living Systems Institute has revealed how early embryo cells decide between contributing to the foetus or to the supporting yolk sac.

Understanding this decision is important because the yolk sac is essential for later development in the womb. Producing the right number of yolk sac forming cells may be critical for infertility treatment using in vitro fertilised (IVF) embryos.

Only limited research can be performed directly on human embryos. The research team which included the University of Edinburgh, therefore used naïve stem cells that are able to make all the cell types and structures of the early embryo. They designed stem cell models to study formation of yolk sac founders, called hypoblast.

The key discovery, published in Cell Stem Cell, is pinpointing a critical signal that acts during a short window of time, less than one day, to trigger cells to become hypoblast. The signal is a protein called fibroblast growth factor that is made within the embryo. Previous studies had missed the importance of this signal in human embryos. The new findings show that the initial processes that form an embryo and its supporting tissues are similar for humans and other mammals.

Lead author Dr Ge Guo, of the University of Exeter’s Living System Institute, said: “Our findings provide insights into how the correct proportions of different cell types form in the early human embryo. We hope our research will benefit infertility treatment in future.”

Professor Austin Smith, the Director of the University of Exeter’s Living Systems Institute, said: “This study shows the power of stem cell-based models for revealing how the human embryo begins to develop. This marks a significant milestone in stem cell research and embryo models, providing a framework for future research into the early development of the human embryo.

The paper is entitled ‘Naive pluripotent stem cell-based models capture FGF-dependent human hypoblast lineage specification’ and is published in Cell Stem Cell. The work is a collaboration with Professor Jennifer Nichols at the University of Edinburgh.

ENDS 

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JOURNAL

Cell Stem Cell

DOI

10.1016/j.stem.2024.05.003 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Cells

ARTICLE TITLE

Naive pluripotent stem cell-based models capture FGF-dependent human hypoblast lineage specification’

ARTICLE PUBLICATION DATE

31-May-2024

Disclaimer: AAAS

MINERAL ALCHEMY

Ancient medicine blends with modern-day research in new tissue regeneration method

Inspired by past medical uses of natural, inorganic materials, researchers have discovered a new technique for tissue regeneration using mineral-based nanomaterials.

TEXAS A&M UNIVERSITY

For centuries, civilizations have used naturally occurring, inorganic materials for their perceived healing properties. Egyptians thought green copper ore helped eye inflammation, the Chinese used cinnabar for heartburn, and Native Americans used clay to reduce soreness and inflammation.

Flash forward to today, and researchers at Texas A&M University are still discovering ways that inorganic materials can be used for healing.

In two recently published articles, Dr. Akhilesh Gaharwar, a Tim and Amy Leach Endowed Professor in the Department of Biomedical Engineering, and Dr. Irtisha Singh, assistant professor in the Department of Cell Biology and Genetics, uncovered new ways that inorganic materials can aid tissue repair and regeneration.

The first article, published in Acta Biomaterialia, explains that cellular pathways for bone and cartilage formation can be activated in stem cells using inorganic ions. The second article, published in Advanced Science, explores the usage of mineral-based nanomaterials, specifically 2D nanosilicates, to aid musculoskeletal regeneration.

“These investigations apply cutting-edge, high-throughput molecular methods to clarify how inorganic biomaterials affect stem cell behavior and tissue regenerative processes,” Singh said.

The ability to induce natural bone formation holds promise for improvements in treatment outcomes, patient recovery times and the reduced need for invasive procedures and long-term medication.

“Enhancing bone density and formation in patients with osteoporosis, for example, can help mitigate the risks of fractures, lead to stronger bones, improve quality of life and reduce healthcare costs,” Gaharwar said. “These insights open up exciting prospects for developing next-generation biomaterials that could provide a more natural and sustainable approach to healing.”

Gaharwar said the newfound approach differs from current regeneration methods that rely on organic or biologically derived molecules and provides tailored solutions for complex medical issues.

“One of the most significant findings from our research is the ability of these nanosilicates to stabilize stem cells in a state conducive to skeletal tissue regeneration,” he said. “This is crucial for promoting bone growth in a controlled and sustained manner, which is a major challenge in current regenerative therapies.”

Gaharwar recently received a research program (R01) grant from the National Institute of Dental and Craniofacial Research to continue developing biomaterials for clinical applications. With the grant, Gaharwar will use inorganic biomaterials in conjunction with 3D bioprinting techniques to design custom bone implants for reconstructive injuries.

“In reconstructive surgery, particularly for craniofacial defects, induced bone growth is crucial for restoring both function and appearance, vital for essential functions like chewing, breathing and speaking,” he said. “Inducing bone formation has several critical applications in orthopedics and dentistry.”

Former biomedical engineering graduate student, Dr. Anna Kersey ’23, was the lead author for the article published in Acta Biomaterialia and biomedical engineering graduate student Aparna Murali was the lead author for the follow-up article published in Advanced Science.

“This approach not only bridges ancient practices with modern scientific methods but also minimizes the use of protein therapeutics, which carry risks of inducing abnormal tissue growth and cancerous formations,” Gaharwar said. “Collectively, these findings elucidate the potential of inorganic biomaterials to act as powerful mediators in tissue engineering and regenerative strategies, marking a significant step forward in the field.”

 By Bailey Noah, Texas A&M Engineering

 

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JOURNAL

Advanced Science

DOI

10.1002/advs.202402468 

ARTICLE TITLE

Inorganic Biomaterials Shape the Transcriptome Profile to Induce Endochondral Differentiation

 

AMS Science Preview: Sea-ice loss may accelerate; tornadoes and flying cars

Early online research from journals of the American Meteorological Society

Peer-Reviewed Publication

AMERICAN METEOROLOGICAL SOCIETY

 

IMAGE: 

“FIG. 1. PHOTOGRAPH OF A THROWN COMBINE FROM THE GROUND SURVEY OF THE JULY 1, 2023, DIDSBURY, AB EF4 TORNADO” FROM MILLER ET AL. (2024), "Estimating Wind Speeds in Tornadoes using Debris Trajectories of Large Compact Objects," MONTHLY WEATHER REVIEW.

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CREDIT: FIG. 1. PHOTOGRAPH OF A THROWN COMBINE FROM THE GROUND SURVEY OF THE JULY 1, 2023, DIDSBURY, AB EF4 TORNADO” FROM MILLER ET AL. (2024), "ESTIMATING WIND SPEEDS IN TORNADOES USING DEBRIS TRAJECTORIES OF LARGE COMPACT OBJECTS," MONTHLY WEATHER REVIEW.

The American Meteorological Society continuously publishes research on climate, weather, and water in its 12 journals. Many of these articles are available for early online access–they are peer-reviewed, but not yet in their final published form.

Below is a selection of articles published early online recently. Some articles are open-access; to view others, members of the media can contact kpflaumer@ametsoc.org for press login credentials.

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JOURNAL ARTICLES

Large-Scale Climate Modes Drive Low-Frequency Regional Arctic Sea Ice Variability
Journal of Climate

Arctic sea ice loss may accelerate in the coming decade. This study examined the dominant natural climate patterns affecting Arctic summer sea ice, including the Interdecadal Pacific Oscillation, El Niño-Southern Oscillation, and the Atlantic Multidecadal Observation. The results suggest that the phases of these dominant patterns favor enhanced loss of Arctic sea ice in the next ten years.

Extreme Temperatures, Birth Outcomes, and Social Inequalities: Evidence from South China
Weather, Climate, and Society

Exposure to extreme temperatures may lead to adverse birth outcomes in China. Low birth weight is correlated with long-term adverse health outcomes. Analysis of 1 million+ birth records from Dongguan, China shows that a 1% increase in days a pregnant person was exposed to extreme heat was associated with an average reduction in birth weight of 2.31 g and a 2% increase in odds of low birth weight. The link was stronger when birthing parents were migrants or less educated, and for vaginal births. Extreme cold was also associated with adverse outcomes, though slightly less severe.

Changes in the Typhoon Intensity under a Warming Climate: A Numerical Study of Typhoon Mangkhut
Journal of Climate

Ocean warming intensifies typhoon … somewhat. Researchers modeled Super Typhoon Mangkut (2019) under conditions of increased ocean warming, finding that warming increases the energy available to a developing typhoon. However, while typhoon intensity is likely to increase in the future, the study suggests that intensity will be moderated somewhat by future changes in atmospheric temperature and humidity.

Assessing NOAA Rip-Current Hazard Likelihood Predictions: Comparison with Lifeguard Observations and Parameterizations of Bathymetric and Transient Rip-Current Types
Weather and Forecasting

NOAA rip current forecasting model underpredicts transient rip currents. This study evaluated the performance of NOAA’s rip current forecast model with results from remote sensing and lifeguard observations at Salt Creek Beach in Dana Point, California. They found that NOAA’s model did a good job predicting bathymetric rip currents (which occur when waves break on sandbars interspersed with channels), but was less able to predict transient rip currents, which are shorter in duration and are caused by breaking waves coming from multiple directions.

Long-Term Climate Impacts of Large Stratospheric Water Vapor Perturbations
Journal of Climate

2022 Hunga Tonga volcano may have worldwide effects for several more years. The massive atmospheric injection of water vapor from the Hunga Tonga-Hunga Ha’apai (HTHH) volcanic eruption continues to have regional atmospheric warming and cooling effects around the world, which may not peak until 2025–2029 in some areas, according to a new modeling study. Model simulations indicate winter temperature increases over North America, the Arctic, and central Eurasia, and cooler temperatures over Scandinavia and Australia during southern hemisphere winter. They also found precipitation anomalies in areas including Europe, the U.S. West Coast, and the Pacific and Indian Oceans.

Tornadoes

Several recent papers have focused on tornadoes and their impacts.

A Comprehensive Analysis of the Spatial and Seasonal Shifts in Tornado Activity in the United States
Journal of Applied Meteorology and Climatology

Study confirms true eastward (and seasonal) shift in U.S. tornado dangers. Studies have suggested that the area of greatest tornado danger has moved eastward, away from the Great Plains and toward the Southeast and Midwest. This comprehensive study used data from 1951 to 2020 to confirm that tornado activity to the east has increased–all due to an increase in autumn and winter tornadoes–while western tornadoes have decreased by 25%. Jackson, MS, saw the greatest tornado increase; Cleburne, TX, saw the greatest decrease during the study period.

Estimating Wind Speeds in Tornadoes using Debris Trajectories of Large Compact Objects
Monthly Weather Review

Can flying cars and fridges help rank tornado winds? The EF scale only uses certain types of tornado damage to estimate wind speed, ignoring the harder-to-characterize evidence of cars and other large objects picked up by the storm. This study analyzed large debris from Canadian tornadoes using computer simulations. When solely estimating the wind speed needed to pick up and move the objects, their results agreed with general EF rankings of tornadoes; however, considering the actual flight path of the object led to a higher wind speed estimate than other ways of ranking the tornado.

Linking Survivor Stories to Forensic Engineering: How an Interscience Approach Reveals Opportunities for Reducing Tornado Vulnerability in Residential Structures
Bulletin of the American Meteorological Society

Tornado survivors help researchers understand the aftermath. An interdisciplinary research team tested a new approach to assessing storm damage, and found that “survivors’ stories, photos/video and access to structural elements were invaluable for understanding how a tornado interacted with the residence.” Surveys found that most survivors took sheltering actions, but they were half as likely to reach a good sheltering place when a tornado struck at night. Half were able to describe important details (e.g., sequences of events) that helped researchers better characterize the storm and its impact.

The Tornado Archive: Compiling and Visualizing a Worldwide, Digitized Tornado Database
Bulletin of the American Meteorological Society

A global tornado archive. A new tornado database, the Tornado Archive, is the most comprehensive ever, combining over 100,000 tornado records from around the world–thus establishing a lower boundary for the number of documented tornadoes and improving our ability to study global tornado climatology. While information varies greatly across time and space, some trends are evident, including a decrease in tornadoes during the Dust Bowl, disproportionately large numbers of tornado fatalities in Bangladesh (8,325 recorded despite relatively low tornado frequency), and a strange uptick in Mediterranean tornadoes during the winter.

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You can view all research published in AMS Journals at journals.ametsoc.org.

About the American Meteorological Society

The American Meteorological Society advances the atmospheric and related sciences, technologies, applications, and services for the benefit of society. Founded in 1919, AMS has a membership of around 12,000 professionals, students, and weather enthusiasts. AMS publishes 12 atmospheric and related oceanic and hydrologic science journals; hosts more than 12 conferences annually; and offers numerous programs and services. Visit us at www.ametsoc.org/.

About AMS Journals

The American Meteorological Society continuously publishes research on climate, weather, and water in its 12 journals. Some AMS journals are open access. Media login credentials are available for subscription journals. Journals include the Bulletin of the American Meteorolocial Society, Weather, Climate, and Society, the Journal of Climate, and Monthly Weather Review.

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JOURNAL

Journal of Climate

 

CU researchers analyze prevalence, impact of ethical or religious barriers to providing medical aid in dying

The recently published paper finds that 26% of physician respondents reported large ethical or religious barriers to participating in medical aid in dying, but many were still willing to engage in discussions with patients and provide referrals for care.

UNIVERSITY OF COLORADO ANSCHUTZ MEDICAL CAMPUS

Recently published research led by the University of Colorado Anschutz Medical Campus examined the prevalence — and impact — of physicians’ ethical or religious barriers to their involvement in medical aid in dying (MAiD), a multi-step process where a physician provides a terminally ill adult with decision-making capacity with a lethal dose of medication to end their life.  

The research article, “Conscience-Based Barriers to Medical Aid in Dying: A Survey of Colorado Physicians,” was published this May in the Journal of General Internal Medicine. It shows that 26% of physician survey respondents reported large ethical and/or religious barriers to their involvement in MAiD.  

Despite these barriers, the research suggests these conscience-based barriers do not appear to affect these physicians’ willingness to discuss medical aid in dying with their patients. However, they are much less likely to have any direct participation in it — being significantly less likely to serve as a consulting or attending physician — compared to physicians without these barriers. 

Informing public policy 

As legislators and health leaders across the nation continue to debate policies related to medical aid in dying, research like this is vital to making informed decisions. 

“Medical aid in dying is under consideration in a number of states, and it comes up every legislative session. You cannot make policy around things that are not well understood, and so it was critical to gather data to better understand what's going on,” says Mika Hamer, PhD, MPH, the first author on the paper and a post-doctoral research fellow with the CU Center for Bioethics and Humanities. “It is important to look at the actual behaviors of physicians. This research offers essentially the first look into what is happening on the ground in a previously hidden and difficult-to-study population.”  

For Hillary Lum, MD, PhD, a co-author of the paper and associate professor in the CU Division of Geriatric Medicine, getting involved in this research was important to her as a geriatrician and palliative medicine physician, given that questions about MAiD may arise when caring for older adults with serious illnesses.  

“Medical aid-in-dying was legalized in 2016 in Colorado, but physician experiences providing care for patients seeking MAiD was under-studied,” Lum says. 

A reason for the lack of data is because there are extensive protections in place for physician and patient privacy. As a result, the vast majority of data that exists are from qualitative studies or surveys of the general physician population.   

“There is a long-standing debate around MAiD — the legality, the ethical appropriateness, the morality — and people have extremely strong opinions about it. But when we let those really strong opinions drive policy, rather than empirical data, we run the risk of implementing misguided policy that is more amenable to the cultural sentiment or social context at the time,” Hamer says. 

To gather data about this important issue, researchers used anonymized, aggregate information on the 554 patients known to have received a MAiD prescription in Colorado from 2017 to 2020 and then identified the clinical conditions most prominent in this patient population. The research team then determined which physicians in Colorado were providing care to patients likely to qualify for MAiD based on their clinical conditions and sent them an anonymous survey regarding their willingness to provide MAiD and actual prior participation in MAiD. Ultimately, 300 physicians responded. 

Since then, researchers have published several papers about the study, including: a scientific report about the research methodology; an analysis of physician’s attitudes and experiences; an examination of their perspectives on disclosure, presence, and eligibility; and the use and influence of medical aid in dying service on physician experiences.  

“We felt there was an opportunity to look at this untapped aspect of the survey research. We had a hunch that there was something about ethical or religious barriers that may be different than other types of barriers physicians faced, like lack of time or fear of stigma,” Hamer says.  

“We wanted to understand what these physicians have actually done when faced with these decisions, and we had a unique opportunity to measure that and lend some empirical data into what is a very contentious topic — but one that’s really quite understudied as far as hard data goes,” she adds.   

Lum agrees with Hamer, saying: “In the absence of data, it’s easy to make assumptions — either that there are many physicians who have a conscientious objection to MAiD, or that there are few.” 

“Thus, this study was important to actually measure the percentage of physicians who have a religious or ethical reason for not participating in MAiD activities,” Lum adds.  

What the research shows 

Out of the 300 survey respondents, 26% of physicians likely to care for MAiD-eligible patients in Colorado reported large ethical and/or religious barriers to participating in MAiD activities.  

The survey also shows physicians with a longer time in practice and those identifying as non-white were more likely to report these conscience-based barriers. 

Hamer said she was surprised that the survey data shows the physicians with these conscience-based barriers are still willing to participate in some aspects of the MAiD process. Specifically, when comparing physicians with and without these barriers, there was no difference in ancillary participation, meaning having discussions about MAiD or referring patients to other providers.  

However, there were significant differences regarding direct participation in MAiD. To be eligible for MAiD, a patient must have decision-making capacity and a prognosis of less than six months to live. This prognosis must be independently verified by two physicians — an attending and consulting physician.  

The survey found that only 5% of physicians with conscience-based barriers had served as a MAiD consultant, as compared to 31% of physicians without conscience-based barriers. When it came to serving as a MAiD attending, no physicians with conscience-based barriers had served in this role compared to 21% of physicians without these barriers.   

“Participation looks different for different people. As far as consulting or attending, which are much more active roles that may involve writing prescriptions or doing evaluations — that’s where we start to see those barriers really show up in terms of changes in behavior,” Hamer says.  

Lum says, “I think this emphasizes the importance of the relationship between physicians and patients. Whether a physician is willing to discuss, refer, serve as a consulting physician, or serve as a MAID attending physician is likely to vary. And there may be different reasons and situations related to the individual patient.” 

Both Hamer and Lum noted that this study was limited in its sample size, highlighting the need for further research. With regard to conscience-based barriers, Hamer says it is important to distinguish that these “are not necessarily barriers to be overcome in the traditional sense of barriers.” 

“We really see this as a space where physicians need accommodation — not intervention to help change their mind around this barrier,” Hamer says. “It calls for continued protection of physician rights to conscientiously object or not participate in a service to which they have deeply held, conflicting beliefs.” 

There is also a need to better understand what support systems and processes need to be in place in clinics or hospitals to help support those physicians who have religious or ethical barriers. For instance, perhaps a formal referral process could be created so that physicians with these barriers can be involved in the beginning stages of MAiD, but when it comes to the more active roles, there is an established team the patient can be referred to.  

“We must have protections in place and processes to support these physicians while ensuring patients are able to get the care they desire,” Hamer says. “It is something that needs to be considered especially as the legality of MAiD potentially expands. We need a balance between protecting physicians’ rights and preserving patient access.”  

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JOURNAL

Journal of General Internal Medicine

DOI

10.1007/s11606-024-08782-y 

ARTICLE TITLE

Conscience-Based Barriers to Medical Aid in Dying: A Survey of Colorado Physicians

 

Want to be a successful scientist? The McClements family has some tips

Senior food scientist from UMass Amherst joins with daughter and nephew to write latest book

Book Announcement

UNIVERSITY OF MASSACHUSETTS AMHERST

 

IMAGE: 

DAVID JULIAN MCCLEMENTS, DISTINGUISHED PROFESSOR OF FOOD SCIENCE, CO-WROTE HIS LATYEST BOOK WITH DAUGHTER ISOBELLE FARRELL MCCLEMENTS AND NEPHEW JAKE MCCLEMENTS.

 

 

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CREDIT: COURTESY OF DAVID JULIAN MCCLEMENTS

The latest book of prolific author David Julian McClements is a family affair. The Distinguished Professor of Food Science, along with his daughter Isobelle Farrell McClements and nephew Jake McClements, have written “How to be a Successful Scientist: A Guide for Graduate Students, Postdocs, and Professors” (Springer, 2024).

The three authors offer different perspectives as scientists at different stages in their careers. Julian McClements, who has published more than 1,300 scientific articles and numerous books, is the most highly cited author in food science in the world and a renowned expert in food design and nanotechnology.

Jake McClements recently completed his Ph.D. in the United Kingdom and is now a lecturer at Newcastle University in Newcastle on Tyne, focusing his research on developing next-generation biosensors to improve human health and well-being.

Isobelle McClements has just completed her first year as a Ph.D. student in chemistry and chemical biology at Cornell University in Ithaca, N.Y.

“We hope this book will be useful for those wanting to be more efficient and impactful scientists,” Julian McClements says.

The book includes tips on designing, performing, and analyzing experiments, writing manuscripts, preparing scientific presentations, writing grant proposals, networking and defending a graduate thesis, among other things. 

“A major emphasis of the book is the importance of writing and publishing scientific manuscripts, as this is the main way that scientific knowledge is disseminated, as well as being an important element for building a strong curriculum vitae,” the senior McClements says.

 

Overcoming barriers to heat pump adoption in cold climates and avoiding the 'energy poverty trap'

UNIVERSITY OF MICHIGAN

 

 

Converting home heating systems from natural gas furnaces to electric heat pumps is seen as a way to address climate change by reducing greenhouse gas emissions.

 

But a new University of Michigan study of 51 Southeast Michigan households shows that switching to efficient, cold-climate heat pumps would increase annual utility bills by an average of about $1,100.

 

Home weatherization upgrades, such as adding attic insulation and sealing around doors and windows, could help reduce utility bills and make electric heating more affordable.

 

But those energy retrofits are expensive and are likely beyond the reach of many low-income households, which could lead to what the researchers call an energy poverty trap.

 

"The clean energy transition is hindered by an energy poverty trap because the extensive retrofits needed to make electrification affordable are themselves too expensive for low-income households," said study lead author Claire McKenna, a doctoral candidate at the U-M School for Environment and Sustainability.

 

"Our findings suggest that heat pumps are not a feasible economic alternative for households currently using natural gas, unless governments offset energy cost premiums through public funding. Policymakers should act to help lower the operating costs of heat pumps compared to natural gas for low-income households in cold climates."

 

The study was published online May 31 in the peer-reviewed journal Resources, Conservation & Recycling.

 

Residential heat pumps are reversible air conditioners that use electricity to move heat from one place to another, providing both heating and cooling in a building. In the winter, heat pumps move heat from the outdoors into a building, and in summer they move heat from the inside to the outside.

 

Heat pumps are growing in popularity and for the last two years have outsold gas furnaces in the United States.

 

For their study, U-M researchers analyzed utility bills, thermostat settings and energy burdens—the proportion of income that households spend on electricity and gas costs—for 51 homes in Wayne and Washtenaw counties, half of them below median income levels. Then they used a heat pump coefficient-of-performance model to determine energy cost and energy-burden impacts of switching to a heat pump.

 

The researchers also hired a contractor to conduct energy assessments of the homes and to provide energy-retrofit recommendations, including estimated costs and savings.  Members of the research team are from U-M's School for Environment and Sustainability, the Institute for Social Research and the School of Public Health.

 

The researchers found that converting homes to electric heat pumps would increase annual energy costs 58%, on average. Below-median-income households, which today experience a median energy burden of 6% (which is considered high and is twice the national average), would see that burden rise to 10% if they switched from natural gas heating to electric heat pumps.

 

Weatherization could offset the increase, bringing energy burdens back down to pre-electrification levels. However, median payback time for the retrofits was 24 years, making them "infeasible for the poorest," according to the study authors.

 

And it's not just the lowest income households that would feel the pinch of the heat pump transition.

 

Households earning $50,000 or more annually, which currently have a median energy burden of 2.6%, would see that number rise by more than one percentage point, on average, indicating that "energy burden could become a concern for households which are currently energy secure," according to the study.

 

The 51 homes in the study were, on average, 60 years old and were built in an era when Michigan did not have energy-efficient building codes. The cost of the average retrofit package recommended by the energy-audit contractor was $7,628.

 

On top of that, efficient cold-weather residential heat pumps typically cost between $5,000  and $10,000 for the hardware, and installation costs can double the total price tag.

 

"The upfront costs of weatherization and heat-pump installation can be very high," said study senior author Parth Vaishnav of the School for Environment and Sustainability. "Our findings clearly demonstrate the challenges associated with heat pump adoption in cold climates."

 

In the study, the lowest-income households had the least energy-efficient homes and also used the lowest amount of energy. That finding suggests that low-income households are likely not using enough energy to meet their health, safety and comfort needs, McKenna said.

 

Given that households below median income currently have a 6% median energy burden on their existing natural gas heating systems, the transition to electric heat pumps "would severely worsen existing energy insecurity," the study authors wrote.

 

"That, in turn, could increase coping behaviors like trading off paying utility bills for paying for rent or food, or the underconsumption of energy in households that struggle to pay their bills. This could have huge ramifications for health," said study co-author Carina Gronlund, an environmental epidemiologist at the U-M Institute for Social Research and the School of Public Health.

 

The researchers identified three ways that policymakers can help lower heat pump costs for low-income households in cold climates. First, government-sponsored initiatives to advance more energy-efficient heat-pump technology are essential.

 

Second, state regulators should exercise "a more robust scrutiny" of utility company returns and create more opportunities to improve customer outcomes in the rate-making process. Most households in the U-M study were DTE customers, with a few supplied by Consumers Energy.

 

Third, states should consider implementing "percentage of income payment plans," known as PIPPs, which place a cap on energy expenditures relative to household income. Such programs can be paired with federal- and state-funded retrofit programs to simultaneously improve the building stock and mitigate energy poverty, according to the study authors.

 

"The economics of electrification are adverse for the existing housing stock in cold climates," the authors concluded. "Policy action is needed to make heating electrification viable."

 

The study was funded by the U-M Graham Sustainability Institute's Heating with Justice project and by the U.S. Department of Energy Building Technologies Office Innovation in Buildings graduate research fellowship.

 

Study: Heating with justice: Barriers and solutions to a just energy transition in cold climates (DOI: 10.1016/j.resconrec.2024.107699)

 

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JOURNAL

Resources Conservation and Recycling

DOI

10.1016/j.resconrec.2024.107699 

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