Many doctors may have an unconscious bias that prompts them to take less aggressive steps to revive cancer patients who have had heart attacks than they would with people with other medical problems, an unusual new study has found.
Some of the bias may be explained by lack of awareness among physicians in some specialties of the ability of many cancer patients to survive indefinitely with their diseases. After researchers explained specifics of cancer survival, the willingness of some physicians to resuscitate a cancer patient increased.
Sampling of 182 Doctors
Researchers at the University of Texas Health Science Center in San Antonio who conducted the study also found that women physicians--at least those included in the study group--are less inclined than men to resuscitate cancer victims.
The physician who headed the project said she is uncertain whether the finding means women doctors are less inclined to expose their patients to the risk of lingering death and suffering or whether they are simply less aggressive than their male counterparts.
Dr. Valerie Lawrence urged caution in interpretation of the results because the findings were based on questionnaires filled out by 182 doctors at her center in San Antonio. She noted that her research had not attempted to follow up in detail to determine whether doctors actually did in practice what they said they would do on the questionnaires.
Specialty Groups Questioned
Nevertheless, she said, the results may be illustrative of subtle attitude biases against cancer patients among physicians that are not dissimilar to prejudices widely prevalent in the public at large. The biases could be a function of misunderstandings that lead people to think that anyone with diseases in the cancer group is more likely to die, anyway, than a patient with some other disorder. Lawrence's study was published in the journal Archives of Internal Medicine.
Lawrence found that cardiologists and pulmonary specialists favored resuscitation for cancer patients who went into cardiac arrest in just 60% of all cases when they were first asked their preferences. After an explanation of improved cancer survival rates, the same physicians said they would resuscitate about 75% of the cases.
Of four different specialty groups questioned, cancer treatment doctors said they would resuscitate most often. Overall, 74% of women initially favored resuscitation compared to 81% of men. After a clarification of cancer mortality risk, the percentages rose to 77% of women physicians and 85% of men.
"The first thing this should mean for patients is that doctors are human, too," Lawrence said. "They can have different attitudes and levels of knowledge. Patients shouldn't be afraid to question their physicians, and it's going to require a move on both sides to get brave about discussing these issues."
Menopause and Exercise
Postmenopausal women who engage in an exercise program that emphasises muscular fitness may improve their chances of avoiding bone deterioration from osteoporosis because sedate aerobics may alter blood chemistry enough to increase bone density.
That finding led the San Jose State University researcher who conducted the study to counsel women to actively pursue programs that emphasize what are called extension exercises.
Christine Snow-Harter, now at San Jose State but who did her study while affiliated with the University of Oregon, examined the effects of such exercise on 12 post-menopausal women who attended specially designed exercise classes three times a week, 50 minutes each. The exercisers were matched against a control group that did not exercise.
Blood chemistry changes--focusing on calcium levels and reflecting an increase in bone density--began to become apparent after only eight weeks in the program, Snow-Harter reported in the journal Physician and Sportsmedicine. She said the muscle fitness program "may positively alter" bone density chemistry and called the shortness of the exercise period required "encouraging."
Snow-Harter said she hopes to produce a videotape to show postmenopausal women how to perform potentially helpful exercises. One standard maneuver, she said, involves lying on the stomach with the hands clasped behind the back or resting alongside the hips. Once positioned that way, the woman lifts her head and chest from the floor.
Other variations can be used, including standing upright with the hands clasped stiffly behind the head, head pressing back against the hands while tilting the head back so the chin lifts toward the ceiling.
Premature Birth Risks
Five risk factors--one related to blood chemistry and four to socioeconomic status--have been identified as the possibly most significant explanations for the perplexing tendency of black women, as compared to whites, to give birth prematurely to dangerously small babies.
A study by doctors at Brigham and Women's Hospital in Boston found that many of the premature births seemed related to an abnormal hematocrit--the proportion of red cells in the blood.
But four strictly socioeconomic factors were related to low birth weight and prematurity, as well, the researchers reported in the New England Journal of Medicine. The four factors were being younger than 20, being single, being on welfare and not having been graduated from high school.
One risk factor implied a moderate increase in the risk of giving birth prematurely, while two or more risk factors elevated the risk significantly. The study was based on a review of the cases of 8,903 births to black and white women.