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Medscape
30-07-2025
- Health
- Medscape
Terri Schiavo's Legacy: When to Ethically Stop Life Support
This transcript has been edited for clarity. Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of Medicine in New York City. Twenty years ago this month, from the time I'm talking with you, in March 2005, a young woman named Terri Schiavo was allowed to die. It was one of the most controversial, and probably the most important, end-of-life-care cases ever to unfold in the United States. Terri was left permanently unconscious after a heart attack. Her husband [Michael Schiavo], after efforts were made to see if they could revive her and after efforts were made to see if she really was permanently unconscious, basically said she would not want to be in this state. She was kept alive by artificial nutrition, artificial fluids, and he said she just wouldn't want to be hereunable to think, sense, or feel, implying, "I know her, I have decision-making authority, and I want her feeding tubes and her artificial fluids disconnected. I want her to be allowed to die. That's what she would want." He wasn't saying that's what he would want. He said that's what she would want, acting as her, if you will, guardian or person making a substituted judgment. Terri's parents and her brother did not agree. They felt that Terri might recover. They also argued that they weren't totally convinced she was completely unable to communicate, think, feel, or hear. They made tapes when they went to visit her that suggested that she wasn't totally unconscious and was somewhat responsive. They went to court in the state of Florida where Terri was after her heart attack in a long-term care facility and engaged in a legal battle with Michael, the husband, to keep her alive. That fight took over 8 years, I think. It went up and down the Florida court system as to who could make the decision on whether artificial nutrition and fluids could be stopped. The fight reached 14 Florida courts, up and down their appellate system, then five federal courts, then intervention from the US Congress on the side, I should add, of Terri's parents and siblings. There were people arguing from the floor of Congress, including Congressman David Weldon and Senator Bill Frist [both of whom are physicians], that they didn't think she was in a permanent vegetative was very controversial because they made that diagnosis based on videos, without seeing her. Ultimately, the Supreme Court was approached. They said they were not going to hear the case, but the last court decision gave authority to the husband. On March 31, 2005, Terri's artificial life support was discontinued and she died. That case has reverberated throughout American healthcare ever since. It's not just a story of how we got to where we are in terms of having the right to stop care that a person doesn't want. This set the stage for stopping care that some people think is not medical care — food and water — but others argue quite vociferously that it's technology coming through a tube made out of special solutions,not eating pudding off a spoon. One issue that seems to have been resolved by the Schiavo case is that artificial feeding, artificial life support, and artificial fluids are medical technologies and can be stopped. At the same time, we have had many arguments since about how you adequately diagnose permanent vegetative state. Some scientists today are arguing that even with what we think is permanent vegetative state, there still may be some consciousness there. I don't believe that was true at all for Terri because on autopsy, her brain had shrunk to the size of a walnut. Her optic nerves had disconnected from her brain. She would not have been able to sense, feel, observe, or respond to any stimuli. Do we have to make a more precise diagnosis of permanent vegetative state before we get into arguments about what to do next? I do believe also that it's important, if you are dealing with someone who's terminally ill or has a serious illness, to get the discussion going early about who's in charge. We still have fights between husbands, families, sisters, and cousins coming in about who has veto power or decision-making power. The earlier we can establish who it is that the patient wants to speak for them if they can't, the better. Reenacting that war that we saw in the courts and Congress over Terriis a lesson that early communication, although it's hard to do, can really save terrible and disturbing emotional battles — not only for the family, but also for the nurses, doctors, and everybody who's involved in treating someone when one of these fights breaks out about stopping food and water, shutting off the ventilator, or stopping dialysis or antibiotics. Terri has quite a legacy. She left us with the understanding that it is possible legally and ethically to end life support, that someone else can make that decision, and that a [spouse] has more standing than the rest of the family. Given all that, it's still important to engage in early, explicit discussion about who ought to be in charge if the patient can't be. I'm Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for watching.
Medscape
08-07-2025
- Health
- Medscape
Why Long COVID May Hit Toddlers Harder Than Thought
In young children, the long-term effects of SARS-CoV-2 infection may differ significantly from those in older children or adults. A recent study in JAMA Pediatrics systematically investigated the symptoms experienced by children under the age of 5 years and the frequency of long COVID in this age group. The analysis revealed that 14% of infants and toddlers and 15% of preschoolers in the cohort showed symptoms consistent with long COVID. Roland Elling, MD, is the head of Pediatric Infectious Disease Research at University Medical Center Freiburg, Freiburg, Germany. He also serves as the principal investigator of the MOVE-COVID-BW project, a multicenter initiative in Baden-Württemberg, Germany, focused on long COVID in children and adolescents. Speaking to Medscape Medical News, Elling expressed surprise at the reported rates. Symptom Discrepancy 'This would mean that 1 in 6 children in these age groups develop long-term COVID after a SARS-CoV-2 infection. This does not correspond to the clinical reality we experience in our specialized outpatient clinics,' said Elling. 'In our view, long COVID is primarily a condition of the second decade of life, not the first 10 years. We see almost no cases in toddlers — and that holds true at all university clinics in Baden-Württemberg, not just Freiburg,' he added. In contrast, findings from a multicenter cohort study suggested a different age pattern. Rachel S. Gross, MD, professor at NYU Grossman School of Medicine in New York City, and co-principal investigator of the NIH RECOVER Pediatric Observational Cohort Study, led the study from 2022 to 2024. The results identified persistent post-COVID symptoms, even among children under the age of 5 years. The study combined retrospective and prospective data to identify symptoms that are more common in children with prior SARS‑CoV‑2 infection and to develop an age-specific long COVID index. The researchers enrolled 472 children aged 0-2 years and 539 children aged 3-5 years. Among them, 59% (278 of 472) of the younger group and 74% (399 of 539) of the older group had documented prior infections. These findings produced distinct symptom indices for each age group. Elling noted a key limitation: 'Seroprevalence studies showed that by 2023, over 90% of children had been infected with SARS-CoV-2. As younger children often have asymptomatic infections, many cases may have been missed. No serologic testing was performed; all data relied on parental information.' On average, parents of younger children were surveyed 10 months after infection, and parents of preschoolers were surveyed 17 months after infection. Although this helps separate long COVID from short-term symptoms, Elling stated that the long delay makes the data unreliable. 'I cannot reliably ask parents if their child had symptoms lasting 4 weeks over a year ago,' he said. The questionnaires assessed 41 symptoms in children aged 0-2 years and 75 symptoms in preschoolers aged 3-5 years. These symptoms were grouped into eight clinical areas: general health, ENT, heart and lungs, digestion, skin, muscles and joints, nervous system, and mental health. According to the Long COVID Symptom Index developed in the RECOVER project, 14% of children aged 0-2 years and 15% of those aged 3-5 years were identified as likely to have long COVID. Age-Specific Symptom The most common symptoms in infants and toddlers were sleep disturbances, irritability, loss of appetite, nasal congestion, and a productive cough. According to parents, preschoolers more often experience dry cough, daytime fatigue, and low energy levels. Parents also reported that children with more severe symptoms had a poorer quality of life, reduced overall well-being, and sometimes developmental delays. 'In older children and adolescents, it is neurocognitive symptoms such as postexertional malaise or brain fog that significantly impact daily life — not cough or other respiratory issues,' said Elling. He noted that these complex symptoms are difficult to detect in young children. Conclusion Studies have shown that less than 1% of adolescents develop long COVID, with the risk likely to be even lower in younger children. Elling said, 'Young children cope better with COVID-19 than adolescents and adults.' Elling agreed with the authors that long COVID presents differently in very young children than in older children and should be defined and studied by age. 'I would go even further,' he said. 'To truly understand the disease, we need to move away from the broad term 'long COVID,'' he said. Elling emphasized that long COVID should be classified not only by age but also by the organ systems affected. 'It is medically inaccurate to group all symptoms lasting more than 12 weeks — such as headache, anosmia, or dyspnea — under one broad diagnosis. We don't do this for any other disease,' he said. These symptoms are likely to have different underlying mechanisms; for example, loss of smell after COVID-19 is not the same as chronic headaches or breathing issues. Despite some methodological limitations, Elling supported the study's approach. 'Systematic assessment of long COVID in early childhood is important. However, we must remain realistic. If the data suggest that four children in every class develop long COVID after a SARS-CoV-2 infection, it would be a serious concern. But I don't think that's actually the case,' he said. This story was translated from Medscape's German edition.
Yahoo
03-07-2025
- Health
- Yahoo
Is This Popular Wellness Trend Worth Your Money? Doctors Share Surprising Answer
Vitamin IV therapy is one of the latest wellness trends to hit the zeitgeist. The idea is that when you're feeling sick, hungover, or otherwise under-the-weather, you get hooked up to an IV bag full of vitamins and minerals. Proponents claim the therapy can energize you, boost your immune system, and make your skin look more radiant. But can it? We spoke with two doctors to find out the truth. They explain whether vitamin IV therapy works, who should consider trying it, and whether there are any risks you should be aware of before you do. Vitamin IV clinics claim the therapy offers all kinds of benefits: It can help you beat your hangover, brighten your skin, or cure your common cold. But experts say for the most part, evidence to support these claims is scant. 'I do not know of any convincing evidence that, for example, an IV drip of zinc, B12, C, and magnesium will cure colds and flu,' says Sidney C. Ontai, M.D., a family medicine doctor and associate clinical professor at Texas A&M College of Medicine. But Albert Ahn, M.D., an internal medicine physician and clinical assistant professor at NYU Grossman School of Medicine, says vitamin IV drips could offer two clearcut benefits. First, vitamin IV therapy helps your body absorb vitamins and minerals faster than a traditional oral supplement. 'Some people may prefer that quick fix,' Dr. Ahn says. 'Will it boost your [vitamin and mineral] stores quicker? Yes it will. But to sustain those stores, you'll still need to continue to take it in. You're better off probably taking an oral supplement on a daily basis.' Second, vitamin IV therapy also boosts your hydration levels. 'That will, for most people, make you feel better—whether you have a cold or an infection, or you're a little hungover or feeling a little under-the-weather,' Dr. Ahn says. But you can reap the same benefits by simply drinking more fluids. And if you're healthy and hydrated before you get the IV drip, odds are, you'll just excrete any extra fluids your body doesn't need. 'If you don't absolutely need these drips, [you] might just be passing it out throughout the day,' Dr. Ahn says. It's possible you might feel better right after vitamin IV therapy. But if you're healthy, Dr. Ahn says any benefits can likely be chalked up to the placebo effect. Who could benefit from vitamin IV therapy? Anyone with a health condition that makes it challenging to retain or process nutrients. Delivering nutrients via IV ensures vitamins and minerals directly enter the bloodstream—bypassing the gut—which can help you replenish nutrients faster. Because of this, doctors routinely prescribe vitamin IV therapy for a number of medical conditions, says Dr. Ontai. For example, he might prescribe IV thiamine for someone going through alcohol withdrawal, IV B12 for renal dialysis patients, or IV multivitamins for people with health conditions that make it hard to tolerate or absorb food in the stomach or intestines. 'With certain conditions, the absorption [via IV] may be quicker,' Dr. Ahn explains. For example, people with chronic or severe anemia may find that taking oral iron supplements causes an upset stomach or other side effects. In contrast, getting an iron IV may replenish their levels faster without provoking stomach issues. But Dr. Ontai and Dr. Ahn agree that most relatively healthy people don't need vitamin IV therapy. You're better off saving your money—and getting your nutrients through your diet instead. 'For your average, healthy, young patient, it's probably not a necessity,' Dr. Ahn says. 'If they have good gut health and healthy habits and a decent diet, [they] should be able to get most of these [nutrients] through food and a normal diet.' While vitamin IV therapy may not offer all the benefits it claims to, experts say it's also unlikely to do you much harm. 'If it makes [you] feel better, there's not a whole lot of downside,' Dr. Ahn says. That said, it's always smart to exercise caution when getting an IV. 'Any time you introduce something intravenously, there are risks,' Dr. Ahn says. For example, you might experience bleeding, bruising, or risk of infection at the injection site. For this reason, Dr. Ahn says it's important to vet any clinic before getting treatment. 'Make sure you're going to a place that is well-certified and well-staffed and that does everything appropriately,' he says. 'You want to make sure everything's completely sterile because you're introducing something into the body that could potentially cause problems.' Perhaps the biggest downside of vitamin IV therapy is that it's expensive. Treatments often range from $100 to $500, and they're not usually covered by health insurance. That's a lot to spend on something you might excrete because your body doesn't need it. The bottom line: You don't need to waste your money on vitamin IV therapy if you're healthy. Unless you have a serious medical condition, experts say you're better off getting vitamins and minerals through food. 'There are very few vitamins that you're not able to get through food,' Dr. Ahn says. And if you're low on a key nutrient, talk to your doctor about oral supplementation. 'In general, oral administration is adequate and generally safer and more practical for most vitamin deficiencies,' Dr. Ontai says. By getting your nutrients the old-fashioned way, you can save time and money—and you're likely to see the same results. You Might Also Like Can Apple Cider Vinegar Lead to Weight Loss? 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Medscape
23-06-2025
- Health
- Medscape
Avoiding the COVID Shot Talk? Here's What to Do
Do you hesitate to bring up COVID vaccines with your patients? You're not alone — and experts said these conversations are becoming less common in routine care. The reasons are complex, ranging from short visit times and shifting clinical priorities to the health attitudes of both physicians and patients — and something Arthur Caplan, PhD, head of the Ethics Division at NYU Grossman School of Medicine, New York City, called 'COVID exhaustion.' Arthur Caplan, PhD 'There is a feeling that everybody who's going to get COVID either got it or got vaccinated or doesn't want [the shot],' said Caplan. But your silence can leave patients feeling unsure about what to do. New CDC guidance for COVID boosters — and even baseline vaccination — for healthy people (including children) has shifted toward shared clinical decision-making. What does that mean? According to the now-fired CDC vaccine advisory panel, shared clinical decision-making means 'informed by the best available evidence of who may benefit from vaccination; the individual's characteristics, values, and preferences; the healthcare provider's clinical discretion; and the characteristics of the vaccine being considered.' The panel added, 'There is not a prescribed set of considerations or decision points in the decision-making process.' In other words, you're on your own. All the major US physician organizations still recommend the shots for everyone 6 months and older. Amid widespread misinformation about the vaccines' risks and lack of benefit, there's another reason providers should bring them up — protecting those most at risk for severe COVID, Caplan said. 'We're so individualistic, so focused on personal choice, so focused on the individual, that we're undercutting a moral basis or the ethical basis for vaccination, which is the community,' he said. Surveys consistently showed that more people say they plan to get COVID vaccines than actually do, and the barriers throttling that conversion rate are unclear. If you find yourself hesitating to bring up the COVID vaccine, ask yourself why — so you can thoughtfully address that hesitation in practice. Why You Don't Bring Up COVID Shots With Healthy Patients Timothy Callaghan, PhD First, the elephant in the room: Many people are hesitant to talk about COVID vaccines because of how politically charged the topic has become, and clinicians are no exception. 'Physicians may be hesitant to bring up any topics that might induce partisan beliefs and lead people to be less trusting of seeking out medical care,' said Timothy Callaghan, PhD, associate professor at the Boston University School of Public Health, Boston, and an expert in vaccine hesitancy and health behavior. 'They might forego discussing those to make sure they're doing everything they can to keep patients engaged with the healthcare system so that they can keep them safe and healthy.' Jen Brull, MD Another key challenge is the topic's complexity. 'Sometimes those conversations need to be lengthy to let people feel comfortable that their questions were answered, their fears were addressed, the confusion was resolved,' said Jen Brull, MD, president of the American Academy of Family Physicians. 'In a 10- or 15-minute office visit, you might say, 'Do I want to open this Pandora's box today? Do I have time to do this? How late am I?'' In the pediatric setting, parents' perception is often that COVID is generally well-tolerated by healthy children, and they view COVID vaccines differently than they do vaccines that are required for school, said Jesse Hackell, MD, chair of the American Academy of Pediatrics Committee on Pediatric Workforce. 'If I've got a kid who needs the measles vaccine and the COVID vaccine, I don't want to poison the atmosphere for the measles vaccine by pushing the COVID vaccine,' Hackell said. Your move? Don't wait for the Pandora's box moment. Start preparing now. Your Vaccine Recommendation Plan You may not be thinking about your fall vaccine campaign yet, but now is the time to plan — before an unexpected surge leaves you unprepared. Jesse Hackell, MD One exception to fall timing is baseline vaccination of 6-month-olds, Hackell said. Data show the risk for severe illness during the first year is high, so these babies should get vaccinated 'as soon as possible.' Otherwise, here are some ways to incorporate COVID vaccine recommendations both in and outside the clinic:
Medscape
06-06-2025
- Health
- Medscape
Restricting Kids' Cell Phone Use at School: Ethicist
This transcript has been edited for clarity. Hi. I'm Art Caplan. I'm at the NYU Grossman School of Medicine, where I'm the head of the Division of Medical Ethics. The state that I live in, Connecticut, has seen some very interesting legislative proposals recently around cell phone use. Many other states — New York, New Jersey, and many others — are having similar Connecticut one, I think, is the furthest along of them all. It becomes important because I think parents ask questions about cell phone use for their kids. What should I be thinking? Should I restrict it? Is it dangerous? What should I do? The state of Connecticut wants to help. First, they've proposed legislation to pull cell phones out of schools — at least kindergarten up through high school — to get the cell phones taken away from the kids so that they're not distracted and that they're paying attention to the teacher and also engaged in social interaction. Even more radically, there's a proposal in Connecticut, a bill that would ban in young children from being able to access social media platforms, iPads, cell phones, or whatever between midnight and 6:00 AM. Is this a good idea? A colleague of mine at NYU, Jonathan Haidt, wrote a book called The Anxious Generation . He believes that the rates we see of teenagers who are now experiencing anxiety, which has increased from 2010 to today from 1 in 10 to 1 in 4; the number of teenagers experiencing depression, which has gone up from 1 in 10 to 1 in 5; and even death by suicide, one of the leading causes of deathfor kids aged 15-24, have to do with social media. Harassment, peer pressure, and getting stalked and bombarded with messages that attack self-esteem, target young people, and make them feel bad about their bodies can absolutely create mental health disorders. Is there sufficient evidence in his book?Do we have sufficient evidence from other studies to say for sure it's the cell phone or the iPad that somebody's looking at late at night? I'm going to concede that we don't. There's suggestive evidence, but not really many gold-standard studies that say, yes, it's the cell phone, iPad, or computerand where they are on social media. On the other hand, I support these legislative efforts, like Connecticut's, to get the cell phones out of school, to get kids talking to one another, to get them paying attention more, and to do what we can to get them off [of their devices] in the middle of the night. I would look at it this way.[Cell phones] may be causing problems by giving access to disturbing social media outlets. Let's face it, social media is a cesspool at this point, a sewer all over the place, and the companies that run it are doing nothing to self-regulate it. If we're wrong, the worst that happened is [kids] are not online for certain parts of the day. I know parents sometimes say, well, what about if there's a shooting or an emergency at school? I think we can manage that. You can absolutely have teachers with cell phones. The staff can have cell phones. It's not that there wouldn't be any ability to alert the police or to allow some communication as necessary with the kids.I don't think the rarity of a school shooting, as much as we worry about it, is enough to say, yes, let's let the kids just get lost all day long at school in their cell phones. I also understand why people are asking how this is going to really be enforced. Maybe it will be possible at school when you ask the kids to turn the cell phones in and lock them up or put them in a pouch where the teacher has the code or is that enforceable at home at night? One of the things missing, I think, from these efforts in Connecticut and elsewhere to decrease access by young kids to social media is the use of parental controls. I think some social platforms do a pretty good job saying before you give that cell phone to your kid or let them have their own computer, you're going to be able to program it with social parental discretion controls. Other platforms don't seem to care. Let's set some standards and expectations about what parents could do and would be able to do to restrict access at different times. It's going to take an across-the-board effort from parents, government requirements, and a willingness of people who control social mediato try to make sure that kids aren't getting in trouble, but we have to really start to take steps. We've got a problem in just saying there's nothing we could do about it, like the horse is out of the barn. That's not a response. I support the Connecticut effort. We'll see. I don't think federal government's going to be moving in this area anytime seem oriented toward deregulation. I think many states may, and I think that's something that, as physicians, we should try to support. Less access to social media at certain times of the day and night is not a bad thing for kids. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of for watching.
