News briefs

Assisted dying not driven by poverty or poor access to health care

A Canadian study of people who received known as medical assistance in dying in Ontario found that about three‐quarters were in the care of palliative care practitioners at the time of their request for voluntary assisted dying, and that those assisted were younger, of higher socio‐economic status, and more likely to be married than the general population. These findings ease concerns that requests for assisted dying are driven by lack of access to palliative care services or by socio‐economic vulnerability. The study was published in CMAJ with a related editorial. Voluntary assisted dying has been legal in Canada since June 2016, and by October 2018, 6749 Canadians had received medical assistance in dying. The Canadian and Quebec governments have been discussing new eligibility criteria for medical assistance in dying after the Quebec Superior Court ruled that one provision of the law violated the Canadian Charter of Rights and Freedoms. The investigators compared clinical and socio‐economic data from the Office of the Chief Coroner for Ontario and ICES (a health informatics not‐for‐profit corporation) for 2241 Ontarians who had received medical assistance in dying with data for the 186 814 people in the province who had died during June 2016 – October 2018. The median age of patients who had received assistance to die was 75 years and half were women; almost two‐thirds of patients (64%) had cancer, 12% of patients had neurodegenerative diseases, 8.5% cardiovascular diseases, and 7.5% respiratory diseases. Patients who received assistance to die reported both physical (99.5%) and psychological (96.4%) suffering. The study found that only 6.6% of families reported problems obtaining medical assistance for dying, and these problems were not associated with socio‐economic status. The authors noted, however, that the dataset included only people who had actually received assistance, so their findings would not reflect the experience of patients who had requested but not received medical assistance in dying.

https://www.cmaj.ca/content/early/2020/02/11/cmaj.200016

https://www.cmaj.ca/content/early/2020/02/11/cmaj.200213

Cracking the code for hookworm infestation

Monash University researchers have uncovered a mechanism that allows hookworms to evade the human immune system, providing new hope in the search for a vaccine. Importantly, the researchers, led by Professor Nicola Harris of the Monash University Central Clinical School, may have discovered why infected people are unable to kill these parasites. Hookworms infect nearly around 700 million people around the world, mostly in countries where sanitation is poor and people often walk barefoot. The immune system is critical to thwarting infection by the hookworm, but the parasites are often able to evading its defences and people typically remain infected for life, often resulting in death or complications related to anaemia. The research, published in Cell Host and Microbe, shows that neutrophils, white blood cells central to immune responses, can kill hookworms by releasing neutrophil extracellular traps (NETs) of toxin‐coated DNA. However, hookworms have evolved a mechanism for degrading the DNA backbone of the trap, allowing it to continue infecting its host. Professor Harris and her colleagues believe that NETs could be effective in people in hookworm‐prone areas by boosting their immunity. Professor Harris says that the discovery could lead to a vaccine to achieve this goal. “We may now be able to look at new vaccination approaches that target the enzyme secreted by the hookworm parasite to alleviate infestation and to decrease the likelihood of re‐infection.”

https://doi.org/10.1016/j.chom.2020.01.011