In this installment of Med Op-Ed: a leading cause of death in Japan falls outside traditional biomedical models; why primary care clinicians should screen for gambling disorder; and a call to stop administering high-dose vitamin C to patients with severe burns.

‘Old Age’ as Official Cause of Death

Japan officially recognizes dying of old age — rousui — as a legitimate cause of death, and the diagnosis is the third leading cause of death nationally. While global medical conventions require specific disease names on death certificates, the practice in Japan invites a rethinking of how medicine approaches dying in the oldest patients, according to Teruhiko Imanaga, MD, PhD, with Kanade Clinic in Hasuda, writing in Annals of Family Medicine.

The Context

• Japan has among the longest life expectancies in the world, and physicians there typically diagnose rousui based on a gradual decline in activities of daily living and food intake in the absence of other diseases. They continue to check for reversible problems such as dental issues or medication side effects.
• Approximately 80% of Japanese citizens consider rousui a peaceful and acceptable way to die, although 7% express concern that the diagnosis could imply neglect or insufficient medical care, according to an online survey.
• Standardized diagnostic processes and shared language frameworks are needed to help physicians discuss age-related trajectories with patients and families, Imanaga writes.

In Their Own Words

“Dying of ‘old age’ may not fit neatly within traditional biomedical models, but that makes it no less real.”

Read it: Death by Rousui in Japan: Rethinking Death, Diagnosis, and Care in an Aging Society

Make Gambling Screening Routine in Primary Care

Screening for gambling-related problems in primary care can help clinicians detect and mitigate gambling-linked harms, including suicidality, according to Debi A. LaPlante, PhD, and Heather M. Gray, PhD, writing in The New England Journal of Medicine. The authors are affiliated with Cambridge Health Alliance in Malden, Massachusetts, and Harvard Medical School in Boston.

The Context

• Research shows people with gambling-related problems may have a higher risk for suicidal ideation and attempts.
• Brief validated screening tools — like the Brief Biosocial Gambling Screen, Lie-Bet, and NODS-CLiP — are available for identifying a potential gambling disorder, but clinicians rarely use them due to concerns about patient privacy, lack of awareness, or low confidence in their ability to manage patients with positive results on these screenings.
• Treatment options include cognitive behavioral therapy, motivational interviewing, and mindfulness. Some evidence supports pharmacologic therapies like nalmefene and naltrexone, but no medications are FDA-approved for gambling disorder, the authors note.

In Their Own Words

“Primary care is an established setting for detecting high-risk behaviors, such as smoking and heavy drinking; incorporating screening for problem gambling into primary care could therefore be a natural first step in expanding detection and treatment.”

Read it: Detecting Gambling-Related Problems – An Opportunity to Reduce Suicidality

A Call to End Intravenous Vitamin C for Severe Burns

Recently published trial results should put an end to decades of speculation about the potential benefits of high-dose intravenous vitamin C in patients with severe burns, according to David G. Greenhalgh, MD, from the University of California, Davis, writing in JAMA. Vitamin C did not improve patient outcomes in the 238-patient study, and doctors should no longer use this treatment approach, Greenhalgh writes.

The Context

• The VICTORY trial found high-dose vitamin C did not reduce organ dysfunction or death in patients with severe burns and might be harmful.
• An interim analysis for futility or harm found the rate of mortality or persistent organ dysfunction at 28 days, the primary outcome, occurred more often in patients who received vitamin C compared with placebo (40.8% vs 29.7%), which prompted early termination of the trial.
• Initial enthusiasm for ascorbic acid in burn resuscitation was based on the idea that it might reduce the amount of fluid that patients require. Researchers also thought vitamin C might reduce the risk for sepsis.

In Their Own Words

“In the end, the VICTORY trial leaves a clear message. High-dose intravenous vitamin C administered early after injury did not reduce organ dysfunction or death and should not be a treatment in severe burns.”

Read it: High-Dose Vitamin C in Burns: Time to Stop

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.