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Viewing by month: June 2011
June 29, 2011 | Posted By Posted By David Lemberg, M.S., D.C.

As we're all aware, the U.S. is the only developed nation that does not provide its citizens with some form of universal health care. Are we special, or are we stupid?

We're certainly not special. The U.S. is near the bottom of the rankings for two critical measures of a nation's overall health - infant mortality and longevity. And we're near the bottom for many more health care parameters.

Yes, the U.S. has the most technologically advanced medical care. But as a Dartmouth Institute study - Health Care Spending, Quality, and Outcomes - showed with crystalline clarity, more is most decidedly not better.

So are we stupid? Yes, and what's worse we're blindingly selfish. Health care is a right. The polity of every other developed country recognizes this. Universal health care is necessary in the U.S.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 28, 2011 | Posted By Posted By David Lemberg, M.S., D.C.

Although the ranters rant that those without health care insurance should "get a job", investigating the facts tells a different story. But in early 21st century America, facts are easily swept aside as mere inconvenience.

Who needs facts when we have opinions? Blather, posturing, speciousness, and irresponsible inanities are the coin of our public discourse.

A few Americans do inquire as to the state of the facts. A substantial proportion of the 47+ million uninsured Americans are employed. And many millions more of those who do have health insurance have less than satisfactory coverage. Cost-shifting has burdened Americans with high annual deductibles and exorbitant co-payments.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 25, 2011 | Posted By Posted By David Lemberg, M.S., D.C.

Randomized clinical trials (RCT) may be the Tyrannosaurus rex of the clinical research field. Formidable, very powerful, and doomed to extinction.

The as-if-ripped-from-today's-headlines 1991 article, "Of Mice But Not Men: Problems of the Randomized Clinical Trial",1 recommends reevaluating the preeminence of this method of conducting clinical research. Insisting on RCTs represents clinging to tradition in the face of new imperatives.

Clinical research has become big business. All the parties are in bed with each other. The fact that physicians are paid per referred research subject is profoundly disturbing.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 23, 2011 | Posted By Posted By David Lemberg, M.S., D.C.

The free market has not fared well in recent years. Adam Smith's "invisible hand" has had its thumb on the scales for a very long time. In the last 75 years U.S. markets have been free only in the sense that businesses are free to seek as much government protection as they believe necessary.

The financial sector is a glaring testament to the infinite ways in which greed and corruption can distort the workings of a presumably free market. If finance was forced to return to "free" practices the big players would lose all their "free" money. Paradoxically, heavy regulation of the financial sector is now necessary to restore the mechanisms of a free market.

Similarly, the health care market as we know it is not "free". Supply and demand factors are not applicable to health care. Supply of services is necessarily limited - these resources are not infinitely available. Demand is always 100% - demand is not able to fluctuate. A consumer may put off purchasing a new car for many reasons. But she cannot delay a life-saving medical service.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 20, 2011 | Posted By Posted By David Lemberg, M.S., D.C.

The New York Times reported last year that virtually every state is making or planning significant cuts in Medicaid benefits.1 These actions are taking place while demand for Medicaid grows. This entitlement, originally conceived as a support for those in lower socioeconomic classes and disabled persons, now is a necessary lifeline for those formerly in middle income groups who have lost their jobs. Medicaid enrollment soared by 7.5% from June 2008 to June 2009 (3.3 million new enrollees). The 2009–2010 increase is expected to be even larger.

The American health care crisis is not a doomsday scenario concocted by shrill socialist Chicken Littles. State governments can’t afford to pay their health care bills. It’s not surprising that individual Americans can’t afford to pay for health insurance and are dropping coverage by the millions.

The Medicaid news is the canary in the coal mine. When the canary dies, it’s time to pack up your gear and get out. In terms of health care, the demise of Medicaid is the clearest possible signal that the entire edifice is about to come crashing down.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 18, 2011 | Posted By Posted By David Lemberg, M.S., D.C.

Ethical relativism provides a flimsy moral gloss condoning questionable activities of global pharmaceuticals in developing nations. But the Emperor has no clothes. Ultimately, there’s no such thing as a little bit of ethics.

Conflicts of interest are easy to overlook in the rush to approve new, important “research”. The rush to do so is very real. In the last 20 years clinical trials have become big business. And, most clinical trials are now largely controlled and conducted by the pharmaceutical industry.1 Even more alarming, much of the work of these trials is outsourced to contract research organizations (CROs). In 2004, more than 40% of pharmaceutical drug development expenditures had been committed to outsourcing.2 In 2001, CROs generated $7 billion in revenues.

The implications are clear. Clinical trials can no longer be accurately categorized as research. Clinical trials are a business activity, items on the balance sheet of global pharmaceutical corporations.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 15, 2011 | Posted By Ricki Lewis, PhD

Brandon Alspaugh is worried. He’s an interventional radiologic technologist at South University in Charlotte, NC, taking human genetics in preparation for physician’s assistant school. When he got to the end of my textbook, where I ask students to e-mail me their concerns, he wrote the following:

“Dr. Lewis,

Coming from the medical field, I worry that personal genomics, while useful in terms of screening for genetic disease, will come to have the same effect as full-body CT scans, where the amount of noisy data generated will drown out the important bits. As with atypical anatomy, a person might spend a month chasing down a suspicious allele only to find it's a normal variant of a beneficial gene.”

Brandon’s describing a new breed of incidentaloma, looking for one sign of abnormality that turns up what could be another. I went in for a CT scan of my lungs, for example, and the doctor fretted over my polycystic liver. A friend had it much worse. She volunteered to be a control in an Alzheimer’s imaging trial, and her scan revealed two brain aneurysms!

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 10, 2011 | Posted By Posted By David Lemberg, M.S., D.C.
Dr. Adina Roskies
Download Podcast Click the icon to play the podcast

Dr. Adina Roskies is Associate Professor in the Department of Philosophy at Dartmouth College. Her areas of specialization are Philosophy of Science, Philosophy of Cognitive Science, and Philosophy of Mind.

Dr. Roskies was Project Fellow on the MacArthur Project in Law and Neuroscience from 2007 through 2010. Her recent publications include Neuroscientific challenges to free will and responsibility, published in Trends in Cognitive Sciences; “Neuroethics beyond genethics”, published in EMBO Reports; and Neuroimaging and inferential distance, published in Neuroethics.

In our 5-3-2011 BIOETHICS TODAY conversation, Dr. Roskies discusses

  • Free will and determinism
  • Compatibilism and incompatibilism
  • Neuroscience–the brain as a mechanism
  • Can the brain cause behavior?
  • Neuroscience, determinism, and moral responsibility
  • Neuroscience and the law

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 6, 2011 | Posted By Ricki Lewis, PhD

Early June marks the 30th anniversary of the reporting of the first AIDS cases, but it’s also an older medical anniversary – recognition that the drug diethylstilbestrol (DES) derailed development of the reproductive systems of a huge cohort of fetuses. I was one.

My mom, like millions of others, was handed “a vitamin” while pregnant with me in 1954, which in those days of medical paternalism, she never questioned. And so when I became a teenager, I began to drip, and was hauled off to the gyno. The verdict: Adenosis. The label: DES daughter. It was scary.

As an endocrine disrupter before the term was coined, DES, among other things, played havoc with the boundaries between tissues of the cervix, which prevented glands from vanishing on schedule. With the hormonal onslaught of adolescence, the errant glands went into overdrive. Fortunately, I didn’t have the otherwise rare cancer whose sudden appearance led to identifying the problem, as with AIDS. I also escaped the trademark DES small uterus, and my husband, a DES son, escaped XY-related problems. But my mom did die of breast cancer – another legacy of the “vitamin” thought to protect against pregnancy loss. And so far the DES Follow-up Study on the third generation – my three daughters – has revealed only a slight increase in ovarian cancer risk that is likely a statistical fluke awaiting larger numbers. 

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 3, 2011 | Posted By Danielle Holley, JD, MS

In 2010, the New York State legislature passed, after 17 years, the Family Health Care Decisions Act (FHCDA), codified in NY Public Health Law Art. 29-CC (2010).  This law provides a much-needed mechanism to make decisions for incapacitated individuals who have not appointed an agent under the health care proxy.  The law creates provisions to appoint a surrogate or allow physicians to make decisions for incapacitated individuals who have no one.  This is extremely important as most people have not appointed an agent to make decisions for them if they lose capacity.  The law also acknowledges emancipated minors and provides provisions for an emancipated minor to withdraw or withhold life-sustaining treatment.  The FHCDA also made an important step in allowing for decisions, including decisions regarding withdrawal or withholding of life-sustaining treatment, to be made based on the patient’s known wishes but if those are unknown, in the best interest of the patient, therefore not relying anymore on the higher standard of clear and convincing evidence.  

The FHCDA also recognizes an important mechanism, that of the Ethics Committee.  The law requires that each hospital and nursing home have an ethics committee, whether it is institutional or community-based, to assist in making decisions under certain circumstances.  The ethics review committee can be used to mediate disputes.  The law also gives binding authority for the Ethics Review Committee’s decision in two circumstances, including (1) when an attending physician objects to the surrogate’s decision to withdraw or withhold artificial hydration or nutrition, and (2) when an emancipated minor seeks to withhold or withdraw life-sustaining treatment.  Conferring binding authority thus allows the committee to be the arbitrator instead of resorting to a court proceeding, 

The law makes some important changes; however, it is very long and has a lot of provisions and checks.  To assist practitioners in the hospital in applying the law, we developed a set of algorithms.  The algorithms are a set of eight charts that lay out the provisions of the law.  These algorithms are intended to guide practitioners but do not cover all possible scenarios that may arise.  So far, it has been a great resource and guide for practitioners in facilitating the decision-making process for those who lack capacity.  

Click here to see the full publication.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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ABOUT BIOETHICS TODAY
BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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