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Viewing by month: September 2012
September 26, 2012 | Posted By Hayley Dittus-Doria, MPH

An article about the concept of overtreatment recently caught my eye. We live in a world of excess-bigger houses and larger food portions, among others. These are necessarily bad, just perhaps more than we need. The same goes for medical treatment. Like many things in the U.S., people equate “more” or “bigger” with “better.”

The problem with this mentality when it comes to healthcare procedures is the large cost that comes with it. According to the article, overtreatment is costing the U.S. healthcare system $210 billion each year. And spending that money doesn’t earn us high marks in terms of our health outcomes compared to the rest of theworld. Between “one fifth and one third of our health care dollars” are spent “on care that does nothing to improve our health” according to Shannon Brownlee, author of “Overtreated.” In a 2009 New Yorker article, Dr. Atul Gwande also points out the fact that simply because you’re receiving more aggressive healthcare doesn’t necessarily mean you’re healthier. 

Overtreatment has additional, non-financial ramifications as well. Emotional consequences can be quite serious. What if you had a cough for a few weeks? And when looking into the cough, you discover something else? And when looking into that new diagnosis, yet another problem comes to light? When your expectation was just to be treated for your cough, would you want to find out all of the other illnesses you might have? Maybe. But maybe not. Perhaps, other than your cough, you felt fine, but now your days are spent getting test done, blood work run, procedures scheduled.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 21, 2012 | Posted By Bruce D. White, DO, JD

In a recent article about medical repatriation in a national bioethics journal, philosopher Mark Kuczewski argues that the practice can be an “ethically accepted option” only if three conditions are met:

  1. Transfer must be able to be seen by a reasonable person as being in the patient’s best interests aside from the issue of reimbursement.
  2. The hospital must exercise due diligence regarding the medical support available at the patient’s destination.
  3. The patient or appropriate surrogate must give fully informed consent to being returned to another country.

Surely Dr. Kuczewski knew – when he wrote the article – how completely absurd these three “conditions” or prerequisites are?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 18, 2012 | Posted By Lisa Campo-Engelstein, PhD

Thanks to health care reform, beginning last month women with health insurance no longer have to pay for contraception. While I fully support this legislation, I think it has unintended negative consequences for both women and men. Specifically, I am concerned that this legislation, as well as the debate surrounding it, once again conflates reproduction with women, thereby ignoring men’s reproductive responsibility and autonomy.

This legislation is based on and buttresses our current heterosexual contraceptive arrangement in which women are largely held responsible for contraception, especially in monogamous relationships where couples are more likely to depend upon long-acting, reversible contraceptives (LARCs) or sterilization rather than barrier methods. Women today actively participate in all contraceptive methods except vasectomy, which only accounts for 9% of contraception use in the U.S. Part of the reason for this is due the disparity between the number and types of female and male contraceptives: there are eleven contraceptive options for women, including various types of LARCs, and only two for men—male condoms and vasectomy—neither of which are LARCs. Monogamous couples not ready for sterilization generally don’t delegate contraceptive responsibility to men because male condoms are not well-suited to their needs: they are not nearly as effective as female LARCs (16% versus under 3% failure rate for typical use) and they can interrupt and minimize pleasure during sex.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 13, 2012 | Posted By Wayne Shelton, PhD

The Supreme Court ruled this past June that the Affordable Care Act (ACA), otherwise known as Obamacare, was indeed constitutional. But this ruling only occurred when Chief Justice came over to the more liberal side. However, he made it clear that the basis for its constitutionality could not be the commerce clause but rather the right of the federal government to impose new taxes. That is, the government could not require citizens to buy certain services but they could, via elected representatives, impose new taxes to support those services. On the conservative side, there seems to be the notion that health care itself is a normal market service or product like any other. Requiring someone through the imposition of a mandate to purchase health care is therefore the same as requiring them to purchase broccoli. Though most of us on the liberal side are glad that the ACA was deemed constitutional, it causes us considerable pause to leave just a wrongheaded legal understanding embedded in our public policy moving forward.

Broccoli has many health benefits. It is filled with vitamin A and C, folic acid, calcium and fiber. It may help prevent high blood pressure and colon cancer. And it’s really delicious steamed up as an accompaniment with other vegetables and almost any meat or carbohydrate. In fact I would prefer to spend the remaining time in this blog describing all the ways broccoli can be enjoyed and used to promote health. But my point here is only to say, as wonderful as broccoli is, it is dispensable in one’s diet. Former President George H. W. Bush famously claimed his right to refuse to eat broccoli any longer because he was now president and could do as he wished. He just didn’t like it. And as difficult as I find it to empathize with such a sentiment, I must say, it makes virtually no practical difference either to former president Bush, society and to the marketplace in which broccoli is sold. He will hopefully find other vegetables he finds more palatable or take vitamin supplements, or just hope that his genes help him get to a long life. There are countless market products and services just like broccoli, in terms of being really, really good for you, but if you don’t buy them, neither you nor the rest of society will be harmed.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

September 11, 2012 | Posted By Jane Jankowski, LMSW, MS

Plans are underway at some drug store chains and other discount retailers to open in-store clinics which will offer an expanded menu of low cost vaccines and basic clinic services to consumers. Vaccines for flu and pneumonia have been available at retail locations for a number of years, and have become a familiar practice at drugstore chains and other retailers particularly during autumn when the newest flu vaccines are available. A folding table and chairs, consent forms, alcohol swabs and a sharps container typically wait at the end of often long lines of people seeking these prophylactic shots. More recently, several retailers began opening in-store clinics and current estimates of existing in-store clinics hover around 1,300. The pending expansion of these clinics may bring the numbers up to over 3,000 within the next 3 years. 

The self-proclaimed low price leader, Wal-Mart, plans to open independently owned and operated in-store clinics which will treat walk-in patients seven days a week. The list of services ranges from acne care and common vaccines to flu treatment (for those who missed the Wal-Mart flu shots) and upper respiratory infections. It seems reasonable to presume that other in-store clinics are or will be similarly equipped. For the millions of Americans who have difficulty accessing primary care, this may be a tolerable solution which falls somewhere in between going to the ER for these routine healthcare issues and having a primary care physician who can provide comprehensive on-going care. As noted in a piece printed in The Detroit News, the Affordable Care Act will thrust millions of newly insured patients into the waiting rooms of medical offices clogging an already strained primary care system. Perhaps the locating clinics in popular stores is a kind of outreach for clinic owners who  have been unsuccessful in efforts to provide care to underserved populations. I am not convinced these clinics represent such altruistic intentions. This expansion of medical services raises questions about whether or not this venue truly supports the best interests of patients.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit ourwebsite.

September 5, 2012 | Posted By John Kaplan, PhD

I have not been identified as a bioethicist for most of my career. I am a scientist. I trained in physiology and also worked in the realms of biochemistry and cell biology. Just like others in the disciplines a big part of my job was research and to be successful it was necessary to publish my findings. One of the determinations I needed to make on a regular basis was which journals did I submit my work to for consideration of publication. Early in my career as a doctoral student and later postdoctoral fellow and as a young faculty member in physiology there was an obvious choice, the American Journal of Physiology. This journal was highly regarded, had rigorous editorial standards, and publication in this journal was prestigious providing me an advantage in career advancement in my field and, importantly, competing for grant support to continue my work. As my career progressed I continued to seek to publish in high profile biomedical science journals and was pleased to be published in top-tier journals in biochemistry, hematology and immunology.

The journals I referred to above all had something in common. All of these journals were operated by the scholarly professional society representing the respective disciplines (e.g. the American Journal of Physiology was published under the auspices of the American Physiological Society).This society sponsored journal format had important implications for quality, standards, and operations. Most important it assured that editorial standards and criteria corresponded to the consensus standards of community. Moreover they were all run as non- profit entities. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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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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