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March 4, 2015 | Posted By Bruce White, DO, JD

Probably not. It’s just not the American way.

And, it is true that Americans pay more out-of-pocket for prescription drugs than citizens in other developed countries. Other nations use government cost controls and aggressive cost containment strategies to regulate prescription drug costs. Historically, the US Congress has deliberately and consistently refused to regulate prescription drug pricing directly.

The American pharmaceutical industry often has been accused of gouging consumers and profiteering. Its investor return on equity is usually much higher than other industries. And prescription drug pricing differentials have always been difficult to understand, whether at the local pharmacy or within similar hospitals in the same locale.

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. 

February 26, 2015 | Posted By Zubin Master, PhD

In the past State of the Union address, Obama announced his precision medicine initiative involving the creation of a new, national level biobank.

Biobanks collect biological samples (e.g., DNA, cells, tissues, blood) and health and lifestyle information (e.g., disease information, smoking habits). By collecting it once, biobanks store biosamples and information such that they can be used as new biomarkers are discovered. As the samples are shared with others, biobanking research offers a novel research platform to perform large-scale, epidemiological studies in order to associate genotypic or biological information with healthand disease. Many nations have made significant investments into biobanking research creating national level biobanks such as the U.K. Biobank, which has half a million samples, and the Icelandic biobank called deCode Genetics.

Obama’s goal is to have at least 1 million American volunteers enroll in the biobank which will aim to conduct longitudinal studies examining genes, health and the environment. Collecting these many samples may not be so straightforward concluded a panel of experts at a recent workshop at the National Institutes of Health. Several scientific and logistical issues were discussed. What types of diseases will be studied? Who will have access to the data? Who will be recruited? Will samples from other biobanks be incorporated into the precision medicine initiative? Yet with the many scientific and logistical issues, there are numerous ethical issues including informed consent, commercialization, and the return of results that must be given due consideration.

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. 

February 20, 2015 | Posted By Wayne Shelton, PhD

It is my sense that the majority, perhaps the vast majority, of cases on which clinical ethics consultants (CECs) are asked to consult and make an ethics recommendation, there is, or would be, a general consensus on the part of the CECs about what counts as the appropriate recommendation. However, the question arises of how clinical ethics as a field should deal with issues that come up about which there is not a clear consensus, such as in cases where a basic right to have an autonomous choice respected by the patient is pitted over and against the obligation of the physician to do no harm—the traditional tension between respect for patient autonomy and beneficence/nonmaleficence. This tension or conflict often occurs in cases of alleged medical futility where the patient or the patient’s surrogate requests a treatment option the physician deems will only cause harm and no benefit to the patient. For example, consider a patient’s surrogate who insists that she will not consent to a DNR order and in fact expects the physician to perform CPR if the patient arrests. For a patient without capacity dying of metastatic disease, this directive by the surrogate presents a stark dilemma to the physician—is it a violation of the physician’s obligation to the patient to “do no harm” (nonmaleficence)? Or is respect for the patient’s wishes or her representative’s wishes so sacrosanct that the physician’s obligation to follow the patient’s wishes is paramount and outweighs the obligation to do no harm?

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. 

February 17, 2015 | Posted By Lisa Campo-Engelstein, PhD
In recognizing the health-related and financial benefits of preventive reproductive health services, the Affordable Care Act (ACA) has included them (namely contraception and preconception care) as part of standard care and without co-payment. While the inclusion of women’s reproductive health care in the ACA is a milestone for women’s health, children’s health, and reproductive health overall, it is troubling that the ACA does not seem to make any mention of men’s reproductive health

Men's reproductive health is not only missing from policy, also from everyday practice. Whereas women know to see a gynecologist for their reproductive health and can easily do, men are often unsure of where to turn for the reproductive health needs. Most men have never heard of the field of andrology, which is devoted to men's reproductive health, and this field is so small and fragmented that it may be difficult for a man to find a nearby andrologist. Some men seek out urologists for their reproductive health, but many urologists are not trained in all areas of men's reproductive health. Men may also talk to their primary care physician about their reproductive health needs, but many of these physicians are not very familiar with men's reproductive health since it is barely covered in medical school. Family planning centers tend to focus on treating women and some family planning providers have even been known to be hostile toward men. The lack of healthcare providers trained to treat in men’s sexual and reproductive health contributed to American Board of Obstetrics and Gynecology recent statement that condoned OBGYNs treating certain areas of men’s sexual and reproductive health.

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. 

February 13, 2015 | Posted By Bruce White, DO, JD

The US controlled substances prescription abuse statistics are simply staggering and they’re only getting worse:

·         America has 4.5% of the world’s population; America’s doctors prescribe more than 80% of the world’s opioid drug supply annually.

·         Each day 46 persons in the US die from a prescription pain killer overdose.

·         Ten of the states that have the highest narcotic drug-prescribing rate are in the South.

·         Prescription pain medicine abuse in the US is so bad that addicts who can’t get their opioid prescriptions any longer are turning to street heroin to get their narcotic fixes.

However, the federal government and the states have been responding to stop the prescription drug abuse epidemic with marginal success to date:

·         Over 35 states now have prescription drug monitoring programs (PDMPs) that require physicians and pharmacists to check databases before writing or filling some controlled substances prescriptions.

·         At least one nationwide pharmacy chain has instituted policies to avoid filling some controlled substances prescriptions that are suspect.

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. 

February 11, 2015 | Posted By Jane Jankowski, DPS, LMSW

It’s a challenging time of year for those of us living in the snowbound regions of North America. Cold temperatures limit outdoor activity to quick spurts broken up by the need to get warm and sunshine can be hard to come by. Ground hogs are disrupted from their morning naps every Feb. 2 to see if warmer days will be welcomed back sooner rather than later. We yearn for the return of leafy trees, green grass, and less slippery walkways. Science has taken an interest in just what we gain from exposure to nature, and it seems there is more to it than simply wishing winter a glad farewell.  Though we may consider it common sense that people feel better when they get outdoors, breathe fresh air, and spend time in green spaces filled with grass and trees, there is a growing body of literature to back it up.

According to the NYS Department of Environmental Conservation spending time in forests makes us healthier.  The noted benefits include: boosts immunity, reduces stress, lowers blood pressure and improves mood, helps with focus and concentration, increases energy, and improves sleep. “Recognizing those benefits, in 1982, the Japanese Ministry of Agriculture, Forestry and Fisheries even coined a term for it: shinrin-yoku. It means taking in the forest atmosphere or "forest bathing," and the ministry encourages people to visit forests to relieve stress and improve health”. It seems they are onto something important here. Rx: Forest time.

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. 

February 3, 2015 | Posted By John Kaplan, PhD

I knew that I was going to write this blog post about the news concerning the resurgence of measles and its relationship to the dangerous and misguided anti-vaccination movement. The difficulty was with all the lunacy out there I did not quite know where to start. I grew up in the era prior to vaccination against childhood diseases. I had measles, mumps, rubella and chicken pox. I remember the fear people had of these infectious diseases and even as a child I was aware of how welcome these immunizations were when they became available. It seems absolutely inconceivable that decades later people are advocating against vaccines and placing their children and others at risk of infection with potentially devastating diseases.

There now seems to be a perfect storm of parents making poor choices for their children, a few vocal physicians giving bad advice, a staggering number of ill-informed celebrities saying truly stupid things, and political cowardice and hypocrisy failing to react appropriately. Let’s talk about the history leading to this unfortunate circumstance. Keep in mind that in the year 2000 measles was considered to have been vanquished in the US. There were a few dozen cases all contracted by people who had travelled overseas. However, these few cases were not transmitted to others because the rate of immunization was so high, despite the high level of contagiousness. This circumstance has now changed with people forgoing the vaccinations and like-minded people creating communities with high levels of the unvaccinated.

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. 

January 27, 2015 | Posted By Zubin Master, PhD

Academic journal publishing is big business. More journals are popping up in almost every field especially with the open access movement dominating academic publishing. While editors of some high impact journals might reject papers outright, editors of most journals, especially open access journals, might be willing to send the paper out for peer review so long as it isn’t methodologically flawed (Arns, 2014). Some predatory open access journals likely provide far less scrutiny and may send seriously flawed or poorly written papers to reviewers – I can personally vouch for this happening for one open access journal in my field. With the rise of journals and the increased pressure for scientists to publish, the demand and strain on peer reviewers and the peer review system is growing.

There are certainly signs that peer review is placing demands on researchers. For example, my previous supervisor who is an expert in bioethics and health law once told me he receives a request to peer review an article every couple of days. Another researcher at Mt. Sinai Hospital at the University of Toronto in Canada mentioned that he receives 300 requests to review papers a year, each of which takes him 3-4 hours to complete (Diamandis, 2015). Many of my colleagues who are prolific researchers turn down peer reviews, trying to do only a few a year or pass it off to junior researchers. In a recent column of the journal Nature, Martijn Arns explains that the increased pressure to review and the reluctance of researchers to undertake peer review might mean that editors will assign papers to reviewers who might not have the appropriate expertise in a particular area. Peer reviewers who are not experts on the topic should not accept articles to review, or declare to editors what areas they can appropriately review. Certainly junior researchers or doctoral students may not be international experts on a topic, but junior researchers might do a better job of reviewing manuscripts by investing more time and giving fair consideration to an article. However, given the time involved and the sense of obligation to conduct peer review, some reviewers might cut corners and perform mediocre reviews.

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. 

Previous Posts

January 23, 2015 | Posted By Lisa Campo-Engelstein, PhD
January 19, 2015 | Posted By Wayne Shelton, PhD
January 16, 2015 | Posted By Jane Jankowski, DPS, LMSW
January 12, 2015 | Posted By John Kaplan, PhD
January 6, 2015 | Posted By Lisa Campo-Engelstein, PhD
December 22, 2014 | Posted By Zubin Master, PhD
December 18, 2014 | Posted By Jane Jankowski, DPS, LMSW
December 15, 2014 | Posted By Wayne Shelton, PhD
December 11, 2014 | Posted By Dan Thompson, MD
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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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