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August 19, 2014 | Posted By Lisa Campo-Engelstein, PhD

Given the continuing controversy surrounding insurance coverage for female contraceptives, I want to point out another drug that also targets sexuality and reproduction yet does not generate the nearly same degree of controversy. In fact, insurance companies began covering it immediately upon approval by the FDA with no fanfare. I’m referring to erectile dysfunction drugs. The public’s different responses to female contraceptives and male sexuality medications have been discussed in academic circles as well as in the media. Here I want to present some feminist perspectives on this topic. 

Some feminists argue that part of the reason we understand and treat pregnancy and impotence differently is because we have different standards for women's and men's health, which result from the traditional gender norms at play in our society. We (as a society) expect women to adhere to norms of chastity (e.g. fall on the “virgin” side of the virgin/whore dichotomy by not having sex until marriage) and one way we do this is by limiting their access to sexual and reproductive health care. In contrast, because our notions of masculinity are tied into sexual prowess, we are more receptive to providing health care for men who are not able to maintain an erection. 

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. 

August 14, 2014 | Posted By Jane Jankowski, DPS, LMSW

I was struck by the NY Times article that described tracing the path of the recent Ebola outbreak back to a two year old boy living in Guinea, Africa (NY Times) on the border of Sierra Leone. Not only does it forever impress me how epidemiologists and health officials are able to map the transmission of a rapidly spreading disease back to a likely origin, but the mystery surrounding how it all began is not, nor likely to ever be, known. Was it a bat? A piece of contaminated fruit? It is staggering to think that perhaps natural childhood curiosity set the stage for this kind of significant international health crisis.

Compounding the tragedy of the numbers of lives lost is the fear. While the World Health Organization (WHO) have made recommendations to attempt to limit further spread through education and travel restriction (WHO) the world is watching and waiting to see what happens, hoping enough help and support can be mobilized to halt the spread of this epidemic (West Africa Health Emergency). Though this health emergency is playing out in West Africa, it is a stark reminder to all just how vulnerable humans are to existing disease. There is no vaccine and no clear treatment protocol, though US health workers did receive experimental treatment with good effect (see blog by John Kaplan). In Africa, however, it is a matter of containment.

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. 

August 11, 2014 | Posted By Wayne Shelton, PhD

In my last blog I asked the question, “What is ethics doing?” where I contrasted the armchair, academic ethics that I knew as a graduate student with the clinical ethics cases in which I am now involved in clinical ethics consultations. I alluded to the famous paper by Stephen Toulmin (1922-2009), “How medicine saved the life of ethics” by providing ethics with many practical value laden problems to address. The very process of becoming involved with applied ethics and ethical problems of practicing physicians in the healthcare system was itself as, or perhaps more, transformational for ethics than it was for medicine. Even though medicine needed a serious study of its value-laden issues, which has evolved into bioethics and clinical ethics, the very activity of doing applied ethics has evolved into a better defined field of inquiry with a clearer purpose. But what about the armchair, academic pursuits of philosophical ethics of old? Is there anything left for it to do? This is the question I will attempt to answer in this blog.

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. 

August 8, 2014 | Posted By John Kaplan, PhD

Questions regarding the availability and utilization of experimental drugs for treatment of disease have moved to the forefront following the apparently successful use of an experimental treatment used for two American health workers treating the Ebola outbreak in West Africa. 

The questions that have been raised include both who such drugs should be made available to and under what circumstances they should be made available. An additional consideration is what processes should be put into place to assure that these decisions are made properly to allow patients with valid cases to obtain access while protecting ill people from inappropriate risks and suffering. An additional question which I will not delve into here is who pays for them. Health insurance does not pay for experimental treatments so someone else must. First I should clarify exactly what I mean by an experimental drug. I am referring to drugs that have a scientific rationale for their use and some scientific basis for believing they might work. I do not include cockamamie ideas with no reasonable basis simply because somebody thinks they should be used. I have previously written about physicians who chose to use unreasonable treatments.

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. 

August 4, 2014 | Posted By Bruce D. White, DO, JD

In December 2013, the FDA approved Sovaldi® (sofosbuvir, Gilead Sciences, Inc.) for treatment of hepatitis C. A truly wonderful medical breakthrough, the oral drug effectively cures 90% of patients who take it correctly. The online physician resource Web site Medscape has referred to this drug as a “game changer.” Clearly it will change the health care delivery game in any number of ways.

But the miracle comes with a catch: the cost is prohibitive. The full treatment course is so expensive that very few can afford it even with good health insurance. Each pill costs about $1000; patients will need to take the medicine once a day for about 12 weeks for a full course. The total cost will be about $90-120,000 per patient. Many are asking how is it possible to justify the cost? Is this fair?

Of course, the principal difficulty at first glace is that the costs will strain the system to a degree never before seen with the introduction of a new drug. The strain may break the bank. Recently Reuters has reported that one Florida health insurer – WellCare Health Plans – has sustained significant corporate losses attributable to the fact that Florida requires insurers to prove sofosbuvir to Medicaid patients. It has been reported that 47 state Medicaid programs are covering the drug, and about half have some form of preauthorization. Illinois Medicaid has recently changed its preauthorization criteria to provide the drug only to those patients with advanced liver disease, and to those who can tolerate interferon as an adjunctive treatment, and to exclude individuals with a history of alcohol or drug abuse. It has been projected that drug availability to California residents alone will add $18 billion to health care costs in one year.

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.

July 29, 2014 | Posted By Lisa Campo-Engelstein, PhD

The goal of the Bill & Miranda Gates Foundation Family Planning program is “to bring access to high-quality contraceptive information, services, and supplies to an additional 120 million women and girls in the poorest countries by 2020 without coercion or discrimination, with the longer-term goal of universal access to voluntary family planning.”  This is an extremely important endeavor and I'm glad that this program is devoting so many resources to achieving its goal. 

MicroCHIPS, a company based in Lexington Massachusetts, is one of the companies/organizations working with the Bill & Melinda Gates Foundation Family Planning program. They are developing a contraceptive chip that can be implanted under a women's skin. The chip, just 20 x 20 x 7 millimetres, would deliver daily dose hormones and could last up to 16 years. The chip will be controlled by remote control so that if a woman decides she wants to become pregnant, she can deactivate the chip. When she wants to resume contraceptive use, she can reactivate the chip.

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.

July 22, 2014 | Posted By Wayne Shelton, PhD

I recall being a PhD candidate in philosophy in the 1970’s, I often pondered the subject matter of my graduate courses in ethics. I would ask myself, what does any of this have to do with ethics? What are we doing?

As our courses went from Kant to Mill to G.E. Moore to the Emotivists and others, I couldn’t help but have a sense of unreality about the content of what I was learning.

How can we use reason to find a basis for knowing right action? What are the ways we can define right action based on a normative moral theory?

What is the meaning of good? Right? And obligation? Can these terms be defined within a theoretical, substantive moral framework or are they just expressions of feelings and emotions without any cognitive content? If they are more than the latter, what do they mean?

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.

July 16, 2014 | Posted By Jane Jankowski, DPS, LMSW

I have been slow to fully embrace the full potential my smartphone. I have a few apps that I use regularly for entertainment or basic information, like weather updates and maps. It’s convenient. I can entertain myself with games or social networking while I wait in lines or for a child to finish theater rehearsals, basketball/ballet/swimming practices. If I look up, most others waiting in parked cars are doing the same thing, a faint blue glow radiating from somewhere below the steering wheel.  Before we had devices to entertain us, we would more than likely spend the minutes talking, person to person. I tend to think person to person is better, after all a pen and ink letter, sharing coffee at a small café table, or a supportive hug must mean more than emoticon symbols. But maybe these tiny pictures can convey the intended emotion and offer a substitute when the real thing must be delayed or is otherwise not possible. Where is the line at which an electronic emotion, or interpretation of feeling is no longer enough? When I first learned that there were suicide prevention apps, I was aghast. Have we lost so much human connectedness that even acute emotional despair is summarized in a miniature touch screen? How can an app provide the essential emergent interventions to a person in such despair that he or she is contemplating suicide? But if this is where our social focus is anyway, and the first place people search when looking for help, perhaps it is not such a bad idea.

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.

July 14, 2014 | Posted By Bruce D. White, DO, JD

On the very last day of the 2014 legislative session, the New York Senate passed “The Compassionate Care Act” (S.1682-A, Savino) approving the legalization of medical marijuana.  The Assembly had previously passed a companion bill (A.6357-A, Gottfried). The Senate bill has been sent to Governor Cuomo for his signature. The governor endorsed the bill in the legislature, but as of July 4, 2014, has yet to sign it.

New York medical marijuana proponents have been advocating for the availability of cannabis for several years. Neighboring states Connecticut, New Jersey, and Vermont, and 18 other states and the District of Columbia currently allow medical marijuana. However, last minute compromise changes to the New York law will severely restrict access to medical cannabis. In fact, the limitations are so rigid that some might say the bill is a hallow shell, a sham, one designed to appear to allow medical marijuana yet really not. Regardless of how one feels about medical cannabis, to hype the public into believing that marijuana will be available for medical purposes and then establishing barriers to its accessibility that is a fraud. It would be unconscionable to raise the hopes of distressed patients, many suffering with chronic and painful conditions, only to see those hopes dashed.

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.

July 10, 2014 | Posted By Zubin Master, PhD

Both parts I and II of this blog were originally published as a commentary in the Office of Research Integrity’s Newsletter (http://ori.hhs.gov/newsletters) Volume 22, Number 2, March 2014 and has been reproduced with permission for the AMBI blog.

In Part I, published last month, I discussed my experience organizing and developing a responsible conduct of research (RCR) workshop for stem cell scientists that was held at the Till and McCulloch Meeting in October 2013 as part of Canada’s Stem Cell Network at http://www.stemcellnetwork.ca. In Part 2, I discuss the importance of developing RCR pedagogy that includes both lecture and informational components, and provides ethical cases such that students have a rich understanding of normative, policy, and practical aspects to different RCR topics.

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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