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Topic: Bioethics and Public Policy
August 30, 2013 | Posted By Zubin Master, PhD

Stem cell tourism is a pejorative term used to describe clinics that offer untested stem cell interventions as bonafide therapies to patients with injuries and diseases. This includes Parkinson’s disease, multiple sclerosis, ALS, blindness, cancer, cerebral palsy, spinal cord injury and many others. We used to think about stem cell tourism as potential patients traveling to clinics from countries like the US, UK, Canada and Australia to countries with lax regulations, but this simply is not the case anymore. There are several clinics within the US that offer stem cell interventions to treat back aches or sports injuries. This direct-to-consumer market has more recently attracted celebrity types including several high profile athletes, Hollywood stars, and even a US State Governor.

Clinics generally tend to overemphasize benefits, and use rhetoric terms like “alternative medicine” or “experimental treatment” to explain that it is another form of treatment not offered by conventional medicine. But at the end of the day, there is an almost complete lack of scientific evidence supporting the claims made by clinics in regards to the efficacy of these stem cell interventions. The evidence provided to patients is based only on testimonials by other patients; no other measures are used to determine treatment efficacy. The overemphasis of benefits when patients tell others of how great they feel and how it has helped them and given hope only fuels their frustration and distrust in their domestic healthcare, research and regulatory system. The stem cell clinics play on the hype and power of stem cells and they stand to make money as therapies range from $5,000 to $30,000 and in many cases clinics require patients to have repeated 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.

July 5, 2013 | Posted By John Kaplan, PhD

Usually when I write about stupidity in Congress I wait a couple of months before doing it again. However, I cannot help myself. This is low hanging fruit and I have to pick it. This is “truth is stranger than fiction” type of stuff. You cannot make this up. In this blog post I would like to introduce the readers to Representative Michael Clifton Burgess M.D., republican representative from Texas’ 26th Congressional District. Dr. Burgess was born in December 1950. I mention this only because it was the same month I was born. He graduated with a Bachelors of Science from North Texas State University. He graduated from medical school at The University of Texas Health Science Center at Houston. He completed his residency in Obstetrics and Gynecology from Parkland Memorial Hospital in Dallas. He also completed a Masters degree in Medical Management from the University of Texas at Dallas. Dr. Burgess is the founder and chair of the Congressional Health Care Caucus, albeit it’s only member. This all suggests the likelihood that Dr. Burgess is smart. His recent statements seem to refute that likelihood.

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.

June 27, 2013 | Posted By Marleen Eijkholt, PhD

Sarah is a 10-y old girl with cystic fibrosis who, until recently, was in desperate need of a lung transplant. The doctors had estimated that Sarah would only have a couple more weeks to live without a transplant. Recent news headlines reported about her quest for this transplant, the success of the operation and, over the weekend, they issued the happy news about her regaining consciousness. Most of this news paralleled comments about the battle to revise the legislation, and underscored antagonism towards policy or policy makers (lawyers and ethicists), as if hindering good medicine. 

In this post I would like to comment on this antagonism, and propose that the policy makers did quite a good job in Sarah’s case. I propose that we need a symbiotic relation between medicine and policy makers. As a clinical ethicist with a background in law, I feel a lot of fear for ‘lawyers’, and prejudice against the idea that law, ethics and medicine can go together. In this post, I seek to outline how they can go together, and how Sarah’s case provides an opportunity for partnership. I must note here, however, that this issue is a minor one given the terrible ordeal of all the involved individuals.

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.

June 7, 2013 | Posted By John Kaplan, PhD

I have commented previously on the stupidity with which some members of congress approach science. I never seem to have any trouble finding new material on this subject. The House Committee on Science, Space and Technology seems to be an especially rich source of such material.  You would think that the members of congress from Oklahoma and Texas would be pretty busy these days. With a huge fertilizer explosion in Texas and the direct hit of a massive EF5 tornado in More, Oklahoma the need for humanitarian aid and rebuilding would be enough to keep Senator Tom Coburn (R-Oklahoma) and Representative Lamar Smith (R-Texas) quite busy, as well they should be. But these guys are nonetheless able to find plenty of time to mess with the operations of the National Science Foundation (NSF).

Senator Coburn initiated this latest episode earlier this year by successfully attaching language to the 2013 appropriation for the National Science Foundation that prohibits funding for any political science research unless the director of the NSF certifies that it relates to national security or economic development. Representative Smith, the chair of the House Committee on Science, Space and Technology has now initiated an attempt to apply these principles to the entire portfolio of NSF funding in all disciplines. The current guidelines to reviewers of grant applications for funding by NSF to address the “intellectual merit” of the research proposal as well as its broader impact on society and the scientific community.

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.

June 4, 2013 | Posted By Bruce White, DO, JD

In her Sunday, June 2, 2013, New York Times article titled “The 2.7 Trillion Medical Bill”, reporter Elizabeth Rosenthal reminds us once again that with the U.S. healthcare “system,” traditional economic market forces are a myth. In example after example, from angiogram to colonoscopy to hip replacement surgery to Lipitor to everyday radiology studies, she shows how U.S. costs are three-to-four times higher than charges in other countries, and how no one can really explain why. For this reason alone, why do some continue to insist on saying that American healthcare is sustained by free market forces as if it were another “business”?

Victor R. Fuchs – in his 1986 text The Health Economy – recalled that a typical market includes: (1) many well-informed buyers and sellers, with no large group of either able to influence price; (2) buyers and sellers acting independently; and (3) free entry of new buyers and sellers. The American healthcare market departs remarkably from these competitive conditions, often as a consequence of openly debated public policy. In America, it is very difficult for patients, consumers, “to vote with their feet” as Nobel Laureate Milton Friedman oft wrote.

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 14, 2013 | Posted By Jane Jankowski, LMSW, MS

In the wake of the Sandy Hook Elementary tragedy and the movie theatre massacre in Colorado, accounts of mentally ill perpetrators are offered as partial explanations as to how these horrific events came to pass. The public outcry for revised gun control measures is understandable and well placed. I don’t disagree. Yet, the predictability of which firearm aficionados may also harbor a latent predisposition toward violence may be an unreasonable task for agencies tasked with licensing weapon worthy citizens, particularly when it comes to assessing someone with a history of mental illness. The paradox of a system which relies on questions about a personal history of psychiatric treatment does not mean an individual has not needed care.  If behavioral health services are not accessible or available, there would not be any record of such intervention. This does not mean that such intervention has not been suggested, desired, or otherwise indicated.  That said, a history of mental health treatment ought to not automatically suggest the applicant should be denied a right offered other citizens.  Focusing funding and effort on firearm marketplace controls may override the much needed attention on community mental health care which are lacking across the nation.  Ensuring our nation also has accessible, high quality behavioral health treatment programs will have benefits which extend far beyond the gun control debates.  Though we may never be able to fully disentangle the issues of gun rights and mental illness, perhaps we can maximize this opportunity to press our leaders into putting some real muscle, in the form of dollars, behind mental health treatment programs.  

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 3, 2013 | Posted By John Kaplan, PhD

More than in any other academic field, I have observed that bioethicists love to express their opinion. This has lead to a great proliferation of bioethics blogs, a huge presence in social media, and a number of active email listserves and discussion groups. All of these are tools for bioethicists use to expand the reach of the field and an outlet for voices laying claim to the need for bioethicists to weigh in on a broad array of issues. Considering this, and considering the news of the last several weeks, it is amazing how little bioethicists are saying about the need for gun control. To his credit Arthur Caplan has called fortreating violence as a public health issue and viewing  gun control as a public health tool. However the dialogue on gun control in the myriad venues for bioethical discussion has been lacking. It should also be noted that the American College of Physicians called for this in 1998 to no avail.

What should be the role of the bioethicist in this discussion? First of all, bioethicists are people and people with so much to say should surely express their outrage on the ready availability of weapons of war in the hands of the populace and its use to prey on both innocent children and the first responders we all count on for public safety. But there are also issues which fall in the mainstream of bioethical focus which require bioethicists to speak up.

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.

December 7, 2012 | Posted By John Kaplan, PhD

Throughout history there has been persecution of scientists and physicians. In some of the most notable historic cases persecution has been lead by powerful institutions including both church and government and has resulted in prosecution, conviction and punishment.  The current prosecution of earthquake scientists underway in Italy seems to be an example of the worst sort of persecution and is indeed reminiscent of the types of unjust attacks by frustrated and wrong-headed government officials looking for scapegoats when there are none. The serious implications of this prosecution have intensified with the conviction of these scientists.

There seems to have been a great diversity in the basis for such persecution and these current events give us opportunity to review the reasons. I acknowledge the previous reviews and commentaries on this subject for having compiled much of the information.

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.

November 6, 2012 | Posted By John Kaplan, PhD

I recently received a mass mailing from the American Association for the Advancement of Science (AAAS), an organization that I am a member of.  On the envelope was the statement: “The future of science is at stake.”This seemed pretty dire so I opened the envelope to learn more. The letter was about the possible consequences to science research and development funding as a result of the Budget Control Act of 2011. The Budget Control Act of 2011 is the result of the inability to develop a budget compromise and dictates sequestration of discretionary defense and domestic funding in the absence of such a compromise. It is the act popularly characterized as the “fiscal cliff”. While many are primarily concerned about one side of the budget or the other those who recognize the importance of research and development funding need to be concerned with both. Research and development funding will not only be hit hard by cuts to the domestic funding for budgets of the National Institutes of Health and the National Science foundation but also significant funding through the Department of Defense for biomedical research as well as aerospace and communications. Additional funding cuts to science are likely in the domestic research and development funding which is included in the NASA budget as well as the Departments of Energy and Agriculture. As suggested in the letter there is indeed much at stake. However, the fiscal cliff is not what I thought of when I saw the dire warning on the envelope. 

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 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.

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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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