Does a person have a disease or disorder? Or is the person unwell with an illness? Are the concepts of disease and illness distinct? If we have been lulled to sleep by 100 years of Cartesian diktats from the medical establishment, we may miss the point. But if our thinking is super-sharp, we may be able to detect a critical difference.

A prominent legacy of Cartesian dualism, the mind/body problem, causes a split between the “I” that I know myself to be and the physical body that the “I” inhabits. “I” am a passenger in my body. My body carries “me” around, but we are two separate entities. Thus, my body is something separate from “me” and things can happen to it, e.g., my body can become diseased.

The practice of modern medicine is based on this seemingly real separation. But if that’s all there is, much is being missed. Investigation of the illness vs. disease antinomy offers a profound opportunity for improved medical care of people as patients.

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.

Is helping the lay public better understand how to interpret health information accurately – in the face of widely disseminated misinformation – one of the pressing challenges for today’s bioethicists?

The June 6, 2012 New York Times carried an article that may illustrate this point perfectly: “Abortion Qualms on Morning-After Pill May Be Unfounded.” The article highlights how politics-driven misinformation is so difficult to counter or contradict, even with sound medical and scientific data. Apparently, for some politicians just saying that emergency contraceptives are “abortive pills” is enough to make it so. Of course, there are other recent examples of this phenomenon too, such as Michele Bachmann claiming that HPV vaccine might cause “mental retardation.”

Regardless, if nothing else, clinical ethics is all about informed consent. Informed consent – in a nutshell – is met when the physician shares with the patient information about the working diagnosis, the available intervention options and prognoses, the benefits and burdens of each option (including the possibility of no intervention at all) and the likely outcomes, and the physician and patient – using a shared-decision making model – agree on an immediate course or plan to implement.

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.

Ethics as a foundation of human affairs is fast disappearing from our world. The litany of human selfishness, crassness, and sheer bad behavior is unending. Whether the topic is Wall Street robber barons betting against securities they sold to clients (who naively trusted their “bankers” and purchased the recommended financial instruments in good faith) or the venality and mendacity of congressional “representatives” whose true loyalty is to those who fill their campaign war chests rather than to the citizens who elected them and foolishly count on their wisdom and judgement, the public arena and daily news cycle are replete with cautionary tales of failed trust.

So it can't be a surprise that our own brief period of prominence is seemingly bereft of any substantive ethical framework. Ethics provides solutions to every problem humanity is facing. The problem is that ethics is in short supply. Implicitly, thinking is in very short supply. This assertion is awfully ironic, as the primary difference between humans and all other species is self-knowledge. Humans know that we know. But if we don’t know much, we’re not going to be able to help ourselves. Now more than at any time in history, our survival advantage depends on our being able to take care of each other. But we have never done a very good job of that. Not even close.

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.

April 2012 brought news of the latest shot fired over the bow of genetic inheritance as we know it. Ever since the discovery of the structure of DNA by Watson and Crick in 1953 and the subsequent elucidation of the triplet nature of the genetic code by Marshall Nirenberg and others in the early 1960s, many scientists have fantasized about obtaining mastery over this primordial biomolecule.

An interim pinnacle of achievement in this hopeful process would be to create a DNA-like molecule whose information content would be both heritable and evolvable. Synthetic Genetic Polymers Capable of Heredity and Evolution presents elegant work along this path which may signal a substantive shift in humankind’s ability to manipulate the language of life.

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.

We (in America) live in a capitalist society. That is a given. We also live in a democratic society. The Declaration of Independence states that all men [humans] are endowed by their Creator with certain inalienable rights including life, liberty, and the pursuit of happiness. It is not clear that any of these specific rights can be fulfilled when access to a minimum standard of health care is denied, obstructed, or otherwise not available. In the case when health care is available, that care needs to be delivered stripped of any considerations other than those related to providing assistance for that patient.

But in America many ancillary considerations intervene. Care of a patient is confounded by care for special interests, often involving kickbacks (whether in the form of travel expenses, gifts, complimentary lunches and dinners, or even cash payments) rendered by obsequious agents of big pharma or medical device corporations. Worse, on a broader scale, the recent phenomenon of the Patent and Trademark Office (PTO) blithely granting biomedical patents to any and all comers has seriously harmed medical practice and the health of Americans in need.

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.

Do we really need more drugs? We can gain some insight into this question by posing a qualifying question: “How’s it working out so far?” The answer is rather obvious: “Not all that well.” Despite spending $2.5 trillion in 2009 on health care, representing almost 18% of our gross domestic product, the life expectancy of Americans ranks #36 worldwide. Numerous developing nations enjoy longer lifespans than we do. (Costa Rica, for example, ranks #30.) On the other end of the spectrum, the New York Times recently reported that the U.S. rate of premature births is comparable to that of developing nations. Regarding this impactful public health issue with long-term consequences for society, the U.S. does worse than any Western European country. The U.S. premature birth rate of 12% is comparable with that in Kenya, and Honduras. In other words, on this measure the overweening technological superiority of our notoriously costly health care system fares no better than that of countries with per capita incomes of $2 a day.

With respect to chronic disease, it is not unreasonable to assert that medical treatment has obtained equivocal results in the population. Statins are a drug class that has demonstrated proven benefit. For persons who have risk factors for atherosclerotic coronary artery disease, statin use effectively reduces the risk of death due to cardiovascular disease, including stroke. Benefits of statin use increases over time. But drug companies want to extend the statin hegemony to include persons at low cardiovascular risk. In other words, global pharmaceutical corporations want physicians to prescribe statins for prevention in otherwise healthy persons.

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.

The year is 2029. After discussing schedules, I've picked early afternoon April 28 as my day. That works for most of us. My wife will have returned from her conference. My sisters can fly in after their dance recital. My brother rescheduled his interviews.

Cousins can drive in from the coast. Some nieces and nephews can't make it, but that's all right. They're busy. Dr. Landis assured us it would be brief. I'll just take the pill the good doc gives me and fall quickly asleep, peacefully, forever. No pain. I'm doing what's right. It is better for all of us.

As we face dying's three dreads — pain, abandonment, helplessness — what is the practical allure of physician-assisted suicide?

“A call to arms” may be a bit martial for many bioethicists, but we live in perilous times. Meaningful action is needed across the board with respect to the functioning of government, whether federal, state, or local. We are confronted with the effects of benighted policies (or lack of policies and lack of regulations) that threaten to destroy our national (and global) financial system, our national health care “system” (really a default hodgepodge of buyers, sellers, and canny middlemen), and our global ecosystem. Standards of living continue to erode in the U.S. and Europe. Unemployment persists at high levels. In the United States, at least, educational achievement is in free fall. We live in a national culture that has degraded to the narrow perspective of me and mine. It is not an exaggeration to assert that many Americans have lost their moral compass, if indeed they ever had one. For the rest of us, those who recall what it means to be blessed with the right to life, liberty, and the pursuit of happiness, it is long past time to do what anchorman  Howard Beale did in Network: throw open the windows to the street, lean our heads out, and shout I’m mad as hell and I’m not going to take this anymore!

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.

In Fasil Tekola Ayele’s native Ethiopia, the people call it “mossy foot.” Medical textbooks call it podoconiosis, non-filarial elephantiasis, or simply “podo.”

The hideously deformed feet of podo result not from mosquito-borne parasitic worms, as does filarial elephantiasis, nor from bacteria, like leprosy. Instead, podo arises from an immune response to microscopic slivers of mineral that penetrate the skin of people walking barefoot on the damp red soil that tops volcanic rock. Podoconiosis means “foot” and “dust” in Greek.

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.

 

Something remarkable is happening in the world of medicine (the field is often considered a monolithic special interest group). On April 4, 2012, nine medical specialty societies released lists of the "Top Five" services that are the most expensive and "have been shown not to provide any meaningful benefit to at least some major categories of patients". These nine lists are the first results of the "Choosing Wisely" campaign, launched by the American Board of Internal Medicine in response to a 2010 article in the New England Journal of Medicine.

That article challenged physicians to take the lead in health care reform. Rather than waiting for the government to impose new standards and regulations, the article encouraged physicians and professional medical societies to identify wasteful services and procedures that could be readily eliminated.

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.