Medical educators over the past six decades have designed educational objectives and curricula as though it was the educational process itself that determines students’ values and their behavior as professionals, without considering the influence of the structural environment on medical trainees. From the 1950’s on, asSamuel Bloom observed in 1988, there are examples, continuing to present day, of medical schools devising curricula with the goal “…to repair what were believed to be the dehumanizing effects of scientific specialization, but with the retention of the best of science.” To achieve these goals educators drew from the social sciences and humanities, and by the 1970s, from the growing interest in medical humanism and specifically from the field of medical ethics, which now is mostly referred to as bioethics. Bloom claims these subjects, like science, have been split off from the context of how they impact medical practice and taught mostly as an intellectual activity, thus creating a dualism between theory and practice. The curriculum has been assumed on its own to be an instrument of behavioral change that follows from knowledge. The essential process of social organization is sadly lost from view and deemphasized. How can we account for this rift?

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.

At the end of the article “Disability and narrative: new directions for medicine and the medical humanities” Rebecca Garden states, “However, rather than ‘coping with’ or ‘overcoming’ their impairments, many disabled people see their impairments as integral to their lives.”  This may have been the most important, and overlooked, message regarding new directions in medicine for working with people with disabilities.  I would like to share a personal story that illustrates this point.

I’ve been short all my life, but always just too tall to be considered disabled.  When I lived in China, every adult was always trying to get me to grow, like I had a choice in the matter.  They’d either bring up the fact that I can’t get a job since there’s a height requirement for pretty much every occupation (I wanted to be a teacher and the height requirement for that was the ability to reach the top of the chalkboard) or they’d have these false hopes and reassured me over and over again that I simply have one last growth spurt to hit (at that time, I was visiting family and already 18 years old).  I was fine with my height and the incessant chatter was extremely discouraging and annoying.  When I came to America and learned that most civilian jobs had no height requirement, I was so happy to be leaving the Chinese thinking regarding height impairment.  Here, in the land of accessibility ramps, being short would not affect my life style and I can go into any career that I’d like.  I will no longer hear people sigh at me or look down upon me, no pun intended. 

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.

The July 31, 2012, issue of the Chicago Tribune carried an article entitled “Chicago-Based Accretive Health Banned from Doing Business in Minnesota for 2 Years.”

Facts in the article are sketchy: (1) The Minnesota attorney general’s office began investigating possible privacy breaches when a hospital account collections company laptop was stolen two years ago. The laptop contained the names and protected health information of 23,000 patients treated at two Minnesota hospitals. (2) The company – Accretive Health – manages billing and collections for hospitals. One hospital in Minnesota accounted for 9.9% of Accretive’s first quarter revenue - $25 million out of $253.7 million.

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.

Sometimes we forget the accomplishments we have made in the Alden March Bioethics Institute since we began almost 20 years ago. We now have a fully integrated set of offerings in both medical education and graduation bioethics.  So I thought it was time to describe them all in a bit more detail.

The Alden March Bioethics Institute began as the Center for Medical Ethics, Education and Research in 1994. Our principal charge was to design and implement a new course as part of the curriculum reform effort that was underway called Health, Care and Society (HCS).  This was a broad course in professionalism, medical ethics and humanities that would become integrated throughout all four years of medical schools. As a required course for all medical students we began in year one, and added a new component each year until the curriculum in all four years were complete. Each year consists of about 40 hours of class work.  In the first two years a little over half the classes are in large groups on topics such as professionalism, special topics in bioethics, medical ethics case analysis, end of life care, effective communication, cultural diversity and alternative/complementary medicine; about a third of so of the classes are small group discussions. In the third and fourth years HCS is integrated into the clinical clerkships and rotations and consists primarily of small groups discussions of a wide range of topics relating to the type of patients students are encountering. One important part of HCS in the third year is in the Medicine rotation, each one consisting of nine meetings where students bring to the table real concerns and issues from cases they are directly experiencing. By now HCS has become normal part of the curriculum and students generally enjoy the chance to discuss these topics that will be so important to their careers as physicians. 

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.

We are pleased to announce the approval of the Doctorate of Professional Studies, with a concentration in Clinical Ethics Consultation, by the New York State Education Department. This program is, to our knowledge, the first online program of its kind to offer advanced level training in the knowledge and skills of clinical ethics consultation for qualified applicants. The new program is designed specifically for working, health care professionals who possess a master’s degree in bioethics, or equivalent, and who seek a fellowship level, advanced training in clinical ethics consultation. Students will use their professional work environments as the clinical training ground as they complete advanced fellowship courses related to clinical ethics consultation and mediation, elective courses and a doctoral research project.

The fellowship courses include clinical practica in coordination with AMBI faculty and agreed upon mentors at the student’s home institutions.  At the end of the program, graduates will have a portfolio of 32 case consultation reports and will have demonstrated advanced level mastery of the ASBH Core Competencies in Clinical Ethics Consultation.

For more information, visit our website or contact Wayne Shelton at sheltow@mail.amc.edu or 518-262-6423.

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

As the world knows, obesity has become a public health epidemic over the last several years in the United States, with over 35% of US adults falling into the obese category.  But when public health experts and lawmakers try to “do the right thing” by forcing people to engage in healthier behavior, are they going too far?

In a June 8th article on CNN.com, Harriet Washington believes that the ban on sugary drinks that New York City mayor Michael Bloomberg has proposed is the wrong way to go about encouraging healthy eating and drinking habits.  She also disagrees with “sin taxes,” stating that they often have unintended consequences.  In the sugary beverages ban proposal, restaurants, street carts, and movie theaters would not be able to sell any sugary drinks over 16 ounces.

While I don’t necessarily support an outright ban of sugary drinks, I do think that, for the most part, taxes imposed on items (such as those for tobacco and alcohol) are a great step toward  discouraging people from partaking in these unhealthy behaviors and increasing state revenue at the same time.  Many states have implemented a tax on sugary beverages in recent years, and many others have tried, but failed, for a soda tax to catch on.  Mayor Bloomberg even proposed a soda tax in 2009 for NYC, yet this proposal was eventually abandoned and never came to fruition.

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.

“Human speech is like a cracked kettle on which we tap crude rhythms for bears to dance to, while we long to make music that will melt the stars.” — Gustave Flaubert, Madame Bovary

“The chances of factual truth surviving the onslaught of power are very slim indeed … ” — Hannah Arendt, Between Past and Future

Although this may be more apparent than real, it seems as if the lying and the lies are increasing in frequency on the national level. Politics has long been characterized as a blood sport, but the escalation of vicious contentiousness since 2008 is unusual and extreme. Factual truth has been cast aside, casually thrown to the wind as if one were systematically ripping the petals off a roadside wildflower and tossing them into the air as so much refuse. The losers are the public, of course, the citizens who depend on the government for sound fiscal policies, welfare for those unable to care for themselves, and protection in the form of national defense.

None of this is a surprise. As Arendt states in her essay “Truth and Politics”, modern ideologies “ openly proclaim them to be political weapons and consider the whole question of truth and truthfulness irrelevant”. Further, “it may be in the nature of the political realm to deny or pervert truth of every kind”. As the nature of truth as such is limiting (in other words, it is what it is) , politicians will naturally bend the truth to fit their purposes. As citizens, we need to be on our guard and strive to identify factual truth or the lack thereof in political pronouncements. But such activity requires substantial effort. Thinking is required, as is the concomitant ability to simultaneously hold two contrasting concepts or points of view in mind. A broad education is required, as is a good facility with language. Sadly for us, most of these requirements and capabilities are now in short supply.

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 front page of the Sunday, June 10, 2012, New York Times included an article by Alan Schwarz titled “Risky Rise of the Good-Grade Pill.” The one sentence teaser on the Internet copy read: “At high schools across the United States, pressure over grades and competition for college admissions are encouraging students to abuse stimulants.” The article also used a term that I had not heard or seen in some time: “study drugs.” The story describes how students are using prescription drug stimulants like Adderall XR® (mixed salts of a single entity amphetamine, Shire) so they can “focus” when preparing for examinations and taking tests, in hopes of achieving better scores. Sadly, in the article, one student compared taking stimulants as study drugs was just like taking a vitamin.

Amphetamines are indicated for attention deficit hyperactivity disorder and narcolepsy. They were first synthesized in 1887 as a chemical that was to be a substitute for ephedrine. In the US in the 1930s, the drug manufacturer Smith Kline & French sold a volatile base form of the drug as Benzedrine inhaler for nasal congestion. During World War Two, amphetamines were used extensively to combat fatigue and increase alertness.

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.

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.