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.

Medicine as treatment or medicine as healing? Despite facile responses, these two constructions are distinct. It is possible that the failure to distinguish between the the modalities of treatment and healing is responsible for much of the current health care mess. Such failure may also account in large part for the abject failure of medicine to provide meaningful solutions to the epidemics of type II diabetes and overweight/obesity. Similarly, when a person ill with cancer or a person ill with a cardiovascular disorder encounters the health care system, the orientation of his physicians to treatment or healing will have a significant impact on the person’s long-term health and well-being.

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.

“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.

Scientists now have the capability of changing the world. Literally. A prominent researcher observed in a 2011 Science article that "our genome engineering technologies treat the chromosome as an editable and evolvable template". The advent of such technologies is disturbing from many points of view.

Until very recently scientific research contributed to the advancement of knowledge about the world around us without simultaneously creating tools for altering the characteristics and parameters of that world. None of these activities threatened the integrity of the biosphere — namely, that of planet earth. The ability to do so should give all of us, primarily scientists, pause, but they do not. As Hans Jonas observed, the deeds of biological engineering are irrevocable.

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.

It has been a very busy week at the Supreme Court. Three days of arguments on the various challenges to the Patient Protection and Affordable Care Act each merited front-page coverage in The New York Times. SCOTUSblog, the blog of the Supreme Court, received more than 800,000 hits in three days, which was more than the site has received in its first 4 years of existence. Regardless of the court's final ruling (expected on June 28th), the active engagement in our robust democratic politics of so many Americans and interested parties worldwide bodes well for the future of our way of life. Separation of powers, first described and promulgated by John Adams (second president of the United States) in his treatise, Thoughts on Government, Applicable to the Present State of the American Colonies, is alive and well.

It's easy to experience the ebbing of America's power. Our national political scene is a toxic partisan shambles. We have been severely depleted — our blood and treasure have been unthinkingly squandered in 10 years of geopolitically useless war in Iraq and Afghanistan. We are beset by real threats to our welfare and continued existence . . .

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 need less medical care, not more. We need more preventive services and more patient education, not more high-technology crisis care. Specifically, we need more primary care physicians.

Most informed citizens are aware that in the U.S., per capita expenditures on health care are the highest in the world. Each American spends an average of $8100 per year, representing a substantial proportion of annual income. The total U.S. health care burden of $2.5 trillion (in 2009) is 17.6% of our gross domestic product.

These numbers need to come down, but costs continue to rise. A long-term solution is available, one that doesn't involve structural changes in how health care services are bought and paid for. [Such structural change is critically important, but vested interests continue to severely dominate the U.S. political landscape.] The specific long-term solution involves focusing on primary care.

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.

If we were not capable of autonomous thought and merely accepted and acted on what others told us, the future prospects of our communities, nations, and race would be bleak indeed. Fortunately, a few humans are capable of independent thinking, creativity, insight, and innovation. Every "benefit" of modern existence is a direct result of independent thinking in the form of scientific activity. Those of us who live in developed nations would be very hard-pressed to get through a day without readily available electricity and running water. Imagine living without automated transportation. Imagine living without television or cinema. Imagine living without a computer.

The study, investigation, and application of mathematics, physics, chemistry, and biology, and their combined disciplines such as engineering, agriculture, and architecture, have given us the world we inhabit. And yet in the United States close to half the population is being trained daily to believe that science is a bad thing.

For example, the theory of evolution (a classical example of the scientific method) has been under attack for several decades. A Gallup Poll conducted two years ago, around the time of the 200th anniversary of Darwin's birth, revealed that only 39% of Americans "believe in the theory of evolution". Twenty-five percent did not believe in the theory and 36% had no opinion.

Of course, in order to be able to assess the value of a scientific theory, even from a high-level view, one has to have the ability to assemble facts and be able to recognize associations and connections among disparate threads and competing explanations. Sadly, it seems that such abilities, formerly mastered in grade school, are no longer accessible to the majority of our fellow citizens.

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.

“Are you still collecting stories about DTC testing? I've got one for you!” my grad student L.W. e-mailed a few days ago. Little did I know her family's experience would change my mind about direct-to-consumer genetic testing.

L.W. had taken my online course “Genethics” in 2008 for the master’s program at the Alden March Bioethics Institute of Albany Medical College. For one assignment, students choose a DTC testing company, peruse the website, and indicate 3 tests that they would take and 3 that they wouldn't – and why. 

As a class activity, L.W. didn’t really approach the testing seriously. “It's fun cocktail party info. ‘Why, yes, I'd love another mocha cappuccino at 9 pm. No problem... I'm a fast caffeine metabolizer!’” 

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.