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Viewing by month: October 2012
October 30, 2012 | Posted By Michael Brannigan, PhD

Here is cardiac surgeon Christiaan Barnard's account of his conversation with Louis Washkansky just before he performed on him the first human heart transplant, in 1967:

"'We know you have a heart disease for which we can do nothing more. You have had all possible treatment, and you are getting no better. We can put a normal heart into you, after taking out your heart that's no longer any good, and there's a chance you can get back to normal life again.'

"'So they told me. So I'm ready to go ahead.'

"Washkansky said no more. His eyes remained on me but with no indication he wanted to know anything more.

"'Well, then ... goodbye,' I said.

"'Goodbye.'"

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.

October 24, 2012 | Posted By Ricki Lewis, PhD

When I was a fetus, I was left alone. My amniotic fluid and chorionic villi were untouched, and I arrived apparently normal, except for a mark on the part of my anatomy where a bullet “directly bit” Forrest Gump.

Perhaps that’s too much information. But TMI is precisely the problem when prenatal genetic testing detects a DNA sequence variant, but we don’t know exactly what it means. The fuzzy line between “unusual or uncertain” and “abnormal” in test results can cause great anxiety. This is especially so when “abnormal” before birth doesn’t affect health after, thanks to a characteristic of genes termed incomplete penetrance: not everyone with a genotype develops the corresponding phenotype.

A recent article in Genetics in Medicine examines the distress of a sample of women receiving “abnormal” fetal test results. Lead investigator Barbara Bernhardt, MS, a genetic counselor and co-director of the Penn Center for the Integration of Genetic Healthcare Technologies, reports that some of the participants called the test results “toxic knowledge.”

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.

October 17, 2012 | Posted By Zubin Master, PhD

Stem cell tourism is a pejorative term used to describe clinics that offer under or untested stem cell interventions to patients with debilitating 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 under or untested stem cell interventions, some of which are being challenged by the FDA. The stem cell tourism market is an internet-based, direct-to-consumer market. There is a lack of scientific evidence and clinical research supporting the claims made by clinics in regards to the efficacy of these so-called “treatments”. The evidence sold to patients are testimonials by other patients saying how great they feel and how it has helped them and given hope. This is further fueled as some public perception studies indicate that several patients are frustrated and seem to distrust their domestic healthcare, research and regulatory system. So why offer these therapies? Well for starters, stem cell providers could make a ton of money (ranging from $5,000 to $30,000), especially because sometimes patients require repeated treatments. The market has more recently attracted celebrity types including several high profile athletes, Hollywood stars, and even a US State Governor.

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.

October 15, 2012 | Posted By Lisa Campo-Engelstein, PhD

I just returned from the annual Oncofertility Consortium Conference and one of the ethical topics that came up was the possibility of disputes over frozen reproductive materials. Before undergoing life-saving cancer treatment, people may opt to freeze gametes, gonadal tissue, or embryos in order to preserve their fertility. If these people die or separate from their partners, a battle over what to do with the frozen reproductive materials can ensue. The best and easiest way to deal with disputes over reproductive material is to try to prevent them before they happen. In this blog, I discuss two ways to prevent such disputes. 

One way is to have the individual with cancer write an advance directive that clearly outlines what should be done with the reproductive material should the patient die. If the reproductive materials are gametes or gonadal tissue, then ultimately the decision of what to do with the reproductive material should be made by individual with cancer, as it is her/his genetic material. If the reproductive materials are embryos, then the individuals who contributed the gametes to create the embryos should come to an agreement about how the embryos should be handled under unfortunate circumstances (e.g. death of the genetic parents or separation of the couple). Many infertility clinics require all patients—both individuals and couples—to complete a document outlining how to handle reproductive materials in unfortunate circumstances and I think this should be standard practice for oncofertility patients as well. 

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.

October 12, 2012 | Posted By Jane Jankowski, LMSW, MS

A patient walks into her local Emergency Department complaining of back pain. She appears uncomfortable, and states that she was injured in a car accident about a year ago and now has chronic pain in her back. Her x-ray looks normal. She states that her pain is best managed with regular doses of oxycodone, but she ran out and has not been able to see her regular doctor for a refill. She came to the Emergency Department for a prescription instead. Imagine you are the physician. What action would you take?

a. Provide a dose of medication to the patient in the ER to be sure it will be adequate and give the patient a prescription for a couple days’ worth of the requested medication.

b. Call her regular doctor to confirm the medication and dose before providing any medication.

c. Check the state database to be sure this patient is not seeking prescriptions from multiple providers.

d. Offer only non-narcotic pain medications.

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.

October 10, 2012 | Posted By Wayne Shelton, PhD

The modern era in the West marks the beginning of a new way of understanding the purpose of a social system and how people fit in to it. The transition to the modern world was from a medieval world that was perceived to have inherent ends and truths, based on Aristotelian metaphysics and Catholic moral theology, that provided authoritative answers to fundamental questions about the nature of ultimate reality, knowledge, human nature and morality. In Europe during the 15th and 16th centuries, the radical political turmoil, stemming from the Protestant Reformation, and a growing sense of the rights of humans were leading philosophers like Hobbes (1588-1679), Locke (1632-1704) and Rousseau (1712-1778) to articulate a fundamentally new type of social and political system. Instead of the divine rights of kings to assert complete rule over subjects, which created an obligation for subjects to obey those divine rights, there emerged the concept that the social and political order should be structured so as to protect and preserve the natural rights of human beings qua citizens. This new understanding of how to understand society and individuals—later called social contract theory—provided the conceptual underpinnings of the eventual emergence of democratic systems: The idea that the social system should be structured in a manner so as to allow individual citizens to be free to live according to their life goals and values within the limits of respecting those same rights of others. This meant that individual citizens should agree to give up some of their rights, e.g. to steal and kill, for the larger benefit of living safely and in a manner of one’s own choice. 

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.

October 5, 2012 | Posted By John Kaplan, PhD

It seems today that the popular press is replete with stories telling us that scientific findings which were widely believed based on earlier studies were untrue, that conclusions unsupported by previous studies are true, and in the extreme that most medical research is wrong. Why is this happening, how could this be, and most important are the studies indicating that things are not as was previously believed, in fact, correct? It turns out that much of the basis for these contradictions is the increasingly prevalent use of meta-analysis.

Meta-analysis is a technique which combines the results of multiple studies in order to provide more statistical power to the study. Statistical power is a concept that basically says that as the number of experimental observations increases, the variance (variation of data) decreases and the effect size (difference between control and experimental observations) increases, a study becomes more powerful. Therefore, by using the results of multiple studies statistical power increases, generally due to a greater number of experimental observations.

It is important to keep in mind that meta-analysis is not a single well established technique but rather a general approach with various techniques used to combine results. Most use weighted averages of outcomes with weighting of individual studies based on sample size or event rate. There is nothing wrong with this approach. 

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.

October 3, 2012 | Posted By Bruce White, DO, JD

The September 20, 2012, issue of The New England Journal of Medicine carried two Sounding Board pieces about recommendations to contain health care spending. One article is titled “A Systematic Approach to Containing Health Care Spending” was produced by nationally known health policy experts working in cooperation with the Center for American Progress.

About half of the 11 recommended solutions are not new, nor have they proven to be anything more than platitudes from the past. Among these recommendations are: (a) “accelerate use of alternatives to fee-for-service payment”; (b) “simplify administrative systems for all payers and providers”; (c) “make better use of nonphysician providers [such as nurse practitioners and physicians assistants]”; (d) “expand the Medicare ban on physician self-referrals”; and (e) “reduce the costs of defensive medicine.” Should one peruse any one of several books produced in the 1980s written by politicians and health system gurus – such as Alain C. Enthoven’s Health Plan (1980), Joseph A. Califano, Jr.’s America’s Health Care Revolution (1986), Victor R. Fuch’s The Health Economy (1986), and Rashi Fein’s Medical Care, Medical Costs (1989) – they would find the same recommendations. Also, not so curiously, all of these authors and many others agreed in spirit – in the 1980s – that health care spending “trends [then] could squeeze out critical investments in education and infrastructure, contribute to unsustainable debt levels, and constrain wage increases for the middle class.” This at a time when total health care spending was one-tenth of what it is today (health care spending in 1980 was $256 billon; health care spending in 2020 was $2.6 trillion).

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.

October 1, 2012 | Posted By Ricki Lewis, PhD

On July 11, Wills Eye Institute ophthalmologist Carl Regillo delicately placed 100,000 cells beneath the retina of 52-year-old Maurie Hill’s left eye. She was rapidly losing her vision due to Stargardt disease, an inherited macular dystrophy similar to the much more common dry age-related macular degeneration (AMD).

Maurie’s disease was far along, the normally lush forests of photoreceptor cells in the central macula area severely depleted, especially the cones that provide color vision. Would the introduced cells nestle among the ragged remnants of her retinal pigment epithelium (RPE) and take over, restoring the strangled energy supply to her remaining photoreceptors? They should, for the cells placed in Maurie’s eye weren’t ordinary cells. They were derived from human embryonic stem cells (hESCs).

I’ve waited 15 years to see human embryonic stem cells, or their “daughter” cells, make their way through clinical trials. And thanks to Maurie’s sharing her story, I’m witnessing translational medicine.

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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