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.

A recent New York Times article shares the story of Debra Demidon, who developed severe ovarian hyperstimulation syndrome (OHSS) after undergoing IVF. This potentially life-threatening condition caused her to gain more than 30 pounds of fluid and have trouble breathing, and ultimately landed her in the hospital for 5 days. OHSS is much more common in the US and UK than in Europe and Japan because the former countries rely on high-dose hormones for IVF where the latter countries use lose-dose hormones. Although rare, OHSS following high-dose hormone IVF is now one of the leading causes of maternal mortality in parts of the UK. OHSS is not the only adverse side effect of high-dose IVF for women; there are myriad other possible side effects including increased cancer risk, memory loss, and liver disorders.  Furthermore, there can also be increased risk for children born from high-dose IVF, such as low birth rate. 

Knowing these serious potential health-related outcomes, why is high-dose IVF the dominant and default method used in the US? The main reason is that high-dose IVF produces many more eggs (often 20-30 eggs and sometimes even more) than low-dose IVF produce (8-10 eggs). Given that most insurance companies do not cover infertility treatments (only 15 states have laws mandating insurance companies to cover infertility treatments and there are many exemptions and caveats), many people pay out of pocket for IVF. In order to save money – IVF costs $15,000 - $30,000 a cycle – people are often willing to increase their risks to themselves (choosing high-dose IVF or low-dose IVF) if it means they’re likely to generate more eggs. Individuals in time pressure situations who may only have one shot at gathering eggs, such as cancer patients wanting to preserve their fertility before undergoing treatments that will hopefully save their lives but may render them infertile, may also opt for high-dose IVF.  

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.

Tis the season for family vacations, and like others, our clan tries to incorporate visits with extended family into our routes or final destination. This year, I was able to spend some time with an almost 95 year old grandparent who had some strong views on what she wanted for end of life care. Now, keep in mind, this lady puts most of us to shame with her daily swims, daily reading of the Wall Street Journal, efficient home economics, and speed at calculating Cribbage points. I was struck by the progressive stances held by this wise woman, and was forced to recognize the real risk that her preferences could easily be overlooked in an emergent medical situation.

Sitting in the yoga studio at the assisted living center where she resides, I notice a rather substantial silver bracelet dangling from her left wrist. Unusual for a jewelry minimalist, I asked about it. It is a DNR bracelet. My bioethicist ears perk. Upon closer examination, I see the engraved words, “DO NOT RESCUSITATE” marking the surface.  “Many of us have them,” I am told. Explaining the pervasive concerns shared by her peer group that EMTs will perform CPR no matter what, the message is clear that in this cohort of older adults there is a fear that no matter how well documented and verbalized their preferences may be, these wishes may be overlooked. And this fear is not without merit. 

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.

With the Supreme Court upholding the individual mandate of the Affordable Care Act (ACA) constitutional but rejecting the notion that the states had to expand their Medicaid program to cover a significant percentage of the populations, some inequities in health care delivery will only grow.

One might use any number of examples to illustrate identified expected unfairness. For the relatively poor Southern states – Alabama (AL), Louisiana (LA), and Mississippi (MS) – patients covered by Medicaid and the Children’s Health Insurance Program (CHIP) is significantly higher than the national average now. With the proposed ACA expansion in these three states effected by 2019, the percentage of Medicaid & CHIP-eligible populations would swell from 20% to 27% (AL), 26% to 34% (LA), and 26% to 37% (MS). In Louisiana and Mississippi, these percentages are approaching the number of persons in the state who have traditional private health insurance. [The projected numbers used here are from the Kaiser Family Foundation Website.]

Moreover with the increased numbers of patients who will have Medicaid and CHIP coverage, proportionately more practitioners will be critical in providing the care in these states. Is it realistic to think that Alabama, Louisiana, and Mississippi, will be able to grow their provider availability by 37%, 32%, and 41% in four years to meet the demand? The national average is 25.7 active physicians per 10,000 persons. Louisiana is very close to the US mean with 24.2 physicians per 10,000, but Alabama and Mississippi are will below the national average with 20.6 and 17.3 physicians per 10,000 respectfully. Is it reasonable to assume that these states will be able to multiply their physician populations to meet any increased demand?

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.

On Sunday morning, July 21, I faced a room of people from families with Leber congenital amaurosis (LCA), an inherited blindness caused by mutations in any of at least 18 genes. It was the final session of the Foundation for Retinal Research’s bi-annual LCA family conference, and I was there to discuss the history of gene therapy. But I zapped through that quickly, because the future is much more intriguing.

The excitement pervading the room that day was palpable, following a day of scientific updates, and not only because those with young children were soon to visit Sesame World and the sights of Philadelphia.

Exome sequencing identified the rare mutation that causes Gavin Stevens’ hereditary blindness (Leber congenital amaurosis, or LCA). (Photo: Jennifer Stevens)

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.

It was reported in the New York Times earlier this month that GlaxoSmithKline was fined three billion (yes billion!) dollars by the feds to settle civil and criminal penalties for illegally promoting ten of its drugs. In Maythe drug firm Abbott Laboratories was fined 1.6 billion (yes billion!) dollars for illegally promoting their drug Depakote. In April Johnson & Johnson was fined 1.2 billion (yes billion!) dollars in Arkansas for marketing practices of their drug Risperdal. We can keep this short by primarily reporting fines from this year and those in the billion-plus range. I do feel the need to recall Pfizer’s 2.3 (yes billion!) dollar fine in 2009 for illegal marketing of Bextra. Taxpayers Against Fraud reports over ten billion in such settlements and civil and criminal penalties during the current fiscal year.

How can pharmaceutical companies engage in such costly activities on an ongoing basis? It turns out that what seems like a lot of money to you and me is not so much to these huge corporations. Avandia, Paxil, and Wellbutrin, just three of the ten drugs that GlaxoSmithKline was marketing this way had sales of over 25 billion (again, yes billion!) during the ten year period covered by the settlement. According to Patrick Burns, spokesman for Taxpayers Against Fraud, this “can be rationalized as the cost of doing business.” The market apparently agrees that this is a reasonable cost to do business as these fines barely registered in terms of the valuation of stock in these companies. Implicit in this conclusion is that these companies are making a purposeful decision to act in this manner and thus could be considered criminal enterprises.

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.