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Viewing by month: December 2013
December 31, 2013 | Posted By Zubin Master, PhD

Bioethics research is closely tied with policy. While discrepancies exist, I classify bioethics as an interdisciplinary field of study. As most interdisciplinary fields, one aim of bioethics is to develop practical solutions for real world problems in the biomedical and clinical sciences among other fields it impacts. Thus much of bioethics scholarship is closely intertwined and aims to inform health, social and science policy. Bioethics scholarship is also meaningful in attempting to raise awareness and educate researchers, practitioners, patients and the public on many areas of ethics in the health sciences. As a bioethics academic who has worked in both Canadian and U.S. institutions, I have enjoyed the benefit of examining policy and educational landscapes in both countries. Today, I want to specifically talk about research integrity policies, practices and education in Canada and compare it to the U.S.

What is research integrity?

Academics in every discipline including the fundamental and applied sciences (i.e., biomedical science, engineering), the social sciences, and humanities are self-governed professionals who conduct research upholding principles of research integrity. Research integrity (a.k.a. scientific integrity or the responsible conduct of research) captures a range of principles and practices governing ethical research. It includes practices such as research misconduct (commonly known as fabrication, falsification, and plagiarism), authorship and publication ethics, peer review, mentoring, conflicts of interest, research involving animals and humans and social responsibility. Yet beyond outlining principles and practices, there is a growing field of research on research integrity where scholars try and improve our understanding of the normative and practical aspects of research integrity. I’ve written about different topics within research integrity including what is conceptual bioethics research? and peer review in previous AMBI blogs.

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.

December 20, 2013 | Posted By Benita Zahn, MS

Like everyone else, I don't want dangerous criminals roaming the streets. So on the face of things the recent US Supreme Court ruling allowing states could take DNA samples from persons accused of serious crimes without need of a warrant, sounds like a good thing. 

But, like everything in life, the devil's in the details. 

If it's okay to get that swap from a suspect's mouth for DNA when the crime is 'serious' what about when it's less serious? Who will be the judge of what constitutes a 'serious' crime? That has not been determined. 

What if the police get 'the wrong guy' .. not the guilty one. What happens to that DNA evidence and all the information contained within? 

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.

December 20, 2013 | Posted By Lisa Campo-Engelstein, PhD

There are many celebrities who make the news because they have used a gestational surrogate to have their children, including Sarah Jessica Parker, Guiliana Rancic, Elizabeth Banks, Nicole Kidman, Ricki Martin, Neil Patrick Harris, and Elton John. From the little information provided about their surrogacy arrangements, it seems like most of the celebrities partner with surrogates who live in the US. What is almost never mentioned in these articles is the legality and enforceability of surrogacy contracts, which can vary dramatically from state to state. Each state has to determine how they want to regulate surrogacy because there is no federal legislation, though there was a push for it following the infamous Baby M case. 

Surrogacy laws can be categorized into three categories. The first category is comprised of laws that permit surrogacy contracts by outlining the criteria for the contracts to be lawful and enforceable. For example, surrogacy laws in Florida require that the intended couple must be over 18 years old and married, the intended mother must be incapable of gestating a pregnancy without physical risk to herself or the fetus, and at least one of the intended parents must be biologically related to any resulting child. These requirements have to be fulfilled in order for any surrogacy contract to be legal and enforceable.

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.

December 19, 2013 | Posted By Wayne Shelton, PhD

There are some ominous social and political trends currently in American society on which the field of bioethics should focus more attention. In this informal and admittedly polemical blog, I would like to briefly explore a couple of them.

Governors from about half of the states, mostly from the Tea Party GOP, have invoked their constitutional right to deny healthcare coverage to individuals in their states who make less that 138% of the federal poverty level. These governors calmly claim that pragmatism, not politics, is the basis for their decision to refuse their states the opportunity to participate in the Medicaid expansion program under the Affordable Care Act (ACA). It’s just too costly and the Medicaid program is broken, so they say.

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.

December 16, 2013 | Posted By John Kaplan, PhD

Open post-publication scientific peer review is here. Almost. Now we need to ask whether or not that is a good thing. Some are trumpeting this as a game-changing innovation which will improve the quality of scientific publication. Others are concerned that scientific publication will become more like Twitter and Facebook.

The site Pubmed Commons allows one to comment on any Pubmed indexed publication. Although the system now permits access in a limited way for testing, it will be open to essentially all who have Pubmed indexed papers in the relatively near future. Just as there are sites to review movies, restaurants, and contractors one will soon be able to include their insights and feelings about scientific papers. The advocates of this system believe that post-publication will open the peer review system to all qualified and can allow science to be communicated in a more transparent and less biased manner.

Advocates of post-publication peer review have been very critical of conventional pre-publication peer review

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.

December 12, 2013 | Posted By Bruce White, DO, JD

A July 28, 2012 article in The New York Times by Anne Lowry and Robert Pear titled “Doctor Shortage Likely to Worsen with Health Law” was recently updated with a follow-up report about Medicaid expansion by Abby Goodnough in a piece titled “Medicaid Growth Could Aggravate Doctor Shortage.” 

Many report that there’s not enough doctors now. It may be curious and rhetorical, but why would anyone suspect that there’s not going to be doctor shortages of some degree – in the very near future – if Medicaid expands by 9 million new persons and the Affordable Care Act (ACA) adds another 30 million or so newly-insured patients to those already covered by some plan. How could this not have been anticipated? It must have been factored into the ACA equation. In the same way that legislators should have realized that some insured would not be able to “keep their coverage” once the new health law was to take effect.

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.

December 9, 2013 | Posted By Jane Jankowski, LMSW, MS

A recent article published in ACPInternist (www.acpinternist.org) estimates that 35% of adults have looked online to try to diagnose a medical condition for themselves or for someone else, based on a 2013 survey.  While many providers dread having to explain that minor ailments are indeed minor because the patient fears something more dire based on website material, it seems that other providers are learning to accommodate and embrace the possibilities the internet holds for both patients and physicians. Like it or not, it seems clear that the online medical tools have become a part of many doctor patient relationships.

Given that you are reading this on a website, it seems reasonable to presume that my audience here is internet savvy and likely to be aware of the many types of websites and services available to healthcare consumers. There and numerous informational sites, symptom Mayo Clinic symptom checker, medical detective services where (for a fee) a large group weighs in with opinions on what an elusive diagnosis might be www.CrowdMed.com . Just to see what these tools offer, I decided to play ‘patient’ with Isabel, a relatively advanced symptom checker.

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.

December 5, 2013 | Posted By Marleen Eijkholt, PhD

Early November 2013: TB, a 32 year old deer hunter from Indiana, falls 16 feet from a tree while on a hunting trip and crushes his spinal cord. He injures his C3,4 and 5 vertebrae, but does not suffer any brain damage. TB’s prognosis includes paralysis from the shoulders down and potentially life-long dependence on a ventilator. His family asks the physicians if they can get him out of sedation and remove his ventilator, so that he can decide about how to proceed with his treatment. Once awake, TB hears his prognosis and asks to stop treatment. He dies one day after incurring his injury.

Several factors seem to have sparked the headlines and stir controversy, and I would like to focus on one of these. I question whether TB’s decision was and could be informed. Using this case, I propose that TB’s decision was perhaps a shot in the dark. I raise some of the pressing questions about informed consent in the clinical ethics context. I ask how we should ensure informed decision making, what we should do to enlighten patient’s perspectives and what we should do if patients refuse information that we consider material in the decision making process? 

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.

December 3, 2013 | Posted By Zubin Master, PhD

This is part 2 of a blog written last month. In Part 1, I explained how open access (OA) journals work and some of the shortcomings of peer review. This was done to provide a background on a recently published study by staff at the leading journal Science. In this part, I will cover the specific experiment reported by Science and explain some of the limits of its design followed by an interesting and novel model of the non-profit OA journal BioéthiqueOnline.

Part 2: Open Access Journals, Peer Review, and Conflicts of Interest

Do OA Journals Perform Rigorous Peer Review?

Recently, John Bohannon of the Science group conducted an investigation where he submitted scientifically flawed papers using fake names and provided the names of research or academic institutions that didn’t exist to 304 OA journals (Science 342: 60-65, 2013). The idea was to create a scientific paper with major errors, so that “[a]ny reviewer with more than a high-school knowledge of chemistry and the ability to understand a basic data plot should have spotted the paper’s shortcomings immediately.” Bohannon created a database of molecules, lichens and cancer cell lines and ran them through a computer program to generate unique papers, but with a standard structure: “molecule X from lichen species Y inhibits the growth of cancer cell Z.” He also created fake authors from fictitious African institutions with the hope that using developing world authors would lessen suspicion by journal editors. The main flawed graph showed a dose-dependent decrease in cell growth yet despite rising concentrations, the effects on cells were modest. In addition, the anti-proliferative molecule was dissolved in a large amount of ethanol and because the control group was not treated with the same solution buffer, the anti-proliferative effects seen could simply be due to the cytotoxic effects of ethanol. In a second experiment, Bohannon attempted to show an “interactive effect” by adding the molecule with radiation, but the control cells were not exposed to any radiation. As the experiments had a tragically flawed design, the idea was that any peer reviewer should pick them up and the article should be rejected.

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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