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April 14, 2015 | Posted By John Kaplan, PhD

Last week we posted an article to our Facebook page from the Washington Post entitled “We don’t need more STEM majors. We need more STEM majors with liberal arts training”.  

Reading this got me to thinking and a bit of reminiscing about my own education. Long before STEM meant science technology engineering and math I was a STEM major. I received my undergraduate degree from the University of Illinois in 1972 from the College of Liberal Arts and Sciences. That is, I was a STEM major who received a liberal arts education. The replacement of the word “education” for “training” is intentional on my part as I value education far beyond training but I digress.  I focused on science to the greatest degree possible with a biology major and a chemistry/physics minor. But as a student in the College of Liberal Arts and Sciences I was required to complete requirements which were satisfied by sequences in social sciences, humanities, foreign language, and rhetoric. I remember these experiences to varying degrees. Some are fond memories, some seemed more like torture. Collectively, however, I look back on these courses as a great well rounded and very rewarding educational experience. I do have every confidence that I benefited greatly from my non-STEM courses and they helped me with the skills and the experience to better communicate as a scientist and the non-scientific responsibilities I also had as a faculty member.

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. 

April 10, 2015 | Posted By Wayne Shelton, PhD

The history of America from the beginning was a struggle of opposing ideological perspectives over the role of the state’s power vis-à-vis the consciences of individual citizens. The 17th century Puritans in the Massachusetts Bay Colony basically transported to America the same kind of religious, state intrusion into the lives of individuals they were trying to escape in England by requiring citizens to subscribe to the official state religion. Fortunately, there were courageous individuals there at the time, like Roger Williams (1603-1683), who strongly resisted such requirements. Williams, prior to coming to America, had been educated at Cambridge and worked for Lord Chief Justice Edward Coke. (1552-1634)  Coke was the famous English jurist whose work provided much of the foundations of the Anglo-American legal system, and who famously “declared the king to be subject to the law, and the laws of Parliament to be void if in violation of "common right and reason”.  No doubt Williams’ prior education and influences from Coke, and from others like Francis Bacon (1561-1626) who taught him the way of learning through experiment and observation, helped temper his strong theological commitments in relation to his views about the proper relationship between the authority of the state and religion, and the extent to which the state could have control over the consciences of free individuals, what Williams called “soul liberty”. Williams himself did not have theological quarrels with the Puritans; however, he did not believe religious conviction could be coerced. It was on this moral and political basis, that Williams founded Rhode Island, the first state ever to have a constitution guaranteeing expansive freedom of conscience to individual citizens. Fortunately, the thinking of Williams became the mindset of the key founders, particularly Jefferson (1743-1826) and Madison (1751-1836), of the American constitutional system. (For a full account of Roger Williams’ life and influence, see the wonderful book, Roger Williams and the Creation of the American Soul: Church, State, and the Birth of Liberty by John M. Barry)

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. 

April 7, 2015 | Posted By Bruce D. White, DO, JD

On March 30, 2015, the American Pharmacists Association (APhA) House of Delegates – the group’s representative assembly – adopted a policy discouraging pharmacists from participating in executions. The APhA policy is only one sentence long: “The American Pharmacists Association discourages pharmacist participation in executions on the basis that such activities are fundamentally contrary to the role of pharmacists as providers of health care.”

In defending the new policy, APhA Executive Vice President and CEO, Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, stated, “Pharmacists are health care providers and pharmacist participation in executions conflicts with the profession’s role on the patient health care team. This new policy aligns the APhA with the execution policies of other major health care associations including the American Medical Association, the American Nurses Association, and the American Board of Anesthesiology.”

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. 

April 2, 2015 | Posted By John Kaplan, PhD

Peer review of scientific manuscripts has been around a long time. There are apparently plenty of people who think something is not quite right with peer review because they keep trying to change it. Specifically I am talking about the peer review of manuscripts for publication. I have addressed this subject periodically and new developments lead me to address this subject again.

One new development is so called fast-track peer review.  This type of review is being adopted by at least one journal of the prestigious Nature Publishing Group, Scientific Reports. The publisher has contracted with a private peer review company, Rubriq.  Authors submitting papers to Scientific Reports can opt to have their manuscript review fast tracked as long as they are willing to pay $750 to cover the costs. Rubriq in turn pays the peer reviewers $100 per manuscript to review the manuscript quickly. Imagine that, a faster publication, something every scientist aspires to is now available to those willing and able to pay more. This sounds disturbingly like a two-tiered system based on economic resources. I am also a bit jealous that I did not get paid to review all those manuscripts over the last forty years. The perverse component of this scheme is that it makes what was always a volunteer activity into one that now consumes limited research resources.

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. 

March 26, 2015 | Posted By Zubin Master, PhD

A 2005 study conducted by the Pew Forum on Religion and Public Life reported that 64% of Americans support teaching creationism alongside evolution in U.S. public schools while only 26% opposed this idea (1). Moreover, 38% of Americans preferred that creationism be taught instead of evolution. The decisions of several court cases explain that there is no room for teaching intelligent design and creationism in high school biology or other classes. Intelligent design, creationism, and many of its alternative theories should be excluded in public school science education because it serves to legitimize religious based ideologies as though they were scientifically grounded theories. In addition to the legal rulings, State governments emphasize evolution as a central theme in the instruction of science, but vary in the amount of detail and importance the offer schools and teachers (2). Yet despite the emphasis on evolution from State boards and court rulings, U.S. science teachers seem cautious when teaching evolution.

In 2007, two political scientists Drs. Michael B. Berkman and Eric Plutzer in the Department of Political Science at Penn State University published a landmark study examining the teaching of evolution and creationism in U.S. public schools. Of the 938 teachers that participated (48% response rate), 17% did not cover human evolution (as opposed to covering evolution of non-human animals) while 60% spent one to five hours of class time. Of the teachers that discussed evolution as part of their pedagogy, only 23% strongly agreed that evolution is a unifying theme in their biology or life science classes (2). 

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. 

March 18, 2015 | Posted By Lisa Campo-Engelstein, PhD

The story about the UK passing a law to allowa reproductive technology called mitochondrial donation, what has been informally known as three person or three parent embryos, recently dominated the news.Part of the reason this story received so much attention is because the idea of a child with more than two biological parents sounds really scary, even Frankensteinish.While new medical technologies often raise ethical concerns, it is imperative to understand the science behind these technologies in order to accurately assess the likelihood and degree of potential harms caused by these technologies. In the case of three parent embryos, once we understand the science, this technology is not as threatening as it may initially appear.

The UK will only allow mitochondrial donations in cases where women could pass along mitochondrial diseases to their children. There are various types of mitochondrial diseases, which affect approximately one in 8,500 people and can lead to serious and fatal conditions. The mitochondria are located in the cytoplasm of the cell and serve as the cell powerhouses. Mitochondria have their own set of DNA with the 37 genes and a mitochondrial disease occurs when there is a mutation in the mitochondrial DNA. Mitochondrial donation allows women who are at risk for passing along mitochondrial diseases to the children to avoid doing so by using the mitochondria of a donor. There are two ways this can be done. In the first way, known asmaternal spindle transfer technique, the nucleus from the donor egg is removed and replaced with the nucleus from the intended mother's egg. The resultant eggwill carry the nucleus with all the genetic information from the intended mother, but will also contain the healthy mitochondrial DNA from the donor egg.The second way, known as pronuclear transfer, removes the nucleus from a donor embryo and replaces it with the nucleus of an embryo that contains the genetic material from intended mother and father. Here again,the resultant embryo contains the genetic material from the intended parents, but avoids inheriting mitochondrial diseases because donor mitochondria is used. 

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. 

March 13, 2015 | Posted By Wayne Shelton, PhD

Those of us who aspire to eventually having an affordable, quality, accessible healthcare system for all citizens, or even for most citizens, must first face an obvious but under-discussed challenge that uniquely American: The major players in the US healthcare system—including private insurance companies, pharmaceutical companies, medical device and equipment makers, medical specialties and sub-specialties, healthcare organizations and their executives and shareholders, and all of their lobbyists—are motivated by their own economic self-interests first and foremost. Which means our aspirations must be viewed as a long-term struggle.

Healthcare in American is simply unfettered capitalism at work. Let me hasten to add, this is not to say that all of these entities don’t do some remarkable work—I owe my life to the U.S. healthcare system as do millions more. But the fact remains that much of the extravagantly high costs of medical care in the U.S. healthcare system has nothing to do with improving or adding quality care for patients and producing good outcomes. Rather it’s a reflection of how these key players pursue their own entrenched financial interests, while creating narratives to the public that the services they provide is essential for quality healthcare. Interestingly, over time, this bloated, inefficient system has been generally accepted by the public and therefore gained a façade of legitimacy that makes it virtually intractable to reform.

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. 

March 10, 2015 | Posted By Jane Jankowski, DPS, LMSW

One of the challenges clinicians must learn to manage is the patient who does not adhere to medical recommendations while expressing the desire to be well. It is widely accepted that patients with the capacity to make informed decisions retain the right to make choices that are good for them and choices that are not, there are instances where capacity to make a choice becomes less relevant than the practical considerations related to achieving the patient’s goals. When patients state they wish to recover from illness but refused to comply with the necessary treatments this disconnect poses a different kind of dilemma. Morally, it is simpler to digest that that some patients will refuse treatment, and there is robust support for respecting refusals. But what do we do when a patient asks for one thing but does another? Such cases pose intractable impasses for providers who arrange care plans based on the patient’s stated goals of recovery, yet encounter what seem to be enigmatic refusals to adhere to recommendations and interventions. There is a clear obligation to attempt to understand the patient’s perspective and thoroughly as possible. What may appear to be inconsistencies in preference may very well have a logical explanation. Once efforts to unpack dissonant expressions have been exhausted, a different approach may be needed to figure out what may be possible for such a patient. The first question is often about capacity – does a patient who asks for one thing but does another possess the ability to make an informed decision? In some cases, the resolution ends here if the patient is found to be unable to make an informed decision – or does it? If the objection is strong, and the intervention requires a high degree of cooperation from the patient, capacity may be moot because there is no practical way to proceed without cooperation. For example, a patient who insists she does not want to die, but simultaneously resists life sustaining dialysis leaves providers with very few options. A patient receiving a temporary intervention to buy time for recovery may in fact, not achieve the desired healing – how long must a bridge therapy continue? In such cases, capacity may be part of the picture, but I would argue it sometimes becomes a red herring we chase instead of taking a hard look at the medical facts and practical considerations in such cases. 

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. 
March 4, 2015 | Posted By Bruce White, DO, JD

Probably not. It’s just not the American way.

And, it is true that Americans pay more out-of-pocket for prescription drugs than citizens in other developed countries. Other nations use government cost controls and aggressive cost containment strategies to regulate prescription drug costs. Historically, the US Congress has deliberately and consistently refused to regulate prescription drug pricing directly.

The American pharmaceutical industry often has been accused of gouging consumers and profiteering. Its investor return on equity is usually much higher than other industries. And prescription drug pricing differentials have always been difficult to understand, whether at the local pharmacy or within similar hospitals in the same locale.

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. 

February 26, 2015 | Posted By Zubin Master, PhD

In the past State of the Union address, Obama announced his precision medicine initiative involving the creation of a new, national level biobank.

Biobanks collect biological samples (e.g., DNA, cells, tissues, blood) and health and lifestyle information (e.g., disease information, smoking habits). By collecting it once, biobanks store biosamples and information such that they can be used as new biomarkers are discovered. As the samples are shared with others, biobanking research offers a novel research platform to perform large-scale, epidemiological studies in order to associate genotypic or biological information with healthand disease. Many nations have made significant investments into biobanking research creating national level biobanks such as the U.K. Biobank, which has half a million samples, and the Icelandic biobank called deCode Genetics.

Obama’s goal is to have at least 1 million American volunteers enroll in the biobank which will aim to conduct longitudinal studies examining genes, health and the environment. Collecting these many samples may not be so straightforward concluded a panel of experts at a recent workshop at the National Institutes of Health. Several scientific and logistical issues were discussed. What types of diseases will be studied? Who will have access to the data? Who will be recruited? Will samples from other biobanks be incorporated into the precision medicine initiative? Yet with the many scientific and logistical issues, there are numerous ethical issues including informed consent, commercialization, and the return of results that must be given due consideration.

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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