Basking in the glow of having finished my final paper for our bioethics class, I wonder what I will be wondering about this time next week without an assigned dilemma to consider.
For me, the stem cell debate, the genetics debate, the euthanasia debate, etc. all come together very concretely in the issue of health care worker’s ‘conscience clause’. I borrow from the Washington Post article linked below to describe some examples.
“In Chicago, an ambulance driver refused to transport a patient for an abortion. In California, fertility specialists rebuffed a gay woman seeking artificial insemination. In Texas, a pharmacist turned away a rape victim seeking the morning-after pill.”
Is it right for health care workers to refuse to do thing that violate their own moral and religious values? Or do healers have an ethical and professional responsibility to put patients first?
The heck if I know.
But I will be thinking on it. ... sort of like a never-ending Thursday night discussion.
http://www.washingtonpost.com/wp-dyn/content/article/2006/07/15/AR2006071500846.html
PJM
Friday, December 12, 2008
Elective surgery with a side of nan
You can now get an all-expense paid trip for yourself and a companion to travel to India and get that procedure taken care of.
http://www.nytimes.com/2008/11/21/health/21abroad.html?_r=1
One of the many any issues that occur to me regarding international ‘medical tourism’ is how this impacts informed consent issues. A search for ‘medical tourism’ turned up the two following medical travel agencies. These are not providers or insurers. From what I can see, you sign your consent in the foreign country after consultation with the foreign doctor.
I wonder if this consent would hold up in the United States? After traveling thousands of miles for the purpose of a surgical procedure, isn’t an individual somewhat captive and under some duress and ‘forced’ to sign a consent? Or is traveling thousands of miles to get a elective surgical procedure a form of consent in and of itself? I have always been focused on health care in the United States and would like to know more about how ethical practices are handled in situations like this.
http://www.medicaltourismsolutions.com/procedures/sample_packages.htm
http://www.medpathgroup.com/
http://www.nytimes.com/2008/11/21/health/21abroad.html?_r=1
One of the many any issues that occur to me regarding international ‘medical tourism’ is how this impacts informed consent issues. A search for ‘medical tourism’ turned up the two following medical travel agencies. These are not providers or insurers. From what I can see, you sign your consent in the foreign country after consultation with the foreign doctor.
I wonder if this consent would hold up in the United States? After traveling thousands of miles for the purpose of a surgical procedure, isn’t an individual somewhat captive and under some duress and ‘forced’ to sign a consent? Or is traveling thousands of miles to get a elective surgical procedure a form of consent in and of itself? I have always been focused on health care in the United States and would like to know more about how ethical practices are handled in situations like this.
http://www.medicaltourismsolutions.com/procedures/sample_packages.htm
http://www.medpathgroup.com/
Thursday, December 11, 2008
Declaration of Helsinki Abandoned
Earlier this year the FDA made a decision that would replace the Declaration of Helsinki (DOH), a system put in place in the 1970s by the U.S. and several other countries to govern drug trials on humans, with a system called Good Clinical Practice (GCP). http://www.thenation.com/doc/20080602/shah In charge of this new system is the International Conference on Harmonization which consists of drug regulators and pharmaceutical representatives from the U.S., EU and Japan. Instead of the standards set in place by DOH, which outlined principles emphasizing that “extreme care must be taken in making use of a placebo-controlled trial” where proven therapies exist, this new system practically allows pharmaceutical companies to dictate their own ethical rules in conducting experiments.
Though the DOH wasn’t a perfect system either, as it had undergone numerous revisions and had been characterized as being too vague, it was much less biased than the system in place now. The significance of this change is that the FDA will now permit pharmaceutical companies to conduct clinical trials in which the control group could be treated with placebos. Instead of old treatments being tested against new treatments, this change allows new treatments to be tested against placebos. This is a departure from the DOH which restricted the use of placebos ensuring that the patients would not be denied already proven life saving treatments. The argument for using placebo groups in less developed countries rests on the justification that those patients wouldn’t have access to traditional treatments anyway, so the placebo experiments are merely testing the new treatment against the existing “standard of care”—meaning no treatment.
It’s obviously unfair that trials which would never be conducted in the U.S. are being conducted elsewhere, but what worse is that this new system approved by the FDA allows pharmaceutical companies to conduct trials on their own terms. At least the provisions by the DOH provided that patients would obtain access to the study drug after the trials ended and that the communities in which the drugs were tested would likely receive benefits from the research—but the GCP does away with these restrictions.
It’s well known that lack of consent is common in poorer countries, but under this new system, there will be far less oversight on pharmaceutical companies than there was previously. I wouldn’t be surprised if many of these patients were coerced into these experiments due to lack of any alternative treatments. The lack of informed consent combined with coercion leads me to consider that much of what’s going on bears resemblance to the crimes perpetrated by those found guilty in the Nuremburg Trials.
Though the DOH wasn’t a perfect system either, as it had undergone numerous revisions and had been characterized as being too vague, it was much less biased than the system in place now. The significance of this change is that the FDA will now permit pharmaceutical companies to conduct clinical trials in which the control group could be treated with placebos. Instead of old treatments being tested against new treatments, this change allows new treatments to be tested against placebos. This is a departure from the DOH which restricted the use of placebos ensuring that the patients would not be denied already proven life saving treatments. The argument for using placebo groups in less developed countries rests on the justification that those patients wouldn’t have access to traditional treatments anyway, so the placebo experiments are merely testing the new treatment against the existing “standard of care”—meaning no treatment.
It’s obviously unfair that trials which would never be conducted in the U.S. are being conducted elsewhere, but what worse is that this new system approved by the FDA allows pharmaceutical companies to conduct trials on their own terms. At least the provisions by the DOH provided that patients would obtain access to the study drug after the trials ended and that the communities in which the drugs were tested would likely receive benefits from the research—but the GCP does away with these restrictions.
It’s well known that lack of consent is common in poorer countries, but under this new system, there will be far less oversight on pharmaceutical companies than there was previously. I wouldn’t be surprised if many of these patients were coerced into these experiments due to lack of any alternative treatments. The lack of informed consent combined with coercion leads me to consider that much of what’s going on bears resemblance to the crimes perpetrated by those found guilty in the Nuremburg Trials.
Placebo Effect
A nationwide survey this year suggested that as many as half of U.S. doctors prescribe a fake treatment — or placebo — at least once a month.
That sounds.. relatively harmless to me. Studies have shown repeatedly that placebos are effective in treating health complaints with a strong psychological component, such as pain, depression, constipation and erectile dysfunction. As long as the pill that I am given is having its desired effect (i.e. reducing the itching on the rash I want to go away, calming my anxiety, etc.), then I have no problems with not knowing that there is actually no real "medicine" in the harmless pill.
However, the survey ALSO found that most doctors who prescribed placebos actually were using real drugs not proven effective in treating patients' complaints. These "impure placebos," such as antibiotics and sedatives, could be doing more harm than good.
And THAT.. is when it becomes frightening. It's one thing if I am being prescribed harmless "sugar pills" which do nothing but alleviate the mental component of my "illness", and thereafter alter some physical effects as well. It's entirely a different stories when I am unknowingly putting actual drugs with actual effects (and possible side effects) into my body without full disclosure by the physician. That to me is a very scary thought, borderlining on malpractice.
Article found at: http://www.usatoday.com/news/health/2008-12-10-placebo_N.htm?loc=interstitialskip
That sounds.. relatively harmless to me. Studies have shown repeatedly that placebos are effective in treating health complaints with a strong psychological component, such as pain, depression, constipation and erectile dysfunction. As long as the pill that I am given is having its desired effect (i.e. reducing the itching on the rash I want to go away, calming my anxiety, etc.), then I have no problems with not knowing that there is actually no real "medicine" in the harmless pill.
However, the survey ALSO found that most doctors who prescribed placebos actually were using real drugs not proven effective in treating patients' complaints. These "impure placebos," such as antibiotics and sedatives, could be doing more harm than good.
And THAT.. is when it becomes frightening. It's one thing if I am being prescribed harmless "sugar pills" which do nothing but alleviate the mental component of my "illness", and thereafter alter some physical effects as well. It's entirely a different stories when I am unknowingly putting actual drugs with actual effects (and possible side effects) into my body without full disclosure by the physician. That to me is a very scary thought, borderlining on malpractice.
Article found at: http://www.usatoday.com/news/health/2008-12-10-placebo_N.htm?loc=interstitialskip
Practical Ethics
I thought you might be interested in playing a game called 'practical ethics'. Once a month or so, AHA poses a fictitious ethical dilemma to its magazine readers. First, you read the question. Then take a minute to think about what you would do. Then you compare your thinking to two opposing responses from hospital CEOs.
I thought I would share this question on patient privacy - that's a bit different than what we have been discussing, but I thought I would leave you with something a little less profound to grapple with - ethics in the trenches.
QUESTION:
Two members of your staff took photos with cell phone cameras of patients in the emergency room. The photos were later posted on the Internet on social networking sites. Since then, you’ve dismissed the employees who were responsible, and it appears that the patients were unrecognizable in the photos. Still, there is concern in your organization that this could happen again—and potentially lead to HIPAA violations—and some think you should ban staff from having cell phones outside of employee-only areas as a precautionary step. What should you do?
++++++++++++++++++++++++++++++++++++++++++++++
Doug Vinsel, CEO, Duke Raleigh (N.C.) Hospital
The action taken has to be balanced and proportionate to the problem at hand. Certainly the scenario described is one that creates the potential for institutional embarrassment and liability. The dismissal of the employees involved and the presumed apologies to the patients/families is appropriate. While the thought of banning cell phones outside of employee-only areas is an understandable reaction, it is, I believe, an overreaction and an impractical way to address the misconduct of two employees. Employee education around the proper use of cell phones should be a requirement for department managers to ensure staff understanding of appropriate usage. However, the vast majority of staff can be trusted to use cell phones appropriately and understand the consequences of not doing so. We want to build a culture of trust and treating one another and our patients respectfully. Establishing a ban on cell phones is contrary to those principles.
+++++++++++++++++++++++++++++++++++++++++++++++++++++
Anthony Spezia, CEO, Covenant Health, Knoxville, Tenn.
We absolutely support and wholeheartedly agree with the terminations of the two employees. This is a clear violation of our corporate compliance program, code of conduct and our standards of behavior. I would not place the ban on staff. Our values are incorporated into our strategic plan, are utilized in many internal and external communications and are all approved by the board of directors. This is not a matter of compliance; it is a matter of conviction, faith and trust. If our culture is to be strong, we must trust employees to do the right thing in clear cases where a situation is covered by our policies and standards. This is such a case, and we would not support banning cell phones solely for the purpose of enforcing an articulated policy. We would not violate our employees’ trust, nor would we diminish their commitment to act according to our norms by taking away their cell phones. Rather, we would trust them and our strong culture of accountability.
This article 1st appeared in the November 2008 issue of HHN Magazine.
____________________________________________________________________________________PJM
I thought I would share this question on patient privacy - that's a bit different than what we have been discussing, but I thought I would leave you with something a little less profound to grapple with - ethics in the trenches.
QUESTION:
Two members of your staff took photos with cell phone cameras of patients in the emergency room. The photos were later posted on the Internet on social networking sites. Since then, you’ve dismissed the employees who were responsible, and it appears that the patients were unrecognizable in the photos. Still, there is concern in your organization that this could happen again—and potentially lead to HIPAA violations—and some think you should ban staff from having cell phones outside of employee-only areas as a precautionary step. What should you do?
++++++++++++++++++++++++++++++++++++++++++++++
Doug Vinsel, CEO, Duke Raleigh (N.C.) Hospital
The action taken has to be balanced and proportionate to the problem at hand. Certainly the scenario described is one that creates the potential for institutional embarrassment and liability. The dismissal of the employees involved and the presumed apologies to the patients/families is appropriate. While the thought of banning cell phones outside of employee-only areas is an understandable reaction, it is, I believe, an overreaction and an impractical way to address the misconduct of two employees. Employee education around the proper use of cell phones should be a requirement for department managers to ensure staff understanding of appropriate usage. However, the vast majority of staff can be trusted to use cell phones appropriately and understand the consequences of not doing so. We want to build a culture of trust and treating one another and our patients respectfully. Establishing a ban on cell phones is contrary to those principles.
+++++++++++++++++++++++++++++++++++++++++++++++++++++
Anthony Spezia, CEO, Covenant Health, Knoxville, Tenn.
We absolutely support and wholeheartedly agree with the terminations of the two employees. This is a clear violation of our corporate compliance program, code of conduct and our standards of behavior. I would not place the ban on staff. Our values are incorporated into our strategic plan, are utilized in many internal and external communications and are all approved by the board of directors. This is not a matter of compliance; it is a matter of conviction, faith and trust. If our culture is to be strong, we must trust employees to do the right thing in clear cases where a situation is covered by our policies and standards. This is such a case, and we would not support banning cell phones solely for the purpose of enforcing an articulated policy. We would not violate our employees’ trust, nor would we diminish their commitment to act according to our norms by taking away their cell phones. Rather, we would trust them and our strong culture of accountability.
This article 1st appeared in the November 2008 issue of HHN Magazine.
____________________________________________________________________________________PJM
No More Stretchmarks
http://www.commondreams.org/views02/0117-05.htm
This is article on the advancing medical technology of artificial wombs. Although it was of signifigant value in my final paper, I was unable to find evidence of any more research being done in this area.
Roe v Wade needs to be reevaluated and challenged with this new technology in mind. In 1973, abortion via surgical method was the only option. Since the 1990's we have many many herbal and chemical abortive options readily and cheaply available.
This is article on the advancing medical technology of artificial wombs. Although it was of signifigant value in my final paper, I was unable to find evidence of any more research being done in this area.
Roe v Wade needs to be reevaluated and challenged with this new technology in mind. In 1973, abortion via surgical method was the only option. Since the 1990's we have many many herbal and chemical abortive options readily and cheaply available.
TO Die Early
To Die Early
Persons that are considered mentally ill tend to die early. The question is why? Depending on the individuals mental illness they are granted surrogate or guardians that play a major role in their finances, property management if owned, and medical decision. So what are the contributing factors? The Association of State Mental Health Program Directors conducted research and determined that people that are severe mentally ill die 25years earlier than the general population. Therefore, the journey began to decide why this occurs. The illnesses that are prevalent are diabetes, obesity, and cigarette smoking. The diseases are all treatable and preventable. The socioeconomic factor does play a role for person without money do not always have access to healthcare and one could only image how hard it is to receive care when it is determined that you are mentally ill. The article pointed out that person who are mentally ill tend to substandard medical because physicians do not take their concerns seriously. Smoking was cited as the leading cause of death and in some psychiatry hospitals patients are used as reinforcement if behaved well the reward was a cigarette and if your actions were deemed deplorable a cigarette was denied. Obesity is contributed to medication and the adverse effects. As well the general public has an issue with obesity. If people are in a controlled area then why is exercise not included in their daily regimen. Not too compare state mental facilities to jail yet, in jail exercise is considered necessary for their quality life So is a person that is mentally disable, does their life lack quality. There are many changes that are occurring in that are require the standard of medical care for patients in a clinical setting. For example, the patient’s weight, fasting blood glucose test, and carefully reviewing the patient’s medical history. The issue I have are the standards that are set because the standards are the normal standard of care that each patient should receive. SO why was the standard so different for mentally ill patients.
KIRK
Article title: Why Do the Mentally Ill Die Younger?
http://www.time.com/time/health/article/0,8599,1863220,00.html
Persons that are considered mentally ill tend to die early. The question is why? Depending on the individuals mental illness they are granted surrogate or guardians that play a major role in their finances, property management if owned, and medical decision. So what are the contributing factors? The Association of State Mental Health Program Directors conducted research and determined that people that are severe mentally ill die 25years earlier than the general population. Therefore, the journey began to decide why this occurs. The illnesses that are prevalent are diabetes, obesity, and cigarette smoking. The diseases are all treatable and preventable. The socioeconomic factor does play a role for person without money do not always have access to healthcare and one could only image how hard it is to receive care when it is determined that you are mentally ill. The article pointed out that person who are mentally ill tend to substandard medical because physicians do not take their concerns seriously. Smoking was cited as the leading cause of death and in some psychiatry hospitals patients are used as reinforcement if behaved well the reward was a cigarette and if your actions were deemed deplorable a cigarette was denied. Obesity is contributed to medication and the adverse effects. As well the general public has an issue with obesity. If people are in a controlled area then why is exercise not included in their daily regimen. Not too compare state mental facilities to jail yet, in jail exercise is considered necessary for their quality life So is a person that is mentally disable, does their life lack quality. There are many changes that are occurring in that are require the standard of medical care for patients in a clinical setting. For example, the patient’s weight, fasting blood glucose test, and carefully reviewing the patient’s medical history. The issue I have are the standards that are set because the standards are the normal standard of care that each patient should receive. SO why was the standard so different for mentally ill patients.
KIRK
Article title: Why Do the Mentally Ill Die Younger?
http://www.time.com/time/health/article/0,8599,1863220,00.html
The Logic of HPV
The Logic of HPV
If I want to peanut butter and jelly I go to the cabinet and get the bread, peanut butter, and go to the refrigerator and get the jelly. Now that brings back so many memories as well how disappointed I was when there was not any jelly. My mom forgot to pick up some jelly or my brother used the last of the jelly and decided not to tell anyone. At the end of the day I will not have my coveted sandwich. The vaccine HPV is currently marketed to young women as a way to prevent cervical cancer….One less as the ad proclaims. That is important as well if there was a vaccine to prevent breast cancer many parents would offer this vaccine to their sons and daughters because it effects us all. The controversy surrounding this vaccine is the ideology of pre-marital sex and particularly young women. If the young lady decides to have sex she is considered “protected” from cervical cancer or at least she has received preventable care. The fact is in order to have sex a partner is needed. True the young lady may become a lesbian so what are her worries…..that is not of issue the premise is that men induce the likely hood of a women developing cervical cancer. So why are boys not vaccinated. If this is a sexually transmitted disease why not offer the vaccine to all of the actors involve. The reality is that some boy may become sexually active while some will not. The reality is some girls may become sexually active and some will not. As well even though the marketing was directed at women I wonder how many people question the motive of the pharmaceutical company. The boys were left out. It is said in 2009 boys will begin receiving this vaccine, the question are parents willing to protect only their daughters and if so how protected are they if their future lover is not vaccinated.
KIRK
Article title: Vaccinating Boys for Girls’ Sake?
http://www.nytimes.com/2008/02/24/fashion/24virus.html?pagewanted=1
If I want to peanut butter and jelly I go to the cabinet and get the bread, peanut butter, and go to the refrigerator and get the jelly. Now that brings back so many memories as well how disappointed I was when there was not any jelly. My mom forgot to pick up some jelly or my brother used the last of the jelly and decided not to tell anyone. At the end of the day I will not have my coveted sandwich. The vaccine HPV is currently marketed to young women as a way to prevent cervical cancer….One less as the ad proclaims. That is important as well if there was a vaccine to prevent breast cancer many parents would offer this vaccine to their sons and daughters because it effects us all. The controversy surrounding this vaccine is the ideology of pre-marital sex and particularly young women. If the young lady decides to have sex she is considered “protected” from cervical cancer or at least she has received preventable care. The fact is in order to have sex a partner is needed. True the young lady may become a lesbian so what are her worries…..that is not of issue the premise is that men induce the likely hood of a women developing cervical cancer. So why are boys not vaccinated. If this is a sexually transmitted disease why not offer the vaccine to all of the actors involve. The reality is that some boy may become sexually active while some will not. The reality is some girls may become sexually active and some will not. As well even though the marketing was directed at women I wonder how many people question the motive of the pharmaceutical company. The boys were left out. It is said in 2009 boys will begin receiving this vaccine, the question are parents willing to protect only their daughters and if so how protected are they if their future lover is not vaccinated.
KIRK
Article title: Vaccinating Boys for Girls’ Sake?
http://www.nytimes.com/2008/02/24/fashion/24virus.html?pagewanted=1
Treat me Please
Treat me please…
Pediatricians see children all of the time and most children keep their pediatrician until they are 18. When children are infants the parents stay in the room the doc. will ask how he is eating, sleeping, playing and etc. Does the formula upset his stomach and what vegetable does he really like? As time goes on the child will grow and the next visit the questions are how is he adjusting to school, does he seem behind to you developmentally if so I will refer you to Dr. Brown. The child gets older and pretty soon it is time for the parent to leave the exam room and give their pre-teen or teenager privacy. This fosters a relationship of trust and most importantly the pediatrician is able to speak privately with their patient. The first statement out of the child’s mouth is you are not going to tell me mom….and the answer is no. Of course the pediatrician is not going to tell the mother or father their conversation for the pediatrician needs a great relationship with their patients. Therefore, many pediatricians not only provide their discipline of care rather psychological care and the child just may need an ear. So what can you tell the parents? If the child is thinking about death is that a warning sign or rather the reality of growing up or just human nature. If the child is being bullied at school is that information to give to the parent or just a part of life. Not to trivialize certain issues rather it is important to assess the context of the conversation and the issues surrounding the situations. If your grandfather or mother passed away we would all question death. As well at some point in our lives we were teased we were not always this cool. I am sure that is still to be determined rather we have learned to accept ourselves. The point is a child truly autonomous when it comes to their care. The child does not decide their doctor, where they live, where they attend school, what car to drive, and etc. This is all determined by the parent. If my child was being bulled I would want to know and if my child was thinking of death I would want to know or would I want to know that if he has any issues he is able to seek counseling from an adult that I trust. I just hope the pediatrician will clue me by immediately suggesting that this is an interesting time in his life. That is a very broad statement but it says so much. Yet, at what time should the parent become informed of the child personal thoughts. The reality is as an adult no one truly knows our deep personal thoughts so what right does a parent have to their child’s.
KIRK
Article: What to Do When the Patient Says, ‘Please Don’t Tell Mom’
http://www.nytimes.com/2008/12/09/health/09klas.html?ref=science
Pediatricians see children all of the time and most children keep their pediatrician until they are 18. When children are infants the parents stay in the room the doc. will ask how he is eating, sleeping, playing and etc. Does the formula upset his stomach and what vegetable does he really like? As time goes on the child will grow and the next visit the questions are how is he adjusting to school, does he seem behind to you developmentally if so I will refer you to Dr. Brown. The child gets older and pretty soon it is time for the parent to leave the exam room and give their pre-teen or teenager privacy. This fosters a relationship of trust and most importantly the pediatrician is able to speak privately with their patient. The first statement out of the child’s mouth is you are not going to tell me mom….and the answer is no. Of course the pediatrician is not going to tell the mother or father their conversation for the pediatrician needs a great relationship with their patients. Therefore, many pediatricians not only provide their discipline of care rather psychological care and the child just may need an ear. So what can you tell the parents? If the child is thinking about death is that a warning sign or rather the reality of growing up or just human nature. If the child is being bullied at school is that information to give to the parent or just a part of life. Not to trivialize certain issues rather it is important to assess the context of the conversation and the issues surrounding the situations. If your grandfather or mother passed away we would all question death. As well at some point in our lives we were teased we were not always this cool. I am sure that is still to be determined rather we have learned to accept ourselves. The point is a child truly autonomous when it comes to their care. The child does not decide their doctor, where they live, where they attend school, what car to drive, and etc. This is all determined by the parent. If my child was being bulled I would want to know and if my child was thinking of death I would want to know or would I want to know that if he has any issues he is able to seek counseling from an adult that I trust. I just hope the pediatrician will clue me by immediately suggesting that this is an interesting time in his life. That is a very broad statement but it says so much. Yet, at what time should the parent become informed of the child personal thoughts. The reality is as an adult no one truly knows our deep personal thoughts so what right does a parent have to their child’s.
KIRK
Article: What to Do When the Patient Says, ‘Please Don’t Tell Mom’
http://www.nytimes.com/2008/12/09/health/09klas.html?ref=science
The Right to Die
The Right to Die
The other night a documentary aired on Britain’s television and it was the actual last moment of Craig Ewert. Mr. Ewert actually died in 2006 at a clinic in Zurich. Craig Ewert traveled to this clinic because it is illegally to assist, counsel, and procure suicide. This places many individuals in a compromising position, Craig Ewert stated: “If I go through with it, I have death. If I don’t go through with it, my choice is essentially to suffer and to inflict suffering on my family, and then die.” That statement is a reflection of the how the individual feels about their right to die. Craig Ewert’s wife was not prosecuted for helping her husband travel to Zurich and recently another family assisted their son in traveling to Diginistas, a clinic located in Switzerland. This family was not charged due to public interest. As well, last month a young woman of the age 13, decided to forgo a heart transplant and die at home with her family. The parents did not object to her decision rather the hospital. The hospital threatens to send the parents to jail for neglect and not acting in the child’s best interest. The hospital also threatens to take legal action to receive a court order to force a transplant. Therefore, the question, is it ever right to end your life? Is my life truly my own or rather is it in the best interest of the government. If I decided to cut my hair no one would question my actions. If I decided to fly to Paris someone might wonder why yet, they may not question my actions. If I decide to forgo medical treatment someone might question my decision but it is predicated upon the end result. The reality is we will all die. No one can argue or question that statement. If I am a religious person I may believe that I am going to heaven or hell yet, I am content with my decision. So what interest does the government have with this decision? The British government has decided to forgo treatment for patients due to the fact that they are going to die based on evidence care. The individuals life is not work the amount of money it would take to prolong the person life if only for six months. The person may only need six months to prepare for death and an individual such as Craig Ewert may not need another day to live their life. So, if the government may decide to stop treating an individual that is dying then why is the individual unable to make that determination.
KIRK
Article titled: TV Broadcast of an Assisted Suicide Intensifies a Contentious Debate in Britain
http://www.nytimes.com/2008/12/11/world/europe/11suicide.html?_r=1&ref=health
Article titled: Britain Debates a Child's Right to Choose Her Own Fate
http://www.washingtonpost.com/wp-dyn/content/article/2008/11/13/AR2008111303879.html?hpid=moreheadlines
The other night a documentary aired on Britain’s television and it was the actual last moment of Craig Ewert. Mr. Ewert actually died in 2006 at a clinic in Zurich. Craig Ewert traveled to this clinic because it is illegally to assist, counsel, and procure suicide. This places many individuals in a compromising position, Craig Ewert stated: “If I go through with it, I have death. If I don’t go through with it, my choice is essentially to suffer and to inflict suffering on my family, and then die.” That statement is a reflection of the how the individual feels about their right to die. Craig Ewert’s wife was not prosecuted for helping her husband travel to Zurich and recently another family assisted their son in traveling to Diginistas, a clinic located in Switzerland. This family was not charged due to public interest. As well, last month a young woman of the age 13, decided to forgo a heart transplant and die at home with her family. The parents did not object to her decision rather the hospital. The hospital threatens to send the parents to jail for neglect and not acting in the child’s best interest. The hospital also threatens to take legal action to receive a court order to force a transplant. Therefore, the question, is it ever right to end your life? Is my life truly my own or rather is it in the best interest of the government. If I decided to cut my hair no one would question my actions. If I decided to fly to Paris someone might wonder why yet, they may not question my actions. If I decide to forgo medical treatment someone might question my decision but it is predicated upon the end result. The reality is we will all die. No one can argue or question that statement. If I am a religious person I may believe that I am going to heaven or hell yet, I am content with my decision. So what interest does the government have with this decision? The British government has decided to forgo treatment for patients due to the fact that they are going to die based on evidence care. The individuals life is not work the amount of money it would take to prolong the person life if only for six months. The person may only need six months to prepare for death and an individual such as Craig Ewert may not need another day to live their life. So, if the government may decide to stop treating an individual that is dying then why is the individual unable to make that determination.
KIRK
Article titled: TV Broadcast of an Assisted Suicide Intensifies a Contentious Debate in Britain
http://www.nytimes.com/2008/12/11/world/europe/11suicide.html?_r=1&ref=health
Article titled: Britain Debates a Child's Right to Choose Her Own Fate
http://www.washingtonpost.com/wp-dyn/content/article/2008/11/13/AR2008111303879.html?hpid=moreheadlines
Should changing your sex be tax-deductible?
Last October, the Washington Post reported on a Massachusetts transgender woman's suit filed against the IRS for the right to claim her sex-change operation as a medical deduction on her income taxes.
http://www.washingtonpost.com/wp-dyn/content/article/2007/09/30/AR2007093001194.html
During the trial, Rhiannon O'Donnabhain, 64, described the struggles she faced as a gender conflicted young boy in a staunchly conservative, Catholic family. Growing up she played with boys, worked in construction and even ultimately married a woman and fathered three children.
In 1996, at 53, Rhiannon was diagnosed with gender identity disorder. In the following five years, she underwent intensive counseling and hormone treatments in order to complete her sexual reassignment surgery in 2001. According to the article, this was the first time in her life, that she felt at peace:
"I'm just so glad I did this," stated Rhiannon.
The article explains that Rhiannon spent more than $25,000 on sex-reassignment surgery in 2001, and claimed a $5,000 deduction. After sending Rhiannon the $5,000 check, the IRS denied the deduction, claiming the surgery was cosmetic and thus not a deductible medical condition.
According to leading medical experts, Gender Identity Disorder is a recognized medical condition that results in an estimated 1,000 to 2,000 sex-change operations a year in the U.S. alone.
Marshall Forstein, an associate professor of psychiatry at Harvard Medical School, asks: "When did the IRS suddenly become physicians?" Forstein reiterated that transgender identity is a condition expressly discussed in diagnostic manuals. Forstein continued:
“It seems the IRS is now in the business of practicing medicine without a license."
According, to Rhiannon's lawyers from the Gay and Lesbian Advocates and Defenders (GLAD), the case will likely set a precedent as to whether such procedures will be considered tax deductible.
Independent of whether Gender Identity Disorder is a medical condition, sexual reassignment surgery may have substantial legal repercussions. Firstly, in 31 states, documented proof of sexual reassignment surgery is necessary in order to change your legal sex status on your driver's license.
Secondly, in a 1997 unreported case of Vecchione v. Vecchione, a California Superior court held that a postoperative transsexual acquires his postoperative sex for purposes of marriage. In the middle of a custody battle dispute over her three year old daughter, Christie Vecchione, claimed her marriage to Joshua Vecchione should be annulled. After revealing to the court that her husband had been recognized as a female at birth, she pointed to the state's ban on same-sex marriages to argue that the marriage had never been valid. Superior Court Judge Gary Ryan held that the annulment and not the marriage was invalid. In ruling that Christie was legally a female, the court placed great weight on a state statue that expressly permits a post operative transgender individual the right to change the sexual designation on their birth certificate.
I would like to see the IRS explain to Mr. Vecchione that sexual reassignment surgery-- a procedure that directly prevented the annulment of his marriage and protected his custody rights over his 3 year old daughter--is merely a cosmetic operation.
The producers of Jurassic Park IV have announced that it is unlikely that they will go forward with the project .
Although our class devoted a sufficient amount of time on the issues on the frontier of genetics -- e.g. synthetic biology, hybrids, and chimeras-- for some inexplicable reason, Professor Herder failed to touch upon a subject incredibly relevant to our day to day world: the potential cloning of mammoths.
Okay, granted this topic is mostly only relevant in the worlds created by Michael Crichton (rest in peace). Nevertheless, what is a bioethics blog without a piece on mammoths?
According to a November New York Times piece, scientists believe that the extinct woolly mammoth could be scientifically regenerated for a mere $10 million.
http://www.nytimes.com/2008/11/20/science/20mammoth.html
However, in this month's Time magazine, Stephan Schuster, a prominent scientist with the project, warns us not to get too excited: "What I'm trying to say is that there is a workable route to do that, but it is at this time technically, and cost-wise and time-wise, not feasible." http://www.time.com/time/health/article/0,8599,1861136,00.html
Nevertheless, the scientific and legal community have been moderately excited about this for a while. Back in 2000, A Stanford Technological Law Review analyzed the legal implications of the matter and concluded there to be no national or international hurdles to pass.
Primarily, the brief is most excited about the project's “potential application to the conservation of the endangered and near-extinct species of our own time.”
The Law Review counter ecological and evolutionary arguments opposed to the project, by asserting that any such problems would be averted by keeping them in captivity.
To the Stanford Law Review's defense, I should add that Jurassic Park III had not yet been released.
Other common points/counterpoints on this issue include:
Con: These animals are extinct. Are we playing God by trying to resurrect them?
Pro: Humans had a role in killing off mammoths.
(Although studies point to climate change being the primary cause, it would be difficult to claim that humans didn't have at least a partial role in that as well. )
http://www.democraticunderground.com/discuss/duboard.phpaz=view_all&address=115x53524
Con: Cloning will create monsters that will destroy life as we know it.
Pro: Mammoths would actually be incredibly similar to an elephant, although hairier.
Consequently, the mammoth clone would be reared by an elephant mother.
Con: There are no modern environments suitable for these creatures.
Pro: Environmental conditions for mammoths can be replicated.
Con: It would be inhumane.
Pro: Mammoth clones would not be laboratory specimens.
Con: Such an endeavor would release a plague of unknown diseases on Earth.
Pro: There is no evidence of transmissible disease from defrosted specimens.
http://www.actionbioscience.org/biotech/agenbroad.html
Sadly, as Schuster points out, all this discussion is more or less moot at this point. Unfortunately, the world has considerably more important issues to face and then post about on bioethics blogs.
Wednesday, December 10, 2008
The "Three's Company" episode where they discuss bioethics
Last February the UK Telegraph announced that British scientists had created an embryo with three parents. Researchers at the University of Newcastle took the nucleus of an embryo produced during assisted reproduction and placed it inside an egg from which the original DNA was removed, leaving behind the donor's mitochondria. Thus, the resulting embryo contained genetic contributions from three people.
The researcher's goal is to create a procedure to prevent mitochondria-related diseases.
Although, these diseases are rare, the results can be devastating. By using the Newcastle method, a traditionally-formed embryo with a defective mitochondria could then be replaced with functional mitochondria.
The Telegraph explained that “in effect, the new technique would be like changing a battery in a computer without affecting the hard disk, the nuclear DNA that influences our appearance and other characteristics, so that an affected woman does not pass them on to her children.”
http://www.telegraph.co.uk/scienceandtechnology/science/sciencenews/3324321/Transplant-creates-embryos-with-three-parents.html
At this time, the legality of the operation in England is still in question.
Although the Telegraph piece focused on the pathological implications. The internet instantly buzzed about the cultural possibilities. A Wired.com article explained that the Newcastle procedure might be useful for people in a trinogamous relationship or “a long-term union of three people rather than two.” (The article notes that linguistically binogamous would be proper, however, the class of individual for which the term applies have apparently already taken the aforementioned term).
The article explains that “like anyone else, people in trinogamous relationships may want to have children with DNA from all the parents. Enter the Newcastle method. The same holds for same-sex couples for whom an embryo conceived through traditional assisted reproduction contains DNA from only one partner.”
http://blog.wired.com/wiredscience/2008/02/calling-jerry-s.html
Although I tend to believe that a human family is best structured around a monogamistic center (be of it any combination of gender and sex), I am not opposed to a trinogamous child. Indeed for individuals opposed to monogamy, such a unique child would certainly be an incredible way to reinforce their non-monogamistic union. As I type this, I'm finding more and more that I have strong conservative feelings as to monogamy; still, as I do not know any trinogamous individuals I can't get myself to judge such domestic situations as wrong per se.
On the other hand, in the event such a trinogamistic societies are structured around one male and multiple females I might be concerned with the implications of encouraging such domestic situations. Although, HBO's Big Love does make a relatively strong case for polygamy.
(incidentally the DNA used in the Newcastle method happened to be 2 women and 1 male).
Watching a Suicide
http://news.aol.com/health/article/british-tv-will-show-assisted-suicide/272690
An assisted suicide is being aired on television tonite. I do not have the stomach to watch it.
This man was dying of ALS, a very severe disease that inspires even additional sympathy in all healthcare workers caring for their patients. I am hoping that if this film is done in an appropriate manner, it will also generate sympathy and understanding from the general public.
The amount of pain and expense for dying patients is immense. Assisted suicide, if carefully controlled by healthcare is a viable option. Going forward we need to explore all options in controlling costs. This certainly would include educating the general public of the benefits of hospice and educating them realistically about their prognosis.
Patients have a right to choose their medical treatments under the law.
Jennifer Burns RN
An assisted suicide is being aired on television tonite. I do not have the stomach to watch it.
This man was dying of ALS, a very severe disease that inspires even additional sympathy in all healthcare workers caring for their patients. I am hoping that if this film is done in an appropriate manner, it will also generate sympathy and understanding from the general public.
The amount of pain and expense for dying patients is immense. Assisted suicide, if carefully controlled by healthcare is a viable option. Going forward we need to explore all options in controlling costs. This certainly would include educating the general public of the benefits of hospice and educating them realistically about their prognosis.
Patients have a right to choose their medical treatments under the law.
Jennifer Burns RN
Brain Candy--Part 3
To my dismay, as I checked my email before posting my blog, I realized that several other students had blogged about the exact same issue. So, in addition to posting my blog below I’ll first comment on a few of my classmates’ thoughts--in order for my entry to appear less redundant.
I also believe there is a distinct difference between OTC remedies like caffeine and drugs like Adderall. These differences stem not only from the fact that one is more precise and therefore more effective than the other. In an excellent article by Erik Parens, “Is Better Always Good?” several bioethicists get together to discuss the ramifications of cognitive enhancements. They state that the difference lies in treating different means as morally the same. Not to get into a philosophical debate, but there are concerns that resorting to drugs to enhance ourselves, we are blinding ourselves to underlying problems in our society. For example, they compare administering Ritalin to hyperactive kids as opposed to decreasing class size. In some ways, forcing pills on kids who don’t learn in a typical classroom setting is ignoring the fact that there is something wrong with our education system.
In regards to the use of enhancements in sports, there is a similar line of thinking in banning its use in sports as well as in academics. The reason why we ban steroids is somewhat related to the value we place on winning. In an article in the Atlantic Monthly entitled, “The Case Against Perfection” by Michael Sandel, he states that the use of enhancements cheapens the game. If we win or get A’s simply because of the edge we get through steroids or Adderall, would we really feel as fulfilled and satisfied with the achievement? We as a society value achievement not only because of the hard work involved, but also because of the unique talents that allow get us to that level of achievement. If we are all placed on a level playing field through an array of enhancements, winning wouldn’t mean as much.
(Beginning of original blog entry) Now that we’re nearing the end of the semester, with the pressure of finals and research papers looming over us, many of us probably use energy drinks or extra cups of coffee to stay awake—or as a growing number of students prefer, take Ritalin or Adderall.
A study by the National Center on Addiction and Substance Abuse at Columbia found that almost twenty percent of college students have used Ritalin or Adderall to increase concentration and pull all-nighters. http://www.nytimes.com/2005/07/31/education/edlife/jacobs31.html
Ritalin or Adderall is easily obtainable through friends who are written prescriptions after claiming to have ADHD. These stimulants are now commonplace among college campuses. "Things have really gotten out of hand in the last four to five years," says Dr. Robert A. Winfield, director of University Health Service at the University of Michigan. "Students have become convinced that this will help them achieve academic success." "The culture here actually encourages people to use stimulants," remarked a student at Columbia.
Though relatively safe, and non-addictive, the Adderall could pose risks if combined with other drugs. However, those with heart problems should be cautious as the drug increases heart rate and disorientation, which can lead to sudden death. In fact, due to reports of twenty international deaths due to Adderrall, the Canadian government temporarily suspended sales of Adderall in 2005, as reported by the NYT.
Despite the health issue, off-label use of prescription stimulants in schools poses other serious problems involving fairness. Is it fair for some students to obtain an edge in concentration and perhaps even increase memory capacity and not others? If the effects are nominal than what explains the increasing prevalence among college students? As enhancements are banned in sports, should cognitive enhancements like Ritalin or Adderall be banned in universities? Like the sports enhancement debate, discussions around cognitive enhancement raise concerns of larger ethical questions regarding not only fairness and cheating but concerns of a competitive society that drives us to take drugs in order to get an edge over the next person.
Ellie
I also believe there is a distinct difference between OTC remedies like caffeine and drugs like Adderall. These differences stem not only from the fact that one is more precise and therefore more effective than the other. In an excellent article by Erik Parens, “Is Better Always Good?” several bioethicists get together to discuss the ramifications of cognitive enhancements. They state that the difference lies in treating different means as morally the same. Not to get into a philosophical debate, but there are concerns that resorting to drugs to enhance ourselves, we are blinding ourselves to underlying problems in our society. For example, they compare administering Ritalin to hyperactive kids as opposed to decreasing class size. In some ways, forcing pills on kids who don’t learn in a typical classroom setting is ignoring the fact that there is something wrong with our education system.
In regards to the use of enhancements in sports, there is a similar line of thinking in banning its use in sports as well as in academics. The reason why we ban steroids is somewhat related to the value we place on winning. In an article in the Atlantic Monthly entitled, “The Case Against Perfection” by Michael Sandel, he states that the use of enhancements cheapens the game. If we win or get A’s simply because of the edge we get through steroids or Adderall, would we really feel as fulfilled and satisfied with the achievement? We as a society value achievement not only because of the hard work involved, but also because of the unique talents that allow get us to that level of achievement. If we are all placed on a level playing field through an array of enhancements, winning wouldn’t mean as much.
(Beginning of original blog entry) Now that we’re nearing the end of the semester, with the pressure of finals and research papers looming over us, many of us probably use energy drinks or extra cups of coffee to stay awake—or as a growing number of students prefer, take Ritalin or Adderall.
A study by the National Center on Addiction and Substance Abuse at Columbia found that almost twenty percent of college students have used Ritalin or Adderall to increase concentration and pull all-nighters. http://www.nytimes.com/2005/07/31/education/edlife/jacobs31.html
Ritalin or Adderall is easily obtainable through friends who are written prescriptions after claiming to have ADHD. These stimulants are now commonplace among college campuses. "Things have really gotten out of hand in the last four to five years," says Dr. Robert A. Winfield, director of University Health Service at the University of Michigan. "Students have become convinced that this will help them achieve academic success." "The culture here actually encourages people to use stimulants," remarked a student at Columbia.
Though relatively safe, and non-addictive, the Adderall could pose risks if combined with other drugs. However, those with heart problems should be cautious as the drug increases heart rate and disorientation, which can lead to sudden death. In fact, due to reports of twenty international deaths due to Adderrall, the Canadian government temporarily suspended sales of Adderall in 2005, as reported by the NYT.
Despite the health issue, off-label use of prescription stimulants in schools poses other serious problems involving fairness. Is it fair for some students to obtain an edge in concentration and perhaps even increase memory capacity and not others? If the effects are nominal than what explains the increasing prevalence among college students? As enhancements are banned in sports, should cognitive enhancements like Ritalin or Adderall be banned in universities? Like the sports enhancement debate, discussions around cognitive enhancement raise concerns of larger ethical questions regarding not only fairness and cheating but concerns of a competitive society that drives us to take drugs in order to get an edge over the next person.
Ellie
Brain Candy Pt. 2
Just now walking from my locker up to library I passed an incomprehensible scene, a pair of book-carrying law students engaged in a heartfelt laugh during finals week. I wanted to stop and shake some sense into both of them. Then it hit me. They must have been on drugs.
Although, a cheerfully composed student during exam week may be the product of a semester of preparation (or even a semester of ignorant bliss), it's also possible that their studies have been supported by such academic steroids as Adderal or a number of AdHd drugs.
It appears CTF has beat me to the punch on this issue, but here are some additional matters to consider. Firstly, I believe the study that CTF's article is alluding to is a 2005 study by Addiction Journal. After surveying students at 119 American colleges, a 2005 study by Addiction Journal, found that up to 25% of students at competitive schools had misused an ADHD medication within the year.
http://www2.jsonline.com/story/index.aspx?id=410902
I personally do not know any law students that partake in such practices, but I would not be surprised if such practices were common on campus.
The academic trend was tracked in “Brain Enhancement Is Wrong, Right?”, a New York Times piece from last March. http://www.nytimes.com/2008/03/09/weekinreview/09carey.html?_r=1&pagewanted=1
The article lightheartedly compares academic enhancement to our recent doping era of sports. The article also, however, brings up some serious questions as to the repercussions of such academic enhancement habits. “What happens if you’re in a fast-paced surgical situation and they’re not available?” asks one graduate student. “Will you be able to function at the same level?”
Dr. Anjan Chatterjee, an associate professor of neurology at the University of Pennsylvania, envisions a world where such performance enhancement usage is not only a common professional practice, but one that is required. “You can imagine a scenario in the future” posits Dr. Chatterjee, “when you’re applying for a job, and the employer says, ‘Sure, you’ve got the talent for this, but we require you to take Adderall.’ Now, maybe you do start to care about the ethical implications.”
Indeed, there are signs that Adderall usage may be coming more widespread as noted by CTF's piece and as evidenced in other countries. For example in 2006, Canadian medical regulators decided to allow Adderall XR back on pharmacy shelves. http://pn.psychiatryonline.org/cgi/content/full/40/19/2
In spite of this trend, my number one qualm with both CTF's AP link and my NY Times' article, is that the negative repercussions are not emphasized. While CTF's piece claims a “drug to improve brain function is functionally no different than getting a good night’s sleep or eating healthy,” chronic well-restedness or a chronic healthy diet, will never lead to psychosis; the chronic use of Adderall might:
“Chronic abuse of amphetamines can result in the manifestation of amphetamine psychosis”
Pliszka, et al., A Double-Blind, Placebo-Controlled Study of Adderall and Methylphenidate in the Treatment of Attention-Deficit/Hyperactivity Disorder, Journal of the American Academy of Child & Adolescent Psychiatry. 39(5):619-626, May 2000.
Interestingly, while academia remains relatively mute on the ethics of the matter, some sports are taking a hardline position against such brain enhancement. For example, the Nevada State Athletic Commission recently banned athletes in the state from using Adderall. Tim Credeur was removed from a UFC fight on the finale of The Ultimate Fighter 7 because of a positive drug test due to his use of it.
http://sportsillustrated.cnn.com/2008/mma/06/23/credeur.cancelled/index.html?eref=si_latest
If wrestlers are ready to go to the mat against Adderall's unfair advantage, perhaps academia should at least further consider the matter as well.
Over the Counter Prozac Continued: Should we Consider Over the Counter Adderall too?
When I read the post about Prozac potentially being sold over the counter, I immediately commented about what seems to me a pretty interesting problem: the overuse and over-prescription of attention deficit hyperactivity disorder (ADHD) medicine, such as Adderall and Ritalin. I found myself struggling to decide whether I thought these kinds of medications should be made available over the counter, and I’m still not sure what side of the fence I fall on. I spent a few minutes looking online for related articles, and I came across a fairly persuasive article entitled “Scientists Back Brain Drugs for Healthy People.” The article can be found here: http://hosted.ap.org/dynamic/stories/M/MED_BRAIN_PILLS?SITE=NCKIN&SECTION=HOME&TEMPLATE=DEFAULT.
The article explains that there are a growing number of professionals, including authors, ethics experts, and doctors, that are publicly arguing that “brain drugs,” like Ritalin, should be made available to the public. There are a number of arguments made in the article, a few of which I’ll mention here. For example, one argument suggests that taking a drug to improve brain function is functionally no different than getting a good night’s sleep or eating healthily. And the benefit is tangible: these drugs would allow people to multitask better and boost memory. Most importantly: the side effects are minimal. Another argument is that because these drugs do not have significant side effects, they function really as an improved version of caffeine, and there’s no ban on caffeine.
I’m not sure I buy this last argument. I think the devil is in the details and I think comparing prescription “brain” drugs to caffeine found in coffee or soft drinks is a little disingenuous. The way and amount that these drugs alter the brain is so significantly more than we see with caffeine that I think the comparison is a little moot. I may be making assumptions, but I personally feel this comparison is trying to equate apples and oranges. Adderall and caffeine may overlap in some ways or even fall into the same category, but there is a distinct difference.
I think the most interesting ethical argument is whether we should make these drugs ore widely available simply because a lot of people are already taking advantage of them and using them. The article cites that at some colleges, students who have used these drugs are as high as 25%. I know from my own experience as an undergrad and here in law school, that MANY students have been taking advantage of Adderall and Ritalin despite not having ADD or ADHD. I’ve asked some of my friends whom I know do not suffer from ADD how they managed to get a prescription, and the response is usually very similar: they simply tell the doctor they have a hard time focusing, or that they can’t manage multiple things at one time, and poof! Prescription. And I wonder if this is like this everywhere, because I know people from different parts of the country who all have basically the same story. More concerning, is the fact that once diagnosed, people seem to be able to get more meds with relative ease, which I believe is why people are now buying and selling Adderall and the other meds “illegally.”
So is the fact that this is has become almost a common practice reason enough to make these drugs available to everyone? I do not think so. While it is a completely different issue, I think the way sports (struggle) to handle steroids sheds some light on this problem as well. Even though many people use banned substances, the NFL isn’t about to let steroids and other banned enhancements become sanctioned. The idea is to keep the field as natural and fair as possible. And when people violate the rules, it is an unfortunate consequence. But penalties seek to deter infractions, and at least by keeping substances illegal, it makes access to them more difficult. While it is ENTIRELY unrealistic to assess “penalties” for this kind of drug use, I think imposing some restraints on their access is prudent and at least keeps the problem from expanding at an exponential rate. Shouldn’t we seek to keep our brains as “natural” as possible and not encourage stimulate use/abuse?
Importantly, even the pro-drug corner believes that more research needs to be done before such a drastic step is taken. The supporters want more research to be done into the use, benefits, and risks of the drugs. I think we need to know more before we make a significant judgment call like allowing these to be sold over the counter. Supporters also believe that doctors need to develop policies for the use of such drugs, and legislatures need to rethink the issues. All of these suggestions I do agree with. Opening up the drugs to more scrutiny would be a better way to assess their potential pros and cons.
However, I do not think that this would eliminate the most critical concern with drugs like these: that people would either feel coerced into taking them, or that the drugs would get abused. It is easy to imagine the scenario where “everyone’s doing it,” and therefore, to compete in (very competitive) workplaces or schools, people almost have to resort to such enhancements simply to keep the playing field level. Opening access to these drugs, even if they don’t have serious side effects, to the public would cause an explosion in the use of such drugs, and I think that many people who would not have sought or needed these drugs in the past would be forced to take them or would at least heavily consider it.
The article explains that there are a growing number of professionals, including authors, ethics experts, and doctors, that are publicly arguing that “brain drugs,” like Ritalin, should be made available to the public. There are a number of arguments made in the article, a few of which I’ll mention here. For example, one argument suggests that taking a drug to improve brain function is functionally no different than getting a good night’s sleep or eating healthily. And the benefit is tangible: these drugs would allow people to multitask better and boost memory. Most importantly: the side effects are minimal. Another argument is that because these drugs do not have significant side effects, they function really as an improved version of caffeine, and there’s no ban on caffeine.
I’m not sure I buy this last argument. I think the devil is in the details and I think comparing prescription “brain” drugs to caffeine found in coffee or soft drinks is a little disingenuous. The way and amount that these drugs alter the brain is so significantly more than we see with caffeine that I think the comparison is a little moot. I may be making assumptions, but I personally feel this comparison is trying to equate apples and oranges. Adderall and caffeine may overlap in some ways or even fall into the same category, but there is a distinct difference.
I think the most interesting ethical argument is whether we should make these drugs ore widely available simply because a lot of people are already taking advantage of them and using them. The article cites that at some colleges, students who have used these drugs are as high as 25%. I know from my own experience as an undergrad and here in law school, that MANY students have been taking advantage of Adderall and Ritalin despite not having ADD or ADHD. I’ve asked some of my friends whom I know do not suffer from ADD how they managed to get a prescription, and the response is usually very similar: they simply tell the doctor they have a hard time focusing, or that they can’t manage multiple things at one time, and poof! Prescription. And I wonder if this is like this everywhere, because I know people from different parts of the country who all have basically the same story. More concerning, is the fact that once diagnosed, people seem to be able to get more meds with relative ease, which I believe is why people are now buying and selling Adderall and the other meds “illegally.”
So is the fact that this is has become almost a common practice reason enough to make these drugs available to everyone? I do not think so. While it is a completely different issue, I think the way sports (struggle) to handle steroids sheds some light on this problem as well. Even though many people use banned substances, the NFL isn’t about to let steroids and other banned enhancements become sanctioned. The idea is to keep the field as natural and fair as possible. And when people violate the rules, it is an unfortunate consequence. But penalties seek to deter infractions, and at least by keeping substances illegal, it makes access to them more difficult. While it is ENTIRELY unrealistic to assess “penalties” for this kind of drug use, I think imposing some restraints on their access is prudent and at least keeps the problem from expanding at an exponential rate. Shouldn’t we seek to keep our brains as “natural” as possible and not encourage stimulate use/abuse?
Importantly, even the pro-drug corner believes that more research needs to be done before such a drastic step is taken. The supporters want more research to be done into the use, benefits, and risks of the drugs. I think we need to know more before we make a significant judgment call like allowing these to be sold over the counter. Supporters also believe that doctors need to develop policies for the use of such drugs, and legislatures need to rethink the issues. All of these suggestions I do agree with. Opening up the drugs to more scrutiny would be a better way to assess their potential pros and cons.
However, I do not think that this would eliminate the most critical concern with drugs like these: that people would either feel coerced into taking them, or that the drugs would get abused. It is easy to imagine the scenario where “everyone’s doing it,” and therefore, to compete in (very competitive) workplaces or schools, people almost have to resort to such enhancements simply to keep the playing field level. Opening access to these drugs, even if they don’t have serious side effects, to the public would cause an explosion in the use of such drugs, and I think that many people who would not have sought or needed these drugs in the past would be forced to take them or would at least heavily consider it.
Tuesday, December 9, 2008
Over the Counter Prozac
In an interview with Josephine Johnston, associate for law and bioethics at the Hastings Center, a nonpartisan research institute, TIME magazine posed the question of whether antidepressants such as Prozac should be readily available over the counter like many other drugs. As the most frequently prescribed class of drugs in the United States, antidepressants make up about 5% of all prescription medication recorded in outpatient files, according to 2005 figures from the U.S. Centers for Disease Control and Prevention. The question raised is then, if the demand for antidepressants is so high and the pills are so readily dispensed (with the side effects now reasonably well known), would life be easier for many Americans if antidepressants were just available at the drug store?
On one side of the fence, proponents of dispensing antidepressants over the counter argue that people should be free to treat their own problems. Antidepressants are not that dangerous. And even if they are, in America, an argument about autonomy and people making their own choices can end up trumping anything else.
On the other side, opponents of free dispensal argue that antidepressants work best when they're used in conjunction with other kinds of treatment. If you use antidepressants under the supervision of a physician, you can also talk to the physician about how to address some of the underlying problems which have led you to the depressed state. By providing such medication over the counter is to decouple them from an important part of the treatment, and to risk undermining or taking valuable resources away from more intensive treatment that involves therapy or communication.
I can honestly see both sides of the argument in this debate. However, as I think about it, I appear to leaning more towards the side of allowing antidepressants to be provided over the counter in drug stores. Americans have the freedom to choose how they wish to interact with many other forms of "dangerous" items, including alcohol, guns, and even vehicles. To limit their interaction with such things due to the danger possibility would be to take away a fundamental American right of autonomy. There are many similarities between antidepressants and liquor, both of which are used by many Americans to deal with issues of unhappiness and distress in their lives. If Americans have the freedom to obtain liquor without a prescription, shouldn't they have the same freedom of access to antidepressants as well?
Article at: http://www.time.com/time/health/article/0,8599,1809504,00.html
On one side of the fence, proponents of dispensing antidepressants over the counter argue that people should be free to treat their own problems. Antidepressants are not that dangerous. And even if they are, in America, an argument about autonomy and people making their own choices can end up trumping anything else.
On the other side, opponents of free dispensal argue that antidepressants work best when they're used in conjunction with other kinds of treatment. If you use antidepressants under the supervision of a physician, you can also talk to the physician about how to address some of the underlying problems which have led you to the depressed state. By providing such medication over the counter is to decouple them from an important part of the treatment, and to risk undermining or taking valuable resources away from more intensive treatment that involves therapy or communication.
I can honestly see both sides of the argument in this debate. However, as I think about it, I appear to leaning more towards the side of allowing antidepressants to be provided over the counter in drug stores. Americans have the freedom to choose how they wish to interact with many other forms of "dangerous" items, including alcohol, guns, and even vehicles. To limit their interaction with such things due to the danger possibility would be to take away a fundamental American right of autonomy. There are many similarities between antidepressants and liquor, both of which are used by many Americans to deal with issues of unhappiness and distress in their lives. If Americans have the freedom to obtain liquor without a prescription, shouldn't they have the same freedom of access to antidepressants as well?
Article at: http://www.time.com/time/health/article/0,8599,1809504,00.html
Getting high on HIV drugs in South Africa
According to this BBC News article, anti-retroviral drugs used to treat HIV/Aids are being bought and smoked by teenagers in South Africa to get high. Reports suggest that the drugs are being sold by patients and even healthcare staff for money. Schoolchildren have been spotted smoking the drugs, which are ground into powder and sometimes mixed with painkillers or marijuana. Aids patients themselves have been found smoking the drugs instead of taking them as prescribed. Apparently this has now become a national problem in South Africa.
Documentary-maker Tooli Nhlapo told the BBC World Service's Outlook programme that the young users that she spoke to get access to these drugs from HIV patients or healthcare workers, and that they know when the individual patients go to collect the drugs and buy them, or if they do not have any money, they steal them. She also said that when she was doing the story, many HIV patients were complaining that they don't get the drugs and that queues are long and it was taking a long time to access them. "It is well organised, no matter how high they are, they do not tell you who is giving them the drugs," said Ms Nhlapo.
The potential health implications of this are huge, on top of the access to care issue. When health care workers themselves are selling ARVs to be used as recreational drugs, what else will happen? These users are exposing themselves to side effects, and the HIV patients are putting themselves at huge risk by not taking these medications as they should be taken. I can only imagine what kind of black market this is going to create, especially in that part of the world. If this spreads to war-torn regions of Africa, how many more human rights violations will occur?
I've little idea how to begin to wrap my head around this one. Just mind-blowing. Wait until word gets round here in the US that apparently ARVs can be used for this. We'll have to watch to see if/when this comes out in the history of the next patient who rolls in to the ER with a CD4 count of, say, 4.
AD
Documentary-maker Tooli Nhlapo told the BBC World Service's Outlook programme that the young users that she spoke to get access to these drugs from HIV patients or healthcare workers, and that they know when the individual patients go to collect the drugs and buy them, or if they do not have any money, they steal them. She also said that when she was doing the story, many HIV patients were complaining that they don't get the drugs and that queues are long and it was taking a long time to access them. "It is well organised, no matter how high they are, they do not tell you who is giving them the drugs," said Ms Nhlapo.
The potential health implications of this are huge, on top of the access to care issue. When health care workers themselves are selling ARVs to be used as recreational drugs, what else will happen? These users are exposing themselves to side effects, and the HIV patients are putting themselves at huge risk by not taking these medications as they should be taken. I can only imagine what kind of black market this is going to create, especially in that part of the world. If this spreads to war-torn regions of Africa, how many more human rights violations will occur?
I've little idea how to begin to wrap my head around this one. Just mind-blowing. Wait until word gets round here in the US that apparently ARVs can be used for this. We'll have to watch to see if/when this comes out in the history of the next patient who rolls in to the ER with a CD4 count of, say, 4.
AD
Sunday, December 7, 2008
Cleveland Clinic Discloses Doctors Financial Ties
http://www.nytimes.com/2008/12/03/business/03clinic.html?pagewanted=1&em
The Cleveland Clinic, one of the nation’s most prominent medical research centers, is making a complete disclosure of doctors’ and researchers’ financial ties available on its Web site, www.clevelandclinic.org. It will now publicly report the business relationships that any of its 1,800 staff doctors and scientists have with drug and device makers.
This comes as the nation’s doctors and hospitals are under mounting pressure to address potential financial conflicts of interest that can occur when they work closely with companies to develop and research new drugs and devices.
In American medicine, doctors’ links to industry are often hidden from public view, and critics argue that such relationships can taint the integrity of medical research and patient care. In one of the most recent controversies, a highly regarded and influential psychiatrist at Emory University, Dr. Charles B. Nemeroff, drew criticism in October for failing to disclose at least $1 million in consulting fees from drug makers.
Senator Charles E. Grassley, Republican of Iowa, has brought Congressional scrutiny to the issue and introduced legislation that would require drug and device makers to divulge the payments they make to doctors. Some drug companies, including Merck and Eli Lilly, say they plan to starting publicly disclosing their payments to doctors next year.
Dr. Cosgrove, chief executive of the Cleveland Clinic, said that potential conflicts of interest need to be managed, not automatically eliminated, because working with industry encourages innovation by the clinic and its doctors.
Some experts wonder how useful the industry disclosures actually are to patients when they are told of a doctor’s industry ties before agreeing to take part in a research trial. A patient, they argue, may not know what to make of such information.
To me, this is quite analogous to attempts to curb political lobbying in D.C. by making earmark requests and the source of fundraising dollars more transparent to voters. Transparency is hyped as the fix to political corruption, but its still unclear whether it really stops "bad" behavior. Voters overwhelmingly disapporove of Congress in general (a dismal 32% as of Dec. 2008 http://mediamatters.org/items/200712130008), but often express approval of their own member of Congress. Many people simply don't care enough to look up the donor lists, and who can blame them? It's hardly enjoyable bedtime reading.
I wonder if patients will pay attention to this type of disclosure. And if they notice, will they care?
The Cleveland Clinic, one of the nation’s most prominent medical research centers, is making a complete disclosure of doctors’ and researchers’ financial ties available on its Web site, www.clevelandclinic.org. It will now publicly report the business relationships that any of its 1,800 staff doctors and scientists have with drug and device makers.
This comes as the nation’s doctors and hospitals are under mounting pressure to address potential financial conflicts of interest that can occur when they work closely with companies to develop and research new drugs and devices.
In American medicine, doctors’ links to industry are often hidden from public view, and critics argue that such relationships can taint the integrity of medical research and patient care. In one of the most recent controversies, a highly regarded and influential psychiatrist at Emory University, Dr. Charles B. Nemeroff, drew criticism in October for failing to disclose at least $1 million in consulting fees from drug makers.
Senator Charles E. Grassley, Republican of Iowa, has brought Congressional scrutiny to the issue and introduced legislation that would require drug and device makers to divulge the payments they make to doctors. Some drug companies, including Merck and Eli Lilly, say they plan to starting publicly disclosing their payments to doctors next year.
Dr. Cosgrove, chief executive of the Cleveland Clinic, said that potential conflicts of interest need to be managed, not automatically eliminated, because working with industry encourages innovation by the clinic and its doctors.
Some experts wonder how useful the industry disclosures actually are to patients when they are told of a doctor’s industry ties before agreeing to take part in a research trial. A patient, they argue, may not know what to make of such information.
To me, this is quite analogous to attempts to curb political lobbying in D.C. by making earmark requests and the source of fundraising dollars more transparent to voters. Transparency is hyped as the fix to political corruption, but its still unclear whether it really stops "bad" behavior. Voters overwhelmingly disapporove of Congress in general (a dismal 32% as of Dec. 2008 http://mediamatters.org/items/200712130008), but often express approval of their own member of Congress. Many people simply don't care enough to look up the donor lists, and who can blame them? It's hardly enjoyable bedtime reading.
I wonder if patients will pay attention to this type of disclosure. And if they notice, will they care?
Friday, December 5, 2008
Proposition 8
Go to www.funnyordie.com and click on the Prop 8 skit
http://en.wikipedia.org/wiki/California_Proposition_8_(2008)
I have never seen a larger wikipedia entry than this on California's Proposition 8, a ballot proposition that changed the state Constitution to restrict the definition of marriage to to that being between a man and a woman.
My marriage cost about $15,000 and my divorce costs are still escalating at over $100,000, (yes think about this boys!. I have always thought at the very least, bible thumpers could understand the fudicial benefits of same sex marriages.
Jennifer B.
http://en.wikipedia.org/wiki/California_Proposition_8_(2008)
I have never seen a larger wikipedia entry than this on California's Proposition 8, a ballot proposition that changed the state Constitution to restrict the definition of marriage to to that being between a man and a woman.
My marriage cost about $15,000 and my divorce costs are still escalating at over $100,000, (yes think about this boys!. I have always thought at the very least, bible thumpers could understand the fudicial benefits of same sex marriages.
Jennifer B.
Stem Cell-ebration
http://www.cbsnews.com/stories/2008/11/19/health/main4615769.shtml?source=RSSattr=SciTech_4615769
This is an article to found in Time magazine in which European physicians announced the success of a breakthrough procedure in which a woman's windpipe was rebuilt using her own stem cells. The operation, seeded a stripped-down segment of a donor's trachea with stem cells from her own bone marrow ensuring a perfect tissue match and reducing transplant rejection. This is a milestone that could pave the way for radical improvements in organ transplantation and treatment of serious illnesses.
This is very promising for regrowing organs such as soft tissue, lungs, bladder, uterus, pancreas. Also note that although a pioneered operation like this was done at Mt Sanai in New York in 2005, this successful operation was a result of the COMBINED efforts of Milan and England.
I do not know what the attitudes and understanding of Europeans in regard to this research is, any comments?
Jennifer B.
This is an article to found in Time magazine in which European physicians announced the success of a breakthrough procedure in which a woman's windpipe was rebuilt using her own stem cells. The operation, seeded a stripped-down segment of a donor's trachea with stem cells from her own bone marrow ensuring a perfect tissue match and reducing transplant rejection. This is a milestone that could pave the way for radical improvements in organ transplantation and treatment of serious illnesses.
This is very promising for regrowing organs such as soft tissue, lungs, bladder, uterus, pancreas. Also note that although a pioneered operation like this was done at Mt Sanai in New York in 2005, this successful operation was a result of the COMBINED efforts of Milan and England.
I do not know what the attitudes and understanding of Europeans in regard to this research is, any comments?
Jennifer B.
Thursday, December 4, 2008
Separation of Church and Health?
After blogging about the CDC restriction on homosexual males donating organs, I started thinking about how Jehovah's Witnesses refuse blood transfusions during organ transplant surgeries, which is a vitally important part of the surgery and recovery process. A good friend of mine is a cardiologist, and when I asked him about this, he responded that many such surgeries are unsuccessful. My initial reaction was that this just wasn't fair - that there are thousands of people on transplant lists who would have much higher chances at success. It seemed to me that religion, which in my opinion should not have a place in science, is a solid part of society in the United States.
An article entitled, "Are Scientists Playing God? It Depends on Your Religion", reported that American and European researchers have made most of the progress so far in biotechnology. Yet they still face one very large obstacle — God, as defined by some Western religions. Some scientists who are frustrated with the governmental debate over the morality of stem-cell research and genetic engineering have in fact moved to Asia, which offers researchers new labs, fewer restrictions and a different view of divinity and the afterlife. “Asian religions worry less than Western religions that biotechnology is about ‘playing God,’” says Cynthia Fox, the author of “Cell of Cells,” a book about the global race among stem-cell researchers. “Therapeutic cloning in particular jibes well with the Buddhist and Hindu ideas of reincarnation.” Most of southern and eastern Asia displays relatively little opposition to either cloned embryonic stem-cell research or genetically modified crops. China, India, Singapore and other countries have enacted laws supporting embryo cloning for medical research (sometimes called therapeutic cloning, as opposed to reproductive cloning intended to recreate an entire human being).
In another article entitled, "Children's health can't be left to faith alone," the author argues that when parents won't seek medical care, they must be punished by law. This was in response to a case where a 15 month old baby died from bronchial pneumonia and a blood infection, problems easily treated with antibiotics; however, she received no antibiotics because her parents belong to a small fundamentalist sect, The Followers of Christ Church, and do not believe in antibiotics. The Followers believe that faith will heal all and that death, if it comes, it is God’s will. While their baby struggled for days to breathe, her parents prayed, never calling a doctor, an ambulance or 911. I agree with the author that any adult has and should have the right to refuse medical care. I also agree with him that society must make the protection of children a core value, and the way to do that is to make it clear that child neglect is still neglect, even when performed under the cover of religious faith.
I am very interested to see how the separation between church and state evolves under the Obama presidency, and where this takes stem cell research. America is on the verge of scientific breakthrough, and I think it should heed the message when some of its most important researchers are moving across the world in the name of science. Religious freedom is revered in the United States, but health should be given as much deference.
An article entitled, "Are Scientists Playing God? It Depends on Your Religion", reported that American and European researchers have made most of the progress so far in biotechnology. Yet they still face one very large obstacle — God, as defined by some Western religions. Some scientists who are frustrated with the governmental debate over the morality of stem-cell research and genetic engineering have in fact moved to Asia, which offers researchers new labs, fewer restrictions and a different view of divinity and the afterlife. “Asian religions worry less than Western religions that biotechnology is about ‘playing God,’” says Cynthia Fox, the author of “Cell of Cells,” a book about the global race among stem-cell researchers. “Therapeutic cloning in particular jibes well with the Buddhist and Hindu ideas of reincarnation.” Most of southern and eastern Asia displays relatively little opposition to either cloned embryonic stem-cell research or genetically modified crops. China, India, Singapore and other countries have enacted laws supporting embryo cloning for medical research (sometimes called therapeutic cloning, as opposed to reproductive cloning intended to recreate an entire human being).
In another article entitled, "Children's health can't be left to faith alone," the author argues that when parents won't seek medical care, they must be punished by law. This was in response to a case where a 15 month old baby died from bronchial pneumonia and a blood infection, problems easily treated with antibiotics; however, she received no antibiotics because her parents belong to a small fundamentalist sect, The Followers of Christ Church, and do not believe in antibiotics. The Followers believe that faith will heal all and that death, if it comes, it is God’s will. While their baby struggled for days to breathe, her parents prayed, never calling a doctor, an ambulance or 911. I agree with the author that any adult has and should have the right to refuse medical care. I also agree with him that society must make the protection of children a core value, and the way to do that is to make it clear that child neglect is still neglect, even when performed under the cover of religious faith.
I am very interested to see how the separation between church and state evolves under the Obama presidency, and where this takes stem cell research. America is on the verge of scientific breakthrough, and I think it should heed the message when some of its most important researchers are moving across the world in the name of science. Religious freedom is revered in the United States, but health should be given as much deference.
GISAID - Flu Trackers
http://gisaid.org/
I came across GISAID while researching the World Health Organization's (WHO) Pandemic Influenza Preparedness Plan (see http://wikileaks.org/leak/avian-flu-chair-text-2008.pdf).
GISAID stands for "Global Initiative on Sharing Avian Influenza Data." It is a non-profit that was started in August of 2006 by a group of leading scientists and researchers, headed up by Dr. Nancy Cox, head of the Influenza Division at the US Centers for Disease Control and Prevention (CDC), and Ilaria Capua, an Italian veterinary virologist who is a leading advocate of greater sharing of H5N1 genetic data.
GISAID "is the world's largest and most comprehensive influenza database." (See http://www.flutrackers.com/forum/showthread.php?t=81678). GISAID aims to facilitate access to avian influenza research and vaccines through a publicly accessible online database that offers basic intellectual property rights to those who submit genetic information. The website says, "We have all pledged to share the data, to analyze the findings jointly, and to publish the results collaboratively, on the basis of open sharing of data respecting the rights and interests of all involved parties." As a result, GISAID has encouraged many countries including Indonesia, China, Russia, and others to start sharing information about their viruses again.
GISAID is currently frustrated with the WHO, claiming that the WHO is going to extreme lengths to withhold money from GISAID ($450,000 that the United States' CDC intended to go to GISAID). Furthermore, WHO is apparently asking for $10 million to start its own online database, which GISAID already has established free of charge. GISAID scientists do not understand the WHO secretariat's unwillingness to embrace them, after they have put much effort and time into the development of an effective and efficient avian influenza technology transfer database.
It will be interesting to see whether WHO embraces or at least acknowledges GISAID as it moves forward with the Pandemic Influenza Preparedness plan, as GISAID is not currently mentioned anywhere in the text.
I came across GISAID while researching the World Health Organization's (WHO) Pandemic Influenza Preparedness Plan (see http://wikileaks.org/leak/avian-flu-chair-text-2008.pdf).
GISAID stands for "Global Initiative on Sharing Avian Influenza Data." It is a non-profit that was started in August of 2006 by a group of leading scientists and researchers, headed up by Dr. Nancy Cox, head of the Influenza Division at the US Centers for Disease Control and Prevention (CDC), and Ilaria Capua, an Italian veterinary virologist who is a leading advocate of greater sharing of H5N1 genetic data.
GISAID "is the world's largest and most comprehensive influenza database." (See http://www.flutrackers.com/forum/showthread.php?t=81678). GISAID aims to facilitate access to avian influenza research and vaccines through a publicly accessible online database that offers basic intellectual property rights to those who submit genetic information. The website says, "We have all pledged to share the data, to analyze the findings jointly, and to publish the results collaboratively, on the basis of open sharing of data respecting the rights and interests of all involved parties." As a result, GISAID has encouraged many countries including Indonesia, China, Russia, and others to start sharing information about their viruses again.
GISAID is currently frustrated with the WHO, claiming that the WHO is going to extreme lengths to withhold money from GISAID ($450,000 that the United States' CDC intended to go to GISAID). Furthermore, WHO is apparently asking for $10 million to start its own online database, which GISAID already has established free of charge. GISAID scientists do not understand the WHO secretariat's unwillingness to embrace them, after they have put much effort and time into the development of an effective and efficient avian influenza technology transfer database.
It will be interesting to see whether WHO embraces or at least acknowledges GISAID as it moves forward with the Pandemic Influenza Preparedness plan, as GISAID is not currently mentioned anywhere in the text.
Paying Doctors to Ignore Patients
The United States have higher health care costs than any other advanced country, whether measured on a per capita basis, as a percentage of the economy, or in total dollars spent. The high cost of health care in America has been largely affected by the current financial crisis, and public insurance programs are also being hit. State and federal governments are straining to meet the rising costs of Medicaid and Medicare. Many states are having to decrease funding in other areas, such as education, to meet elevated Medicare costs. For physicians, especially, Medicare has become a burden more than a blessing. It is a source of frustration that at times prohibits physicians from doing the jobs they set out to do, in the name of regulation and money. Currently one in seven Americans are covered by Medicare. For the physicians who treat these people, Medicare may become a barrier to proper treatment.
Under Medicare Part B, physicians are only reimbursed for procedures that are considered to be reasonable and necessary. Physicians are not compensated for talking to patients, but rather for the procedures they complete and for the number of patients they see. Physicians are often criticized for not spending enough time with their patients and for not providing informed medical care with empathy and effectiveness. However, it is Medicare that dictates how many patients that physicians must see in order to meet the reimbursement quota, and therefore how much time they can spend with each patient. Overhead practice expenses, including rent, nurses’ salaries, and malpractice insurance, have become so high that physicians must see more patients in order to be able to pay for all of the other costs associated with practicing. The physicians who do not own expensive equipment, such as MRI machines, which are much more lucrative as far as Medicare reimbursements than office visits, are forced to see fewer patients in more time in order to keep up with their overhead. Dr. Michael Stewart, chairman of the department of otorhinolaryngology at New York-Presbyterian Weill Cornell Medical Center, said that the challenge today is that “everything is going up except reimbursement. The tendency is to see more patients in a given amount of time, and so less time is spent with each patient.”
Although each fee paid by Medicare to physicians is meant to reimburse them for the time and skill they put into each service to each patient, the reality of the system seems to have become almost the opposite. Many physicians believe they cannot fully perform their jobs and desire to have more face-to-face time with their patients. They are frustrated that they are unable to do so because regulations deny them the ability to do something that automatically should be done.
The future of medicine will depend on how the Medicare system adapts and evolves with the realities of health care today. Dr. Byron M. Thomashow, medical director of the Center for Chest Diseases at New York-Presbyterian Columbia Medical Center, said, “We need to go forward with something that keeps the humanity in medicine.” I agree.
http://www.nytimes.com/2008/07/24/opinion/24bach.html
AD
Under Medicare Part B, physicians are only reimbursed for procedures that are considered to be reasonable and necessary. Physicians are not compensated for talking to patients, but rather for the procedures they complete and for the number of patients they see. Physicians are often criticized for not spending enough time with their patients and for not providing informed medical care with empathy and effectiveness. However, it is Medicare that dictates how many patients that physicians must see in order to meet the reimbursement quota, and therefore how much time they can spend with each patient. Overhead practice expenses, including rent, nurses’ salaries, and malpractice insurance, have become so high that physicians must see more patients in order to be able to pay for all of the other costs associated with practicing. The physicians who do not own expensive equipment, such as MRI machines, which are much more lucrative as far as Medicare reimbursements than office visits, are forced to see fewer patients in more time in order to keep up with their overhead. Dr. Michael Stewart, chairman of the department of otorhinolaryngology at New York-Presbyterian Weill Cornell Medical Center, said that the challenge today is that “everything is going up except reimbursement. The tendency is to see more patients in a given amount of time, and so less time is spent with each patient.”
Although each fee paid by Medicare to physicians is meant to reimburse them for the time and skill they put into each service to each patient, the reality of the system seems to have become almost the opposite. Many physicians believe they cannot fully perform their jobs and desire to have more face-to-face time with their patients. They are frustrated that they are unable to do so because regulations deny them the ability to do something that automatically should be done.
The future of medicine will depend on how the Medicare system adapts and evolves with the realities of health care today. Dr. Byron M. Thomashow, medical director of the Center for Chest Diseases at New York-Presbyterian Columbia Medical Center, said, “We need to go forward with something that keeps the humanity in medicine.” I agree.
http://www.nytimes.com/2008/07/24/opinion/24bach.html
AD
Monday, December 1, 2008
The Vatican’s bioethics opinion: what does it mean?
http://www.catholicnews.com/data/stories/cns/0805983.htm
Later this month, the Vatican is planning on issuing a bioethics opinion on human cloning and stem-cell research. This opinion is being created by a Vatican department known as the Congregation for the Doctrine of the Faith and is meant to examine biological research and health care as it relates to Catholic ethics. These issues have not specifically been by the Vatican in previous opinions such as "Donum Vitae" ("The Gift of Life") and "Evangelium Vitae" ("The Gospel of Life") which were written in 1987 and 1995 respectively. Specific topics that are going to be discussed include the freezing of human embryos, the selective, pre-implantation genetic diagnosis (PGD), research on embryonic stem cells, and attempts at human cloning.The pope said the starting point for the church's opinion is: "The two fundamental criteria for moral discernment in this field are unconditional respect for the human being as a person from the moment of conception to natural death, (and) respect for the originality of the transmission of human life through the acts proper to spouses."
This area of bioethics seems very interesting because it seems as though the Catholic Church is going to take a very different stance on many issues than many nations. For instance, abortion is legal in the U.S., it is illegal in many countries and this policy falls in line with Catholicism. However, from what I am reading about for my paper concerning the use of PGD, most nations are allowing PGD even though the Church will presumably say that PGD is unethical.
The question arises of how important the opinion of the Catholic is and how will people respond to a nation allowing for a medical procedure that a religious entity says is illegal. Surely this is not the first instance of this happening, but a though I had was that this was becoming more common with these newer topics of biological research and health care with new procedures.
Later this month, the Vatican is planning on issuing a bioethics opinion on human cloning and stem-cell research. This opinion is being created by a Vatican department known as the Congregation for the Doctrine of the Faith and is meant to examine biological research and health care as it relates to Catholic ethics. These issues have not specifically been by the Vatican in previous opinions such as "Donum Vitae" ("The Gift of Life") and "Evangelium Vitae" ("The Gospel of Life") which were written in 1987 and 1995 respectively. Specific topics that are going to be discussed include the freezing of human embryos, the selective, pre-implantation genetic diagnosis (PGD), research on embryonic stem cells, and attempts at human cloning.The pope said the starting point for the church's opinion is: "The two fundamental criteria for moral discernment in this field are unconditional respect for the human being as a person from the moment of conception to natural death, (and) respect for the originality of the transmission of human life through the acts proper to spouses."
This area of bioethics seems very interesting because it seems as though the Catholic Church is going to take a very different stance on many issues than many nations. For instance, abortion is legal in the U.S., it is illegal in many countries and this policy falls in line with Catholicism. However, from what I am reading about for my paper concerning the use of PGD, most nations are allowing PGD even though the Church will presumably say that PGD is unethical.
The question arises of how important the opinion of the Catholic is and how will people respond to a nation allowing for a medical procedure that a religious entity says is illegal. Surely this is not the first instance of this happening, but a though I had was that this was becoming more common with these newer topics of biological research and health care with new procedures.
What is wrong with choosing the sex of your baby?
(CNN) -- A new type of embryo testing is being offered by a growing number of fertility clinics as a way of improving the chances of a successful pregnancy.
It involves genetic testing of chromosomes in embryos created by in vitro fertilization, or IVF, and implanting only those embryos with normal chromosomes into the mother. (cnn.com by Kahn, 2002)
As a nurse who has investigated the IVF process personally, I would like to offer some insider info. The IVF process has actually come a long way. In my opinion this is not a dangerous procedure at all. Hormone intramuscular shots are given to the female for one month stimulating hyper ovulation. Ultrasound is used to determine the exact day/hour when normal ovulation should occur. Female is prepped for surgery with a Valium sedative and lidocaine injections internally at the site. Scope is passed through the vaginal wall and obtains the eggs via suction. Patient recovers shortly and is able to walk out and go home to rest.
The eggs (approx 15-25) are inspected under microscope for abnormalities. IVF occurs after the sperms are also cleaned and inspected. The gamete is inspected all along the way. Only the most viable and healthy gamete is implanted.
As a woman from a family of girls, I was only blessed with two boys myself. I wanted a girl badly. The physician offered to centrifuge the sperm prior to IVF and draw off only female sperms. This can be done because female sperms are heavier and sink to the bottom. This is a very common request and method in America. I was paying out of pocket $17,000.00, I wanted that daughter. Isn't this America? Do we just let the wind blow? Do we leave it to chance? No. We pay to "have it your way"!
Jennifer B.
It involves genetic testing of chromosomes in embryos created by in vitro fertilization, or IVF, and implanting only those embryos with normal chromosomes into the mother. (cnn.com by Kahn, 2002)
As a nurse who has investigated the IVF process personally, I would like to offer some insider info. The IVF process has actually come a long way. In my opinion this is not a dangerous procedure at all. Hormone intramuscular shots are given to the female for one month stimulating hyper ovulation. Ultrasound is used to determine the exact day/hour when normal ovulation should occur. Female is prepped for surgery with a Valium sedative and lidocaine injections internally at the site. Scope is passed through the vaginal wall and obtains the eggs via suction. Patient recovers shortly and is able to walk out and go home to rest.
The eggs (approx 15-25) are inspected under microscope for abnormalities. IVF occurs after the sperms are also cleaned and inspected. The gamete is inspected all along the way. Only the most viable and healthy gamete is implanted.
As a woman from a family of girls, I was only blessed with two boys myself. I wanted a girl badly. The physician offered to centrifuge the sperm prior to IVF and draw off only female sperms. This can be done because female sperms are heavier and sink to the bottom. This is a very common request and method in America. I was paying out of pocket $17,000.00, I wanted that daughter. Isn't this America? Do we just let the wind blow? Do we leave it to chance? No. We pay to "have it your way"!
Jennifer B.
Saturday, November 29, 2008
Snake oil Anyone?
A company in Boulder, CO is offering a genetic test to determine what kind of sport your child is most genetically suited for. For $149, with the swab of a cheek your child will know if he or she would be best at speed and power sports like sprinting or football, or endurance sports like distance running, or a combination of the two.
These seems like a terrible idea to me. First of all you are possibly pigeon-holing your child into a specific sport when he or she could excel at any number of activities. Secondly, this is frighteningly a reminder of our eugenics past. Where will this drive for genetic advanage stop?
Also as many of the Dr.'s in this article point out. Everything we know about genetics is pointing less and less to the isolation of certain genes causing certain traits and more towards a combination of genetic and environment causes.
Seems like a new snake oil salesman if you ask me.
These seems like a terrible idea to me. First of all you are possibly pigeon-holing your child into a specific sport when he or she could excel at any number of activities. Secondly, this is frighteningly a reminder of our eugenics past. Where will this drive for genetic advanage stop?
Also as many of the Dr.'s in this article point out. Everything we know about genetics is pointing less and less to the isolation of certain genes causing certain traits and more towards a combination of genetic and environment causes.
Seems like a new snake oil salesman if you ask me.
Thursday, November 27, 2008
http://news.aol.com/article/poll-rates-most-and-least-ethical-jobs/259161?icid=100214839x1214058528x1200860973
Why is it that every year nurses are voted the most ethical of professions? I will be very proud and pleased to explain it to you.
The philosophy and understand standing of ethics in healthcare is taught directly from the first day of nursing school. While we are learning the biology and science of medicine we are constantly reminded of the ramifications of what could go wrong given a situation. This concept is driven into our head at every turn and the answers on every multiple-choice question. In addition, the instructors also boost our pride at every opportunity by glorifying the profession and reminding us that we are the patient advocate. Our primary purpose in life is to protect the patient from harm and to educate them because we have better bedside manners.
This is not the case in every culture I have found however. Specifically in some east Indian cultures I have come to learn that nurse is our one of the bottom respected professions. As a matter of fact lower than a housekeeper, janitor, maid. For whatever reason having to care for the old and sick is not respected. I have run into this discrimination many times in my career and now do not take offense by this. I view it as an opportunity to engage more fiercely with that family member or patient that usually is not getting the appropriate emotional care they deserve as a human being.
I plan to use my law degree in the area of advocacy within the court systems. Although I do this every day through communication and facilitation, I know there are some patients who get caught up in the legal system with no appropriate representation. I have been complemented many times on this natural ability. A recent manager of mine once stated on my review, “I always want you on my side and God help me if I am up against you on a patient issue.”.
Why is it that every year nurses are voted the most ethical of professions? I will be very proud and pleased to explain it to you.
The philosophy and understand standing of ethics in healthcare is taught directly from the first day of nursing school. While we are learning the biology and science of medicine we are constantly reminded of the ramifications of what could go wrong given a situation. This concept is driven into our head at every turn and the answers on every multiple-choice question. In addition, the instructors also boost our pride at every opportunity by glorifying the profession and reminding us that we are the patient advocate. Our primary purpose in life is to protect the patient from harm and to educate them because we have better bedside manners.
This is not the case in every culture I have found however. Specifically in some east Indian cultures I have come to learn that nurse is our one of the bottom respected professions. As a matter of fact lower than a housekeeper, janitor, maid. For whatever reason having to care for the old and sick is not respected. I have run into this discrimination many times in my career and now do not take offense by this. I view it as an opportunity to engage more fiercely with that family member or patient that usually is not getting the appropriate emotional care they deserve as a human being.
I plan to use my law degree in the area of advocacy within the court systems. Although I do this every day through communication and facilitation, I know there are some patients who get caught up in the legal system with no appropriate representation. I have been complemented many times on this natural ability. A recent manager of mine once stated on my review, “I always want you on my side and God help me if I am up against you on a patient issue.”.
http://news.yahoo.com/s/ap/20081119/ap_on_he_me/med_artificial_heart
Please see the above article in which a young girl was kept alive on a heart machine for over 100 days while waiting for heart transplant. The machine is approximately the size of a photocopier and pumps the blood through the body.
In light of our discussions recently in regards to the donation prosthetic process and lack of available organs, I am thrilled to see this successful piece of medical technology. I feel it is only a short matter of time when we are able to produce medically sufficient man-made organs. I believe that going further with stem cell research and DNA transfer will only expedite the process.
Jennifer B.
Please see the above article in which a young girl was kept alive on a heart machine for over 100 days while waiting for heart transplant. The machine is approximately the size of a photocopier and pumps the blood through the body.
In light of our discussions recently in regards to the donation prosthetic process and lack of available organs, I am thrilled to see this successful piece of medical technology. I feel it is only a short matter of time when we are able to produce medically sufficient man-made organs. I believe that going further with stem cell research and DNA transfer will only expedite the process.
Jennifer B.
Monday, November 24, 2008
Save the Cord - Non-Controversial Source of Stem Cells
Cord blood is blood left in the umbilical cord or placenta after childbirth that is said to be a non controversial source of stem cells. Cord blood banking seems like a promising way to ensure that stem cells will be available for future medical use, partly because the procedure is easy and non-invasive, and it does not interfere with the childbirth process in any way. Women who choose to preserve cord blood have the option of donating their cord blood to a public bank, or paying to store it in a private bank for later use exclusively within their own family.
In the case of private banks, when a donor or immediate family member has a disease that requires a stem cell transplant, cord blood from a newborn bay in the family may be the best treatment option, as it will be a perfect match for the donor and has a 1 in 4 chance of being a perfect match for a siblings.
Unlike bone marrow transplants, which require a perfect match, cord blood transplants only require 3/6 Human Leukocyte Antigens (HLAs) to match. Cord blood is unique in this respect because it is the “youngest” source of stem cells and, thus, readily accepted in to a recipient’s system.
Save the Cord Foundation (www.savethecordfoundation.org) is a non-profit organization that was started by co-founders Charis Ober and Anne Sarabia. Both women graduated from the University of Arizona, and worked in the biotech and pharmaceutical industries before starting the foundation. They were motivated to start the foundation after visiting a public cord blood bank in Tucson, AZ, and meeting children with leukemia and sickle cell anemia whose lives had been saved with cord blood donations. Save the cord aims to make the collection of cord blood the standard of care in hospitals across the nation, and to make public cord blood banks a national priority.
Cord blood seems like a promising solution for stem cells. Are there any mothers contributing to this blog who have donated or preserved their cord blood? If not, did you know about the option at the time of giving birth? Thanks for any input!
In the case of private banks, when a donor or immediate family member has a disease that requires a stem cell transplant, cord blood from a newborn bay in the family may be the best treatment option, as it will be a perfect match for the donor and has a 1 in 4 chance of being a perfect match for a siblings.
Unlike bone marrow transplants, which require a perfect match, cord blood transplants only require 3/6 Human Leukocyte Antigens (HLAs) to match. Cord blood is unique in this respect because it is the “youngest” source of stem cells and, thus, readily accepted in to a recipient’s system.
Save the Cord Foundation (www.savethecordfoundation.org) is a non-profit organization that was started by co-founders Charis Ober and Anne Sarabia. Both women graduated from the University of Arizona, and worked in the biotech and pharmaceutical industries before starting the foundation. They were motivated to start the foundation after visiting a public cord blood bank in Tucson, AZ, and meeting children with leukemia and sickle cell anemia whose lives had been saved with cord blood donations. Save the cord aims to make the collection of cord blood the standard of care in hospitals across the nation, and to make public cord blood banks a national priority.
Cord blood seems like a promising solution for stem cells. Are there any mothers contributing to this blog who have donated or preserved their cord blood? If not, did you know about the option at the time of giving birth? Thanks for any input!
Sunday, November 23, 2008
Why Discussing Limiting Medicare Benefits for the Elderly Is Worthwhile
While browsing the opinion section of the New York Times, I came across an interesting editorial about limiting benefits for senior citizens in order to make health care more effective. The article, by Daniel Callahan, can be found here: http://newoldage.blogs.nytimes.com/2008/11/13/heart-surgery-how-old-is-too-old. Callahan, in essence, argues that we should limit expensive treatment given to the elderly in order to cut costs upon the Medicare system and avoid otherwise necessary increases in taxes.
Callahan succinctly explains the burdens levied upon the Medicare system by expensive treatments for the elderly. While I believe some will find that assessing life-saving treatments as “burdensome” or perhaps “wasteful,” as Callahan certainly implies, the cold numbers are extremely persuasive. And they should at the very least not be overlooked. So let’s examine the numbers. The Medicare program cost $429 billion in 2007, and has a 7% annual cost increase. Thus, by 2017, it should cost $884 billion. Most importantly, by 2017, the Medicare program will be bankrupt.
Now, how do expensive treatments for the elderly factor in? While Old age itself is certainly not a barrier to coverage. In fact, the average age of those undergoing heart surgery, organ transplantation, kidney dialysis, and cancer treatment is continually rising, Callahan explains. Essentially, science is finding ways of keeping the sick or weak alive longer. It is important not to forget that just a few decades ago, the methods used to keep people alive were not even dreamed of. Significantly, not only are people staying alive longer, but many elderly people are opting for expensive, aggressive treatments, even when the likelihood of success is dismal. I personally do not blame anyone for this decision; if your life is on the line, wouldn’t you opt to try to extend it? But the fact remains: people aren’t likely to simply roll over and die. If treatment is available, they’ll want it.
Thus, the effect on the system is significant. Callahan writes that the average Medicare recipient has to spend between $5,000 and $10,000 for treatment not covered by the program. Doctors are becoming reluctant to take on elderly patients because they are often poorly reimbursed. Out of pocket costs for drugs and co-payments are expected to jump anywhere from 31 to 60 percent in 2009 alone. Therefore, if I interpret the numbers correctly, it seems that not only is the system going bankrupt, but recipients are facing significant price increases or will have to pay out-of-pocket because the system itself cannot afford to treat them.
In light of these numbers, Callahan argues that limiting benefits based on age should be done, because it is not likely that the other possible fix (raising taxes) will be seriously considered in the near future. I thought the most important part of Callahan’s argument was the simple fact that he acknowledges that age-based rationing will not be accepted. Thus, I think he effectively removes that contention from the argument. However, his point is that we can’t completely factor out cost and age from the equation. Congress has refused to allow Medicare to take costs into account in its coverage decisions. But should it play some role? Should age? Callahan’s answer is emphatically yes. I agree with Callahan’s sentiment that our society “can not, and should not, promise open-ended, progress-driven medical care that is indifferent to costs.” Because in the real world, age does matter. It matters in that there are more and more elderly people undergoing expensive care, putting increasing burdens on a system that is already on the brink of collapse. This is a practical way to save money. This is not a proposal to eliminate access to benefits for the elderly altogether. It's a proposal that cuts extremely expensive treatments that likely either won't work or won't work for long. And freeing up cash helps the system. And, although now I am editorializing, I wonder: at the end of the day, what is better? A functioning system that, admittedly has its flaws and is imperfect? Or no system whatsoever? I say an imperfect system.
Keep in mind, age isn’t the only factor. Likelihood of success, cost, and patient wishes should all weigh in. Perhaps a government-regulated healthcare system would solve ALL of these problems? But we’re not there yet, and I think it is important to try to make our system work until we get there. I think Callahan’s point is that we need to consider solutions that may not be popular or pleasant, not because they will ultimately be implemented, but because they are often realistic and therefore, a reasonable starting point to formulate serious solutions.
Callahan succinctly explains the burdens levied upon the Medicare system by expensive treatments for the elderly. While I believe some will find that assessing life-saving treatments as “burdensome” or perhaps “wasteful,” as Callahan certainly implies, the cold numbers are extremely persuasive. And they should at the very least not be overlooked. So let’s examine the numbers. The Medicare program cost $429 billion in 2007, and has a 7% annual cost increase. Thus, by 2017, it should cost $884 billion. Most importantly, by 2017, the Medicare program will be bankrupt.
Now, how do expensive treatments for the elderly factor in? While Old age itself is certainly not a barrier to coverage. In fact, the average age of those undergoing heart surgery, organ transplantation, kidney dialysis, and cancer treatment is continually rising, Callahan explains. Essentially, science is finding ways of keeping the sick or weak alive longer. It is important not to forget that just a few decades ago, the methods used to keep people alive were not even dreamed of. Significantly, not only are people staying alive longer, but many elderly people are opting for expensive, aggressive treatments, even when the likelihood of success is dismal. I personally do not blame anyone for this decision; if your life is on the line, wouldn’t you opt to try to extend it? But the fact remains: people aren’t likely to simply roll over and die. If treatment is available, they’ll want it.
Thus, the effect on the system is significant. Callahan writes that the average Medicare recipient has to spend between $5,000 and $10,000 for treatment not covered by the program. Doctors are becoming reluctant to take on elderly patients because they are often poorly reimbursed. Out of pocket costs for drugs and co-payments are expected to jump anywhere from 31 to 60 percent in 2009 alone. Therefore, if I interpret the numbers correctly, it seems that not only is the system going bankrupt, but recipients are facing significant price increases or will have to pay out-of-pocket because the system itself cannot afford to treat them.
In light of these numbers, Callahan argues that limiting benefits based on age should be done, because it is not likely that the other possible fix (raising taxes) will be seriously considered in the near future. I thought the most important part of Callahan’s argument was the simple fact that he acknowledges that age-based rationing will not be accepted. Thus, I think he effectively removes that contention from the argument. However, his point is that we can’t completely factor out cost and age from the equation. Congress has refused to allow Medicare to take costs into account in its coverage decisions. But should it play some role? Should age? Callahan’s answer is emphatically yes. I agree with Callahan’s sentiment that our society “can not, and should not, promise open-ended, progress-driven medical care that is indifferent to costs.” Because in the real world, age does matter. It matters in that there are more and more elderly people undergoing expensive care, putting increasing burdens on a system that is already on the brink of collapse. This is a practical way to save money. This is not a proposal to eliminate access to benefits for the elderly altogether. It's a proposal that cuts extremely expensive treatments that likely either won't work or won't work for long. And freeing up cash helps the system. And, although now I am editorializing, I wonder: at the end of the day, what is better? A functioning system that, admittedly has its flaws and is imperfect? Or no system whatsoever? I say an imperfect system.
Keep in mind, age isn’t the only factor. Likelihood of success, cost, and patient wishes should all weigh in. Perhaps a government-regulated healthcare system would solve ALL of these problems? But we’re not there yet, and I think it is important to try to make our system work until we get there. I think Callahan’s point is that we need to consider solutions that may not be popular or pleasant, not because they will ultimately be implemented, but because they are often realistic and therefore, a reasonable starting point to formulate serious solutions.
Friday, November 21, 2008
America Shrugs at Being Fat
The fattest city in America has just been named, and apparently it "shrugs" at that moniker. This makes me think long and hard about how a city in America, a country so weight-obsessed, can be as nonchalant about being called The Fattest. Professor Pasquale's lecture about image-obsession reminded me of how beauty throughout history has been paralleled with wealth. Huntington, West Virginia, the aforementioned unhealthiest city in America, also has a poverty level worse than the national average. With the economy in the state it is, will the future of America's health suffer as dramatically as the stock market? And if so, how will the health care system adapt? The economy is sickening the hospitals in the U.S. Decline in elective procedures and admissions, and patients who cannot pay for care have left hospitals in an economic slump. Poor times call for cheap measures, for sure. Kentucky Fried Chicken's $10 Challenge is no help. A KFC commercial challenged a family in a grocery store to put together a dinner for $10 or less that was comparable to the KFC $9.99 7-piece value meal. Access to health seems to be as big of an issue as access to health care.
Huntington leads the nation in a half dozen other ailments too, including diabetes, heart disease, and tooth loss. I wonder how a city that is so evidently health-poor can just not seem to care? When did being healthy become associated with being rich? When did health become a luxury? Americans pine after having the newest thing, and despite the economic situation, people will keep shopping. KMart reinstated layaway just in time for the holidays. But people don't seem to want to spend that money on healthier foods -- the apathy is there, and it doesn't seem to be going anywhere. Not even the mayor of the fattest town in America seems to want to do anything about it.
In Mauritania, fatter women are considered beautiful. Young girls in rural areas are forcefed until they vomit in order to attain this goal. This, on a continent with with 50% of the population living below the poverty line, seems reflective of the trend that wealth equals beauty. In India, even in the most rural areas, the poorest of women wear a piece of jewelry because that represents her beauty. However, even with America's economy plummeting as it has, that desire for beauty in the U.S. seems to fade. Priorities change, and rightly so, but the desire to preserve one's health, the most basic human instinct, has seemed to vanish from the American psyche. One would think being called the fattest city in the entire country would be a wakeup call, but when the reaction is no more than a shrug, I worry.
Huntington leads the nation in a half dozen other ailments too, including diabetes, heart disease, and tooth loss. I wonder how a city that is so evidently health-poor can just not seem to care? When did being healthy become associated with being rich? When did health become a luxury? Americans pine after having the newest thing, and despite the economic situation, people will keep shopping. KMart reinstated layaway just in time for the holidays. But people don't seem to want to spend that money on healthier foods -- the apathy is there, and it doesn't seem to be going anywhere. Not even the mayor of the fattest town in America seems to want to do anything about it.
In Mauritania, fatter women are considered beautiful. Young girls in rural areas are forcefed until they vomit in order to attain this goal. This, on a continent with with 50% of the population living below the poverty line, seems reflective of the trend that wealth equals beauty. In India, even in the most rural areas, the poorest of women wear a piece of jewelry because that represents her beauty. However, even with America's economy plummeting as it has, that desire for beauty in the U.S. seems to fade. Priorities change, and rightly so, but the desire to preserve one's health, the most basic human instinct, has seemed to vanish from the American psyche. One would think being called the fattest city in the entire country would be a wakeup call, but when the reaction is no more than a shrug, I worry.
Thursday, November 20, 2008
Please Make Me Look White?
An issue was raised in class a couple weeks ago regarding the trend that in an effort to appear more white, Asians were demanding plastic surgery. I’ve often questioned this idea and wondered if it wasn’t instead a misperception perpetrated by the media.
Consider for example the argument which posits that the reason Asians flock to plastic surgeons for double eyelid blepharoplasty is to achieve larger, rounder, Caucasian eyes. It seems like a post hoc argument to me (hearkening back to the LSAT, it’s a necessary but not sufficient condition). Associating the rise in blepharoplasty procedures with the rise in Western media influence is certainly plausible, but it’s not an entirely sound argument.
I’m not discounting the fact that the media plays an enormous role in shaping perceptions of beauty, but I think that it’s just as important to look to the underlying evolutionary basis (that crosses cultural lines) behind plastic surgery trends. Obviously there’s much interplay between these two, but when it comes to this debate I often see the focus on the aforementioned cultural imperialist notion rather than on evolutionary reasons.
It seems almost universal that humans are drawn to big eyes—notice our penchant for babies, puppies, and kittens. Big eyes are associated with youthfulness, as evidenced by the popularity of brow lift procedures in older American woman seeking to “open up” their eyes. And seeing that there are almost four billions Asians in the world there are obviously those with varying eye sizes.
After college, I lived in Taiwan for a couple years and traveled extensively throughout Asia. I met a few people with plastic surgery, but none would say that getting their eyes done made them look more Caucasian. In fact, the surgery allowed them to look more like other Asians who had relatively larger eyes. Naturally occurring double eyelids are prevalent in those from the southern part of China and Southeast Asia, and to a lesser extent (but not uncommon) in Northern Chinese, Koreans, and Japanese.
Another issue that is often discussed is the fixation with skin lightening. Again, I’m wary of the media’s conclusions that it’s just another example of Asians desiring to look more Caucasian. Throughout the centuries in Asia, dark skin has been frowned upon because of its association with toiling under the sun and menial labor—thus, the reason fair skin is generally desirable.
I just had to throw it out there, but there are plenty of other reasons Asians prefer bigger eyes or lighter skin and it may be due to reasons other than trying to look like their Western counterpart. It’s more likely that their reasons for doing so are more similar to the reason Westerners prefer bigger eyes.
When two cultures collide there’s bound to be misperceptions. As someone who embodies both Asian and American cultures and has lived on both sides of the world, I think it’s important to take what you read with a grain of salt-- there are obvious reasons which needn’t be mentioned here why the Western media’s portrayal of the East is skewed (as with the East’s portrayal of the West).
Ellie
Subscribe to:
Posts (Atom)