While this article takes a light-hearted approach to "Santa the public health menace," some of the jokes ring true. The ethical issue that the journalist-turn-comedian gets at is whether parents should be limiting their children's exposure to unhealthy role models? Perhaps if there were some other jolly, old fat man who thought he was magical the parents wouldn't be as pleased. So, does that mean that in the sake of tradition, it is ethically defensible to encourage children's admiration of unhealthy behaviors?
(Submitted by Tara Vaughn)
Showing posts with label Peer Discussion Prompts. Show all posts
Showing posts with label Peer Discussion Prompts. Show all posts
Thursday, December 17, 2009
Wednesday, December 16, 2009
Organ Donation and Kidney Transplants
In class, specifically during one group's presentations, we talked about organ donation. The following article describes a program which helped supply new kidneys to 13 patients through a mix-and-match effort. Our discussions focused on whether or not one should be able to decide who gets their organs. In this article, friends or family members who were not matches to needed recipients would give their kidneys to others in order to get one in return for their friend or family member in need. Although they do not get to pick where their organs go, is this really an altruistic action considering these people know they will be receiving a kidney for a loved one in return? In addition, do these kidney matching programs conflict with traditional UNOS lists?
(Submitted by Caren Steinway)
(Submitted by Caren Steinway)
Doctor-Patient Relations
The doctor-patient relationship has been a changing one ever since its inception. Traditionally focused on the ideas of beneficence and paternalism, the doctor-patient relationship has now changed into one that focuses on autonomy. The following article addresses the issue of doctors being called by their first names during routine clinical visits. Does this alter the doctor's ability to do no harm? To benefit others? Does this matter at all?
(Submitted by Caren Steinway)
(Submitted by Caren Steinway)
PGD and IVF
As we improve technology more and more, we are faced with ethical dilemmas that were unimaginable to past generations. In the following article, a technique called PGD is highlighted. This technique was developed to allow doctors to screen embryos for genetic disorders when using IVF. In addition to screening for these genetic disorders, it is also possible to detect the babies sex. Is it ethical for parents to choose the sex of the embryos being implanted? What further ethical dilemmas can you see stem from this? In addition, the article shows the opinions of people from different countries. Do the differing view points impact the ethical issues at play? How does cultural relativism play a role? More info is available here.
(Submitted by Caren Steinway)
(Submitted by Caren Steinway)
H1N1 Vaccine Revisited
In light of the H1N1 outbreak that began last spring, there was extreme determination to create and distribute large quantities of vaccine to protect against the virus. One of the most targeted populations for this vaccine have been children. The following article highlights a current recall of H1N1 vaccine that was targeted for young children. Although the vaccine poses no health risks to the children, the vaccine is not potent enough. Taking the utilitarian approach (the greatest good for the greatest number of people), is there a moral problem here? Is it safe to say that the companies producing the vaccine did so too quickly thus compromising the positive affect they could have? More info is available here.
Monday, December 14, 2009
The Ethics of the Octomom
We talked about this awhile ago, but I thought this article brought up some interesting issues that never came up in class, namely the insurance aspect of the case. Medical insurance covers IVF, so people like the Octomom have the opportunity to have children; however, those without insurance must pay out of pocket, which can run in the tens of thousands of dollars. With the right to give birth being a negative right, how can doctors and insurance companies limit a woman's ability? Why is the right to have children only a wealthy right? Should abuses, like the octomom, constitute grounds for unethical behavior by both the mother and the doctor? What can be done to stop such abuses, and allow for more equitable justice of the right to give birth?
(Submitted by Jane Tingley)
(Submitted by Jane Tingley)
Assisted Suicide
In this article, a man was found trying to assist his terminally ill wife in her own death. Principally, is this ethical or unethical? Consider the rights that family members have in other medical circumstances. Compare this case to the Terri Schiavo case. What similarities are there? Why is this case ethically different?
(Submitted by Jane Tingley)
(Submitted by Jane Tingley)
Zen and the Art of Hospital Care
Another NY Times article, which further explores the issues involving medical and faith
In this article, it acknowledges the further blending of medical and faith, and the duality that bother clergy and doctors have started to exhibit. We have already considered this issue of duality, but not that some doctors are so open about it, does anything change? Consider a doctor who is also in training to become a deacon. Is this ethical? Unethical? What factors are at play here? Consider the duties to his patient, the type of care he might provide with this dual role, the end of like decisions he would assist in making.
(Submitted by Jane Tingley)
In this article, it acknowledges the further blending of medical and faith, and the duality that bother clergy and doctors have started to exhibit. We have already considered this issue of duality, but not that some doctors are so open about it, does anything change? Consider a doctor who is also in training to become a deacon. Is this ethical? Unethical? What factors are at play here? Consider the duties to his patient, the type of care he might provide with this dual role, the end of like decisions he would assist in making.
(Submitted by Jane Tingley)
Poor Children Less Likely to Get Antipsychotics
Another NY Times article, which uncovers a recently discovered health disparity.
In reading this article we must think about whether or not doctors treating poorer patients can, in an ethically defensible manner, change the course of treatment? Do the duties of doctors change to patients of different financial means? If a patient has unlimited funds for treatment, what duties does the doctor have to that patient, and his others? Are doctors motivated by principles of justice and equability when treating the poor?
(Submitted by Jane Tingley)
In reading this article we must think about whether or not doctors treating poorer patients can, in an ethically defensible manner, change the course of treatment? Do the duties of doctors change to patients of different financial means? If a patient has unlimited funds for treatment, what duties does the doctor have to that patient, and his others? Are doctors motivated by principles of justice and equability when treating the poor?
(Submitted by Jane Tingley)
How much do we disclose?
Here is an article from the NY Times weekly Ethicist column. The question pertains to the right to disclose a medical condition to avoid harm to others.
For this case, I do believe that the patient should disclose their radioactive condition; however, its begs the question, what other risky behavior or conditions we should disclose to those around us. Consider smoking, the secondhand risks are a lot greater than this patients radioactive condition; however, rarely in any circumstances do smokers have the responsibility to disclose their condition. Is this ethical?
I think it is unethical, because smokers are putting others at risk just as much, if not more, than this radioactive patient, and for smokers, this risk is present every day until they stop smoking. Therefore, smokers are disregarding the autonomy of those around them, and are committing maleficent acts by smoking around others, since you can still get lung cancer even if you are not the one smoking. Thoughts?
For this case, I do believe that the patient should disclose their radioactive condition; however, its begs the question, what other risky behavior or conditions we should disclose to those around us. Consider smoking, the secondhand risks are a lot greater than this patients radioactive condition; however, rarely in any circumstances do smokers have the responsibility to disclose their condition. Is this ethical?
I think it is unethical, because smokers are putting others at risk just as much, if not more, than this radioactive patient, and for smokers, this risk is present every day until they stop smoking. Therefore, smokers are disregarding the autonomy of those around them, and are committing maleficent acts by smoking around others, since you can still get lung cancer even if you are not the one smoking. Thoughts?
Thursday, December 3, 2009
In the following article highlights studies done that indicate the radiation from mammograms (used to detect breast cancer) can lead to a high risk of breast cancer.
After reading the article and thinking about all sides presented, do you think it would be ethically to use mammography to screen for breast cancer in younger, higher risk, patients, even if it meant their chances of getting breast cancer in the future? Why or why not?
[Submitted by Caren Steinway]
After reading the article and thinking about all sides presented, do you think it would be ethically to use mammography to screen for breast cancer in younger, higher risk, patients, even if it meant their chances of getting breast cancer in the future? Why or why not?
[Submitted by Caren Steinway]
Psychiatry and Ethcis
The following article talks about a covert investigation of Psychiatric Hospitals in the Netherlands. Undercover observers posed as patients in order to get admitted into hospitals in order to attest to the real conditions of the facilities. Would anything like this study every get funded in the US today? Is it ethically moral to pose as a psychiatric patient? Was the information they were looking for only obtainable by this method?
[Submitted by Caren Steinway]
[Submitted by Caren Steinway]
Sunday, November 29, 2009
enhancement/disability
spotted by Leslie...
The modern sports ethos that we've constructed is based upon increasing advantages. Because certainly, in so many sports, we have pushed past natural human function to facilitate a more exciting game—better times, better performance. But where does an advantage become unfair? The crux of that question lays under the umbrella of ethics, which should indeed govern our rule structure within the competitive arena, but there's something in this story which specifically points toward a deep-seated fear, one we don't want to talk about in polite conversation, one which parallels historical instances of racial integration of sport and gender integration of sport. If we allow a person, one who we view as our inferior (in whatever way), to play with us, and then that person beats us, what does that say about us?
In the 1930s, Jesse Owens and Joe Louis blew the lid off common thinking of how "capable" an athlete of African descent was compared to an athlete of European descent, although the beginning of league integration took a decade more to achieve, and in some sports another three decades. It was as recent as 2003 when some members of the PGA balked at Annika Sorenstam's quest to compare her talent to the best men in the world, admitting their fear of how it might feel to have a woman beat them, an embarrassing display of archaic thinking.
In 2001, golfer Casey Martin, who played with a degenerative circulatory leg condition that made it nearly impossible to walk an 18-hole course, successfully won a Supreme Court decision allowing him to use a cart as an acceptable assistive medical device. The PGA Tour fought Martin for years, saying all pro golfers must walk because uniform rules are essential for the integrity of the sport. "Accommodating Martin with a golf cart will not fundamentally change the game," Justice John Paul Stevens wrote for a 7-2 majority.
What keeps percolating for me is this perceived discrepancy between advantage and "unfair" advantage. It's absurd to look at a star line-up of athletes and think that they all have an equal shot. We don't cry foul play when an athlete from the United States, with the best access to training facilities, coaching staffs, and nutritional science is up against someone from say…Uzkbekistan. It's tough luck that 5' 11" Tyson Gay has to line up against a 6'5" Usain Bolt.
It makes me twitch when we talk about "a level playing field." No two athletes are the same genetically and environmentally, and the mental and emotional factors they've endured in their life are relevant in their performance, too. The only reason athletes today are better than those of decades ago is because of science and technology: We know exactly what and when to feed our bodies for maximum energy, we have lighter shoes and better bikes and new rubberized track surfaces and (legal) supplements and altitude training. We are upping the ante each Olympic year with "smarter" design of an athlete's tools, both inside and outside the body.
A whopping 74 world records were broken last year between March and November with the Speedo Fastskin LZR Racer suit. 74! Do you wonder if Mark Spitz is annoyed that his times are compared to those of athletes using something he didn't have the opportunity to use or wear?
My interest was piqued in the latest version of the Fastskin LZR suit, an R&D collaboration with NASA. From the initial press releases to subsequent monthly articles, whatever I could find describing it was overwhelmingly celebratory: Writers cooed about the sharkskin-inspired biometric fiber panels for less drag in the water, and its corset-like torso construction, enabling a swimmer to compress their physique and keep better, more supported form during fatigue, making them markedly more efficient in the water.
Very, very few writers brought up any kind of ethical concern of such a tool like this suit until after the Beijing Olympics, choosing to focus on the race between swimwear companies to develop their own supersuit. Even then, the majority of articles on swimming were marveling at how Michael Phelps says he "literally felt like a rocket coming off the wall" using the device. Jason Rance, the lead designer on this Speedo suit, commented, "It's part of the evolution of the sport, and it's really exciting for swimmers. They say they feel like Superman."
After the ensuing arms-race to out-do the performance of the Speedo, the Americans and Australians led a protest to FINA, the governing body of swimming. In July of this year, FINA banned the full-length suit, having the suit stop at the knee instead, and mandated that all must be constructed of a "textile," which is in itself an incredibly ambiguous, vague rule. The ban will take effect in January 2010, and—most intriguing—FINA will allow all records set with the suits to stand.
Let's think about Tiger Woods having not one, but two LASIK surgeries to achieve 20/15 vision, when what we consider the best of natural vision to be is a mere 20/20. Before his first LASIK surgery, Woods had lost 16 straight tournaments. Immediately following the surgery, he won 7 of his next 10. Advantage through technology, or not?
On a company website he endorses, there's a quote from Tiger after his first LASIK surgery, and I found what he said remarkable on a few levels. He said:
For years I played golf with an invisible handicap, invisible to everyone but me. It was my contact lenses. My eyes would sting burn and water all the while I was trying to concentrate on championship golf. I had the Lasik procedure with a TLC laser eye center surgeon and the results were fabulous. I'm 20/20 with no contacts. My vision is so crisp I feel I can read all the subtleties of the green and look down the fairway hundreds of yards and focus perfectly on the fly. I'm very happy with the results, and grateful for my TLC center experience.
The first remarkable aspect of this is that for him, the "handicap" was the ineptitude of the contact lenses, and not the fact that he was visually impaired. (He suffered from -11 nearsightedness, considered the worst 1%, legally blind without corrective glasses or contacts.) The second is his own literal description of being able to now clearly see—without the impediment of burning, stinging eyes—hundreds of yards down the fairway thanks to his technological altering. He himself declares the advantage.
"Invisible to everyone but me." So is that why nobody's up in arms, the fact that you can't see his augmentation? Is that why nobody's challenging this medical method which assists him in achieving dominance in golf? Of course, in the same way that my running legs don't power themselves, Tiger's new eyes don't power and execute a beautiful swing. His athletic talent is further revealed and enabled than what it would have been under the limits of nature, thanks to technology.
Advantage is just something that is part of sports. No athletes are created equal. They simply aren't, due to a multitude of factors including geography, access to training, facilities, health care, injury prevention, and sure, technology.
I really don't know how we compare world records of today to those of 50 years ago. A modern climber's ascent to Everest has innumerable inherent differences than an ascent of a climber who didn't have access to lighter tanks, comfortable breathable fibers against the skin, medical support at base camp, etc. The competitive benchmarks in that sport have changed from simply being, "Can you climb the mountain?" to "Can you climb it with oxygen, or without?" A wooden tennis racket isn't the same thing as the graphite ones used now. We wholeheartedly accept titanium golf clubs, LASIK surgery, the invention of new pitches, better injury prevention and repair, titanium knee and hip replacements, Tommy John surgery (surprisingly even in Youth Leagues), and a notable shift in the size of the average NFL player.
Where do we draw this ethical line on performance enhancement? I'm not sure I can answer that right now. What I will say is that I don't think it's useful to have this discussion around the existing Cheetah Leg, confusing the current non-enhanced technology with future prosthetics that will indeed provide augmentation. As with all evolution in sport, let's decide the parameters of competition when the technology actually exists, when we have metrics that inform us as to what extent augmentation is a certainty. Conjecture has no place in this discussion.
Maybe our acceptance of Tiger's LASIK super vision is really answered in the question, "Can everyone have access to it?" In other words, perhaps because the average citizen out there on the street can get laser surgery, it's okay for Tiger to get it, too, whereas the nature of a bionic prosthetic is still viewed as exclusive, and having to wear one isn't exactly a position the average citizen covets.
What's going to happen in the future, especially with the rise of more capable prostheses? The human leg is actually a series of internal motors and springs, so the fact that external motors aren't allowed in track is kind of interesting. (Case in point: Dean Kamen placed 14 motors in his new design of the artificial arm to simulate human function.)
In the not-so-distant future, designers will be able to build a prosthetic leg with a chip in it that they can program to accurately simulate human performance thresholds. (Since we know that no two "able-bodied" athletes have the same bodies, and therefore what they can achieve with their bodies are different, will they average out individual "able-bodied" thresholds to get those metrics? Will they cap how fast they imagine the fastest man on earth to be at 9.58? That time was unimaginable even 18 months ago, when Bolt then set the new WR at 9.72.)
The chip used in a prosthetic that will dictate "acceptable human" metric-based output is what will be allowed in the Olympic standard; meanwhile, the Paralympics will be no holds barred. In an ironic, amazing cultural flip, you will see runners in the Paralympics going faster than those in the Olympics. Now won't that be an interesting comment on "dis"ability?
Aimee Mullins is an athlete, speaker, actress and model we met at TEDMED. She's also the guest editor for our theme week This Cyborg Life. Read her bio here.
This week, Gizmodo is exploring the enhanced human future in a segment we call This Cyborg Life. It's about what happens when we treat our body less as a sacred object and more as what it is: Nature's ultimate machine.
Is it right that disabled athletes are an "inspiration" when they are trailing behind, but the second a disabled athlete beats or competes on the same level as able bodied athletes they're called cheaters? As the author discusses, how is an amputee running with a prosthesis any different from Tiger Woods golfing after having LASIK surgery to correct his vision? Is it ethically appropriate to distinguish between athletes who have disadvantages such as poor eyesight or amputated limbs, and athletes who are "able bodied"? Where do we draw the line?
The modern sports ethos that we've constructed is based upon increasing advantages. Because certainly, in so many sports, we have pushed past natural human function to facilitate a more exciting game—better times, better performance. But where does an advantage become unfair? The crux of that question lays under the umbrella of ethics, which should indeed govern our rule structure within the competitive arena, but there's something in this story which specifically points toward a deep-seated fear, one we don't want to talk about in polite conversation, one which parallels historical instances of racial integration of sport and gender integration of sport. If we allow a person, one who we view as our inferior (in whatever way), to play with us, and then that person beats us, what does that say about us?
In the 1930s, Jesse Owens and Joe Louis blew the lid off common thinking of how "capable" an athlete of African descent was compared to an athlete of European descent, although the beginning of league integration took a decade more to achieve, and in some sports another three decades. It was as recent as 2003 when some members of the PGA balked at Annika Sorenstam's quest to compare her talent to the best men in the world, admitting their fear of how it might feel to have a woman beat them, an embarrassing display of archaic thinking.
In 2001, golfer Casey Martin, who played with a degenerative circulatory leg condition that made it nearly impossible to walk an 18-hole course, successfully won a Supreme Court decision allowing him to use a cart as an acceptable assistive medical device. The PGA Tour fought Martin for years, saying all pro golfers must walk because uniform rules are essential for the integrity of the sport. "Accommodating Martin with a golf cart will not fundamentally change the game," Justice John Paul Stevens wrote for a 7-2 majority.
What keeps percolating for me is this perceived discrepancy between advantage and "unfair" advantage. It's absurd to look at a star line-up of athletes and think that they all have an equal shot. We don't cry foul play when an athlete from the United States, with the best access to training facilities, coaching staffs, and nutritional science is up against someone from say…Uzkbekistan. It's tough luck that 5' 11" Tyson Gay has to line up against a 6'5" Usain Bolt.
It makes me twitch when we talk about "a level playing field." No two athletes are the same genetically and environmentally, and the mental and emotional factors they've endured in their life are relevant in their performance, too. The only reason athletes today are better than those of decades ago is because of science and technology: We know exactly what and when to feed our bodies for maximum energy, we have lighter shoes and better bikes and new rubberized track surfaces and (legal) supplements and altitude training. We are upping the ante each Olympic year with "smarter" design of an athlete's tools, both inside and outside the body.
A whopping 74 world records were broken last year between March and November with the Speedo Fastskin LZR Racer suit. 74! Do you wonder if Mark Spitz is annoyed that his times are compared to those of athletes using something he didn't have the opportunity to use or wear?
My interest was piqued in the latest version of the Fastskin LZR suit, an R&D collaboration with NASA. From the initial press releases to subsequent monthly articles, whatever I could find describing it was overwhelmingly celebratory: Writers cooed about the sharkskin-inspired biometric fiber panels for less drag in the water, and its corset-like torso construction, enabling a swimmer to compress their physique and keep better, more supported form during fatigue, making them markedly more efficient in the water.
Very, very few writers brought up any kind of ethical concern of such a tool like this suit until after the Beijing Olympics, choosing to focus on the race between swimwear companies to develop their own supersuit. Even then, the majority of articles on swimming were marveling at how Michael Phelps says he "literally felt like a rocket coming off the wall" using the device. Jason Rance, the lead designer on this Speedo suit, commented, "It's part of the evolution of the sport, and it's really exciting for swimmers. They say they feel like Superman."
After the ensuing arms-race to out-do the performance of the Speedo, the Americans and Australians led a protest to FINA, the governing body of swimming. In July of this year, FINA banned the full-length suit, having the suit stop at the knee instead, and mandated that all must be constructed of a "textile," which is in itself an incredibly ambiguous, vague rule. The ban will take effect in January 2010, and—most intriguing—FINA will allow all records set with the suits to stand.
Let's think about Tiger Woods having not one, but two LASIK surgeries to achieve 20/15 vision, when what we consider the best of natural vision to be is a mere 20/20. Before his first LASIK surgery, Woods had lost 16 straight tournaments. Immediately following the surgery, he won 7 of his next 10. Advantage through technology, or not?
On a company website he endorses, there's a quote from Tiger after his first LASIK surgery, and I found what he said remarkable on a few levels. He said:
For years I played golf with an invisible handicap, invisible to everyone but me. It was my contact lenses. My eyes would sting burn and water all the while I was trying to concentrate on championship golf. I had the Lasik procedure with a TLC laser eye center surgeon and the results were fabulous. I'm 20/20 with no contacts. My vision is so crisp I feel I can read all the subtleties of the green and look down the fairway hundreds of yards and focus perfectly on the fly. I'm very happy with the results, and grateful for my TLC center experience.
The first remarkable aspect of this is that for him, the "handicap" was the ineptitude of the contact lenses, and not the fact that he was visually impaired. (He suffered from -11 nearsightedness, considered the worst 1%, legally blind without corrective glasses or contacts.) The second is his own literal description of being able to now clearly see—without the impediment of burning, stinging eyes—hundreds of yards down the fairway thanks to his technological altering. He himself declares the advantage.
"Invisible to everyone but me." So is that why nobody's up in arms, the fact that you can't see his augmentation? Is that why nobody's challenging this medical method which assists him in achieving dominance in golf? Of course, in the same way that my running legs don't power themselves, Tiger's new eyes don't power and execute a beautiful swing. His athletic talent is further revealed and enabled than what it would have been under the limits of nature, thanks to technology.
Advantage is just something that is part of sports. No athletes are created equal. They simply aren't, due to a multitude of factors including geography, access to training, facilities, health care, injury prevention, and sure, technology.
I really don't know how we compare world records of today to those of 50 years ago. A modern climber's ascent to Everest has innumerable inherent differences than an ascent of a climber who didn't have access to lighter tanks, comfortable breathable fibers against the skin, medical support at base camp, etc. The competitive benchmarks in that sport have changed from simply being, "Can you climb the mountain?" to "Can you climb it with oxygen, or without?" A wooden tennis racket isn't the same thing as the graphite ones used now. We wholeheartedly accept titanium golf clubs, LASIK surgery, the invention of new pitches, better injury prevention and repair, titanium knee and hip replacements, Tommy John surgery (surprisingly even in Youth Leagues), and a notable shift in the size of the average NFL player.
Where do we draw this ethical line on performance enhancement? I'm not sure I can answer that right now. What I will say is that I don't think it's useful to have this discussion around the existing Cheetah Leg, confusing the current non-enhanced technology with future prosthetics that will indeed provide augmentation. As with all evolution in sport, let's decide the parameters of competition when the technology actually exists, when we have metrics that inform us as to what extent augmentation is a certainty. Conjecture has no place in this discussion.
Maybe our acceptance of Tiger's LASIK super vision is really answered in the question, "Can everyone have access to it?" In other words, perhaps because the average citizen out there on the street can get laser surgery, it's okay for Tiger to get it, too, whereas the nature of a bionic prosthetic is still viewed as exclusive, and having to wear one isn't exactly a position the average citizen covets.
What's going to happen in the future, especially with the rise of more capable prostheses? The human leg is actually a series of internal motors and springs, so the fact that external motors aren't allowed in track is kind of interesting. (Case in point: Dean Kamen placed 14 motors in his new design of the artificial arm to simulate human function.)
In the not-so-distant future, designers will be able to build a prosthetic leg with a chip in it that they can program to accurately simulate human performance thresholds. (Since we know that no two "able-bodied" athletes have the same bodies, and therefore what they can achieve with their bodies are different, will they average out individual "able-bodied" thresholds to get those metrics? Will they cap how fast they imagine the fastest man on earth to be at 9.58? That time was unimaginable even 18 months ago, when Bolt then set the new WR at 9.72.)
The chip used in a prosthetic that will dictate "acceptable human" metric-based output is what will be allowed in the Olympic standard; meanwhile, the Paralympics will be no holds barred. In an ironic, amazing cultural flip, you will see runners in the Paralympics going faster than those in the Olympics. Now won't that be an interesting comment on "dis"ability?
Aimee Mullins is an athlete, speaker, actress and model we met at TEDMED. She's also the guest editor for our theme week This Cyborg Life. Read her bio here.
This week, Gizmodo is exploring the enhanced human future in a segment we call This Cyborg Life. It's about what happens when we treat our body less as a sacred object and more as what it is: Nature's ultimate machine.
Is it right that disabled athletes are an "inspiration" when they are trailing behind, but the second a disabled athlete beats or competes on the same level as able bodied athletes they're called cheaters? As the author discusses, how is an amputee running with a prosthesis any different from Tiger Woods golfing after having LASIK surgery to correct his vision? Is it ethically appropriate to distinguish between athletes who have disadvantages such as poor eyesight or amputated limbs, and athletes who are "able bodied"? Where do we draw the line?
End of Life: Man emerges from coma 23 years later
from NIkhil:
Trapped 'coma' man: How was he misdiagnosed?
By Mark Tutton, CNN
November 24, 2009 -- Updated 1651 GMT (0051 HKT)
Click to play
23 year coma patient communicates
STORY HIGHLIGHTS
* Man diagnosed as being in vegetative state for 23 years was fully conscious
* Study found that 41 percent of patients in minimally-conscious state were wrongly diagnosed
* Lack of careful assessment can contribute to misdiagnosis
London, England (CNN) -- A Belgian car crash victim who was misdiagnosed as being in a vegetative state for 23 years was conscious the whole time, it has emerged.
For years he listened to the conversations going on around him but he was unable to communicate with his doctors or family.
Rom Houben was 23 at the time of the near-fatal car crash in 1983 that left him paralyzed. Doctors presumed he was in a vegetative state following the accident and they believed he could feel and hear nothing.
Neurologist Dr.Steven Laureys of the University of Liege, in Belgium carried out a brain scan using state-of-the art scanning system and discovered that Houben's brain was fully functional.
In an interview with the UK's ITV news Monday, Rom communicated by typing on a special keyboard attached to his wheelchair, and aided by his carer.
He said: "At some moments it was terribly lonely but I knew my family was believing in me."
"I simply want to enjoy life," he added. "I notice a big difference now I'm back in contact with the world."
Video: Assessing comas
He was conscious for a long time, but it's difficult to know for how long.
--Caroline Schnakers, Coma Science Group
RELATED TOPICS
* Brain Injuries
* Health Care Issues
* Health and Fitness
The case has highlighted the difficulties doctors face when trying to diagnose the level of consciousness of a patient in a coma-like state.
Watch Laureys explain how comas are assessed
A study carried out last year on 103 patients by Laureys and his colleagues at Liege's Coma Science Group found that 41 percent of patients in a Minimally Conscious State (MCS) were misdiagnosed as being in the much more serious Vegetative State (VS).
Dr. Daniel Hanley, professor of neurology at Johns Hopkins Medicine, in Maryland, told CNN that VS is a coma-like state in which patients have a sleep and wake cycle, and can show reflex chewing, swallowing and blinking, but don't respond to language or stimulation.
Patients in MCS occasionally show they are aware of their environment, for example moving to face a doctor when asked, but only infrequently.
Laureys said of his research, "Differentiating the vegetative from the minimally conscious state is often one of the most challenging tasks facing clinicians involved in the care of patients with disorders of consciousness.
"Misdiagnosis can lead to grave consequences, especially in end-of-life decision-making."
Watch one iReporter's reaction to the situation
Caroline Schnakers, who carried out the research with Laureys, told CNN that one probable reason for the high rate of misdiagnosis is that doctors often base their diagnosis on observations of a patient's behavior, rather than assessing patients using standardized tests.
"Assessment is usually behavioral," Schnakers told CNN. "For example, if you come into a room and a patient's eyes follow you, or if they smile when you make a joke, they are conscious -- but it doesn't mean they will still be able to do that one hour later."
Schnakers said that using standardized tests could reduce incidents of misdiagnosis.
The Glasgow Coma Scale is a standardized test that classifies a patient's motor, verbal and eye response on a graded scale. It was widely used until about 2000 to classify a patient's level of consciousness, but Schnakers says it may contribute to misdiagnosis.
She told CNN, "In our study we used the JFK Coma Recovery Scale-Revised (CRS-R), which is standardized for detecting signs of consciousness in someone recovering from a coma. It's very sensitive and avoided a lot more misdiagnosis than the Glasgow Coma Scale."
The CRS-R was developed at the JFK Johnson Rehabilitation Institute and grades patients' verbalization, communication, motor function, visual function and response to sound.
Diagnosis can be further complicated by another condition, called Locked-In Syndrome. Much less common than VS or MCS, patients in a locked-in state are totally aware of their environment but have minimal reflexive movements, typically only being able to blink their eyes. Hanley told CNN that Houben may have been in a locked-in state.
But Houben's diagnosis may have been made more difficult by the fact that he was partly paralyzed, meaning he was unable to show a motor response.
"He was conscious for a long time, but it's difficult to know for how long," said Schnakers. "Maybe he had a period of VS, but you wouldn't know how long it lasted, even if you ask a patient how long they were in VS or MCS."
Hanley explained that diagnosis is also more difficult if a patient is being treated with sedative drugs, which can cause severe neurological impairment that can mimic VS. But even given those considerations, Hanley says neurologists should easily be able to tell the difference between a patient in VS and MCS.
Dr. Nicholas Schiff, of the Weill Cornell Medical Center, in New York, told CNN that the risk of misdiagnosis is increased because a patient's condition can change over a long period and the transition from VS to MS often takes place outside the time window of careful assessment.
"The 'standard' is probably transfer to nursing home from acute care at an early stage, where an accurate diagnosis of VS gets replaced at the nursing home with an inaccurate prognosis of permanent VS, explicitly or implicitly," Schiff said.
"Because there are no standards for reassessment or any access to rehabilitation centers for many of these patients this is the status quo."
CNN's Caleb Hellerman contributed to this story.
Trapped 'coma' man: How was he misdiagnosed?
By Mark Tutton, CNN
November 24, 2009 -- Updated 1651 GMT (0051 HKT)
Click to play
23 year coma patient communicates
STORY HIGHLIGHTS
* Man diagnosed as being in vegetative state for 23 years was fully conscious
* Study found that 41 percent of patients in minimally-conscious state were wrongly diagnosed
* Lack of careful assessment can contribute to misdiagnosis
London, England (CNN) -- A Belgian car crash victim who was misdiagnosed as being in a vegetative state for 23 years was conscious the whole time, it has emerged.
For years he listened to the conversations going on around him but he was unable to communicate with his doctors or family.
Rom Houben was 23 at the time of the near-fatal car crash in 1983 that left him paralyzed. Doctors presumed he was in a vegetative state following the accident and they believed he could feel and hear nothing.
Neurologist Dr.Steven Laureys of the University of Liege, in Belgium carried out a brain scan using state-of-the art scanning system and discovered that Houben's brain was fully functional.
In an interview with the UK's ITV news Monday, Rom communicated by typing on a special keyboard attached to his wheelchair, and aided by his carer.
He said: "At some moments it was terribly lonely but I knew my family was believing in me."
"I simply want to enjoy life," he added. "I notice a big difference now I'm back in contact with the world."
Video: Assessing comas
He was conscious for a long time, but it's difficult to know for how long.
--Caroline Schnakers, Coma Science Group
RELATED TOPICS
* Brain Injuries
* Health Care Issues
* Health and Fitness
The case has highlighted the difficulties doctors face when trying to diagnose the level of consciousness of a patient in a coma-like state.
Watch Laureys explain how comas are assessed
A study carried out last year on 103 patients by Laureys and his colleagues at Liege's Coma Science Group found that 41 percent of patients in a Minimally Conscious State (MCS) were misdiagnosed as being in the much more serious Vegetative State (VS).
Dr. Daniel Hanley, professor of neurology at Johns Hopkins Medicine, in Maryland, told CNN that VS is a coma-like state in which patients have a sleep and wake cycle, and can show reflex chewing, swallowing and blinking, but don't respond to language or stimulation.
Patients in MCS occasionally show they are aware of their environment, for example moving to face a doctor when asked, but only infrequently.
Laureys said of his research, "Differentiating the vegetative from the minimally conscious state is often one of the most challenging tasks facing clinicians involved in the care of patients with disorders of consciousness.
"Misdiagnosis can lead to grave consequences, especially in end-of-life decision-making."
Watch one iReporter's reaction to the situation
Caroline Schnakers, who carried out the research with Laureys, told CNN that one probable reason for the high rate of misdiagnosis is that doctors often base their diagnosis on observations of a patient's behavior, rather than assessing patients using standardized tests.
"Assessment is usually behavioral," Schnakers told CNN. "For example, if you come into a room and a patient's eyes follow you, or if they smile when you make a joke, they are conscious -- but it doesn't mean they will still be able to do that one hour later."
Schnakers said that using standardized tests could reduce incidents of misdiagnosis.
The Glasgow Coma Scale is a standardized test that classifies a patient's motor, verbal and eye response on a graded scale. It was widely used until about 2000 to classify a patient's level of consciousness, but Schnakers says it may contribute to misdiagnosis.
She told CNN, "In our study we used the JFK Coma Recovery Scale-Revised (CRS-R), which is standardized for detecting signs of consciousness in someone recovering from a coma. It's very sensitive and avoided a lot more misdiagnosis than the Glasgow Coma Scale."
The CRS-R was developed at the JFK Johnson Rehabilitation Institute and grades patients' verbalization, communication, motor function, visual function and response to sound.
Diagnosis can be further complicated by another condition, called Locked-In Syndrome. Much less common than VS or MCS, patients in a locked-in state are totally aware of their environment but have minimal reflexive movements, typically only being able to blink their eyes. Hanley told CNN that Houben may have been in a locked-in state.
But Houben's diagnosis may have been made more difficult by the fact that he was partly paralyzed, meaning he was unable to show a motor response.
"He was conscious for a long time, but it's difficult to know for how long," said Schnakers. "Maybe he had a period of VS, but you wouldn't know how long it lasted, even if you ask a patient how long they were in VS or MCS."
Hanley explained that diagnosis is also more difficult if a patient is being treated with sedative drugs, which can cause severe neurological impairment that can mimic VS. But even given those considerations, Hanley says neurologists should easily be able to tell the difference between a patient in VS and MCS.
Dr. Nicholas Schiff, of the Weill Cornell Medical Center, in New York, told CNN that the risk of misdiagnosis is increased because a patient's condition can change over a long period and the transition from VS to MS often takes place outside the time window of careful assessment.
"The 'standard' is probably transfer to nursing home from acute care at an early stage, where an accurate diagnosis of VS gets replaced at the nursing home with an inaccurate prognosis of permanent VS, explicitly or implicitly," Schiff said.
"Because there are no standards for reassessment or any access to rehabilitation centers for many of these patients this is the status quo."
CNN's Caleb Hellerman contributed to this story.
Saturday, October 31, 2009
H1N1 Vaccine Safety
Read this article and watch this youtube video, and then respond to the following prompt:
Considering the widespread reach and severity of the H1N1 pandemic, vaccinations have been rushed through the manufacturing process to the public by the government. The first round of people are about to receive vaccines right now, and it should be available to the general public by the end of this month. Considering that the potential side effects are unknown in scope and severity, is it best for the government to act deontologically and release an untested vaccination? Or is it in the best for the government to act from the standpoint of utilitarianism and not side-step all health and safety precautions pertaining to this vaccine?
(Submitted by Nikhil Shah)
Considering the widespread reach and severity of the H1N1 pandemic, vaccinations have been rushed through the manufacturing process to the public by the government. The first round of people are about to receive vaccines right now, and it should be available to the general public by the end of this month. Considering that the potential side effects are unknown in scope and severity, is it best for the government to act deontologically and release an untested vaccination? Or is it in the best for the government to act from the standpoint of utilitarianism and not side-step all health and safety precautions pertaining to this vaccine?
(Submitted by Nikhil Shah)
Friday, October 30, 2009
Clinical Studies and Doctors
After participating in and critiquing the NIH training, this article is an interesting one.
After reading, do you think it is morally right or wrong for doctors to bend the rules of clinical studies in order to help their patients? Why or why not?
(Submitted by Caren Steinway)
After reading, do you think it is morally right or wrong for doctors to bend the rules of clinical studies in order to help their patients? Why or why not?
(Submitted by Caren Steinway)
Thursday, October 15, 2009
Overtesting, Insurance, and Genomics
This article is connected to a discussion about whether it is ethical to run tests of questionable necessity on patients simply because they have the insurance to handle it (not the rarest of actions taken by many hospital administrators).
Additionally, how might this relate to the commercialization of genomics? At present we are limited by technology's ability to manipulate the human genome, but should it advance quickly, this may be the slippery slope that creates an ethical basis for in vitro commercialized manipulation of children.
Read the article here.
(Submitted by Chris Wagner)
Additionally, how might this relate to the commercialization of genomics? At present we are limited by technology's ability to manipulate the human genome, but should it advance quickly, this may be the slippery slope that creates an ethical basis for in vitro commercialized manipulation of children.
Read the article here.
(Submitted by Chris Wagner)
Overtreatment and Dementia
This article discusses overtreatment of patients with terminal dementia and the tendency for less-informed family members to order overly aggressive treatments on the patient's behalf that have no chance of affecting the patient's outcome. This sets the stage for an interesting exchange about how involved a physician should be in family decisions, especially when the patient has lost his/her mental facilities and is no longer competent to make treatment choices. Resource management, cost, emotional distress, and autonomy all factor into this discussion. See the article here.
(Submitted by Chris Wagner)
(Submitted by Chris Wagner)
Wednesday, October 14, 2009
AIDS Vaccine
t is an emotional cycle familiar to most AIDS-vaccine researchers: the high of finally making measurable headway against HIV, followed by the crushing low of discovering that the virus has once again found a way to elude them.
It happened again on Saturday when researchers learned that the first ever successful AIDS vaccine turned out not to be the triumph they had originally hoped. In September, scientists from the National Institutes of Health (NIH) and the U.S. Army announced the results of an AIDS-vaccine study in Thailand involving more than 16,000 volunteers. The data showed that the new vaccine had protected 31% of inoculated participants from becoming infected with HIV. But a closer look at a subset of the study's volunteers now reveals that the vaccine in fact protected only 26% of the people who received it. (See pictures of Africa's AIDS crisis.)
The difference is small but critical because the new success rate of 26% falls below the threshold for statistical significance. That means that the odds of being protected from infection by the AIDS vaccine may be no better than chance.
At issue is a matter of head count. If the entire group of volunteers who were enrolled in the study were included in the data, then the results would suggest a 31% effectiveness rate, with 51 in the vaccine arm and 74 in the control group becoming infected with HIV. These are the results that were announced in September. But because this particular vaccine was given in six doses over a six-month period — in what is referred to as a prime and boost regimen, in which the early shots prime the immune system to fend off HIV and the follow-up shots boost the body's immunity — some volunteers became infected with HIV before receiving all six shots, rendering them ineligible to complete the study. Since researchers are aiming to study how well the complete set of inoculations protects against infection, the final data should exclude the one-third of participants who became infected before the study concluded. (Watch an audio slideshow about aging AIDS patients.)
The resulting tally, then, includes a much smaller pool of participants, which automatically lessens the significance of whatever effect, if any, the vaccine appeared to have, says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "When you lose statistical power, something that would have been significant in the [original, larger] population, could now fall below significance merely by the lower numbers. That's what happened with this trial," Fauci says.
According to statisticians, however, scientists generally include all data from the complete, original population, since these numbers more accurately reflect what might happen in the real world. In other words, it's a more rigorous analysis of how effective a vaccine might be in a population of people who, realistically, could be exposed to HIV before they finish the full six doses of a vaccine.
As for why investigators did not reveal both sets of data in their initial announcement, the Army researchers posted this update on the website of the U.S. Military HIV Research Program: "Explaining the differences between them is complex and the appropriate venue for this technical discussion of statistics is at an open scientific conference and in the scientific publication now under review at a major journal." (See the most common hospital mishaps.)
So does this mean the vaccine was not effective? That depends on whom you ask. Some experts argue that the vaccine's effect, if it exists, is so tiny that it's not worth pursuing in a significant way. "Would I invest in it? The answer is no," says Dr. David Ho, director of the Aaron Diamond AIDS Research Center in New York City. "There are other things that are more likely to work, that are better, easier and more straightforward than this vaccine."
(Submitted by Anne Aldrich)
It happened again on Saturday when researchers learned that the first ever successful AIDS vaccine turned out not to be the triumph they had originally hoped. In September, scientists from the National Institutes of Health (NIH) and the U.S. Army announced the results of an AIDS-vaccine study in Thailand involving more than 16,000 volunteers. The data showed that the new vaccine had protected 31% of inoculated participants from becoming infected with HIV. But a closer look at a subset of the study's volunteers now reveals that the vaccine in fact protected only 26% of the people who received it. (See pictures of Africa's AIDS crisis.)
The difference is small but critical because the new success rate of 26% falls below the threshold for statistical significance. That means that the odds of being protected from infection by the AIDS vaccine may be no better than chance.
At issue is a matter of head count. If the entire group of volunteers who were enrolled in the study were included in the data, then the results would suggest a 31% effectiveness rate, with 51 in the vaccine arm and 74 in the control group becoming infected with HIV. These are the results that were announced in September. But because this particular vaccine was given in six doses over a six-month period — in what is referred to as a prime and boost regimen, in which the early shots prime the immune system to fend off HIV and the follow-up shots boost the body's immunity — some volunteers became infected with HIV before receiving all six shots, rendering them ineligible to complete the study. Since researchers are aiming to study how well the complete set of inoculations protects against infection, the final data should exclude the one-third of participants who became infected before the study concluded. (Watch an audio slideshow about aging AIDS patients.)
The resulting tally, then, includes a much smaller pool of participants, which automatically lessens the significance of whatever effect, if any, the vaccine appeared to have, says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "When you lose statistical power, something that would have been significant in the [original, larger] population, could now fall below significance merely by the lower numbers. That's what happened with this trial," Fauci says.
According to statisticians, however, scientists generally include all data from the complete, original population, since these numbers more accurately reflect what might happen in the real world. In other words, it's a more rigorous analysis of how effective a vaccine might be in a population of people who, realistically, could be exposed to HIV before they finish the full six doses of a vaccine.
As for why investigators did not reveal both sets of data in their initial announcement, the Army researchers posted this update on the website of the U.S. Military HIV Research Program: "Explaining the differences between them is complex and the appropriate venue for this technical discussion of statistics is at an open scientific conference and in the scientific publication now under review at a major journal." (See the most common hospital mishaps.)
So does this mean the vaccine was not effective? That depends on whom you ask. Some experts argue that the vaccine's effect, if it exists, is so tiny that it's not worth pursuing in a significant way. "Would I invest in it? The answer is no," says Dr. David Ho, director of the Aaron Diamond AIDS Research Center in New York City. "There are other things that are more likely to work, that are better, easier and more straightforward than this vaccine."
(Submitted by Anne Aldrich)
Friday, October 9, 2009
Ethics and Malpractice
General medical insurance is not the only issue causing problems for our health care system. Costs are also being driven up by doctors practicing defensive medicine and ordering large numbers of unnecessary tests to protect themselves from lawsuits. Even when doctors perform all necessary tests, patients are still able to sue for damages if something goes awry.
For example, a close family friend of ours is a general practitioner. Four years ago he saw a patient who was at high risk for a stroke, and he recommended the patient stay in the hospital overnight for observation. The patient politely declined, and returned home. The next day the patient returned to the hospital in an ambulance, mid-stroke. The patient was admitted into the hospital, treated, and eventually returned home perfectly fine. He did not have any long-term damage from the stroke, and was immediately put on blood thinners and modified his diet and exercise regimen. Not long after the patient returned home, our friend was summoned to court for a malpractice suit. The patient claimed that the stroke was the physician's fault, and that he should have forced him to remain in the hospital overnight. Again, the patient had no long-term damage, no Palsy, nothing except a slight scare and a large medical bill. Initially, the case was thrown out for being frivolous. Our friend believed that the suit was over, and he would be fine minus some legal bills. Four years later the patient again summoned him to court, with new lawyers and before a new judge. The judge accepted the case, and warned our friend to get a good lawyer. Our friend was forced to take a week off from work (thus reducing his usual paycheck by 1/4), hire a lawyer, and begin the process of defending himself for something that was completely ridiculous. The former patient was demanding $500,000 in damages, to compensate him for medical costs, his lawyers, and any emotional damage he may have suffered. Recently, the court again stated that the case was frivolous and threw it out, but our friend still had to incur legal bills for four years, an increase in his malpractice insurance premiums, and the loss of a full week of work (about 80 hours).
Given this example, how can doctors act beneficently when their fear of what may happen if something goes wrong overrides their concern for a patient? Should there be restrictions within the legal system on what is an appropriate malpractice suit?
(Submitted by Leslie Baggeson)
For example, a close family friend of ours is a general practitioner. Four years ago he saw a patient who was at high risk for a stroke, and he recommended the patient stay in the hospital overnight for observation. The patient politely declined, and returned home. The next day the patient returned to the hospital in an ambulance, mid-stroke. The patient was admitted into the hospital, treated, and eventually returned home perfectly fine. He did not have any long-term damage from the stroke, and was immediately put on blood thinners and modified his diet and exercise regimen. Not long after the patient returned home, our friend was summoned to court for a malpractice suit. The patient claimed that the stroke was the physician's fault, and that he should have forced him to remain in the hospital overnight. Again, the patient had no long-term damage, no Palsy, nothing except a slight scare and a large medical bill. Initially, the case was thrown out for being frivolous. Our friend believed that the suit was over, and he would be fine minus some legal bills. Four years later the patient again summoned him to court, with new lawyers and before a new judge. The judge accepted the case, and warned our friend to get a good lawyer. Our friend was forced to take a week off from work (thus reducing his usual paycheck by 1/4), hire a lawyer, and begin the process of defending himself for something that was completely ridiculous. The former patient was demanding $500,000 in damages, to compensate him for medical costs, his lawyers, and any emotional damage he may have suffered. Recently, the court again stated that the case was frivolous and threw it out, but our friend still had to incur legal bills for four years, an increase in his malpractice insurance premiums, and the loss of a full week of work (about 80 hours).
Given this example, how can doctors act beneficently when their fear of what may happen if something goes wrong overrides their concern for a patient? Should there be restrictions within the legal system on what is an appropriate malpractice suit?
(Submitted by Leslie Baggeson)
Subscribe to:
Posts (Atom)