March Issue of AJOB is Now Online!
Trans fat bans, peer recruitment for human subjects research, and the clash of culture versus the rights of physicians are the featured issues in this month's issue of The American Journal of Bioethics.
First, David Resnik's article questions the limits of government intervention on banning a particular food, or specifically food chemical, and how effective it might be, and the ethical justification for it.
Second, the ethics of a new method for recruiting human subjects in research involving peer-to-peer recruitment is questioned. Is it okay to have the community members involved in research recruit more study subjects? Are they biased or are they they most informed recruiters?
Lastly, the well-documented case of Samuel Golubchuk forces us to confront deeply held values about patient autonomy, the role of the physician, and the influence of culture upon patient decision-making. As this case is revisited, the authors and commentators alike weigh in on what did and what should have happened in the case.
To read more, go to bioethics.net for this exciting issue!
Summer Johnson, PhD
Trans Fats Today. Hot Dogs Tomorrow?
Will banning artificial trans fats today effect your ability to have a hot dog tomorrow?
On the The Bioethics Channel, Lorell LaBoube seeks an answer from David Resnik, a bioethicist and IRB chair for the National Institute of Environmental Health Sciences at the National Institutes of Health.
Dr. Resnik writes about this in the March 2010 issue of the American Journal of Bioethics.
Summer Johnson, PhD
Looking for Dr. Right? Get Yours via Speed Date!
Want to find your "Dr. Right"? Now, you can! You can meet your next doctor on a "speed date."
Dne Texas hospital is trying its hand at a method once left to the dating world and to ads in in-flight magazines like "It's Just Lunch".
Texas Health Harris Methodist Hospital outside Fort Worth has created Doc Shop as a way for prospective patients to meet with docs before committing to being a patient, says CNN. It's a way, they say, to see whether patients and doctors click before signing on to that first appointment. How efficient!
According to AMA and AHA, says CNN, Doc Shop is one of a kind. Could it catch on? Maybe.
But should it? Not a chance. From a patient perspective, one could argue that it saves them from wasting all those hours on initial visits only to find out that doctors don't know the current literature or aren't "their type". Of course, Doc Shop won't tell prospective patients how long the wait in the waiting room is at their office, how good or bad the office staff is, or anything else about the practice. And it certainly tells patients nothing about the quality of the physicians charming them across the table.
Even more so, anyone can put on a good face for a minute or two and hide their uglier side. Doc Shop is a totally contrived situation where doctors are selling themselves just a few minutes at a time. They are not under the pressures of daily medical practice--their pager isn't going off, they don't have a call from an angry patient on line one and an even angrier insurance company on line two.
While Doc Shop may seem like a good idea to frustrated patients who can't find a good doctor, I don't think that they are any more likely to find their dream physician any more than someone is likely to find the love of their life from speed-dating around a room of men or women eager to sell themselves off to any one who would have them.
I say if you need a good doctor, ask a friend.
Summer Johnson, PhD
End of Life-ology
William King is dying from MS. His two twenty-something sons, Ennis and Malcolm, already lost their mother to cancer 15 years earlier and now must deal with his slow deterioration. To make matters worse, the King family is poor, or as they put it "broke" and faced with the difficult choices of a generation that is passing, a generation that is looking to take flight and the tension that comes when illness comes between them.
This is the nexus of the play, "Broke-ology", which I had the privilege of watching last night at the Kansas City Reparatory Theater. The story, set in just across the state line Kansas City, Kansas, has come home to roost after first being produced at the Lincoln Center Theater.
I, of course, am no theater critic, but what drew me to this work of art was essentially the story of two young men and their father struggling with the notions of care giving, the end of life, and ultimately letting go.
You cannot understand the King family unless you understand where they live, which is to understand that they are a poor African-American family living in a rundown, dying (what appears to be) exclusively African-American neighborhood in Kansas City, Kansas. The elder son, Ennis', theory about making it in this community "broke-ology" boils down to a simple formula of living on government dole, thriftiness, hard work, and pride in his own family.
But ultimately, "broke-ology" doesn't get you very far when your father is dying of MS. William greets us in the very first scene before Ennis is even born, young and full of vigor, but by scene two, he comes lumbering down the stairs in bathrobe, slippers, and an eye patch (emblematic of his failing vision from MS). In a paradigmatic representation of health disparities in the African-American community, William and his sons understand very little about his condition. They refer to "his doctor" without name, "expensive medicines" without name, and talk openly about their ignorance about William's prognosis, disease progression, and what will come next.
It is the eldest son, however, who has remained in the community (while the younger brother moved off to UConn to earn multiple college degrees), who has become the caregiver for William, giving him his multiple shots per day, reminding him about medications as his memory as failed. Ennis does this even as his own family obligations (a new wife and child on the way) have created his own burdens and struggles. Malcolm represents the paradigmatic son who returns home with much fanfare and glory and who interjects himself with much tumult into medical decision-making. In a gut-wrenching scene, Malcolm and Ennis scream at each other after a visit to an assisted living facility
"Broke-ology" is not a story about being broke, it is a story about dying. The children becoming the parent for their parent is a time old tale, but the nuance added with this African-American family gives the story some richness it might not have had otherwise. Where the play is weakest is in the development of the mother, Sonia, who appears sporadically throughout the play, but who does give William much of his soul. Her death and her life go largely unexamined, however, and this is a real shame.
But ultimately, the end of life-ology is a tale of a family making tough choices and William's the toughest and most definitive of all. He cannot save his family from their broke-ness, but at least they have one last summer together. For most families with parents suffering from terminal illness, that is pretty much all they could ask for.
**SPOILER ALERT***: Broke-ology ends with William making a choice: the choice to end his life with a fatal overdose. The burden upon his caregivers is too much--so ultimately William gives Ennis and Malcolm the freedom to live their lives in the way that he could never could have or give his own wife. He would not condemn his sons to the same fate.
Sadly, what is left unexamined is whether William's suicide and so many of his simultaneously sad and hilarious moments are the result of dementia, depression, or some other side effect of his MS. So many chronically ill patients, as we know, choose to end their own lives, not out of autonomous choice, but as a result of depression. The clinical facts are lacking in this play because the inter-personal drama seems to make them not matter.
Summer Johnson, PhD
If You Are STILL Wondering Why Health Care Reform Is Important...
Check out this statistic from the Chicago Tribune today: "Illinois consumers to pay up to 60% more [for health insurance premiums], data show." When do they pay more? AFTER they have lost their employer-sponsored health care coverage. In other words, just when they can afford to, right?
Oh and this 60% figure is the base rate for insurance premiums (up from 8.5% last year). It doesn't factor in additional increases in the cost of premiums for age, gender or most importantly, health status.
Whether you believe that access to basic health care services is a right (as I do) or whether you believe there is a right to be healthy (I'm less sanguine on that point), it just seems criminal that while so many industries in health care continue to make money hand over fist, some of the most vulnerable among us (children, the recently unemployed) are finding it increasingly difficult to insure themselves.
I don't think there is just a single culprit here. It would be all to easy to just point a figure at the "evil health insurance industry" or "Washington politicians" who have to date have been unable to pass reform. But it isn't that simple.
Unfortunately, the facts are. Those in the individual insurance market, not just in Illinois, but all over the country, are finding themselves priced right out of a market that was supposed to be designed for them. Something can and must be done, whether it will be--in terms of reforming our health care system--remains to be seen.
Summer Johnson, PhD
Glenn McGee and American Catholics in Assisted Reproduction Barfight
First published in the St. Louis Post-Dispatch and then the Washington Post, Glenn McGee makes the provocative claim that American Catholics aren't any more likely to follow the most recent edict from the Vatican that Catholics should not use IVF for reproduction than they are heeding admonitions against using birth control.
The statistics say that only 4% of married Catholic couples use natural family planning--so what do you think the rest of them are using? So to extrapolate, what do you think that Catholic couples having trouble with fertility are going to do? Listen to Rome and not have a child or go see a fertility specialist and use reproductive technologies? What do you think?
I think McGee has it right. The teachings of the Church are out of sync with that American Catholics are likely to do--but hey, it's not the first time.
Summer Johnson
The blog.bioethics.net Archive Rises Like a ...
At last we've found a few minutes to assemble the archive of The American Journal of Bioethics Editors' blog through 2007 and publish them in an accessible venue. If you get nostalgic for the days when we translated documents about the Korean stem cell scandal, or those glorious years of the neocon bioethics movement, drop by and shuffle through thousands of posts on every topic in bioethics. Especially the "this didn't really happen, did it?" chapter in the history of bioethics: who can forget, for example, that sunny morning when the President's Commission on Bioethics' chairman lobbied in the Senate Chambers bearing a paper copy of "the Bush 2nd term agenda for bioethics?"
Back then, everyone else had to identify that they weren't an editor, except, um, the editor. The blog posts that are not signed in the archive were authored by yours truly as Editor-in-Chief.
Glenn McGee PhD
Whistleblowers Everywhere Breathe A Sigh of Relief
Texas nurse Anne Mitchell has won a victory for whistleblowers everywhere after being sued under Texas law for reporting the physician she worked for as being malpracticable using confidential information.
He said that she had ruined his reputation, that she was malicious and had inappropriately used records to which she had access. I mean, how dare she? She's a nurse! What is she doing looking through those medical records?
Apparently this doctor wouldn't know a lot about medical ethics and records. He had previously been dinged by the Texas Medical Board in 2007 for $1,000 and "continuing medical education in the area of ethics, medical records and the treatment of obesity."
Mitchell in her letter had claimed a set of 6 additional, more recent violations. She reported his performing a skin graft, other minor surgical procedures and prescribing herbal medications that the doctor sold on the side.
To boot, he has searched her computer to find her anonymous letter and he fired her after her found it.
Ultimately, if you are a physician working at a weight-loss clinic, do you really need to be performing skin grafts? But more than that, if you have already been fined by the Texas Medical Board and have been told you are not qualified to oversee a physician assistants or nurse practitioners and to get ethics training, you'd better be on your best behavior.
Whether this nurse was an "upstart" isn't the point. Neither is whether nurses generally are saints. This case should never have become the referendum on nurses and whistleblowers it was.
This doctor just seemed to be, and has been for sometime, a not very good one--and the fact that someone had the guts to point it out should be applauded. Thank goodness the Texas courts had the good sense to protect this woman regardless of whether she was a nurse or a good person or anything else. Her right, and everyone else's, to protect patients from quackery has prevailed.
Summer Johnson, PhD
Jacob Appel Takes on the Pope
What do you do when you are a Catholic hospital in value conflict? Ignore the Pope or ignore the indigent, the needs of American Catholics for birth control and abortions, and healthcare generally in conflict with the edicts of Rome?
It's a tough call, but according to Jacob Appel today on the Huffington Post the saving grace is that doctors in these hospitals are still bound by the same ethical guidelines regardless of the kind of hospital they are working in, Catholic or not.
And thank goodness, I would really hate to have the Pope governing my healthcare decisions. So if you have to go to a Catholic healthcare institution, be glad that there are medical ethics guidelines for your healthcare professionals.
Summer Johnson, PhD
Do You Know Why Glenn McGee Wants to Live Forever?
Well, your first answer chould be, "Doesn't everyone?"
But if the actual answer is, "I haven't a clue", then click on this link.
McGee, the John B. Francis Chair in Bioethics at the Center for Practical Bioethics, will discuss how science is giving us an opportunity, if not to actually live forever, to live an additional 25, 50, or 100 years in his inaugural lecture on February 24th at 6 PM.
But before you grab for that stem cell smoothie, McGee will ask his audience to grapple with many of the questions, not only of can we but of ought we extend our lives. Questions both for individuals but also for communities that were addressed in the December 2009 issue of AJOB.
To learn more about the lecture or to register to attend, contact the Center for Practical Bioethics.
Summer Johnson, PhD
