Yale’s Friday Newsletter – 09/14/12

Here’s this week’s newsletter from the Yale Interdisciplinary Center for Bioethics, with the latest bioethics news, scholarship, opinion, and other announcements.  Take a look!

In the News

Brownlee, Shannon. When Patients—Not Doctors—Make Medical Mistakes.  Time Magazine. 10 September 2012.

For most patients in the real world, getting good medical care involves complicated decisions. It’s not as simple as what often gets shown on TV, where a patient goes in, the doctor figures out what’s wrong, and then he performs some lifesaving surgery. Most of modern medicine, especially for the elderly, is a lot messier — usually there’s not “right” answer, no perfect treatment. And a patient needs to be an active participant in making choices in treatment. All too often, they don’t have that opportunity to do that, and it gives rises to a common — but unacknowledged — kind of medical mistake. Continue reading…

Abortion

And Then There Was One. The Economist. 8 September 2012.

Mississippi’s sole remaining abortion clinic is a small single-story sandstone building on a street corner in the state’s capital. The Jackson Women’s Health Organisation (above) appears unremarkable, until you notice the reflective glass in all the doors and windows, the multiple security cameras and the thick black plastic draped over the wrought-iron fence to shield clients from protesters, who have kept vigil daily for decades. Continue reading…

Food & Nutrition

Severson, Kim. More Choice, and More Confusion, in Quest for Healthy Eating. New York Times. 8 September 2012. 

Lisa Todd’s grocery cart reflects the ambivalence of many American shoppers. Ms. Todd, 31, prowled the aisles of a busy Kroger store here last week. Her cart was a tumble of contradictions: organic cabbage and jar of Skippy peanut butter. A bag of kale and a four-pack of inexpensive white wine. Pineapples for juicing and processed deli meat. Continue reading…

Walsh, Bryan. Can GM Crops Bust the Drought? Time Magazine. 10 September 2012.

The drought is eating away at U.S. crops—and climate change could make it worse in the future. Are GM crops an answer? Continue reading…

Children

Petersen, Andrea. Letting Babies Cry a Bit is OK. Wall Street Journal. 10 September 2012. Letting babies cry for short periods of time while teaching them to sleep by themselves doesn’t cause long-term psychological problems or damage the parent-child relationship, says a study being published Monday in the journal Pediatrics. The study, which followed children until they were 6 years old, will likely add fuel to an emotional debate that rages on playgrounds, on Facebook and within marriages: whether or not exhausted parents should “sleep train” their babies. Continue reading…

Health Care

Neighmond, Patti. X-Ray Tests May Heighten Cancer Risk In Susceptible Women. NPR. 7 September 2012.

Researchers report that women with genetic mutations that put them at dramatically increased risk of developing breast cancer may also face a heightened risk from radiation used during medical screening and diagnosis. Continue reading…

Abrams, Lindsay. Biological Implausibility Aside, Acupuncture Works. The Atlantic. 11 Sept 2012.

A large meta-analysis has shown that acupuncture’s benefits can’t be fully attributed to placebo effect, raising the question throughout Western medicine: Why? Continue reading…

Law and Bioethics

Hartocollis, Anemona. U.S. Court Halts Some Cuts for Medicaid Home Care. New York Times. 5 September 2012.

Charles Strouchler, a former publicity agent for classical-music management companies, has such severe multiple sclerosis that he has to be washed, fed, secured in a wheelchair during the day and turned in bed at night. For the past 15 years, he said, he has been able to live at home only because Medicaid pays for aides to take care of him around the clock. Continue reading…

Medical Ethics 

Meier, Barry. A Clash Over a Spine Treatment. New York Times. 5 September 2012.

Dr. Daryl F. Fourney’s role as a lead researcher in a clinical trial for a device to treat back pain began normally enough. Under his agreement with the device maker, the neurosurgeon was supposed to report on how patients had fared six months after undergoing the treatment, which involves removing tissue that is compressing the spine. Continue reading…

Anand, Geeta. A Woman’s Drug-Resistant TB Echoes Around the World. Wall Street Journal 8 September 2012.

MUMBAI—As dawn broke on July 16, a tiny woman pushed a metal trunk aboard a train, pausing a moment to cough into the green-and-black-print scarf around her head. Her husband carried a comically large water jug. “You’ve decided to travel with Powai Lake,” Rahima Sheikh quipped to her husband, referring to a lake near the city of Mumbai. She helped him stow the jug under their seat. Then, promptly at 6:35 a.m., the Gorakhpur Express heaved out of the station, carrying Mrs. Sheikh on a 1,000-mile journey home, where she expected to die.  Continue reading…

Public Health 

Doucleff, Michaeleen. ‘Test And Treat’ Strategy For Curbing HIV Draws Questions. NPR. 6 September 2012.

San Francisco is trying a new tactic to fight AIDS. Health workers are aggressively testing people for HIV and then immediately putting those who test positive on potent antiretroviral drugs. Continue reading…

Reproduction

Finn, Holly. Men’s Baby Clocks Tick Loudly, Too. Wall Street Journal. 7 September 2012.

Things started so well. In a study published last year by the National Foundation for Fertility Research, male mice were paired over time with assorted female mice, all of them fertile. “We mated them not just with one but with many young females,” says Mandy Katz-Jaffe, scientific director of NFFR. “Let’s put it this way, these males had a really good life.” Continue reading…

Technology

Flinn, Ryan. Video Dial-a-Doctor Seen Easing Shortage in Rural U.S. Bloomberg. 5 September 2012.

Until recently, when children in Ware County, Georgia, needed to see a pediatrician or a specialist, getting to the nearest doctor could entail a four- hour drive up Interstate 75 to Atlanta. Now, there’s another option. As part of a state-wide initiative, the rural county has installed videoconferencing equipment at all 10 of its schools to give its 5,782 students one-on-one access to physicians. Telemedicine sites for adults have also sprung in the area. Instead of taking a full day off from work or school, residents can now regularly see their specialist online.  Continue reading…

Clark, Liat. Infrared-Camera Algorithm Could Scan for Drunks in Public. Wired UK. 4 September 2012.

Computer scientists have published a paper detailing how two algorithms could be used in conjunction with thermal imaging to scan for inebriated people in public places. Continue reading…

In the Journals

Hansson, Mats.  Where should we draw the line between quality of care and other ethical concerns related to medical registries and biobanks? Theoretical Medicine and Bioethics.  August 2012.

Together with large biobanks of human samples, medical registries with aggregated data from many clinical centers are vital parts of an infrastructure for maintaining high standards of quality with regard to medical diagnosis and treatment. The rapid development in personalized medicine and pharmaco-genomics only underscores the future need for these infrastructures. However, registries and biobanks have been criticized as constituting great risks to individual privacy. In this article, I suggest that quality with regard to diagnosis and treatment is an inherent, morally normative requirement of health care, and argue that quality concerns in this sense may be balanced with privacy concerns. Continue reading…

Sotoya,Tsuyoshi. Ethical Concerns of Artificial Insemination by Donor in Japan.  Asian Bioethics Review.  June 2012.

Artificial Insemination by Donor (AID) has been widely used around the world by couples who want to have children but cannot due to male factor issues such as physical infertility or psychological conditions. The purpose of this Assisted Reproductive Technology (ART) is for women to achieve fertilisation and pregnancy by using a donor’s sperm, typically when Artificial Insemination by her partner is not available. In Japan, it has been more than 60 years since the first procedure was undertaken at Keio University Hospital in 1948 (Senba 2003). In contemporary Japan, hundreds of children are reportedly born through AID every year (Nara 2005). As the news and, notably, the success stories of AID are reported in the media, increasing numbers of infertile couples perceive it as a viable and beneficial option for having children. Continue reading…

Kaebnick, Gregory.  The ACA Decision: Law and Philosophy. The Hastings Center Report.  September/October 2012.

The Affordable Care Act survived the Supreme Court—but “just barely”—according to Mark Hall, a contributor to the Report’s At Law column. That “just barely” leaves much to ponder, and in this issue a special installment of At Law, appearing as a set of essays, looks into it. Continue reading…

Hartzband, Pamela, MD, and Jerome Groopman, MD.  There Is More to Life Than Death.  The New England Journal of Medicine.  September 13, 2012.

Physicians and patients alike crave certainty. We all want to know that we’re making the best decisions about our health. But how do we know what’s best? The value of screening tests such as mammograms, prostate-specific antigen (PSA) measurements, colonoscopies, electrocardiograms, and routine physical examinations has recently been called into question. Expert groups have made sweeping recommendations regarding such testing that will significantly affect medical practice. Continue reading…

Opinion

Los Angeles Times

Romney, Lee. On the frontier of medical pot to treat boy’s epilepsy. September 13, 2012.

MODESTO —Topamax. Depakote. Phenobarbital. The list goes on. Before Jayden David turned 5, he had tried a dozen powerful medications to tame a rare form of epilepsy. The side effects were devastating. Continue reading…

Editorial. A farm bill and food stamps. September 12, 2012.

Midwestern farmers, facing uncertainty about their crops in the midst of the worst drought in half a century, have something else to steam about: Congress’ failure to pass a new farm bill, even though the old one is slated to expire Sept. 30. That may not sound so bad, because farm bills are invariably bloated with market-distorting corporate welfare for agribusiness that we’d be better off without. Yet they also fund the federal food stamp program, one of the most important strands of the U.S. safety net. Continue reading…

Editorial. Sex change at taxpayer expense? September 13, 2012.

Though the psychiatric world recognizes and treats gender identity disorder — defined by the National Institutes of Health as a disconnect between a person’s physical gender and the gender the person identifies with — that recognition hasn’t translated into widespread insurance coverage for sex-change operations that some patients feel is the only solution to their turmoil. Most private insurance and Medicaid programs do not pay for the surgery, viewing it as elective; neither does Medicare. Continue reading… 

New York Times 

Editorial. Fewer uninsured people. September 12, 2012.

The number of Americans who lack health insurance declined last year, the first drop since 2007. This is, in large part, the result of the health care reform law and better coverage under public programs like Medicaid. This also shows why repealing the health care law or revamping and shrinking Medicaid, as many Republicans want to do, would be disastrous moves. Continue reading…

Editorial. False promises on Ovarian Cancer. September 11, 2012.

New evidence that women are more likely to be harmed than helped by screening tests for ovarian cancer is disturbing. The tests do nothing to prevent healthy women from dying from the usually fatal disease. Yet they often lead doctors to perform needless surgeries that cause serious complications in many patients. Continue reading…

Editorial. Waste in the health care system. September 10, 2012.

A new report from a panel of experts convened by the Institute of Medicine estimated that roughly 30 percent of health care spending in 2009 — around $750 billion — was wasted on unnecessary or poorly delivered services and other needless costs. Lack of coordination at every point in the health care system is a big culprit. Continue reading…

Slate

Bor, Daniel. When do we become truly conscious? September 4, 2012.

It is easy to view consciousness as a kind of magic. In religion it is represented by the mysterious soul, and in science the concept of consciousness at first appears quite alien. But many fields, such as the study of what distinguishes life from nonlife, had their earlier magical states eroded by careful scientific study. Consciousness is in the midst of a similar revolution. Continue reading…

Conferences & Off-Campus Events

Global Health & Innovation Conference 2013
Yale University, New Haven, Connecticut, USA
Saturday, April 13 – Sunday, April 14, 2013

http://www.uniteforsight.org/conference

The Global Health & Innovation Conference is the world’s largest global health conference and social entrepreneurship conference.  This must-attend, thought-leading conference annually convenes 2,200 leaders, changemakers, students, and professionals from all fields of global health, international development, and social entrepreneurship.  Register during September to secure the lowest registration rate. Interested in presenting at the conference? Submit an abstract for consideration.  The final abstract deadline is September 30. Presented by Unite For Sight, 10th Annual Conference.

Calls for Papers & Nominations

The Many Faces of Moral Distress Among Clinicians

Call for Stories

Narrative Symposium: The Many Faces of Moral Distress Among Clinicians
Edited by Cynda Hylton Rushton, PhD, RN, F.A.A.N. and Renee Boss, MD, MHS

Narrative Inquiry in Bioethics will publish an issue devoted to personal stories from clinicians regarding situations that cause moral distress and how they have responded to them. Moral distress arises when professionals find that they are unable to act in accordance with their moral convictions. The focus of this inquiry is on the personal and professional short- and long-term impact of moral distress and the ways that clinicians respond to and make meaning from that distress. Appropriate contributors might include nurses, physicians, social workers, nursing assistants, clinical ethicists, occupational and physical therapists, and professionals in training. We want true, personal stories in a form that is easy to read. We want your true, personal stories in a form that is interesting and easy to read.

In writing your story, you might want to think about:

  • Which specific clinical situations give rise to moral distress? Why?
  • How do you experience moral distress—physically, psychologically, socially or spiritually?
  • How do you deal with moral distress? In past distressing situations …
  • Did you take actions that allowed you to uphold your deepest values?
  • What conditions within yourself, the people involved, and the external environment allowed you to do this?
  • How did you made sense of the situation?
  • What have been the short or long term consequences?
  • Have you ever been professionally disciplined for acting upon your moral conviction?
  • How has moral distress affected your job performance or your commitment to your job?
  • What has been left undone or been the residual impact?
  • How have your own values evolved as a result of moral distress?
  • How would you change the system (e.g., policies, hierarchies, processes) to alleviate moral  distress within your position? Do you think it can be alleviated, or is it inevitable?

You do not need to address all of these questions—write on the issues that you think are most important to share with others. You do not need to be a writer, just tell your story in your own words. We plan to publish 12 stories (800 – 2000 words) on this topic. Additional stories may be published as online-only supplemental material. We also publish two to four commentary articles that discuss the stories in the journal.

If you are interested in submitting a story, we ask you first to submit a 300-word proposal—a short description of the story you want to tell. Please include a statement about what type of clinician you are and what kind of environment you work in (no institutional names are needed). Inquiries or proposals should be sent to the editorial office via email: narrativebioethics@gmail.com.  We will give preference to story proposals received by Oct 31st.

For more information about the journal Narrative Inquiry in Bioethics, the guidelines for authors, and privacy policies, visit our webpage with Johns Hopkins University Press at: http://www.press.jhu.edu/journals/narrative_inquiry_in_bioethics/guidelines.html

Call for Nominations: The Hastings Center Cunniff-Dixon Physician Awards

The Hastings Center Cunniff-Dixon Physician Awards are national prizes given to physicians whose exemplary actions serve to foster excellent leadership in advancing the art of medicine for patients near the end of life and families. The 2012 award prizes will total $95,000. Two $25,000 prizes will be awarded to a senior and midcareer physician who demonstrate, through leadership and practice, a serious commitment to end-of-life care. Three additional awards of $15,000 each will go to physicians early in their careers who have made a valuable contribution, through practical research or clinical work, to the field of end-of-life medicine. The successful candidate also receives a framed award certificate and is honored at a ceremony before their peers at their home institution. Nominations are due October 30, 2012. These prestigious awards are given by The Cunniff-Dixon Foundation, whose mission is to enrich the doctor-patient relationship at the end of life, in partnership with The Hastings Center, a bioethics research institute known for its pioneering work on end-of-life decision-making. The nomination and selection process will be administered by the Duke Institute on Care at the End of Life. The prize recipients will be drawn from a national group of nominated candidates selected by a committee convened by The Hastings Center. All nominees must be licensed physicians practicing in the United States. Any individual or group, including professional associates, patients, and families, may submit nominations. Nominations submitted in prior years may be resubmitted. Nomination forms with detailed instructions are available here.

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