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03/31/2013

How the Internet Can Benefit Older Americans

On April 24, 2013, the FCC will host a free Senior Digital Literacy Day seminar, "How the Internet Can Benefit Older Americans." Seniors, and those who work with and/or care for seniors, are invited to attend and learn about how Broadband (high ...

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

03/30/2013

Challenges of Surrogate Decision Making

I am excited to be a part of an upcoming Geisinger Health System Conference, "On Another's Behalf: The Law, Ethics, and Challenges of Surrogate Decision Making" on April 10. While not the focus of this conference, Geisinger is well-known for its Prove...

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

03/29/2013

The Increasingly Hard Life of a Drug Rep

I manage to get on some strange e-mail lists, partly because I used to write a regular newspaper column on medical issues, and partly because I am now identified as having something to do with Pharma. As a result I get unsolicited "cold calls" via e-mail, some of which shine a light indirectly on issues related to this blog. A recent message seems to suggest that the campaign us pharmascolds have launched is having success, making life harder for drug reps, and driving the companies to look for new ways to influence physicians.

A nice publicist wanted me to know all about Activate Networks:
http://www.activatenetworks.net/

This outfit will help drug marketers get more bang for the buck by mapping the local physician social network, and picking out the docs who have the most influence over their peers. These docs, the firm points out, may not themselves be the heaviest prescribers of the drug, and so might initially escape notice from the data usually generated by drug firms that focus on prescribing volume. Yet (they argue) if you go after these docs, using the methods kindly supplied for you by Activate (I assume for a hefty fee), you can get a lot more payoff from your detailing efforts, as is explained in detail:
http://activatenetworks.web12.hubspot.com/recharging-pharma-commercialization-infographic

Why bother? The e-mail lists the woes faced by today's reps, that make it mandatory that they'd use whatever new technology they can:

The Changing Face of Pharma Detailing


Pharma companies are battled for physicians’ time:

• One out of four physicians work in a practice that refuses to see reps

• Sales reps are never seen by the doctor in 43% of calls

• Two thirds of medical schools and a quarter of private-practice physicians have limited sampling in some way

• For every 100 reps who visit a practice, 37 place their products in the office's sample cabinet, and only 20 speak to a physician in person

Of course from my own point of view this is all good news, and signs that some progress is slowly being made.

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This entry was posted in Health Care and tagged . Posted by Howard Brody. Bookmark the permalink.

03/29/2013

The Most Important Conversation: Tools and Techniques for Advance Health Care Planning

On Thursday, April 11, 2013 2:00 PM - 3:30 PM EDT, the ABA and the National Consumer Law Center are hosting a free online webinar:  "The Most Important Conversation: Tools and Techniques for Advance Health Care Planning." A shift in focus has ta...

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

03/29/2013

Same-Sex Marriage: Is It Ethical?

While currently, in the United States, the issue of same-sex marriage is holding attention of the public and the United States Supreme Court, it is a settled matter in a number of other countries (Argentina, Belgium, Canada, Denmark, Iceland, Netherlan...

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This entry was posted in Health Care and tagged , . Posted by Maurice Bernstein. Bookmark the permalink.

03/27/2013

Can you use the Emotiv scales for anything?

How should you do a neuromarketing test? I’m increasingly being asked whether the scales from the Emotiv EPOC Affective™ Suite system can be used to assess cognitive and emotional responses in e.g. customers. After all, it would be really appealing if we could use a full box set with responses such as Engagement, Meditation, Frustration and […]

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This entry was posted in Health Care and tagged , , , , , . Posted by Thomas Ramsoy. Bookmark the permalink.

03/26/2013

Facebook Can Help You Die – Better

I will be giving two talks on Thursday in Amarillo, Texas, as part of the 2013 Creative Mind Lecture Series:  Facebook Can Help You Die - Better Averting Today’s Biggest Public Health Epidemics with Social Media I developed these presentatio...

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

03/26/2013

So does neuromarketing work?

I was compelled to reply to a blog post at ESOMAR, as seen here, and would like to share the comment here, with a few additions: Neuromarketing is not a unique and novel application of neuroscience outside it’s domain of origin. Psychology has used neuroscience for decades now, aka neuropsychology, and with great success in […]

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This entry was posted in Health Care and tagged , , , , . Posted by Thomas Ramsoy. Bookmark the permalink.

03/24/2013

Waiting to Speak – Waiting for the Surrogate to Speak

 

Why Wait

The determination of a patient’s capacity to make decisions is based upon her understanding of her disease or illness and the risks and benefits of treatment. If she is unable to articulate a clear understanding it may be determined that she lacks the necessary capacity to make her own decision and is further taken out of the loop of information and adequate and legitimate updates on her condition. Concomitantly, surrogate decision makers are not always available to see the treating physicians and consults, and often get a cursory explanation of the patient’s condition.

Physicians remain exceedingly reluctant to confront the difficult subject of end of life care. The New York times, on January 11, 2009 published an article, by Denise Grady, - “Facing End-of-Life Talks, Doctors Choose to Wait.” Discussing a survey of 4,074 doctors who took care of cancer patients, who had only four to six months left, but was still feeling well. 65 percent said they would talk about the prognosis, but wait to discuss end of life preferences.

67%: Making sure family is not burdened financially by my care
66%: Being comfortable and without pain
61%: Being at peace spiritually
60%: Making sure family is not burdened by tough decisions about my care
60%: Having loved ones around me
58%: Being able to pay for the care I need
57%: Making sure my wishes for medical care are followed
55%: Not feeling alone
44%: Having doctors and nurses who will respect my cultural beliefs and values
36%: Living as long as possible
33%: Being at home
32%: Having a close relationship with my doctor

                 

Why Wait?

As time progresses and severity of illness increases, being able to say what she – the patient - actually wants is of paramount importance. Respecting person’s wishes is both ethically required and legally mandated because we recognize that each of us is owed the respect to decide what is done to our bodies, how we wish to live. These human rights are not relinquished when sever illness must be faced. The need to provide timely information to the patient must not be ignored. If the determination of the true wishes of the patient are, in fact  paramount in decision making than the earlier information is provided then there is a greater probability of knowing – with confidence – the wishes and decisions of the patient. Moreover, be speaking early the patient has the opportunity to ask questions of her physicians that she deems important. All this is lost by waiting. When a patient loses capacity the physicians are forced to turn to the surrogate decision maker who may be reluctant to express the wishes of the patient or unable to face the harsh realities of the situation and delay decisions.

A surrogate cannot be permitted to cause a delay in decision making which will harm the patient by causing unnecessary suffering and costly delays.

If a surrogate cannot or will not be fully informed and understand the diagnosis and prognosis, he or she may not continue as surrogate

If a surrogate cannot or will not decide – find a new surrogate, or move to a best interest standard.

Often the surrogate is a family member suffering from fear and grief, often at odds with the views of other family members and friends. There is an understandable empathy for people in this position and the desire to help them through such a hard time in their lives is great. Yet, it is not the job of a physician or nurse or bioethicist to become involved with the surrogate to the point that the surrogate’s feelings seem more important than the need to uncover by the most reliable means possible under the circumstances to know the true perspective and intentions of the patient.

It must be of crucial importance to maintain focus on the patient’s wishes and not see the surrogate and family as a filter or as an easier method  to arrive at a decision. The surrogate must make a decision, not based on a consensus of the family or the advice of the doctor or nurse, but on the best and clearest representation of the wishes of the patient.

 

 

 

From "Waiting for Godot" Samuel Beckett

 

VLADIMIR:

Let's wait till we know exactly how we stand.

ESTRAGON:

On the other hand it might be better to strike the iron before it freezes.

VLADIMIR:

I'm curious to hear what he has to offer. Then we'll take it or leave it.

ESTRAGON:

What exactly did we ask him for?

VLADIMIR:

Were you not there?

ESTRAGON:

I can't have been listening.

VLADIMIR:

Oh . . . Nothing very definite.

ESTRAGON:

A kind of prayer.

VLADIMIR:

Precisely.

ESTRAGON:

A vague supplication.

VLADIMIR:

Exactly.

ESTRAGON:

And what did he reply?

VLADIMIR:

That he'd see.

ESTRAGON:

That he couldn't promise anything.

VLADIMIR:

That he'd have to think it over.

ESTRAGON:

In the quiet of his home.

VLADIMIR:

Consult his family.

ESTRAGON:

His friends.

VLADIMIR:

His agents.

ESTRAGON:

His correspondents.

VLADIMIR:

His books.

ESTRAGON:

His bank account.

VLADIMIR:

Before taking a decision.

ESTRAGON:

It's the normal thing.

VLADIMIR:

Is it not?

ESTRAGON:

I think it is.

VLADIMIR:

I think so too.

 

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03/24/2013

Waiting to Speak – Waiting for the Surrogate to Speak

Why Wait The determination of a patient’s capacity to make decisions is based upon her understanding of her disease or illness and the risks and benefits of treatment. If she is unable to articulate a clear understanding it may be determined that she lacks the necessary capacity to make her own decision and is further taken out of the loop of information and adequate and legitimate updates on her condition. Concomitantly, surrogate decision makers are not always available to see the treating physicians and consults, and often get a cursory explanation of the patient’s condition. Physicians remain exceedingly reluctant to...

The post Waiting to Speak – Waiting for the Surrogate to Speak appeared first on Clinical Bioethics Blog.

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