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Author Archive: Craig Klugman

06/20/2017

Ethics of Transparent Pharmaceutical Pricing Laws: The Harms Do Not Outweigh the Risks

by Craig Klugman, Ph.D.

Despite campaign promises that drug prices would be lowered, the current administration and Congress seem on target for giving pharmaceutical companies more power over pricing, over keeping out competition and over expanding their monopolies. The President’s “Drug Pricing Innovation Working Group” is staffed by many current and former industry lobbyists. While the federal government is deliberating, some states are already acting.

Last week, Nevada passed a law that requires pharmaceutical manufacturers to disclose the prices, profits, and discounts of insulin. If they want to raise the price of insulin by more than inflation, they must submit a written explanation to the state.…

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06/14/2017

Trump Opioid Task Force Considers HIPAA Exception for Overdoses

by Craig Klugman, Ph.D.

Confidentiality is one of the sacrosanct principles of medicine. By keeping the secrets that patients share with health care providers, the patient trusts the provider and the provider has the information necessary to diagnose and treat. The Hippocratic Oath, American Medical Association commentaries, 1974 Federal Privacy Act and 1996 Health Insurance Portability and Accountability Act place confidentiality front and center in ethics and law.

Although we place confidentiality on a high pedestal, it does have many exceptions—some which are acceptable and some of which are required. For example, under the Tarasoff rule a provider in most states must report a specific and explicit threat to a third party.…

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06/07/2017

In Calls for Repeal Comes Opportunity for Universal Coverage

by Craig Klugman, Ph.D.

According to the conservative press, the Affordable Care Act is failing. They point to the number of insurance companies that have withdrawn from the marketplaces including Ohio, where there are 20 counties with no plans available. They point to rising premiums and co-pays, and consider the experiment a failure that must be repealed. Of course, they are not considering the cost savings that preventive care provides in the longer term or the improved quality of life in having medical care. Those reports also ignore that the federal government has been giving confusing messages, rolling back the supportive regulations and subsidies, and that the healthcare industry is trying to adapt to a shifting landscape.…

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06/01/2017

When Ideology Trumps Reason, Do The Life Sciences Resist or Capitulate?

by Craig Klugman, Ph.D.

The world of the life sciences and medicine is being changed radically in 2017. The proposed Trump budget cuts funding for the CDC, NIH, NSF, NEH, NEA, EPA, and PHS will radically change how science is done, how much science is done and by whom. The US is withdrawing from the Paris Climate Treaty. Cuts to social security that traditionally pays for medical residents have also been proposed. The American Health Care Act will take affordable health insurance away from 23 million people. For the rest of us, the AHCA means higher premiums and less coverage. At the same time, we live in an era of “fake news,” “leaks,” incendiary tweets, and loyalty as the sign of someone’s worth.…

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This entry was posted in Cultural, Featured Posts, Justice, Politics, Science and tagged , . Posted by Craig Klugman. Bookmark the permalink.

05/31/2017

Time to Secure Your Implantable Medical Devices from Hackers

by Craig Klugman, Ph.D.

In the last few weeks, a major malware attack (WannaCry) paralyzed computers around the world, including electronic health records at the UK’s National Health Service and at hospitals throughout the world. Hacking is a growing problem that can cripple computer systems and even household appliances. Consider that in October 2016, an internet attack came from web-enabled residential devices (cameras, refrigerators, virtual assistants, thermostats, all of which are part of the internet of things) that crippled major websites. Rogue code was placed into these devices where it stayed unnoticed until the signal to attack was given.…

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This entry was posted in Featured Posts, Informed Consent, Privacy and tagged , , . Posted by Craig Klugman. Bookmark the permalink.

05/23/2017

Dear Mr. President: It’s Time for Your Bioethics Commission

by Craig Klugman, Ph.D.

Last week, seven Democratic members of the U.S. House Representatives sent a letter to the White House asking President Trump to appoint a director to the Office of Science and Technology Policy (OSTP), position that normally serves as the presidential science advisor. The impetus for writing the letter was a communication from the Deputy National Science Advisor that two hoax reports, that tried to undermine climate change, were circulating through the West Wing as “science.” The Congresspersons state “Where scientific policy is concerned, the White House should make use of the latest, most broadly-supported science…Relying on factual technical and scientific data has helped make America the greatest nation in the world.” Among the signers are a PhD in math and a PhD in physics.…

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05/16/2017

End of Life in Global Perspective

by Craig Klugman, Ph.D.

In its April 29th issue, The Economist published an article on people’s “hopes and worries for their end-of-life wishes.” The study compares responses to a set of questions from subjects in the Brazil, Italy, Japan, and the US. The data was part of a larger study conducted by the journal and the Kaiser Family Foundation on perceptions of health held by people in the four countries. The results supports other studies conducted in recent years in the U.S. and also gives insight into how we compare to the rest of the world.

The study is extensive, drawing comparisons about conversations with a health care provider, experiencing the death of a loved one, being aware of a dying loved one’s end of life wishes, loved one’s experience with pain and access to treatment, as well as awareness and use of hospice (US awareness at 36% is 3 times higher than any other nation).…

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This entry was posted in Cultural, End of Life Care, Featured Posts and tagged . Posted by Craig Klugman. Bookmark the permalink.

05/08/2017

Woolgathering: It’s a Bag, It’s a Baby, It’s an Artificial Womb!

by Craig Klugman, Ph.D.

An announcement last week took the science dream of an artificial womb one step closer to science fact: premature lambs were gestated in a biobag (technically an “extra-uterine system”). The researchers were trying to solve a problem surrounding premature human births—babies born critically early (before 26 weeks) have severe complications that lead only half to survive. The survivors often suffer from life-long medical conditions and developmental challenges. Those babies need more time in the womb to develop.

In the experiment, 8 lamb fetuses between 105 to 115 days gestational age (lambs usually reach term at 145 days) were removed from their mother’s uterus and placed in an artificial womb.…

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05/08/2017

BioethicsTV: Violating consent, living with difficult patient choices, and helping family choose

by Craig Klugman, Ph.D.

On Grey’s Anatomy (Season 13, Episode 22), two storylines looked at when a physician’s desire to do good should outweigh a patient’s choice. [Shortcut answer: Rarely] In the first storyline, a young woman enters the ED after falling down a flight of stairs while leaving the apartment of a one-night stand. She has an inoperable heart tumor and has decided to spend her remaining time being as hedonistic as possible. At one point, she turns to the doctors and tells them that she knows what they are thinking: That they alone can give her a chance; that there is some technique that only they can do.…

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This entry was posted in End of Life Care, Featured Posts, Pediatrics and tagged , , , . Posted by Craig Klugman. Bookmark the permalink.

05/02/2017

BioethicsTV: Boundary Crossings, Savior Children, and Euthanasia

by Craig Klugman, Ph.D.

In last week’s episode of Chicago Med (Season 2, Episode 21), Dr. Charles cannot separate his personal and professional roles. When his daughter (an epidemiologist in the hospital) is being evaluated by his resident, Dr. Charles is concerned that no one can evaluate his daughter as well as he can. Rather than trusting his resident and the system, he interferes at every step. First, he arranges to have his resident (rather than someone else’s) evaluate his daughter. Second, he logs onto the electronic medical record to look at the notes on his daughter’s case. Third, he consistently asks his resident questions about the case.…

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