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Author Archive: Craig Klugman

About Craig Klugman

06/13/2018

Over-Screening, Rigid Protocols, and Changing Guidelines: A Personal Journey Through the Looking-Glass

by Craig Klugman

A new JAMAarticle reports on a US Preventive Services Task Force recommendation against routine ECG in patients without symptoms of heart disease: “For asymptomatic adults at low risk of CVD events (individuals with a 10-year CVD event risk less than 10%), it is very unlikelythat the information from resting or exercise ECG (beyond that obtained with conventional CVD risk factors) will result in a change in the patient’s risk category….”The report states that over-screening can lead to harms such as “invasive procedures, overtreatment, and labeling.”Such advice follows with recent suggestions against many preventive screenings that were de rigueur just a few years ago for prostate cancer, breast cancerand more (the one exception is a recent expansion of colon cancer screening).…

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This entry was posted in Clinical Ethics, Featured Posts and tagged , , . Posted by Craig Klugman. Bookmark the permalink.

06/04/2018

BioethicsTV (May 30, 2018): #CodeBlack Patient racism and DNRs

by Craig Klugman, Ph.D.

Code Black (Season 3; Episode 5): Patient Racism

A middle-aged-white patient needs an appendectomy. As he is being wheeled to surgery, he is beside the chief of surgery and a new trauma surgery resident. The patient is jovial and says he feels a connection with the resident. The patient states that he wants the resident to do his surgery. The resident responds that he is still learning and they are lucky to have the best surgeon in the hospital. The patient insists and says he does not even want the chief in the OR. What becomes clear is that the patient is making this request because the resident is white and the chief is black.…

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

05/31/2018

Targeted Medicine: Advertising to the Medically Vulnerable

by Craig Klugman, Ph.D.

Imaging going to the doctor and suddenly finding ads popping up on your phone. Perhaps there’s a discount for receiving a specialized treatment. Another ad might advertise a vitamin or sunscreen. Or you might even get an ad for a competing service down the street. Targeted advertising is when a business or service sends its messages to people who meet a certain pre-determined demographic, in this case being in a certain geographic location. In the world of medicine, people used to receive ads for their diagnoses or other services at their health care provider because patient lists could be sold and used for marketing.…

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This entry was posted in Ethics, Featured Posts, Health Regulation & Law, Justice, Privacy and tagged , . Posted by Craig Klugman. Bookmark the permalink.

05/22/2018

The Land of the Gagged and the Home of the Complicit: Domestic Abortion Gag Rule is Unethical

by Craig Klugman, Ph.D.

On his fourth day in office, Trump reinstated the Mexico City Rule. The MCR was originally declared by Ronald Reagan in 1984 to prohibit U.S. federal funds from going to non-governmental health organizations if they provide, promote, refer, or mention abortion services unless abortions were given at a separate facility. Last week, Trump announced that he was going to issue a domestic gagrule that would prohibit health care providers who receive federal funding from performing or mentioning abortion as an option to women. In other words, he was going to bring the gag rule home.…

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This entry was posted in Featured Posts, Politics, Reproductive Ethics and tagged , , . Posted by Craig Klugman. Bookmark the permalink.

05/22/2018

BioethicsTV (May 14-22): #TheResident, #ChicagoMed

by Craig Klugman, Ph.D.

The Resident (Season 1; Episode 14): Treating Loved Ones; Chemo for Healthy Patients ; Chicago Med (Season 3; Episode 20): Doctor and jury

The Resident (Season 1; Episode 14): Treating Loved Ones; Chemo for Healthy Patients

In the season finale, we learn that Hunter has been telling healthy people that they have cancer (when they do not) and giving them chemotherapy. She is committing Medicare fraud and also artificially bumping her success rates at curing cancer. Pravesh informs Lily, a frequent flyer, that she does not have cancer and is a victim of Hunter. The residents tells Bell that they have informed the FBI of the problem and they suggest he suspend Hunter immediately.…

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This entry was posted in BioethicsTV, Featured Posts, professional ethics. Posted by Craig Klugman. Bookmark the permalink.

05/17/2018

Big Data Studies and Abuse of Fiduciary Duties

by Craig Klugman, Ph.D.

A study published in the May 17th, 2018 issue of Cell, “Disease Heritability Inferred from Familial Relationships Reported in Medical Records,” shows a connection between families and certain diseases at three large urban university medical centers. The researchers took private health information from electronic medical records, identified family trees by matching emergency contacts, examined diagnoses and other health information, and matched that with any tissue samples from biobanks to build a picture of disease heritability. The people whose private health information was used have no idea that the study occurred.

This study is similar to the recent revelation of Facebook data being used and shared without permission if a friend consented to a quiz.…

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

05/11/2018

BioethicsTV (May 7-11): #ChicagoMed, #GreysAnatomy

by Craig Klugman, Ph.D.

Chicago Med (Season 3; Episode 19): Maternal-Fetal Conflict; Grey’s Anatomy (Season 14; Episode 23): Personal Disclosures of Illness

As the traditional television season comes to a close, many medical dramas have steered away from ethical dilemmas in medical care to heighten the drama among their characters in order to provide strong cliff hangers for the season finale.

Chicago Med (Season 3; Episode 19): Maternal-Fetal Conflict

Tracey Hermann is a 25-year-old pregnant woman (21 weeks) who comes into the ED with shortness of breath and fatigue. Scans show that she has a problem with her mitral valve—a condition she’s likely always had but has only manifested with the added pressure on her body of the fetus.…

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05/08/2018

Speaking to the Media about Antimicrobial Resistance: A Deeper Description of How I Wear Many Hats as a Bioethicist

by Craig Klugman, Ph.D.

Last week, I was interviewed by an academic news serviceabout antimicrobial resistance (AMR) after a study reported that giving antibiotics to children in selected African towns led to a decreased mortality rate.  The reporter learned of my work by reading the blog I had written onAMR a few weeks before. Many reporters today will send a list of questions to which you can write answers. Sometimes they will speak you to after you’ve read the questions and other times they will accept written answers. I find these approaches better than a cold phone interview because it allows me time to think more carefully about what I have to say and to be sure that the words accurately reflect my thinking.…

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05/07/2018

BioethicsTV (April 30 – May 4): #TheResident; #ChicagoMed

by Craig Klugman, Ph.D.

The Resident (Season 1; Episode 12): Pressures of the Medical Life; Making promises; Chicago Med (Season 3; Episode 18): Crisis response

The Resident (Season 1; Episode 12): Pressures of the Medical Life; Making promises

When Bradley, a resident, falls through a glass ceiling and crashes onto the board room table, Bell’s first reaction is that neither the hospital nor he are responsible for the epidemic of suicides in medicine. Rather than trying to find a solution to the problem or even trying to find out what happened, Bell is trying to be sure he has a chair when the music stops.…

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05/02/2018

From Westworld to the Rest of the World: Time to Regulate the Mining of Third Party Data

by Craig Klugman, Ph.D.

You do not have control over your ideas, your passions, or even your DNA anymore. Your biological material and your ideas may be taken without your awareness of it. You do not need to consent anymore, for people to take the products of your body or mind. This fact was highlighted in the Season 2 premiere of HBO’s Westworld, a show that echoes many of our high tech, dystopian fears of AI, robotics, and humans relieved of their civil veneer.

Before the show premiered in 2016, their website had a hidden “Terms of Use” for anyone who expressed interest in visiting the fictional park (a great marketing gimmick).…

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