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Author Archive: Craig Klugman

08/17/2017

The Aftermath of Charlottesville: What’s a bioethicist to do?

by Craig Klugman, Ph.D.

Figuring out how to respond to one of the most egregious displays of racism in modern times (U.S.)  is not an easy task. Figuring out what this event means from a bioethics perspective is even more challenging. As anyone in the connected world knows, Mr. Trump explained his support (or at least lack of condemnation) of white nationalists and neo-Nazis in a rally in Charlottesville, Virginia. This progressive city in the south has a long history of bioethics. This city is the home of the University of Virginia, which has been “exploring and teaching…about the complexities of human illness, suffering, and practices of healing, as well as the processes of research and policymaking” since the 1960s.…

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

08/09/2017

Right to Try: Why Logic and Facts Won’t Win This One

by Craig Klugman, Ph.D.

Last week the U.S. Senate passed bill S. 204, the Trickett Wendler Right to Try Act of 2017. Trickett Wendler was a woman with ALS. The ALS association and her family lobbied Congress to support this bill to give all patients living with a terminal illness the “right” to purchase experimental drugs from pharmaceutical companies. Essentially, this bypasses the FDA’s compassionate use program. Instead of filing an application for FDA compassionate use (which the FDA approves 99% of the time), the patient asks the drug manufacturer directly. As I have written in this space before, such laws threaten public health efforts through the FDA to ensure safe and efficacious pharmaceuticals.…

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08/04/2017

The Age of Designed Babies Arrives

by Craig Klugman, Ph.D.

In the film Gattaca, a couple desiring to have a child visits their neighborhood geneticist:

Geneticist: You have specified hazel eyes, dark hair and fair skin. I’ve taken the liberty of eradicating any potentially prejudicial conditions. Premature baldness, myopia… alcoholism and addictive susceptibility… propensity for violence, obesity, etc.

Marie Freeman: We didn’t want… Diseases, yes, but– [looks at Antonio]

Antonio Freeman: We were just wondering if it’s good to leave a few things to chance?

Geneticist: We want to give your child the best possible start. Believe me, we have enough imperfection built in already. Your child doesn’t need any more additional burdens.

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08/02/2017

Sterilization for Prisoners Is Not New and Shows That Studying History is Essential

by Craig Klugman, Ph.D.

In 1927, Supreme Court Justice Oliver Wendell Holmes ruled that Carrie Buck and her baby could be sterilized because of a perception that they were “mental defectives.” In the 20th century, 32 states had federally funded programs that sterilized “undesirable” populations. Approximately 60,000 people in the U.S. were sterilized without their consent or even knowledge of the procedure. This history made an unexpected reappearance last week when a Tennessee judge offered to reduce the jail sentences of prisoners if they underwent sterilization.

The inmates were offered vasectomies (males) or contraceptive implants (females) in exchange for him shaving 30 days off of their prison sentences.…

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07/25/2017

Heads Up: Time to Say Goodbye to Football

by Craig Klugman, Ph.D.

Suppose a prescribed drug caused brain damage in 99.1% of people who took it. Would you take the drug? How long before that drug was pulled from the marketplace and the lawsuits against the manufacturer began? What if that drug made the company $7.2 billion per year? What if those who took the drug became celebrities for a brief period of time? Would you consider taking it then? Most rational people would refrain from the medication and the FDA would remove it from the market.

If you substitute the word “football” for “drug,” then you know the results of a new study in

JAMA, which definitively proves that football is bad for one’s health.…

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

07/19/2017

The Constructed Sex Worker: Clinical Tool or Normalizer of Sexual Objectification

by Craig Klugman, Ph.D.

Sex robots are real and so are the campaigns to free them. In the 2016 HBO series Westworld, viewers are introduced to an old Wild West town which includes a saloon where one can buy a drink, listen to music, or procure the services of an android sex worker. In the real world, male and female robot companions are already on the market. One can choose the gender, race, eye and hair color, make up (for female versions), and even hair patterns for $9,995.  If that’s too much, you can rent a doll for a few hours.…

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

07/12/2017

Forget the DNR, Time for Opt-In CPR

by Craig Klugman, Ph.D.

A nurse in the UK was sanctioned with a ”caution order” (a warning or demerit) on her record for 24 months after she did not perform CPR on a patient who presented as “waxy, yellow and almost cold” when she was called to look at him in his hospital room. The patient was dead. However, since the patient lacked a DNAR order, under UK law and standard of care, she was obligated to begin CPR even though the process has not been known to revive a cold corpse. This incident begs the question as to why performing CPR is the default order and leads me to recommend a policy change: DNAR ought to be the default code status unless a patient or family opts-in for full-code.…

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

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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