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Author Archive: Hayley Dittus-Doria

About Hayley Dittus-Doria

10/22/2015

Truth Telling In Medicine: Problems Old and New

<p style="font-size: 11.2px; line-height: 19.04px;">The issue of truth telling in medicine was a lively concern in the early days of modern medical ethics during the 1970’s. A new moral awareness had emerge that provided a clear moral rejection of the paternalistic approach taken in the physician-patient relationship that prioritized the traditional values of beneficence and non-maleficence over truth telling. Of course the key development that fueled this new moral perspective as well as the growing passion for medical ethics was the newfound sense that arose beginning in the 1960’s that patients with capacity have a fundamental right both to refuse unwanted treatment and give voluntary informed consent to treatments they were considering. It became obvious to students of medical ethics that if patients are to be able to exercise their right to give voluntary informed consent they must receive a full and accurate disclosure of the relevant information necessary for them to make a decision.</p> <p style="font-size: 11.2px; line-height: 19.04px;">Up to the early 1960’s, patients coming into the health care system very well may not have had an opportunity to give voluntary informed consent. Giving patients this opportunity just wasn’t part of the medical culture. In the early 1960’s it was common for oncologists to not disclose a diagnosis of cancer; by the late 1970’s there was almost universal agreement that full disclosure was the expectation. The full moral force of the principle of respect for patient autonomy happened relatively quickly, especially after the Belmont Report of 1978, which articulated the basic principles of medical ethics (though non-maleficence was subsumed under beneficence). There is no question that the physician-patient relationship has been evolving ever since with new levels of expectations and involvement of patients and their surrogates. There is now universal agreement that physicians are expected to be truthful to patients and accurately disclose their medical condition, including diagnosis and prognosis. Without this first basic step of truth telling in disclosing the medical facts to the patient about their condition, patients cannot exercise their right to express their preferences and wishes about medical treatment and care goals, and specially give voluntary informed consent to medical interventions to treat their condition.</p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>

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This entry was posted in End of Life Care, Health Care and tagged , , , . Posted by Hayley Dittus-Doria. Bookmark the permalink.

10/21/2015

Police and Persons with Mental Illness: The Overlooked Frontline Care Providers

<p>My original plan for this blog was to consider whether or not there remained a need for the old “Drunk Tank” way of managing persons who are acutely intoxicated by allowing them to sleep off or wait out their inebriation at the police station before determining whether or not further mental health care was needed, rather than bringing individuals to hospital emergency rooms for supervised sleep and conversation about detox services or psychiatric evaluation. Though the task of caring for acutely intoxicated persons, sometimes folks who are frequently seen in ERs repeatedly, can seem to be an inappropriate use of resources by clinicians we must appreciate that the motivation is often about safety, protection, and the welfare of the patient as well as the public. In the social context of fear and mistrust toward law enforcement following the many egregious cases of police brutality, my focus is a reminder of the ways in which police can, and often do, intervene with persons who have mental illness and addiction in order to protect these vulnerable mentally ill individuals. In no way do I condone the misconduct and violence we have come to hear about too often, but rather will focus on the important ways police can and very often do work with mental health professionals to assist persons in acute crises. </p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>

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10/16/2015

If I Were Running the Place

<p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">I have a riddle for you.  Start with six attorneys; add three management consultants, three financial executives/advisors and a couple of bankers. Sprinkle in, one each, clothing store chain CEO and entertainment retail chain CEO. Add executives from a supermarket chain, a construction company, and a paper products company. Fold in a hedge fund manager, real estate executive, and an accountant. Finish with a reputation management expert and exactly one educator and one physician. What have you got? Perhaps you have the membership of an exclusive club, perhaps a class reunion of an exclusive prep school. No not these.  I will not make you guess any more. What you have is the Board of Directors of a large academic medical center which includes a major teaching hospital and a medical school. This academic medical center educates medical students and physicians, graduate students in science and other health professions. This teaching hospital is a major health care provider in the state capital of a large northeastern state. The academic medical center is the leading biomedical research organization in the region.</span></p> <p style="font-size: 11.2px; line-height: 19.04px;">The Board of Directors is fully responsible for the governance of this large and complex organization. This organization has a mission to educate, to conduct biomedical research, and to provide patient care services. I was expecting to see that this list of directors would include expertise from renowned educators with national reputations. I was expecting to see a list containing outstanding biomedical researchers who discovered knowledge which made the world a better place. I was expecting leaders from the field of healthcare and medicine. But that is not what I found. I was surprised.</p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>

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This entry was posted in Health Care, Research Ethics and tagged , , , . Posted by Hayley Dittus-Doria. Bookmark the permalink.

10/12/2015

An F.D.A. Commissioner With Ties to the Pharmaceutical Industry? Heaven Forbid?

<p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">On September 16, 2015, </span><a style="font-size: 11.2px; line-height: 19.04px;" href="http://www.nytimes.com/2015/09/16/health/cardiologist-nominated-to-be-head-of-fda.html">President Obama nominated</a><span style="font-size: 11.2px; line-height: 19.04px;"> the internationally known Duke University cardiologist-researcher </span><a style="font-size: 11.2px; line-height: 19.04px;" href="https://medicine.duke.edu/faculty/robert-m-califf">Robert M. Califf, MD</a><span style="font-size: 11.2px; line-height: 19.04px;">, to be Commissioner of Food and Drugs. He will replace</span><a style="font-size: 11.2px; line-height: 19.04px;" href="http://www.nytimes.com/2015/02/06/health/margaret-hamburg-fda-commissioner-stepping-down.html">Margaret Hamburg, MD</a><span style="font-size: 11.2px; line-height: 19.04px;">, who left the agency last March. Dr. Califf – a registered Democrat but well regarded by Senate Republicans – has served as </span><a style="font-size: 11.2px; line-height: 19.04px;" href="http://www.fda.gov/AboutFDA/CentersOffices/ucm452317.htm">Deputy Commissioner at the F.D.A.</a><span style="font-size: 11.2px; line-height: 19.04px;"> since February. The Senate must confirm the commissioner.</span></p> <p style="font-size: 11.2px; line-height: 19.04px;">Immediately prior to joining the F.D.A., Dr. Califf was professor of medicine and vice chancellor for clinical and translational research at Duke. While at Duke, he founded the Duke Clinical Research Institute and served as director of the Duke Translational Medicine Institute. A highly esteemed expert in cardiovascular medicine, health outcomes research, healthcare quality, and clinical research, Dr. Califf has led many landmark clinical trials and authored or co-authored over 1,200 publications in the peer-reviewed literature. He is one of the American Medicine’s most frequently cited authors in the biomedical sciences. His credentials are unimpeachable. Two of Dr. Califf’s area of interests are improving the design of drug research projects and streamlining the regulatory process to bring innovative drugs to market more quickly.</p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>

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10/09/2015

Deeply Superficial

<p style="padding-left: 60px;"><span><span><span class="UFICommentBody"><span>“People need to be made more aware of the need to work at learning how to live because life is so quick and sometimes it goes away too quickly.” – Andy Warhol</span></span></span></span></p> <p><span><span><span class="UFICommentBody"><span>This past weekend was the last one for The Late Drawings of Andy Warhol: 1973-1987 exhibit at <a href="http://www.hydecollection.org/">The Hyde Collection Museum in Glen Falls</a>, and I almost didn’t go to it. I told myself there were far too many other things to do: the stack of recent journal articles I’ve been meaning to get to; student assignments that are in need of grading; the upcoming presentations for which I haven’t even begun putting together powerpoints; the apartment that, despite ongoing efforts, never seems to be completely clean; the piles of unwashed or unfolded laundry; and so on. In terms of triaging my limited time, a two-hour round trip trek to see a handful of sketches hardly seemed sufficiently important.</span></span></span></span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>

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10/05/2015

Elective or Life-Saving? Catholic Hospitals and the Ban on Tubal Ligation

<p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">A Catholic hospital </span><a style="font-size: 11.2px; line-height: 19.04px;" href="https://www.rt.com/usa/315359-catholic-hospital-denies-sterilization-request/">came under fire recently</a><span style="font-size: 11.2px; line-height: 19.04px;"> for stating that it would not permit doctors to perform a tubal ligation during a c-section scheduled for October.  According to news reports (including an</span><a style="font-size: 11.2px; line-height: 19.04px;" href="http://www.thedailybeast.com/articles/2015/09/23/a-catholic-hospital-says-it-s-evil-for-me-to-get-my-tubes-tied.html">article written by the patient herself</a><span style="font-size: 11.2px; line-height: 19.04px;">), the pregnant patient has a brain tumor, and her doctor have advised her that another pregnancy could be life-threatening.  Her doctor has recommended that she have a tubal ligation at the time of her c-section.  While my knowledge about this hospital, this case, and the participants is limited to what has been reported in the media, it raises an interesting question: in our pluralistic society, where conscientious objection is respected while maintaining a patient’s right to a certain standard of care, is it ethical to allow a religiously-affiliated health care institution to refuse to provide certain treatments it finds morally objectionable?</span></p> <p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">As background, the Catholic Church has historically been outspoken on bioethical issues and has a strong and robust bioethical teaching.  Catholic hospitals are governed by the </span><a style="font-size: 11.2px; line-height: 19.04px;" href="http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf">Ethical and Religious Directives for Catholic Health Care Services</a><span style="font-size: 11.2px; line-height: 19.04px;"> (ERDs), a document promulgated by the United States Conference of Catholic Bishops (USCCB) that clearly articulates the bioethical policies that must be followed in a health care institution based on the Church’s moral teachings.  It explains the Church’s teaching against direct sterilization as a method of birth control based on the </span><a style="font-size: 11.2px; line-height: 19.04px;" href="http://plato.stanford.edu/entries/double-effect/">principle of double effect</a><span style="font-size: 11.2px; line-height: 19.04px;">.  “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.  Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.” (Directive 53).  In other words, if the sterilization procedure directly treats a pathology, it is licit; if it is used as a form of birth control to prevent a pregnancy, even if that pregnancy would be life-threatening, it is not licit.</span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>

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10/01/2015

Is it Ethical for Parents to Create a Savior Sibling?

<p style="font-size: 11.2px; line-height: 19.04px;">Savior siblings are children who are born to provide HLA compatible body parts, typically umbilical cord blood to be used for bone marrow transplantation, in order to save the life of their older sibling. They are created using IVF so that the embryos can be screened in order to find and implant one that is a match to the existing child. The <a href="https://en.wikipedia.org/wiki/Adam_Nash_(savior_sibling)">first savior sibling</a>, Adam Nash, was born in the US was born in 2000. Lisa and Jack Nash decided to create a savior sibling after their doctor suggested it might be the best option for a cure for their daughter Molly, who was born with a severe type of Fanconi anemia. Immediately after Adam was born, Molly received a bone marrow transplant using the umbilical cord blood from her brother. The notion of savior siblings gained more attention with Jodi Picoult’s book <em><a href="http://www.jodipicoult.com/my-sisters-keeper.html">My Sister’s Keeper</a></em> and the <a href="http://www.imdb.com/title/tt1078588/?ref_=nv_sr_1">movie based on the book</a>. In contrast to Adam Nash, the savior sibling in the book and movie is expected to continue giving bodily to her sister throughout her childhood, including organ transplantation, rather than one time umbilical cord donation.</p> <p style="font-size: 11.2px; line-height: 19.04px;">Is it ethical for parents to create a savior sibling? Some argue that the parents’ intention plays a role in considering whether it is ethical to create a savior sibling. If the parents were not planning on having any more children and they are the having the savior sibling only for the sake of the older child, then there is the concern of using the savior sibling as a means to an end. If the parents were planning on having more children, then some claim that the savior sibling is wanted for her/his own sake and is not being created for just one purpose (i.e. to save the older child).</p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>

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This entry was posted in Health Care, Reproductive Medicine and tagged , , . Posted by Hayley Dittus-Doria. Bookmark the permalink.

09/25/2015

Publishing Research Ideas

<p><span style="font-size: 11.2px; line-height: 19.04px;">The newest science journal on the block with several unique twists is <a href="http://riojournal.com/">Research Ideas and Outcomes</a> (RIO). RIO aims to publish a variety of outputs in the research cycle, not only the results of research. The journal will publish papers on ideas, proposals, methods, research results, and software. They also publish review articles, opinion pieces, data papers, software descriptions, workflows, data management plans, conference abstracts, single figure publications, project reports and much more. Their aim is to better use the efforts scientists spend on writing and evaluating research proposals and other products within the research cycle. RIO does have limits; they will not accept teaching lectures or materials, clinical trials, patient or other data that may be considered unethical, homeopathy, nuclear or bioweapons research, creationist or religiously motivated research, cryptozoology, and pseudoscience. The journal also has many other interesting aspects. While they are an open access journal, unlike others, they do not charge the typical high costs of thousands of dollars. The journal charges between 50 to a few hundred euros for most types of publications. Peer review is also optional and RIO relies on public scrutiny to promote transparent and public peer review. Expert driven peer review, typically done in most medical and science journals, however, can be done upon the author’s request. The typical review process for papers submitted to RIO includes several technical checks and an external pre-submission review from a colleague.</span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>

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09/22/2015

Label Non-GMO Food Products

<p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">I have </span><a style="font-size: 11.2px; line-height: 19.04px;" href="/BioethicsBlog/post.cfm/who-s-afraid-of-gmo">previously written</a><span style="font-size: 11.2px; line-height: 19.04px;"> about genetically modified organisms (GMOs), concluded that their consumption is safe and that labelling them is not a good idea</span><span style="font-size: 11.2px; line-height: 19.04px;">. I am writing about them again and you might wonder why. Nothing has changed really. The scientific evidence of their safety remains strong and more accumulated experience of consumption by both humans and domestic animal supports this conclusion. Nothing has really changed. There remains an entrenched opposition to the use of genetically modified organisms. This opposition remains opposed to their consumption despite being unable to find scientific evidence to support their claims. Some have even resorted to making up scientific evidence that GMOs are harmful. There has been an ongoing movement to require that foods which contain GMO derived ingredients be labelled as such defended by the always compelling “people have a right to know” argument. So why am I writing about GMOs again. It is because prominent bioethicist Arthur Caplan has now <a href="http://www.nbcnews.com/health/health-news/why-gmo-foods-should-be-labeled-n423451">indicated his support</a> for labelling products containing GMO derived ingredients. </span></p> <p style="font-size: 11.2px; line-height: 19.04px;"> His argument is not based on safety. He believes GMO foods should be labelled because “ It is clear that some consumers want to know what they are eating and have a right to know what is in their food.” I strongly disagree. Not really about the right to know what is in their food. I disagree because labelling food because it is GMO derived is completely inconsistent with current practice and to bring that current practice up to the standards aspired for GMO food is more or less impossible.</p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>

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This entry was posted in Genetics, Health Care and tagged , . Posted by Hayley Dittus-Doria. Bookmark the permalink.

09/22/2015

Label Non-GMO Food Products

<p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">I have </span><a style="font-size: 11.2px; line-height: 19.04px;" href="/BioethicsBlog/post.cfm/who-s-afraid-of-gmo">previously written</a><span style="font-size: 11.2px; line-height: 19.04px;"> about genetically modified organisms (GMOs), concluded that their consumption is safe and that labelling them is not a good idea</span><span style="font-size: 11.2px; line-height: 19.04px;">. I am writing about them again and you might wonder why. Nothing has changed really. The scientific evidence of their safety remains strong and more accumulated experience of consumption by both humans and domestic animal supports this conclusion. Nothing has really changed. There remains an entrenched opposition to the use of genetically modified organisms. This opposition remains opposed to their consumption despite being unable to find scientific evidence to support their claims. Some have even resorted to making up scientific evidence that GMOs are harmful. There has been an ongoing movement to require that foods which contain GMO derived ingredients be labelled as such defended by the always compelling “people have a right to know” argument. So why am I writing about GMOs again. It is because prominent bioethicist Arthur Caplan has now <a href="http://www.nbcnews.com/health/health-news/why-gmo-foods-should-be-labeled-n423451">indicated his support</a> for labelling products containing GMO derived ingredients. </span></p> <p style="font-size: 11.2px; line-height: 19.04px;"> His argument is not based on safety. He believes GMO foods should be labelled because “ It is clear that some consumers want to know what they are eating and have a right to know what is in their food.” I strongly disagree. Not really about the right to know what is in their food. I disagree because labelling food because it is GMO derived is completely inconsistent with current practice and to bring that current practice up to the standards aspired for GMO food is more or less impossible.</p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>

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This entry was posted in Genetics, Health Care and tagged , . Posted by Hayley Dittus-Doria. Bookmark the permalink.