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Author Archive: Hayley Dittus-Doria

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09/18/2015

Heads Up: Plans for Head Transplant in 2017

<p><span style="font-size: 11.2px; line-height: 19.04px;">Frankenstein might want to weigh in on the release of a plan to provide a new body to a Russian man suffering from the rare muscle wasting disease, Werdnig-Hoffmann disease.  Commentators speculate that the proposed fusion of “Mr. Valery Spiridonov, a 30-year-old computer scientist from Vladimir, Russia” to a donor body is unlikely to ever actually be performed due to the <a href="http://www.medicalnewstoday.com">seeming unlikely odds</a> that the technical challenges could be overcome. Nonetheless, this extreme experimental undertaking raises important ethical questions about how far to press the boundaries of surgery. At one time, hemicorporectomy surgery was proposed as theoretically feasible, and though the suggestion was laughed at initially, this procedure has now been done successfully multiple times, albeit with significant risk of mortality. If we are indeed embarking on a new path where the head of one living being can be transplanted onto another, we must attend to the underlying values that we ascribe to mind, body, and personhood. <br /></span></p> <p><span style="font-size: 11.2px; line-height: 19.04px;"></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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09/14/2015

Is Sex Selection Ethical?

<p>In some countries where there is a strong preference for sons due to cultural and religious reasons, women sometimes choose to have an abortion after learning the sex of the fetus they carry is female, which is often referred to as sex selection abortion. For example, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166246/">sex selection abortion</a> is common in India and has increased significantly in the couple of last decades, especially for pregnancies following a firstborn daughter. The prevalence of sex selection abortion is also common in China, often referred to as the “<a href="http://jhr.uwpress.org/content/45/1/87.short">missing girls of China</a>” phenomenon, and is due to a similar cultural preference for sons as well as the One Child Policy.</p> <p>Given the strong pressure women are under to have sons, is ethical for them to have sex selection abortions? Some point out that it may not be women’s authentic choice that is leading them to abort female fetuses but rather familial pressure from their husband and other family members as well as broader social pressure. In these situations, paternalistic approaches may be more justifiable in order to protect women from oppressive social forces that may coerce them into having sex selection abortion. From a justice perspective, outlawing sex selection abortion sends the message that sex discrimination is wrong, seeks to protect female fetuses, and attempts to ensure a balanced birth ratio between females and males.</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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09/10/2015

Will America Ever Come To Terms With Its Past?

<p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">In my <a href="/BioethicsBlog/post.cfm/some-reflections-on-summer-vacation-reading">last blog</a> I wrote, what was in effect, a review of three books from my summer reading I did while on vacation. The first book covered the life of George Washington from the time of his resignation as General in the Continental Army, through his leadership in the Constitutional Convention in 1788, until his inauguration ceremony on 1789. The second book was a narrative history of the Great Migration of African Americans from the Jim Crow south to Northern and Western cities, and the hardships they endured throughout. And finally the third book was a contemporary description of what it is like to live in a black body today in the United States. I have been continuing my thoughts on the fate of blacks in America.</span></p> <p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">From the era of George Washington, we see the American political and social power structure becoming embedded into a political system filled, from the first moment with enormous hope but with equal, deeply troubling contradictions. There was eloquent language of the “many” no longer having to remain subservient to the “few” that seemed to reflect through reason the rights of human kind. Yet it was equally clear that Washington’s America was created to protect the financial interests of privileged white males as many human beings were excluded from participation in the new, fledgling nation, including women, native Americans who would be driven from the lands and basically exterminated, and African Americans, a few of whom were free but most enslaved as the property of white slave owners. </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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09/08/2015

Thoughts on Flexner and Professionalism, 1915 and 2015

<p style="font-size: 11.2px; line-height: 19.04px;"><span style="font-size: 11.2px; line-height: 19.04px;">Education reformer <a href="/BioethicsBlog/">Abraham Flexner</a> (1866-1959) is regarded by many as the father of Modern America’s medical education curriculum. He authored the Flexner Report for the Carnegie Foundation after making site visits to all the country’s medical and osteopathic medical schools of the day. He harshly criticized the vast majority of the schools he visited. His insightful recommendations were adopted for the most part within just a few years and his Report continues to influence medical education today.</span></p> <p style="font-size: 11.2px; line-height: 19.04px;">In 1915, Flexner addressed the National Conference of Charities and Corrections. The title of his speech was “<a href="http://scholar.google.com/scholar_url?url=http://thorn.pe.kr/attachment/cfile10.uf%4018606E444E7FBD4D025599.pdf&amp;hl=en&amp;sa=X&amp;scisig=AAGBfm2BgvQhpf9d1DrnsPpZz_hCI3a1-g&amp;nossl=1&amp;oi=scholarr">Is Social Work a Profession?</a>” He answered that <a href="https://www.ssa.uchicago.edu/reassessing-social-works-first-critic">it was not</a>. Flexner compared social workers of the day against the “benchmark” professionals of medicine, law, and preaching, and found that those who provided social work services had not yet achieved true professional status. He saw the social worker of the day as a “narrow minded technician.” In deference to social workers, Flexner also viewed nurses and pharmacists the same way.</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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09/04/2015

Are Primary Care Providers Providing Primary Care?

<p class="MsoNormal" style="font-size: 11.2px; margin-bottom: 0.0001pt; line-height: normal;"><span style="font-size: 11.2px;">I initially set out to write a post about lack of access to primary care physicians, but the more I explored the topic, the more I realized that the issue is not only that access to PCPs is limited, but that the medical model of primary care itself has changed.</span></p> <p class="MsoNormal" style="font-size: 11.2px; margin-bottom: 0.0001pt; line-height: normal;"><span style="font-size: 11.2px;">It has been widely discussed among bioethicists and health care policy experts that emergency departments are overcrowded, urgent care centers are rapidly</span><a style="font-size: 11.2px;" href="http://registerguard.com/rg/news/local/33331415-75/ccundoctored-sidebar-hedliney-herey.html.csp">becoming a substitute for the traditional primary care doctor</a><span style="font-size: 11.2px;">, and that the number of new physicians specializing in primary care medicine has been declining </span><a style="font-size: 11.2px;" href="/BioethicsBlog/post.cfm/what-we-can-learn-from-medical-students-about-the-need-for-health-care-reform-in-the-u-s">in favor of other, higher-paying specialties</a><span style="font-size: 11.2px;">.</span><span style="font-size: 11.2px;">  </span><span style="font-size: 11.2px;">Still, many insurance plans require regular visits with a PCP and only cover specialty services if the referral is made by the patient’s primary doctor.</span><span style="font-size: 11.2px;">  </span><span style="font-size: 11.2px;">Specialists and urgent care clinicians also insist that patients follow up with their PCP after treatment and make sure that their records are forwarded.</span><span style="font-size: 11.2px;">  </span><span style="font-size: 11.2px;">Despite the push for establishing a “medical home” and centralizing care around the primary care physician, demand for urgent care or emergency services is still high, and getting into a practice or getting a timely appointment with a primary care physician is difficult.</span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.04px; font-size: 12px;"><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; line-height: 19.04px; font-size: 12px;">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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08/28/2015

Marketing Trumps Science, or How the Pink Pill Does Not Even the Score

<p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">This month’s blog is going to be a bit of a rant. I don’t generally consider myself a rant-y person, but some of the commentary surrounding the recent </span><a style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;" href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm458734.htm">FDA approval</a><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"> of the sexual desire disorder drug Addyi has proven too much for my delicate constitution.</span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">First, what I am NOT doing: I am NOT denying the existence of hypoactive sexual desire disorder (HSDD), or that for women who are so afflicted it can cause serious distress or otherwise negative consequences. I am NOT challenging the notion that HSDD is a medical problem that warrants seeking a medical treatment or medical solution. I am NOT arguing against pharmaceuticals in general, or here specifically, as a potentially viable medical treatment for HSDD. I am NOT saying all pharmaceuticals should have absolutely no risks or side effects, or should be required to produce overly substantial benefits for it to be appropriate for them to be FDA-approved and released to the market. I am NOT calling into question the claims that there are very real sex and gender disparities in medicine, human medicalization, and medical treatment. And I am NOT disputing the value of empowering women with greater control over their own bodies and their own healthcare.</span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.0400009155273px; font-size: 12px;"><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; line-height: 19.0400009155273px; font-size: 12px;">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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08/25/2015

Reproducibility Project or Research Police?

<p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">One of the great things about scientific knowledge is that it is subject to confirmation or refutation by subsequent research. Science can be confirmed by other laboratories repeating the same studies and finding the same results. However this rarely occurs in the actual course of normally conducted science. In the course of doing science most scientists choose not to simply try to simply replicate the previous study. Rather they consider the findings in the previous study develop the next hypothesis and do a study to extend the findings. Now this seems to be changing.</span></p> <p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">In 2011 authors from Target Research, a component of Bayer Healthcare, published <a href="http://www.nature.com/nrd/journal/v10/n9/pdf/nrd3439-c1.pdf">correspondence in Nature</a> reported that surveys of their internal scientists found “that only in ~20–25% of the projects were the relevant published data completely in line with our in-house findings”. This figure has been widely quoted in the literature but has been transformed into only 20-25% of these research findings were reproducible. There are many problems with this statement and this argument. First it is predicated on the presumption that an appropriate standard for reproducibility is data being entirely “in line” with the work done by internal scientists at Bayer Healthcare. Moreover the studies at Bayer Healthcare, unlike the studies they sought to replicate, were not submitted to the scrutiny of external peer review. There is every reason to consider the possibilities that the fault lies with the replicating studies at Bayer or possibly they did not exactly replicate the studies. We are left to simply accept the word of Bayer without the normal standard of quality that derives from peer review.</p> <p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.0400009155273px; font-size: 12px;"><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; line-height: 19.0400009155273px; font-size: 12px;">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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08/21/2015

Some Reflections On Summer Vacation Reading

<p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">I love to read novels and works of non-fiction in concentrated sittings so I can really lose myself in what I am reading. Because I am so busy during the course of my work-a-day professional life I rarely have such luxury. This is why vacation for me means a time when I can find a few really interesting books on my reading list and just devour them. Having recently returned from vacation and being overdue for my AMBI Blog, I thought I would share a few thoughts on my vacation reading, and even see if there is a lesson for bioethics.</p> <p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">This summer my reading was unusual in that it was all non-fiction, which included “The Return of George Washington” by Edward J. Larson, “The Warmth of Other Suns” by Isabel Wilkerson, and “Between the World and Me” by Ta-Nehisi Coates. I really didn’t plan to be reading these books together. But as it turns out, after finishing all three, I found a theme of interesting, often disturbing, questions about the past and present treatment of African Americans in the United States—questions that challenge the moral foundation and integrity of American democracy from its origins to the present.</span></p> <p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;"><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: 19.0400009155273px;">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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08/19/2015

NIH Budget Increase on One Hand, Fewer Outputs on Another

<p class="MsoNoSpacing" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">I love reading the news posts in </span><em style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Nature </em><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">and </span><em style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Science</em><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"> that I receive in the journal’s eAlerts. This past month was most interesting because there were two news posts that I thought were actually a bit contradicting. The first one titled “Spending bills put NIH on track for the biggest raise in 12 years” was published in July of this year and explains how both houses of congress want to increase the National Institutes of Health’s (NIH) annual budget (Kaiser, 2015a). The Presidential branch wants to give the NIH a 1 billion dollar increase while just recently, a Senate panel approved a 2 billion increase. The article also goes onto say that certain programs have been given priority such as the Alzheimer’s research and others like the Agency for Healthcare Research and Quality will receive cuts. Needless to say, I am sure that biomedical and behavioral scientists throughout the country are probably ecstatic. But is this really a good thing?</span></p> <p class="MsoNoSpacing" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">The other news blurb I read was titled an “A for effort, C for impact from U.S. biomedical research, study concludes” also written by the same author (Kaiser, 2015b). In this article, Jocelyn Kaiser reports the results of a study by two research scientists Dr. Arturo Casadevall and Anthony Bowen who examined publications in the PubMed database and the number of authors, along with the approval of new drugs and their work was published in the journal </span><em style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Proceedings of the National Academy of Sciences (USA)</em><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">. The researchers compared publication outputs with the number of new molecules approved by the U.S. government. What they found was not too surprising. </span></p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.0400009155273px; font-size: 12px;"><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; line-height: 19.0400009155273px; font-size: 12px;">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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08/14/2015

Living Organ Donations and Social Media

<p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Articles about improving organ donation registration rates by targeted social media campaigns have indicated that such efforts can successfully increase the numbers of individuals who elect to become organ donors </span>(Pena, 2014) (Cameron AM, 2013)<span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">. While it is acknowledged that social medial is a useful medium for generating widespread recognition of the need for organ donation, concerns about whether or not donor registration actually increases donation rates is left unknown. Additional concerns about such registrations meet the standards for informed consent. These are productive conversations, and social media holds tremendous potential for conveying information and generating levels of interest in topics at a ‘viral’ level.</span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Discussions up to this point seem to focus on donation after death, or in the context of imminent death. What has not been robustly discussed is the role of social media in the role of live organ donation. How should transplant programs view the relationship of acquaintances that begin on social media in the context of seeking information or support related to organ donation? Decisions to donate a solid organ, such as a kidney, ought not to be undertaken lightly, and perhaps the screening process will weed out donors with ambivalent intent or poor understanding of what they have offered a recipient. Given that concerns about informed consent have been noted in prior studies, it seems prudent to exercise added caution when approving donation transactions initiated via social media outlets.</span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;"><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: 19.0400009155273px;">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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