Will the Real Patient Please Stand Up?
What do your local McDonald's, Macy's and hospital have in common? While you are in line to get your Big Mac, Crocs or to get healthcare, you could be waiting behind a "secret shopper". As reported in Nebraska's La Vista Sun, a number of Midwestern hospitals, as well as others around the country, are turning to the customer service research methods of the retail industry to know how to serve patients better. These "secret shoppers" pose as patients gathering data about how patients are treated, how long they wait, what waiting rooms are like, and more. All in the service of improving customer service. Something seems strange about this...
A 1918 Flu Memoir
My grandfather was an amazing man, biologically speaking. He lived until age 103, so healthy that family lore has it that his cancer-ridden prostate actually grew back, apparently normal enough to have enabled him to survive another few decades. He ate his favorite food, deep fried crabs, until the day he died, and he didn't seem to have succumbed to anything in particular other than perhaps running out of ATP.
Grandpa Sam would amaze people with his memories of having seen Babe Ruth in action. But what always impressed me was his having survived the 1918 influenza pandemic that killed 50 million. My grandmother was his nurse - that's how they met. 
I remember clearly my grandfather teaching me how to blow my nose correctly, my sister and cousins happily spraying all manner of nasty pathogens around the circa-1960s kitchen in Brooklyn. As a child I'd wonder why and how he never had so much as a sniffle, given his constant exposures. Years later, as a graduate student in genetics and entrenched in evolutionary biology, I began to suspect that his having survived the Great Influenza somehow endowed him with a superhuman antibody response that lasted a very long lifetime. Maybe other astonishingly elderly antibodies are what protected him against the various rhinoviruses and adenoviruses that cause the common cold, which he also never seemed to contract.
Top 5 Stories of the Week on Bioethics.net
Just in case you missed them, below are the most-read news stories of the week from bioethics.net.
Summer Johnson, PhD
New possibilities for stem cell research
10 Aug 2008 - As America struggles with such weighty issues as the war in Iraq, the foundering economy and the run-up to a historic presidential election, it may be difficult to recall that seven years ago this month the most wrenching issue facing the nation was human embryonic stem cell research.
As Swimming Records Fall, Technology Muddies the Water
12 Aug 2008 - He swam so improbably fast, making up so much ground in a foaming, desperate attempt to reach the wall first in the 4x100-meter relay, that Jason Lezak not only won a gold medal for the United States on Monday, but he also helped to shatter the world record by nearly four seconds.
Let the Games Be Doped
12 Aug 2008 - Once upon a time, the lords of the Olympic Games believed that the only true champion was an amateur, a gentleman hobbyist untainted by commerce. Today they enforce a different ideal.
Handle With Care
12 Aug 2008 - Last year, a private company proposed "fertilizing" parts of the ocean with iron, in hopes of encouraging carbon-absorbing blooms of plankton. Meanwhile, researchers elsewhere are talking about injecting chemicals into the atmosphere, launching sun-reflecting mirrors into stationary orbit above the earth or taking other steps to reset the thermostat of a warming planet.
The ethics of eating organically and sustainably
12 Aug 2008 - Science, developments in food technology and a free exchange of information mean that the simplest of human reflexes has become a complex moral and philosophical conundrum.
Harvesting Hearts As Fast as One Can: Is It Ethical?
The controversy surrounding the New England Journal of Medicine article about using cardiac death as the criterion for death in pediatric heart transplant has sparked significant discussion among ethicists. Bioethicists have been asked to consider whether it is ethical that precious organs were harvested within literally seconds (75 to be exact) of cardiac death to preserve the integrity of the hearts prior to transplantation into their recipients.
One has to wonder: were the parents' decisions rushed in order to harvest organs, or if not in these cases, could they be in the future if this became standard practice? Does preserving the integrity of the organ justify whatever sacrifices of considered judgment might be made?
Personally, this policy seems to make sense for children who have experienced cardiac death and whose parents clearly have made up their minds that they wish to donate their child's organs to another needy recipient. However, for those parents whose child's death is sudden, which would be the case for many children whose hearts are healthy in the first place, and/or who may not have considered judgments about when they would consider their child dead (a horrible thing to even think about) and under which circumstances they would wish to donate organs, I am concerned that these parents may not be able to make adequately informed and rational choices about organ donation. These three cases presented by the NEJM article clearly did not suffer from these problems--but could other less carefully thought out protocols? No doubt.
Moreover, I question the NEJM authors' assertion that using cardiac death as the definition would increase substantially the number of donors available for pediatric heart transplantation. Certainly, it would make more persons and families POTENTIAL donors, but unless the majority of those parents choose to donate their child's organs one has to wonder if embracing this policy, even just for heart transplantation, would be justifiable in virtue of the number of actual donations gained.
Stay tuned to the blog for more updates as comments and commentaries come in about this issue. There no doubt it is bound to be a conversation starter among ethicists, doctors, and policy-makers all around.
Summer Johnson, PhD
Money! Turns Out Its Bad for You...
Peter Singer opines in today's Accra Daily Mail, one of Ghana's capital city newspapers, about the evils of money. Singer cites a behavioral study that concludes that even the slightest suggestions of money presented to a group of individuals (e.g. money passing on a computer screen) made them less likely to ask for help or even sit next to others. 
Does anyone else think that these conclusions about how money isolates us and makes us less willing to be helpful in our society ring a bit hollow? And what does the conclusion that money is not neutral really get us? We can't function without money in our society and I don't know how we'd try to be more "aware" of money in our lives as to counteract the effects Singer describes in his essay.
Rather than engage with Singer's claims, which fail to "cash out", let me just ask this--does it seem ironic to anyone else that this column, appearing in one of Ghana's major newspapers, written by a full professor with an endowed chair at Princeton University who literally makes, in salary alone, seventy times what the average Ghanaian earns a year (even minus his admirable 20% donation of his annual salary to charity). Strange that this philosopher should be making an argument about the non-neutrality of money to the Ghanaian people--don't you think?
In any case, Singer fails to make a positive suggestion for what we would do to counteract the negative pull that money creates. Start trading corn cobs? No, says Singer, even he acknowledges we can't escape money in this day and age. Then in the absence of a barter system or something to replace money that does not have the negative effects, what can we do?
I'm not sure--but I'm going to go buy a book to find out.
Summer Johnson
Should We Change the Definition of Death? Watch the Video...
Today's, New England Journal of Medicine published a report of successful pediatric heart transplantation from donors who suffered cardiac death. Part of their paper argues that using circulatory system failures as a definition of death would open up a significantly larger portion of cadavers available to donate organs.
To hear the ethics debate about this paper and the arguments surrounding cardiac death as a definition for death, check out NEJM's Perspective Roundtable on video.
The Olympics Heat Up Debate on Enhancement
With the Olympic competitions heating up, the debates on enhancement, sport, and the human form have more than left the starting blocks in the newspapers and online. Personally, I can't muster up more than a review of what's been written as I'm less than convinced that there are any really interesting ethical issues here to talk about.
Andy Miah's commentary in the Washington Post
argues that enhancement is great, but that steroids are not. Huh? In the New York Times, John Tierney says that if we can't test for enhancing drugs, we might as well "let the games be doped". Jonathan Moreno never really stakes a claim, but his Science Progress piece reminds us that progressives care about enhancement too, or at least know how to talk about it over sandwiches, liberal-style. Jere Longman and Gina Kolata, also in the Times, advance the claim that better technology, not better humans, is the reason why records are being shattered in Beijing.
Anyone else have a comment about enhancement? As for me, I'm going back to just enjoying watching the struggle, the thrill of victory, and leaving it to someone else to care whether the ancient Greeks are rolling over in their graves at the events of the 2008 Olympics.
Summer Johnson, PhD
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Coming Soon: Robo-Pancreas
Thanks to the folks at Engaget we have learned that researchers have developed an artificial pancreas complete with a remote device that monitors your blood sugar, morning, noon and night. 
This device could be a lifesaver for those with diabetes, particularly juvenile diabetes, if it could be a permanent implant that would allow for constant monitoring of blood sugar levels and injection of insulin from the device, says MIT Technology Review. One would hope that this device can be made accessible, affordable, and is proven to be safe for long-term use by the FDA. This device could potentially make disease management for diabetes incredibly simple and easy.
Yet, one wonders why one would prefer to have the Robo-Pancreas when they could have a real new pancreas grown from their own cells? One wonders why the Juvenile Diabetes Research Foundation is pursuing this line of research rather than that of Anthony Atala at the Wake Forest Institute of Regenerative Medicine who have already engineered artificial pancrei.
Yet while the Juvenile Diabetes Research Foundation continues to fund this work (see the project here), it is possible that Robo-Pancreas will be available in the not too distant future.
But if it were between a cellular replacement or a robotic one, for those dealing with diabetes, the bottom line is a pancreatic replacement of some kind will result in better health outcomes for all. Only time will tell which will be the better solution.
Summer Johnson, PhD
Beware: Your Doctor May Be a Blogger...
A recent report in the Journal of General Internal Medicine, as reported on US News and World Report, found that more than half of medical blogs allowed the physicans themselves to be identified and even some patients could identify themselves from the blog entries.
Far be it from us to discourage blogging, but we certainly do encourage ethical blogging by doctors who protect patient privacy, disclose financial or other conflicts of interest, and adhere to ethical standards in regard to advertising and promoting medical products (all of which the JGIM article suggests some physician blogs failed to do).
So next time you are in your doctor's office, you might want to casually ask: "Hey Doc, do you blog?"
Summer Johnson, PhD
