Blog.
01/29/2015
V-Ticket to Ride
by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership I haven’t been to Disneyland since my senior year in high school, and I’ve actually never visited one of the Disney World resorts. Frankly, I never really cared for the noise, the crowds and the artificiality of the Disney parks. The fact that […]
Last year, I blogged about the 2014 Oklahoma Medical Treatment Laws Information Act.
This law was enacted to educate clinicians about their duties, and patients about their rights, under the 2013 Oklahoma Nondiscrimination in Treatment Ac...
01/28/2015
End of life conversations
Having conversations with patients about death are difficult. Sometimes I think we need to talk, but the patient or family does not seem to be ready. I suspect that sometimes the patient wants to talk, but I am not sensitive to that. Sometimes a patient clearly has a terminal illness, but the patient or the family is in denial. Sometimes different physicians approach the patient... // Read More »
by Craig M. Klugman, Ph.D.
This past weekend I spent a cold, snowy day in the theater watching the movie Still Alice. Julianne Moore plays Alice Howland, a renowned neurolinguistics professor at Columbia University who is diagnosed with familial, early onset Alzheimer’s Disease. The film opens with Howland celebrating her 50th birthday where she has a momentary lapse in thought. We next see her giving a lecture at UCLA where she loses her place in giving a presentation. Then she is jogging through the campus where she has taught for decades and finds that she recognizes nothing.
The film shows Moore’s doctor visits as she seeks a diagnosis, her heartbreaking revealing of her disease to her family members, and how she and her life changes dramatically—and in a brief period of time—as she becomes someone else.…
The 2015 legislative session (the 84th) in Texas has just begun and some are getting ready to again tackle the Advance Directives Act.TADA was last amended in 2003. Multiple bills were advanced in 2007, 2009, 2011, and 2013. But none were enacted. Get ready for round five.
In the January 2015 issue of TEXAS MEDICINE: "In anticipation of another round of debates over end-of-life care, TMA's workgroup dedicated to the issue will work to protect physicians' ability to do what's best for patients in their final days."
Defending TADA is part of the Texas Medical Association's strategic roadmap for state advocacy initiatives, Healthy Vision 2020 (2d ed.).
"Legislation has been introduced over the past four legislative sessions that would instead require indefinite treatment with no provision for the physician exercising ethics or moral judgment. TMA has opposed these proposals because they would prolong unnecessary — and often painful or even torturous — care that cannot prevent but can only prolong death. They would also require physicians, nurses, and other health care professionals to provide medically inappropriate care, even if that care violates medical ethics or the standard of care. They also would set a dangerous precedent for the legislature to mandate the provision of physician services and treatments that may be medically inappropriate, outside the standard of care, or unethical."
Being a physician in an academic setting, my attention was drawn to this recent article in Academic Medicine: “Time Well Spent: The Association Between Time and Effort Allocation and Intent to Leave Among Clinical Faculty” by Pollart et al. I had mixed gut reactions to this topic; ranging from the notion that this is an awesome topic long overdue for attention, to the questioning of... // Read More »
Bertha Alvarez Manninen
01/27/2015
The Hepatitis C Epidemic in One Picture
Hepatitis C has been in the news lately, because of amazing (and amazingly expensive) new treatments that promise to cure their life-threatening illness. While we ought to debate the expense of these treatments, we should also remind ourselves of how … Continue reading →
01/27/2015
Medical Benefit Is ALWAYS Patient Determined
The value or benefit of any medical intervention can be assessed on two dimensions. First, the intervention can be assessed physiologically (e.g. does it restore function to an organ). Second, the intervention can be assessed subjectively f...
01/27/2015
Paying for Journal Peer Review
<p class="MsoNoSpacing" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Academic journal publishing is big business. More journals are popping up in almost every field especially with the open access movement dominating academic publishing. While editors of some high impact journals might reject papers outright, editors of most journals, especially open access journals, might be willing to send the paper out for peer review so long as it isn’t methodologically flawed (Arns, 2014). Some predatory <a href="http://scholarlyoa.com/publishers/">open access journals</a></span><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"> likely provide far less scrutiny and may send seriously flawed or poorly written papers to reviewers – I can personally vouch for this happening for one open access journal in my field. With the rise of journals and the increased pressure for scientists to publish, the demand and strain on peer reviewers and the peer review system is growing.</span></p>
<p class="MsoNoSpacing" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">There are certainly signs that peer review is placing demands on researchers. For example, my previous supervisor who is an expert in bioethics and health law once told me he receives a request to peer review an article every couple of days. Another researcher at Mt. Sinai Hospital at the University of Toronto in Canada mentioned that he receives 300 requests to review papers a year, each of which takes him 3-4 hours to complete (Diamandis, 2015). Many of my colleagues who are prolific researchers turn down peer reviews, trying to do only a few a year or pass it off to junior researchers. In a recent column of the journal </span><em style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Nature</em><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">, Martijn Arns explains that the increased pressure to review and the reluctance of researchers to undertake peer review might mean that editors will assign papers to reviewers who might not have the appropriate expertise in a particular area. Peer reviewers who are not experts on the topic should not accept articles to review, or declare to editors what areas they can appropriately review. Certainly junior researchers or doctoral students may not be international experts on a topic, but junior researchers might do a better job of reviewing manuscripts by investing more time and giving fair consideration to an article. However, given the time involved and the sense of obligation to conduct peer review, some reviewers might cut corners and perform mediocre reviews.</span></p>
<p class="MsoNoSpacing" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a 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="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong><span style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span></span></p>
AJOB
Target Articles:
Transferring Morality to Human–Nonhuman Chimeras
Ethical Review of Health Systems Research in Low- and Middle-Income Countries: A Conceptual Exploration
Correspondence:
Changing the Discourse on Health Systems Research: Response to Open Peer Commentaries on “Ethical Review of Health Systems Research in Low- and Middle-Income Countries: A Conceptual Exploration”