» Health Care Where the World Finds Bioethics Mon, 21 Jul 2014 19:32:44 +0000 en-US hourly 1 DALLAS BUYERS CLUB meets SCIENTIFIC INTEGRITY Sun, 20 Jul 2014 20:24:00 +0000
DALLAS BUYERS CLUB  is a biopic about an unlikely hero, directed by Québécois Jean-Marc Valle and written by Craig Borten and Melisa Wallack. In case you get a call from your local AIDS-Walk coordinator, remember 50,000 cases of AIDS (Acquired Immune Deficiency Syndrome) still occur in the USA annually. Transmission is largely preventable with education, testing and early intervention. Ethnic peoples of color are disproportionately affected in new cases. Thirty-five years ago, I never imagined AIDS would be the defining disease of my career and then some.  After my AIDS-Walk call, I pulled out my notes on Dallas Buyers Club, which screened October, 2013 at the Mill Valley Film Festival. It has won three Oscars and too many to count other awards.

The year 2013, brought a number of film releases with main characters who had significantly degenerate moral fiber. You know them, good acting, sex, drugs, brutality prominent but few redeeming qualities.  Dallas Buyers Club (DBC) is not one of those films. Its lead character is definitely a degenerate, but develops moral fiber.  If “The Star” of a film is the person who undergoes the most change, Ron Woodroof (Matthew McConaughey) may be the star of the millennium. His character moves from self-serving reprobate to enlightened self-interest. In the process, he believably expands compassion for others. The compassion fall-out includes Jared Leto, (Rayon) who well plays a stereotype of a transgender woman whose script, in contrast to Woodroof’s, traverses only the narrow ground between dying and dying more.

Dr. Eve Saks (Jennifer Gardner) spoke particularly to me. She had that deer in the headlights feel to her -- as she decided to which side of the road she would jump -- with her patients, or with her retrograde moving profession. Her subtle portrayal of an overwhelmed newbie was reminiscent of my internship at Cook County Hospital, Chicago in 1985.  I saw 17 hospitalized patients with AIDS, within my first 35 days. Fortunately, I had good role modeling by Drs. Ron Sable, Renslow Sherer and Dr. Jonathan Mann. 

Among those 17 patients was an 8 year old girl with Leukemia, AIDS and tuberculosis - the later was diagnosed on autopsy, which brings me to the bioethical point. Four years before that autopsy, I was told in medical school that miliary or disseminated tuberculosis no longer existed -- that was then, this was now.  Diseases change and so should the manner of treating and studying them and their cures.  In medicine it’s not “location, location,” but “observation, observation.”

DBC is about how AIDS, science, research and Federal Drug Administration regulations were forced to change. The change was pushed by the autonomy of people who ran the most risk of dying from AIDS and their allies.  The principle of justice requires equipoise or the equitable distribution of burdens and benefits.  The job of clinicians is to understand and communicate the burdens and benefits so that individuals, who can, are able to exercise their autonomy. When there is no proven cure, those with life threatening illnesses and intact decisional capacity, now, can choose through the informed consent process, to run the risks of clinical research protocols, whose outcomes are as yet unproven.  Access to such trials is currently a health disparity. Navigating the clauses in the three proceeding sentences is the job of bioethics in new diseases, therapies and research.  This is how we learned that oral anti-virals could reduce HIV/AIDS vertical transmission from mother to child. 

Data safety monitors (DSM), augment institutional review boards and were given teeth during the rise of the AIDS epidemic.  DSM allowed tracking of acceptable burdens associated with research, on vulnerable persons while the studies are in progress.  DSM also can stop studies where the burdens outweigh the benefits, or the benefit is so clear that lifesaving therapies should not be with-held to complete the research.  This acceptability should be consistent with the 2013 World Medical Association amended Declaration of Helsinki on Medical research. Significantly this amendment references identifiable human material or data. This would recognize the privacy of genomic material correcting ethical violations associated with HeLa cells and other genetic technologies. Consider, non-small-cell lung cancer, the most ubiquitous cancer in the world.  In that case, we look at the value of Palliative Care, genomic-bio-marker driven therapy and clinical trials, all three at once. The criteria for treatment look like a menu at an over stocked diner, but bioethics helps to navigate them.   Such protocols would not be possible without changes in policy and procedure reflected by the struggles of those affected by HIV/AIDS and the bioethical analysis accompanying them.

Set in 1985, the story is sandwiched between the year before AZT was found effective (the first of the anti-viral drugs used in HIV/AIDS) and the year after, Robert Gallo and Luc Montagnier both discovered HIV-1 as the agent causing AID.  The footprints of the Dallas Buyers Club are everywhere.


Dallas Buyers Club (35mm) directed by Jean-Marc-Vallee (2013) Focus Features (USA) 116 min

Some other films about the HIV/AIDS epidemic:

How to Survive A Plague (35mm) David France (2012) Sundance theatrical/IFC (USA) 109min

Philadelphia(35mm) directed by Jonathan Demme (1993) Tri Star (USA) 125 min

Yesterday (35mm) directed by Darrell Roodt(2004)HBO USA ( South Africa) 96 min ( Zulu, English  subtitled)

The Declaration of Helsinki  accessed July 16, 2014 2013

HIV/AIDS statistics USA accessed July 16, 2014.

World Association of Bronchoscopy and Interventional Pulmonology Academy : Small Sample Tissue Acquisition and Processing for Diagnosis and Biomarker-driven Therapy of NSCLC. Bioethical issues video commentary.
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Do Oregon and North Dakota Healthcare Surrogates Perform Better? Sun, 20 Jul 2014 02:39:00 +0000 0 Is complicity important in Hobby Lobby decision? Fri, 18 Jul 2014 19:22:54 +0000 0 Safeguarding Children in Emergencies through Ethical Pediatric Research Fri, 18 Jul 2014 15:00:29 +0000 0 Pope Cited by NRLC before Senate Judiciary Committee Fri, 18 Jul 2014 08:30:00 +0000 0 Great but “unaffordable” new drugs Thu, 17 Jul 2014 21:03:09 +0000 Read More »]]> 0 Nature Isn’t What It Used To Be Thu, 17 Jul 2014 14:54:00 +0000 0 She Ain’t Heavy, She’s My Brother Thu, 17 Jul 2014 13:37:44 +0000 ]]> 0 Only a Third Who Express a Preference to Die at Home, Actually Die at Home Thu, 17 Jul 2014 12:15:00 +0000 0 Rationing Is Not a Four-Letter Word Thu, 17 Jul 2014 08:00:00 +0000 Philip M. Rosoff is a practicing physician and Professor of Pediatrics and Medicine at Duke University Medical Center, where he is also a member scholar of the Trent Center for Bioethics, Humanities, and History of Medicine, and Director of Clinical Ethics at Duke University Hospital.

He has just published Rationing Is Not a Four-Letter Word with MIT Press.  I like this book's thesis and explored it (a little) in some posts like "Top 10 North American Death Panels."

Here is the abstract:

Most people would agree that the healthcare system in the United States is a mess. Healthcare accounts for a larger percentage of gross domestic product in the United States than in any other industrialized nation, but health outcomes do not reflect this enormous investment. In this book, Philip Rosoff offers a provocative proposal for providing quality healthcare to all Americans and controlling the out-of-control costs that threaten the economy. He argues that rationing—often associated in the public’s mind with such negatives as unplugging ventilators, death panels, and socialized medicine—is not a dirty word. A comprehensive, centralized, and fair system of rationing is the best way to distribute the benefits of modern medicine equitably while achieving significant cost savings.
Rosoff points out that certain forms of rationing already exist when resources are scarce and demand high: the organ transplant system, for example, and the distribution of drugs during a shortage. He argues that if we incorporate certain key features from these systems, healthcare rationing would be fair—and acceptable politically. Rosoff considers such topics as fairness, decisions about which benefits should be subject to rationing, and whether to compensate those who are denied scarce resources. Finally, he offers a detailed discussion of what an effective and equitable healthcare rationing system would look like.
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Reading the Body: Live! Wed, 16 Jul 2014 14:29:09 +0000 0 Freedom and our connection to the root Wed, 16 Jul 2014 13:40:48 +0000 Read More »]]> 0 Defending Advance VSED – Hasten Death by Dehydration Wed, 16 Jul 2014 07:30:00 +0000 0 Suicide Prevention: There’s an App for That Wed, 16 Jul 2014 04:07:39 +0000 0 A “diagnosis” a physician can no longer make? Wed, 16 Jul 2014 03:06:13 +0000 Read More »]]> 0 The VA Crisis is Fundamentally an Ethics Crisis Tue, 15 Jul 2014 14:54:00 +0000 Evelyne Shuster]]> 0 Hello, From Michigan! Tue, 15 Jul 2014 13:51:50 +0000 0 Call for Papers – AALS Section on Law, Medicine & Health Care Works-in-Progress for New Teachers Tue, 15 Jul 2014 08:30:00 +0000 Call for Papers

AALS Section on Law, Medicine & Health Care

Works-in-Progress for New Law School Teachers

AALS Annual Meeting, Washington, DC

Saturday, January 3, 2015

The AALS Section on Law, Medicine and Health Care is pleased to announce a Call for Papers for a special Works-in-Progress for New Law School Teachers Program.  The Section will run the Program from 5:15 to 6:30 p.m. on Saturday, January 3, at the AALS 2015 Annual Meeting in Washington, DC.

This program will bring together junior and senior health law scholars for a lively discussion of the junior scholar's’ works-in-progress.  Junior health law scholars will submit papers that they expect to submit in the spring 2015 law review submission cycle.  After they briefly present their papers in a concurrent roundtable setting, senior scholars will provide oral comments and critiques.  This new program presents an opportunity for the audience to hear cutting edge health law scholarship by recent members of the academy.

We will limit our selection to two or three papers.

Form & Length of Submission

Eligible faculty members are invited to submit either manuscripts or abstracts dealing with any aspect of health law or policy.  Abstracts must be comprehensive enough to allow the committee to meaningfully evaluate the aims and likely content of the papers proposed.  Papers may be accepted for publication but must be at a stage where input still would be useful.  Papers must not be published prior to the Annual Meeting.

Deadline & Submission Method

To be considered, manuscripts or abstracts and a CV must be submitted electronically to both: 
Chair, Section on Law, Medicine, and Health Care
Ani B. Satz, Emory University School of Law,
Chair-elect, Section on Law, Medicine, and Health Care
Thaddeus Pope, Hamline University School of Law,

The deadline for submission is September 1, 2014.

Selection & Notification

Papers will be selected after careful review and discussion by the Executive Board of the AALS Section on Law, Medicine, and Health Care.

The authors of the selected papers will be notified by September 22, 2014.

If a selected author has submitted only an abstract for review, the author must submit the corresponding manuscript by December 15, 2014.

The Call for Paper participants will be responsible for paying their annual meeting registration fee and travel expenses.


Full-time untenured faculty members of AALS member law schools are eligible to submit papers.  The following are ineligible to submit: foreign, visiting (without a full-time position at an AALS member law school) and adjunct faculty members, graduate students who are not also enrolled in a qualifying J.D. program, fellows, non-law school faculty, and faculty at fee-paid non-member schools.  Papers co-authored with a person ineligible to submit on their own may be submitted by the eligible co-author.

Please forward this Call for Papers to any eligible faculty who might be interested.

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Med Student vs. Dr. Oz Tue, 15 Jul 2014 02:49:29 +0000 Read More »]]> 0 Patient Modesty: Volume 67 Mon, 14 Jul 2014 18:31:00 +0000

 So with Volume 66 reaching some 170 postings, we should move on to this Volume 67.  What is special on starting this new Volume is the fact that Artiger  joined us in Volume 66.  Artiger is a male physician (surgeon) verified by the Medscape medical website, where we both participate, who has provided us  with the long-needed professional input and education from the outside of this blog.  It appears that those writing to this thread have found his comments of interest and has accepted his presence here.  I have no idea how long Artiger will stick around but as long as he decides to do so, I will find him most welcome as a significant contributor to the ongoing discussion.  Here is Artiger's last posting from Volume 66. ..Maurice.

Misty, participating in this blog simply reinforced my current practice. I work on the assumption that everyone cares about modesty. If you'll go back to my original comments (posted by Maurice on June 26 at 7:30am), you'll see what I am thinking about during an examination or procedure. When discussing breast incisions with women, I tell them about where the scar will be, and my method of closure to achieve the best possible cosmetic outcome. Many of them tell me that they don't care what it looks like, and I respond by telling them that I care what it looks like.

I certainly understand if a female patient wants to drive another 100 miles or more to see a female surgeon. Like I said, I've got plenty more here that come to see me because of the service and courtesy I provide, not to mention how quickly I get them in to see me or get their procedure scheduled. Some people care more about that than gender. As an example I may have already mentioned, in an area we used to live, my wife drove 100 miles (past 2 female OB/gyn's) to see my best friend from medical school. Why? Because he gave her the best in care and service. I didn't have to convince her, seeing him was her idea. Never bothered either of us in the slightest, even when we would go visit them socially or take trips with them.

Don, yes, discussing these issues and concerns are about half of the office visit. Although we don't shave (we use clippers) we don't remove any more hair than necessary, just enough to allow for a clear field for the proposed incision. As for catheters, that is always discussed ahead of time as well. Catheters are useful but they are not without their risks, and they are not to be taken lightly.

No, the referring providers usually don't cover these things (they really wouldn't have a clue where to begin, I'll tell you candidly), as it's not their place to do so. That is what the office visit with me is for. If they could discuss all these things adequately then they could just call and schedule the procedure. I have never felt comfortable doing it that way, but there are a lot of places where you can get a colonoscopy without ever meeting the person who will do it. That's another part of my office visit that I feel is important...I want the patient to know me, who I am, what I look like, have all of their questions answered, and be comfortable with me as their surgeon.


Thom, Robert A.: Paré. Photograph. Britannica Online for Kids. Web. 14 July 2014.  
Ambroise Paré was a French army surgeon in the 1500s who invented compassionate ways to handle wounds and hemorrhages. The painting was done by Robert A. Thom in about 1954.

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Funerals – Posing the Dead as Living Mon, 14 Jul 2014 09:00:00 +0000 0 New York’s Medical Marijuana Law May Just Be a Political Hoax? Mon, 14 Jul 2014 05:07:23 +0000 0 20th World Federation Conference of Right to Die Societies Sun, 13 Jul 2014 08:00:00 +0000 0 Kentucky Judge to Decide on Hospital Treatment for Dead 2-Month Old Isaac Lopez Sun, 13 Jul 2014 08:00:00 +0000 0 Safeguarding Our Stories, Our Selves Sat, 12 Jul 2014 12:00:47 +0000 Read More »]]> 0 International Conference on End of Life: Law, Ethics, Policy, and Practice Sat, 12 Jul 2014 07:30:00 +0000 0 How To Tell Someone That She Is Dying Fri, 11 Jul 2014 15:25:48 +0000 Continue reading ]]> 0 Multidisciplinary Members and Staff Reflect the Unique Field of Bioethics Fri, 11 Jul 2014 14:54:23 +0000 0 The Recent Stem Cell News Fri, 11 Jul 2014 13:49:39 +0000 Read More »]]> 0 Nominate the Medical Futility Blog Fri, 11 Jul 2014 09:30:00 +0000 0 The Principle of Equivalence Reconsidered: Assessing the Relevance of the Principle of Equivalence in Prison Medicine Thu, 10 Jul 2014 19:36:48 +0000 0 Hensinki Declaration revisions weaken protections for developing country trial participants Thu, 10 Jul 2014 16:46:37 +0000 0 Moral Distress Education Project Thu, 10 Jul 2014 09:00:00 +0000 Medical futility disputes have been repeatedly measured as one of the biggest causes of moral distress, especially among nurses.

The University of Kentucky has launched a completely free continuing education version of The Moral Distress Education Project. The program functions as a self-guided documentary that provides up to 2.0 hours credits. 

Unidentified or unresolved moral distress leads to retention problems; horizontal violence; and patient-care gaps. By the end of this program learners will understand the root causes of moral distress and how to prevent it by developing better communication strategies and systems-based approaches to reduce moral distress and moral residue, which improves patient care overall and faculty/staff competencies. By completing all three modules, you'll become aware of what moral distress is, and how it occurs. You’ll also be able to properly define moral distress and share definitions with colleagues/coworkers.

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Time to Divorce Health Insurance & Employment Thu, 10 Jul 2014 05:07:31 +0000 by Craig Klugman, Ph.D.

In my last blog, I talked about ideologically-backed corporate control of health care choices as a result of the U.S. Supreme Court’s Hobby Lobby decision. That piece has led to several conversations this past week, many of which have revolved around the question of how to fix the problem of employer theology limiting or curtailing choices, because nearly half of all people in the U.S. have health insurance through their employer.

The result of these conversations is a consensus that there are two health policy moves that can be made: Changing a law and changing a system.…

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Relevance of Case-Based Studies in Workshops on RCR for Diverse Audiences: the importance of including both (Part II) Thu, 10 Jul 2014 03:07:26 +0000 0 Understanding Cultural Diversity at End-of-Life – New eBook Wed, 09 Jul 2014 15:24:00 +0000 0 Burwell v. Hobby Lobby: A thin margin indeed Wed, 09 Jul 2014 02:52:35 +0000 Read More »]]> 0 Merck Says It Regrets Strong-Arming Italian Researcher Tue, 08 Jul 2014 16:32:34 +0000 0 Persons, Personhood, and Primates Tue, 08 Jul 2014 15:07:55 +0000 Read More »]]> 0 Hobby Lobby Decision Likely to Increase Health Care Inequity Tue, 08 Jul 2014 14:54:00 +0000 Michael K. Gusmano]]> 0 Palliative Care – An Illustrated Story Tue, 08 Jul 2014 01:28:00 +0000 0 Don’t Cry for Me, Doctor Tina? Mon, 07 Jul 2014 15:07:01 +0000 Continue reading ]]> 0 Alzheimer’s Disease, Biomarkers, and Suicide: Why We Need to Think About All Three Together Mon, 07 Jul 2014 14:54:00 +0000 0 Imagine there were no Private Academic Publishers Mon, 07 Jul 2014 02:07:42 +0000 0 Louisville Judge Orders Kosair Children’s Hospital to Continue Ventilating Brain Dead Child Fri, 04 Jul 2014 12:40:00 +0000 0 Louisville Judge Orders Kosair Children’s Hospital to Continue Ventilating Brain Dead Child Fri, 04 Jul 2014 12:40:00 +0000 0 POLST Introduces No New Risks Fri, 04 Jul 2014 08:30:00 +0000 0 POLST Introduces No New Risks Fri, 04 Jul 2014 08:30:00 +0000 0 Musing About the Hobby Lobby Decision Thu, 03 Jul 2014 23:35:13 +0000 Read More »]]> 0 The Curious Case of Hobby Lobby Thu, 03 Jul 2014 10:43:16 +0000 ]]> 0