Articles Posted in Ethics

Collinslab-150x150Mukamal-144x150The National Institutes of Health, perhaps the world’s leading medical research institution, has moved fast to try to fix self-inflicted damage to its reputation caused by a controversial $100-million study on alcohol and its harms.

NIH Director Francis Collins halted the study, and an advisory group backed his action, lambasting researchers for soliciting funding and counsel from the alcohol industry for a work that purported to answer key and fundamental questions about booze but from its outset leaned toward seeing benefit in moderate drinking.

The New York Times deserves credit for digging into the dubious  actions by researchers supported by the National Institute on Alcohol Abuse and Alcoholism, an arm of NIH.

mentalnyt-300x142Although Americans keep making progress toward ending the stigma associated with mental disorders, including trying to put public funding for the diseases’ treatment on a more even footing, patients with serious mental illness suffer unfairly and harshly still due to their conditions.

Dhruv Khullar, a doctor at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, has written a painful piece for the “Upshot,” an evidence-based column for the New York Times. His article, “The Largest Health Disparity We Don’t Talk About,” reports that:

Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younger than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It’s a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half-century [for most in this country] have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world’s poorest countries.

catheterablation-300x193It’s one thing when modern medicine becomes so hidebound that it struggles over shedding a bit of traditional doctors’ garb. But new information emerging about cardiology’s entrenched reliance on maverick surgeons and evidence-light therapies in treating heart problems raises real questions: Exactly what’s going on in this costly area of care?

Haider Warraich ── a cardiology fellow at Duke and author of “Modern Death,” a book exploring how technology and modern mores are changing patients’ end-of-life experiences ── deserves praise for raising major concerns about the too easy acceptance by doctors and surgeons of existing, device-based treatments for heart conditions. The headline on his Op-Ed in the New York Times summarizes well his tough point: Don’t Put That in My Heart Until You’re Sure It Really Works.

He, of course, points to recent challenges about the effectiveness of cardiac stents. They have been commonly used for years now ── in hundreds of thousands of surgeries ── supposedly to relieve blockages in patients with stable chest pain. But recent research has started to show they provide no benefit over drugs, and it was only after further study showed that a new kind of dissolving stent contributed to increased heart attack risks that the device maker pulled the already in-use product, Warrich notes.

insurersPP-300x296Patients who expect their health insurer will work in their interests to contain costs by medical providers might just as well hope for assistance from leprechauns, unicorns, or the tooth fairy.

Marshall Allen, a reporter for the Pulitzer Prize-winning investigative site ProPublica, has just penned a strong myth-busting piece, cross-posted on the National Public Radio site, about health insurers, writing:

The United States spends more per person on health care than any other country does. A lot more. As a country, by many measures, we are not getting our money’s worth. Tens of millions remain uninsured. And millions are in financial peril: About 1 in 5 is currently being pursued by a collection agency over medical debt. Health care costs repeatedly top the list of consumers’ financial concerns. Experts frequently blame this on the high prices charged by doctors and hospitals. But less scrutinized is the role insurance companies — the middlemen between patients and those providers — play in boosting our health care tab. Widely perceived as fierce guardians of health care dollars, insurers, in many cases, aren’t. In fact, they often agree to pay high prices, then, one way or another, pass those high prices on to patients — all while raking in healthy profits.

medicare-300x109Callous institutional inertia can allow dangerous doctors to keep harming patients. But media digging deserves credit for raising needed alarms when professional caregivers and others fail to step up to protect individuals as disparate as taxpayers, seniors, coeds, and heart transplant recipients.

The Milwaukee Journal-Sentinel and MedPage Today performed a public service, reporting that they found more than 200 doctors nationwide who surrendered a license, had one revoked, or were excluded from state-paid health care rolls in the previous five years  but somehow remained on the federal Medicare rolls in 2015.

This meant the problem doctors could keep bad practices afloat, in part because Uncle Sam ─ that’s taxpayers like you and me ─ paid these hundreds of MDs $25.8 million to care for seniors, among the nation’s most vulnerable patients.

Did you hear it? Was that a giant sigh of relief by Big Pharma executives around the globe? Or was it the air deflating from any Americans who still had high expectations that President Trump, as he had promised for more than a year, really would offer a quick, powerful, and effective public policy prescription to slash skyrocketing drug prices?

The stock market made a big bet that Big Pharma would do just fine, sending drug manufacturer stocks higher.

mdanderson-300x168With cancer care raining down more than $200 billion in billings on providers, giant hospitals and specialty treatment centers are resorting to unacceptable marketing and advertising hype, including pitches that “sell out” the credibility of science and a pillar of medical practice, commentators say.

Credit’s due to journalist Steve Salerno and the Wall Street Journal for a recent Op-Ed that’s worth a read as it makes the case outlined in the piece’s headline: “In war on cancer, truth becomes a casualty.”

Salerno blasts MD Anderson Cancer Center, Memorial Sloan-Kettering, and the Cancer Treatment Centers of America and others for waging costly, nationwide ad campaigns targeted at desperately sick patients. He faults these well-known institutions for relying on pure emotion and not fact to sell themselves. He says they resort to tugging at heart strings with “tear-jerker” patient testimonials, or by using pitch people with no other credibility than their celebrity.

roulette-300x188Although Americans may love to wager on ponies, lotteries, and even church bingo games, they’re getting restive and confused about playing the odds with their health — and doctors need to step up their game a lot to help patients better cope with medical uncertainties.

Dhruv Khullar, a physician at NewYork-Presbyterian Hospital and a researcher at the Weill Cornell Department of Healthcare Policy and Research, has written an excellent piece for the New York Times’ evidence-driven “Upshot” column, detailing a modern, thorny part of doctor-patient relationships:

Medicine’s decades-long march toward patient autonomy means patients are often now asked to make the hard decisions — to weigh trade-offs, to grapple with how their values suggest one path over another. This is particularly true when medical science doesn’t offer a clear answer: Doctors encourage patients to decide where evidence is weak, while making strong recommendations when evidence is robust. But should we be doing the opposite? Research suggests that physicians’ recommendations powerfully influence how patients weigh their choices, and that while almost all patients want to know their options, most want their doctor to make the final decision. The greater the uncertainty, the more support they want — but the less likely they are to receive it.

mom-300x171Big Medicine can paper over its troubles with basic fairness by slapping fancy terms on them: take “health and gender disparities,” for instance. But doctors, hospitals, and the rest of us can’t make medical care more equitable, accessible, safe, and affordable without looking at inequities, square on.

That’s why the New York Times, Washington Post, and Associated Press deserve credit for recent deep digs into the struggles of women, poor women, and especially black women with modern medicine:

juul-300x197Big Tobacco, Big Sugar, and technology may be targeting the well-being of young people faster than regulators can prevent them from heading back to the future in a bad way:  Teens getting hooked on nicotine, while tots take in excess calories with super sweet breakfast cereals.

The Wall Street Journal and the New York Times each have big take-outs, reporting on the “explosive” and “epidemic” trend, mostly by more affluent teens, of vaping with so-called e-cigarettes,  notably a hot new device called the Juul.

It’s about the size of a computer flash drive, and it uses fruity-flavored liquids to deliver a jolt of nicotine — more than what users might get by puffing a pack of old-fashioned cigarettes.

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