Articles Posted in Ethics

mlk-300x207With the nation taking a holiday to celebrate the remarkable life of the Rev. Dr. Martin Luther King and his pioneering push for Americans’ civil rights, it may be worth remembering that his far-reaching visions of equality and social justice were deeply unpopular in their time, as was he.

King infuriated many, including in medicine and health care, observing, for example, that:

“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”

dresserfallikea-300x169Doctors, hospitals, insurers, politicians, and businesses may assail the civil justice system over sums it awards to people who have proven they have been harmed. But as significant as some judgments may be, they may be exactly what judges and juries decide may be required to get institutions and enterprises to stop stubborn wrongs.

Is $215 million enough in a federal case, for example, to get the University of Southern California to learn the hard lesson that it needs to listen and to act swiftly if  coeds and nurses complain about  inappropriate sexual behavior of  its student health service staff?

Is $46 million sufficient to get Ikea to fix, recall, and inform the public yet more about the dangers to children of pieces of its furniture that can tip over and kill kids — the latest victim being Jozef Dudek, 2?

hal9000-300x225In recent years, doctors, hospitals, and popular media have promoted emerging treatments to the public with enthusiasm that in each case would turn out to be overblown. Just consider the red-hot chatter that once surrounded regenerative medicine, precision medicine, gene therapy, or immunotherapy. And now, it may be the turn of artificial intelligence to be hyped hard in health care.

Caveat emptor, as Liz Szabo reported for the Kaiser Health News Service. She sets the stage, thusly, about developments in a field that might worry some who remember Hal 9000 from “2001: a Space Odyssey”:

“Health products powered by artificial intelligence, or AI, are streaming into our lives, from virtual doctor apps to wearable sensors and drugstore chatbots. IBM boasted that its AI could ‘outthink cancer.’ Others say computer systems that read X-rays will make radiologists obsolete. ‘There’s nothing that I’ve seen in my 30-plus years studying medicine that could be as impactful and transformative’ as AI, said Dr. Eric Topol, a cardiologist and executive vice president of Scripps Research in La Jolla, Calif. AI can help doctors interpret MRIs of the heartCT scans of the head and photographs of the back of the eye, and could potentially take over many mundane medical chores, freeing doctors to spend more time talking to patients, Topol said. Even the Food and Drug Administration ― which has approved more than 40 AI products in the past five years ― says ‘the potential of digital health is nothing short of revolutionary.’”

drugslockedup-300x264Hospitals, clinics, and other health care settings — and those who staff them — aren’t immune to the ravages of the opioid crisis and its related abuse of prescription and illicit drugs. For patients, their caregivers’ addictions can have serious consequences, including a less-discussed nightmare: diversions of their drugs.

Lauren Lollini, a psychotherapist and a patient-safety advocate, has penned a powerful and scary Op-Ed for Stat, a health and medical news site. She describes how, while undergoing a relatively routine kidney stone removal at a respected Denver hospital, she was infected with hepatitis C — a draining and chronic liver disease that is blood-borne and is often associated with drug abusers. Lollini, however, had been healthy and did not use drugs. So, how did she get so sick? As she explained:

“[An investigation by the] Centers for Disease Control and Prevention, showed that I and at least 18 others had been infected with hepatitis C by Kristen Parker, a technician at Rose Medical Center who had tested positive for the disease before she was hired. She stole patients’ fentanyl-filled syringes off medication trays, injected herself with the painkiller, then refilled the syringes with saline. In the summer of 2009 — about three months after I learned I had hepatitis C — Parker was arrested in one of the biggest hospital drug diversion incidents to date. In 2010, she was sentenced to 30 years in prison.”

zenmagnets-1-150x150Consumers may need to give a few seasonal gifts a second look about their safety and other health-related issues:

docprescriptionpad-300x238Although it’s always important to remember in research studies that associations don’t prove causation, findings from two separate works should raise serious concerns about doctors’ independence and judgment in prescribing drugs and reporting conflicts of interest about payments from makers of medical devices.

That’s because doctors who get money from drug makers in connection with a specific medication tend to prescribe that drug “more heavily” than colleagues who don’t get similar cash, ProPublica, a Pulitzer Prize-winning investigative site, has found.

And doctors who are among those receiving the highest compensation from surgical and medical device manufacturers show some of the biggest discrepancies between the sums they report for institutional conflicts of interest and what a federal database of payments shows, according to  physician-researchers at the University of California, Irvine (UCI).

cpsc-150x150One of the nation’s top consumer protection agencies cozied up to the businesses it was supposed to watch over, leaving children and other consumers vulnerable to significant harms.

That’s the disturbing conclusion of congressional staffers reporting to Maria Cantwell, the ranking Democrat on a U.S. Senate committee with oversight responsibilities for the Consumer Product Safety Commission.

The Democratic staffers ripped the agency, headed by a Republican appointee who has since resigned, for its poor performance with high-profile cases involving Britax’s BOB jogging stroller, Fisher-Price’s Rock ‘n Play inclined sleeper, and the safety of residential elevators.

pickpocket-300x200If department stores, car mechanics, or restaurants billed their customers in the same way that hospitals and doctors do, prosecutors might have their hands full. That’s because what patients now accept in sheepish fashion as simple “errors” or misstatements or curious charges on their medical bills more correctly ought to be called something else: fraud.

That’s the reluctant but tough view now taken by Elisabeth Rosenthal, an editor, journalist, and onetime practicing doctor.

She has written an Op-Ed for the New York Times, her former employer, in which she recounted how she long has reported on health care costs and economics, including in her much-praised book, “An American Sickness: How Healthcare Became Big Business and How You Can Take It Back.” She said she has listened to too many patient complaints, as well as experienced problems of her own, to keep allowing establishment medicine to deem its relentless chiseling, oops, a little mistake.

alexahhs-150x150cmsseemav-150x150Here’s a point to ponder: A quarter of Americans say they or someone they know has put off treatment for a serious medical condition due to cost. That’s the worst such response pollsters at Gallup have gotten on this matter in almost three decades.

Two people have a lot to say about Americans’ health care finances, including their insurance, drug prices, and protections if they are poor, old, young, or chronically ill, physically or mentally. But, gee, the duo of Alex and Seema just can’t get along. They’re not playing nice. It’s gotten so bad that their big bosses, Don and Mike, have called them both in for a tough chat about working together.

carecostdelaychart-300x215Now, if it were you and me, and the office politicking got so out of hand that it attracted enough national attention to potentially embarrass majordomos of the organization, wouldn’t there be a screen door banging with some suits also getting tossed to the curb?

ucipic-300x245
Elite researchers — professors and staff with ties to 20 of the nation’s top universities and the respected National Institutes of Health — may be failing to be as candid as institutions and laws require about their potential professional conflicts of interest, notably the significant sums they get from Big Pharma and medical device makers.

ProPublica, the Pulitzer Prize-winning investigative organization, and the Los Angeles Times jointly scrutinized the experts’ required disclosures, finding they not only fall short. They may fail to give the public a fair view of the credibility of their findings. And, in California, they may be a unique rip-off of the state’s top university system. The “UCs” provide research faculty with costly facilities and other support, as well as sharing its global renown — in exchange for revenue the experts may earn outside the system.

In total, after examining records on tens of thousands of university scholars and NIH experts, ProPublica not only has made public its “Dollars for Profs” database, it also quotes federal watchdogs as estimating that with the NIH alone, conflicts of interest with agency grants amounts to $1 billion.

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