The Neiswanger Institute for Bioethics at Loyola University

When the Price at the Pump Begins to Effect Quality Health Care, We Know We Have a Real Problem...

As today's Washington Post article reports on bioethics.net, the recent surge in gas prices is making the cost of providing home health care for those individuals who require services in the home even greater. While some companies are sensitive to this burden and are handing out gas cards to prevent home health care providers from dropping from the ranks, if gas prices continue to rise, it will only be a matter of time before home health care companies will have to find a way to cut costs--reducing the number of visits, putting the burden back on providers, or reducing costs in some other way that is certain to reduce the quality of care provided in the home. Just when you thought the economy and the oil barons couldn't hurt us any more, it turns out they can hurt our health too....

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Where's the Beef...or Should I Say Pork?

With the Food and Drug Administration's most recent approval of an antiwrinkle injectible that will keep a person's face expressionless, an important question must be asked: can the new Evolence, made from the stuff of food-grade pigs, be used by Jews without violating the Rabbinic laws?

In other words, is Evolence kosher?

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Hello Health Guide, Goodbye Doctor's Waiting Rooms

The US Food and Drug Administration approved Intel's newest healthcare gadget: an in-home health monitoring system for patients with chronic conditions, called Health Guide.

While the clear advantages of this device's gathering health information and helping patients keep on schedule with their medications, such devices for these purposes already exist. It is the added technological features, including video conferencing and Internet relayed health data, that have dubious advantages when weighed against the privacy concerns and the real ability to integrate such a device into the healthcare system.

Goodbye Marcus Welby, MD--Hello Hal, Health Guide.

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Much More Than An Apology

On Thursday, July 10th, the American Medical Association issued an apology for past inequalities in the treatment of African American physicians and patients. This apology was the result of an AMA panel convened to investigate the disparities in access and outcomes between caucasian and African-Americans in the US. Such an acknowledgment by the AMA is a dramatic move forward in claiming responsibility for health disparities between minorities and caucasians in this country, but what one should hope is the first step toward repairing the damage and reducing health disparities.

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No to Pens and Yes to Pizza

The Pharmaceutical Research and Manufacturers of America (PhRMA) Board of Directors have adopted a new code of ethics on interactions with healthcare professionals (bioethics.net News, July 12, 2008). This change in the code would further restrict pharmaceutical reps and other industry professionals in regard to their interactions with doctors, nurses, and other healthcare industry workers. While these changes might seem like a step in the right direction, a closer look suggests that it may be at best a half-step.

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A Weighty Subject

Writes guest blogger Dr. Summer Johnson:
As described in the Newsweek article, "Should the Obese Pay More for Airline Tickets?", one of the latest social disincentives created by the airline industry to penalize those obese persons choosing to fly the not-so-friendly skies is to charge a double fare to cover the extra fuel that it costs to fly overweight people who must sit in two seats.

However, it is hard to see how such policies invoked by airlines would do anything more but embarrass obese passengers, prevent economically disadvantaged passengers from flying in many cases, and focus attention on the harms of obesity in America rather than upon finding positive, constructive solutions to prevent or solve it. Such policies are clearly unethical and should be revoked by the airlines, even if they reduce the carbon footprint.

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The 5 most popular Bioethics News stories from the week of June 9

Here are the most popular Bioethics News items from last week based on average clicks per day:

1. Japan looks to drop a few pounds
(NYT) A law that recently took effect there requires local governments and companies to measure the waistlines of those ages 40-75. If certain population targets aren't met, the governments and companies will face financial penalties.

2. New guidelines for stem cell research and treatment
(Reuters) The International Society for Stem Cell Research hopes the guidelines will combat "snake oil" treatments that purport to treat a wide range of diseases with stem cells.

3. Undercover patients
(AP) The AMA's ethics council has recommended that the organization vote in favor of using "mystery shopper" patients to help assess the performance of doctors and staff.

4. Insured, but not covered
(NYT) A study by the Commwealth Fund reports that about 25 million Americans did not have enough health insurance to keep them out of financial hardship should they become seriously ill.

5. Harvard researchers failed to disclose millions from industry consulting
(NYT) The researchers, both psychiatrists, have now reported earning $1.6 million in consulting fees between 2000 and 2007. One of the researchers has been an influential figure in the movement toward using powerful antipsychotic drugs in children.

The 5 most popular Bioethics News stories from the week of June 1

Here are the most popular Bioethics News items from last week based on average clicks per day:

1. Race and place
(NYT) A study by researchers at Dartmouth reports that a person's place of residence or ethnicity can have a dramatic impact on the type of care they receive. For example: blacks with diabetes are almost five times more likely than whites to have a leg amputated.

2. Report: many med schools failing to adequately police industry relationships
(NYT) In rankings compiled by the American Medical Student Association, Just seven of 150 medical schools received "A" grades for their conflict of interest policies. Sixty got an "F."

3. Everyone dies, but not necessarily the same way
(NYT) An analysis of hospital rankings reveals that end-of-life care in New York City varies greatly between patients in elite private hospitals and those in municipal hospitals.

4. Companies push against shouldering costs of health coverage
(Boston Globe) A coalition of businesses and health insurers in Massachusetts has formed a lobbying group to prevent more of the costs of universal coverage from being shifted upon employers.

5. Feds move toward encouraging e-prescriptions
(AP) Current versions of the Medicare bill included penalties for doctors who stick with pen and paper prescriptions. Proponents of electronic prescriptions say they save money and reduce errors.

The 5 most popular Bioethics News stories from the week of May 26

Here are the most popular Bioethics News items from last week based on average clicks per day:

1. It matters where you grow up
(USA Today) According to a report from The Commwealth Fund, the quality of children's health care varies greatly from state to state.

2. Japanese mob members got liver transplants at UCLA
(LA Times) There's no evidence doctors at the medical center knew of the patients' criminal ties. But ethicists say the transplants are troubling because organs are in such short supply in the US.

3. Monkeys control robotic arm with brain-machine interface
(NYT) Researchers report in Nature that that tiny sensors implanted in the brains of two monkeys allow primates to control a robotic arm with just their thoughts.

4. Francis Collins leaving NIH
(Washington Post) The genome pioneer is leaving the National Human Genome Research Institute to write a book and consider new options.

5. Placebos for kids
(NYT) Ethicists are concerned about a company's plan to market placebos for children. One psychiatrist likened them to candy cigarettes.

Francis Collins: A view from the press room

By Ricki Lewis

francis collinsFrancis Collins, the soon-to-be former director of the National Human Genome Research Institute (NHGRI), boldly ventured where not too many scientists dare – the press room.

At the annual meeting of the American Society of Human Genetics, Dr. Collins is as much a fixture of the reporters’ official turf as the coffee and bagels. Not just popping in for scheduled press conferences and media updates, he stops by at all hours, chatting with whomever is about.

At last year’s meeting, amidst the smoke of the fires in San Diego, he addressed a packed auditorium about the importance of communication and education in human genetics. He certainly practices what he preaches.

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“Doctors are thinking about bioethics more than they have in the past,” McGee said. “But the bottom line is it’s not enough. They need training. We need more people to teach doctors. Training doctors is important. . . . The bottom line about bioethics is that we don’t think we have the answers. The reason we exist is because nobody else is asking the questions.”

+ Glenn McGee in the Daily Gazette: "Medical ethics taking center stage"

"It's one thing to say, "I don't want a pregnancy.' It's another to say, "I don't want to have a baby with Tay Sachs disease, which is going to kill him anyway,' versus, "I don't want a baby with Down,' versus, "I don't want a baby who's blind,' versus, "I don't want a baby that's gay.' Every one of those could, and eventually will, be a part of genetic testing. In that sense, this debate isn't about Down testing, it's about how to handle genetic information about the fetus."

+ Art Caplan in the Intelligencer (Philadelphia): "The risks of testing"

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