bioethics

A premature infant is born with a form of severe lung injury that carries a 20% chance of survival. Her physician decides to throw a medical “Hail Mary” and try an untested adult technique to bypass the injured lungs. The infant survives, and after a few more tries, the physician realizes that the survival rate may be as high as 80% with this new treatment. Does he know enough that the treatment should become standard practice, or is a randomized clinical trial required?

In modern medicine, randomized clinical trials (RCTs) are a very effective way to determine the efficacy of different treatments. In an RCT, patients are randomly assigned to receive one of the treatments under study, and the differences in their outcomes are measured. Randomization can be a very helpful tool to...

There is no denying when public figures experience medical issues they can draw greater awareness and attention toward disease prevention; informing society and providing beneficial education. But, the hospitalization of the First Lady, who is thankfully expected to make a full recovery for a “benign kidney condition,” raises concerns surrounding the intersection of patient privacy and a loved one seeking and holding elective office. Should an unelected citizen be unduly compelled to reveal any aspect of their health status? 

Many would argue that when someone runs for public office, everything is fair game. Perhaps it is time to re-examine that issue. Where...

Though the current buzzword in healthcare is “patient-centered,” it appears our “thought leaders” instead tend to subscribe to more paternalistic endeavors to control – oops! I mean steward - behavior. Look no further than the debacle of how forced, mandatory electronic medical records were implemented and the havoc that continues to cause (see here) or the American Academy of Pediatrics’ (AAP) recent strategy to make it okay for doctors, as a last resort, to refuse allowing families who decline vaccination to be a part of their practice.

A just published opinion...

Electronic medical records (EMRs) were pitched as a long-sought concept of computerized universal personal health material that would mitigate issues with access and barriers to care. In reality, when I speak of EMRs, I am referring to what they actually delivered to physicians, billing platforms that marginalize meaningful patient data necessary to inform diagnosis and therapeutic interventions.

If the promise lived up to an inkling of the reality, then the excessive clerical burden imposed on physicians to enter data, that often results in more eyes on the computer screen than the patient would not cause almost 1 in 5 U.S. physicians to plan to reduce their clinical hours in the coming year and nearly 1 in 50 to expect to leave the field...

Without a doubt, almost all alternative medicine is junk science. That would include widespread practices like acupuncture, which the biomedical literature has shown convincingly confers no real medical benefits compared to placebo.

But the placebo effect is powerful. It is far more than the "power of positive thinking." Instead, the placebo effect has real, measurable effects on the human body. Therefore, even if a "treatment" is nothing more than a placebo, some people undoubtedly will benefit from using it.

However, that raises a serious ethical question: Should...

If you pose the question "Should authors of premier medical textbooks be required to disclose industry payments or patents?," then an affirmative answer is to be found in a recent study published by the AJOB Empirical Bioethics. Unlike primary literature (like journals) along with clinical guidelines, it is not commonplace to include potential financial conflicts of interest (pCoIs) in biomedical textbooks.

The old adage "if it ain’t broke, then don't fix it” comes to mind.

This is more a reflection of current concerns about conflicts of interest than insight or fruitful discovery. By searching databases for patent listings and compensation for authors of the most recent...

Early on January 27, 2018, The Most Interesting Man in the World passed away at the age of 91.

No, I'm not speaking of Jonathan Goldsmith, the guy who just pretended to be The Most Interesting Man in the World. I'm speaking of the real deal, my grandfather, Dimitri Berezow -- a man who survived Stalin and Hitler, cheated death on multiple occasions, and went on to live the American dream.

His was an impossibly unique story – one that seems too extraordinary to be true (and yet is) -- capped with a cautionary tale about modern healthcare.

Living Free in Stalin's Russia

For many people, including my Ukrainian grandmother, life in the Soviet Union was hell. To break...

"Clinical trial" is a nice way of saying "human medical experiment." Experimenting on humans is ethical, so long as the people who volunteer give informed consent and receive a treatment that is thought to be medically beneficial.

That latter criterion makes some clinical trials ethically impossible. We could, for instance, prove definitively that vaccines do not cause autism by randomizing a group of children to receive vaccines and another group not to receive vaccines. But not vaccinating children is unethical, so this experiment could never be done.

A similar line of thinking explains why we can't feed people donuts every day to see if they develop diabetes. Though many people might willingly sign up for that clinical trial, it is unethical to design an experiment...

One of the key pillars of suicide prevention is identifying those at risk of suicide and getting them the counseling or treatment that they need. Typically, this responsibility falls to family, friends, and therapists.

But what about Dr. Google? The Internet is the go-to source of information on everything from stock prices to toenail fungus cures. As it turns out, people who are contemplating suicide turn to Google, as well.

Vincent Chandler, a professor at St. Mary's University, searched Google Trends for the popularity of suicide-related searches from 2006 to 2014. He included terms such as "suicide kill myself" and "suicide want to die," but excluded terms like "Suicide Squad," a popular comic that was turned into a movie in 2016. Then, he linked these search terms to...

A case report of 22-month-old conjoined twins evaluated and operated on last year at Massachusetts General Hospital was published in today’s New England Journal of Medicine (NEJM). The staff and family faced impossible choices that prompted involvement of a bioethics committee before rendering such an irreversible decision.

Due to the complexity of the twins abdominal and pelvic connections, doing nothing would have inevitably resulted in their demise. While intervening would facilitate the process for the more challenged one already at imminent risk of dying, it posed the best hope for the stronger, more independent twin. But, held no guarantees.

Before talking about the details of this scenario and the 14-...