Ethical Issues in Health & Medicine

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Tuesday, January 26th, 2010

As we gain better and better control of the body and its health, we are exposed to worse moral dilemmas.  Here are some of the toughest ethical issues in health & medicine.

Being a medical ethicist has never been harder.

1) Genetic modification

The complete sequencing of a copy of the human genome was a tremendous breakthrough.  Since then, however, treatments and cures based off of genetics have been limited.

That said, right now innovative treatments based off genetic modification are becoming more and more plausible.  For instance, recently a man was cured of AIDS when he received a bone marrow transplant (because he also had leukemia).  We are reaching the stage where we might be able to harvest some cells from your body, inject them with new genetic material, and put them back in.

Another area of concern is that of “designer babies.”  We are now able to tell at an extremely early stage if a baby will have certain genetic disorders.  And that allows selective abortions to take place, which can prevent tragedies like a child who will die an agonizing death over several months.  It can also allow selection for traits like sex and even height.

It could get worse.  We could reach a point where fetuses are normally removed from the womb, injected with genetic data, and reimplanted.

This can lead to a society where only the rich can afford to make their babies healthier, smarter, better looking.

2) Premature babies

We are turning the clock back on when a baby needs to be born in order to survive.  As science gets better and better, extremely premature babies have switched from certain death to possible struggle to survive.

The problem is that such care can be very expensive and doesn’t guarantee health.  A baby could survive with retardation and barely functional lungs, for instance, at the cost of several million.  By contrast, that same money could have saved hundreds of fully healthy people from starvation.

(Can you imagine having to tell a parent that?)

Being able to save babies that are very young also indirectly threatens the morality of abortion.  If a month old fetus could live a happy and healthy life if supported in a laboratory, it somehow seems more of an ethical quandary to commit an abortion.

3) Performance Drugs

As we understand the brain in greater detail, we are able to develop drugs that stimulate it.  This has proven a life-saver for the millions of people with attention deficit disorder, and could be a tremendous breakthrough for those suffering from Alzheimer’s disease.

It could also, however, be of great use to normal people.  If a pill could improve your memory, focus and concentration – why not take it?  This also leads to a slippery slope.  You can imagine a workforce where it is the culture to take performance enhancers routinely, and your boss yelled at you if you didn’t do so as well.

This pressure to take pills for focus is already intense at the best schools.  Spend time in the library at any top college, and you will overhear students talking about using pills like Adderall for better focus and attention.

4) Resuscitation and Life Support

With modern technology, we can keep people alive for a long time.  In the vast majority of cases, this has proven a godsend, and can be of especial use to save someone who has slipped into a temporary coma.  It has, however, led to controversy.

Is it worth spending a large amount of resources on keeping someone who is totally brain-dead alive?  Some medical ethicists have reported that question is on the easier side of what they face!

Imagine you’re a doctor operating on a patient whose life you could save.  But if you do, they will spend their entirely life completely immobilized, only able to move their eyes.  Worse, they would be in tremendous pain.

Fully conscious but unable to do anything whatsoever.

All you would have to do to prevent this from happening is slow down a little.  If your operation took 2 hours instead of 1 and a half, the patient would die.  And no one would ever know.

That’s an ethical dilemma.

5) Euthanasia

What do you do when someone is undergoing a slow, horrible death – and they want your help out?  People who suffer from amyotrophic lateral sclerosis slowly become paralyzed and lose the ability to swallow or talk and eventually die.

What on earth do you do for someone who has that and wants to die?

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general interest

Top 15 Investigative Blogs in Healthcare

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Monday, August 31st, 2009
an award for investigative blogging in health

It’s hard to find blogs that are well written and interesting.  And it’s easy to find blogs that try to throw dirt at the establishment.

But blogs that are well written, based off solid sources, and actually finding things that drug companies would rather us not know?  They’re a rare species.

The 15 blogs that follow win our Investigative Blog in Healthcare Award – the Health Muckraker Award – for their excellence in uncovering issues in HealthCare.

1) Neuroskeptic

Neuroskeptic looks at important issues in neurological medicine and analyzes them thoroughly and skeptically.  This blog’s level-headedness combined with its sharp analyses and points make it a winner for investigative blogging, and place it at number one on this list.

Make sure to check out his fascinating article on Neurogenesis and Antidepressants.

2) Before You Take That Pill

Doug Bremmer is a doctor taking a stand against the market power of big pharma.  His blog analyzes medical fiascoes and controversies with wit and depth.  He is an authority in his field and it shows; you can clearly tell that he knows what he’s talking about.

Make sure to see his recent article on ghost-writing in medical research.

3) Furious Seasons

Philip Dawdy has dug up tons of dirt that makers of psychological drugs don’t want you to know and have simply tried to repress.  From analyzing abuse of Seroquel to discussing the downsides of antidepressants, he’s helped patients understand much better the risks of the meds they’re taking.

His work is helping expose things that we have a right to know.

Make sure to see his famous compilation of the Zyprexa documents.

4) Scientific Misconduct Blog

Another doctor blogging about the darker side of medicine.  This blog is marked by a higher intellectual tone and careful analysis/arguments.  Dr. Blumsohn makes sure to look at issues that are important to doctor behavior and catches issues that people not so involved with the field might miss.

Importantly, he doesn’t attack harder than he has to, and he’s willing to post in defense of the good stuff, like vaccines.

Make sure to see his post on the anti-vaccine meme.

5) Clinical Psychology and Psychiatry: A Closer Look

Sharp, sharp posts attacking the many problems in psychological medications.  Powerful criticism with occasional big picture posts.  Some important issues raised by the blog include antidepressant efficacy and excessive marketing.

Make sure to see the posts on Abilify.

6) Hooked: Ethics, Medicine, and Pharma

Dr. Brody focuses on pharmaceutical issues and develop.  He is very analytical and likes looking at issues in depth and bouncing ideas off his readers.  While incisive and sharp, his analysis tends to be slower and less “headline”-y than some of the others.  Which doesn’t make them less useful; their impact just takes a little longer.

Make sure to see his analyses of antidepressants.

7) The Carlat Psychiatry Blog

Dr. Carlat’s blog has won some impressive awards – and for good reason. His articles are excellently written. They’re in depth, sarcastic at times, and digging up stories for the general public to see what’s going on.

Check out the blog. Almost any post from it is worth a read.

8) Alison Bass

This blog isn’t popular enough. It’s well written, comprehensive, and makes an impact with strong arguments and discussions. Allison covers the crucial problems facing medicine today like overprescribing and lack of safety information for many popular drugs.

Make see to see her article on conflicts of interest in statin research.

9) Chemical Imbalance.org

Chemical imbalance is another blog focused on the controversies around psychiatric medications.  They are specifically aimed at analyzing the chemical imbalance theory of depression and mental illness as well as a general goal of looking at the problems of psychology.

They take pride in presenting balanced posts.

Make sure to see their analyses of problems with clinical publishing.

10) Medical Consumerism

An excellent blog produced by multiple authors from the University of Minnesota.  Very high quality writing that overviews other sources and a wide variety of interesting topics important to health care and medicine.  It isn’t dedicated to exposes but manages to raise important and thought provoking questions.

Because it’s mostly analysis of other sources, we’ll skip the recommended post.  Just check the blog out!

11) Pharma Marketing

John Mack blogs about the marketing tactics of pharmaceutical companies and provides analysis of their ethics.  Key issues he focuses on include exploitation of consumers and selling benefits while downplaying costs.  He’s good enough at what he does to be quoted by the New York Times.

Make sure to see his article on whether disclosure is enough in medical publishing.

12) Eye on FDA

Mark Senak writes about many different issues in health care and has a healthy skepticism and quick wit. As the name implies, he’s mainly focused on evaluating FDA policy and their ethical and business implications. Important topics he covers include monitoring safety and the darker side of the decisions that the FDA makes.

Make sure to read his post on the transparency of the FDA blog.

13) The Health Media Watch

Christine is a teacher of ethics at NYU, and she combines her deep understanding of ethics with analysis of health news and policy. Hard hitting posts include calling out a lack of disclosure in funding of clinical studies and sloppy reporting on Parkinson’s disease.

Make sure to see her hilarious spoof post on drug advertising

14) Health Care Renewal

The many authors off this blog are dedicated to “addressing threats to health care’s core values.” They have an academic slant and take on very important issues like corruption, transparency, and un-reported dangers. They’ve been around for a while, and have done some great work.

Make sure to check out their recent coverage of the Pfizer $2.3 billion fine.

15) Mental Dimensions

I love this site.  It has some great articles and some wonderful analyses.  One of the bigger problems with it, is that it doesn’t post enough.  But when it does, it’s worth it.

Make sure to see it’s article on addiction and SSRIs.

If you found this article useful, I’m happy.  Thanks for reading!

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general interest

How To Improve Health Care in the USA

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Friday, August 28th, 2009
A Black Stethoscope Lying on a Table

Obama is trying to change the health care system in America.  I agree with him that there needs to be change.  What’s not entirely clear is what his ideas actually are.

The fact is, we spend among the most on health care of all the major nations, and aren’t getting better health care.  We all have similar life spans and health results.

That said, our system does have its advantages.  The USA has produced the vast majority of the innovations in medicine over the past 50 years.  The free market is a powerful tool, and those who opposed it have been buried by the sands of time.

Yet we need change.  The system has become broken.  Here are 5 specific ideas that can make a significant impact on the quality and cost of health care in the USA.

1) Publicly funded research should be repaid

The National Institute of Health, or NIH, funds hundreds of millions of dollars of research. Sometimes that research plays a major role in the development of a medication.

The best selling cancer medication, Taxol, was in a large part discovered due to taxpayer dollars. The NIH invested $484 million in its development.

With that kind of investment, it only makes sense that the NIH should have significant ownership of the medication and get repaid. Taxol is a billion dollar drug, after all.

But as is, the government is heavily subsidizing research and not getting repaid. For Taxol, Bristol-Myers Squibb generously agreed to pay the NIH 00.5% of sales, a promise it actually didn’t even meet.

It’s absurd. Hundreds of millions of our tax-payer dollars go to develop drugs that are then sold to us at exorbitant prices.

When we’re the ones subsidizing the research, we should either get repaid by a percentage of revenue, or by our representative – the FDA and NIH – having a stronger say in drug pricing.

2) Recommend options

The fact is that there are hundreds of medications on the market, and for any given class, say cholesterol lowering pills or antidepressants, there are many, many options. Often one medication isn’t necessarily any better than another. They just cost different amounts and tend to have different side effects.

An impartial analyst should look at all the options and propose a best practice choice – a medication that works best in the cost-benefit analysis, including economic cost. While not binding, having an official recommendation based off good science will certainly help doctors make better prescribing choices.

And those choices will save money by avoiding expensive variants that don’t show significant advantage over the existing options.

3) Require improvement over old

The FDA should be able, in exceptional cases, to require a medication prove itself against existing options. When the consumer already has 20 options that are all essentially the same, the FDA should be able to require new medications to prove their efficacy not against just placebo but against the existing options.

This will fight the proliferation of me-too drugs. And it will promote research into new classes of medication, something that has been lacking.

4) Improve the patent law

Drugs are rightfully protected by patents. Unfortunately, those laws have become abused by drug companies to aggressively bully generic manufacturers. They have also become exploited by allowing minor changes to extend the patent and keep costs up.

Right now, once a drug goes off patent, the parent company typically sues the first generic manufacturer to prevent competition. These preemptive lawsuits hurt the consumer greatly, because they can delay the introduction of generics by thirty-months.

It’s an abuse of the law to thwart the market.

5) Strengthen dietary supplement control

In 1994, a law was passed that significantly reduced the control of the FDA over dietary supplements. As long as they avoided making any specific health claim, they didn’t have to pass the stricter controls that drugs typically undergo.

The result? Half of dietary supplements don’t contain what they claim or are poorly manufactured. Some are even contaminated with lead.

Poor quality dietary supplements have become a chronic problem. In August 2009 alone, several were recalled. Weight loss supplements are particularly thorny, as they have tended to contain amphetamine-like compounds that potentially cause heart problems.

We need stronger control of health supplements.

You might like:

50 Ways to Making Friends

Help – I think I’m losing my mind!

Sources:

Powerful Medicines, Jerry Avorn, M.D
Understanding the Antioxidant Controversy

http://healthlifeandstuff.com/2009/07/24-ways-to-make-friends-improve-relationships/
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general interest