medical ethics
oracknows | August 26, 2013I've written a lot about Stanislaw Burzynski and what I consider to be his unethical use and abuse of institutional review boards and clinical trials. Before that, I used to regularly write about Mark and David Geier and their unethical use and abuse of IRBs and clinical trials. In both cases, I lamented how they could use their own IRBs stacked with their own cronies to rubberstamp scientifically and ethically dubious studies. Mark and David Geier got away with it for years. Stanislaw Burzynski got away with it for decades and, apparently, is still getting away with it to some extent. (His…
palmd | July 14, 2010I was a bit torn when trying to figure out how to approach this piece. A reader emailed me about an article in the Huffington Post, and there is so much wrong with it that I felt overwhelmed. My solution is to focus on a few of the problems that can help illuminate broader points.
There is a small but vocal movement of people who refuse to believe that skin cancer caused by sunlight is a significant health risk. These people tend to also believe that the risk is being purposely hyped by others, and that our current approach to skin cancer prevention is causing an epidemic of vitamin D…
palmd | April 12, 2010In the Soviet Union, party membership was everything. Your job, your access to food and other consumer goods, and your apartment all depended on your standing with the party. And votes were simply a tool to provide a patina of legitimacy. No one who liked warm weather voted against the Party.
One of the many advantages of the protections provided by the U.S. constitution is that we generally cannot be hired or fired based on our personal or political beliefs. We also get to elect our leaders frequently. So it should be with a great sense of irony that various teabagger groups shout and…
palmd | March 15, 2010The work up of "fever of unknown origin" (FUO) is a classic exercise in internal medicine. Originally defined as a temperature greater than 38.3°C (101°F) on several occasions for more than three weeks with no diagnosis after one week of inpatient study, the definition has shifted. This reflects the dramatic increase in the sophistication of outpatient work ups in the fifty or so years since the term was formally defined. About a third of cases turn out to be infection, another third cancer, a smaller percentage so-called collagen vascular diseases such as lupus. A significant percentage…
palmd | February 3, 2010I'm heartened by the discussions of medical ethics arising out of The Immortal Life of Henrietta Lacks. From reading and listening to interviews with writer Rebecca Skloot, and from my brief conversations with her, I know that medical ethics were very much on her mind during the ten years it took her to create the book. If you read the book, you will see that she was also very concerned that she not be just another exploiter of the Lacks family. That's one reason comments such as this one are disturbing----and at the same time not really disturbing at all. It helps to highlight the amount…
palmd | February 1, 2010Treating patients with narcotic analgesics is not simple. Narcotics can be very effective at relieving pain, but they come with a whole set of problems, including risk of adverse effects such as nausea, constipation, and altered mental status; overdose; and dependence. As I've written before, narcotic-dependent patients can be a challenge to treat. One of the tools we use is the "narcotic contract", a document which explicitly states the rights and responsibilities of the health care provider and the patient (although in practice, it tends to put more emphasis on the rights of the provider…
palmd | January 31, 2010This is a special shout out to the doctors and scientists out there. Everything we do in our fields has repercussions, often unexpected ones. Because of this, we strive to practice ethically to help prevent or minimize negative repercussions.
This discussion comes up specifically as an epiphenomenon of the release of The Immortal Life of Henrietta Lacks (my full review can be found here.) How one reacts to this book would, I suppose, depend on your perspective. A neighbor of the Lacks's might react quite differently than a 22 year old doctoral student. And that's really the point.
This…
palmd | January 20, 2010There has been much written about the doctor-patient relationship, and specifically how to best maintain a clinical distance while at the same time being empathic and compassionate. This is something individual doctors work on throughout their careers, but something else interests me here.
Most physicians derive enjoyment from helping people. Altruism (a topic way too complex for me to pretend to understand in depth) feels good both from the act itself and from the response one gets from the object of the altruism. This last bit has comes with potential pitfalls.
My job is to help people…
palmd | January 8, 2010Next week, Val Jones and I are leading a discussion of professional ethics as they intersect with a professional's online life.
Each profession has its own set of ethics and draws its own lines but medicine is what I know best. I'd like to invite participants (or anyone, actually) to proffer ethical dilemmas related to having an online presence.
Some things to think about:
Some professionals bypass the issue by either staying off the internet or remaining anonymous/pseudonymous. To abandon the internet is like practicing abstinence for STD and pregnancy prevention. To stay offline without…
palmd | November 4, 2009No matter how you feel about incarceration, it's a dangerous business. Inmates have high rates of serious transmissible diseases which aren't turned into the warden when they are released. Around 2.5 million people are held in American correctional facilities. HIV rates for imprisoned men 1.6% and for women is 2.4% (compared to about 0.4% among Americans as a whole). About 4.5% of inmates reported sexual victimization. Of the facilities that provide hepatitis B vaccination, 65% target "high risk" groups only. Tuberculosis rates are also very high. This is just a sampling of the horrifying…
palmd | August 19, 2009In his latest comment, Philip H has accelerated my reluctant discussion of health care reform. In fact, it was Philip who bullied me into writing about this topic in the first place. I've been avoiding wading into this mess, but being on the front line, it's in my face every day.
What he says in his latest comment is this:
[T]he idealogical leap PalMD is asking for is a good one, but it misses the mark. The leap we need to make is that healthcare is not a good, like Cheerios, or cars, or flatscreen tv's, that exists in anything like a free marketplace.
Commenter Donna B. makes a tangent…
palmd | August 4, 2009Morning report is a daily conference for medical residents. It is done differently at different institutions, but normally a case is presented, often by the post-call team, and discussed by the senior residents and an attending physician. --PalMD
A 35 year old man was brought to the Emergency Department(ED) after being found unconscious on a sidewalk. On initial evaluation by emergency personnel, he was otherwise medically stable, with normal vital signs, a clear airway which he was guarding well, and no obvious evidence of trauma. On arrival at the ED, a CT of the brain and X-rays of the…
palmd | July 30, 2009You can count on the Wall Street Journal for pretty good reporting and for extremist right-wing wackaloonery on the OpEd page. Today, they deliver the latter, with bonus fear-mongering at no extra charge.
The piece is entitled, "GovermentCare's Assault on Seniors" and that pretty much sums up the content of the article. Unfortunately (at least, for the moral health of the author), there is little below the headline to justify the inflammatory headline.
Setting aside the oxymoronic tone that simultaneously lauds Medicare and condemns government involvement, the piece is one big mendacious…
palmd | July 22, 2009Since I abhor the entombment of real news beneath the Michael Jackson story, I didn't think I'd be posting about it, but here I am. You see, Jackson was reportedly under the "care" of a privately hired physician when he died, and was being treated with medications not normally used outside the hospital. I have a problem with this.
According to the Times, authorities are looking for records at the doctor's Houston office. That's not a bad idea.
I'm not a lawyer, and I don't know if: 1) the doctor was licensed to practice in California, or 2) if a doctor from Texas may practice in…
palmd | June 24, 2009Everyone who uses the internet leaves some sort of footprint, even if it's just a string of visited addresses. This presence is magnified if you've ever been in the news, been listed on a website (e.g., as faculty), or if you write a blog. Social networking sites such as facebook and Twitter add a whole new dimension of online presence. Everyone should be concerned about what their online presence says about them (if your public Amazon wish list is full of sex toys, for example...) but physicians should have special concerns which fall into some broad categories. First, we'll briefly…
palmd | May 28, 2009My buddy Janet always makes me think, which is one of the things I like about her (that, and her cookies). Today, she wrote about a recent PLoS Biology article about the vaccine-autism debate (Orac has also covered it, of course). I especially like Janet's take on expert status and accountability. Let's examine these issues from a doctor's perspective (and speaking of credentials, "Janet" is also Dr. Stemwedel, a professor of philosophy and ethics, and former physical chemist, so she's not making this stuff up).
Who is an "expert"?
Dr. Stemwedel addresses this problem head-on, questioning…
palmd | May 20, 2009I've been reluctant to write about the Daniel Hauser case. I don't even want to imagine what his parents are going through. If you're not a parent, I can't explain it to you, so you'll have to trust me---having a kid with a life-threatening illness can drive you to do the unimaginable.
And what Daniel's parents have chosen to do is nearly unimaginable, but until you've been there, judgment must be tempered by compassion. But that compassion is only for the parents and the patient, not for those who are supporting their horrible decisions.
The basics
Daniel is 13 year old boy with…
palmd | May 18, 2009In relation to my recent bits about Jenny McCarthy and her antivaccination nonsense, reader Isabel asks the following:
I've been following this discussion for awhile, PalMD, and while I agree that JM sounds like a nut, and while I feel sorry for her kid for being stuck with her as a mother, it's hard for me to see her as the evil force she is being portrayed as.
For starters, through no fault of her own, she's obviously not particularly bright, which makes it hard to take her seriously, in either a positive or negative way. She seems like countless other neurotic women who are desperate for…
rskloot | May 15, 2009
Earlier this week, the American Civil Liberties Union and several other groups filed suit against Myriad Genetics -- the company that holds the patent on the breast cancer gene. They're hoping to get the breast cancer gene patent revoked, but more than that, they're aiming to stop gene patenting all together.
Today, in my new column in Slate's Double X Magazine, I go into the story of the breast cancer gene and the impact the ACLU claims it's had on science and patient care (a hint: it's not good). I also look at the suit itself, the cases that have come before this one, and what they say…
palmd | May 7, 2009In a recent post, Dr. Free Ride made some excellent points about conflict of interest and medical professionalism (emphasis mine):
What I find more interesting, and problematic, here is [the authors'] unexamined premise that it is a bad thing that medical experts have a certain kind of monopoly. Indeed, their monopoly is recognized by the state: you can't practice medicine without being properly trained and licensed.
Because of their specialized training, physicians and medical scientists have an expertise that arguably puts them in a better position than the state to promulgate disease…