High U.S. Medical Costs: “It is the fault of patients, wanting too much and shopping too carelessly”

Why are medical costs so high in the United States?

“It is the fault of patients, wanting too much and shopping too carelessly”
“It is the fault of physicians for giving into the wishes of those patients to keep the patient happy, protect against the patient's malpractice claims or provide additional income for the doctors”
“It is the fault of the insurance companies for giving into the wishes of those patients and the doctors’ orders”

..and who got the patients to want too much and shopping carelessly?

Why.. it’s the media and the TV doctor shows, it’s the pharmaceutical companies, it’s the Internet medical sites, it’s the patient's neighbor who had this and this done for this and this condition. And it is the doctors who give in to their patient's uneducated demands for this and that and add their own self-interest to the mix.

How can we begin to cut the costs of medical care in the United States?
Educate the patient to want less and shop more carefully.
Enough said. Or do you have an argument with this? ..Maurice.

Ethical Dilemma: "A Class of Embryos that it would be a Felony Not to Destroy" vs Human Dignity

Reproductive cloning, that is cloning for the purpose of implanting the cloned embryo into a woman with the expectation that a cloned human will be born is not acceptable and not approved in the United States but there are as yet no federal prohibition laws. However, there are a number of states which have specific laws to restrict cloning for therapy and/or reproductive cloning. For example, in California, the Business and Profession and Health and Safety codes can be summarized as follows: “Prohibits reproductive cloning; permits cloning for research; provides for the revocation of licenses issued to businesses for violations relating to human cloning; prohibits the purchase or sale of ovum, zygote, embryo, or fetus for the purpose of cloning human beings; establishes civil penalties”

The March-April 2009 issue of the online Hastings Center Bioethics Forum has a
statement written by some members of the President’s Council on Bioethics (who joined the Council during the Bush administration) trying to express some balance between the research and use of stem cells but also the limitation of creation of stem cell lines from embryos. Yet, a very interesting dilemma is brought up by these members with regard to the recent statement made by President Obama. It is this dilemma which I would like my visitors to write about.

Here is what the group wrote pertinent to this issue:

In his remarks on March 9, President Obama promised to “ensure that our government never opens the door to the use of cloning for human reproduction.” While this may seem comforting, it stands in need of clarification.

The president’s announced policy would permit federal funding of research not only on stem cell lines derived from “spare” IVF embryos but also on lines derived from created and/or cloned embryos. In the latter two cases, we would be producing embryos simply in order to use them for our purposes.

What researchers most desire, in fact, are not spare IVF embryos but cloned embryos, produced in order to study disease models. The funding decision announced by the president on March 9 will encourage such cloning. Nor should we be reassured that, at the same time, the president opposed “the use of cloning for human reproduction.” If cloned embryos are produced, they may be implanted and gestated.

To prevent that, it will be necessary, as we noted in Human Cloning and Human Dignity, “to prohibit, by law, the implantation of cloned embryos for the purpose of producing children. To do so, however, the government would find itself in the unsavory position of designating a class of embryos that it would be a felony not to destroy.” We cannot believe that this would advance our society’s commitment to equal human dignity.”


So, unlike the current status where unused embryos created by artificial fertilization techniques can be stored frozen until implanted or simply destroyed at the option of the parents of the embryos, if embryos would be cloned for research, by law they would have to be destroyed. I suspect the California law, currently, would meet that case. So, if some embryos, those embryos cloned, by law must be destroyed, would this change the way we look at dignity for human embryo? Or does human dignity really begin when a human is born? What do you think? ..Maurice.

The Story of Dr. Leo and the Journal: Is There an Ethics Lesson to be Learned?

Here is the story as described by Dr. Leo and was published as a letter in the OnLine Wall Street Journal where you can access the multiple internet reference links to which Dr.Leo provides.

ACADEMIC FREEDOM AND CONTROVERSY OVER THE PUBLICATION OF FACTUALLY CORRECT, PUBLICLY AVAILABLE INFORMATION

Jonathan Leo, Ph.D.

Over the past several years, I have written about the potential impact of conflicts-of-Interest in medicine (COI). I have also watched how the mainstream media reports the results of medical research with great interest. As a neuroanatomist, I was particularly interested in a recent study published in the Journal of the American Medical Association (JAMA), which reported that the prescription of escitalopram lowered the rate of depression in patients who had recently suffered a stroke. I co-authored a letter to JAMA with Dr. Jeffrey Lacasse of Arizona State University, in which we pointed out the problem of selective reporting within the study: Problem-solving psychotherapy was statistically equivalent to escitalopram, but this was never mentioned. In the mass media, the principal investigator recommended that all stroke victims should be prescribed antidepressants without mentioning that problem-solving therapy was statistically equivalent.



In the process of reading this body of research, my co-author and I noticed a problem with the COI disclosures in this positive trial of escitalopram published in JAMA. The principal investigator on the project, Dr. Robert Robinson, had not declared that he had previously received funding from Forest Laboratories, the makers of escitalopram. The financial relationship with Forest Laboratories was well-documented and easily discoverable via a Google search, as evidenced by Dr. Robinsonπs previous self-disclosures in varied sources such as here, here, here, here, and here.

I urge my students to carefully consider COI when they read an article as such conflicts can be important in how one interprets research. I do not consider myself a whistleblower, but I do think that the full story behind clinical trials should be transparent so that patients and doctors can make informed decisions. This instance of unreported COI in a gold-standard study published in JAMA seemed like a perfect case study of problematic COI issues. First, I informed JAMA of what we had found. We then co-authored a commentary describing this saga and the potential implications, linking together the unreported COI, selective reporting in JAMA, and in the mass media. We submitted it to the British Medical Journal (BMJ), who agreed to publish it as a Rapid Response on their website.

Months later, before publishing the BMJ letter, I called JAMA editorial staff twice to talk about the upcoming piece, and I also sent an email. Given the topic of the letter, I wanted to give JAMA an opportunity to correct any factual errors. No one from JAMA responded to my phone calls or email. The letter underwent legal review at BMJ and was approved for publication. We then published what we thought of as a fairly unremarkable letter primarily of interest to researchers who study COI.

The immediate, aggressive response from JAMA has been well documented. Threatening phone calls, personal attacks, and emails were accompanied by demands that we retract the entire BMJ letter.

Our letter was published without any negative commentary regarding JAMA itself, and included the following statement: We are fully aware that JAMA is concerned about conflicts of interest and has taken a leading role in promoting policies to benefit the medical community. We are pleased to report that we learned at the end of business on Thursday (3/5/09) that the JAMA Editorial Staff has looked into this matter and will be discussing it in the forthcoming March 11 issue. Our letter did not attack JAMA and, if anything, presents the facts of the matter flatly.

JAMA continued to ask that the entire piece be retracted. We were stunned by the continued, heated reaction from JAMA, and were concerned that we might have inadvertently made an error of fact in our letter. I made the following offer repeatedly: Please tell me what we have written that is factually incorrect, and if we have made a mistake or misinterpretation, we will retract the entire piece and issue a public apology. No factual errors were ever pointed out. I remain confused as to why JAMA felt they could demand that we retract an accurate letter.

Phone calls were followed by a scathing JAMA editorial which pinpoints my actions as the cause of the problem- with no mention of the culpability of the researchers who failed to disclose their COI, or the fact that the undisclosed COI was unearthed by a 5-minute Google search.

JAMA now insists that it was inappropriate to disclose the COI while they were conducting an investigation. This is curious, for several reasons. First, their investigation was complete by the time our letter was published. Second, the undisclosed COI information contained in the article is publicly available on the Internet (again, here, here, here, here, and here). JAMA has never clarified how the re-publication of publicly available information after the fact could interfere with a completed investigation. This investigation, which took five months, resulted in a short correction published in JAMA, along with a letter from the authors apologizing for their lapse of memory resulting in undisclosed COI. JAMA has claimed that the result of their investigation was more comprehensive than our BMJ piece. I only ask that readers actually compare the material published in JAMA with that published in BMJ. The material published in JAMA does not include any analysis of the context or potential implications. I believe our BMJ letter presents a more complete (and troubling) story.

Importantly, I am under the impression that JAMA objected not to the timing of the publication of the letter, but to us publishing the letter at all. In their most recent editorial, JAMA seems to assert that they have some right to control the publication of publicly available information outside their own medical journal. I do not believe they have any such right. It would seem to be an infringement of academic freedom to threaten academics who analyze publicly stored information. This information was available to anyone with access to the Internet. The view that JAMA should control such information is anachronistic at best. At worse, it is a reflection of a scientifically and ethically inappropriate effort to suppress the free exchange of information, which is at the heart of productive scientific discourse.


The implications of the JAMA's reaction to our letter are significant. For instance, the pharmaceutical industry is often criticized for their impact on evidence-based medicine. In the past, I have criticized direct-to-consumer advertising of psychiatric medications, which is not helpful to Big Pharma. However, I have never been telephoned or threatened by representatives from Big Pharma. In contrast to my experience with JAMA, any exchanges have been civil and appropriate.



The claim that JAMA can control the flow of information in the public record should be considered by bioethicists and other academics who study the process of medical research and publication. In my opinion, this claim has shifted this issue markedly. What began as a short (and potentially obscure) letter about undisclosed COI has now led to questions about the limits of institutional authority in the medical publishing industry, the extent of academic freedom, and even the role of the First Amendment.



Competing Interests: None.

Acknowledgement: Jeffrey R. Lacasse, Ph.D., provided editorial assistance in the preparation of this letter.

The description and views of the entire conflict between JAMA and Dr. Leo and the subsequent changes in the policy of the Journal is available as a free full text Editorial written by the editors in the March 20 2009 Online edition of JAMA and titled "Conflicts Over Conflicts of Interest".

It has been well established that study author conflict of interest with the drug company may affect what is published and what is disseminated to the public. Dr. Leo can be looked upon as a "whistleblower". I do want to know what my visitors think about the Dr. Leo vs JAMA story in terms of how should "whistleblowers" be dealt with in the realm of scientific journal publication of pharmaceutical studies or any other studies where important potential conflicts of interest exist and are exposed. Indeed, isn't it possible that medical journals who publish paid advertisements by the pharmaceutical companies have their own conflict of interest as an ethical concern? ..Maurice.

Patient Modesty: Volume 12

We continue on, with Volume 12, in this discussion of patient bodily modesty in terms of the professional considerations, professional ignorance of it or alleged abuse by professionals, the history, the dynamics of the modesty concerns, the relationship to provider gender selection and alleged patient gender inequality of selection. Despite literally thousands of comments posted on this subject here since the subject was started 3 1/2 years ago, further discussion is welcome. Please be sure you stick to this specific topic when you write and try not to change the point of the discussion to other issues that are covered elsewhere on this blog. And again, I would like to remind our contributors who wish to remain anonymous, in order to maintain continuity for those who read, please use at least a consistent pseudonym or initials to end your postings.

One of the last posts in Volume 11 was an excellent presentation of the history of nudity and bodily modesty issues as written by our visitor MER. I thought it would be appropriate to start out this Volume by re-posting his writing here. ..Maurice.

Saturday, March 21, 2009 2:05:00 PM, MER said...
One point I’ve tried to consistently make in my past posts is – how we feel about nakedness is contextual, depends upon the situation. The same person who may frequent nudist events may be embarrassed or even humiliated being naked in other contexts. The same is true for those who are extremely embarrassed being naked in front of a female nurse or doctor. In other contexts, in front of a male doctor or nurse, they may not be embarrassed.

I’ve been trying to study the change in attitudes toward nakedness in Western culture, especially the US, within the last 100 years or so. This is a complex subject and I don’t pretend to have “the” answer. But I do have a few suggestions. In the late 19th century, early 20th century, interest in Greek culture with the start of the Olympics, reminded us that these Greek athletes competed in the nude, and often trained in the nude. The Greek perfection of the unity of mind and body became visible in statues of the “perfect” athletic body. I think the early Olympics had some influence on attitude changes. This about the time we begin to see the growth of modern nudism and males swimming nude in public swimming pools.

About the 1890’s, when Boy’s Clubs, YMCA’s, (the scout movement, etc.) became popular, attitudes toward masculinity changed. The notion was that we were becoming weak as a culture, especially males, with the closing of the frontier. These male bonding institutions in connection with exercise and wilderness experiences helped shape our attitudes toward nudity. In UK, as the empire was declining, a similar attitude developed about the decline of masculinity and the traits associated with it. Early indoor swimming pools started being built. They had filtering systems that were sensitive. For that reason among others, males were required to swim naked. It started in the YMCA’s and Boy’s Clubs and later came into some of the college and high school systems. But, and this is a big BUT – it seems to me that there was always an understood, tacit agreement – no females were allowed. This would be strictly for men and men felt safe in these situations.

I don’t think naked military induction exams really became standard until WW1. That’s not to say it didn’t occur during the Crimean War, the American Civil War or the Franco-Prussian War. We’d have to research that. But before “modern” warfare, governments were more interested in bodies in any condition to man the front lines. Doctor’s examining naked bodies didn’t really begin seriously until after the French Revolution secularized the hospital system and doctors from all around the world headed to Paris to study and get access to real bodies. Read George Eliot’s “Middlemarch” to see how one of the main characters, a British doctor, brings back modern medicine to England from his Paris studies. There’s a revealing chapter in Tolstoy’s “Anna Karenina” where Kitty is ill and must go through a complete examination with one of the “new” thinking doctors who insists that he examine her entire naked body. Very revealing. It shows the arrogance of that doctor, how the modesty of the patient is completely ignored. If ever there’s a literary example of Foucault’s medical “gaze” it’s there in Tolstoy. Kitty was simply an object for this doctor to examine. My point in all this is that the modern medical examination of the complete naked body doesn’t start until the mid to late 19th century.

We occasionally see photos of naked soldiers from WW1 and WW2 being examined. This was standard. But I would argue that there was a strict, assumed, tacit agreement that there would be no women present. The question is often asked as to why these men felt comfortable swimming nude together, or being examined naked during military inductions. I would argue it was because of this understanding that this was a male ritual that excluded women.

Now – something begins to change after WW2 and comes into being in the 1960’s. It has many sources, but I argue that it’s closely connected to what we call the “sexual revolution” and the growing feminist movement. As more women enter male occupations, as this process gets embedded in legal doctrine, that is, giving rights to the same access for women as for men – we see things change. As more women want access to these indoor pools the policy about men swimming naked changes. As gay rights becomes an issue and as more gays come out of the closet, some men show more homophobic tendencies and become less comfortable being naked around other men. As sexual abuse, predation and crimes become more publicized, people become more wary with exposing their bodies in more and more situations.

How does this relate to what we’re talking about? Before we get to medicine – we see one example with the military induction during the Vietnam War. With more women becoming doctors and joining the military, we find many anecdotal examples of naked male inductees facing female doctors and nurses. In fact, there are a significant number of anecdotes of female clerks and other non medical personal having access to these naked men. Here’s where we see the old understood, tacit, agreement breaking down. In the past, it was understood that there would be no females present for these nude male rituals. Things now change. I would argue that during WW1 and WW2, as a general rule males in the military (unless seriously wounded – again, I’m not referring to extreme examples) were not subject to intimate examinations by female doctors or nurses. I grant the exception of the USSR and some other European countries. But remember, medicine wasn’t opened to women in the early USSR because the Soviets were concerned with gender equity. I suggested more women became doctors than men because being a doctor didn’t have the social status it did in other countries. It wasn’t considered the highest, most honorable calling for men.

Combine all this with the dominance of post modern philosophy – the concept of gender doesn’t exist, it’s only a cultural construct – and we see this attitude enter the medical system. Exempting emergency situations, it wasn’t that long ago that male orderlies or nurses or doctors handled intimate procedures with male patients. Even the “older” retired nurses today will tell you that. As more women entered medicine, it was just expected that gender didn’t matter and that they would have access to males just as the male doctors over the years had had access to females. Although attitudes are changing, this world view is still significantly embedded with the medical culture. These attitudes changes that now claim gender neutrality have come relatively quickly and without an open, honest discussion which includes patients at the table.

I don’t claim this is the whole story. I’ve probably missed some important elements and movements. I present this summary, my opinion, for discussion and criticism. I believe it’s relevant to what we’re discussing here.

Graphic: Women and Men's separate toilet buildings, photograph recently taken by me at the Santa Monica, California beach.

NOTICE: AS OF TODAY APRIL 3, 2009 "PATIENT MODESTY: VOLUME 12" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 13.

Medical Professionalism: A Charter for the 21st Century

What is or makes a physician? What should be the physician's responsibility? What should be the physician's goals? These and many other questions physicians and the public should ask and be educated. For this reason, I have taken the liberty to copy and publish here on a bioethics blog a very important document prepared by the Foundation of the American Board of Internal Medicine in partnership with the American College of Physicians Foundation and the European Federation of Internal Medicine.

There has been much discussion on various threads on this blog about how doctors behave. Well, this Physician's Charter should tell how the profession should expect them to behave. Do you agree? ..Maurice.

MEDICAL PROFESSIONALISM IN THE NEW MILLENNIUM:
A PHYSICIAN CHARTER


Preamble


Professionalism is the basis of medicine’s contract with society. It demands placing the interests of patients above those of the
physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of
health. The principles and responsibilities of medical professionalism must be clearly understood by both the profession and
society. Essential to this contract is public trust in physicians, which depends on the integrity of both individual physicians and
the whole profession.
At present, the medical profession is confronted by an explosion of technology, changing market forces, problems in health
care delivery, bioterrorism, and globalization. As a result, physicians find it increasingly difficult to meet their responsibilities to
patients and society. In these circumstances, reaffirming the fundamental and universal principles and values of medical professionalism,
which remain ideals to be pursued by all physicians, becomes all the more important.
The medical profession everywhere is embedded in diverse cultures and national traditions, but its members share the role of
the healer, which has roots extending back to Hippocrates. Indeed, the medical profession must contend with complicated political,
legal, and market forces.Moreover, there are wide variations in medical delivery and practice through which any general
principles may be expressed in both complex and subtle ways. Despite these differences, common themes emerge and form the
basis of this charter in the form of three fundamental principles and as a set of definitive professional responsibilities.

Fundamental Principles

Principle of primacy of patient welfare. The principle is based on a dedication to serving the interest of the patient. Altruism
contributes to the trust that is central to the physician-patient relationship. Market forces, societal pressures, and administrative
exigencies must not compromise this principle.
Principle of patient autonomy. Physicians must have respect for patient autonomy. Physicians must be honest with their patients
and empower them to make informed decisions about their treatment. Patients’ decisions about their care must be paramount, as
long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care.
Principle of social justice. The medical profession must promote justice in the health care system, including the fair distribution
of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender,
socioeconomic status, ethnicity, religion, or any other social category.

A Set of Professional Responsibilities
Commitment to professional competence. Physicians must be committed to lifelong learning and be responsible for maintaining
the medical knowledge and clinical and team skills necessary for the provision of quality care.More broadly, the profession as
a whole must strive to see that all of its members are competent and must ensure that appropriate mechanisms are available for
physicians to accomplish this goal.
Commitment to honesty with patients. Physicians must ensure that patients are completely and honestly informed before the
patient has consented to treatment and after treatment has occurred. This expectation does not mean that patients should be
involved in every minute decision about medical care; rather, they must be empowered to decide on the course of therapy.
Physicians should also acknowledge that in health care, medical errors that injure patients do sometimes occur.Whenever
patients are injured as a consequence of medical care, patients should be informed promptly because failure to do so seriously
compromises patient and societal trust. Reporting and analyzing medical mistakes provide the basis for appropriate prevention
and improvement strategies and for appropriate compensation to injured parties.
Commitment to patient confidentiality. Earning the trust and confidence of patients requires that appropriate confidentiality
safeguards be applied to disclosure of patient information. This commitment extends to discussions with persons acting on a
patient’s behalf when obtaining the patient’s own consent is not feasible. Fulfilling the commitment to confidentiality is more
pressing now than ever before, given the widespread use of electronic information systems for compiling patient data and an
increasing availability of genetic information. Physicians recognize, however, that their commitment to patient confidentiality
must occasionally yield to overriding considerations in the public interest (for example, when patients endanger others).
Commitment to maintaining appropriate relations with patients. Given the inherent vulnerability and dependency of patients,
certain relationships between physicians and patients must be avoided. In particular, physicians should never exploit patients for
any sexual advantage, personal financial gain, or other private purpose.

Commitment to improving quality of care. Physicians must be dedicated to continuous improvement in the quality of health
care. This commitment entails not only maintaining clinical competence but also working collaboratively with other professionals
to reduce medical error, increase patient safety, minimize overuse of health care resources, and optimize the outcomes of care.
Physicians must actively participate in the development of better measures of quality of care and the application of quality measures
to assess routinely the performance of all individuals, institutions, and systems responsible for health care delivery.
Physicians, both individually and through their professional associations, must take responsibility for assisting in the creation and
implementation of mechanisms designed to encourage continuous improvement in the quality of care.
Commitment to improving access to care. Medical professionalism demands that the objective of all health care systems be the
availability of a uniform and adequate standard of care. Physicians must individually and collectively strive to reduce barriers to
equitable health care.Within each system, the physician should work to eliminate barriers to access based on education, laws,
finances, geography, and social discrimination. A commitment to equity entails the promotion of public health and preventive
medicine, as well as public advocacy on the part of each physician, without concern for the self-interest of the physician or the
profession.

Commitment to a just distribution of finite resources. While meeting the needs of individual patients, physicians are required
to provide health care that is based on the wise and cost-effective management of limited clinical resources. They should be committed
to working with other physicians, hospitals, and payers to develop guidelines for cost effective care. The physician’s professional
responsibility for appropriate allocation of resources requires scrupulous avoidance of superfluous tests and procedures.
The provision of unnecessary services not only exposes one’s patients to avoidable harm and expense but also diminishes the
resources available for others.
Commitment to scientific knowledge. Much of medicine’s contract with society is based on the integrity and appropriate use of
scientific knowledge and technology. Physicians have a duty to uphold scientific standards, to promote research, and to create
new knowledge and ensure its appropriate use. The profession is responsible for the integrity of this knowledge, which is based
on scientific evidence and physician experience.
Commitment to maintaining trust by managing conflicts of interest. Medical professionals and their organizations have many
opportunities to compromise their professional responsibilities by pursuing private gain or personal advantage. Such compromises
are especially threatening in the pursuit of personal or organizational interactions with for-profit industries, including medical
equipment manufacturers, insurance companies, and pharmaceutical firms. Physicians have an obligation to recognize, disclose
to the general public, and deal with conflicts of interest that arise in the course of their professional duties and activities.
Relationships between industry and opinion leaders should be disclosed, especially when the latter determine the criteria for conducting
and reporting clinical trials, writing editorials or therapeutic guidelines, or serving as editors of scientific journals.
Commitment to professional responsibilities. As members of a profession, physicians are expected to work collaboratively to
maximize patient care, be respectful of one another, and participate in the processes of self regulation, including remediation and
discipline of members who have failed to meet professional standards. The profession should also define and organize the educational
and standard-setting process for current and future members. Physicians have both individual and collective obligations to
participate in these processes. These obligations include engaging in internal assessment and accepting external scrutiny of all
aspects of their professional performance.

Summary
The practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies. These
challenges center on increasing disparities among the legitimate needs of patients, the available resources to meet those needs, the
increasing dependence on market forces to transform health care systems, and the temptation for physicians to forsake their traditional
commitment to the primacy of patients’ interests. To maintain the fidelity of medicine’s social contract during this turbulent
time, we believe that physicians must reaffirm their active dedication to the principles of professionalism, which entails
not only their personal commitment to the welfare of their patients but also collective efforts to improve the health care system
for the welfare of society. This Charter on Medical Professionalism is intended to encourage such dedication and to promote an
action agenda for the profession of medicine that is universal in scope and purpose.

2004❧ ABIM FOUNDATION ❧ ACP FOUNDATION ❧ EUROPEAN FEDERATION OF INTERNAL MEDICINE

Patient Modesty: Volume 11

We are starting "Patient Modesty: Volume 11" migrating from Volume 10. The theme continues and comes from male patients who are uncomfortable with female healthcare providers when dealing with particularly the male genital area. The argument is that the medical system arranges for women patients to have women healthcare providers for modesty sensitive exams and procedures if the woman wishes but the same opportunity to gender selection is not provided to male patients.

Volume 10 is now closed for comments there. The story will continue here. ..Maurice.


GRAPHIC: Cystoscope and Gender Selection. An ArtRage composition by myself.

Criteria for Ethical Scientific Research? If So, What are They?

With President Obama reversing the presidential order of President Bush from 2001 regarding federal funding for research with embryonic stem cells, the question arises with regard to how far should scientific research be separated from political, moral and religious views. Can scientific research be ethical simply because the goal is to cure devastating diseases of humans despite treading on the religious and moral views of some against that the use and destruction of human embryos? Some may readily argue that scientific research cannot be ethical simply because it is of great human benefit despite the methodology. The supporting arguments for such an argument could be the experience with the Tuskegee syphilis studies or the human experiments in the Nazi era. And where does politics enter the equation? Should politics which considers views of part or the majority of the population affect the direction or support of scientific inquiry? If government finances research should government set the standards for research? Should scientific research with the goal of human beneficence as the result be ethical by itself and not restricted, hindered or diminished because of political, moral or religious issues? Or should the studies be defined as ethical only based on specific criteria? If so, then what criteria should society use when considering whether any scientific research is ethical? ..Maurice.

Graphic: A Balance constructed by me with ArtRage.

Negative Comments About Doctors on the Internet: Name Names?

This is an issue, I have noted on several threads on this blog. Should blogs and other internet lists and sites publish negative comments about doctors presumably by their patients or former patients identifying the doctor by name? Though it is true that there is an apparent unbalance of “power” between the physician and the patient with power directed to the physician and that the patient should have the right to comment. Unfortunately, the right to comment seems may lead to injustice since the physician is limited by federal regulations (HIPAA), preventing disclosure of personal patient information, to return comments and defend their actions or outcomes.

Read the current article by Associated Press writer Lindsey Tanner titled “Docs seek gag orders to stop patients' reviews” and express here what you think of doctors attempting to “gag” bad publicity as directed to specific named physicians. As with all of my threads on this blog, write clearly, fully and with civility but don’t name names! ..Maurice.