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Tue, November 05, 2013

CBSSM Faculty member, Darin Zahuranec, MD, was featured in MedPageToday for his study on intracerebral hemorrhages and how the condition may be both over- and under-treated. Read the article here

Thu, October 29, 2015

Jeremy Sussman has received much press for a recent study in JAMA about rates of treatment deintensification in diabetes. Dr. Sussman is first author of a study that found that among older diabetes patients whose treatment resulted in very low blood pressure, only a minority (27% or fewer) underwent treatment deintensification for diabetes, which represents a lost opportunity to reduce overtreatment. The study suggests practice guidelines and performance measures should place more focus on reducing overtreatment through deintensification.

Tanner Caverly and other CBSSM faculty co-authored a national survey study in JAMA examining VA primary care health-care professionals' beliefs regarding prescribing for older diabetics. This study found misperceptions about the benefits of stringent blood glucose control and concerns about negative repercussions following deintensification of therapy. This study is also being cited in a number of press articles.

Original studies:

Sussman, Jeremy B., Eve A. Kerr, Sameer D. Saini, Rob G. Holleman, Mandi L. Klamerus, Lillian C. Min, Sandeep Vijan, and Timothy P. Hofer. "Rates of Deintensification of Blood Pressure and Glycemic Medication Treatment Based on Levels of Control and Life Expectancy in Older Patients With Diabetes Mellitus." JAMA Internal Medicine (2015): 1-8.

Caverly, Tanner J., Angela Fagerlin, Brian J. Zikmund-Fisher, Susan Kirsh, Jeffrey Todd Kullgren, Katherine Prenovost, and Eve A. Kerr. "Appropriate Prescribing for Patients With Diabetes at High Risk for Hypoglycemia: National Survey of Veterans Affairs Health Care Professionals." JAMA internal medicine (2015): 1-3.

Jeffrey Kullgren, MS, MD, MPH

Faculty

Dr. Jeff Kullgren is a Research Scientist in the Center for Clinical Management Research at the VA Ann Arbor Healthcare System and an Assistant Professor in the Department of Internal Medicine at the University of Michigan Medical School and Institute for Healthcare Policy and Innovation.  Dr.

Last Name: 
Kullgren
Kathryn L. Moseley, MD, MPH, will present "African American and White Disparities in Pediatric Kidney Transplantation: Unfortunate or Unjust?"on Thursday, March 18, 2010, 3:30-4:45 pm, room 7C-09 North Ingalls Bldg, University of Michigan, Ann Arbor campus. Dr. Moseley is an Assistant Professor in the Department of Pediatrics and Communicable Diseases and the Bioethics Program.  All are welcome!
 

Sarah Hawley, PhD, MPH

Faculty

Dr. Sarah T. Hawley is a Professor in the Division of General Medicine at the University of Michigan and a Research Investigator at the Ann Arbor VA Center of Excellence in Health Services Research & Development. She holds a PhD in health services research from the University of North Carolina and an MPH from Yale University Department of Public Health. Her primary research is in decision making related to cancer prevention and control, particularly among racial/ethnic minority and underserved populations.

Last Name: 
Hawley

Michele Gornick, PhD, MA

Faculty

Dr. Michele Gornick is a Research Investigator in the Department of Internal Medicine at the University of Michigan Medical School. Her background training is in cancer genetics, with a focus on using quantitative methods to better understand the genome. Dr. Gornick joined CBSSM to pursue her interest in translational medicine, specifically dealing with issues surrounding communicating genomic information to patients, physicians and other health care providers. She was a VA and CBSSM Postdoctoral Fellow, 2012-2015.

 

 
Last Name: 
Gornick

Raymond De Vries, PhD

Associate Director

Raymond De Vries PhD is Associate Director at the Center for Bioethics and Social Sciences in Medicine at the University of Michigan and is a Professor in the Department of Learning Health Sciences and the Department of Obstetrics and Gynecology. He is also visiting professor at CAPHRI School for Public Health and Primary Care, University of Maastricht, the Netherlands.

Last Name: 
De Vries

CBSSM affiliates will be presenting at the WMU Ethics Center Conference: "Bioethics: Preparing for the Unknown" (March 17-18th).

CBSSM Postdoc Kayte Spector-Bagdady: “The Google of Personalized Healthcare: 23andMe and Enabling the Privatization of Genetic Biobanking"

Lan Le, Natalie Bartnik, Michele C. Gornick and Nicole Exe: “Examining the Psychosocial and Ethical Issues Arising from the Identification, Disclosure and Communication of Genomic Results to Patients and Clinicians,” Chair: Raymond De Vries

Other presentations with CBSSM/UM bioethics connections include:

"Patient Understanding and Satisfaction Regarding the Clinical Use of Whole
Genome Sequencing: Findings from the MedSeq Project," Archana Bharadwaj, School of Public Health

"The Voice is As Mighty as the Pen: Integrating Conversations Into Advance Care
Planning Policies," Kunal Bailoor, UM Medical School

Here is the link to the the program: http://www.mywmu.com/s/1428/images/gid2/editor_documents/events/prelimin...

Here is the link to register: http://www.mywmu.com/s/1428/gid2/index.aspx?sid=1428&gid=2&pgid=2900&con...

J. Scott Roberts, PhD

Faculty

Scott Roberts, PhD, is Associate Professor of Health Behavior & Health Education at the University of Michigan’s School of Public Health (U-M SPH), where he directs the School’s Public Health Genetics program and teaches a course on public health ethics. A clinical psychologist by training, Dr. Roberts conducts research on the psychosocial implications of genetic testing for adult-onset diseases.

Last Name: 
Roberts

The Diabetes Lobby (Dec-09)

Tell us what you think about certain public policies designed to reduce the incidence of diabetes in the US.

Please read this hypothetical news article and then answer a few questions at the end.

People with Diabetes Lobby Congress This Week

Washington, March 28 – About 1000 patients with type 2 diabetes (also commonly known as adult-onset or non-insulin-dependent diabetes) have converged here as advocates for the American Diabetes Association (ADA). They will be meeting with their members of Congress to discuss their condition and advocate for federal policies to address their disease. In addition, they will hold a rally on Thursday of this week on the National Monument grounds, to attract popular attention to their disease.
 
According to the Centers for Disease Control and Prevention, nearly 21 million Americans have diabetes, but one-third of these people do not yet know they have the disease. More than 90% of people with diabetes have type 2 diabetes, a form of diabetes which typically emerges when people are adults but which may develop during childhood. The number of people diagnosed with type 2 diabetes has been increasing every year. There were over 1 million new cases of diabetes diagnosed in 2005 among adults. Researchers believe that the conditions in the neighborhoods where people live increase their chances of getting type 2 diabetes. Rates of diabetes are highest among people living in poor neighborhoods.
 
People with type 2 diabetes develop a problem with the way their body secretes or responds to insulin, a hormone that regulates blood glucose levels. As a result, they have elevated blood sugar levels, which they must check multiple times per day and monitor their food intake. Researchers are working hard to understand more about what causes type 2 diabetes. Diabetes expert Dr. Howard Smith says, "People who live in neighborhoods where the majority of stores sell food with high calories and low nutritional value, such as fast food restaurants or convenience stores, are much more likely to develop diabetes." Several other scientific studies have supported the idea that people’s neighborhoods, including not having convenient or safe places to exercise, and being exposed to many advertisements selling high-calorie foods, are associated with the development of diabetes.
 
If left untreated, people with diabetes can become blind, have kidney damage, lose their limbs, or die. Physicians, health plans, employers, and policymakers are considering new ways to prevent diabetes, help patients manage their diabetes, and reduce this deadly epidemic. It is expected that the U.S. Senate Committee on Health, Education, and Labor will consider several bills about diabetes in the upcoming session of Congress.
 
Some people with diabetes check their blood sugar with a device called a glucometer.
 
Having read this news article, please tell us if you agree with the following policies:
 
The government should impose higher taxes on food high in calories and fat, like it does for cigarettes.
 
  • strongly disagree
  • disagree
  • neutral
  • agree
  • strongly agree
The government should provide financial incentives to encourage grocery stores to locate in areas where there are few.
 
  • strongly disagree
  • disagree
  • neutral
  • agree
  • strongly agree
The government should regulate advertisements for junk food like it does for cigarettes and alcohol.
 
  • strongly disagree
  • disagree
  • neutral
  • agree
  • strongly agree

Generally speaking, do you usually think of yourself as a Republican, a Democrat, an Independent, or what?

  • Strong Democrat
  • Not so strong Democrat
  • Independent, close to Democrat
  • Independent
  • Independent, close to Republican
  • Not so strong Republican
  • Strong Republican
  • Don't know, haven't thought much about it

How you answered: 

Researchers affiliated with CBDSM and the School of Public Health have found that "Americans' opinions about health policy are polarized on political partisan lines. Democrats and Republicans differ in the ways that they receive and react to messages about the social determinants of health."

In the study, lead author Sarah Gollust, PhD, randomly assigned participants to read one of four hypothetical news articles about type 2 diabetes. Diabetes was used as an example of a common health issue that is widely debated and that is known to have multiple contributing factors, including genetic predisposition, behavioral choices, and social determinants (such as income or neighborhood environments).

The articles were identical except for the causal frame embedded in the text. The article that you read in this Decision of the Month presented social determinants as a cause for type 2 diabetes. Other versions of the article presented genetic predisposition or behavioral choices as a cause for type 2 diabetes, and one version had no causal language.

Dr. Gollust then asked the study participants their views of seven nonmedical governmental policies related to the environmental, neighborhood, or economic determinants of diabetes:

  • bans on fast food concessions in public schools
  • incentives for grocery stores to establish locations where there are currently few
  • bans on trans fat in restaurants
  • government investment in parks
  • regulating junk food advertisements
  • imposing taxes on junk foods
  • subsidizing the costs of healthy food

Dr. Gollust also asked participants their political party identification and a number of other self-reported characteristics.

The most dramatic finding of this study was that the news story with the social determinants as a cause for type 2 diabetes had significantly different effects on the policy views of participants, depending on whether they identified themselves as Democrats or Republicans. After reading the social determinants article, Democrats expressed a higher level of support for the proposed public health policies. Republicans expressed a lower level of support for the proposed public health policies. This effect occurred only in the group of participants who were randomly assigned to read the version of the news article with social determinants given as a cause for type 2 diabetes. Dr. Gollust summarizes: "Exposure to the social determinants message produced a divergence of opinion by political party, with Democrats and Republicans differing in their opinions by nearly 0.5 units of the 5-point scale."

The study suggests several possible explanations for these results:

"First, the social determinants media frame may have presumed a liberal worldview to which the Republican study participants disagreed or found factually erroneous (ie, not credible), but with which Democrats felt more comfortable or found more familiar. . . Second, media consumption is becoming increasingly polarized by party identification, and . . . the social determinants message may have appeared particularly biased to Republicans. . .Third, the social determinants frame may have primed, or activated, study participants' underlying attitudes about the social group highlighted in the news article. . . Fourth, participants' party identification likely serves as proxy for . . . values held regarding personal versus social responsibility for health."

Dr. Gollust and her colleagues conclude that if public health advocates want to mobilize the American public to support certain health policies, a segmented communication approach may be needed. Some subgroups of Americans will not find a message about social determinants credible. These subgroups value personal responsibility and find social determinants antagonistic to their worldview. To avoid triggering immediate resistance by these citizens to information about social determinants of health, public health advocates may consider the use of information about individual behavioral factors in educational materials, while working to build public familiarity with and acceptance of research data on social determinants.

For more details about this study:

Gollust SE, Lantz PM, Ubel PA, The polarizing effect of news media messages about the social determinants of health, Am J Public Health 2009, 99:2160-2167.
 

 

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