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Thu, February 11, 2016

Raymond De Vries, PhD and Scott Kim, MD, PhD 's study of euthanasia and assisted suicide (EAS) for persons with psychiatric illnesses was recently written up in the New York Times. They found that persons receiving EAS for psychiatric disorders in the Netherlands were mostly women, of diverse ages, with complex and chronic psychiatric, medical, and psychosocial histories. They also reported that in more than half of approved cases, people had declined treatment that could have helped, and that many cited loneliness as an important reason for wanting to die. Dr. De Vries and Dr. Kim are current and former co-directors of the Center for Bioethics and Social Sciences in Medicine (CBSSM) .


Citation: Kim SYH, DeVries RG, Peteet JR. Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. 2016.

 

Fri, October 30, 2015

Brian Zikmund-Fisher was quoted by a number of news outlets on the relaunch of 23andme.

In an interview for the LA Time article regarding the relaunch, “Genetic testing evolves, along with health and ethics debates,” Brian Zikmund-Fisher disagrees that more information is always good.  Dr. Zikmund-Fisher points out, "Providing people with more information is not helpful if they can't do anything about it, or it leads them to focus on the wrong thing" — on their genes rather than their lifestyles, for example.”

Holly Witteman, formerly a post doctoral fellow at CBSSM and currently an assistant professor in the Faculty of Medicine at Université Laval, and colleagues’ 2016 article “One-Sided Social Media Comments Influenced Opinions And Intentions About Home Birth: An Experimental Study” was featured on Eurekalert!  an online, global news service operated by AAAS, the American Association for the Advancement of Science. The article was published in the April edition of Health Affairs and the co-authors are Angela Fagerlin, Nicole Exe, Marie-Eve Trottier and Brian Zikmund-Fisher.

An online experiment revealed that one-sided comments after health articles could influence people’s opinion about the health topic. It raises questions about how to ensure health related comment sections remain balanced.

EurekAlert!

Research Topics: 

Bioethics Grand Rounds -Scott Grant MD, MBE

Wed, May 24, 2017, 12:00pm
Location: 
UH Ford Auditorium

Scott Grant, MD, MBE, University of Chicago: "Dealing with complications and poor outcomes and surgical futility"

Scott Grant, MD, MBE, University of Chicago

Abstract: Surgical complications are ubiquitous and effect all surgeons. This talk will review how surgical ethics is distinct from traditional medical ethics in that surgeons have a greater and more direct responsibility for the outcomes of their patients than medical doctors. It will review how surgery harms before healing and the importance of weighing risks and benefits in decision making. Ways of assessing perioperative risk and preventing complications will be reviewed. Strategies for coping with complications will be described. Human error theory and the "Swiss cheese" model of human error will briefly be discussed. The SPIKES protocol for breaking bad news will be reviewed. Different definitions of futility will be described. Various procedural approaches to futility disputes will be analyzed. The best tool in approaching challenging "futility" situations will be described - open and honest communication between the patient or surrogate and the physician.

Andrew R. Barnosky, DO, MPH

Faculty

Dr. Andrew R. Barnosky is an Associate Professor in the Department of Emergency Medicine and the former Chair of the Adult Ethics Committee for the University of Michigan Hospitals and Health Centers. In the College of Literature, Sciences, and the Arts, he is the director of the Health Sciences Scholars Program for undergraduate students. He is a graduate of the A. T. Still University of Health Sciences - College of Osteopathic Medicine (Missouri), and holds a master's degree (MPH) in public health and health policy from the Harvard School of Public Health.

Research Interests: 
Last Name: 
Barnosky
Wed, April 24, 2013

Angela Fagerlin is cited in a recent Reuters Health article: “Discuss cancer-reducing drugs with women – panel."

"For a woman who starts out with a one in 40 chance of developing cancer, she told Reuters Health, "Your risk goes from 2.5 to 1.25 (percent). It's a 1 percent difference in your risk of breast cancer, having to take a drug every day for five years that has some side effects."

But for some women who have a much higher short-term risk of breast cancer - as high as 16 percent - the drugs are more likely to be worth potential side effects, said Fagerlin, who wasn't involved in the new review or the Task Force decision.

Research Topics: 

Submit Your Paper for Consideration in the ASBH Student Paper Competition

If you are a student who would like to be considered for the Student Paper Award, please send your paper to the ASBH office in an electronic format (Word or PDF) to candersen@asbh.org, with “ASBH Student Paper Competition” in the subject line.  All papers need to be received at the ASBH office by July 15, 2013 to be considered.    The Awards Committee will review and rank all submissions.  The top three papers will be placed in a special session at the Annual Meeting, and one winner will be chosen at the meeting by the Awards Committee. The award will be presented during the Members’ meeting.

All papers will be assessed anonymously.  Do not include identifying information in your paper submissions, such as title pages with your name. Previous winners are not eligible for consideration. Eligible papers should be no more than 3500 words in length. A student is defined as one who is actively pursuing an advanced degree and has not received a doctoral-level degree (e.g., MD, PhD, JD or equivalent degree). Authors who are not students according to the definition above are not eligible for the Student Paper Award. Coauthored papers are eligible only if all authors are students.

If you have any questions, please do not hesitate to contact the ASBH office at: info@asbh.org

Thank you,
 
American Society for Bioethics + Humanities (ASBH)
Phone: 847-375-4745

www.asbh.org

 

When Money is Tight (Jul-04)

Because of the high cost of many prescription drugs, some people take fewer pills than prescribed. What are the health implications?

Imagine that four months ago, you started getting chest pains whenever you exerted yourself physically, and at the time you decided this was serious enough to see a doctor. After your doctor examined you and ran some tests, you were told that you have angina, a kind of heart disease. This disease can develop when the coronary arteries become narrow and clogged from high cholesterol and the heart can't get the oxygen that it needs. Your doctor helped you plan some lifestyle changes to treat your condition. You have been very devoted to the new way of life, eating healthier and doing the proper kinds of exercise regularly. Also, part of your treatment involves regularly taking the medication that your doctor prescribed for you. You were told to take one pill each day.

The trouble is your prescription drug insurance is limited and you find yourself having to pay the majority of the cost for the angina medication out of pocket. What's more, you have been struggling just to break even every month after accounting for all of your living expenses. Now you are worried about being able to afford the medication if you take it as regularly as prescribed. A pill a day may be doctor's orders, but it is getting costly for you.
 
Would you take the pill as often as prescribed or would you skip some days to try to save money?
 
  • I would take the pill every day as prescribed.
  • I would skip some days to save some money.

How do your answers compare?

You have to save money somehow, right? Perhaps you would just have to cut back on other expenses in your life, but apparently you felt the medication had to be taken as prescribed. Research has found, however, that especially among the elderly, a significant portion of the population reports restricting medications due to cost. An important question is whether this leads to adverse health outcomes. Policy debates have been largely divided on this issue.

Do those who restrict their medications due to cost experience adverse health outcomes?

A research team led by Dr. Michele Heisler and Dr. Kenneth Langa conducted a study to investigate this question. Prior to this study, no one had examined this question by studying the same individuals at different points in time to see if those who restricted medication due to cost were more likely to develop adverse health outcomes. The researchers obtained nationally representative data that was the result of nearly 8000 interviews. Each respondent was interviewed in 1995 or 1996 and then re-interviewed in 1998. At both times, individuals were asked about cost-related medication restriction and about their health. The health questions assessed overall health, angina and other cardiovascular diseases, diabetes, arthritis, and depression.

The researchers found that cost-related medication restriction was associated with almost twice the odds of experiencing a significant decline in overall health. The association between restricting medication due to cost and poor health outcomes was strongest for those who had cardiovascular disease. Of these individuals, those who restricted their medication had a 50% increased odds of suffering angina and a 51% increased odds of having a stroke. Aren't you glad on the previous page you said you wouldn't restrict your angina medication?

Those who had arthritis or diabetes and restricted their medication due to cost did not report worse disease-related outcomes at the second interview. For arthritis, this might have been because of equally effective over-the-counter pain medications, and for diabetes, higher rates of kidney disease would likely require a longer period of follow-up to detect. When looking at age as a factor, the results showed that older adults experienced significant declines in overall health, worse cardiovascular outcomes, and increased depression. The study showed that younger people who restrict are also at risk for a decline in their health.

One limitation of this study is the lack of data about how often individuals restricted medications. If an individual restricted only once or twice, it is not clinically plausible that this would have led to an adverse health outcome. Also, the data on health outcomes were self-reported, and thus subject to bias. Previous studies, however, have shown excellent agreement between medical records and self-reports for conditions such as hypertension, diabetes, and stroke.

Implications on policy

This study provides evidence that, contrary to some claims, adults with chronic illnesses who restrict medications due to cost experience adverse health outcomes. As drug costs continue to escalate and individuals continue to lack full prescription coverage from their health insurance, it will be increasingly important for healthcare systems and physicians to develop strategies to screen patients for cost-related underuse of medications and to provide assistance to these patients. Moreover, insurance companies will need to create benefit packages that provide appropriate coverage, taking into account the cost of prescription medications.

For more information see:

Michele Heisler, Kenneth M. Langa, Elizabeth L. Eby, A. Mark Fendrick, Mohammed U. Kabeto, John D. Piette. The Health Effects of Restricting Prescription Medication Use Because of Cost. Medical Care, 42(7). 2004.

Funded by National Institutes of Health; National Insitute on Drug Abuse

Funding Years: 2012-2017

This application seeks a five-year continuation of the panel data collections of the Monitoring the Future (MTF) study, an ongoing epidemiological and etiological research and reporting project begun in 1975. In addition to being a basic research study, MTF has become one of the nation's most relied upon sources of information on trends in illicit drug, alcohol, and tobacco use among American adolescents, college students, and young and middle-aged adults. This application seeks continuation of the mail follow-up surveys of high school graduates (augmented with internet options) at modal ages 19-30, 35, 40, 45, 50, and now 55. The companion main application seeks to continue the in-school data collections and to support the analysis of all of the data in the study, including past and future panel data. (NIDA requests that the study seek continuation funding through two separate applications, as it has done in the last two rounds.)
The study's cohort-sequential longitudinal design permits the measurement and differentiation of three types of change: age (developmental), period (historical), and cohort. Each has different determinants, and all three types of change have been shown by MTF to occur for most drugs. Factors that may explain historical trends and cohort differences also are monitored. MTF is designed to document the developmental history and consequences of drug use and related attitudes from adolescence through middle adulthood, and to determine the individual and contextual characteristics and social role transitions that affect use and related attitudes. Research on risk and protective behaviors for the transmission of HIV/AIDS among adults ages 21-40 also will be continued. All of this work will be extended to new years, cohorts, and ages under this application and the companion main application. The study will examine the importance of many hypothesized determinants of drug use (including attitudes and beliefs and access), as well as a range of potential consequences (including physical and psychological health, status attainment, role performance, and drug abuse and dependence). Impacts of some policy changes on adolescents and young adults will be evaluated, including those of the new FDA cigarette labeling requirements. MTF will experiment with the use of internet response methods and pursue several new approaches to making its panel data more accessible to other investigators.
The study's very broad measurement covers (a) initiation, use, and cessation for over 50 categories and sub-categories of licit and illicit drugs, including alcohol and tobacco; (b) attitudes and beliefs about many of them, perceived availability, and peer norms; (c) other behaviors and individual characteristics; (d) aspects of key social environments (home, work, school) and social role statuses and transitions; and (e) risk and protective behaviors related to the spread of HIV/AIDS. Results will continue to elucidate drug use from adolescence through middle adulthood (including the introduction of new drugs) with major implications for the policy, research, prevention, and treatment agendas.

PI(s): Mick Couper

Co-I(s): Lloyd Johnston, Patrick O'Malley, John Schulenberg, Megan Patrick, Richard Miech

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