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Bioethics Grand Rounds

Wed, June 27, 2018, 12:00pm
Location: 
UH Ford Auditorium

Title: Use of Preventive Ethics Rounds to Identify, Anticipate, and Proactively Address Ethical Dilemmas

Presenters: Janice Firn, PhD, LMSW,  Katie Feder, M2, Sally Salari, M4

The intersection of complex, critical illness and evolving medical technology in hospital intensive care units (ICUs) drives ethical dilemmas which in turn affect patient care and contribute to moral distress and burnout in providers. Rounding regularly in ICUs allows clinical ethicists to proactively intervene in ethically challenging cases at a time when they are most amenable to intervention. Through case discussion, clinical ethicists can help educate and support critical care providers in thinking through ethical issues pertinent to patient care throughout the hospital course. This approach can be helpful in offering a common language and framework for addressing ethical issues in every day clinical practice. To provide real-time education in the clinical context and early identification of ethical issues, Michigan Medicine initiated novel, system-wide “preventive ethics rounds” in all the ICUs (medical and surgical, adult and pediatric) in the form of a pre-consult rounding service. Providers use ethics related tools to constructively work through difficult cases as they arise; which can improve patient care and ameliorate moral distress. The presenters will address the ways in which preventative ethics rounds have impacted the formal consultation process, the types of ethical issues and patient characteristics discussed during rounds, and if/how these differ from those discussed during formal ethics consultation.

What is the price of life? (Aug-03)

Do you think that your life is worth more than the amount that the government usually uses as the maximum to spend to provide one year of life?

Imagine that you are a member of a government panel that is trying to decide how cost-effective a medical treatment must be in order for the government to cover the costs of the treatment. Suppose that a certain treatment could provide one additional year of life to an otherwise healthy person. What is the highest amount the government should be willing to pay per person for this treatment?

How do your answers compare?

For the past twenty years, the figure most often used as the maximum amount to spend to provide one year of life has been $50,000. This figure was originally proposed since it was the cost of a year of kidney dialysis, a lifesaving treatment that the U.S. government funds in Medicare.

Should the number be higher or lower than the current standard?

Conventional wisdom would suggest that the number be higher to take into account the inflation that has occurred in the years since the standard was developed. Current practices such as annual Pap smear screening for women with low risk for cervical cancer, which has a cost of $700,000 per year of life gained, also suggest that society is willing to pay more than the current standard for a year of life. The authors of the cited article recommend, based on current treatment practices and surveys of the general public, that the cost-effectiveness threshold should be revised to be around $200,000.

Should the number increase, decrease, or stay the same over time?

Again, it seems that the threshold amount should increase over time due to inflation. However, other factors come in to play that affect the value.

Since new technologies are emerging all the time, some of which will be deemed cost-effective, there will be more and more treatments to be offered in the future. Also, the rate of use of treatments is an important consideration, because even if a new treatment is more cost-effective than an old one, if it is used more often it will end up costing more to society overall. With more treatments becoming available and more people being given treatments, the threshold cost will probably have to decrease so that insurance companies and the government can keep up with the increasing availability and demand.

Why is this important?

Insurance companies and government health care entities face a continuing struggle when trying to determine which medical treatments to cover. Health care costs are increasing rapidly, so these groups will be facing even tougher decisions in the future. Establishing cost-effectiveness guidelines would be extremely helpful as an aid to making the decisions about treatment coverage. Evidence shows that the current threshold is probably not an accurate reflection of the desires of society or actual prescribing practices. It needs to be adjusted to become useful once again, and must be reevaluated periodically to make sure the value keeps up with trends in the health care market, rather than being left alone without question for two decades as is the current situation.

For more information see:

Ubel PA, Hirth RA, Chernew ME, Fendrick AM. What is the price of life and why doesn't it increase at the rate of inflation? Archives of Internal Medicine. 163:1637-1641, 2003.

Tue, January 10, 2017

Jeffrey Kullgren was recently featured in the Michigan Medicine article, "What do health plan deductibles really mean for people with chronic illness? New study takes a look." Dr. Kullgren co-authored a JAMA Internal Medicine Research Letter, which reports that even “low” deductible plans can mean high out-of-pocket costs for many Americans.

CBSSM Seminar: Dina Hafez Griauzde, MD

Wed, January 18, 2017, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Dina Hafez Griauzde, MD
Robert Wood Johnson Foundation Clinical Scholar
VA Special Fellow, Ann Arbor Veterans’ Affairs Medical Center
Clinical Lecturer, Internal Medicine

Abstract: Greater purpose in life (measured using a validated scale)  is associated with lower rates of certain chronic conditions such as cardiovascular disease and stroke.  In this seminar, we will discuss the role of purpose in life in the development of prediabetes and type 2 diabetes as well as the potential to augment ongoing type 2 diabetes prevention efforts with strategies that promote greater purpose in life.

Raymond De Vries is involved in a new research study led by Akbar Waljee, MD, MSc, which will develop a risk-based strategy to help providers tailor timing of treatments among CHC Veterans to ensure that those who most need urgent therapy get it as quickly as possible.

Using democratic deliberation, Dr. De Vries will engage Veterans to learn their thoughts and preferences about such a strategy, which will help with its implementation in a clinical setting.

Click here for more details.

Mon, January 30, 2017

Brian Zikmund-Fisher's The Conversation piece on raw cookie dough was cited in the Popular Science Health article, "The Chemicals In Burnt Toast And Crispy Fries Won't Kill You, But The Calories Might."

Mon, January 30, 2017

Kayte Spector-Bagdady has a new commentary out in The Conversation about the law and ethics of research with human biospecimens. It focuses on the recently published revisions to the human subjects research regulations, highlights the debate that ensued from a draft version over its proposal to include nonidentified biospecimens in its definition of "human subject," and summarizes where the final rule landed and possible steps going forward.

Research Topics: 
Wed, February 01, 2017

Raymond De Vries' commentary, "Giving (Bits of) Your Self to Medicine" was recently published in Medicine at Michigan. He and his colleague, Tom Tomlinson (MSU), published national survey data in JAMA that showed that while most Americans are willing to donate to biobanks, they have serious concerns about how we ask for their consent and about how their donations may be used in future research.

CBSSM Seminar: Martina T. Caldwell, MD

Wed, February 22, 2017, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Martina T. Caldwell, MD
Robert Wood Johnson Foundation Clinical Scholar
VA Special Fellow, Ann Arbor Veterans’ Affairs Medical Center
Clinical Lecturer, Emergency Medicine

Title: Leveraging the Emergency Department for Women’s Reproductive Health Equity

Abstract: As a Robert Wood Johnson / VA Clinical Scholar at the University of Michigan, Dr. Caldwell’s research centers around community-based participatory research frameworks and mixed methodology to develop Emergency Department interventions to help eliminate health inequities in birth control access, uptake and continuation, as well as birth outcomes.

CBSSM Seminar: Tammy Chang, M.D., M.P.H., M.S.

Thu, March 09, 2017, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Tammy Chang, MD, MPH, MS
Assistant Professor, Family Medicine

"Tell us what you REALLY think: Challenges with understanding and engaging youth via technology"

Understanding and engaging youth is crucial to addressing nearly all health challenges today.  However, what are the most effective ways?  How can we use technology that is ubiquitous in their lives?  In this seminar, I will discuss our team’s work in addressing these challenges using text messaging and social media to understand and engage youth.

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