Tolu joined CBSSM in September 2012 as a graduate work study student then transitioned into a full-time Research Area Specialist Associate from August 2015 to May 2017. She received her joint Master’s in Social Work and Urban Planning from the University of Michigan. The bulk of her work at CBSSM includes assisting Dr. Susan Goold on an evaluation of the Healthy Michigan Plan (Michigan’s Medicaid Expansion).
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What's the difference between opting in and opting out of an activity? Who decides if people will be put automatically into one category or another? Click this interactive decision to learn how default options work.
Imagine that you're a US Senator and that you serve on the Senate's Committee on Health, Education, Labor, and Pensions. The Infectious Diseases Society of America has come before your committee because they believe that too many health care workers are getting sick with influenza ("flu") each year and infecting others. As a result, your Senate committee is now considering a new bill that would require that all health care workers get annual influenza vaccinations ("flu shots") unless the worker specifically refuses this vaccination in writing.
Do you think you would support this bill for mandatory flu shots for health care workers?
Imagine that you're the human resources director at a mid-sized company that's initiating an employee retirement plan. Management is concerned that many employees are not saving enough for retirement. They're considering a policy that would automatically deduct retirement contributions from all employees' wages unless the employee fills out and submits a form requesting exemption from the automatic deductions.
Do you think a policy of automatic retirement deductions is reasonable for your company to follow?
Organ transplants save many lives each year, but there are always too many deserving patients and too few organs available. To try to improve the number of organs available for donation, the state legislature in your state is considering a new policy that all people who die under certain well-defined circumstances will have their organs donated to others. The system would start in three years, after an information campaign. People who do not want to have their organs donated would be given the opportunity to sign a refusal of organ donation when they renewed their drivers' licenses or state ID cards, which expire every three years. Citizens without either of these cards could also sign the refusal at any drivers' license office in the state. This is a policy similar to ones already in place in some European countries.
Does this seem like an appropriate policy to you?
How do your answers compare?
For many decisions in life, people encounter default options-that is, events or conditions that will be set in place if they don't actively choose an alternative. Some default options have clear benefits and are relatively straightforward to implement, such as having drug prescriptions default to "generic" unless the physician checks the "brand necessary" box. Others are more controversial, such as the automatic organ donation issue that you made a decision about.
Default options can strongly influence human behavior. For example, employees are much more likely to participate in a retirement plan if they're automatically enrolled (and must ask to be removed, or opt out) than if they must actively opt in to the plan. Researchers have found a number of reasons for this influence of default options, including people's aversion to change.
But default options can seem coercive also. So, an Institute of Medicine committee recently recommended against making organ donation automatic in the US. One reason was the committee's concern that Americans might not fully understand that they could opt out of donation or exactly how they could do so.
The policy scenarios presented to you here have been excerpted from a 2007 article in the New England Journal of Medicine titled "Harnessing the Power of Default Options to Improve Health Care," by Scott D. Halpern, MD, PhD, Peter A. Ubel, MD, and David A. Asch, MD, MBA. Dr. Ubel is the Director of the Center for Behavioral and Decision Sciences in Medicine.
This article provides guidance for policy-makers in setting default options, specifically in health care. Generally, default options in health care are intended to promote the use of interventions that improve care, reduce the use of interventions that put patients at risk, or serve broader societal agendas, such as cost containment.
In this NEJM article, the researchers argue that default options are often unavoidable-otherwise, how would an emergency-room physician decide on care for an uninsured patient? Many default options already exist but are hidden. Without either returning to an era of paternalism in medicine or adopting a laissez-faire approach, the authors present ways to use default options wisely but actively, based on clear findings in the medical literature.
Some examples of default policies that may improve health care quality:
- routine HIV testing of all patients unless they opt out.
- removal of urinary catheters in hospital patients after 72 hours unless a nurse or doctor documents why the catheter should be retained.
- routine ventilation of all newly intubated patients with lung-protective settings unless or until other settings are ordered.
Drs. Halpern, Ubel, and Asch conclude, "Enacting policy changes by manipulating default options carries no more risk than ignoring such options that were previously set passively, and it offers far greater opportunities for benefit."
Read the article:
Harnessing the power of default options to improve health care.
Halpern SD, Ubel PA, Asch DA. New England Journal of Medicine 2007;357:1340-1344.
Michele Gornick, PhD
VA HSRD Fellow & CBSSM Research Investigator
Title: The public’s preferences for the return of secondary findings identified through genome sequencing: Information and deliberation make a difference
Summary: Genomic sequencing is becoming a part of clinical practice. Existing studies are limited and conclude that people would like unrestricted access to all of their genetic information. However, we do not know the extent to which respondents in these studies took into account the complex scientific and ethical issues that attend genome sequencing. In order to address this gap, we organized a deliberative democracy (DD) session to educate members of the public on genome sequencing, to engage them in dialogue about the benefits and risks of the clinical implementation of this technology, and to elicit their informed perspectives about policies governing the return of secondary findings.
BROCHER RESIDENCIES 2016 -- CALL FOR PROPOSALS
The Brocher Foundation offers visiting researchers the opportunity to come at the Brocher Centre in a peaceful park on the shores of Lake Geneva, to write a book, articles, an essay or a PhD thesis. The visiting positions are an occasion to meet other researchers from different disciplines and countries as well as experts from numerous International Organizations & Non Governmental Organizations based in Geneva, such as WHO, WTO, WIPO, UNHCR, ILO, WMA, ICRC, and others. The Brocher Foundation residencies last between 1 and 4 months.
They give researchers (PhD students to Professors) the opportunity to work at the Brocher Centre on projects on the ethical, legal and social implications for humankind of recent medical research and new technologies. Researchers can also apply with one or two other researchers to work on a collaborative project.
CHECK CONDITIONS AND APPLY ON WWW.BROCHER.CH/CALLS
Jodyn Platt, MPH, PhD
Department of Learning Health Sciences
Terms and Conditions for Trust in Learning Health Systems
The next generation of health information technology, organized as “learning health systems,” promises efficient, engineered solutions to the well-known and enduring maladies of the existing U.S. health infrastructure: escalating costs, poor health outcomes, ineffective use of technology, sluggish research pipelines, dangerous medical error rates, and failure to implement known clinical best practices. Learning health systems would capitalize on "big data" enterprises to accelerate the production and application of knowledge in health care. However, the sharing of health information required, both within and across institutions, greatly exceeds the public’s understanding. These initiatives are riding a precarious edge as the gap between public expectations and the realities of institutional data sharing widens at an unprecedented rate. This presentation considers the causes and consequences of trust and mistrust of health information systems, their data sharing practices, and their policy implications.
This seminar features Kirsten McCaffery, BSc (Hons), PhD; Professorial Research Fellow, School of Public Health; Sydney Medical School; NHMRC Career Development Fellow' Deputy Director, Public Health Section, Centre for Medical Psychology and Evidence based Decision Making (CeMPED)
Title: Communicating overdiagnosis in breast cancer screening: a randomised trial of a decision aid among women approaching target screening age.
Abstract: Mammography screening can reduce breast cancer mortality. However, most women are unaware that
inconsequential disease can also be detected by screening, leading to overdiagnosis and overtreatment. We aimed to investigate whether including information about overdiagnosis of breast cancer in a decision aid would help women aged around 50 years to make an informed choice about breast screening. Women (n=879) aged 48-50 were randomised to 1 of 2 decision aids. Both booklets presented evidence based information on key screening outcomes (breast cancer mortality benefit and false positives); 1 booklet also included overdiagnosis information. Study outcomes included informed choice (knowledge, attitudes and intentions) decisional conflict, anxiety, worry, anticipated regret and acceptability of the decision aid. Implications for the effective communication of overdiagnosis in screening and the development of optimal strategies for future information delivery will be discussed.
This month's grand rounds features: Michael Jibson, MD, Psychiatry Department speaking about "Psychiatry, Law, and Society: Ethical and Legal Issues in Mental Health"
Please join us for a lively discussion of medical ethics. The Bioethics Grand Rounds is co-sponsored by the Center for Bioethics and Social Sciences in Medicine, the UMHS Adult and Pediatric Medical Ethics Committee, and the Program of Society and Medicine. This educational session is open to all faculty and staff and members of the public. CME credit is available.
To meet ACCME requirements for Faculty Planner disclosure and Presenter Disclosure to participants of CME activities at UM, please be advised that the following faculty planner(s)/co-planner(s) and presenter have no personal financial relationships relevant to the activity listed below:
- Andrew Shuman, MD
- Christian Vercler, MD
Dr. Kevin Kerber and Dr. Will Meurer will be presenting an implementation trial on the topic of diagnosis and treatment of benign positional vertigo in the emergency department. At this meeting, they will be discussing and seeking input regarding plans for the in-person provider training presentation. Part of the intervention is a website to educate and motivate providers. Please review the website prior to the meeting.
To access the educational website please go to www.dizztinct.com and sign up with your firstname.lastname@example.org email address and create a password. After signing up, you'll receive an email with a link to click, in order to activate your account.
If you do not have a med.umich.edu email address, you can still get access by contacting Patty Johnson at email@example.com
A number of CBSSM faculty spoke at the recent Michigan State Medical Society Conference on Neonatal and Pediatric Ethics on November 13-14 in Ann Arbor
- Welcome and Opening & Closing Remarks: Lauren B. Smith, MD, Chair, MSMS Committee on Bioethics
- “What’s New at the Margin of Viability?” Naomi Laventhal, MD, MA, FAAP, Assistant Professor, Pediatrics; Brandon Neonatal Intensive Care, C. S. Mott Children’s Hospital
- “Elective Operations in Children” Christian J. Vercler, MD, MA, Clinical Assistant Professor, Plastic Surgery; Co-Chair, Pediatric & Adult Ethics Committees; and Co-Director, Clinical Ethics Program, CBSSM
- “Harms of Newborn Screening: Fact or Fiction?” Beth A. Tarini, MD, Assistant Professor, Department of Pediatrics and Communicable Diseases
Visit this link for more information on the conference.