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The Program on Medicine and Religion at the University of Chicago sponsors a Faculty Scholars Program designed to develop faculty leaders who will expand scholarship and education regarding the spiritual dimensions of the practice of medicine.  The program targets junior faculty with an interest in physician spirituality, and successful applicants will receive up to $75,000/year in salary support.  For more information, see pmr.uchicago.edu/fsp. 

Funded by the National Institutes of Health/Princeton University

Funding years: 2009-2013

The goal of this proposal is the development of “bottom-up” measures of daily experience, combining elements of time sampling with detailed episodic reinstantiation of events. Future use of the measures includes research into well-being and age-related changes in activities and experiences. I will (1) design methodological studies for the development and validation of these measures (Event Reconstruction Method, Day Reconstruction Method, and future variants); (2) develop the question program for pilot studies using the measures; (3) supervise the implementation of the pilot studies in form of web-based self-administered questionnaires; (4) participate in meetings in Princeton; and (5) present and publish relevant results.

More information: http://micda.psc.isr.umich.edu/project/detail/34823

PI: Norbert Schwarz

Angela Fagerlin was listed as one of the top 1% of most-cited researchers worldwide.

More than 3,200 researchers worldwide were included in the Thompson Reuters list, which ranks an individual’s impact based on a survey of Highly Cited Papers (defined as being in the top 1 percent by citations in the Web of Science database) between 2002-2012.

The University of Michigan ranks No. 11 in a new list of most-cited researchers produced by Thompson Reuters, with 27 U-M scientists determined by the company to be in the top 1 percent of their fields.

Link: http://research.umich.edu/blog/2014/07/31/u-m-ranks-no-11-in-new-list-of-most-cited-researchers/

Link: https://www.umhsheadlines.org/2014/08/angela-fagerlin-ph-d-listed-as-one-of-the-top-1-of-most-cited-researchers-worldwide/

 

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.

Sat, December 03, 2011

Dr Michael Volk was interviewed by Michigan Radio recently regarding a study he conducted that appears in the journal Liver Transplantation.  He found that 42 percent of people waiting for a liver transplant were unwilling to accept anything less than an ideal organ, even if doing so could cost them their lives. 

Research Topics: 
Mon, June 06, 2016

A recent internet study on the effect of the VAERS (Vaccine Adverse Event Reporting System) on vaccine acceptance and trust was featured in "The Conversation." This study found telling participants about VAERS, without having them read the actual reports, improved vaccine acceptance only very slightly. However, when participants read the detailed reports, both vaccine acceptance and trust in the CDC’s conclusion that vaccines are safe declined significantly. This was true, even though the vast majority of respondents believed that the vaccine caused few or none of the reported deaths and disabilities.

For the original study:

Scherer LD, Shaffer VA, Patel N, Zikmund-Fisher BJ. Can the vaccine adverse event reporting system be used to increase vaccine acceptance and trust?. Vaccine. 2016 May 5;34(21):2424-9.

Research Topics: 

Blocks, Ovals, or People Icons in Icon Array Risk Graphics? (Sept-15)

Imagine that you are concerned about your risk for heart disease. You look on the Web and find a risk calculator for heart disease.

The calculator asks you some questions about your health and uses your answers to estimate how likely you are to develop certain diseases. The health questions include things like age, gender, weight, height, whether you are a smoker, and whether you have diabetes or high blood pressure.

Imagine that you have answered all the health questions.

Should this patient get a liver transplant? (Nov-08)

There aren't enough donor organs to go around for patients who need aliver transplant. This sometimes forces doctors to make tough choices.If you were the doctor, how would you decide in the following scenario?  There aren't enough donor organs to go around for patients who need a liver transplant. This sometimes forces doctors to make tough choices. If you were the doctor, how would you decide in the following scenario?Suppose there is a person who develops acute liver failure (ALF). While waiting for a liver transplant, this person gets sicker and sicker. When an organ is finally available, the chance that this person will survive WITH a transplant is only 42% at five years after the transplant. Since the average survival for most patients who receive a liver transplant is 75% at five years, the doctor wonders if it would be better to save the liver for someone else. Two possible ethical principles may guide the doctor in making this decision. 

Using the principle of URGENCY, the doctor would give the first available organ to the sickest patient on the transplant waiting list, the ALF patient, because she/he is otherwise likely to die within a few days.

Using the principle of UTILITARIANISM, the doctor would try to maximize the quality and quantity of life of all the people on the transplant list. Let's say there are 25 other patients currently on the waiting list, and transplanting the ALF patient increases their risk of death by 2% each, for a cumulative harm of 50%. Since this harm of 50% is more than the benefit to the ALF patient (42%), the liver should be saved for someone else on the list.

A third possibility is for the doctor to weigh both URGENCY and UTILITARIANISM in making a decision about a transplant.

If you were the ALF patient's doctor, what would you base your decision about a transplant on?
 
  • URGENCY (sickest patient on the list gets preference)
  • UTILITARIANISM (maximize benefit for the entire waiting list)
  • A combination of URGENCY and UTILITARIANISM

How do your answers compare?

There's no absolutely right or wrong answer in this case—the choice depends on which of several competing ethical principles or which combination of principles you follow. In choosing a combination of URGENCY and UTILITARIANISM, you've decided to try to balance the needs of the sickest patient with the needs of all the people on the transplant waiting list.

CBDSM researcher Michael Volk, MD, is the lead author on a recent article that tackles difficult decisions like this one. Volk and his colleagues examined a method to incorporate competing ethical principles in a decision analysis of liver transplantation for a patient with ALF. Currently, liver transplantation in the United States is determined by the principle of “sickest first," with patients at highest risk for death on the waiting list receiving first priority. In other words, the principle of URGENCY is paramount. However, most experts agree that, given the limited supply of organs, there should be a cutoff for posttransplant survival below which transplantation is no longer justified.

Where does society draw this line? And what framework can we use for ethical guidance?

Decision analysis of resource allocation would utilize the principle of UTILITARIANISM, to maximize the broad social benefit. But surveys of the general public have shown that most people prefer to temper utilitarianism with other considerations, such as equal opportunity, racial equity, and personal responsibility. Another factor that might be considered is the principle of fair chances. This is the idea that patients who have not had a chance at a liver transplant should receive priority over those who have already had once chance at a transplant.

Volk constructed a mathematical model (Markov model) to test the use of competing ethical principles. First he compared the benefit of transplantation for a patient with ALF to the harm caused to other patients on the waiting list, to determine the lowest acceptable five-year survival rate for the transplanted ALF patient. He found that giving a liver to the ALF patient resulted in harms to the others on the waiting list that cumulatively outweighed the benefit of transplantation for the ALF patient. That is, using UTILITARIANISM as the sole guiding ethical principle gave a clear threshold for the transplant decision: if the ALF patient did not have a five-year survival rate of at least 48%, she/he should not receive a transplant under this principle.

But UTILITARIANISM is not always the sole guiding ethical principle. When Volk adjusted the model to incorporate UTILITARIANISM, URGENCY, and other ethical principles such as fair chances, he got different thresholds. Depending on the combination of ethical principles used, Volk and his colleagues have shown that the threshold for an acceptable posttransplant survival at five years for the ALF patient would range from 25% to 56%.

The authors of this study conclude:

"Our model is an improvement over clinical judgment for several reasons. First, the complexity of the various competing risks makes clinical decision making challenging without some form of quantitative synthesis such as decision analysis. Second, a systematic approach helps ensure that all patients are treated equally. Most important, this study provides moral guidance for physicians who must simultaneously act as patient advocates and as stewards of scarce societal resources."

Volk ML, Lok ASF, Ubel PA, Vijan S, Beyond utilitarianism: A method for analyzing competing ethical principles in a decision analysis of liver transplantation, Med Decis Making 2008;28, 763-772.

Online: http://mdm.sagepub.com/cgi/content/abstract/28/5/763

More information:

Beyond utilitarianism: A method for analyzing competing ethical principles in a decision analysis of liver transplantation.
Volk M, Lok AS, Ubel PA, Vijan S. Medical Decision Making 2008;28(5):763-772.

 

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