Geoff Barnes is a cardiologist and vascular medicine specialist at the University of Michigan Health System. He completed his undergraduate degree in biomedical engineering at Washington University in St. Louis (2003) followed by medical school at the University of Michigan (2007). He then completed a residency (2010), chief residency (2011) in internal medicine, cardiology fellowship (2014) and vascular medicine fellowship (2014) at the University of Michigan. His areas of research interest include anticoagulation, venous thromboembolism, quality improvement and shared decision making.
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Funded by the National Institutes of Health/Centers for Disease Control and Prevention
Funding years: 2010-2020
This proposal is for the planning and conduct of the next ten years of the National Survey of Family Growth (NSFG), with interviewing to be conducted continuously from June 1, 2011 through May 31, 2019. The awarded contract will cover a ten-year period, from September 2010 through May 2020, and include eight years of data collection and three data releases. Working closely and collaboratively with the NCHS/NSFG work team to develop materials and specifications, we shall conduct all the necessary activities, including sample design, pretest, CAPI programming, hiring, supervising and training interviewers, data processing, data file preparation, and data file documentation, for a complete national survey. It is anticipated that the NSFG will be done indefinitely as a continuous national survey, in which interviewing is done every year, producing approximately 5,000 in-person interviews per year with men and women 15-44 years of age, in English and Spanish. Over the life of this proposal, about 40,000 men and women will be interviewed in person in 8 years. This proposal also provides for the preparation and release of up to 3 public use data files.
The National Survey of Family Growth (NSFG) is part of a series of face-to-face surveys based on national probability samples that began in 1955. From 1955-1995, the surveys were limited to women of reproductive age. The University of Michigan is currently the contractor for the NSFG Cycle 6 and The 2006-10 NSFG (Cycle 7). Cycle 6 was conducted beginning in 2002 using a national sample of men and women 15-44; and “The 2006-10 NSFG,” a continuous sample of men and women 15-44. In each NSFG, respondents have been interviewed in person in their own homes by trained professional female interviewers. In Cycles 6 and 7, the NSFG has been conducted using Computer-Assisted Personal Interviewing (CAPI) and Audio Computer-Assisted Self-Interviewing (Audio CASI). CAPI and Audio CASI is being used again in this proposal.
PI: Mick Couper
Funded by the National Institutes of Health/Brigham and Women's Hospital/Boston University
Funding years: 2010-2013
The rapid identifcation of genetic risk factors for common, complex diseases poses great opportunities and challenges for public health. Genetic information is increasingly being utilized as part of commercial effors, including direct-to-consumer (DTC) genetic testing to provide risk information on common diseases to consumers. Very few empirical data have been gathered to understand the characteristics of DTC test consumers, the psychological, behavioral and health impact (clinical utility), and the ethical, legal and social issues associated with DTC services.
In the proposed research, we will survey users of the two leading US companies providing DTC genetic testing (23andMe and Navigenics) regarding their response to genetic test s for common diseases of interest, including heart disease, diabetes, Alzheimer's disease (AD), arthritis, and breast, colon, lung and prostate cancers. Each company now has thousands of customers and each anticipates extensive sales in coming years. Each has agreed to allow our group to survey consumers using third-party data collection and analysis procedures that will enable an independent consideration of the benefits and risks of DTC testing in this format. The companies have also agreed to provide genetic test information (with respondents' permission) for analyses. A total of 1000 consumers (500 from each company) website will be surveyed via the Internet at three time points: 1) before receipt of genetic test results; 2) approximately two weeks following receipt of test results; and 3) six months following receipt of results.
More information: http://www.psc.isr.umich.edu/research/project-detail/35031
PI: Scott Roberts
Co-I: Mick Couper
From 1978 to 2009, Ed was head of the U-M Health System Legal Office. In 2009 he moved into the Medical School Department of ObGyn as an Associate Professor to work full-time on issues of sexual rights and reproductive justice. He has teaching appointments in the Medical School, the School of Public Health, the Law School, and LSA Women's Studies. He teaches courses on the legal and ethical aspects of medicine at the Medical School, the rules of human subjects research at the School of Public Health and reproductive justice in LSA and the Law School.. In 2011, Ed went to Ghana and helpe
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.
- 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.
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.