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Investigator(s)

Conference

Title of Talk/Poster

Ray De Vries

Lisa Harris

et al.

American Society for Bioethics & Humanities (ASBH)

Annual Meeting

 

“Mundane Reproductive Ethics: Beyond the Sensational Lie"

 

"Everyday Ethical Problems in Abortion, In Vitro Fertilization, Pregnancy Planning, and Birth"

 

Ray De Vries

Susan Goold

et al.

American Society for Bioethics & Humanities (ASBH)

Annual Meeting

 

“Learning about Learning from the Public: A Workshop about Methods of Public Engagement on Ethical Issues in Biomedical Research, Health, and Health Care"

 

Angela Fagerlin

et al.

Society for Medical Decision Making (SMDM) Annual Meeting

 

“Minority Cancer Survivors' Perceptions and Experience with Cancer Clinical Trials Participation"

Angela Fagerlin

Andrea Fuhrel-Forbis

Sarah Hawley

Holly Witteman

et al.

 

Society for Medical Decision Making (SMDM) Annual Meeting

“Preferences for Breast Cancer Chemoprevention"

Angela Fagerlin

Andrea Fuhrel-Forbis

Brian Zikmund-Fisher

et al.

Society for Medical Decision Making (SMDM) Annual Meeting

 

“Informed Decision Making About Breast Cancer Chemoprevention: RCT of an Online Decision Aid Intervention"

Angela Fagerlin

Valerie Kahn

et al.

Society for Medical Decision Making (SMDM) Annual Meeting

 

“Literacy and Numeracy in Veterans and Their Impact on Cancer Treatment Perceptions and Anxiety"

Angela Fagerlin

Laura Scherer

et al.

Society for Medical Decision Making (SMDM) Annual Meeting

 

“Anxiety as an Impetus for Action: On the Relative Influence of Breast Cancer Risk and Breast Cancer Anxiety on Chemoprevention Decisions"

Angela Fagerlin

Laura Scherer

et al.

Society for Medical Decision Making (SMDM) Annual Meeting

 

“Literacy and Irrational Decisions: Bias From Beliefs, Not From Comprehension"

Angela Fagerlin

Holly Witteman

Brian Zikmund-Fisher

et al.

Society for Medical Decision Making (SMDM) Annual Meeting

 

“Integers Are Better: Adding Decimals to Risk Estimates Makes Them Less Believable and Harder to Remember"

Andrea Fuhrel-Forbis

Holly Witteman

Brian Zikmund-Fisher

et al.

Society for Medical Decision Making (SMDM) Annual Meeting

 

“Avatars and Animation of Risk Graphics Help People Better Understand Their Risk of Cardiovascular Disease"

Holly Witteman

Brian Zikmund-Fisher

et al.

Society for Medical Decision Making (SMDM) Annual Meeting

 

 

“If I'm Not High Risk, Then That's Not My Risk: Tailoring Estimates for Low-risk Patients May Undermine Perceived Relevance"

 

Brian Zikmund-Fisher

et al.

Society for Medical Decision Making (SMDM) Annual Meeting

“The Effect of Narrative Content and Emotional Valence on Decision About Treatments for Early Stage Breast Cancer"

 

2018 Bishop Lecture featuring Barbara Koenig, PhD

Tue, May 01, 2018, 11:15am
Location: 
Henderson Room, Michigan League, 911 N. University Avenue, Ann Arbor, MI

The 2018 Bishop Lecture in Bioethics was presented by Barbara Koenig, PhD, Professor of Bioethics and Medical Anthropology and Director of UCSF Bioethics at the University of California, San Francisco. Professor Koenig presented a talk entitled, " Does Enhancing Individual Choice and Control Promote Freedom? Challenges in Contemporary Bioethics." The Bishop Lecture serves as the keynote address during the CBSSM Research Colloquium.

Abstract: Over the past three decades, the discipline of bioethics has advocated for enhanced patient choice and control over a range of medical decisions, from care near the end of life to participation in clinical research. Using two current policy challenges in California—1) the advent of legally sanctioned medical aid in dying and, 2) efforts to share UC Health “big data” from the electronic health record in research with private sector partners—Professor Koenig will explore how current bioethics practices may unintentionally and ironically impede our shared goals of promoting human freedom.

Barbara A. Koenig, PhD is Professor of Bioethics and Medical Anthropology, based at the Institute for Health & Aging, University of California, San Francisco. She is the Director of “UCSF Bioethics,” a nascent program that spans ethics research, clinical ethics, and ethics education across the university’s four professional schools. Prof. Koenig pioneered the use of empirical methods in the study of ethical questions in science, medicine, and health. Prof. Koenig’s current focus is emerging genomic technologies, including biobanking policy and using deliberative democracy to engage communities about research governance. Her work has been continuously funded by the National Institutes of Health since 1991. Currently, she: 1) directs the ELSI component of a NICHD award focused on newborn screening in an era of whole genome analysis, 2) is P.I. of UCSF’s Program in Prenatal and Pediatric Genomic Sequencing (P3EGS), part of the CSER2 national network, and, 3) is supported by NCI to conduct an “embedded ethics” study of the Athena “Wisdom” PCORI-funded clinical trial of genomic risk-stratified breast cancer prevention. Previously, she directed an NHGRI-funded “Center of Excellence” in ELSI Research. Prof. Koenig was the founding executive director of the Center for Biomedical Ethics at Stanford University; she created and led the Bioethics Research Program at the Mayo Clinic in Rochester, Minn. She received her Ph.D. from the University of California, Berkeley and San Francisco joint program in Medical Anthropology. She is an active participant in policy, having served on the ethics committee that advises the director of the CDC and the Department of Health and Human Services “Secretary’s Advisory Committee on Genetic Testing.” She recently served on a state-wide “Health Data Governance Task Force” which advised UC’s president.

Click here for the video recording of the 2018 Bishop Lecture.

Funded by Health and Human Services, Department of-National Institutes of Health

Funding Years: 2014 - 2016.

Mexican Americans (MAs) suffer more from stroke than non-Hispanic whites (NHWs). Ischemic stroke is more common in MAs and their neurologic, functional and cognitive outcomes after stroke are worse than in NHWs. The reasons for the disparity in post-stroke outcome are unclear. Pre-stroke function and initial stroke severity are similar between the two groups as are ischemic stroke sub-types. One potential explanation for the worse post-stroke neurologic, functional and cognitive outcome in MAs compared with NHWs is allocation and effectiveness of post-stroke rehabilitation. There is remarkably little data demonstrating whether rehabilitation is dosed differently for MAs compared with NHWs, and still less information about whether, for a given dose of rehabilitative services following stroke, there is differential benefit by ethnicity. The current application will utilize the existing population-based Brain Attack Surveillance in Corpus Christi (BASIC, NSR0138916) project's infrastructure and strong community relations to develop and pilot a method to collect the necessary data to determine the role of rehabilitation in ethnic disparities in post-stroke outcomes. Previous studies have suggested that looking at overall time spent in rehabilitation does not predict post-stroke outcome. However, specific components of physical, occupational and speech therapy, a practice-based approach, has been shown to be associated with stroke outcomes, and these associations have been shown to vary by race. However, this practice-based approach has not been implemented in a population-based manner across the range of settings where stroke patients receive rehabilitation services, and no study has used this approach in an ethnically diverse population. Therefore, our plan is to build on previous work by developing and utilizing a practice-based design in our population-based stroke study. Specifically, we will 1) continue to build the needed relationships with rehabilitation service providers in the community;2) work with local rehabilitation therapists to refine data collection instruments as part of the practice-based design;3) pilot test data collection of specific rehabilitation components of post-stroke rehabilitation across all rehabilitation settings;and 4) analyze this data to determine the feasibility of this approach for a larger study and to provide preliminary data on differences in access and effectiveness by ethnicity. In total, our infrastructure development, refinement of tools to measure specific therapy modalities and pilot testing will position us perfectly to submit an R01 application to identify ethnic differences in access to rehabilitation and specific rehabilitation services associated with improved functional outcome in MAs and NHWs.

PI(s): Lynda Lisabeth, Lewis Morgenstern

Funded by the National Heart Lung and Blood Institute

Funding Years: 2009-2015

PROJECT SUMMARY/ABSTRACT This study seeks to understand the barriers facing junior physician faculty researchers, and women in particular, in order to inform efforts to improve gender equity in academic medicine. Despite a dramatic increase in women's participation in the medical profession over the past four decades, women remain in the distinct minority in the senior positions of academic medicine. Some have dismissed these disparities as resulting from gender differences in preferences regarding the balance between work and other pursuits or between research and clinical activity. The proposed work focuses upon an extremely selective cohort of highly apt, research-oriented junior faculty members: physician-recipients of K08 and K23 mentored career development awards from the NIH. In so doing, it minimizes the impact of potential gender differences in the desire to pursue research and in access to monetary support, allowing for the impact of other challenges and barriers to be isolated. In a preliminary study, we discovered that female K08 and K23 awardees were significantly less likely to obtain a subsequent independent R01 grant than their male colleagues. In this application, we propose a mixed-methods and interdisciplinary study to illuminate why this disparity exists. Specifically, in order to identify the key elements of academic success and to investigate and promote gender equity among these highly motivated and accomplished physician-researchers, we propose a three-phase study. In the first phase, we will conduct a large-scale survey of the entire population of 1425 physicians receiving K08 and K23 Awards from the NIH in 2005-2008, in order to assess gender differences in access to critical resources, such as protected research time and mentoring. We will then proceed to conduct a qualitative analysis of interviews with 120 relevant stakeholders, including 60 former K08 and K23 recipients and their mentors. Finally, we will conduct a follow-up survey of the 1425 physicians receiving K08 and K23 Awards in 2005-2008 to determine which resources, individual, and institutional characteristics are associated with academic success, including publication, attainment of independent funding, satisfaction, promotion, and retention within academic medicine, as well as to identify which factors primarily mediate gender differences in these outcomes. In this way, this study will illuminate the key elements of academic success for men and for women, including revealing which elements are common and which are unique, allowing for the informed design of targeted interventions to improve gender equity in academic medicine. For more information, visit NIH Reporter

PI(s): Reshma Jagsi 

The Privileged Choices (Jan-08)

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.

Scenario 1

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?

  • Yes
  • No

Scenario 2

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?

  • Yes 
  • No

Scenario 3

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?

  • Yes 
  • No

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.

CBSSM is soliciting applications from qualified individuals for 1-2 postdoctoral research fellow positions for the 2018-2019 academic year.

The mission of CBSSM is to be the premier intellectual gathering place of clinicians, social scientists, bioethicists, and all others interested in improving individual and societal health through scholarship and service.

Bioethics Post-Doctoral Research Fellow
Active projects in bioethics at CBSSM currently include the ethical, legal, and social implications of genomic medicine, human subjects research ethics, empirical research with relevance to clinical ethics, global bioethics, gender equity, reproductive justice, deliberative democratic methods in bioethics, resource allocation, ethical issues associated with learning health systems, and the sociology of medical ethics/bioethics, among others. Candidates' area of focus must be in bioethics, although their backgrounds may be in social or natural sciences, humanities, medicine, or law.

Decision Sciences Post-Doctoral Research Fellow
This fellowship focuses on understanding and improving the health care communication and decisions made by both patients and providers. Past postdoctoral fellows have included scholars whose research in health care communication and decision making has been approached using theories drawn from social cognition, motivation and emotion, risk communication, human factors, ethics, and economics.

Postdoctoral fellows are expected to collaborate on established projects and are encouraged to conduct independent research with an emphasis on study inception, manuscript writing, and applying for grants. CBSSM’s resources and collaborative support enable fellows to build their own research programs.

Please see: http://cbssm.med.umich.edu/training-mentoring/post-doctoral-fellowship for more details about these fellowship opportunities.

 

Bioethics Grand Rounds -Reshma Jagsi, MD, DPhil

Wed, October 25, 2017, 12:00pm
Location: 
UH Ford Auditorium

Reshma Jagsi, MD, DPhil

Title – "Ethical Issues Related to Fundraising from Grateful Patients"

Abstract: Health care institutions are becoming increasingly deliberate about philanthropic fundraising given the need to sustain their missions in the face of decreases in governmental research funds and lowering reimbursement for clinical care.  Donations from grateful patients constitute 20% of all philanthropic contributions to academic medical centers, totaling nearly $1 billion a year in recent years.  Institutions frequently employ development professionals to facilitate philanthropy. The development literature describes various approaches for identifying patients capable of contributing, cultivating potential donors, and engaging physicians in the solicitation of grateful patients, emphasizing that patients themselves may also benefit from exercising altruism in this way.  However, little evidence exists to guide the ethical practice of grateful patient fundraising, and concerns exist regarding privacy and confidentiality, patient vulnerability, and physicians' conflicts of obligations in this context.  Therefore, we will discuss how the process of philanthropic development should be structured in order to demonstrate respect for all persons involved, including patients who donate, those who might consider donation, those who do not wish to donate, and those who cannot afford to do so.

Lunch is provided. Please note: Lunch is first come, first served.

 

2018 CBSSM Research Colloquium and Bishop Lecture (Barbara Koenig, PhD)

Tue, May 01, 2018, 8:30am
Location: 
Henderson Room, Michigan League, 911 N. University Avenue, Ann Arbor, MI

The Center for Bioethics and Social Sciences in Medicine (CBSSM) Research Colloquium was held Tuesday, May 1, 2018 at the Henderson Room, Michigan League, 911 N. University Avenue, Ann Arbor, MI 48109.

The CBSSM Research Colloquium featured the Bishop Lecture in Bioethics as the keynote address. Barbara Koenig, PhD presented the Bishop Lecture with a talk entitled: “Does Enhancing Individual Choice and Control Promote Freedom? Challenges in Contemporary Bioethics."

Barbara A. Koenig, Ph.D. is Professor of Bioethics and Medical Anthropology, based at the Institute for Health & Aging, University of California, San Francisco. She is the Director of “UCSF Bioethics,” a nascent program that spans ethics research, clinical ethics, and ethics education across the university’s four professional schools. Prof. Koenig pioneered the use of empirical methods in the study of ethical questions in science, medicine, and health. Prof. Koenig’s current focus is emerging genomic technologies, including biobanking policy and using deliberative democracy to engage communities about research governance. Her work has been continuously funded by the National Institutes of Health since 1991. Currently, she: 1) directs the ELSI component of a NICHD award focused on newborn screening in an era of whole genome analysis, 2) is P.I. of UCSF’s Program in Prenatal and Pediatric Genomic Sequencing (P3EGS), part of the CSER2 national network, and, 3) is supported by NCI to conduct an “embedded ethics” study of the Athena “Wisdom” PCORI-funded clinical trial of genomic risk-stratified breast cancer prevention. Previously, she directed an NHGRI-funded “Center of Excellence” in ELSI Research. Prof. Koenig was the founding executive director of the Center for Biomedical Ethics at Stanford University; she created and led the Bioethics Research Program at the Mayo Clinic in Rochester, Minn. She received her Ph.D. from the University of California, Berkeley and San Francisco joint program in Medical Anthropology. She is an active participant in policy, having served on the ethics committee that advises the director of the CDC and the Department of Health and Human Services “Secretary’s Advisory Committee on Genetic Testing.” She recently served on a state-wide “Health Data Governance Task Force” which advised UC’s president.

The CBSSM Research Colloquium (9 a.m. to 2 p.m.) brings together presenters highlighting research related to bioethics, health communication, and medical decision making.

2018 Colloquium Schedule:
 

  • 8:30     Check in, refreshments
  • 9:05     Welcome
  • 9:10     Presentation 1: “Parent Perceptions of Antenatal Consultation for Extreme Prematurity" Stephanie Kukora, MD
  • 9:35     Presentation 2: “Hospice Care Quality in U.S. Nursing Homes Reported by Patients and Caregivers in Yelp Reviews” Chithra Perumalswami, MD, MSc
  • 10:00   Medical Student in Ethics Award: Megan Lane
  • 10:10   Presentation 3: “Impact of MCI on Patient and Care Partner Preferences and Physician Decision Making for Cardiovascular Treatment” Bailey Reale, MPH & Emilie Blair
  • 10:35   Presentation 4: “It’s all about Context: A Mixed-Methods Study of Local Context Assessment by Institutional Review Boards” Adrianne Haggins, MD
  • 11:00   Break
  • 11:15   Bishop Lecture: Barbara Koenig, PhD
  • 12:45  Lunch

Edward Goldman, JD, BA

Faculty

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

Research Interests: 
Last Name: 
Goldman

Conference on Bioethics: First Do No Harm: Avoiding Overdiagnosis and Overtreatment in Medicine

Sat, November 11, 2017, 8:45am
Location: 
Sheraton Ann Arbor Hotel | 3200 Boardwalk Street | Ann Arbor, MI

Registration available here.
 
8:45 am
Welcome, Opening Remarks, and Presentation of Certification of Appreciation Award to Blue Cross Blue Shield of Michigan Foundation
Lauren B. Smith, MD, Chair, MSMS Committee on Bioethics; Department of Pathology, University of Michigan
Audrey J. Harvey, CEO, Blue Cross Blue Shield of Michigan Foundation; and,
Shauna Ryder-Diggs, MD, Blue Cross Blue Shield of Michigan Foundation
 
9:00 - 10:00 am
7 Assumptions that Drive Too Much Medical Care
H. Gilbert Welch, MD, MPH, Professor of Medicine, Community & Family Medicine, The Dartmouth Institute, The Geisel School of Medicine at Dartmouth, Adjunct Professor, Business Administration, Tuck School
of Business and Adjunct Professor, Public Policy, Dartmouth College
 
10:00 - 11:00 am
Responding to those who Hope for a Miracle
Devan Stahl, PhD, Assistant Professor, Center for Ethics & Humanities in the Life Sciences, Department of Pediatrics & Human Development, Michigan State University
 
11:15 am - 12:15 pm
Whose Decision is it Anyway? Code Status and the Unilateral DNAR
Adam Marks, MD, Associate Director of the Adult Palliative and Supportive Care Clinic, East Ann Arbor Health and Geriatrics Center, Adult Palliative Care Medical Director, Arbor Hospice
 
1:15 - 2:15 pm
Capacity for Preferences: An Overlooked Factor in Ethical Dilemmas with Incapacitated Patients
Jason A. Wasserman, PhD, Associate Professor, Biomedical Science, Faculty Advisor on Professionalism, Oakland University William Beaumont School of Medicine; and,
Mark C. Navin, PhD, Associate Professor of Philosophy, Oakland University William Beaumont School of Medicine
 
2:15 - 3:15 pm
Over-treatment/Over-diagnosis of Genetic Testing
Michele Gornick, PhD, MA, Department of Internal Medicine, University of Michigan Medical School
 
3:30 - 4:30 pm
Case Studies
 
4:30 pm
Closing Remarks
Lauren B. Smith, MD, University of Michigan

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