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In videos for The Trust Project, bioethicist and sociologist Raymond De Vries explores trust in medicine from a sociological perspective.

In How Trust Shapes the Medical Field: A Sociologist's Perspective, De Vries offers a historical perspective on trust in medicine:

  • What role did industrialization play in changing interpersonal trust?
  • What can we learn about trusting relationships from past societies?

In The Rise of Bioethics in Response to Medical Distrust: Key Findings, De Vries discusses some key research in the field of trust and bioethics:

  • How did the erosion of trust in medicine lead to the rise in the study of bioethics?
  • Does the bureaucracy that comes with research ethics committees enhance or undermine trust?

An another video, Evolution of Trust in Bioethics medical research ethics.

The Trust Project at Northwestern University features scholars and executives exploring Trust in videos that cover theory, research and practice. By combining multiple and diverse perspectives, The Trust Project aspires to illuminate new insights for research and management.

CBSSM Seminar: Peter Jacobson, J.D., M.P.H.

Tue, October 10, 2017, 3:00pm
NCRC, Building 16, Room 266C

Peter Jacobson, J.D., M.P.H.
Professor of Health Law and Policy
Director, Center for Law, Ethics, and Health

Title:  Addressing Health Equity Through Health in All Policies Initiatives.

Scholars and public health advocates have expressed optimism about the potential for Health in All Policies (HiAP) initiatives to improve both health equity and population health. HiAP is a collaborative approach across multiple sectors. In a qualitative study to assess these concepts, we found considerable variation across the sites on: how HiAP and equity initiatives are defined and governed; the integration of equity as a core goal; institutional capacity; and the determination of actual policy changes. We found a general migration from a HiAP-centered strategy to one based more on health equity. Regardless of the specific nomenclature, the implementation focus was directed more toward changing practices than policies.


Funded by National Institutes of Health

Funding Years: 2014-2016

Nearly half of patients undergoing coronary artery bypass grafting (CABG) nationwide are exposed to red blood cell (RBC) products. While large volumes (3+ units) of transfusions may be delivered to a given patient to preserve life in cases of acute blood loss, evidence suggests that even small amounts (1-2 units) of RBCs often transfused to address poor oxygen delivery are associated with a 16% increase in a patient's risk of mortality and a 27% increase in morbidity, even after case mix adjustment. It is vitally important to allocate RBC products appropriately, given both that cardiac surgery utilizes between 20-25% of the total national blood supply, and the Red Cross reports that 32 of their 36 regions had less than a day's supply available to meet hospital needs. In short, it is important to improve our understanding of how and in what context decisions are made regarding 1-2 units of RBCs, given its association with morbidity, mortality and resource utilization. Growing evidence suggests that some transfusions may be discretionary. In the state of Michigan, nearly 40% of CABG patients are exposed to 1-2 units of RBCs, although the absolute rate varies 32% across institutions. Center-specific variation in transfusion practices is likely attributed to thelack of consensus regarding the indications, setting and hematocrit trigger for transfusions. Given this uncertainty, transfusion rates may be the consequence of differences in organizational (e.g. protocols, types of decision-makers, lack of performance feedback regarding transfusion practice) and provider (e.g. knowledge, beliefs concerning the benefit/harm of transfusions, and inclination to transfuse) factors. Interventions to reduce the rate of unnecessary transfusions first require identifying the set of determinants (at the organizational or provider level) that mot fully explain the observed variation in RBC utilization across regional medical centers. We will use the prospective data and infrastructure of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC), a consortium of all 33 cardiac surgical programs in Michigan, to: (1) Develop, pilot, and implement surveys to hospitals and clinical providers within the state of Michigan to describe determinants of 1-2 units of RBC transfusions during cardiac surgery, and (2) Identify the primary organizational and provider characteristics contributing to variability in transfusions. Results from this study will set the sage for a behavioral modification study aimed at reducing the rate of RBC transfusions in the setting of cardiac surgery.

PI(s): Richard Prager, Donald Likosky

Co-I(s): Darin Zahuranec, Min Zhang, Marc Zimmerman, Milo Engoren

Working Group

The Working Group provides a forum for project focused discussions and interdisciplinary collaborations in topics related to bioethics, health communication, decision making and any other topic that fits within the 5 domains of CBSSM.

Working group meetings provide an opportunity for investigators to receive feedback on research proposals, drafts of papers, grant applications, or any other aspects of projects at any stage of development. These sessions are to help move forward a project in any stage of its development. So if your project is in the works, in the planning stages, or perhaps it is still just an idea, you design the session and determine how to best solicit the help and support of your colleagues.
Some examples could be:

  • Outline sketch of specific aims for a grant. (Presenter would provide a one page summary before the session)
  • Outline of a proposed paper or paper in draft stage. (Discussion would be based on one page summary. Presenter would walk the group through the outline or draft, and solicit feedback on significance and coherence of ideas)
  • Determining a paper’s relevance. (Presenter could ask group members to read a paper, in order to discuss/determine if that paper is crucial to the project that the person has in mind-- different from a journal club exercise.)

This meeting is designed as an informal working group not a formal presentation.

The working group usually meets on Tuesdays or Wednesdays at 4pm in NCRC B16-266C. To be added to the email list, please contact Amy Lynn at OR join our email list.





Raymond De Vries, PhD

Associate Director

Raymond De Vries PhD is Associate Director at the Center for Bioethics and Social Sciences in Medicine at the University of Michigan and is a Professor in the Department of Learning Health Sciences and the Department of Obstetrics and Gynecology. He is also visiting professor at CAPHRI School for Public Health and Primary Care, University of Maastricht, the Netherlands.

Last Name: 
De Vries

Funded by University of Essex.

Funding Years: 2016-2017

To date there are no surveys in the UK (or other developed countries) that measure income, expenditure, assets and debts for the same households. These data limitations constrain our understanding of the dynamics of living standards. For example, expenditure surveys in the UK and other countries suggest that households with the lowest incomes spend as much as households with much higher incomes. It is however not known whether this pattern is the result of measurement error in expenditure or income or whether it reflects genuine borrowing or dissaving. Having data about the assets and debts of a household over time, in addition to income and expenditure, would enable analysts to resolve this puzzle.

Understanding the spending, saving and borrowing of households is critical for assessing the sustainability of economic growth, including whether the current recovery is fuelled by unsustainable consumer spending. There are other similar unresolved puzzles. For example, in survey data richer households save larger proportions of their income, however aggregate savings rates have not increased over time as real incomes have increased. This discrepancy could again be due to measurement error or reflect true behaviours. A better understanding of household finances will allow a clearer picture of which households are disadvantaged, and how advantage and disadvantage cumulate across time and generations.

PI: Mick Couper

Research Ethics

Research Ethics Service

The Research Ethics Service, led by Kayte Spector-Bagdady, JD, MBioethics and Raymond De Vries, PhD within the Center for Bioethics and Social Sciences in Medicine, aims to enable a culture of normative, empirical, and educational inquiry to serve as the ethical backbone of research at Michigan Medicine. Its three areas of focus include:

1. Education: providing instruction on Research Ethics and Responsible Conduct of Research;
2. Consultation: offering a consulting service for colleagues with questions about the ethical conduct of research; 
3. Research: using a variety of methods to study issues in Research Ethics.

Research Ethics and Responsible Conduct of Research Education

Coursework and independent projects into research ethics and the responsible conduct of research may be available upon request. Current courses include the Responsible Conduct of Research for K Awardees (RCR4K) Implementation Package offered through the Michigan Institute for Clinical & Health Research (MICHR) and Legal Rules and Ethical Issues for Clinical Research (HMP 540) through the Clinical Research Design and Statistic Analysis Masters Program at the UM School of Public Health.

Research Ethics Consultation Service

Personalized Research Ethics Consultation may be available during normal business hours for investigators across Michigan Medicine designing or conducting their own research protocols. For further information or to request a consultation please contact

Mixed Methods Research into Human Subjects Research Ethics

The Program in Research Ethics also supports a vibrant mixed-methods empirical program for research on human subjects research ethics.

Bioethics Grand Rounds -Reshma Jagsi, MD, DPhil

Wed, October 25, 2017, 12:00pm
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.


Funded by the Agency for Healthcare Research and Quality

Funding Years: 2015-2019

The theme of the University of Michigan Patient Safety Learning Laboratory ("M-Safety Lab") is to improve the delivery of inpatient care by cross-linking investigators from diverse disciplines - including engineering, medicine, nursing, architecture and design and computer science - who share a common interest in patient safety. Our overarching goal is to implement novel methods to enhance cognition and communication among care providers in order to reduce hospital-acquired complications. The M-Safety Lab will include a robust infrastructure that will support two projects, each of which has the potential to transform the delivery of inpatient care. Both projects - Project 1 will develop a new monitoring system for hospitalized patients and Project 2 will address the common, but understudied area of diagnostic and therapeutic error - will be based on two major interrelated themes: Preventing hospital-acquired complications and improving medical decision-making through enhanced cognition and communication. We have assembled an extremely broad and productive group of investigators from a large number of synergistic disciplines. The Laboratory-Wide Aim is to establish a cohesive M-Safety Lab comprised of multidisciplinary, collaborating teams of investigators supported by a robust infrastructure including an Innovation, Development, Evaluation and Administration (IDEA) Core that will help oversee the development and successful completion of both projects from problem analysis to evaluation, and will provide methodological, technical, and administrative support for the M-Safety Lab.

PI(s): Sanjay Saint

Co-I(s): Amy Ellen Cohn, Frank Jacob Seagull, Jan Stegemann, Jennifer Meddings, Laurence McMahon, Mary Rogers, Michael Greene, Milisa Manojlovich, Rachael Schmedlen, Richard Lewis, Robert Adams, Sarah Krein, Satinder Baveja, Scott Flanders, Timothy Hofer, Vineet Chopra

2015 Bishop Lecture featuring Lawrence O. Gostin, J.D., LL.D. (Hon.)

Tue, March 17, 2015, 11:00am
Founders Room, Alumni Center, 200 Fletcher St., Ann Arbor, MI

Bishop Lecture in Bioethics: "Law, Ethics, and Public Health in the Vaccination Debates: Politics of the Measles Outbreak" (Keynote Address for the 2015 CBSSM Research Colloquium)

Abstract: The measles outbreak of early 2015 is symptomatic of a larger societal problem–the growing number of parents who decide against vaccinating their children. This failure is causing the resurgence of childhood diseases once eliminated from the United States.
falseThis presentation explores the legal and ethical landscape of vaccine exemptions. While all states require childhood vaccinations, they differ significantly in the types of religious and/or philosophical exemptions permitted, the rigor of the application process, and available review mechanisms. States with relaxed exemption policies disproportionately experience more outbreaks of vaccine-preventable disease.

Vaccine exemptions are an illustration of the “tragedy of the commons,” in which parents choose not to vaccinate their children, relying on the fact that other parents will vaccinate their children, thus providing community immunity. However, the net result of many individual decisions not to vaccinate is the collapse of herd immunity and thus an upsurge in preventable disease and death.
The failure to vaccinate puts others at risk, thus violating an important ethical principle. However, punishing individual parents could entrench political opposition to vaccine policy. The most ethical and effective solution is for state legislatures to tighten vaccination laws, making it more difficult to obtain non-medical exemptions.

Lawrence O. Gostin, J.D., LL.D. (Hon.) is University Professor, Georgetown University’s highest academic rank conferred by the University President. Prof. Gostin directs the O’Neill Institute for National and Global Health Law and is the Founding O’Neill Chair in Global Health Law. He is Professor of Medicine at Georgetown University, Professor of Public Health at the Johns Hopkins University, and Director of the Center for Law & the Public’s Health at Johns Hopkins and Georgetown Universities. Prof. Gostin is also the Director of the World Health Organization Collaborating Center on Public Health Law & Human Rights.

  • Click here for video-recording of the 2015 Bishop Lecture