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Fri, October 30, 2015

Brian Zikmund-Fisher was quoted by a number of news outlets on the relaunch of 23andme.

In an interview for the LA Time article regarding the relaunch, “Genetic testing evolves, along with health and ethics debates,” Brian Zikmund-Fisher disagrees that more information is always good.  Dr. Zikmund-Fisher points out, "Providing people with more information is not helpful if they can't do anything about it, or it leads them to focus on the wrong thing" — on their genes rather than their lifestyles, for example.”

Wed, February 15, 2017

According to a study by Reshma Jagsi and colleagues, doctors often fail to recommend genetic testing for breast-cancer patients, even those who are at high risk for mutations linked to ovarian and other cancers. They surveyed 2,529 breast-cancer patients and found that although two-thirds of the women reported wanting genetic testing, less than a third actually got it. About 8 in 10 women at highest risk for BRCA mutations — because of family history or ancestry — said they had wanted testing, but only a little more than half received it.

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
Location: 
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.

 

Tue, April 10, 2018

In light of the #MeToo campaign denouncing sexual assault and harassment, Reshma Jagsi, MD, DPhil has written a perspective piece in the New England Journal of Medicine about sexual harrassment in academic medicine. This perspective piece and a recent survey published in JAMA related to sexual harassment and gender bias in academic medicine has been highlighted in multiple media outlets.

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 lynnam@umich.edu 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 kaytesb@med.umich.edu.


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.

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