Darin B. Zahuranec, M.D, M.S., (Residency 2005, School of Public Health 2009), is an associate professor of neurology in the University of Michigan Medical School. Dr. Zahuranec received his bachelor's degree, summa cum laude, from Case Western Reserve University in Cleveland, Ohio, in 1997, and earned his medical degree from Case Western Reserve in 2001. He completed an internship at University Hospitals of Cleveland; residency in the Department of Neurology at the U-M, where he served as chief resident in 2004-05; and a fellowship in vascular neurology here.
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Patients sometimes skip treatments because they just feel too busy. What should physicians do when their patients ignore their recommendations?
Imagine you are a businessperson who works long hours and you are on your way up to having a successful and lucrative career. You have a major business deal that will consume nearly all of your time over the upcoming month and your boss is relying on you to make sure the deal goes through. This is your chance to really make your mark and show your corporation that you are the kind of person that can handle deals as big as this one. Also suppose you have been smoking on and off for 25 years. You know it's a bad habit that could destroy your lungs, but you just can't quite kick it. Lately, you have been feeling tired, you have been experiencing chest pains when you are really busy at work and when you exercise, and you have had trouble breathing when climbing a flight of stairs. The chest pains are usually relieved by a little rest, but you decide it's time to get this examined by a doctor.
One day after work, you go to see Dr. Coral, who gives you a stress test and determines that you'll need an appointment for an angiogram to better evaluate your coronary arteries. Fortunately, you find one free day right before things get hectic at work, so you schedule the angiogram. Now imagine you have just had the angiogram and you are recovering in a paper gown waiting for Dr. Coral to come back with the results. Dr. Coral enters the room to speak with you and he has a serious look on his face. He says,
"I have both good and bad news for you. The angiogram shows that your 3 main coronary arteries are all severely blocked. The good news is that we caught this before you had a major heart attack."
"The bad news is that I am recommending you have triple bypass surgery as soon as possible. Your heart is working overtime, and it is just a matter of time until it gives out."
- I would put aside Dr. Coral's recommendation and instead take responsibility at work for the current deal. I'll wait to have surgery in about a month.
- I would follow Dr. Coral's recommendation by having surgery immediately, even though this forfeits the current opportunity at work.
A little feedback on what you chose.
- understand the information about the condition and the choices available;
- make a judgment about the information in keeping with his or her personal values and beliefs;
- understand the potential outcomes or consequences of different choices; and
- freely communicate his or her wishes
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.
Tell us what you think about certain public policies designed to reduce the incidence of diabetes in the US.
Please read this hypothetical news article and then answer a few questions at the end.
People with Diabetes Lobby Congress This Week
- strongly disagree
- strongly agree
- strongly disagree
- strongly agree
- strongly disagree
- strongly agree
Generally speaking, do you usually think of yourself as a Republican, a Democrat, an Independent, or what?
- Strong Democrat
- Not so strong Democrat
- Independent, close to Democrat
- Independent, close to Republican
- Not so strong Republican
- Strong Republican
- Don't know, haven't thought much about it
How you answered:
Researchers affiliated with CBDSM and the School of Public Health have found that "Americans' opinions about health policy are polarized on political partisan lines. Democrats and Republicans differ in the ways that they receive and react to messages about the social determinants of health."
In the study, lead author Sarah Gollust, PhD, randomly assigned participants to read one of four hypothetical news articles about type 2 diabetes. Diabetes was used as an example of a common health issue that is widely debated and that is known to have multiple contributing factors, including genetic predisposition, behavioral choices, and social determinants (such as income or neighborhood environments).
The articles were identical except for the causal frame embedded in the text. The article that you read in this Decision of the Month presented social determinants as a cause for type 2 diabetes. Other versions of the article presented genetic predisposition or behavioral choices as a cause for type 2 diabetes, and one version had no causal language.
Dr. Gollust then asked the study participants their views of seven nonmedical governmental policies related to the environmental, neighborhood, or economic determinants of diabetes:
- bans on fast food concessions in public schools
- incentives for grocery stores to establish locations where there are currently few
- bans on trans fat in restaurants
- government investment in parks
- regulating junk food advertisements
- imposing taxes on junk foods
- subsidizing the costs of healthy food
Dr. Gollust also asked participants their political party identification and a number of other self-reported characteristics.
The most dramatic finding of this study was that the news story with the social determinants as a cause for type 2 diabetes had significantly different effects on the policy views of participants, depending on whether they identified themselves as Democrats or Republicans. After reading the social determinants article, Democrats expressed a higher level of support for the proposed public health policies. Republicans expressed a lower level of support for the proposed public health policies. This effect occurred only in the group of participants who were randomly assigned to read the version of the news article with social determinants given as a cause for type 2 diabetes. Dr. Gollust summarizes: "Exposure to the social determinants message produced a divergence of opinion by political party, with Democrats and Republicans differing in their opinions by nearly 0.5 units of the 5-point scale."
The study suggests several possible explanations for these results:
"First, the social determinants media frame may have presumed a liberal worldview to which the Republican study participants disagreed or found factually erroneous (ie, not credible), but with which Democrats felt more comfortable or found more familiar. . . Second, media consumption is becoming increasingly polarized by party identification, and . . . the social determinants message may have appeared particularly biased to Republicans. . .Third, the social determinants frame may have primed, or activated, study participants' underlying attitudes about the social group highlighted in the news article. . . Fourth, participants' party identification likely serves as proxy for . . . values held regarding personal versus social responsibility for health."
Dr. Gollust and her colleagues conclude that if public health advocates want to mobilize the American public to support certain health policies, a segmented communication approach may be needed. Some subgroups of Americans will not find a message about social determinants credible. These subgroups value personal responsibility and find social determinants antagonistic to their worldview. To avoid triggering immediate resistance by these citizens to information about social determinants of health, public health advocates may consider the use of information about individual behavioral factors in educational materials, while working to build public familiarity with and acceptance of research data on social determinants.
For more details about this study:
Kathryn Moseley served as one of the judges at "The Big Ethical Question Slam 5" hosted by a2ethics.org. In addition, Naomi Laventhal, Michele Gornick, Christian Vercler, Lauren Smith, and Lauren Wancata served as judges at the "Michigan Highschool Ethics Bowl 2."
Thanks to all the CBSSM folks who contributed their time!
For more information about these events and other great ethics-related activites, go to a2ethics.org.
A short video about the Highschool Ethics Bowl can be found here.
When Death Comes Callin': Songs and Reflections About Death
Charlotte DeVries, Jeanne Mackey, Merilynne Rush, and friends offer a program of songs and brief readings reflecting various perspectives on death - humorous, sad, thoughtful, and quirky.
Lunch is provided on a first-come, first-served basis.
Vaccine refusal has an impact on public health; however, research has shown that it is very difficult to change attitudes towards vaccines. People are often hesitant about vaccines because they don’t trust that potential harms are documented and reported. The question is: how can we increase trust and vaccine utilization?