Timothy R. B. Johnson, M.D. served as Chair of Obstetrics and Gynecology at the University of Michigan from 1993-2017. He is Bates Professor of the Diseases of Women and Children; and also Arthur F. Thurnau Professor; Professor, Women’s Studies, and Research Professor, Center for Human Growth and Development. His education and training have been at the University of Michigan, University of Virginia and Johns Hopkins.
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Last Saturday, Dr. Susan Goold had the highly esteemed task of presenting to the AMA House of Delegates on modernizing the Code of Medical Ethics. As the chair of the AMA Committee on Ethical and Judicial Affairs (CEJA), Dr. Goold is very involved in this massive reformatting and modernization effort. More information can be found in the AMA Wire press release.
The 2019 Bishop Lecture in Bioethics will be presented by Ruha Benjamin, PhD. Dr. Benjamin will present a talk entitled, “Black Afterlives Matter: Reimagining Bioethics for an Ailing Body Politic." The Bishop Lecture serves as the keynote address during the CBSSM Research Colloquium.
Ruha’s work investigates the social dimensions of science and technology with a focus on the relationship between innovation and inequity, health and justice, knowledge and power.
She is the author of People’s Science: Bodies and Rights on the Stem Cell Frontier (Stanford University Press 2013); Race After Technology (Polity 2019); and editor of Captivating Technology: Reimagining Race, Carceral Technoscience, and Liberatory Imagination in Everyday Life (Duke University Press 2019) among numerous other publications.
Ruha is also the recipient of fellowships from the American Council of Learned Societies, National Science Foundation, and Institute for Advanced Study among others, and in 2017 she received the President’s Award for Distinguished Teaching at Princeton.
For more info, please visit ruhabenjamin.com
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.
"Engaging communities in deliberations about priorities for Medicaid, Community Health Benefits, and Essential Health Benefits"
Presented by Susan Goold
With just a simple search term and a click of the mouse, a person can find a large amount of health information on the Internet. What role does the Internet play in how patients make medical decisions? Does using the Internet as a source for information to help patients make informed decisions vary by health condition? Does the Internet substitute for detailed discussions with a health care provider?
Consider the following:
Imagine that you recently visited your health care provider for an annual physical examination. During the exam your doctor told you that you are at the age where you should start thinking about getting a screening test for colon cancer. In this conversation your health care provider explained some of the reasons why you should get screened. At the end of the visit, you had more information about screening tests for colon cancer but had not yet decided whether or not you wanted to get tested.
- Don't know
How do your answers compare?
In a recent study published in the journal Medical Decision Making, CBSSM investigators Brian Zikmund-Fisher, Mick Couper, and Angela Fagerlin examined Internet use and perceived importance of different sources of information by patients making specific medical decisions.
In this study, US adults aged 40 years and older were asked about how they got information about 9 common medical decisions, including decisions about common prescription medication (for high blood pressure, cholesterol, and depression), cancer-screening tests (for colorectal, breast, and prostate cancer), and elective surgeries (for lower back pain, cataracts, and knee/hip replacement). In addition, they study compared participants' ratings of the Internet as a source of information with their ratings of other sources, such as their health care provider.
So, how did your responses compare to the average adult in this study's population?
Results from this study showed that most patients did not use the Internet to make specific medical decisions like the ones you considered. On average, about 26% of participants made use of the Internet for information to make decisions about colon cancer screening tests and about 47% used it to inform a decision about lower back pain surgery.
Among participants who chose to use the Internet for finding information about specific medical decisions, data show that Internet use varies significantly across different types of medical decisions. Internet users were more likely to use the Internet for information related to elective surgery (36%), such as lower back pain surgery, and prescription medication (32%) than for cancer-screening decisions (22%), such as colon cancer screening.
Another element of this study looked at participants' ratings of different information sources. You are unlike other participants in this study in that you did not consistently rate health care providers as the most important source for information about colon cancer screening and lower back pain surgery. The CBSSM study found that, for both Internet users and nonusers, health care providers were rated highest as a source for information for all 9 decisions studied. Among Internet users, however, the Internet was rated as their 2nd-most important source of information.
The researchers found that Internet use to inform specific medical decisions varied by age ranging from 38% for those aged 40 to 49 years to 14% for those aged 70 years or older. Approximately 33% of 50 to 59 year olds used the Internet to make these medical decisions and 24% for those in the 60 to 69 year age category. This result is consistent with previous research on the demographics of Internet use.
The study authors concluded that the Internet has an impact on people's access to health care information; however, "the data suggest that access is not the same as use, and use for one medical decision does not imply use for all health decisions." In other words, people use the Internet differently depending on the context. The authors end by stating, "Clinicians, health educators, and health policy makers need to be aware that we remain a long way away from having Internet-based information sources universally used by patients to improve and support the process of medical decision making."
For the full text of this article:
Couper M, Singer E, Levin CA, Fowler F, Fagerlin A, Zikmund-Fisher BJ. Use of the internet and ratings of information sources for medical decisions: Results from the DECISIONS survey. Medical Decision Making 2010;30:106S-114S.
What is the impact of medical advertising that is directly targeted at patients? What information do consumers of medical products and therapies need in order to make informed decisions about their health?
Consider the following:
Ms. J, a healthy 50-year old woman, drives by a billboard that advertises low-dose spiral computed tomography (CT) scanning to screen for lung cancer. Although she has no family history of cancer and has never smoked, several of Ms. J’s friends have been diagnosed with cancer recently. She worries that she herself may have an undetected malignancy.
Responding to this advertising, Ms. J decides to pay out-of-pocket for a CT scan at the imaging center advertised on the billboard. The radiologist at this imaging center profits from the number of scans interpreted. As a result of the CT scan, an abnormality is found, and Ms. J undergoes a biopsy of her lung. A complication occurs from this procedure, but Ms. J recovers, and the biopsy comes back negative. She is relieved to learn that she does not have lung cancer.
After reading this scenario and thinking about direct-to consumer medical advertising, which of the following statements best represents your views?
- STATEMENT A: Direct-to-consumer advertising improves patient education and patient-physician communication. Such advertising informs and empowers patients, so that their health care better reflects their needs and values. In particular, certain health services require complex medical equipment with high capital costs. Physicians who invest in such equipment do so because they believe in its promise, and they deserve payment to recoup their investment.
- STATEMENT B: Direct-to-consumer advertising often results in misunderstanding, increased costs, and disruption of the patient-physician relationship. Such advertising can skew information to portray products in a positive light and can prey upon patients’ fears. Physicians closely allied with a treatment cannot offer objective assessment to patients about the efficacy or risks of the treatment. Further, most patients are ignorant of the financial incentives to physicians for various procedures.
- STATEMENT C: I have not formed a viewpoint on direct-to-consumer medical advertising.
How do your answers compare?
CBDSM's Reshma Jagsi, MD, DPhil, has written a powerful challenge to the medical profession and medical industries in a recent issue of the Journal of Clinical Oncology. Dr. Jagsi argues that the increasing proliferation of direct-to-patient advertising has raised questions of how physicians can function as unbiased intermediaries between patients and industry.
In the article, she presents six case studies, one of which has been excerpted and adapted for this Decision of the Month. Dr. Jagsi uses these case studies to address serious issues related to both advertising and conflict of interest. Some examples:
- What implications does the frequently used advertising directive "Ask your doctor about X" have for the doctor-patient relationship?
- How ethical is it to disguise medical advertising—for instance, to hire celebrities to discuss treatments during interviews?
- Should a physician who prescribes a particular medical device be allowed to receive payment from the speakers' bureau of a company that produces that medical device?
- Should a physician who holds an ownership interest in an expensive treatment machine be required to explain alternate treatments to patients?
- When does a website about a medical treatment cross over from being informational to being promotional?
Dr. Jagsi argues that physicians have a strong ethical responsibility to their patients to call attention to potential conflicts of interest and to help interpret medical information in the best interests of their patients.
For more details about this study: