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Funded by the National Institutes of Health/ArchiMD, Inc

Funding years: 2012-2014

 

PI: Alan Tait

Mon, December 15, 2014

Jennifer Griggs, MD, MPH was quoted in recent USA Today article about calls for the U.S. Food and Drug Administration to change its labeling on the drug Tamoxifen - recommending its use for 10 years instead of the current five.

Research Topics: 

PIHCD: Holly Brine

Wed, July 13, 2016, 4:00pm
Location: 
B004E NCRC Building 16
Holly Brine, a NICU fellow, will present on a survey for clinicians about how framing affects decisions about neonatal sepsis.

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

Funding Years: 2014 - 2017.

Suicide is a leading cause of death and suicide attempts are a major cause of disability, lost productivity, and health care costs. Suicide prevention is a research priority of the National Institutes of Health, and the US Surgeon General's National Strategy for Suicide Prevention calls for a shift towards recovery-oriented prevention efforts which promote hope and social support. Hopelessness and social isolation are two proximal risk factors for suicide which may be improved via peer mentorship, a form of peer support effective for preventing depression and repeat psychiatric hospitalizations. The primary aims of this study are to develop and pilot test a peer mentorship intervention for psychiatrically hospitalized patients at high risk for suicide. The intervention will be adapted by an expert panel from existing peer support training protocols to target suicide risk factors and to enhance suicide risk management. Protocols for training and supervising peer mentors and measures of intervention fidelity will also be developed. The intervention will then be pilot teste among 60 participants randomly assigned to receive the peer mentorship intervention plus usual care or usual care alone. Participants will be recruited from the inpatient psychiatry unit at the University of Michigan Health System. Inclusion criteria will include medical record documentation of suicidal ideation or suicide attempt at admission, and exclusion criteria will include significant cognitive impairment (according to the Mini-Cog), current receipt of peer support, or determination that peer mentorship may cause distress to the patient or the peer mentor. The peer mentorship intervention will include an in-person visit on the inpatient unit and regular in-person or telephone follow-up for 3 months post-discharge. The intervention will be delivered by peer specialists--individuals in stable recovery from serious mental illness who have received formal training and certification in peer support from the state of Michigan--with at least 6 months of professional peer support experience. The primary outcomes of the pilot study are acceptability and feasibility of the intervention as determined by: 1) >50% of eligible participants enroll in the study, 2) >70% of enrollees complete final follow- up measures at 6 months, and 3) among those assigned to the peer mentorship intervention, >80% complete an inpatient session and the median number of total sessions is at least 4. Peer mentorship sessions will be recorded and rated for fidelity. Measures of suicidal ideation and suicide attempts (the intended primary outcomes of a subsequent efficacy study) and secondary outcomes such as quality of life, functioning, depression, and service use will be obtained at baseline, 3 months, and 6 months post-enrollment by a research assistant blinded to study arm. An exploratory aim will be to measure potential mediators of intervention effectiveness including belongingness, burdensomeness, and hopelessness according to the interpersonal theory of suicide. If acceptability and feasibility are demonstrated, the study will result in a novel recovey-oriented suicide prevention intervention ready for a fully-powered randomized controlled efficacy trial.

PI(s): Paul Pfeiffer

Co-I(s): Mark Ilgen, H. Myra Kim, Cheryl King, Marcia Valenstein

Holly Witteman, PhD

Alumni

Dr. Holly Witteman was a Postdoctoral Research Fellow at CBSSM, 2009-2011. She studied mathematics and engineering at Queen's University in Kingston, Ontario, and worked in research and design in industry for several years before pursuing a Ph.D. in human factors engineering at the University of Toronto, where she was a fellow in Health Care, Technology, and Place, a strategic training initiative that fosters interdisciplinary collaboration between scholars in the humanities and sciences.

Last Name: 
Witteman
Tue, March 10, 2015

Beth Tarini MS, MD shared the findings of her research in a news article on the UMHS website. The research explores parents' perspectives on genomic sequencing for themselves and their children. "Particularly fascinating was that parents’ interest for having predictive genetic testing done for themselves reflected their interest in testing their children too – it appears to be a global decision for the family," Tarini explained. The study will be published in this month's issue of Public Health Genomics.

Research Topics: 

I Saw It on a Billboard (Feb-10)

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:

Jagsi R. Conflicts of interest and the physician-patient relationship in the era of direct-to-patient advertising. Journal of Clinical Oncology 2007;25:902-905.

 

Naomi Laventhal, MD, MA

Faculty

Dr. Naomi T. Laventhal joined the University of Michigan in August 2009, after completing her residency in pediatrics, fellowships in neonatology and clinical medical ethics, and a master’s degree in public policy at the University of Chicago. She is a Clinical Associate Professor in the Department of Pediatrics and Communicable Diseases in the Division of Neonatal-Perinatal Medicine, and in the Center for Bioethics and Social Sciences in Medicine (CBSSM).

Last Name: 
Laventhal

CBSSM Seminar: Jan Van den Bulck, PhD

Tue, November 28, 2017, 3:00pm
Location: 
NCRC, Building 16, Room 266C

Jan Van den Bulck, PhD
Professor, Communication Studies

Topic:
"Are the media (re-)defining how we interact with each other and with the world?

We know everything there is to know about people we have never even met. Through social media, we follow their every move. We even know their pets. Our media use interferes with healthy sleep, family meals, or even our work. Our children need levels of self-control to manage distractions that threaten their schoolwork. Or do they?"

Beth A. Tarini, MS, MD

Alumni

Beth A. Tarini is an Associate Professor of Pediatrics & Division Director of General Pediatrics and Adolescent Medicine at the University of Iowa. Before that, she was an Assistant Professor in the UM Department of Pediatrics and Communicable Diseases. She received her MD from Albert Einstein College of Medicine (2001) and a master's degree from the University of Washington (2006), where she was a Robert Wood Johnson Clinical Scholar. In addition to her clinical interest in preventative care, she pursues an active research program on issues of newborn screening and genetic testing.

Last Name: 
Tarini

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