1. "Natural" has popularly come to mean what, in the context of medicine?
2. The most unnatural aspect of vaccination is what?
3. What led to the creation of the EPA?
4. What kind of thinking makes no room for ambiguous identities, and what does it threaten?
5. What "troubling dualisms" characterize the vaccination debate?
6. What practice went on in China and India for hundreds of years, to combat smallpox?
7. What metaphor is implied by "inoculation"?
8. What disappointed Biss about the immuno-semiotics conference?
9. What game metaphor does Biss prefer, to describe our immune systems and viral pathogens?
10. What caused the fatal form of croup that has virtually disappeared in this country since the '30s?
11. What caused the spread of puerpal sepsis ("childbed fever")?
DQ
- Do you agree that the popular appeal of what is deemed more "natural" is a product of our "profound alienation from the natural world"?
- Are vaccines unnatural?
- Comment: "It is only when disease manifests as illness that we see it as unnatural." 42
- Should it bother us that Rachel Carson apparently was wrong about DDT being carcinogenic? 44
- With the apparent gutting of the EPA and other federal regulators now under way, will "the judicious use of chemicals" to fight insect-born diseases etc. still be possible? 45
- Are you comfortable with the idea of being a cyborg? 49
- Are you disproportionately afraid of sharks and oblivious to the dangers of bicycles? Does simply acknowledging such misperceptions help you to overcome them?
- Is immunity mostly a metaphor? Is it correctly characterized by metaphors of war? Do you agree with the perspective of alt-med practitioners on this point? 57
- Is parenting, with its attendant decisions impacting the future health of children, more "like time travel" than making health decisions for oneself? What do you make of the Star Trek example? Who in the present anti-vaxx scenario is "heroically return(ing) to the past to die"? 66
- Why do you think women healers historically were regarded as witches, albeit "good" ones? Are women fully welcome in the ranks of professional medicine today?
- Are there modern-day equivalents of "heroic" medicine (bleeding etc.)? Does it have a legitimate place in professional practice?
- Are we overly obsessed with "purity" and with avoiding toxicity? Are we never cleaner than our environment at large?
- Should human breast milk be commodified? If so, how should it be regulated?
- Your DQs
Today in Bioethics, Eula Biss plays some more with the vampire theme and her recognition as both a new mother and a patient that "we feed off of each other, we need each other to live," and that the whole mutual dependency framework of our lives is beautifully "aglow with humanity."
One of the troubling and less lovely expressions of humanity is our tendency to panic in the face of unwarranted and unsubstantiated fears. Such was the "cascade of panic" triggered by Andrew Wakefield's discredited study linking the MMR vaccine to autism. "Wealthier countries have the luxury of entertaining fears the rest of the world cannot afford."
Anderson Cooper (vid)... The Vaccine War (Frontline-vid)... Vaccines-Calling the Shots (Nova-vid)
Refusal of immunity "as a form of civil disobedience" is an opportunity of privilege - "a privileged 1% are sheltered from risk while they draw resources from the other 99%." Consider Marin County, for instance... (vid)
The refuseniks who think they're striking a solid blow against inhumane capitalists, especially Big Pharma, are missing a vital point: shared immmunity "is a system in which both the burdens and the benefits are shared across the entire population," hardly standard operating procedure under capitalism. Opting out really looks more like buying in and supporting the status quo, which is to devalue or ignore appeals to ethical principle in favor of (as Susan Sontag said) "the calculus of self-interest and profitability." What an impoverished state of mind and a shrunken state of heart.
And speaking of Dracula, one more time: "medicine sucks the blood out of people in a lot of ways." So maybe Biss's dad was right: "Most problems will get better if left alone." Problems abound, though, if our reason for choosing to leave them alone is an absence of trust in medical practitioners.
Quiz March 29, OI 77-109
1. What was ambiguous about the vampire metaphor, for Biss?
2. What struck Biss as both magical and mundane?
3. Smallpox is now no longer a disease, but a what?
4. Who were the Polio Pioneers? Where is polio still endemic, and why?
5. What are the profound differences between ethyl and methyl mercury?
6. How did Andrew Wakefield cause a "cascade of panic"?
7. Who accused WHO of collusion in 2009?
8. Why does Susan Sontag say public health is difficult to promote in our society?
9. Why does Arthur Caplan say the marketplace model of healthcare is dangerous?
10. When would Biss consider surgery a conservative option?
11. For what is there no credible evidence, "Dr. Bob" notwithstanding?
12. What's Biss's Dad's argument for preventive medicine?
DQ
- Why is it important to remember that "it's not your blood" that you must depend upon, when you need a transfusion?
- Is mutual bodily dependence ugly, beautiful, both, neither,... ?
- If our knowledge gives viral pathogens immortality, how can we effectively regulate them? 83
- What's the best way to combat "vaccine refusal" in the developing world? Is that different from how we should address it here? What would you say to Biss's Vietnamese friend? 87
- Are you worried about nefarious "invisible commercial influences" having an outsized influence on public health policy? Are you persuaded of the "power of the core public health ethos"? 95
- Is refusing immunity a legitimate form of civil disobedience, or a form of elitist self-indulgence?
- Is "shopping around for a doctor" (see cartoon below) ever appropriate?
- What do you think of Biss's critique of capitalism and what it is "really taking from us"? 97
- What do you think of the anesthesiologist's "disgusting" remarks? 102 Were they unethical, inappropriate, or excusable?
- What do you think of Biss's "Dad's "two sentence textbook"? 103
- Should a doctor be concerned with conditions in other docs' waiting rooms? How should they express such concern? 108
- I suggest we brainstorm several other DQs, in small groups during discussion time, and share them with the whole class before leaving today.
| Medical Ethics & Me (@medethicsandme) | |
|
“Having raised humanity above the beastly level of survival struggles, we will now aim to upgrade humans into... fb.me/ETqAhy3e
| |
"I'll go shop around for a doctor."
Years after research contradicts common practices, patients continue to demand them and doctors continue to deliver. The result is an epidemic of unnecessary and unhelpful treatment.by David Epstein, ProPublica February 22, 2017
First, listen to the story with the happy ending: At 61, the executive was in excellent health. His blood pressure was a bit high, but everything else looked good, and he exercised regularly. Then he had a scare. He went for a brisk post-lunch walk on a cool winter day, and his chest began to hurt. Back inside his office, he sat down, and the pain disappeared as quickly as it had come.
That night, he thought more about it: middle-aged man, high blood pressure, stressful job, chest discomfort. The next day, he went to a local emergency department. Doctors determined that the man had not suffered a heart attack and that the electrical activity of his heart was completely normal. All signs suggested that the executive had stable angina — chest pain that occurs when the heart muscle is getting less blood-borne oxygen than it needs, often because an artery is partially blocked.
A cardiologist recommended that the man immediately have a coronary angiogram, in which a catheter is threaded into an artery to the heart and injects a dye that then shows up on special x-rays that look for blockages. If the test found a blockage, the cardiologist advised, the executive should get a stent, a metal tube that slips into the artery and forces it open.
While he was waiting in the emergency department, the executive took out his phone and searched “treatment of coronary artery disease.” He immediately found information from medical journals that said medications, like aspirin and blood-pressure-lowering drugs, should be the first line of treatment. The man was an unusually self-possessed patient, so he asked the cardiologist about what he had found. The cardiologist was dismissive and told the man to “do more research.” Unsatisfied, the man declined to have the angiogram and consulted his primary-care doctor.
The primary-care physician suggested a different kind of angiogram, one that did not require a catheter but instead used multiple x-rays to image arteries. That test revealed an artery that was partially blocked by plaque, and though the man’s heart was pumping blood normally, the test was incapable of determining whether the blockage was dangerous. Still, his primary-care doctor, like the cardiologist at the emergency room, suggested that the executive have an angiogram with a catheter, likely followed by a procedure to implant a stent. The man set up an appointment with the cardiologist he was referred to for the catheterization, but when he tried to contact that doctor directly ahead of time, he was told the doctor wouldn’t be available prior to the procedure. And so the executive sought yet another opinion. That’s when he found Dr. David L. Brown, a professor in the cardiovascular division of the Washington University School of Medicine in St. Louis. The executive told Brown that he’d felt pressured by the previous doctors and wanted more information. He was willing to try all manner of noninvasive treatments — from a strict diet to retiring from his stressful job — before having a stent implanted.
The executive had been very smart to seek more information, and now, by coming to Brown, he was very lucky, too. Brown is part of the RightCare Alliance, a collaboration between health-care professionals and community groups that seeks to counter a trend: increasing medical costs without increasing patient benefits. As Brown put it, RightCare is “bringing medicine back into balance, where everybody gets the treatment they need, and nobody gets the treatment they don’t need.” And the stent procedure was a classic example of the latter. In 2012, Brown had coauthored a paper that examined every randomized clinical trial that compared stent implantation with more conservative forms of treatment, and he found that stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all. In general, Brown says, “nobody that’s not having a heart attack needs a stent.” (Brown added that stents may improve chest pain in some patients, albeit fleetingly.) Nonetheless, hundreds of thousands of stable patients receive stents annually, and one in 50 will suffer a serious complication or die as a result of the implantation procedure... (continues)
What the top U.S. health official should be saying on vaccines
Health and Human Services Secretary Tom Price. (Joshua Roberts/Reuters)
During a televised town hall last week, the nation’s top health official was asked whether all children should get immunized for measles and other vaccine-preventable diseases. In his response, Health and Human Services Secretary Tom Price parsed his words carefully. He said state governments (presumably rather than the federal government) “have the public health responsibility to determine whether or not immunizations are required for a community population.”
His response angered many doctors and public-health officials, who say the top U.S. health official failed to give full-throated support for immunizations that prevent disease and protect communities at a time when anti-vaccine sentiment is on the rise.
Paul Sax, an infectious disease specialist at Boston’s Brigham and Women’s Hospital, said Price might have been choosing his words carefully for political reasons. Price, he noted, belongs to the Association of American Physicians and Surgeons, an organization that opposes mandatory immunizations. And there’s Price’s boss, President Trump, who has publicly expressed discredited concerns about vaccine safety.
So Sax decided to write tongue-in-cheek answers for what Price should be saying. The post appeared in the HIV and ID Observations blog published by NEJM Journal Watch... (continues)
==
What viruses are in blood transfusions? New study identified 19 human viruses in 42% of study participants. Mindblowing stuff @JCVenter twitter.com/humanlongevity…
==
A new study of postal workers in Scotland suggests we should aim for far more than the 10,000 daily steps commonly recommended...
==
A lower-cost vaccine provides strong protection against rotavirus, a diarrheal disease, and could be particularly useful in poorer countries, researchers said...
==
==
Treatment for addiction grew with the Medicaid expansion under Obama’s health care act, but millions may lose coverage if the House approves a measure to repeal the Affordable Care Act...
==
As biological research races forward, ethical quandaries are piling up. In a report published Tuesday in the journal eLife, researchers at Harvard Medical School said it was time to ponder a startling new prospect: synthetic embryos.
In recent years, scientists have moved beyond in vitro fertilization. They are starting to assemble stem cells that can organize themselves into embryolike structures.
Soon, experts predict, they will learn how to engineer these cells into new kinds of tissues and organs. Eventually, they may take on features of a mature human being.
In the report, John D. Aach and his colleagues explored the ethics of creating what they call “synthetic human entities with embryolike features” — Sheefs, for short. For now, the most advanced Sheefs are very simple assemblies of cells... (continues)
In recent years, scientists have moved beyond in vitro fertilization. They are starting to assemble stem cells that can organize themselves into embryolike structures.
Soon, experts predict, they will learn how to engineer these cells into new kinds of tissues and organs. Eventually, they may take on features of a mature human being.
In the report, John D. Aach and his colleagues explored the ethics of creating what they call “synthetic human entities with embryolike features” — Sheefs, for short. For now, the most advanced Sheefs are very simple assemblies of cells... (continues)
A hint of the future arrived in a study published this month by researchers at the University of Cambridge. They built microscopic scaffolding into which they injected a mixture of two types of embryonic stem cells from mice.
This triggered communication by the cells, and they organized themselves into the arrangement found in an early mouse embryo.
While these artificial embryos developed from embryonic stem cells, it may soon become possible to build them from reprogrammed adult human cells. No fertilization or ordinary embryonic development would be required to build a mouse Sheef.
“We need to address this now, while there’s still time,” Dr. Aach said.
Sophia Roosth, a Harvard historian of science who was not involved in the new paper, said she did not think ethicists would have to start from scratch to find rules for these strange new Sheefs. She was optimistic that experts could draw on the many regulations in place for other kinds of research — including cloning, human tissue studies, and even studies on animals.
“I don’t think the baby has to be thrown out with the bathwater,” she said.
Henry T. Greely of Stanford University was less optimistic. While it is important to have a discussion about Sheefs, he said, it may be hard to reach an agreement on limits as enforceable as the 14-day rule.
“Whether you could come to some consensus is really doubtful,” he said.
Even if ethicists do manage to agree on certain limits, Paul S. Knoepfler, a stem cell biologist at the University of California, Davis, wondered how easy it would be for scientists to know if they had crossed them.
Spotting a primitive streak is easy. Determining whether a collection of neurons connected to other tissues in a dish can feel pain is not.
“It gets pretty tricky out there,” Dr. Knoepfler said. “They’ve opened the door to a lot of tough questions.”
 | douglas rushkoff (@rushkoff) |
This comment has been removed by the author.
ReplyDeleteAlternate Quiz March 21
ReplyDelete1.Who says, “The more artificial a human environment becomes, the more the word ‘natural’ becomes a term of value.”? (40)
2.The ___________ that generate immunity following vaccination are manufactured in the human body, not in factories. (41)
3.(T/F) Colonization and the slave trade were responsible for the introduction of Malaria to the Americas. (44)
4.As an alternative to seeing our immune system as a war we are fighting against ourselves, Biss says we can accept a world in which we are all what?(49)
5.What term that Jenner used for cow pox became the root word for vaccination? (52)
6.Who arranged for variolation of prisoners that were condemned to die and what happened to them?(53)
7.Who first used the term immune system in 1967? What was he trying to accomplish?(57)
8.What was wrong with Biss’s son? How was it different from the other type? (65)
9.According to the __________ ___________ midwives belonged to the class of good witches who healed and did not harm, but this made them no less witches. (67)
10. What is the seemingly innocent concept behind a number of the most sinister social actions of the past century? (75)
1. Wendell Berry
Delete2. antibodies
3.T
4.irrational rationalists
5. vacca
6. The princess of Wales
7. Niels Jerne
DQ: What types of "purity" do we strive for today?
ReplyDeleteExtra Questions (p.40 - 76)
ReplyDelete1. Criticizing 20th century psychologists, Janna Malamud Smith observes that mothers provide a "_____________________". p. 69
2. Donna Haraway: "Women know very well that knowledge from natural sciences has been used in the interests of our _________ and not our _________." p. 71
3. "In the 19th century, smallpox was widely considered a disease of ______, which meant that it was largely understood to be a disease of the _______." p. 72
1. mental illness
Delete2. domination, liberation
3. filth, the poor
Alternative Quiz Questions:
ReplyDelete1. Infectious disease is one of the primary mechanisms of what? (41)
2. What pesticide is being used as one of the most effective means of controlling malaria in some places? (44)
3. How does the drama in Carson’s Silent Spring compare to the plot of Dracula? (46)
4. What does Voltaire suggest could have been avoided if the French had adopted the practice of variolation as readily as the English? (53)
5. What did the three immunologists on a road trip determine that a better understanding of what might enhance their work? (55)
6. A friend of Biss wrote to her, saying that “Antibiotics, vaccines, they’re both like time travel.” What did her friend mean by this, and how does Biss relate this to vaccinating her children? (65)
7. (T/F) Over the next decade from 1998, study after study confirmed that there was in fact a link between the MMR vaccine and autism, and researchers were able to replicate Andrew Wakefield’s hypothesis. (69)
8. Filth theory was eventually replaced by what other theory, which provided a more superior understanding of the nature of contagion? (71)
Alternative Quiz 3/21
ReplyDelete1. Most pharmaceutical available to us are at least as ____ as they are _____. (p. 40).
2. What is always passing through our bodies, whether we are sick or healthy? (41)
3. When was the first recorded epidemic? (42)
4. What brought malaria to the Americas? (44)
5. Our __________ both extends and endangers us (50)
6. What is a precursor of modern medicine (51)
7. What is variolation? (52)
8. When was the term immune system first used? (57)
9. Who is Niels Jerne and what was he trying to reconcile (57)
10. As an infant, what is something that the immune system doesn’t do well? (58)
11. Diphtheria kills as many as ____ percent of children who contact it. (65)
12. Who wrote a Journal of the Plague Year? (66)
1. bad, good
Delete2. live viruses
3. 1493
4. African child
5. technology
6. vaccination
7. beast that would never leave the body
8.1967
Delete9.unite all cells and antibodies involved in the immune system
10.last
ALTERNATIVE QUIZ 3/23
ReplyDelete1. What did Biss's Lake Michigan canoe trip help her to realize? (80)
2. Her son's birth, a bodily violent occasion, Biss was most aware of what? (81)
3. The confliction felt by our literary vampires over their need for blood gives us a new way to think about what? (82)
4. _____ is the next disease likely to be eradicated through vaccination. (85)
5. What makes polio vaccine refusal a viable weapon in international warfare? (87)
6. Why do some countries rely on multidose vaccines? (91)
7. Why do wealthy countries use expensive single-dose vaccines? (91)
8. Who compared capital to vampires? (93)
9. How does refusing vaccination resemble the Occupy movement? (95)
10. How do we justify the costliness and impracticalities of protecting the vulnerable, according to Susan Sontag? (96)
11. Paternalism of doctors has been replaced by what? (99)
12. Barbara Peterson proposes ___________ as an alternative to paternalism in medicine? (99-100)
Extra Questions 2/23 (p. 77-109)
ReplyDelete1. Our vampires are a reminder that _____________. (p. 82)
2. If vaccines can be conscripted into acts of war, it can still be instrumental in ____________. (p. 88)
3. What recent presidential candidate was compared to a vampire? (p. 93)
4. In the ____________ of medicine, the paternalism of doctors has been replaced by the consumerism of patients. (p. 99)
DQ
ReplyDeleteAm I worried about 'nefarious "invisible commercial influences"' on my health? I chuckled a bit when I heard that. Of course I'm worried! Even the simple things like electronic media that have the indirect influence of keeping me inside and away from exercise are significant, not to mention the amount of marketing for unhealthy but convenient food. It's obviously effective, after all. It's interesting because I know that making certain decisions makes me feel better than making others, but that doesn't stop it from being a struggle. The unhealthy choice often seems like the default option, and I don't think that ought to be the natural state of things.
Alternative Quiz Questions:
ReplyDelete1. According to Biss, what do philosophers mean when they call power a “positional good? (82)
2. What risks did the children of Biss’s father’s generation (Polio Pioneers) face in being administered the smallpox vaccine? (84)
3. What was neglected in the push to eradicate polio, even though they killed more children? (86)
4. What accusations would be triggered from the reversal of the WHO and the AAP’s position of excluding thimerosal from the 2013 mercury ban, compared to their 1999 position of removing it? (89-90)
5. Thimerosal, which allows for more rapid production and distribution of vaccines, might yet be as essential in our country as it is in others in the event of what? (91)
6. What was it that independent experts found after investigating the claim that the WHO colluded with pharmaceutical companies in creating a “false pandemic”? (94)
7. What did the Nigerian barber suggest that “the white man” could poison as an easier means to destroy them than using vaccines? (97)
8. What kind of paternalism does Michael Merry say is reflected in legislation and regulations and what do these laws limits? (98-99)
Answers to Sofie's Questions (1-8)
ReplyDelete1.Who says, “The more artificial a human environment becomes, the more the word ‘natural’ becomes a term of value.”? (40) Wendell Berry
2.The ___________ that generate immunity following vaccination are manufactured in the human body, not in factories. (41) antibodies
3.(T/F) Colonization and the slave trade were responsible for the introduction of Malaria to the Americas. (44) True
4.As an alternative to seeing our immune system as a war we are fighting against ourselves, Biss says we can accept a world in which we are all what?(49) irrational rationalists
5.What term that Jenner used for cow pox became the root word for vaccination? (52) vacca
6.Who arranged for variolation of prisoners that were condemned to die and what happened to them?(53) The princess of Wales, they were freed for their troubles
7.Who first used the term immune system in 1967? What was he trying to accomplish?(57) Niels Jerne, the reconciliation of the factions of immunity
8.What was wrong with Biss’s son? How was it different from the other type? (65) He got croup/ striders, it was viral
Alternate Quiz Questions:
ReplyDelete1. What do vaccines invite?
2. What metaphor did Carson use to describe the ‘ecosystem’?
3. What does “A Cyborg Manifesto” suggest?
4. Who created the variolae vaccinae?
5. The term ‘immune system’ was first used by who? When? Why?
6. Describe psycho acoustics.
7. Saint Hildegarde cataloged what? And women lay healers knew what?
8. Who is Benjamin Rush and what did he do?
DQ:
ReplyDeleteAre vaccines unnatural?
Vaccines are unnatural in the sense that through vaccines we prevent diseases or illnesses which we would likely not be able to fight on our own. However, overall, they should be considered natural since they rely on our natural ways of defending against diseases, such as antibodies.
Are you comfortable with the idea of being a cyborg?
I believe there is nothing wrong with being a cyborg, so long as it means I still have my autonomy and still live a happy life, there is nothing uncomfortable to me about the idea of being a cyborg.
Are we overly obsessed with "purity" and with avoiding toxicity? Are we never cleaner than our environment at large?
I believe we are overly obsessed when it comes to the obsession of purity in medicine. As we continue to make advances in technology and medicine we may become more obsessed. Such “purity” will become more valuable due to its rarity. However, just because it is pure of medical or technological properties doesn’t mean that it is a welcomed or ideal approach. The idea of purity and toxicity often are used negatively to include any sort of medical advances that they consider “unnatural,” even if it is proven to be beneficial. However, I do not believe we are overly obsessed when it comes to avoiding toxicity when such lack of purity means that it negatively impacts our well-being. One such example is provided by Bliss in regard to breastfeeding children. When our environment effects this and, in return, our kids, perhaps we should consider such toxins and if there could be a more environmentally friendly way to make products.
Alternative Questions:
1. What epidemic diseases were not present before Christopher Columbus sailed to the Americas?
2. What did Carson fear DDT was?
3. What metaphor was used for conflicts over vaccination?
4. What is the scientific term for a type of white blood cells that are “capable of destroying other cells”? (59)
Alternative Quiz Questions
ReplyDelete1. What word amused Biss when she
was recovering from her sons birth? (80)
2. What did Biss describe as vampiric? (81)
3. According to Zimmer "our ___ gives the virus its own kind of immortality." (83)
4. What vaccine does Biss think is the next likely to be eradicated through vaccine? (85)
5. A Taliban leader banned polio vaccinations until the United states did what? (88)
6. What were people eating that was contaminated with methyl mercury?(89)
7. How did Karl Marx describe Capital? (93)
8. What did loans that were bundled and sold to investors become known as? (93)
Alternate Quiz Questions:
ReplyDelete1. (T/F) Power is what philosophers would call a positional good, meaning its value is determined by how much of it one has in comparison to other people.
2. The smallpox virus exists only in laboratories in what two countries?
3. Jonas Salk tested the first polio vaccine on who?
4. In Minamata, Japan, 1956, people experienced an outbreak of what type of mercury poisoning?
5. Thimerosal is essential for multi-dose vaccines, which are less expensive to ______, ______, and ______ than single-dose vaccines.
6. (T/F) Avian Flu, H5N1, is a highly lethal strain of flu.
7. How does Michael Merry define paternalism?
8. A person can donate their baby’s cord blood to a public bank for? Or a private bank for?
Alternative Quiz Questions for pgs 77-109:
ReplyDelete1. What was injected into Bliss that is also used in bomb making?
2. Where does the smallpox virus now exist?
3. What year and why was there an outbreak of smallpox amongst seventeen countries?
4. Who supported the WHO in excluded thimerosal from the mercury ban?
5. An ambitious vampire sucking the life out of honest workers was a metaphor for what?
6. A privileged ______ are sheltered from risk while they draw resources from the other ______.
7. According to a Nigerian barber, what other plot could be used to destroy Muslims?
8. Autonomy is usually imagined as the alternative to _______________.
9. Biss’s father suggest another vampire metaphor. What is it?
10. Dr Bob’s book The Vaccine Book is based upon a particular middle ground. What is this middle ground?