Aesthetic enhancement and gene therapy

I’m sure you have all heard “I’d be that pretty too if I were that rich!”. In class we have been discussing the ethics of human genetic engineering but what about the ethics of cosmetic enhancement? Now I understand that there is a VAST difference between genetic engineering and cosmetic enhancement, however, the individualistic support of cosmetic enhancement has often been the rudimentary reasoning for genetic engineering.
Could cosmetic enhancement be opening a door to a support system for those who wish to engage in groundbreaking genetic engineering? Could those who support “anti aging” surgeries, and other beauty enhancement come to blindly support genetic engineering? Studies shows that from 1997 from 2005 cosmetic surgeries increased 725% . This means more and more people are supporting and normalizing the adherence to beauty standards.
While some may not agree with gene therapy being conducted to fetuses could there be a possibility in the future to receive gene therapy as an adult? Of course what would then be the implications for your children, would they receive your “original” set of genes or would they inherit the “new” genes.

I always think about the funny *false* story that was circulating the internet a while back about a Chinese man who sued his wife after their baby was born ugly. The story claimed he sued his wife (and won) for not disclaiming the amount of cosmetic surgeries she had.

This false story went viral and sure enough created enough talk between those who support and those who don’t. So my question is, if it became available to receive gene therapy as an adult although we didn’t completely understand the full implication of it, generations to come, should we create laws against it?

Doctors and Racial Bias

Still a Long Way to Go

It would be easy to look at a photo from the 1980s and conclude that things have changed. Many have not.The racist photo in the medical school yearbook page of Gov. Ralph Northam of Virginia has probably caused many physicians to re-examine their past.

We hope we are better today, but the research is not as encouraging as you might think: There is still a long way to go in how the medical field treats minority patients, especially African-Americans.

A systematic review published in Academic Emergency Medicinegathered all the research on physicians that measured implicit bias with the Implicit Association Test and included some assessment of clinical decision making. Most of the nine studies used vignettes to test what physicians would do in certain situations.

The majority of studies found an implicit preference for white patients, especially among white physicians. Two found a relationship between this bias and clinical decision making. One found that this bias was associated with a greater chance that whites would be treated for myocardial infarction than African-Americans.

This study was published in 2017.

The Implicit Association Test has its flaws. Although its authors maintain that it measures external influences, it’s not clear how well it predicts individual behavior. Another, bigger systematic review of implicit bias in health care professionals was published in BMC Ethics, also in 2017. The researchers gathered 42 studies, only 15 of which used the Implicit Association Test, and concluded that physicians are just like everyone else. Their biases are consistent with those of the general population.

The researchers also cautioned that these biases are likely to affect diagnosis and care.

A study published three years earlier in the Journal of the American Board of Family Medicine surveyed 543 internal medicine and family physicians who had been presented with vignettes of patients with severe osteoarthritis. The survey asked the doctors about the medical cooperativeness of the patients, and whether they would recommend a total knee replacement.

Even though the descriptions of the cases were identical except for the race of the patients (African-Americans and whites), participants reported that they believed the white patients were being more medically cooperative than the African-American ones. These beliefs did not translate into different treatment recommendations in this study, but they were clearly there.

In 2003, the Institute of Medicine released a landmark report on disparities in health care. The evidence for their existence was enormous. The research available at that time showed that even after controlling for socioeconomic factors, disparities remained.

There’s significant literature documenting that African-American patients are treated differently than white patients when it comes to cardiovascular procedures. There were differences in whether they received optimal care with respect to a cancer diagnosis and treatment. African-Americans were less likely to receive appropriate care when they were infected with H.I.V. They were also more likely to die from these illnesses even after adjusting for age, sex, insurance, education and the severity of the disease... (continues)

Unsheltered

A review of the novel I mentioned in class, Unsheltered by Barbara Kingsolver. I'm wondering about the scene involving the protagonist's father-in-law being turned away from the university health center. Realistic? Is the 1986 law Elizabeth mentioned in her presentation yesterday relevant? (See the bold passage below...)

When we fantasize about other people’s houses, whether they’re online or on TV shows or around the corner from where we live, we seem to imagine them as gleaming-surfaced oases of tranquillity. And even in our dreams, houses often offer more than we had thought was there: a corridor we hadn’t known about, a hidden wing. But when we enter a walled space inside a novel, we often expect, and in fact go out of our way to seek, trouble. While the term “real estate porn” describes our ecstatic obsession with the ways in which a handful of lucky people get to live and the rest of us generally don’t, there seems to be no obvious term to characterize the literature that limns the trouble that invariably takes place inside fictional houses, whether they are claustrophobic, haunted or simply falling apart. But we are drawn to these houses just the same, not by the dream of tranquillity, but by the durable, and far more interesting, pull of complexity, and even the possibility of impending catastrophe.

From the very first line of “Unsheltered,” Barbara Kingsolver lures us into such a house: “The simplest thing would be to tear it down,” says the contractor offering his professional opinion to Willa Knox, who has inherited this unstable Vineland, N.J., brick house into which she and her husband, Iano Tavoularis, have moved after losing their jobs. The magazine where she was an editor has closed, and so has the college where he taught, and they have relocated here from Virginia so Iano can take a new teaching job nearby. But even the inheritance won’t provide stability, and the couple find themselves vulnerable and strained in all ways. Not least of it is that they are taking care of Iano’s father, Nick, a Greek immigrant who is free with his racist observations, in addition to being beset by medical issues requiring expensive treatment. After being given the runaround at the university health complex, Willa challenges the receptionist: “The best you can do is send him home to fill up his shoes with blood? I think what you’re saying is, the man needs to die.”
(continues)

Full Study Guide- Odd Only

[Thanks, Elizabeth! Addendum: in ch.16, who says we're ethically obligated to deploy technology in order to produce "better children"? In ch.17, who says "the Singularity is near"?]

Quiz Questions

1. Concern for individual autonomy and personal sovereignty can obscure what other issue?
3. What popular sentiment on human reproductive cloning did Planned Parenthood not adopt, "fortunately"?
5. Name two of the distinctive concerns of the "new biopolitics" marking its difference from mainstream bioethics.
7. Who was the Social Darwinists' leading spokesperson, and what did conservatives oppose in his name?
9. Who said "low intelligence is a stronger precursor of poverty than low socioeconomic background"?
==

1. What kind of "motherhood" did Indiana officially promote in the '20s and '30s?
3. What dismaying transfer of power did Ada Schweitzer inadvertently facilitate?

5. What did Schweitzer call the Better Baby Contest at the fair?
7. What role was played by corporate philanthropies and academics in the promotion of eugenics?
9. What was Hitler's "bible"?
==

1. German lawyers meeting in Berlin in 1934 debated bringing what from the statutes of thirty U.S. states to the Third Reich?
3. What is the real problem of disability?
5. Galton's work led directly to what?
7. "The Galton Institute" was originally called what?
9. What did Robert Edwards say he learned from the development of IVF?
==

1. The advent of what common metric made it possible to calculate the efficacy of selling?
3. What was the final impetus for government intervention in research ethics?
5. Feminist theory is an attempt to do what?
7. When is society more willing to intrude on human autonomy?
9. What expectation for disability rights debates is "sadly" unmet?
==

1. What does Catherine Myser mean by "whiteness"?
3. Decentering whiteness would enable bioethics to do what?
5. Bioethicists are fixated on what, with what implication for the demographics of the field's concerns and utility?
7. Why did the Nashvillian participate in Eli Lilly's drug tests?
9. What did Glenn McGee predict in 2003?
11. Who "invented" Bob Dole?

==

1. What do Athanasiou and Darnovsky fear we're at risk of losing, if the human genome is privatized?
3. What published opinion do our authors cite as committing a "naturalistic fallacy"?
5. What practice continued into the 70s in "that liberal paragon Sweden"?
7. What's the logical conclusion of the "Kinsley-Sullivan thesis" and what does it conflate?
9. What's needed most, to reduce the incidence of monogenic disease?

==

1. What are the two major spheres of justice discussed by Campbell? 

3. Another name for the micro-allocation of health care, concerned with prioritizing access to given treatments, is what? (HINT: This was hotly debated and widely misrepresented ("death panels" etc.) in the early months of the Obama administration.)   

5. What is the inverse care law?   

7. How are Quality Adjusted Life Years (QALYs) supposed to address and solve the problem of who should receive (for instance) a transplant?   

9. Under what accounts of health might we describe a sick or dying person as healthy?

==

1.Name one of the basic requirements agreed upon by all codes devised to protect individuals from malicious research.
3. Name one of four areas of research discussed in the book.
5. Name one of four R's used in international legislation pertaining to animal rights in research?
7. What did Hwang Woo-suk do?
9. What categories of human enhancement does Campbell enumerate, and what does he identify as its "extreme end"?
==

1. (T/F) Dignity, respect, and confidentiality are among the aspects of the clinical relationship which emphasize the importance of trust. 

3. The idea that the doctor always knows best is called what? 

5. What general principle allows breach of confidentiality?
7. Why have organizations like the WHO opposed any form of organ trading?
9. What does palliative medicine help recover?

==

1. Chapter 3 begins by asking if our bioethical perspective ("vision") is skewed by _____... (a) cultural assumptions, (b) gender bias, (c) religious faith, (d) all of the above
3. (T/F) The "feminist critique" says bioethics has been dominated by culturally masculine thinking.
5. What's a furor therapeutics?
7. What's allegedly distinctive about "Asian bioethics"?
9. What gives Buddhists and Hindus a "whole new perspective" on bioethical issues?

==

1. (T/F) In Anna's story, why did she wish not to be resuscitated?
3. In deontological theory, what is the difference between hypothetical and categorical imperatives?
5. What would Kant say about Tuskegee, or about the murderer "at our door"?
7. What is the distinctive question in virtue ethics?
9. What is the Harm Principle, and who was its author?

==

1. Name two of the ways you can earn a base in our class. (See "course requirements" & other info in the sidebar & on the syllabus)
3. How do you earn your first base in each class?
5. How can you earn bases on days when you're not present?
7. Suppose you came to class one day, turned on the computer/projector and opened the CoPhi site, had 3 correct answers on the daily quiz, and had posted a comment, a discussion question,  and an alternate quiz question before class. How many runs would you claim in your personal log and on the scorecard that day?
9. What are Dr. Oliver's office hours? Where is his office? What is his email address?

==

1.(T/F) Campbell's examples of bioethical questions include whether health care professionals must meet higher standards than businesspeople, the ethics of longevity via pharmacology, designer babies, human/animal hybrids, state paternalism, euthanasia, and environmental ethics.
3. The _________ required that 'The health of my patient must be my first consideration.' (Hippocratic Oath, Geneva Code, British Medical Association, International Association of Bioethics)
5. What did Ivan Ilich warn about in Medical Nemesis?
7. Bioethics has broken free of what mentality?

9. Do descriptive claims settle evaluative issues?

Report Quizzes

1. Name two of the communities of deaf people.
3. What are the limitations of a deaf patient lip reading in the ER?
5. What percent of the US population identifies as deaf or hard of hearing?
7. What is a potential effect of hearing loss on a person's life?
9. The average hard of hearing person understands ____% of spoken word.

==

1. What did study did Professor Jenson base his research and findings on?
3. What year did his Harvard Educational Review article come out and what were some major world events happening?
5. What scale ultimately transform into the IQ scale known today?

==

1.     An emergency room is a hospital room or area staffed and equipped for the reception and treatment of person’s requiring __________ care. (immediate)

3.     What percentage of individuals visited the emergency department in 2015? (43.3%)

5.     Name one reason why people choose to go to the emergency room over other places. (Convenience, family or friends insisted, Felt hospital offered the best level of care, personal anxiety made them feel like they had to go)

7.     How many times did “Patient G” visit the hospital in three years? (1000)

9.     Name an alternative to using the emergency room. (Urgent Care, Primary Care Physician)

Emergency Department Misuse: Ethical Solutions

     Here is the link to my presentation since we didn't get to go over all of the videos in class. Also, I have attached the article about Patient G, the ultimate frequent flyer. Patient G has extremely high blood pressure and always reports to the hospital with chest pain and shortness of breath, which usually requires immediate admission. However, the staff has began turning him away to to the frequency of visits,  most of the time by ambulance. In the article, it links Patient G's excessive emergency room visits, sometimes once a shift, to a need for the social interaction and not for food or to have a bed and roof over his head. In my experience, many individuals use the emergency room as a place where they can socialize, ease anxiety and kill loneliness.

"And there our patient and the staff of the ED remain, at a difficult and seemingly interminable impasse. A man who refuses to take any responsibility for his own health becomes our responsibility every day. " -hospital staff about Patient G

     In the video we skipped after the box "Frequent Flyer"s, a healthcare worker explains the limitations of doctor's in a busy emergency room. Physicians often don't have the time to worry about homelessness, where a person will sleep, arrangement of transportation and many other social constraints frequent users face. Even if they had the time, do physicians have the knowledge to counsel these patients and the resources to meet their special needs? Please feel free to post any comments or questions related to the presentation or the subject matter.



   

Patient G Article

DQs:

• What are ethical solutions for misuse of the emergency department?
• Should someone ever be turned away or banned from the hospital?
• How can we help physicians remain healthy and receptive of their patients?
• What should be done about frequent flyers?

Strides in Healthcare Disparities

Chapter 10, 11, and 12 of our book "Beyond Bioethics" discuss the factors in healthcare disparities aided by our fundamental ethical approaches. I decided to further investigate ways we can aid these disparities and minimize the gap year by year. First, we look at an issue that the author, Derek Ayeh, discusses in chapter 11: the interest in future technology and the forward-looking bioethicist that often overlook the ethical issues present in healthcare today:

This complexity of this issue comes from nature of disparities that arise in health v healthcare. When you discuss inequities in health you refer to the groups of people that are affected by a higher chance of illnesses in comparison to another groups. While health care disparities are focused on a group(s) that face a different standard of healthcare, i.e., access and use of healthcare. Both are affected by environmental and societal factors explaining the difficulty in trying to find a solution solely through the field. One aspect discussed in chapter 12 was the progression of bioethicist being driven by the financial legitimacy that can be established via bureaucratic procedures. The fundamental that have yet to be addressed, I feel, as a partner of bioethics, is business ethics.

So, what is business ethics and why is it important to bioethics? Business ethics, according to the Marrkula Center at the University of Santa Clara, carries three different “strands”. First it looks at the standard of academic writing, research and publications, this term entered the US in the 1970’s during the development of academia. The second refers to its media usage regarding “business scandals” lacking accordance with ethics of business. Finally, the third is the broadest referring to the commercial exchange and economics. The latter studies the history of ethical commercial exchange written by many philosophers like Aristotle in his Politics, John Locke’s understanding of property etc. Business ethics in academia arose because of the need to understand social concerns and how to address these issues. However, it focuses more on how to create an explicit “framework to evaluate business and especially corporate activities” rather than a “social responsibility approach”. This kind of ethics follows a similar path as that of medical ethics.

I would like to focus on the movements spurred business ethics mostly. Legislation created has mostly prompted business ethical standards, such as Civil Rights Act of 1964 and US Occupational Safety and Health Act of 1970. One important piece of legislation that has aided the corporate ethical standard is the Foreign Corrupt Practices Act, that prohibited US corporations from paying government official for special considerations, although this was already an ethical norm that was followed by many, the implementation of this ethical standard was needed.

Business ethics is important to discuss when you examine the pharmaceutical companies that profit off of health care. Take a look at the company Mylan that sells EpiPens, a cost of this lifesaving epinephrine dosage can cost around 500 or more depending on your insurance plan, deductible, etc. This cost is for 2 of these dosages (note, it’s always recommended to carry 2 of these dosages on you due to possibility of the ineffectiveness of the first one). In 2015 Mylan’s profits hit 1.2 billion and the EpiPens make up 40% of those profits. While Mylan claims that they have always strived to make their EpiPen accessible, legislatures have questioned their ethical approach to the prices of these lifesaving drugs. In fact, according to a NYTimes article, seven pharmaceutical executives are going to testify today, Tuesday 26, 2019, before the Senate Finance Committee to discuss the prices of pharmaceutical drugs. Some believe this is going to be a turning point in the big pharma culture. I believe if we continue to make strides and campaigns to disrupt the unethical standards common in healthcare, we can close these disparities.

Articles to consider (my works cited)

https://www.kff.org/disparities-policy/issue-brief/disparities-in-health-and-health-care-five-key-questions-and-answers/

https://www.scu.edu/ethics/focus-areas/business-ethics/resources/a-history-of-business-ethics/

https://www.nytimes.com/2019/02/24/opinion/drug-prices-congress.html

https://www.forbes.com/sites/emilywillingham/2016/08/21/why-did-mylan-hike-epipen-prices-400-because-they-could/#5d7d609c280c

Emergency Department Misuse: Ethical Solutions

            The emergency department (ED) of a hospital can be important in determining whether a person suffering a life threatening illness lives or dies. The clinical staff and physicians stand in wait of whatever comes through the emergency room doors, whether by walk-in or by ambulance. However, challenges arise when nursing staff and physicians attempt to balance an overloaded ED with incoming traumas. Patients with minor injuries and illness flood the ED, at all hours of the night, looking for treatment, comfort, medication or maybe just a meal and a roof over their head.

            Minor injuries and illness are some of the most common representations in the emergency department. Such injuries could be treated by a primary care physician or an urgent care clinic, but patients continue to use the emergency room despite significantly longer wait times and a much higher cost of care. Why? Some individuals say that they use the emergency room because it is convenient and others say that it offers them a better level of care, but what about the individuals with life threatening emergencies who show up unannounced?

            Many patients, after being admitted to a room in the ED, will be confined to that room for several hours, or even days, waiting on a hospital bed. This ties up valuable resources leaving a sick patient to sleep and lie for hours on an uncomfortable stretcher with an exhausted nursing staff.  What if there are no rooms left? In these situations, hospitals will have to divert patients to other hospitals which means that sick patients may have to travel hours farther before they can receive medical treatment.  

            What about individuals who show up to the emergency room on a weekly basis? Frustration with what are often referred to as “frequent flyers” can often lead to a poor level of care. Often times, the frequent flyers are described as the “difficult patient” who is physically or verbally abusive to the hospital staff. This abusive behavior leads to further frustration and even less attention paid to the patient who may have a new, emergent condition that needs to be treated.

            Individuals with chronic illnesses and substance abuse issues can also be classified as frequent flyers. What can we do to manage the constant use of the ED resources by individuals who do not follow the guidelines to manage chronic conditions such as diabetes, COPD or congestive heart failure? What about recurrent drug users who have been resuscitated multiple times due to overdose? How can the ED create change in that particular community.

            Staff turnover has led to many shortages, and an influx of non-emergent issues can tie up important hospital resources. Physicians and clinical staff are forced to work long hours and take a patient load that would be considered dangerous under normal conditions. These conditions then create more turnover leading to an ED with lesser experienced nurses and physicians, often fresh out of school and unexposed.

What then is the solution to the problem? How do we lessen the number of individuals who use the ED for non-emergent issues? Can we simply send them away and say their need isn’t great enough or they have messed up too many times? What if a non-presenting condition is missed because we are making mere judgments based on their physical or outward appearance. How can we create positive change and an efficient emergency room.

https://www.houstonchronicle.com/business/columnists/tomlinson/article/Patients-who-misuse-the-emergency-room-and-run-up-13138582.php

http://www.georgiahealthnews.com/2013/03/misuse-emergency-rooms-costly-avoidable-error/

https://www.cdc.gov/nchs/data/nhamcs/web_tables/2015_ed_web_tables.pdf

https://www.nehi.net/writable/publication_files/file/nehi_ed_overuse_issue_brief_032610finaledits.pdf

Quiz Questions (Prezi):

1.     An emergency room is a hospital room or area staffed and equipped for the reception and treatment of person’s requiring __________ care.

2.     What is the Emergency Medical Treatment and Labor Act of 1986?

3.     What percentage of individuals visited the emergency department in 2015?

4.     How many of those individuals were admitted to the hospital?

5.     Name one reason why people choose to go to the emergency room over other places.

6.     In any capacity, describe a “frequent flyer”.

7.     How many times did “Patient G” visit the hospital in three years?

8.     Name a consequence of hospital misuse.

9.     Name an alternative to using the emergency room.

10.  T/F. Most emergency room users are uninsured.