Final Blog Post

Direct to Consumer Genetic Tests.

With the new technology provided to us by the modern age many people have started looking back and wondering “Where did I come from”. Direct to Consumer genetic tests fill this hole, allowing people to fully understand where they came from and develop a sense of pride in their ancestry. In some cases, it may even connect you with a relative you may not have known you had.

More than that, this new type of testing allows individuals to have a guess on certain genetic diseases they may be likely to develop, certain ailments they may be susceptible too. This has opened a new avenue for people to learn about themselves, and in many cases, a new thing to stress over in their day to day lives.

How does it work?

Genetic testing works through a couple simple pathways. First and most prevalent is through maternal lineage. This tracing can be done through the mitochondrial DNA, although a new provocative study suggests this may not always be the case, and that the father can contribute too.

Mitochondrial DNA can be inherited from fathers, not just mothers

Not your mom’s genes: Mitochondrial DNA can come from Dad

The next type is to follow the Y chromosome and trace that back. This is slightly more limited since only males have the Y chromosome, the Y chromosome is also considerably shorter then any other of the 46 chromosomes.

However, the greatest determining factor for ancestry lineage is the use of the other 22 non-sex chromosomes. How Do DNA Ancestry Tests Really Work?

These are not always certain though. How the actual matching occurs is through pure pattern recognition of a pre-determined algorithm. They will have a sample size of 8,000 individuals who all claim to be of only one ethnicity. They will then go through with the algorithm of the individuals’ genome and look for sequences that are matching. From then on, the next person who has a 30% match to that genome is considered to be 30% of that ethnicity. This can become very tedious, and also has some tremendous pitfalls. For example, their data is only as good as their sample size. So the less of a certain ethnicity is screening and being tested, the less likely they are to find patterns within the genome.

Now, how does the prediction of genetic diseases work?

This works through the use of SNPs. These are the most common type of genetic variation between individuals, scientists have been able to find over 600 million different distinct SNPs. These work as biological markers to mark certain areas of the genome for coding for an individual gene.

What is direct-to-consumer genetic testing?

Again, this is not a precise science, it is the use of association via an algorithm. They will test certain individuals that have certain detriments, for example a family history of heart disease, find a SNP that is “linked” to, not causing, the disease. After this everyone with that SNP is then predisposed to that type of heart diseases. This can be very inaccurate, because you can develop heart disease without being predisposed to it, you can also develop alcoholism without any family history of it.

Business practice and application to the real world.

In our book, Beyond Bioethics, there is a chapter about the use of genetic testing done on all incoming freshmen at university of California Berkley. This was only a proposed work, but what does it imply? The University claimed that they would only inform the students of their alcohol tolerance, milk intolerance, and need for folic acid intake. Would you personally submit to such a study?

The business practices of these organizations have also come under fire. Under multiple times they have been known to share information with third party buyers, making money off of your personal information without you making any money or gaining anything out of the experience.

5 biggest risks of sharing your DNA with consumer genetic-testing companies

This can also lead to a enforcement by the police to have access to this information. The Golden state killer was caught with the help of DNA from a genealogy company, and while murderers are bad, could it be wrong to allow the federal government access to this database at all times?

 

Final Questions or thoughts?

Would you get a direct-to-consumer genetic test?

Do you think its poor business practice to have less information about ethnic minorities on the books? How should a genetic testing company makeup for this?

Should we understand our own genome, or should we choose to live without it’s knowledge?

Should you get genetic testing, who would you trust more to have it, The US government, or the private businesses?

Why Our Hope for the Planet Is Not Yet Extinct

New life is everywhere, renewing itself among us, reminding us not to give up.

...So we cling to good news in whatever form it takes. Whether it's tenuously hopeful global news (like the I.P.C.C.'s report that we still have time to prevent the worst ravages of climate change) or encouraging local news (like the people who are letting their lawns go wild to feed the bees), being reminded of what is yet possible goes a long way toward countering gloom.

...Americans are now more attuned than ever to the peril the natural world is in, and that is my greatest reason for hope. Ideological holdouts may continue to insist that climate change is a liberal hoax, and clueless people may continue to give the matter no thought at all. But these groups are no longer the norm. According to the Yale Program on Climate Change Communication, 72 percent of Americans believe the planet is warming. Seventy-seven percent support research into renewable energy. The same percentage believes that children should be taught about climate change in school... Margaret Renkl

Final Blogpost

THE USE OF TELE MENTAL HEALTH

“Being able to get care anywhere is our new reality.”

-Jane Ortwig, Executive Director of PSYPACT.

    Since the pandemic, the concept of receiving medical services virtually has increased a lot. Research shows that only 11% of participants used telehealth before 2019, but 76% were interested in using telehealth during the pandemic.



    Among the different medical fields that provided online services, outpatient services in the psychology field were the most accessed by people. Furthermore, mental health studies conducted during the pandemic have confirmed that symptoms of acute stress, anxiety, and depression, as well as suicidality, have been increasing.



I chose this topic because of one of my classes this semester. As part of this class, we had to choose a facility where mental health services were provided and volunteer for at least 9 hours a week there. I chose a counseling center where therapists were available both in-person and via zoom. Every time I had to schedule a new client, I had to ask them if they preferred to see the therapist in person or via telehealth and throughout the semester the one question that I thought over a lot was whether this was a good option or not.

There are a lot of pros and cons to using telehealth. Some of the advantages are: 

1. Convenience: Being able to communicate with the therapist from the comfort of their home could help clients not cancel their appointments. Telehealth also enhances vulnerability and disclosure. Whenever we think about therapy we usually think about a patient on a couch and a therapist nearby, instead of a formal office setting where it could put a lot of pressure on the client. Something along the lines of the below image-


    But sitting at home on the couch or just the fact you are in a place where you’re comfortable could make a person very much relaxed and more prone to having open conversations. Another advantage is that online therapy provides accessibility to individuals who are disabled or housebound as mobility can be a big issue when it comes to accessing mental health care.


2. Generally less expensive than traditional therapy: It saves money that can be spent on transportation. For instance, if someone lives in a remote area, traveling back and forth to the therapy center could cost a lot of gas money, but with online therapy, it wouldn’t cost them as much as it would with in-person.


3. Eliminates fears of running into known others in the waiting area of the therapy office: For various reasons, people would want to keep the fact that they go to therapy a secret. So if it’s from their homes that could encourage them to reach out more.


4. With apps like BetterHelp, a direct communication line to the therapist: One of the services they offer is being able to text the therapist at any point. So if someone is having a panic attack they could immediately text the therapist and ask them what they could do. I found this really helpful because it reminded me of one of the things, Dr. Wen was talking about in the book Lifelines. It was something along the lines of how useful it’d be if there were emergency services but for mental health. And using telehealth sort of gives clients access to immediate help.


5. A good option for remote areas: Online therapy offers access to mental health treatment to people in rural or remote areas. Those who live in rural areas simply might not have access to any other form of mental health treatment because there are few or no mental health practices in their area and providing an online option can encourage them to seek out mental health services.


But on the other hand, there are cons to using online mediums for therapy as well.


1. Confidentiality: Since information is being transmitted online, the situation makes privacy leaks and hacks more of a concern. Technology problems can also make it difficult to access treatment when you really need it. If there are minors and overbearing parents then that could create a potentially unhelpful situation as well. For instance, some parents will want to know everything that goes on in the sessions and for people who live with their parents, it could cause further problems for them.


2. Not appropriate for serious-psychological illnesses: If a person has a serious addiction or has more severe or complex symptoms of a mental health condition, online therapy may not be recommended unless other in-person therapies or treatments are also involved in the plan. As the scope of online therapy can be limited, so it is may not effective for more complex situations.


3. Overlooks body language: If a patient is using text-based therapy, therapists cannot see facial expressions, vocal signals, or body language. These signals can often be quite telling and give the therapist a clearer picture of a person’s feelings, thoughts, moods, and behaviors. Some delivery methods such as voice and video chats can provide a clearer picture of the situation, but they often lack the intimacy and intricacy that real-world interactions offer.


4. Ethical and Legal concerns: Online therapy eliminates geographic restraints, making the enforcement of legal and ethical codes difficult. Therapists can treat clients from anywhere in the world, and many states have different licensing requirements and treatment guidelines. For instance, there are many states in America where you can be a licensed mental health professional with a master’s degree, but most states require a doctoral-level education. So enforcing these rules can be a little difficult.



Ever since the pandemic, we are having to adapt more and more digital mediums to our lives. However, along with that we also have to ensure we tackle the problems that come along with it, like privacy, fairness, transparency, and accountability. This is our first pandemic in a digital era and with that, we have observed and will observe a plethora of digital solutions. Just like in-person therapy, tele-mental health is also an imperfect approach so while it does have its limitations, it can be very effective with a certain subset of the population who are not in a major crisis or require more intervention. 

Deborah Birx’s Excruciating Story of Donald Trump’s Covid Response

"Silent Invasion," an insider's look at the Trump administration's pandemic policies, is earnest and exhaustive

...Her three cornerstone measures — the continued sentinel testing, plus the resumption of masking and the avoidance of indoor gatherings whenever surges return — will remain necessary, she warns, so long as the virus remains capable of that one nefarious trick: transmission from asymptomatic but infected people. In plainer words, silent spread. That's the silent invasion of her title... nyt

A Freelancer’s Forty-Three Years in the American Health-Care System

Bills that aren't bills arrive in the mail, doctors opt out of treatment, and patients need expert help to figure out which diseases they can afford to have... NYr

We Politicized Masks. Now What?

…Committing to large-scale efforts that are less contentious and more effective seems like an easy choice. We spend too much time fighting one another and not enough time fighting the pandemic. Every day we do so, everyone loses. nyt

FINAL VERSION: Ethics Through the Lens of Insurance.

 Hello everyone! 

I gave my presentation just a few weeks ago (I think), and I received word that some of you found it enlightening as insurance is surely one of the most critical black holes in our society. We all need it, and it's strong enough now to topple our economy, and yet most of us just don't understand how it works. The crazy thing is that it was kinda built that way. 

Throughout this semester, we discussed the many faults in our healthcare systems, especially pertaining to the current pandemic, the inequality in its history, and the proverbial walls that most good healthcare people have to break down to try to enact change. This is where I thought insurance would be a relevant topic. Healthcare in this country is so expensive that we have no choice but to pay for insurance so they can pay for the medical bills. There are those who believe that the reason this exists is actually just a circle of exploitation.  Let me explain. 

Insurance is typically written where, while you are currently insured, you will have to pay a certain amount (co-pay) every time you go in and you will also have to pay up to a certain amount overall (deductible) before insurance will pay for everything else. Hospitals see this practice and decide to raise their fees beyond that deductible because they are guaranteed to be paid out by insurance. Insurance sees this, raises the deductible again, and hospitals raise their fees. This practice is common and often why you don't see itemized receipts on your hospital bills. If patients saw that they were technically being charged over a hundred dollars just for sitting on a hospital bed and another thirty for a bandaid, they'd obviously be very upset. Hence, you hear stories of hospital bills dropping drastically when patients ask for itemized billing. 

This practice doesn't necessarily show a bad side to insurance. Afterall, they are reacting to their environment, going off the data and numbers from the previous year. But of course, raising that deductible does not sit well with the insured. They will just feel like they can't go to the doctor, and if they do, and they reach that deducible and go too far over, their monthly payment (insurance premium, can also be a 6-month payment) will surely go up too. 

This is another aspect of the ethical dilemma. 

Now, in my presentation, I offered a small history lesson about insurance. Cargo ships, piracy, Babylonian merchants and such. It's based in spreading the cost of risk across a large group of people to better protect them. The most modern sense of insurance being over the past 120 years, auto to health to life, etc. I discussed how insurance is about looking at the numbers, the statistics of a given situation, determining the risk of that situation needing funds from the pool, the insurer then charges the rate that will indemnify (refill) the pool. Or at least that's the main goal. 

Additionally, rates are determined by how much the company must charge its customer base to remain solvent (open and at least mildly profitable to remain stable). 

This was the ethical dilemma we initially discussed. Market-wise, it makes sense, but that doesn't make the policyholders( normal people) happy cause they know they're being charged just a bit extra than their statistic. Some companies saw that people were upset, so they started advertising online and had ridiculously low rates. "Auto Insurance for just $29 a Month!!!" Yeah, okay. Let's talk about why that's not gonna work. 

Now, perhaps this company is somehow managing to operate on scraps, only online, no physical buildings, no real profit. Their pool of funds is going to be so small that they won't stay solvent for very long. 

Think about this. $29 dollars a month. That's the amount they are getting in per customer. Do any of you remember when it only cost $29 to fix anything on your vehicle? I sure don't. This pool will require the funds from at least 20 other people to pay for the damages from one solid car accident, and they operate on such a low budget that they do not have a backing of funds to cover high expenses. 

So what's my point? Why am I tell you all this?

The underlying theme is that, for the sake of profitability, nearly everything essential in the U.S. has gotten so expensive that the average person living here can't purchase it on their own. I believe this is why insurance has boomed so much. It's also one of the only industries that didn't really take any losses during the pandemic. No one really left that industry during the Great Migration, they just went to a different insurance company to make even more money, and the crazy part is that it's built to simply adapt to its enviroment and spit out new rates to consumers. The high inflation right now? Premiums are going to go up alot next year to counter it. Hospitals start charging even more for COVID testing and vaccines? (Yes, they are already starting to charge for it.) Insurance companies are eventually going to exclude coverage of COVID-related stuff from their policies. That's what happens when something is causing too much damage and the insurance company fears it will empty the pool. That's why war and natural disasters aren't covered under the typical insurance policy. 

I'll step off my soapbox now, but I want you guys to see this and contemplate a double-edge sword:

Is insurance unethical itself or is it unethical because it reflects exploitation in other areas? Personally, I feel it's a little of both. 

Disclaimer: I realize I do not have many insurance links to provide. As I said before, there's a huge disconnect between policymakers and policyholders and every link I find just lacks a solid explanation without going into a bunch of jargon that most people can't vibe with or understand. 

That being said, these aren't completely horrible: 

https://www.thebalance.com/basics-to-help-you-understand-how-insurance-works-4783595 

This offers an explanation of most of those terms I talked about early in the post. 

http://wsrinsurance.com/how-insurance-began-3000-years-of-history/

I think this is the one in my original post. It is very broad, like very, very, very broad, but it does discuss a few key points along the timeline. It's also says modern insurance happened much earlier, which I disagree with cause the methodology now is different, but whatevs. It gives a good summary. 

AND REMEMBER THE ANSWERS TO MY PRESENTATION WERE

Modern Insurance? 120 YEARS

Why Insurance Potententially Unethical? PROFITABILITY

Super excited for Tuesday, Let's kick that test's butt!!!!

It's been awesome having you all in class. 

-Patti Hummel. 

‘It’s Life or Death’

The Mental Health Crisis Among U.S. Teens

…American adolescence is undergoing a drastic change. Three decades ago, the gravest public health threats to teenagers in the United States came from binge drinking, drunken driving, teenage pregnancy and smoking. These have since fallen sharply, replaced by a new public health concern: soaring rates of mental health disorders… nyt

FINAL REPORT: Physician Assisted Suicide

Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act. Internationally, physician-assisted suicide is available in Australia (Victoria and Western Australia) Austria, Belgium, Canada, Columbia, Finland, Germany, India, Luxemburg, Netherlands, and Switzerland. Even if a patient requests physician-assisted suicide and they meet the legal criteria, their physician may not oblige. A physician does not have to provide PAS just because it is legal in the state where they practice medicine. They may believe that engaging in such an act would do more harm than good, or that such an act is incongruous to their primary role as a healer. For example, the physician provides sleeping pills and information about the lethal dose, while aware that the patient will commit suicide). It is different than pulling the plug and allowing a patient to dehydrate. Unlike physician-assisted suicide, withholding or withdrawing life-sustaining treatments with patient consent (voluntary) is almost unanimously considered, at least in the United States, to be legal.

Reasons for physician suicide

Loss of autonomy and loss of ability to enjoy activities were less common reasons among patients in this study compared with other jurisdictions. According to the relative, in 92% of patients, EAS had contributed favorably to the quality of the end of life, mainly by preventing or ending suffering. ALS (ALS is amyotrophic lateral sclerosis, is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord), health care providers support the SCC (Supreme Court of Canada) decision and the majority believe PAD should be available to patients with moderate to severe ALS with physical or emotional suffering. However, few clinicians are willing to directly provide PAD( is physician-assisted death) and additional training and guidelines are required before implementation in Canada.

According to a Canadian study of 112 patients who received medical assistance in dying, the main reasons people requested it included: 2 Loss of control and independence Loss of ability to participate in enjoyable and meaningful activitiesIllness-related suffering (for example, pain or nausea)Fear of future suffering

Based on additional research, other possible reasons for requesting physician assistance with dying include:3 Loss of sense of purpose, Unacceptable quality of life, unable to enjoy life with less ability. 

Opposition to Euthanasia

Reasons for the opposition to Euthanasia include inherent moral reasons (religious). Physicians that disagree and refuse service could have a conscience violation which leads to the toll these deaths would have on doctors (It may restrict Dr‘s freedom to work per their conscious- if they object it would lead to a referral which violates their conscience). PAS disincentives palliative care societally and individually. In Holland. PAS is mainstream and people ask for euthanasia because of fear of poor palliative care. The mainstream idea of euthanasia being considered healthcare has led to patients being refused treatment and offered euthanasia (stemming from financial reasons). Speaking of mainstream, areas that legalize PAS see a 6-12% increase in general suicide rates (affecting vulnerable groups), hinting at an increased inclination of suicide to other individuals. Legalizing PAS puts substantial pressure on vulnerable people to end their lives. The number of people who choose PAS for the reason they think they are a burden has exponentially increased (2 in the first year to 91 in the third)

Why it is a slippery slope

Once the gates are open for doctors killing their patients it is difficult to see how economic pressures would not impose. Those for physician-assisted suicide give autonomy, compassion, and economic arguments (If autonomy is the driving motivation, then why should we impose any limits on euthanasia other than consent? If children or healthy adults or adults with eating disorders want to end their lives, who are we to get in the way of their autonomy? Likewise, if compassion is the driving motivation, it is difficult to see why we should impose any limits at all, even the requirement for a voluntary decision). These have so much power. Side effects come with the regulation of the practice of PAS (Holland had 3200 cases of voluntary euthanasia, and 900 cases of involuntary euthanasia. Belgium had 1800 people die from euthanasia without consent 2 years after implementing PAS. Half are unreported despite legal mandate). The untouchable human rights (Our basic human rights are untouchable such that we are not even entitled to surrender them ourselves. Take, for example, the right not to be enslaved. Most people are agreed that we do not have a right to sell ourselves into slavery as chattel slaves – to do so would be to degrade ourselves and disrespect our own humanity, as well as to set an unacceptable precedent for how human beings may be treated. Likewise, since the right to life is the most basic right, it is reasonable to suppose that we may not violate our own right to life). The intrinsic value of life (Life is measured intrinsically not extrinsically. You can’t be worth more, all people and time is infinitely valuable). Difficult to distinguish between euthanasia and Inegalitarian thinking (Inegalitarians accept inequality, laws will indicate some lives are worth more than others), (90 cases of euthanasia for newborn babies with disabilities mainly spina bifida. Since the passing of physician-assisted suicide in Holland there are attempts to legalize euthanasia for those entirely healthy but tired of life, and already euthanasia for patients with depression and eating disorders). The persuasion of patients with chronic illnesses becomes a threat (as discussed in class, plenty of malpractice- physicians being warped into thinking more lives and less suffering is good. And also the idea OK physician making that his forte). Limits have been expanding in countries that have introduced EPAS, including extending EPAS to patients without their consent (Holland cases that were deemed to be murder were treated with impunity). In Belgium, over 3% of all deaths are from euthanasia without consent, Nearly 1800 cases. In 1998, in 2007 it decreased to 1.7%. The case of Dutch GP, Dr van Oijen, was one of the few to actually be investigated for widespread illegal euthanasia. He breached every single guideline and was convicted of murder (There was no explicit request – in fact, the patient had declared that she did not want to die; there was no unbearable suffering (she was comatose at the time); there was no consultation with another physician; the drug had exceeded its expiration date after being leftover from euthanizing a previous patient; and he lied when reporting the death, saying it was by natural causes.) Dr van Oijen was given a fine( for lying on the report), a short suspended jail sentence, and was given only a warning by the medical authorities. Physician-assisted suicide puts a lot of faith into medicine which has performed as a business. When these patients die, the doctors will not visit their graves. The families will. This obviously puts a lot of responsibility on the government and healthcare workers alike- who may not have the best interests of the patient at heart. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135145/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135118/#b11-064e380 

https://pubmed.ncbi.nlm.nih.gov/17131559/ 

https://n.neurology.org/content/87/11/1152 

https://www.nybooks.com/articles/1997/03/27/assisted-suicide-the-philosophers-brief/ 

https://pubmed.ncbi.nlm.nih.gov/25628351/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847835/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913834/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510045/ 

https://pubmed.ncbi.nlm.nih.gov/29395542/

https://plato.stanford.edu/entries/euthanasia-voluntary/ 

https://www.bmj.com/content/341/bmj.c5174

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882450/

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2614587 

What kind of psychological diagnosis/screening allows a patient to be approved for such a decision?

Could you relate putting an animal down because they are suffering to putting a person to rest?

Is Suffering worse than losing lives?

Could you draw a line on a viable diagnosis that allows the choice of PAS? 

Would a chronic diagnosis for someone under 18 be under their parents jurisdiction? 

Would quality of life being impacted call for the option of physician-assisted suicide? 

Microdose, Earth Day

 Following up on Austin's report, here's the substack newsletter I mentioned: The Microdose...

and following up on Matthew's: Happy Earth Day!

This Earth Day, We Could Be Helping the Environment—and Ukraine
Even as we watch the horrors daily inflicted on the Ukrainians, we have not been asked to change our daily habits in any way to be of help to them... Bill McKibben, continues

The Curious Fact...

Final Post:

The Curious Fact That Many Americans Have Been Willing to Ignore Science During the Covid Pandemic and Grasp at Horsefeathers Instead
Gary Wedgewood
Final Presentation
Bioethics, PHIL 3345, Spring 2022

The largest study to date of the efficacy of the drug Ivermectin in treating COVID has come to what should be an unsurprising conclusion: A drug designed to rid horses of parasitic nematodes does nothing for people afflicted by the coronavirus.

Yet many of our political leaders are offering legislation to help their constituents get Ivermectin more easily and even over the counter.  Ivermectin is by far the favored drug for treating Covid at a time when a highly effective anti-Covid pill (Paxlovid) is barely being used.

How can this be true?  How has such delusional thinking come to dominate the Covid response?  Compared to monoclonal antibodies this antiviral drug is an affordable regimen of five pills over five days taken at home.

It has been shown to be 90% effective in preventing hospitalization and death.  It is available in local pharmacies.  Yet at the peak of the Omicron surge half of the available Paxlovid sat in pharmacies unused.  Ivermectin remains a popular choice.

On several occasions the FDA has urged people to avoid using Ivermectin to treat or prevent Covid.  Yet lawmakers, political operatives, pundits, and others seeking to profit somehow continue to urge legislation to enable more access to Ivermectin.

The disinformation machine has even gone so far as to suggest that Paxlovid (which works on Covid) is actually a disguised version of Ivermectin.  The United States appears to be better at spreading disinformation than Russia or Brazil.

Read more at: https://www.sacbee.com/opinion/article259699615.html#storylink=cpy

Quotes from our reading:
“I would never provide public comments that contradict science. (Who would want a top doctor in the city who goes against science?)  My answer, maybe one-third of Americans?”
Leana Wen, Lifelines, p. 140

No matter how much you prepare, there will be some emergencies for which there is no guidebook.Wen, Leana. Lifelines (p. 146). Henry Holt and Co.. Kindle Edition.

Nearly every initiative was met with resistance on many fronts.Wen, Leana. Lifelines (p. 150). Henry Holt and Co.. Kindle Edition.

Public health’s moral imperative is to see the people that society prefers not to see and media choose not to portray. While everyone focused on the “rioting youth,” the police in military gear, and the state’s attorney’s press conferences, we turned our attention to the people who couldn’t get their basic health needs met.Wen, Leana. Lifelines (pp. 151-152). Henry Holt and Co.. Kindle Edition.

Discussion Questions:
1. What has led to such a high level of mistrust of our scientific and medical community in the USA?
2. The profit motive has distorted our health care system.  How has this same factor worked in the marketing of alternative/herbal medicines?

3. How have politicians “profited” from promoting and legislating misinformation about Covid treatments?
4. Why do you suppose that Dr. Fauci and Dr. Leana Wen have been the targets of extreme criticism at times?

Follow up article from The Tennessean newspaper:

Ivermectin on its way to becoming available without prescription in Tennessee

By Tosin Fakile

Published: Apr. 8, 2022 at 7:22 PM CDT

NASHVILLE, Tenn. (WSMV) -Ivermectin will soon be available for the treatment of COVID-19 without a prescription in Tennessee.

The state’s Senate and House leaders voted overwhelmingly in favor of the bill the final approval on the bill SB2188/HB2746.

The bill will allow a pharmacist to provide Ivermectin tablets to a patient in accordance with a collaborative pharmacy practice agreement containing a non-patient-specific prescriptive order, developed and executed by one or more authorized prescribers.

News 4′s Tosin Fakile talked to Hetal Patel, Pharmacist and Owner of Lebanon Family Pharmacy, who said once she can, she plans to make Ivermectin available at her pharmacy.

She says and the process with pharmacies will involve a number of steps.

“There’s going to be more steps involved in it. The Tennessee Board of Pharmacy is basically going to make the access like naloxone. It’s going to have a standing order protocol. You’ll have to counsel the patient,” said Patel. “It is going to be over the counter but it’s going to have a little more rules and regulations that are going to apply to it,” she added.

The Ivermectin bill will require the Board of Pharmacy (Board) to establish procedures for providing patients with a screening risk assessment tool, providing a standardized factsheet, and providing either ivermectin or a referral to a pharmacy that dispenses ivermectin.

Patel said she understands the move by state legislators.

“Which in one way is good because I’d rather have somebody come and talk to me about their medication than go and buy it at like a co-op store where they have no idea the kind of dosing you have to take,” Patel said.

Studies including one released in March 2022 by the New England Journal of Medicine showed it was unclear how effective ivermectin is when it comes to Covid19.

“As of yet, the amount of data that we have. It does feel like that the data is inconclusive and so we’re not able to say that ivermectin for sure helps in the treatment of covid-19,” said Dr. Parul Goyal, an Assistant professor in the Dept of Internal Medicine and Public Health at Vanderbilt.

Vanderbilt is conducting an ivermectin treatment of covid 19 trial.

“So our trial is funded through the National Institutes of Health, in which we are aiming to study some of the repurposed medications for the treatment of outpatient COVID-19. The name of the trial is called active six, and we are essentially studying three medications. ivermectin, Fluticasone and fluvoxamine,” Dr. Goyal said.

The trial started enrolling patients in September of 2021.

“We’ve actually had great success in patient enrollment, and we’ve been able to complete two study arms in which the patient improvement was completed. However, we added another arm to the trial, in which we added ivermectin high dose to this study arm. So we have two arms that are still open and actively enrolling patients,” Dr. Goyal said

Giyal said ivermectin has been around for several years and is sold at places like tractor supply stores, usually meant for farm animals to treat them against parasitic infections. She said Ivermectin is available in other countries and is used o treat against parasitic infections in humans.

“The doses of Ivermectin are very different,” Goyal said.

Goyal said taking Ivermectin without supervision can be dangerous.

“There are lots of side effects of Ivermectin that are out there for patients who’ve taken them without supervision such as nausea, diarrhea, itching, eczema, swollen lymph glands, it stuff all of these side effects,” Dr. Goyal said.

 “The reason why this [Ivermectin Bill] is okay to pass is because it comes to patient safety and people regardless of what they hear regardless of the studies that are in front of them, they’re not ready to believe that,” Patel said. “Where people will believe what they want to believe in. So instead of having people take whatever dose that they want to,” she added.

News 4 asked Dr. Goyal what her advice is to people as Ivermectin is on its way to not needing a prescription.

“Since the data on Ivermectin from our trial, is still pending you know, I would say that until we get scientific data to support the usage of Ivermectin for the treatment of COVID-19. I would be hesitant for anyone to take it without proper supervision,” Dr. Goyal said.

Goyal is also reminding people that there is approved medication for treating COVID-19 that is available.

The state legislature provides some protections for pharmacists. The bill says, “a pharmacist or prescriber acting in good faith is immune from disciplinary actions or civil liability.”

Copyright 2022 WSMV. All rights reserved.

https://www.wsmv.com/2022/04/09/ivermectin-its-way-becoming-available-without-prescription-tennessee/

 

 

 

remote attendance

 Hi folks! Just wanted to say I'll be attending remotely today - anyone mind marking my diamond on the attendance sheet? 

Thanks, see y'all in class on Tuesday for our exam!

The Future of Psychotherapeutic Palliative Care

“Psychedelics are to the study of the mind what the microscope is to biology and the telescope is to astronomy.” 

- Dr. Stanislav Grof. 

Prior to researching this topic, I conceived of palliative care as specifically care for patients with terminal illnesses. While these patients do often seek out palliative care, a patient need not be terminally ill to receive such care. Palliative healthcare treats the symptoms of an illness rather than its cause, which seems to run counter to standard medical philosophy, but has yielded some surprising recoveries and overall reduction of suffering (1). In the case of the terminally ill, treating one’s symptoms is often the only thing we can do, which is why you see this field commonly associated specifically with end-of-life care.

Palliative care is a rich interdisciplinary field, recruiting everything from physicians and advanced practice nurses to chaplains, social workers, and psychologists (2). This diversity is paramount. While palliative care treats physical discomfort, it must also be flexible enough to have an effective treatment for psychological woes.  Terminally ill patients understandably experience a lot of death anxiety and debilitating depression relating to their condition. The question is, is our current understanding of palliative care equipped for the task? While healthcare professionals generally feel confident in the efficacy of our current methods, some feel that we could be doing more (2). This is where psychedelics enter the picture. 

The current philosophy of treating patients with death anxiety, or “existential distress,” suggests a meaning-centered approach. Healthcare professionals feel that, if  psychedelic-assisted therapies (PAT) are to be effective, they will need to be integrated into existing models of treatment (2). As it so happens, psychedelics have the potential to occasion mystical experiences which subjects have reported as being among the most meaningful experiences of their lives. To see how that might be the case, I strongly suggest you read Mark Huslage’s account of his experience as a subject in a study conducted by Johns Hopkins University. He describes an experience that is nothing short of a shamanic vision quest.

https://www.sociedelic.com/my-first-psychedelic-experience-at-johns-hopkins-changed-my-life/

Here is a short video clip of a different patient who was able to overcome the existential distress related to her terminal cancer.

https://www.youtube.com/watch?v=lqnPVZUzDPc

Though they acknowledge the potential of PAT, healthcare professionals are hesitant because of the lack of evidence to support the efficacy of such treatments. The current body of research is admittedly small, and mostly recent. If you know your history, you know that the CIA was (unethically) playing around with LSD way back in the 1950’s. So psychedelics have been well known for at least 70 years. You might be thinking, “wait a minute, where is all the research? It’s been 70 years!” You can thank the war on drugs for that one.

PAT are experiencing something of a renaissance currently. Psychedelics have been cornerstones for various religious traditions since time immemorial, and PAT date back to the 1950’s. However, following their adoption by the counterculture, psychedelics quickly became stigmatized as a drug for hippies and burnouts. Subsequently, psychedelics fell prey to the war on drugs, earning the label of schedule 1 substance. Research into these substances went dark and has only begun to reemerge in the past 20-30 years. Slowly, both the public and the scientific community are warming up to the idea of PAT. Recently, psilocybin (the active chemical in magic mushrooms) earned the FDA designation of breakthrough therapy for treatment-resistant depression, and MDMA earned the same status for treatment of PTSD (3).

References

1. Psychedelics in Palliative Care. https://blogs.scientificamerican.com/observations/psychedelics-in-palliative-care/

2. Palliative care provider attitudes toward existential distress and treatment with psychedelic-assisted therapies. https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-021-00889-x

3. Ted talk by Rick Doblin 

https://www.youtube.com/watch?v=Q9XD8yRPxc8&t=779s

Final Presentation: The Plastic Disaster

 How we went from discovering a miracle-material from crude oil to polluting every square inch, from the ocean to our lungs. 

The discovery of a cheap, sterile, and abundant material could have been an undeniable boon to humankind, if not for a gross mishandling of our waste, and a violent abuse of our environment. 

First discovered in 1869, synthetic polymers, plastics, quickly became a household product. It's production exploded during World War II, where the cheap and simple product was used both domestically and militarily. Plane parts and windows were manufactured from plastic compounds abroad, while kitchen tools were phased towards plastic at home. 

The explosive growth in plastic production, combined with a negligent and ignorant method of disposal, COMBINED WITH the promotion of single-use plastics to increase income of producers resulted in vast amounts of pollution, especially in our oceans. In 1997, Charles Moore discovers the Great Pacific Garbage Patch. This was an especially startling find, since concern for plastic pollution had been present since the 60's, but was largely assuaged by the start of the recycling contain, promoted heavily by the plastic industry. 

Recycling has, however, not saved us from plastic.

First, the prevalence of plastic pollution has resulted in a ubiquitous presence of microplastics, the result of plastic breaking down. These plastics, ranging from 5μm to 5mm, have been found... everywhere. From the deep ocean to the deep lung, MPs are everywhere. And problematic, they are. Plastics contain additives, some of which are estrogen mimics, affecting the sexual development of anamniotes. We're far from safe, presence of these MPs in our lungs, blood, and placental tissue has resulted in heavy inflammation of these regions. Cell death and DNA damage has been recorded in nonhuman animals. This certainly seems serious enough to make some effort in reducing plastic pollution, right?

The pandemic has complicated plastic pollution, of course.
With the pandemic, especially early on before the CDC had laxed their recommendations, single-use face masks and gloves were hot items. With a spike in usage, however, we see a spike in waste. An area only 20% the size of Nashville, in Toronto, discovered enough pollution related to COVID-19 protection to predict ~14,000 PPE items polluting the area in a year. This is, of course, additional to the already present crisis. These masks leak/break down into additives and MPs, just as any other plastic vinyl does. We can expect an increase in estrogen mimics, chemical pollutants, and MPs from discarded PPE. 

Plastic recycling, as is, has been largely unsuccessful.

Where to begin? First, the cost of recycling plastics is nearly universally more expensive than manufacturing virgin plastic. This incentivizes manufacturing over recycling in our capitalist system, so who would ever recycle? Recall, plastic companies supported the recycling movements early in its conception. In large part this was an attempt to deflect responsibility away from the corporations and onto the individuals. What's worse, unlike glass, plastics can only be recycled 2-3 times at most. Even the most recyclable types. The failure to structure the recycling industry prudently has been another nail in the coffin, as single stream recycling (the public dumps all plastic into one bin, which is organized on site to be recycled) is much too costly and multi-stream recycling (the public dumps plastic in individual bins by type) has been much harder to promote effectively. 

 

What hope do we have?

Recycling can be helpful, though not as a solution. Think of it as applying pressure to a wound. It helps, it can slow the problem at hand, but you should definitely see a doctor. With restructuring, such as better promotion of multi-stream recycling and more effective recycling methods, recycling could be seen as an invaluable tool in combating plastic waste. The problem is, the plastic still exists. While I'm not naive enough to believe we can nix plastic completely, we can use alternatives. Glass, as previously stated, is infinitely recyclable. Alternatives such as metals, which are much more reusable, and bamboo, can cut non-degradable plastic waste. There have, additionally, been efforts to reduce or restrict single-use plastic usage, such as 3 states completely banning single-use plastic bags. 

The Ethics of plastic.
Julie Sze and Jonathan London, two environmental bioethicists, have claimed that plastic pollution has resulted in environmental racism, where locations in the global south and central Asia have been claimed by more prosperous nations as "pollution havens," where plastic can be deposited with little recourse, despite not producing it. This theme is not one-off, as Robert Bullard has claimed this activity is a form of "slow-violence" where the global south is saddled with the repercussions of plastic pollution they didn't produce. Andrew Watterson and William Dinan pointed out the lagging of legislature in terms of environmental sciences, resulting in this slow-violence going unchecked for long periods of time. Speculatively, they claim this may be in part due to the involvement of fossil fuel and plastic industry in politics.