Thursday, December 24, 2009

Nurses, Doctors Rank Among The Most Trusted Professionals in Society. Who's At The Bottom? You Guessed It. Joseph Lieberman and the Gang.

Evidently, Americans believe that health professionals don't lie (except when they think it's good for you, if you read the most recent American Journal of Bioethics, or if you are Dr. House).



Wednesday, December 23, 2009

Mammograms: Evidence not Evident

Rosemary Flanigan
December 23, 2009

The NY Times Magazine for Dec. 13th featured an article that showed how “evidence-based medicine” can be complex, counterintuitive or ambiguous—and the author, a professor of math at Temple—used the recent mammogram testing brouhaha as an example.

The government task force, as you recall, advised that routine screening for asymptomatic women in their 40’s was not warranted and that mammograms for women 50 or over should be given biennially rather than annually. The result was fury on the part of many, especially women!

But to understand the task force’s results and the brouhaha that followed it takes both math and psychology. “Earlier and more frequent screening increases the likelihood of detecting a possibly fatal cancer” – right? Well, no, he says. First, because we don’t know the cumulative effects of all that radiation and second, think of false positives.

Assume there is a screening test for a certain cancer that is 95% accurate; assume that if someone doesn’t have the cancer, the test will be positive just 1% of the time. Assume further that 0.5%--one out of 200 people—actually have this type of cancer. So if you’ve taken the test and your doctor somberly intones that you’ve tested positive, does that mean you’re likely to have the cancer?

And the math professor answers, “Surprisingly, no.”

And here’s the math: Suppose 100,000 screenings for this cancer are conducted. On average 500 of these 100,00 people (0.5%) will have cancer. And so, since 95% of these 500 people will test positive, we will have, on average, 475 positive tests (.95x500). Of the 99,500 people without cancer, 1% will test positive for a total of 1, 470 positive tests (995+475=1,470, or about 32%).

But what about the psychology? The math doesn’t touch people’s perceptions. They still think more is better; earlier screening leads to earlier detection.

The author called the math “trivial”—I thought it was fascinating. But here is an example of “evidence-based medicine” that is not at all “evident” to the general population.


Tuesday, December 22, 2009

Principles of Pandemic Preparedness

Rosemary Flanigan
December 22, 2009

Even with Christmas approaching, I’m thinking of the January 2010 ethics committee meeting and its self-education segment. It’s going to be Pandemic Preparedness, and George Flanagan is helping me lead the discussion.

But to what end??? What expectations do I have for a committee of busy people to mull over pandemic preparedness?

First, knowledge about what is going on Missouri-wide (and nationally) knowing full well that there are inadequate facilities, staffing and funding.

Second, knowledge that the preparedness effort is grounded in ethical principles of fairness, respect, solidarity and limiting harm.

And third, getting the group to discuss the framework, talk over its problem areas, and to choose methods of carrying the discussion to their own groups.

Just in case swine flu is the next pandemic, now that we oldsters are no longer banned from receiving H1N1 shots, I received mine last Friday. I’ll be around to see how the preparedness works!

Any thoughts? Have any of you had these discussions with your committees?


Monday, December 21, 2009

Aging and Suffering

Here are two recent podcasts featuring staff of the Center for Practical Bioethics.


Aging in Kansas City: The Implications

John Carney
December 17, 2009
9 minutes 30 seconds

What does the data tell us about aging in Kansas City? And what are the implications?
The host of The Bioethics Channel, Lorell LaBoube, talks about it with John Carney of the Center for Practical Bioethics.

Why People Still Suffer at the End of Life

Myra Christopher
Center for Practical Bioethics
December 9, 2009
1 hour 2 minutes 26 seconds

People who are seriously ill still suffer needlessly. In this December 9, 2009 lecture Myra Christopher of the Center for Practical Bioethics explores the root causes of this problem and why we as a society are so resistant to change.


Friday, December 18, 2009

Teaching Ethics in Medical Schools

As we near the end of 2009, we offer this guest blog for Practical Bioethics. Thank you for your interest and support in 2009, and here's to a great 2010!

Lorell LaBoube
Practical Bioethics

Teaching Ethics in Medical Schools

Iain Brassington
Blog: Journal of Medical Ethics
December 18, 2009

The best way out of this puzzle, I think, is that students learn to think critically about their own actions - that’s much more important than being able to tick boxes about autonomy, beneficence and justice without ever really thinking about what they mean.


Tuesday, December 15, 2009

Placebos: Deceptive or Legitimate?

Summer Johnson, PhD
December 15, 2009
15 minutes 10 seconds

The December 2009 issue of the American Journal of Bioethics is now available with target articles examining the ethics of using placebos in clinical practice. Executive editor Summer Johnson discusses the new edition with Lorell LaBoube of the Bioethics Channel.

Link: Podcast, 15 minutes 10 seconds


Monday, December 14, 2009

Tapping into Baby Boomers

Brian Hofland
Director of the Center for Economic Justice
AARP Foundation

The first wave of Baby Boomers is already turning 60. And America’s rapidly increasing population of older adults represents a vast and under-tapped resource.

Lorell LaBoube talks about how to tap into this resource with Brian Hofland of the AARP Foundation’s Center for Economic Justice.

Link: Podcast, 7 minutes 33 seconds

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Thursday, December 10, 2009

Me-Me and Pandemic Ethics

Rosemary Flanigan
December 10, 2009

The growing "me-me-me attitude" of Americans rolls on unabated.

I have been planning our January ethics committee self-education on the ethical guidelines for pandemic preparedness and saw immediately that here, too, we are building a levee against me-me-me.

And it will be hard to sell it.

But thinking about and talking about these matters is a MUST. E.g., Is stockpiling some essentials unrealistic, pandering to our “self-sufficiency” ideal, or undervaluing the notion of mutual aid?

The same question could be asked of every hospital resource.

Whether people agree or disagree on the details, a forum or even lunch talk with colleagues can launch us into articulating how our actions reveal who we really are—and whether or not we want to be that person.

Link: "Listen to the People": Public Deliberation about Social Distancing Measures in a Pandemic, American Journal of Bioethics, November 2009


Wednesday, December 2, 2009

Why do people still suffer at the end of life?

Myra Christopher
Center for Practical Bioethics

Wednesday, December 9
5 pm Reception
6 pm Lecture

Kauffman Foundation
4801 Rockhill Road
Kansas City, MO 64110

The lecture is free but registration is requested. Click here to register online.

Podcast: Why do people still suffer at the end of life?, Myra Christopher, November 27, 2009

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