Tag Archives: ethics

Obscure advisory committees on U.S. drug pricing

The obscure advisory committees at the heart of the U.S. drug pricing debate – Reuters – by Caroline Humer – April 2019

Expectations were high last year for three new migraine drugs hitting the market from Amgen Inc, Eli Lilly and Co and Teva Pharmaceutical Industries.

Priced around $7,000 each, the drugmakers called them “breakthrough” treatments designed to prevent migraines when taken year-round, and estimated that millions of patients could benefit

But a small group of external medical experts who quietly advise U.S. health insurers on new drugs was not impressed, according to a private meeting held at UnitedHealth Group’s OptumRx offices in Chicago that was attended by Reuters.   Continue reading

Rein In ‘Sociopaths’ in the Boardroom

Ex-Corporate Lawyer’s Idea: Rein In ‘Sociopaths’ in the Boardroom – NY Times – By  –  July 2019

Jamie Gamble spent most of his career as a partner at the law firm Simpson Thacher & Bartlett, which counts virtually every major company in the United States — including Facebook, General Motors, Google and JPMorgan Chase — among its clients.

Mr. Gamble has had an epiphany since retiring nearly a decade ago that is so damning of his former life that it is likely to give his ex-partners a case of agita. He has concluded that corporate executives — the people who hired him and that his firm sought to protect — “are legally obligated to act like sociopaths.”

He’s not the only one to notice this: 400% price hike for drugs is ‘moral requirement’ Continue reading

Access to Pain Management as a Human Right

Access to Pain Management as a Human Right – free full-text /PMC6301399/Am J Public Health. – Jan 2019

It seems that politicians, government agencies, and law enforcement simply don’t see this, though they’d quickly change their minds if it were their own flesh in agony.

The concept of access to pain management as a human right has gained increasing currency in recent years. Commencing as individual advocacy, it was later embraced by the disciplines of pain medicine and palliative care and by mainstream human rights organizations.

Today, United Nations and regional human rights bodies have accepted the concept and incorporated it into key human rights reports, reviews, and standards.    Continue reading

Doctors’ duty to relieve suffering

The two PubMed articles in this post are from the early 2000s, over 16 years ago, yet they describe the same situation we’re stuck in today, with doctors being squeezed, harrassed, and sued from both sides of the opioid controversy.

Sometimes they are successfully sued for refusing to administer necessary pain relief when a jury decides that “insufficient pain management in a dying patient constituted abuse by a physician.” (which seems obviously right to me)

Other times they are successfully sued when a doctor who “provided comfort care to terminally ill patients was accused of performing euthanasia.” (luckily, the conviction was later overturned)

I’m very glad I’m not a doctor who has to make such potentially career-ending decisions these days.  Continue reading

40% of doctors refuse new patients taking opioids

Access to Primary Care Clinics for Patients With Chronic Pain Receiving Opioids – Jama Network Open – July 2019

This JAMA study shows that 40% of doctors refuse a new patient if they are using opioids. Many refuse not just to manage their pain, but to manage any other aspect of their general health.

Findings  In this survey study of Michigan primary care clinics, 79 clinics contacted (40.7%) stated that their practitioners would not accept new patients receiving opioid therapy for pain. There was no difference based on insurance type.

Meaning  The findings suggest that access to primary care may be reduced for patients taking prescription opioids, which could lead to unintended consequences, such as conversion to illicit substances or poor management of other mental and physical comorbidities.   Continue reading

Ethical Responsibility to Manage Pain and Suffering

The Ethical Responsibility to Manage Pain and the Suffering It Causes – Position Statement of the American Nurses Association, Apr 2018 – Repost

I’m reposting this from last year because it’s such a good (and rare) example of a reasonable attitude toward opioids. The Nurses Association gets credit for standing up for patients a year earlier than others.

The purpose of this position statement is to provide ethical guidance and support to nurses as they fulfill their responsibility to provide optimal care to persons experiencing pain. 

The national debate on the appropriate use of opioids highlights the complexities of providing optimal management of pain and the suffering it causes.

In these first sentences, the difference between nurses and doctors shine through:

Nurses are much more concerned with suffering, while doctors nit-pick about what is painful and what isn’t, who is “really” hurting and who is “catastrophizing”.   Continue reading

Artificial Intelligence: Accuracy versus Explainability

Artificial Intelligence and Black‐Box Medical Decisions: Accuracy versus Explainability – by Alex John London – February 2019

This article explores a big problem with “AI”, one that’s fundamental to its design and function, one that presents thorny philosophical issues that must be confronted and decided before technology decides them for us by default, allow the technology to direct us instead of us directing the technology.

I suspect this is already starting to happen as more medical records are digitized and become available to be processed by an algorithm instead of a person, preferably one with medical knowledge, but these days more commonly a bureaucratic administrator following a procedural “algorithm” of their own.  Continue reading

More CDC Guideline Writers Recant

No Shortcuts to Safer Opioid Prescribing | NEJM Deborah Dowell, M.D., M.P.H., Tamara Haegerich, Ph.D., and Roger Chou, M.D. [!!!] – Apr 2019

This article is astonishing because Dr. Roger Chou has been one of the most influential anti-opioid crusaders. I’m thrilled that he’s finally understanding (or at least noticing) the problems (torture) caused by the CDC Guideline that he helped write.

Since the Centers for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain in 2016, the medical and health policy communities have largely embraced its recommendations.

Although outpatient opioid prescribing had been declining since 2012, accelerated decreases — including in high-risk prescribing — followed the guideline’s release.

“Accelerated decreases” is a deliberately innocuous term when referring to the brutal, suicide-inducing, drastic forced opioid tapers pain patients have had to endure.  Continue reading

Voice-recognition to automate doctors’ data entry

Voice-recognition system aims to automate data entry by doctors – STATBy Casey Ross @caseymrossMarch 4, 2019

I think artificial intelligence (AI) in healthcare simply must happen with so many people’s care sprawling over so many healthcare services (and billing companies). Using AI learning systems in healthcare makes a mockery of any kind of patient or doctor privacy. Even worse, they are dangerously prone to undetectable errors (people have died).

Still, we need these systems to cope with the ever-increasing amounts of data and knowledge, but we need them to serve humans, not to replace them.

Hands down, the one task doctors complain about most is filling out the electronic health record during and after patient visits. It is disruptive and time-consuming, and patients don’t like being talked to over the doctor’s shoulder.    Continue reading

Ethics of Using Facial Recognition Tech in Healthcare

What Are Important Ethical Implications of Using Facial Recognition Technology in Health Care?AMA Journal of Ethics – Nicole Martinez-Martin, JD, PhD

Abstract:

Applications of facial recognition technology (FRT) in health care settings have been developed to identify and monitor patients as well as to diagnose genetic, medical, and behavioral conditions.

The use of FRT in health care suggests the importance of informed consent, data input and analysis quality, effective communication about incidental findings, and potential influence on patient-clinician relationships.

Privacy and data protection are thought to present challenges for the use of FRT for health applications.  Continue reading