NEJM PERSPECTIVE: What should medical professionals do when a law requires them to harm a patient? Center Director Matthew Wynia, MD, PhD, believes this question has become a pressing one as physicians grapple with the implications of state laws banning abortion. A thoughtful debate over whether and how to embark on a path of professional civil disobedience will take time and commitment. Physicians will need to bring specific proposals to their professional associations for ways to assist members who disobey unjust laws, including providing legal, financial, and social support. But I believe now is the time for these conversations to begin.
THE CONVERSATION: How do you know when a research study is reliable and evidence-based? And how can you tell the difference between shoddy research findings and those that have merit? Unreliable scientific studies can be hard to spot – whether by reviewers or the general public – but by asking the right questions, it can be done. Lisa Bero, PhD, has been studying bias in the design, conduct and publication of scientific research for 30 years, and has developed ways to prevent and detect research integrity problems so the best possible evidence can be synthesized and used for decisions about health.
Bero and colleagues recently published, Experts identified warning signs of fraudulent research: a qualitative study to inform a screening tool, in the Journal of Clinical Epidemiology, which found that it’s possible for researchers who review and synthesize evidence to create a checklist of warning signs, and use these warning signs to create a screening tool – a set of questions to ask about how a study is done and reported – that provides clues about whether a study is real or not.
LA TIMES: In this editorial, Wendy Netter Epstein, JD and Daniel Goldberg, JD, PhD state the the lack of a coordinated public health response deprioritizes community health and worsens longstanding health disparities. The CDC has issued tentative and confusing recommendations, leaving critical decisions to local communities and forcing individuals to turn to their healthcare providers. With school starting across the country, public health officials should set clear rules that guard public health as a goal bigger than any one person’s individual risk. And communities should come together to support them.
FAMILIES, SYSTEMS, & HEALTH: In this editorial, authors Sarah Hemeida and Daniel Goldberg assert stigma is an under-recognized health malady that is both rampant for vulnerable communities and difficult to measure for researchers. Stigma has enormous and compounding negative health impacts, associated with lower education levels, employment and income, and poorer control of chronic conditions and illness.
Stigmatizing laws against individuals with addiction have a powerful role in downstream health, including opportunities for employment, access to health insurance, self-stereotyping, and reduced willingness to access recovery resources.
In addition to traditional interventions such as peer supports, addiction counselors, and community-based rehabilitation programs, the legal determinants of health contributing to structural stigma against substance use disorder need to be addressed and corrected.
DENVER POST: Gender-affirming care is not child abuse say experts Warren Binford, JD, Ed.M and Mary Kelly Persyn, JD. At a time when political divisions and partisanship threaten to upend society, it is more important than ever to ensure that social policies are informed by research and evidence, not misinformation and hysteria, especially when it comes to children in their formative years. When transgender youth do not receive affirming love and care, they suffer. According to a survey just released by The Trevor Project, 94% of LGBTQ youth reported in 2022 that current political attacks were taking a toll on their mental health.
CU SCHOOL OF MEDICINE: Congratulations to our own Dr. Tess Jones for her selection by graduating medical students as the recipient of the President’s Excellence in Teaching Award. This is a remarkable and incredibly exclusive honor; to be selected by graduating students as the single most excellent teacher they’ve had during all of medical school is a tremendous demonstration of Tess's knowledge, skill, passion and energy. She serves as an inspiration to us all!
ABA JOURNAL: “During the pandemic, we had to use laptops to connect. But in a physical classroom, they tend not to be a bridge but actually a barrier to the transfer of knowledge and understanding,” says Warren Binford, JD, Ed.M. In her classes, she had a three-strikes policy for being caught looking at something that wasn’t related to class, and the penalty was failing her class. “I’ve never had to fail a student, but I have given two warnings. That’s not really the role I want to be in, walking through different rows making sure no one is buying shoes.”
HEALTH AND HUMAN RIGHTS JOURNAL: Migration to the US has shifted significantly over the last few decades. Once primarily adult, usually male, and overwhelmingly from Mexico, the people crossing the southwestern US border are now often women travelling with children or on their own, unaccompanied children. The needs of migrant children have too often been overlooked—and at times callously disregarded. Children and families have been subjected to abusive conditions and other trauma. Warren Binford and Michael Garcia Bochenek suggest creation of a Federal Children's Ombuds Office to help fill the accountability gap, if it is given the authority to investigate violations of children’s rights by all federal agencies, including CBP, Immigration and Customs Enforcement, and their contractors.
NATURE: Eric G. Campbell, PhD, and co-authors used a novel methodology to identify and survey physicians at high likelihood of participating in MAiD activities. They achieved good overall response rates (55%), and a high proportion of respondents that participated in MAiD activities (52%), demonstrating that it is possible to overcome survey cost and anonymity barriers to conducting quantitative research on MAiD. This methodology could be used in larger scale studies of MAiD or other bioethical issues with “hidden” physician populations.
COLORADO SUN: The number of Coloradans who received prescriptions to end their lives has increased each year since voters passed an aid-in-dying law in 2016, rising 18% in 2021 to 222 prescriptions obtained last year.
In a recent survey of 300 Colorado physicians conducted by Eric G. Campbell, PhD, 80% of doctors said they were willing to discuss medical aid in dying, but not nearly as many were ready to do it or had actually done it, according to Campbell’s research. About 52% said they had discussed aid in dying with a patient. Among physicians who had prescribed medical aid in dying, 75% said it was “emotionally fulfilling and professionally rewarding.” Almost 47% described it as “ethically challenging.”
MINNEAPOLIS STAR TRIBUNE: Dr. Jeffrey Ho is among at least three doctors at Hennepin Healthcare who have side jobs in law enforcement. Ho sees no conflict between his roles, "both doctors and police strive to save lives, he said. "It is my life's work to develop these areas of intersection for the benefit of public protection."
This professional dynamic is unusual, said Eric Campbell, PhD, Director of Research at CBH. The dual allegiance poses a clear conflict of interest in areas of patient privacy and consent. "Police enforce laws," Campbell said. "Doctors, on the other hand, must prioritize the best interest of their patients over other things, which sometimes may include the law. The idea that one can equate doctors and law enforcement officers as being on the same team to quote, 'protect things,' that's a fallacy."
Congratulations to Tess Jones, PhD, Director of the Arts and Humanities in Healthcare Program, who was recognized by the Health Humanities Consortium, a national organization focused on transforming health and healthcare through the arts and humanities. The 2022 Visionary Award recognizes an individual who advances health humanities regionally, nationally and internationally via scholarship, presentations, appointed positions and more.
MEDSCAPE: Documents unsealed during recent talc lawsuits against Johnson & Johnson show that the company was involved in a study in which incarcerated, mostly Black men at Holmesburg Prison in Philadelphia, were paid to be injected with asbestos in order that the company could compare its effect on their skin with that of talc.
ANNALS OF INTERNAL MEDICINE: When a detained person refuses food, their medical team faces ethical challenges. Center Director Matthew Wynia, MD, MPH and co-authors affirm that hunger strikes by immigrants and asylum seekers are constitutionally protected, nonviolent protests of last resort, which occur with remarkable frequency (2,500 during the first 6 months of the pandemic) in ICE detention facilities. Medical care in private prisons operated by GEO Group illustrate disregard for the ethical standards, by using force-feeding for punitive rather than medical reasons. Wynia says force-feeding and other involuntary medical procedures on people who choose to undertake hunger strikes should stop, and health care professionals. Medpage Today also interviewed Dr. Wynia about this topic and article.
MEDICAL ETHICS ADVISOR: Most physicians are willing to talk with patients about medical aid in dying (MAiD) but fewer are willing to serve as an attending or consultant, according to a survey of more than 500 Colorado physicians, conducted by Eric G. Campbell, PhD and co-authors. “Given that MAiD almost universally occurs outside of the inpatient setting, and given that ethics consults are almost universally within the inpatient setting, there’s a need for someone to provide ethical guidance to MAiD. “Education needs to be unbiased and should not be colored by entrenched beliefs about the acceptability, or lack thereof, of medical aid in dying.”
AMERICAN MEDICAL ASSOCIATION: In a recent CDC webinar, “Ethics and Equity in Crisis Standards of Care,” Matthew Wynia, MD, MPH, underscored how complicated—and imperfect—medical ethics can be during disaster response. “This is why ethical dilemmas arise—because you have a circumstance in which you cannot optimize all of your key ethical principles,” Dr. Wynia said. “You have to pick some that are going to exceed the value of others.” For example, equity is important—even when trying to maximize the number of lives saved. In the rollout of vaccines, public health authorities sometimes prioritized older populations over people who have been historically marginalized.
CU ANSCHUTZ TODAY: Christine Baugh, PhD, MPH, studies the risk for and outcomes of traumatic brain injury in football. “In the lab I’ve worked with people suffering from longer-term effects of traumatic brain injury. What’s emerged is that in addition to improving individual health outcomes, we also need to think about this from a population and policy level,” she says. “We need to be asking what we can do to reduce the negative effects of this game?" Football participation and its potential for long-term injury also exacerbate existing health disparities, if schools in lower-income areas don’t have the resources to hire trainers or other health professionals to work with athletes. “Or, it may be a situation where football is the primary way to have your child in an activity after school until you finish your job,” Baugh says. “You want them to do something that’s safer than alternatives that aren’t sanctioned by the school, but then they’re exposed to risk for injury. ”Baugh emphasizes that she and other researchers balance evidence with pragmatism, knowing that people aren’t going to suddenly stop playing or loving football, “so we’re asking how we can leverage this growing awareness of risk to make the game safer,” she says. “How can we improve outcomes for athletes across all levels of play?”
JOURNAL OF ADVANCED NURSING: Quinn Grundy, PhD, RN and co-authors conducted a global analysis of sponsorship of national nursing professionals associations and their major conferences. They found sponsorship is concentrated in North America and Europe and among specialties that have a high rate of technology adoption. Notable was that the medical device industry has a much stronger presence than the pharmaceutical industry, which does show up strongly among oncology associations.