Jul 31, 2024

JAMA VIEWPOINT: Historically, an essential and ubiquitous component of physicians’ oaths and their related ethical codes is the promise to place patients’ interests above any others, including their own. In this perspective, Matthew Wynia, MD, MPH, and Patricia Gabow, MD, address the rising challenges that health providers face in fulfilling this core professional promise not from a virus but from 3 converging fronts: personal conscience, employment contracts, and laws. The authors suggest that health providers need to work to recenter medical care around patients’ interests, which can be difficult or even dangerous, but it is the only path forward if physicians hope to remain a true profession.

Jul 19, 2024

JAMA HEALTH FORUM: Lauren Hersch Nicholas, PhD, MPP, is corresponding author of an investigation that analyzed the experiences of more than a million people receiving Medicare-funded services in the last six months of their lives. Co-authors from our campus are Stacy M. Fischer, MD, Marcelo Coca Perraillon, PhD, and Christine D. Jones, MD.

Nicholas and colleagues found that the kind of Medicare a patient is enrolled in can make a difference in whether that patient gets certain treatments, and whether the patient dies in a hospital or in hospice care. “For patients near the end-of-life, Medicare Advantage incentives may reduce potentially burdensome care and encourage hospice,” Nicholas’ paper says, “but could also restrict access to costly but necessary services.”

Jul 27, 2024

FORBES: When a patient comes to the hospital with a serious infection or fever, one of the first things done is to draw two sets of blood cultures to try to identify the source of the infection and the antibiotics that will most specifically target the bacterial (or fungal) culprit. This blood culture bottle shortage will result in difficult triage and rationing decisions, and both physicians and patients will be hurt, although in different ways.

Matthew Wynia, MD, MPH, notes, “there have been dozens of reports written about how to address drug shortages, all of which include the recommendation that we really ought not have sole source for anything. You need diversification of your supply chain.” Wynia says, “We may never fully recover psychologically from the pandemic and the moral distress associated with having patients who needed something, and we couldn't give it to them because we didn't have it.” He sees the same thing happening now with this critical shortage of blood culture bottles. He also questioned what, if anything, patients will be told.

Jul 8, 2024

NATIONAL PUBLIC RADIO: In a Tennessee operating room, Dr. Marty Sellers is performing a revolutionary organ recovery technique, normothermic regional perfusion. "It replenishes the oxygen deprivation that the organs incur during the dying process," says Sellers. "If we recover the organ and put it on ice in an oxygen-deprived state, it’s not as healthy when it gets into the recipient."

The American Journal of Bioethics dedicated a recent issue to the controversy over whether the technique blurs the definition of death. "The bottom line is that NRP violates foundational ethical norms around the determination of death and should not be pursued," says Matthew DeCamp, MD, PhD, who helped write a policy statement opposing NRP for the American College of Physicians.

Jul 2, 2024

JAMA OPEN FORUM: Christine Baugh, PhD, MPH, Eric G. Campbell, PhD, Lisa Bero, PhD, and co-authors published a study of pharmaceutical and medical device industry events for health professionals, utilizing data from the Medicare/Medicaid Open Payments database. Their findings suggest that expanding and enforcing the reporting requirements to cover all payments to all registered health professionals would improve the transparency and accuracy of estimates of the true extent of all sponsored events, as well as their reach and impact on clinical practice.

Jun 18, 2024

ANNALS OF INTERNAL MEDICINE: Mark J. Kissler, MD, and five CU Anschutz colleagues are the authors of a paper that evaluates medical literature on the role of attention in the clinical environment. They identified 6 categories of literature related to attention: the clinical environment and its effect on attention, personal factors affecting attention, relationships between interventions or factors that affect attention and patient outcomes, the effect of clinical alarms and alarm fatigue on attention, and health information technology’s effect on attention.

The authors propose that a well-functioning environment enables good care without overtaxing the clinician’s cognitive or emotional resources. But simply creating a “sterile cockpit” for a distraction-free environment is unrealistic in most health care settings. They conclude that to be effective, health care quality improvement efforts need to transition from siloed quality improvement interventions to multidisciplinary efforts that understand that health care is composed of complex and overlapping environments.

Jul 1, 2024

Abraham M. Nussbaum, MD, professor of psychiatry and chief education officer at Denver Health, is author of Progress Notes: One Year in the Future of Medicine, a book that follows seven CU medical students through their training, particularly through the longitudinal integrated clerkship (LIC) structure that forms the basis for our new curriculum.

Abraham also offers a clear explanation of how we aim to teach our students to become better physicians: The new curriculum begins with a year of basic sciences but will be organized around clinical complaints. Hence, instead of learning the anatomy of the heart as its own topic, students will learn it in the context of a patient presenting with chest pain. They will learn about the anatomy of the heart in relationship to the physical examination, to available medications and procedures, and to social determinants of health. This book tells the compelling story of how to become a physician, serve our patients and our community, and pursue a fulfilling life. Published by Johns Hopkins University Press.

Jun 12, 2024

JOURNAL OF ELDER ABUSE AND NEGLECT: Kristin Furfari, MD, Jackie Glover, PhD, and co-authors describe the roles and best practices for ethics consultation services and elder mistreatment (EM) response team collaboration; present four in-depth patient scenarios and the ethical frameworks that arise in cases of EM, and describe the collaborative processes that foster the best solutions for these patients.

Jun 4, 2024

ANNALS OF INTERNAL MEDICINE: Artificial Intelligence is expanding throughout the provision of health care, in applications such as clinical documentation, diagnostic image processing, and clinical decision support. Matthew DeCamp, MD, PhD, and co-authors developed 10 recommendations/position statements to ensure the greatest benefit and minimum harm to patients from these new technologies, and to ensure that they are used in alignment with the ethical responsibilities of physicians and the medical profession.

The authors recognize the dynamic and evolving nature of AI technology and advocate for more guidance, regulatory oversight, research, and education for physicians, other clinicians, and health care systems to maximize clinical safety and effectiveness of these tools as well as understanding their potential consequences regarding health disparities.

May 31, 2024

NEW YORK TIMES: People who are starting to experience cognitive decline may miss payments, make impulsive purchases or put money into risky investments. Lauren Hersch Nicholas, PhD, MPP, who studies dementia's impacts on people's finances advises, "We should be thinking about the possibility of financial difficulties linked to a disease we don’t even know we have. Knowing that, people should be on the lookout for these symptoms among friends and family members.”

May 30, 2024

JOURNAL OF THE HISTORY OF MEDICINE AND ALLIED SCIENCES: Law is a powerful social determinant of health. Public health laws, in and out of pandemics, are historically patterned. Daniel Goldberg, JD, PhD, says historical fluency is required for effective work in crafting legal and policy interventions as a part of public health emergency preparedness and response.

The questions of how public health workers and policymakers may acquire such competency and creating space for historical training in crowded public health curricula is its own considerable challenge.

May 6, 2024

JOURNAL OF INTERNAL MEDICINE: in a survey of Colorado physicians, Mika K. Hamer, PhD, MPH, and colleagues found that among 300 respondents, 26% of those likely to care for MAiD-eligible patients reported ethical and/or religious barriers to participating in MAiD activities. However, most physicians, regardless of perceived religious or ethical barriers, are willing to discuss and/or refer patients seeking MAiD

Apr 30, 2024

JAMA Open Research Letter: Conversational agents built on artificial intelligence (AI), known as chatbots, are increasingly being implemented for patient-facing communication in health care systems. Jessica Ellis, BSA, Mika K. Hamer, PhD, and Marlee Akerson, BA, surveyed chatbot users. Of the 617 surveys received the authors found respondent education level, race, and ethnicity impacted perception. These findings could be particularly problematic for groups marginalized by the health care system, for whom trust is already fragile, to avoid contributing to mistrust.

Apr 24, 2024

ACCORDS NEWS: This new grant, Characterizing Engagement and Equity in Research (CHEER), aims to find the best engagement methods for diverse research topics and communities. CU faculty Sarah Brewer, PhD, MPA, Matthew DeCamp, MD, Bethany Kwan, PhD, MSPH, and Matthew Wynia, MD, MPH. will use a consensus process to describe and characterize each engagement method, such as advisory panels or design studios. Then, researchers will engage six CHEER teams, compromised of members from underrepresented communities, to evaluate and rank engagement methods. Finally, each of the six teams will use three engagement methods to plan a research study centered on a priority topic important to their communities.

“The grant is structured to have CHEER teams doing real engagement. This is not hypothetical. This is real engagement on one side and an independent evaluation team that's doing surveys and observations on the other side. This is real world work, accompanied by real evaluation,” DeCamp says.

“We are not only studying the science of engagement, but we also have community engagement on both sides. Our patient and community partner representatives are not just consultants, they are investigators. Through the PCORI funding mechanism, they are themselves considered co-investigators, which is rare. It allows us to meaningfully partner and have shared decision-making, and shared power with community in the conduct of this research,” said Bethany Kwan, PhD, MSPH.

Apr 12, 2024

HEALTH AFFAIRS: In June 2023, the Public Health Ethics and Law (PHEAL) Program convened a workshop at CBH entitled “Teaching Public Health Law Outside of a Law School.” The first output of the workshop, was this commentary published today in Health Affairs. Daniel Goldberg, JD, PhD
Including law within public health curricula provides future practitioners with critical tools to identify and address legal issues to advance public health. Importantly, this foundational education supplies public health students with understanding of the skills to confront the structural drivers of health inequities.