CPR-COLORADO MATTERS: Center Director Matthew Wynia, MD, MPH explains, "There's enormous amounts of disappointment, frustration, anger. You certainly hear that when you speak to people in the healthcare system. Some 80 percent of the folks we're seeing coming into our hospitals with COVID now, are the relatively few people remaining who are completely unvaccinated. That's who's showing up on our doorsteps and that is very frustrating, as we this week are looking at implementing "Crisis Standards of Care," because our health system is so swamped.
At our health system for example, the national standard is you should have is one respiratory technician for every 5 people you have on a ventilator. We currently have one respiratory technician for every 15 people we have on ventilators. That's not only unsafe for patients, that's not at all ideal for those respiratory technicians. They are really being crushed by this current wave."
WASHINGTON POST: Califf, 70, a renowned cardiologist and researcher, is senior adviser for Verily, a research organization, and Google Health. He spent much of his career at Duke University, where he founded the Duke Clinical Research Institute. CBH Research Director Eric G. Campbell is a health-policy expert who has done extensive research on the impact of financial conflicts of interest in medicine, said Califf’s past ties with industry should not disqualify him. “To my knowledge those relationships have been fully discussed and widely debated in the academic and political arena,” Campbell said, adding that many academic trials are underwritten by drug companies.
THE DENVER GAZETTE: The previous standards plan described a dire situation in which patients more likely to live would be given care over others, the focus has now flipped, said Matthew Wynia, MD, MPH. The focus now is likely to be on keeping less-sick patients out of the hospital or out of intensive care beds if that can be safely done. "It's trying to find those people who will be OK, even if they don't get a service they would normally get, even if they get discharged a little early, even if they go to the floor instead of the step-down or to step-down instead of ICU," he said.
DENVER POST: The current standards for rationing care largely rely on a formula to quantify patients’ odds of surviving the next month and the next year. The scoring system doesn’t allow the triage team to consider non-medical factors, like a person’s socioeconomic status, but those could be relevant in deciding who can safely be sent home with a referral to outpatient care, said Matthew Wynia, MD, MPH. “I would hate to see… sending someone home who’s homeless,” Wynia said.
9NEWS: Dr Matt Wynia, Director of the Center for Bioethics and Humanities, said because of that change from predicting mortality to predicting who will be okay without certain services, socioeconomic status needs to be a factor. “I would hate to use a criterion that was purely clinical and end up sending someone home who's homeless, and keeping someone in the hospital who is wealthy and could very well afford to have someone come and check on them at home," Wynia said.
9NEWS: "We're doing this because we have to. We have no choice," according to Matthew Wynia, MD, MPH. "The fundamental ethical principle here is, you're trying to save as many lives as you can, with the limited resources you've got."
KUNC COLORADO EDITION: The number of people hospitalized with COVID-19 in Colorado is at its highest level since last December. With hospitals filling up, Gov. Jared Polis signed an executive order on Oct. 31 that gives the state control over hospital admissions and transfers. Interview with Jon Samet and Matthew Wynia.
DAILY MAIL: Professor Lisa Bero, CBH Senior Scientist and an expert in study fraud at Cochrane, warns of 'paper mills' – shadowy companies that operate online, churning out sham studies much like the 'essay mills' that profit by selling work to students. Academics investigating these paper mills recently flagged more than 1,000 potential research fraud cases linked to them. The article also linked to a UK Podcast, Medical Minefield, where Dr. Bero is interviewed for their story " Can We Really Trust Medical Research?"
COLORADO GAZETTE: "The state has not had to ration care in Colorado during the pandemic," said Matthew Wynia, MD, MPH. Though the worst-case provisions remain inactive, some rural hospitals are implementing similar strategies. Patients who may need an ICU bed are being boarded in the emergency department. “My fear right now is that outside of the hospitals, people don’t realize how bad this is,” Wynia said. “They don’t think this is like January, at all. They think it’s OK right now. So people are behaving as though we have nothing to worry about. ... Unfortunately, that attitude is going to just tear up the health care system.”
WASHINGTON POST: Right now there are “two Colorados,” said Matthew Wynia, Director of the Center for Bioethics and Humanities. “If you’re in the health-care system — if you’re a patient needing services in a hospital or if you’re a medical practitioner, things are really bad,” he said. “But if you’re a regular citizen just walking around on the street, you wouldn’t know it. People are behaving as though things are normal.”
The US Department of Homeland Security cited Professor Warren Binford's research with Human Rights Watch in support of its decision to end the Migrant Protection Protocols. The citation is just in a footnote (Pg.6 fn.19), but the memo quotes from the report at some length.
9NEWS: "If you’re outside and the sun is out and the glory of fall is all around you, you don’t realize that our healthcare system is not just at a breaking point--there are places where it’s breaking," said Matthew Wynia, MD, MPH. The biggest ethical issue Colorado faces, according to Wynia, is choosing where to transfer patients and move staff, since hospitals in areas with a less vaccinated population are more overwhelmed than hospitals in areas with a higher percentage of people vaccinated against COVID-19. "We need the public to do their part as well, which means start doing the stuff that you were doing last winter when people were scared of catching this illness. I fear that people think that things are OK and they’re not OK right now. We’re not OK.”
THE ATLANTIC: Public-health professionals sometimes contend that grand societal problems are beyond the remit of their field. Housing is an urban-planning issue. Poverty is a human-rights issue. The argument goes that “it’s not the job of public health to be leading the revolution,” explains Daniel Goldberg, JD, PhD. As the 20th century progressed, the field moved away from the idea that social reforms were a necessary part of preventing disease and willingly silenced its own political voice. By swimming along with the changing currents of American ideology, it drowned many of the qualities that made it most effective.
JOURNAL OF LAW, MEDICINE AND ETHICS: This Symposium Edition, edited by Daniel Goldberg, JD, PhD, explores the anxieties about feigned illness and the gaps in health and social policies spanning employment status, public benefits, disability accommodations, access to health care, occupational health, sports participation, child welfare and family policy, and veterans’ support in the United States. Professor Goldberg also contributed an essay and a video introduction to the publication.
MEDPAGE TODAY: Second Opinion by Matthew Wynia, MD, MPH. We cannot tolerate a profession where doctors clinging to disproven theories are killing patients. The purpose of professional self-regulation is to protect public safety -- that's it. When significant harms are arising due to a doctor's persistent and demonstrably false beliefs, good intentions and sincerity in holding the false beliefs no longer matter. The medical profession must sanction the COVID quacks.
BILL OF HEALTH: The field of health law makes as big a scholarly contribution outside the legal literature. Scott Burris, Director of the Center for Public Health Law Research at Temple University looked at citations beyond Westlaw, instead using Google Scholar. He found that Daniel Goldberg, JD, PhD ranked 11th nationwide in this list of the most cited law professors. Great work Daniel!
COLORADO PUBLIC RADIO: Carey Candrian, PhD, associate professor at the CU School of Medicine, studies how communication shapes — and is shaped by — perception, attitudes and biases in the LGBTQ+ community. She’s interviewed dozens of older adults from the community about their experiences with the healthcare system. It’s one thing to publish academic articles, speak at conferences for medical professionals or to lecture students, Candrian explained, and it’s another to use art to convey the humanity of the people behind the research.
Candrian decided to photograph 27 of the older LGBTQ+ women she’s interviewed over the last five years and then display those photos with quotes describing some of their thoughts and experiences, at the Fulginiti Pavilion. "They’ve been whispered about, shouted at, insulted, rejected, isolated. But here they are, strong and brave. Look into their eyes," the exhibit's description reads. Visit the exhibit webpage. Read article>>
THE BRITISH MEDICAL jOURNAL: Formula milk is consumed by most European and North American infants, and new formula products need to be tested in clinical trials. But concerns have been raised that formula trials are biased and could undermine breastfeeding. To explore this further, an international team of researchers set out to evaluate the conduct and reporting of formula milk trials. Lisa Bero, PhD and co-authors found the need for a substantial change in the conduct and reporting of formula trials to adequately protect participants from harm and protect consumers from misleading information.
THE HASTINGS CENTER: Congratulations to Professor Eric G. Campbell! Hastings Center Fellows are academic bioethicists, scholars from other disciplines, scientists, journalists, lawyers, novelists, artists or highly accomplished persons from other spheres. Their common distinguishing feature is uncommon insight and impact in areas of critical concern to the Center – how best to understand and manage the inevitable values questions, moral uncertainties and societal effects that arise as a consequence of advances in the life sciences, the need to improve health and health care for people of all ages, and mitigation of human impact on the natural world.
THE COLORADO SUN: Matthew Wynia, MD, MPH explains, If you are looking like you’re about to have to do triage, you should be implementing these strategies in advance. Not withholding services, but you should pull your triage team together in advance; you should be creating the load balancing mechanisms across systems. And that really has to be done at the state level. No single hospital has the capacity to do that. And the biggest ethical failure is if you’ve got a doctor in one hospital saying, “I’m sorry, I don’t have an ICU bed for you” and you end up having to die because you can’t get the intensive care that you need when there was an ICU bed available but it was six miles away at a different hospital.