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?, and co-authors argue that law is as core to public health as epidemiology and biostatistics and should be centered in schools and programs of public health.

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.

Mar 19, 2024

CU ANSCHUTZ NEWS: The CU Departments of Biomedical Informatics and Medicine received a $1.8 million, five-year grant from the National Heart, Lung, and Blood Institute (NHLBI) to offer summer institutes focused on the ethical use of artificial intelligence (AI) and machine learning in data sciences and omics of cardiovascular and lung diseases.

Matthew DeCamp, MD, PhD, who studies the intersection of bioethics and AI, says there’s an increasing need for diversity, equity, accessibility and inclusivity within the field, especially as machine learning and AI continue to integrate into health care and research. Exposing participants in this program to core bioethics issues at the intersection of omics, AI biases, and health disparities is an important addition.”

Mar 19, 2024

NEW YORK POST: From the moment students set foot in medical school, they are instilled with the concept of medical professionalism: their sacred responsibility to conduct themselves with the values of a profession that is granted automatic trust in society. The problem, as many medical students have also learned, is that where “professional” is vague, "unprofessional” is even more so. "This can prove particularly pernicious to residents of color, said Dr. Adaira Landry, an adviser at Harvard Medical School and co-author on a recent NEJM article on the “overpolicing” of Black residents.

Medicine was at a crossroads from 1997 to 2007, when corporations were snapping up individual practices and turning them into for-profit enterprises. Doctors saw their time with patients dwindle, and patients saw their quality of care decline. “There was a rising public perception that doctors were just like everyone else: They’re just looking to make a buck,” said Dr. Matthew Wynia, a medical ethicist studying the ethics of managed care during this period. “The fear was that our sense of professionalism was being lost.”

Feb 23, 2024

NATIONAL BUREAU OF ECONOMIC RESEARCH: Despite the growing need for surrogate decision-making for older adults, little is known about how surrogates make decisions and whether advance directives would change decision-making. In a national survey, Lauren Hersch Nicholas, PhD, and co-authors found participants were more likely to indicate that surrogates should choose comfort care when a hospitalized older adult has dementia, even when the patient’s advance directives indicated s/he would prefer life-extending treatments.

Conversely, for hypothetical patients without dementia, respondents are more likely to state that the surrogate should choose life-extending treatments even when the patient had indicated s/he would want comfort care. Their findings suggest that older adults should choose proxy decision-makers with similar preferences to their own to increase preference-concordant surrogate decisions.

Feb 23, 2024

UNDARK: Behind many pandemic-era debates are deep divisions between two schools of thought in the world of health care; randomized controlled trials (RCTs) vs. evidence-based medicine (EBM). In environmental health, randomized controlled trials are often impossible. “You’re not going to do a RCT of the effects of PFOA on pregnant women. It’s just not going happen,” said Lisa Bero, PhD, Chief Scientist at CBH. To answer public health questions, the Cochrane folks had to get used to applying their methods to observational studies and other forms of evidence. This specifically meant doing more systematic reviews, in order to have a transparent, consist way of evaluating evidence.

Feb 8, 2024

AMERICAN JOURNAL OF PUBLIC HEALTH: In an essay by Warren Binford of the Center for Bioethics and Humanities & the Kempe Center, Janine Young of the University of California San Diego, Michael Garcia Bochenek of Human Rights Watch and Columbia University, and Jordan Greenbaum of the International Center for Missing and Exploited Children, this team of medical and legal experts provide recommendations to improve the health and well-being of unaccompanied immigrant children who continue to arrive at the US–Mexico border. These children are at high risk for ongoing abuse, neglect, and poor mental and physical health.

The authors propose that changes be made at public health, medical, and governmental levels to provide early and comprehensive attention to the needs of unaccompanied immigrant children to maximize the likelihood that they will reach their full potential and positively contribute to society.

Feb 11, 2024

NATIONAL PUBLIC RADIO: Benjamin Franklin famously wrote: "In this world nothing can be said to be certain, except death and taxes." While that may still be true, there's a controversy simmering today about one of the ways doctors declare people to be dead. The debate is focused on the Uniform Determination of Death Act, a law that was adopted by most states in the 1980s. The law says that death can be declared if someone has experienced "irreversible cessation of all functions of the entire brain." But some parts of the brain can continue to function in people who have been declared brain dead, prompting calls to revise the statute.

Matthew Decamp, MD, PhD, co-authored a recent position paper for the American College of Physicians, with the intent of fostering honesty, transparency, respect, and integrity in how death is determined and communicated to patients and families. Physicians can ensure trust by communicating determinations of death that are consistent with medical ethics, the law, and the best available scientific evidence.

Feb 12, 2024

SOM DEAN'S NEWSLETTER: A team of MIT researchers will lead a $65.67 million effort, awarded by the U.S. Advanced Research Projects Agency for Health (ARPA-H) to develop ingestible devices that may one day be used to treat diabetes, obesity, and other conditions through oral delivery of mRNA. Matthew Wynia, MD, MPH and Eric Campbell, PhD along with colleagues at the Center for Bioethics and Humanities, will focus on exploring the ethical dimensions and public perceptions of these types of biomedical interventions.

Jan 30, 2024

THE HARVARD CRIMSON: Interim Harvard President Alan M. Garber ’76 will remain on the board of one pharmaceutical company while leading the University, a decision that complicates his relationship with the Harvard Management Company and raises questions about potential conflicts of interests.

"A conflict of interest isn’t just about money. Money is a big part of it, but it's also about power and decision-making capability,” said Lisa Bero, PhD. “Even if someone’s on a board that they’re not paid for, sometimes people think that’s okay, but they’re still in a position of power. “They can make decisions that would affect them or interests close to them just by serving on the board,” Bero added.

Jan 28, 2024

BOSTON GLOBE: When a blogger posted allegations that researchers at the Dana-Farber Cancer Institute had manipulated data in published studies, the reports were shocking — and yet also familiar. Such cases are appearing with growing frequency, raising concerns about the integrity of scientific research and how carefully papers are vetted at even prestigious journals. The matter is still under investigation, although the hospital is moving to retract six papers and correct 31.

How does bad data slip through? Lisa Bero, Ph, Chief Scientist at CBH explains, "The volume of requests for peer review is just way, way too high. And reviewers’ work varies widely from very cursory to very thorough. The directions they receive are often vague, and rarely include scrutinizing the data." Instead of having more peer reviewers, Bero recommends having reviewers who specialize in certain aspects of research.

Jan 14, 2024

WASHINGTON POST: Lisa Iezzoni, MD, MSc, a professor at Harvard Medical School who has lived with multiple sclerosis since her early 20s says, “For too long, medical providers have failed to address change in society, changes in technology and changes in the kind of assistance that people need.” Among Iezzoni’s notable findings in recent years, are that most doctors are biased.

In a survey published in Health Affairs, 82 percent of physicians admitted they believed people with significant disabilities have a worse quality of life than those without impairments. Only 57 percent said they welcomed disabled patients. “It’s shocking that so many physicians say they don’t want to care for these patients,” said survey co-author, Eric Campbell, PhD.

Jan 2, 2024

JOINT COMMISSION ON QUALITY & PATIENT SAFETY: Individuals with disabilities are one of the largest and most underserved subpopulatioMegan A. Morris, PhD, MPH, CCC-SLP and co-authors interviewed health care organizations (HCOs) and found the main purpose for collection of disability status and accommodation needs in the EHR was to prepare for patients with disabilities.

Participants believed collection should (1) occur prior to patients’ clinical encounters, (2) be conducted regularly, (3) use standardized language, and (4) be available in a highly visible location in the EHR. The authors believe routine collection of this information along with leadership support, will enhance HCOs’ ability to understand the needs of their patients and enhance their ability to proactively provide accommodations to ensure equitable access to health care services.

Dec 24, 2023

NEW YORK TIMES: Why do we attempt to rationalize pain as a deserved punishment or a fit of hyperbolized acting by the weak or lazy? Daniel Goldberg, JD, PhD, says an important aspect is fear. We don’t want to believe we could be stuck in unremittable agony, so we look for differences in those who are afflicted and point to those traits as reasons for their suffering.

Dec 18, 2023

JAMA VIEWPOINT: Adrian C. Traeger, PhD, School of Public Health at University of Sydney and Lisa Bero, PhD, at the Center for Bioethics and Humanities found that over the past 3 years, several independent studies have questioned the safety and efficacy of spinal cord stimulation to manage pain.

The spinal cord stimulator industry was swift to respond by creating counterevidence (original studies and reviews), supporting researchers to write criticisms in industry-sponsored journals. These tactics have historically extended into the tobacco industry, pharmaceutical, lead, vinyl chloride, and silicosis-generating industries, to protect profits.

Bero and Traeger conclude that to maintain independence, professional organizations and publications should not accept industry funding and should have strict policies to actively manage financial conflicts of their members.

Dec 7, 2023

HEALTH AFFAIRS: The American Board of Bioethics Program Directors (APBD) approved a new position this fall, that universal COVID-19 vaccine mandates are not presently ethically supportable. Matthew Wynia, MD, MPH, and colleagues state that the values and principles that guided their earlier position remain the same, but the context has evolved.

Today, although the benefits of updated vaccination to individuals remain considerable, the relative value of universal vaccination against COVID-19 for achieving safety for others seems considerably lower than it was in fall 2021. This is why the APBD now supports policy decisions to lift most COVID-19 vaccine mandates but continues to call for freely available access to updated vaccines against COVID-19. They also recognize that vaccine mandates could again become ethically justifiable should circumstances change.

Nov 27, 2023

AMERICAN JOURNAL OF BIOETHICS: When and how are physicians obligated to patients, colleagues and the community? Drs. Matthew Wynia and Brian Jackson examine 125 years of thought on physician ethics. and how the new concept of "spheres" might help physicians better understand the reasons they feel conflicted in some cases, and become better equipped to negotiate their roles in an increasingly complex and interconnected healthcare system.