"ECT has the potential to change a person in ways that should be avoided if possible."
Viewing entries tagged
thomasremcho
"Hopefully developments will likely provide important information about how the public deals with issues of reproductive ethics."
Doctors are subject to evaluation on many levels. Physicians may be judged on availability, and bedside manner, in addition to their ability to ameliorate patients’ conditions. Interestingly, the reliability of a physician when it comes to addressing health problems does not necessarily correlate to high ratings by patients (Carroll). Patients, or the subset of them who write reviews, may consider other factors more important than outcome. Review websites for doctors are extremely popular with upwards of 33 publically available sites for this purpose. (Lopez) With this many options for publically available data on patient satisfaction it may be appropriate to ask how hospitals determine whether they are meeting customer expectations.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is commonly used as a data source when comparing patient satisfaction levels. This survey is aimed at gaining patients’ perspectives and allowing consumers a way to evaluate the hospitals available to them. This survey also has made a goal of increasing the standards for care (HCAHPS...). Hospitals with better reports, as put forward by patients, are expected to accrue business based on their higher satisfaction ratings and the possibility of a larger market share will push hospitals to improve their reviews. However, some patients may not see alternatives to the hospital they have been using even if they were unsatisfied with their interactions or experience there; and some hospitals may not see improving survey results as a significant way to access more of the market. The levels to which the HCAHPS survey reflects hospitals’ quality have been debated and some studies show that hospitals that perform well on the survey have high clinical standards, while others show quite the opposite (Carroll).
In turning to online reviews hospitals may gain new perspectives on patient satisfaction and, in turn, their own performance. By looking at Yelp reviews instead of HCAHPS data researchers found 12 more metrics that play into a patient’s satisfaction (Carroll). This isn’t saying that the HCAHPS data isn’t a useful way to examine hospitals but does suggest that the factors that influence a patient’s hospital experience are diverse and not fully accounted for in the survey data.
Does the prevalence of online reviews change where we go for care? Do we seek out hospitals and doctors who are held in high regard? A recent study has shown we do: “we find robust evidence across several different conditions and performance measures that higher quality hospitals have higher market shares and grow more over time.” (Chandra). With this in mind it becomes clear that at least some patients see choice in where they go for medical care and can make decisions based on satisfaction as customers. Where patients are gaining the data needed to make such decisions should be investigated further; online reviews may prove to be influential in this regard.
References:
Carroll, Aaron E. "How Yelp Reviews Can Help Improve Patient Care." The New York Times. The New York Times, 12 Sept. 2016. Web. 12 Sept. 2016.
Chandra, Amitabh, Amy Finkelstein, Adam Sacarny, and Chad Syverson. "Health Care Exceptionalism? Performance and Allocation in the US Health Care Sector." American Economic Review 106.8 (2016): 2110-144. Web.
López, Andrea, Alissa Detz, Neda Ratanawongsa, and Urmimala Sarkar. "What Patients Say About Their Doctors Online: A Qualitative Content Analysis."Journal of General Internal Medicine 27.6 (2012): 685-92. Web.
http://www.hcahpsonline.org Centers for Medicare & Medicaid Services, Baltimore, MD. Sept. 12, 2016.
With the Rio Olympics ending, it seems an apt time to review some of the news that emerged surrounding the controversial and long-lived practice of verifying the sex of female athletes. The International Association of Athletics Federations (IAAF) and the International Olympic Committee (IOC) exist to ensure fair competition on the international stage, they police the actions of athletes and teams as well as determining eligibility for competition. The IAAF states it is, “proud of its position at the forefront of the global fight against doping in sport, and is resolutely committed to athletics, and to the preservation of a zero-tolerance policy with respect to doping.” (IAAF Commitment to Healthy and Drug-Free Athletics, 2016). But where is the mention of other standards for fairness, other ways the playing field is leveled? These same governing organizations have been forcing athletes who intend to compete as females to undergo “gender confirmation testing” since the 1940’s, when a medical “femininity certificates” was required to compete as a woman; going as far as “mandatory genital checks” which began in 1966 (Padawer, 2016). Eventually these tests were deemed inappropriate and unjust. No male athletes attempting to compete as women were discovered through this practice. The international governing bodies for sport moved towards chromosome testing, with the intent to remove unfair advantages. This practice has the IAAF viewing genetic discrepancies, not having only two X allosomes, in the same way they treat the advantages doping athletes may posses. This policy changed again in 2011 and the IAAF moved from “gender testing” to testosterone level testing (Padawer, 2016). By looking at hyperandrogenism (high testosterone levels) the agency was implying that this was a source of athletic advantages. They set boundaries on the acceptable levels of testosterone in order to still compete as a woman. Some problems with this have been outlined, “The official Olympic testosterone cutoff for female athletes is 10 nanomoles per liter, but some go beyond it, into the “male” range, and some men fall into the “female” range, thanks to normal hormonal fluctuations that differ from individual to individual.” (Editors, 2016). Surgical and hormone suppressive therapies were set out as ways of reducing testosterone levels and lifting the ban on competing with their natural levels of testosterone. For the 2016 Rio Olympics, the practice of banning athletes based on naturally high testosterone was not employed. However, if significant evidence is found that higher than normal testosterone levels constitute an unfair advantage hyperandrogenism testing may resume on the national stage (Editors, 2016).
With this history outlined, there is a context to consider the games in Brazil. One athlete, in particular should be underlined in relationship to sex verification testing and biological fairness, Caster Semenya. Semenya is a South African runner who took gold this year in the 800m. She has been subject to many sex confirmational tests, the results of which were improperly handled by athletics governing bodies and made it to the press. The general secretary of the IAAF (Pierre Weiss) said publically about Semenya, “She is a woman, but maybe not 100 percent.” (Padawer) Despite all of the barriers to competing and private records leading to headlines she made it to the top of the podium in Rio. Hopefully, other athletes who faced difficulties with “gender verification testing” will see similar success. The news around gender testing is changing it seems that now more than ever the agencies that determine eligibility are under scrutiny rather than just the women striving to compete.
References:
"IAAF Commitment to Healthy and Drug-Free Athletics." IAAF. International Association of Athletics Federation, n.d. Web. 05 Sept. 2016. <https://www.iaaf.org/about-iaaf/medical-anti-doping>.
Editors. "Naturally Occurring High Testosterone Shouldn't Keep Female Athletes out of Competition." Scientific American. Scientific American, 1 Aug. 2016. Web. 5 Sept. 2016. <http://www.scientificamerican.com/article/naturally-occurring-high-testosterone-shouldn-t-keep-female-athletes-out-of-competition/>.
Padawer, Ruth. "The Humiliating Practice of Sex-Testing Female Athletes." The New York Times. The New York Times, 02 July 2016. Web. 05 Sept. 2016. <http://www.nytimes.com/2016/07/03/magazine/the-humiliating-practice-of-sex-testing-female-athletes.html>.
Mr. Frank Palopoli, the chemist who developed a drug to treat infertility and subfertility due to anovulatory tendencies died this past Saturday. He was 94. The drug he helped into existence, Clomiphene citrate, which came to be marketed as Clomid, helps to induce ovulation. Due to it’s safe and effective ability to address infertility through the stimulation of natural hormone production it has been placed on the World Health Organization’s List of Essential Medicines, and remains the only ovulation inducer included. Though the drug was first developed in Palopoli’s lab in 1950 it was took 17 years to come to market, and remains in use today.
It has been shown that the use of clomiphene citrate, in women who experience anovulatory infertility, can increase the chances of pregnancy such that their fertility during treatment can be considered normal. This has allowed many people that previously would have been unable to conceive to do so either naturally or through in vitro fertilization or intrauterine insemination. Up to 80% of anovulatory infertility cases treated with this drug have been shown to be successfully addressed.
More recent research has examined clomiphene citrate as a possible treatment for hypogonadism, the loss of function in the gonads and subsequent decrease in testosterone levels, in men. This alternative use for the drug Mr. Palopoli played an integral role in developing, shows promise and may further extend the impact of his contributions to the collection of drugs used today.
The use of clomiphene citrate and other drugs that induce ovulation has the potential to over stimulate the release of eggs and cause an increase in the rate of multiple pregnancies. Because multiple pregnancies carry a greater risk for both the expectant mother and her children the use of Clomid has also been linked to the abortion debate and the ethics of pregnancy monitoring. The use of this and other fertility therapies remain an important topic in medical ethics.
The group of organic chemists he headed worked under the William S. Merrell Company and contributed to the development of several other agents including triparanol and tamoxifen (researched as possibilities for the treatment of high cholesterol and breast cancer respectively). Clomiphene citrate has now been used by millions of people worldwide.
References:
Kousta, E. "Modern Use of Clomiphene Citrate in Induction of Ovulation." Human Reproduction Update 3.4 (1997): 359-65. Web.
Roberts, Sam. "Frank Palopoli, Who Aided Fertility With Clomid Drug, Dies at 94." The New York Times. The New York Times, 11 Aug. 2016. Web. 11 Aug. 2016.
Shabsigh, Ahmad, Young Kang, Ridwan Shabsign, Mark Gonzalez, Gary Liberson, Harry Fisch, and Erik Goluboff. "Clomiphene Citrate Effects on Testosterone/Estrogen Ratio in Male Hypogonadism." The Journal of Sexual Medicine 2.5 (2005): 716-21. Web.
"WHO Model Lists of Essential Medicines." World Health Organization. World Health Organization, 1 Apr. 2015. Web. 11 Aug. 2016.
"By the time I was walking home, red paint had been added over the white and blue. Over “Awareness” was “Acceptance” and over the puzzle-piece was a heart."
"This and other recent cases shine a light on the need for regulation that goes beyond ensuring hygienic environments in sperm banks."
"[...] people with mental disorders are most commonly excluded from the possibility of accessing PAD under the pretense that their request may be symptomatic or their mental competence is to be questioned."
With cases of Zika virus in pregnant mothers being linked to microcephaly and fatal birth defects, many Brazilians are taking a closer look at the restrictive abortion laws in the country. Currently, getting an abortion is illegal in Brazil unless a mother’s life is put at risk through the continuation of the pregnancy, the mother was raped and this is a resultant pregnancy, or if the fetus is found to be brain-dead prior to birth. Being found guilty of an illegal abortion under these laws can result in one to three years of prison time. One exception to the brain-death allowance for abortion has already been made with anencephaly being considered an acceptable justification for abortion.
Some Catholic leaders are seeking stricter abortion laws. They are proposing measures that would increase prison sentences to a maximum of 15 years, make it illegal to encourage or assist a pregnant woman to have an abortion, or require both a forensic medical exam and a formal police report for all rape-related exceptions to the anti-abortion law. The push for more restrictive laws seems to stem from religious beliefs. Pope Francis has been more accepting of birth control measures but is adamant about the unacceptable nature of abortion. The Pope is quoted as calling abortion, “a crime, an absolute evil.” Members of the Brazilian government have also been quoted as claiming aborting microcephalitic fetuses would constitute an act of eugenics.
It is important to note that microcephaly is not universally fatal and not always diagnosed prior to abortion. There is an increasing consideration of abortion in Brazil, attributed to the fear cause by the rise of Zika in Latin America. This fear is compounded by the fact that Zika is often hard to diagnose due to its occasionally asymptomatic prognosis.
Other movements in Brazil are seeking greater freedom for abortion in possible Zika cases. These movements cite the lack of adequate access to sexual education and contraceptives as a barrier to following the government’s recommended process for dealing with Zika-related birth defects. Brazil’s government has pushed a message of waiting to get pregnant until the virus has been controlled. At least one judge has said he recognizes this movement and will rule abortion due to confirmed microcephaly of the fetus to be acceptable under the same exception made for anencephaly, despite the difference in life expectancies. Anencephaly is almost universally fatal at the fetal stage whereas up to 90% of microcephaly cases result in no mental deficits.
Future shifts in Zika infection rates may encourage change in Brazilian abortion policy. It is not yet clear whether that change will result in more relaxed or tighter control over abortions in Brazil.
Works Cited
Collucci, Claudia. "Pregnant Women with Zika Virus Have Abortions Before Microcephaly Is Confirmed." Folha. Folha De S. Paulo, 1 Feb. 2016. Web. 18 May 2016.
Johnson, Reed, and Luciana Magalhaes. "In Brazil, Zika Fuels Abortion Debate." WSJ. The Wall Street Journal, 8 Mar. 2016. Web. 18 May 2016.
Mcdonald, Brent. "Brazil’s Abortion Restrictions Compound Challenge of Zika Virus." The New York Times. The New York Times, 18 May 2016. Web. 18 May 2016.
Román, Valeria. "Zika Awakens Debate over Legal and Safe Abortion in Latin America." Scientific American. Scientific American, 23 Feb. 2016. Web. 19 May 2016.
Romero, Simon. "Surge of Zika Virus Has Brazilians Re-examining Strict Abortion Laws." The New York Times. The New York Times, 03 Feb. 2016. Web. 18 May 2016.
Sandy, Matt. "Brazilian Legislators Look to Increase Abortion Penalties in the Wake of Zika Outbreak." Time. Time, 22 Feb. 2016. Web. 18 May 2016
The International Society for Stem Cell Research (ISSCR), an independent nonprofit founded in 2002, recently updated their guidelines for stem cell research. This update was completed due to the increased amount of research in the field over recent years. The guidelines acknowledge the importance studying human embryos in the advancement of stem cell understanding. The controversy surrounding the use of human embryos for stem cell research is active and often related to beliefs surrounding the start of human life, or when personhood is gained. The new ISSCR recommendations focus on the preservation of research integrity and patient welfare, as well as respect for the subjects of study and transparency surrounding the methods used. The new document aims to address ethical uncertainties that may be found in the previously offered ISSCR documents “Guidelines for the conduct of Human Embryonic Stem Cell Research” (2006) and “Guidelines for the Clinical Translation of Stem Cells” (2008). Some of these uncertainties may have arisen because of advancements in the field since the publication of the original recommendations. Interestingly, the new guidelines find that it may be acceptable to financially compensate women who donate their eggs. This accommodation is considered to be an appropriate way to ensure there is no burden placed upon women who choose to donate their eggs for scientific research that may not result in lifesaving medical advancements. However, the financial compensation for egg donation could also be viewed as an incentive to donate eggs in order to profit. If this is the case, women are no longer donating eggs but selling them. The new guidelines grapple with the way eggs may be seen. It is clear that eggs may be seen as analogous to organs, potential lives, or crucial ingredients to groundbreaking research. Navigating these views is difficult and is clearly attempted in the new ISSCR document.
The complete document specifying all new guidelines can be found at the ISSCR website: http://www.isscr.org/
Works Cited
"About Us." ISSCR. International Society for Stem Cell Research, n.d. Web. <http://www.isscr.org/home/about-us>.
Guidelines for Stem Cell Science and Clinical Translation. Skokie, Illinois, USA: International Society for Stem Cell Research, 12 May 2016.
Nicholas, Anne. "ISSCR Releases Updated Guidelines for Stem Cell Science and Clinical Translation." ISSCR. International Society for Stem Cell Research, 12 May 2016. Web. 14 May 2016. <http://www.isscr.org/home/about-us/news-press-releases/2016/2016/05/12/isscr-releases-updated-guidelines-for-stem-cell-science-and-clinical-translation>.