Tag: trends

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E-H-ARRGH: The Frustrating Costs and Benefits of the Electronic Health Record

April 28, 2017

by Jami Starr, MD, Clarkson University Bioethics Policy Certificate 2017

E-H-ARRGH: The Frustrating Costs and Benefits of the Electronic Health Record

 The concept of electronic medical recordkeeping was first introduced in the late 1960’s but it did not really become established until this century. Electronic Health Records (EHRs) are expected to provide a number of benefits, including: ability to track data over time, monitoring use of interventions (i.e. vaccinations), and identifying patients in need of preventive screening. Data are forthcoming as to how effectively EHRs meet these goals. What is clear, however, is that it is third party payers profit from EHRs as a result of improvements in claims processing.

The use of EHRs carries implicit hazards with respect to confidentiality. It seems no cyber security system today is impenetrable.  We have witnessed multiple breaches in the past few years involving government agencies, major retail chains, and financial institutions. If a hospital database were hacked, not only would pertinent demographics be exposed (social security numbers, insurance policies, etc.) but also personal information about diagnoses, socioeconomic circumstances, and the like.  While this is a risk with paper medical records as well, the rapid and potentially widespread dissemination of information though a computer data system is far more menacing in scope.  In most clinical settings where EHRs are employed, paper charts have been eliminated and patients do not have an option as to how personal data are maintained.  Vulnerability has been increased de facto by reliance upon this new medium.

Aside from the issues related to cyber security, there are start-up costs related to productivity, burnout and physician-patient relationships.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Subjectivity After the Subject by Sadeq Rahimi

One: Whither The Subject?

It has been exactly 8 years since I wrote the introductory installment of a mini-series on political subjectivity for Somatosphere. When I wrote on political subjectivity at the time, aside from exploring and communicating ideas, a good part of my agenda was to help propagate the concept of political subjectivity in cultural and medical anthropology –the notion that politicality is not something that some people do, but something that is intertwined with meaning and meaning making, and hence defines the very experience of subjectivity that makes us human beings.  As I write this here to initiate what I am hoping to become a follow up set of posts on subjectivity and its future, ‘political subjectivity’ is no longer a new construct nor in need of propagation.  There are numerous books and articles on the topic, and the discussion has moved forward to create intriguing inquiries such as hauntology, and the relationship between intergenerational transmission of affective patterns and political subjectivity.

For me, this has been a satisfying development to see, despite an acute awareness of the fact that this progression is by no means simply a fruit and consequence of intellectual desire and efforts of individuals like myself, but in some eerie sense, the inevitable outcome of much larger historical, technological and geopolitical movements.  Satisfaction aside, in other words, these years have given me the fascinating opportunity of witnessing the incredible ways in which these broad global patterns of movement have given rise to specific intellectual trends, and have pushed specific philosophical, anthropological and psychological questions to the forefront.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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How Machine Learning May Help Tackle Depression

By detecting trends that humans are unable to spot, researchers hope to treat the disorder more effectively. Depression is a simple-sounding condition with complex origins that aren’t fully understood. Now, machine learning may enable scientists to unpick some of its mysteries in order to provide better treatment

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Functional neo-Aristotelianism as a way to preserve moral agency: A response to Dr William Casebeer’s lecture: The Neuroscience of Moral Agency

Written by Dr Anibal Monasterio Astobiza

Audio File of Dr Casebeer’s talk is available here: http://media.philosophy.ox.ac.uk/uehiro/HT17_Casebeer.mp3

 

Dr. William Casebeer has an unusual, but nonetheless very interesting, professional career. He retired from active duty as a US Air Force Lieutenant Colonel and intelligence analyst. He obtained his PhD in Cognitive Science and Philosophy from University of California, San Diego, under the guidance and inspiration of Patricia and Paul Churchland, served as a Program Manager at the Defense Advanced Research Projects Agency from 2010-14 in the Defense Sciences Office and helped to established DARPA’s neuroethics program. Nowadays, Dr. William Casebeer is a Research Area Manager in Human Systems and Autonomy for Lockheed Martin’s Advanced Technology Laboratories. As I said, not the conventional path for a well known researcher with very prominent contributions in neuroethics and moral evolution. His book Natural Ethical Facts: Evolution, Connectionism, and Moral Cognition (MIT Press) presented a functional and neo-Aristotelian account of morality with a clever argument trying to solve G. E. Moore´s naturalistic fallacy: according to Casebeer it is possible to reduce what is good, or in other words morality, to natural facts.

In his public lecture of 14 February 2017, held at the Lecture Theatre, Oxford Martin School, Oxford, entitled “The Neuroscience of Moral Agency (Or: How I Learned to Love Determinism and Still Respect Myself in the Morning”, Dr. William Casebeer resubmitted the case for a functional neo-Aristotelianism  model for agency that defends a compatibilist view of free will: to accept determinism as viable but still hold moral concepts true.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Biofinance: Speculation, Risk, Debt, and Value from Bios: A conference report by Danya Glabau

How does the financialization of life itself figure as a new means of producing value in modern technoscience? That is the question that motivated Kirk Fiereck to convene the panel “Biofinance: Speculation, Risk, Debt, and Value from Bios” at the 2016 American Anthropological Association meeting in Minneapolis, Minnesota this November. Fiereck, panelists Melina Sherman, Danya Glabau, and Emily Xi Lin, discussant Kristin Peterson, and chair David Pederson, offered new ways to think about how financialized life is a source of value, and what this means for the ethics and practice of biomedicine in sites throughout the globe.

In writing this conference report, Fiereck, Sherman, and Glabau each contributed short comments about their talks, which were edited together in the unified first half of this report. The second half includes further reflections that we have attributed to each scholar individually as a way to illustrate the diverse, possibly divergent, uses of “biofinance” as a concept.

 

The Papers

Melina Sherman opened the panel with, “Biofinancial Investments and Disinvestments: Examining the U.S. Opioid Epidemic,” which focused on the cultural and institutional construction of pharmaceutical markets – in particular, the market for prescription painkillers. Markets, especially those situated within the bioeconomy – an economic space in which capital is organized through life (bios) in its various forms – constitute the broader context in which biofinancial practices are situated. Her paper explored the ways in which the selective investments and divestments of federal regulators and opioid consumers condition the growth of this market. The market for prescription opioids is a good example of what Sherman calls an “addiction market” (see also Lovell, 2006), where addiction (understood as a destructive attachment – in this case, of a person to a prescription drug) is built-in to the cultural and economic processes that drive market formation and growth.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Googling PAS

While researching physician assisted suicide legislation this past week, I noticed something odd when I Googled the topic. After I typed “physician assisted” into Google, the search engine’s autocomplete function suggested searches related to “physician assisted death.” I then started to type out “physician assisted suicide,” but as soon as I typed the “s,” all suggestions disappeared. Out of curiosity, I visited Google Trends to… // Read More »

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Stoking the Flames of Competitiveness on an Overheating Planet

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STUDENT VOICES

By: Michael Aprea

This essay is in response to the Carnegie Council for Ethics in International Affairs video “Climate Protectionism and Competitiveness.”  

Steam put the world in motion. It lit up the night, and tightened humanity’s grasp on the forces of nature. Nature, however, has eluded the human race and has forced civilization to reconsider its power in the most fundamental sense. Scientist, politicians, and citizens now face the heat as they scramble to address a cycle of global warming spawned by the progress of the industrial revolution that threatens to unhinge the fragile balance of Earth’s ecosystems. Reducing carbon emissions has been the answer to the problem. This standard that has taken hold in developed nations has morphed into a global economic crusade against carbon emissions through regulation, taxation and sanctions seeking to curb the emissions of the developing world. Although consumer responsibility and global collaboration in an endeavor to reverse global warming trends are laudable, it is important to recognize the risks these steps pose on global trade, the citizens of developing countries, and the debt developed nations have as beneficiaries of the first fruits of fossil fuels.

The United States owes its status as an economic superpower to the progress of the industrial revolution; a revolution fueled by carbon emitting fossil fuels. The rapid growth of nations such as Unites States reliant on fossil fuels came at price–rising global temperatures. Carbon doesn’t only heat up cold economies, it also has the ability to raise average global temperatures as it gets trapped in the atmosphere and captures solar radiation.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Loss: The Hidden Barrier to Professional Identity Formation

By Meaghan P. Ruddy

Paying attention to the wider trends in medical education recently makes it difficult to miss the growing voice of Pamela Wible, MD and her crusade to end physician, resident and medical student suicides.  One premise of her argument is that all the language around burnout and resilience misses the point.  The point it misses? This demographic is suffering from abuse.

I tend to agree.  To this I would add that the result is not burnout but the closely related state of grief…

The book is far from closed on the causes of the depressive states that lead to suicide.  As someone who personally struggles with dysthmia, major depressive episodes and suicidality, something that that has helped me to grow through the pain is the idea that depression can be thought of as grief over loss.  There is as much a plurality over what people feel they have lost as there are people who lose things.  That being said, the smaller the subculture, the more similar the experiences, the more similar the losses.

Think more personal than the loss of patients, which happens and is very troubling.  The sorts of loss we speak of now are loss of self, loss of identity, loss of motivation, loss of so much that once mattered so much.  Medical students, pressured into attempting to master ever expanding curricula can lose the confidence in their ability to learn and think, the very talents got them into the situation in which they feel so lost.  This loss then expands to the people they may never help, the life they may never get to lead because the competition is so stiff for so few spots in the place they want so badly to be: residency.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Is Neuromarketing Influencing Pathological Shopping Behavior?

By Elena Lopez
Elena Lopez is currently pursuing her BBA at Goizueta Business School and is also pursuing a degree in Neuroscience at Emory College of Arts & Sciences. She is involved in volunteer-related organizations that help those with limited resources and offer free consulting services, such as Volunteer Medical Interpretation Services and Emory Venture Strategic Partners. Elena developed a curiosity for neuroethics after attending the NBB Paris study abroad program and the 3rd international Neuroethics Network conference. She hopes to combine her passion for science and business in her future career goals.

Just over a month has passed since the biggest holiday shopping season of the year, and many Americans are already planning how they will financially recover from their overspending and failed budgeting plans. Financial sites like Forbes and the CNBC personal finance page have already come out with articles titled “Oops, you overspent on the holidays” and “Holiday spending hangover? Get your finances back on track” in an attempt to help consumers recover from financial losses. Months before the frenzy began, NBC reported that the National Retail Federation forecasted sales for November and December 2016 would increase 3.6% from last year to reach a whopping $800 billion dollars- with 90% of those sales consisting of online purchases (Weisbaum, 2016). With the growing presence of the digital component in sales and advertising, interactions between consumers and retailers can be tailored to the individual and offer greater shopping experiences. In the same NBC report, Deloitte stated that digital interactions likely influence two-thirds of every dollar spent (Weisbaum, 2016).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Integrated Plans Fertile for Real-World Evidence

January 25, 2017

(Managed Care Magazine) – Real-world evidence (RWE) is the hot topic this year, a way to evaluate treatments—and make changes on the fly, if necessary—under a new president who thinks the FDA moves too slowly. Put simply, RWE looks at how well new medications and medical devices do after they’ve hit the market, relying on data collected outside of traditional clinical studies. Many drugs often don’t do well, said Shalilja Dixit, one of the presenters at a recent conference in Philadelphia by EyeforPharma, a worldwide company that seeks to keep the pharmaceutical industry relevant by tracking shifting trends. Dixit, who studies health outcomes for Intercept Pharmaceuticals, said that 49% of drugs do not have the same impact on outcomes that they had in clinical trials.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.