Tag: ultrasound

Bioethics Blogs

Undermining the USPSTF: The most important stakeholders are the patients

A strange “health care” drama plays out daily in our clinics and hospitals. A healthy person has a medical test done (even though he or she is healthy): a blood test, a chest x-ray or mammogram, maybe an ultrasound of some body part. The test comes back abnormal. The patient (for she has now gone from being a healthy person to being a patient) is struck with worry, and undergoes a further round of testing to determine whether the initial, “screening” test was accurate. This more invasive, risky definitive testing causes the patient pain, complications, infections, further procedures to fix the complications. But the testing shows that the original screening test was wrong, and the patient is relieved of their worry and overcome with a sense of gratitude: “Yes, the follow-up surgery was painful, but at least it’s not cancer.” However, notice what caused the worry in the first place: not some symptom that they were experiencing, but a test that was performed on a healthy person. What a marvelous bit of sorcery: we take a happy patient, create unnecessary worry, then win their undying gratitude by performing risk-laden procedures on them to remove their worry!

There is something very intuitive about the concept that detecting a disease (especially cancer) early leads to better outcomes, that screening tests are inherently good. Yet when one studies the actual outcomes of implementing mass screening programs in a population of people who have no signs or symptoms of a particular disease, one finds to one’s surprise that, not infrequently, more people are harmed by our screening test than are helped (See: PSA testing, carotid ultrasounds, annual stress tests, etc).

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.

Bioethics Blogs

The ethnographic case: series conclusion by Emily Yates-Doerr

Editors note: This entry concludes the series “The Ethnographic Case” which ran every other Monday between June 2015 and July 2016. The bookCase, which holds 27 cases, can be accessed here.

One day, early on in the series, we received two submissions. Their similar anatomy was striking. Each featured a medical waiting room. Someone entered the space with a gift for the clinical personnel, the gift was accepted, and something shifted in the resulting care.

In Aaron Ansell’s case, set within gardens of an informal clinic in Piauí, Brazil, the gift was a small satchel of milk. Rima Praspaliauskiene’s was set in a Lithuanian public hospital and the gift was a rich chocolate cake. Aaron, who works and teaches on legal orders, analyzed the exchange as a challenge to hospital norms of equalitarianism. He helped us to see how the give-and-take of milk interrupts the requirements of a deracinated liberal democracy, offering instead the warm sociality of personal affinity. Rima, who focuses on medical care and valuing, used the object of the cake to query the social scientist’s impulse to explain why people do what they do. She shows us how this impulse may rest upon the linearity and equivalence of rational calculation, uncomfortably treating sociality as a commodity.

The juxtaposition of these submissions is emblematic – a case, if you will – of something we have seen throughout this series: the art of ethnographic writing resides in a relation between what is there and what is done with it.

Beginnings

We might trace the origin of the series to a business meeting at the AAAs, when we offered the idea of “the ethnographic case” for a Somatosphere series.

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.

Bioethics Blogs

Costs, Schmosts!

Talk to your doctor about your out-of-pocket expenses. Ask about the cost of your meds. And await for the sound of silence! Sadly, that is too often what happens in medical clinics today. Here is a nice essay, exploring the topic, from a healthcare reporter.

With access to information about the costs of care, patients can make better choices about treatment paths that are aligned with their financial goals. Absent that information—or conversations with their physicians about costs—it’s virtually impossible for patients to incorporate this information into their decision-making.

Herein lies the problem: When physicians don’t talk to their patients about the cost of the care they receive, patients who are blindsided by medical bills may stop showing up for appointments, stop taking medications, and/or decide against pursuing their recommended treatment plans, which reduces the cost of care in the short term but can result in higher costs—for payers, providers, and patients—in the long term.

“We as physicians are trained to try to help patients weigh pros and cons [associated with treatment paths], but we don’t do that well when it comes to costs,” says Peter Ubel, MD, professor of business administration and medicine at Duke University. “Take an ultrasound, for example. A lot of [physicians] think, ‘What’s the downside? It’s a non-invasive test. I’ll just [order an ultrasound] and check the results.’”

What physicians often forget is that the cost of that ultrasound—which could be as much as $500—can “invade our patients’ wallets,” he says.

To read the rest of this article, please visit the Modern Medicine Network.

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.

Bioethics Blogs

Configurations of diagnostic processes, practices, and evidence: a conference report by Natassia Brenman

Every two years the Medical Anthropology at Home network organises a conference to present and discuss recent work. The ninth conference, held in June 2016 in Northern Norway, was organized by Mette Bech Risør from The Arctic University of Norway and Nina Nissen from the University of Southern Denmark. To address the theme of Configurations of diagnostic processes, practices and evidence, the conference placed diagnosis and diagnostic processes centre-stage — as classification and practices in-the-making, exploring a wide variety of actors, and organizational and discursive levels.

Thirty-two people presented papers in eight sessions broken up by two stirring keynote lectures, one delivered by Simon Cohn — from the London School of Hygiene and Tropical Medicine, UK — and the other by Annemarie Jutel — from the Victoria University of Wellington, NZ. The papers, grounded in rich ethnographic material, offered critical reflections on new developments and transformations of socio-medical realities in Europe, the United States, Canada and Brazil. As medical anthropologists critically engaging with diagnostic practices in our respective projects, we (Natassia Brenman and Anna Witeska-Młynarczyk) each presented papers and participated in the lively discussions that took place over the four days. In the following reflections, we seek to capture the key themes that emerged from the sessions, and to consider how the overarching aim of advancing anthropological debates on diagnosis was pursued throughout the conference.

Diagnosis as containment: an opening thought

Simon Cohn’s opening keynote reflected on how we, as medical anthropologists, might maintain a focus on local practices in a world where it is increasingly hard to represent single bounded locations.

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.

Bioethics News

Should Young Women Sell Their Eggs?

The invasive procedure to extract the eggs is called transvaginal ovarian aspiration and there are risks, such as bleeding and although rare, damage or puncture of the bowel, bladder and nearby blood vessels from the needle attached to the ultrasound probe that is inserted into a woman’s vagina

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.

Bioethics Blogs

The Ethics of Crisis Pregnancy Centers

“Pregnant? Scared? Need Help?”
read signs along major thoroughfares in the southern United States. Many
Americans have seen signs like these, often simultaneously advertising free
pregnancy and sexually transmitted infection (STI) testing. Unless experiencing
a unplanned pregnancy, most people pass by these signs without a second
thought. However, for some of our most vulnerable patients, the
establishments posting these advertisements – known as crisis
pregnancy centers – represent a significant ethical difficulty in
reproductive healthcare. Although these organizations are almost exclusively
run by community volunteers, they represent themselves as healthcare workers by
wearing lab coats and scrubs, providing lab testing and ultrasounds, and setting
up offices that look like medical clinics. This would be problematic in itself
from a legal perspective but the political and religious perspectives of these
organizations provides serious ethical questions as well. Far from
unbiased, crisis pregnancy centers (CPCs) are usually religiously
affiliated organizations with a hard right agenda of
preventing abortion at any cost. Medical evidence and scientific fact are
not considered in this equation so clients of CPCs are often told that abortion
causes breast cancer, infertility, psychiatric disorders (such as the entirely
fictitious post-abortion syndrome), and even, in one case, kidney
failure and subsequent dialysis. Furthermore, results of testing done at
CPCs are frequently fabricated or ignored – clients are given falsely
negative pregnancy test results or incorrect dating ultrasounds to prevent
those considering an abortion from pursuing other care. CPC clients are usually
unaware that these organizations do not employ trained medical providers or that
they have a political agenda. However, the intent is clearly to strongly imply
to CPC clients that they are being given information by medical personnel.

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.

Bioethics Blogs

A World Without Bioethicists? On Sally Phillip’s “A World Without Down’s”

Guest Post by Nathan Emmerich, Queen’s University Belfast

On Wednesday night, BBC2 broadcast a documentary entitled ‘A World Without Down’s Syndrome?’ Even if you did not see the programme itself, you may have heard about it on the radio, read some of the commentary published over the past week, or spotted it on Twitter under the hash tag #worldwithoutDown’s. In my case, it was the presenter Sally Phillips’s appearance on Frank Skinner’s On Demand, that first drew my attention to the programme. There, Phillips talks about Peter Singer’s appearance on HARDtalk (in which he discusses related issues) and – whilst she is hardly alone in doing so – I felt that she misunderstood what Singer has to say. As a result I intended to watch the documentary to see which bioethicists appeared and if their views were represented accurately.

Despite the programme consisting of Phillips speaking with various people involved with questions re: testing for Down’s Syndrome – including doctors, scientists, individuals with the syndrome and their parents, those who run support groups and one brave women who had terminated a pregnancy following a positive test for Down’s – she did not actually speak to a bioethicist or, indeed, explicitly discuss any bioethical ideas.* Thus, whilst one could think that this documentary was about a bioethical issue – prenatal testing and screening for Down’s Syndrome – there was not any real discussion of the matter from a bioethical perspective.

Of course, in any documentary like this one has to make choices and it may be that including a bioethicist was thought to have been one talking head too many.

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.

Bioethics News

Pricey New Treatment Roils Issues of How to Treat Prostate Cancer

(Kaiser Health News) – Men hoping to avoid some side effects of prostate cancer treatment are shelling out tens of thousands of dollars for a procedure whose long-term effects are unknown and insurers, including Medicare, won’t pay for. Proponents say high-intensity focused ultrasound (HIFU) can have fewer negative side effects than surgery or radiation, while giving some patients another option between actively watching their cancer and those more aggressive steps. Critics, however, say the procedure is being oversold, leading some patients to get a treatment they don’t need.

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.

Bioethics News

Study Links Autism Severity to Genetics, Ultrasound

September 2, 2016

(Eurekalert) – For children with autism and a class of genetic disorders, exposure to diagnostic ultrasound in the first trimester of pregnancy is linked to increased autism severity, according to a study by researchers at UW Medicine, UW Bothell and Seattle Children’s Research Institute. The study published Sept. 1 in Autism Research studied the variability of symptoms among kids with autism, not what causes autism. What they found is that exposure to diagnostic ultrasound in the first trimester is linked to increased autism symptom severity. The greatest link is among kids with certain genetic variations associated with autism; 7 percent of the children in the study had those variations.

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.

Bioethics News

Scientists Used Ultrasound to Jump-Start a Man’s Brain after Coma

August 24, 2016

(Medical Xpress) – A 25-year-old man recovering from a coma has made remarkable progress following a treatment at UCLA to jump-start his brain using ultrasound. The technique uses sonic stimulation to excite the neurons in the thalamus, an egg-shaped structure that serves as the brain’s central hub for processing information.   “It’s almost as if we were jump-starting the neurons back into function,” said Martin Monti, the study’s lead author and a UCLA associate professor of psychology and neurosurgery.

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.