• Doctors try a controversial technique to reduce the transplant organ shortage

    Jul 8, 2024
    NATIONAL PUBLIC RADIO: In a Tennessee operating room, Dr. Marty Sellers is performing a revolutionary organ recovery technique, normothermic regional perfusion. "It replenishes the oxygen deprivation that the organs incur during the dying process," says Sellers. "If we recover the organ and put it on ice in an oxygen-deprived state, it’s not as healthy when it gets into the recipient."

    The American Journal of Bioethics dedicated a recent issue to the controversy over whether the technique blurs the definition of death. "The bottom line is that NRP violates foundational ethical norms around the determination of death and should not be pursued," says Matthew DeCamp, MD, PhD, who helped write a policy statement opposing NRP for the American College of Physicians.
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  • Quantifying Industry Spending on Promotional Events Using Open Payments Data

    Jul 2, 2024
    JAMA OPEN FORUM: Christine Baugh, PhD, MPH, Eric G. Campbell, PhD, Lisa Bero, PhD, and co-authors published a study of pharmaceutical and medical device industry events for health professionals, utilizing data from the Medicare/Medicaid Open Payments database. Their findings suggest that expanding and enforcing the reporting requirements to cover all payments to all registered health professionals would improve the transparency and accuracy of estimates of the true extent of all sponsored events, as well as their reach and impact on clinical practice.
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  • Attention Among Health Care Professionals: A Scoping Review

    Jun 18, 2024
    ANNALS OF INTERNAL MEDICINE: Mark J. Kissler, MD, and five CU Anschutz colleagues are the authors of a paper that evaluates medical literature on the role of attention in the clinical environment. They identified 6 categories of literature related to attention: the clinical environment and its effect on attention, personal factors affecting attention, relationships between interventions or factors that affect attention and patient outcomes, the effect of clinical alarms and alarm fatigue on attention, and health information technology’s effect on attention.

    The authors propose that a well-functioning environment enables good care without overtaxing the clinician’s cognitive or emotional resources. But simply creating a “sterile cockpit” for a distraction-free environment is unrealistic in most health care settings. They conclude that to be effective, health care quality improvement efforts need to transition from siloed quality improvement interventions to multidisciplinary efforts that understand that health care is composed of complex and overlapping environments.
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  • Progress Notes: One Year in the Future of Medicine

    Jul 1, 2024
    Abraham M. Nussbaum, MD, professor of psychiatry and chief education officer at Denver Health, is author of Progress Notes: One Year in the Future of Medicine, a book that follows seven CU medical students through their training, particularly through the longitudinal integrated clerkship (LIC) structure that forms the basis for our new curriculum.

    Abraham also offers a clear explanation of how we aim to teach our students to become better physicians: The new curriculum begins with a year of basic sciences but will be organized around clinical complaints. Hence, instead of learning the anatomy of the heart as its own topic, students will learn it in the context of a patient presenting with chest pain. They will learn about the anatomy of the heart in relationship to the physical examination, to available medications and procedures, and to social determinants of health. This book tells the compelling story of how to become a physician, serve our patients and our community, and pursue a fulfilling life. Published by Johns Hopkins University Press.
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  • Examining ethical issues that arise in providing ED/hospital care for patients experiencing elder mistreatment and approaches to address them

    Jun 12, 2024
    JOURNAL OF ELDER ABUSE AND NEGLECT: Kristin Furfari, MD, Jackie Glover, PhD, and co-authors describe the roles and best practices for ethics consultation services and elder mistreatment (EM) response team collaboration; present four in-depth patient scenarios and the ethical frameworks that arise in cases of EM, and describe the collaborative processes that foster the best solutions for these patients.
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  • Artificial Intelligence in the Provision of Health Care: An American College of Physicians Policy Position Paper

    Jun 4, 2024
    ANNALS OF INTERNAL MEDICINE: Artificial Intelligence is expanding throughout the provision of health care, in applications such as clinical documentation, diagnostic image processing, and clinical decision support. Matthew DeCamp, MD, PhD, and co-authors developed 10 recommendations/position statements to ensure the greatest benefit and minimum harm to patients from these new technologies, and to ensure that they are used in alignment with the ethical responsibilities of physicians and the medical profession.

    The authors recognize the dynamic and evolving nature of AI technology and advocate for more guidance, regulatory oversight, research, and education for physicians, other clinicians, and health care systems to maximize clinical safety and effectiveness of these tools as well as understanding their potential consequences regarding health disparities.
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  • Alzheimer’s Takes a Financial Toll Long Before Diagnosis, Study Finds

    May 31, 2024
    NEW YORK TIMES: People who are starting to experience cognitive decline may miss payments, make impulsive purchases or put money into risky investments. Lauren Hersch Nicholas, PhD, MPP, who studies dementia's impacts on people's finances advises, "We should be thinking about the possibility of financial difficulties linked to a disease we don’t even know we have. Knowing that, people should be on the lookout for these symptoms among friends and family members.”
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  • The Need for Historical Fluency in Pandemic Law and Policy

    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.
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  • Conscience‑Based Barriers to Medical Aid in Dying: A Survey of Colorado Physicians

    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
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  • Patient Perceptions of Chatbot Supervision in Health Care Settings

    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.
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  • New $2.1 million award to improve engagement and equity in research.

    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.
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  • Centering Law In Public Health Education

    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
    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.
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  • New Grant Funds Summer Institute for Junior Investigators to Focus on AI, Omics, and Ethics

    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.”
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  • The Unbearable Vagueness of Medical ‘Professionalism’

    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.”
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  • How Do Surrogates Make Treatment Decisions for Patients with Dementia? An Experimental Survey Study

    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.
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  • Are Evidence-Based Medicine and Public Health Incompatible?

    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.
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  • Health Risks of Unaccompanied Immigrant Children in Federal Custody and in US Communities

    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.
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  • Debate simmers over when doctors should declare brain death

    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.
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  • CU Bioethics part of team exploring new treatments for metabolic disease

    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.
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  • Interim Harvard President Garber to Remain on Pharma Company Board

    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.
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