This Code Breaker Is Using AI to Decode the Heart’s Secret Rhythms; Wired, August 15, 2024

 Amit Katwala, Wired; This Code Breaker Is Using AI to Decode the Heart’s Secret Rhythms

"There’s an AI boom in health care, and the only thing slowing it down is a lack of data."

How a Drug Maker Profited by Slow-Walking a Promising H.I.V. Therapy; The New York Times, July 22, 2023

 Rebecca Robbins and Sheryl Gay Stolberg, The New York Times; How a Drug Maker Profited by Slow-Walking a Promising H.I.V. Therapy

"Gilead, one of the world’s largest drugmakers, appeared to be embracing a well-worn industry tactic: gaming the U.S. patent system to protect lucrative monopolies on best-selling drugs...

Gilead ended up introducing a version of the new treatment in 2015, nearly a decade after it might have become available if the company had not paused development in 2004. Its patents now extend until at least 2031.

The delayed release of the new treatment is now the subject of state and federal lawsuits in which some 26,000 patients who took Gilead’s older H.I.V. drugs claim that the company unnecessarily exposed them to kidney and bone problems."

Drones get blood to patients faster—and reduce waste; The University of British Columbia, March 21, 2022

The University of British Columbia; Drones get blood to patients faster—and reduce waste

"Prompt blood delivery can be lifesaving for people who need transfusions for emergencies such as postpartum hemorrhage, severe malaria, or traumatic injuries. However, only a few facilities in Rwanda are able to collect and store blood, posing a serious risk for people who don’t live near distribution centers...

In 2016, Rwanda became the first African country to integrate drone deliveries into its healthcare system. The project is a partnership between the Government of Rwanda and California-based robotics company Zipline Inc.

Currently, the program is focused mainly on blood deliveries. However, the project has started to expand the deliveries of vaccines and essential medicines for the treatment of diseases such as HIV/AIDS, COVID-19, malaria, and tuberculosis.

While most studies to this point have focused on feasibility, the new paper from Nisingizwe and her team is one of the first to measure actual outcomes. Next, the researchers want to determine whether drone delivery improves health outcomes and is ultimately cost-effective, and explore its potential for transporting other perishable health products and medicines.

“Drone technology has tremendous potential to improve access to care for people living in rural and remote areas, not just in Rwanda, but all around the world,” said Dr. Michael Law, a professor in UBC’s Centre for Health Services and Policy Research and senior author on the study.

Drone delivery is being explored as a potential healthcare solution in other countries, including in British Columbia, where a UBC-led study is exploring the feasibility of using drones to transport medical supplies between Stellat’en First Nation and the Village of Fraser Lake."

Right or wrong?: How La Crosse health-care leaders use ethics to make decisions; NEWS 8000, December 29, 2021

 Jordan Fremstad, NEWS 8000; Right or wrong?: How La Crosse health-care leaders use ethics to make decisions

Gundersen Health System ethicist Tom Harter helps providers make best decisions for critical care

"As hospitals fill up and medical supplies are needed for more people, health-care leaders are forced to make even more tough decisions. How do you decide who’s health matters more?

Most of us strive to do what is right.

“We have to be cognizant of the needs of everybody in the hospital,” said Dr. Wayne Bottner, a hematologist at Gundersen Health System...

Bottner has to decide who receives the available resources. However, he doesn’t do it alone.

“We would never want a physician at the bedside to do that,” said Tom Harter, Gundersen’s bioethics and humanities director. “The psychological stress of that is extremely high.”

Health-care decisions are a wide, murky river that Harter helps bring into focus."

A Plea from Cleveland Clinic; December 21, 2021

12/21/21 email from Cleveland Clinic:

A Plea from Cleveland Clinic

"This past month has been sobering for many of us in healthcare. Nearly two years after the COVID-19 pandemic began, we’re seeing some of the highest volumes of patients with the disease in hospitals throughout the Midwest.

"Here at Cleveland Clinic, we’re caring for more than 800 patients with COVID-19 at our Ohio hospitals. Of these patients, more than 200 are in the intensive care unit. The majority of these patients are unvaccinated.  

Our Ohio emergency departments are filled. We have people waiting to get into our hospitals. Neighboring hospitals in our communities are facing the same issues. 

We’ve had to postpone many non-urgent surgeries in Ohio as we try to leave enough space for patients with COVID-19. Our physicians, nurses and caregivers are working around-the-clock to care for these sick patients. They are exhausted.  

Today, we come to you with a plea. Get vaccinated. Please. Whether you are due for your booster shot, undecided about getting your child vaccinated or have been leery of the vaccine all along. The science is clear. Vaccines save lives. Please, get vaccinated.

For those of you who have lost a loved one to COVID-19 this year, we extend our deepest sympathies. We feel your loss. We share in your grief. We, too, are heartbroken.

The only way we can get through this is together. Please do your part for yourself, your family and your community. Get vaccinated. Wear your mask, wash your hands and stay home if you're feeling ill. 

Cleveland Clinic will always be here for you when you need compassionate, high-quality care. The sun will rise tomorrow morning, and with it will bring renewed hope for a better day. 

We wish you and yours a joyous holiday season & a happy and healthy New Year."

Pandemic serves up new questions of medical right and wrong; American Medical Association, April 13, 2020

Timothy M. Smith, American Medical Association; Pandemic serves up new questions of medical right and wrong

"The COVID-19 pandemic is posing unfamiliar challenges for front-line physicians while also casting new light on longstanding health equity issues. An episode of the “AMA COVID-19 Update” explores several underlying ethical questions. Among these: How much risk is too much for physicians? Which patients should get priority access to scarce resources? And how do socioeconomic factors affect quality of care in an emergency?

In a conversation with the AMA’s chief experience officer, Todd Unger, three experts from the AMA delved into relevant ethical guidance.

The AMA and the Centers for Disease Control and Prevention are closely monitoring the COVID-19 global pandemic. Learn more at the  AMA COVID-19 resource center. Also check out pandemic resources available from the AMA Code of Medical Ethics, JAMA Network™, AMA Journal of Ethics®, and consult the  AMA’s physician guide to COVID-19."

ADA council affirms importance of code of ethics during COVID-19 pandemic; American Dental Association, ADA News, April 9, 2020

David Burger, American Dental Association, ADA News; 

ADA council affirms importance of code of ethics during COVID-19 pandemic

The Journal of the American Dental Association publishes essay that emphasizes unity of member dentists

"The ADA Council on Ethics, Bylaws and Judicial Affairs’ ethics subcommittee authored an online essay as part of its Ethical Moment series in the May issue of The Journal of the American Dental Association, affirming that the ADA Principles of Ethics and Code of Professional Conduct is just as important as ever when making the difficult decisions they encounter on a daily basis. 

“During this crisis, when everything seems in flux, it is comforting to remember that the values we pledged to uphold remain unchanged,” said Dr. Mike Kurkowski, council chair. “This article attempts to clarify the application of our Code to some of the emerging issues our member dentists must address. With the overwhelming volume of information practitioners are currently trying to digest, it's important to stay grounded. Placing our community and patients before our needs, and communicating honestly about the evolving science regarding this virus, will help guide dentists to the best decisions.”

The nearly 800-word essay, “Ethical Practice During the COVID-19 Pandemic,” addresses some of the ethical issues that have arisen in concert with the rise of transmissions...

Dr. Guenter Jonke, subcommittee member, said that it was vitally important to reiterate in a clear and concise manner member dentists’ obligations during this pandemic — not in a didactic or moralizing way, but as a way to express a shared commitment.

“Ethics is the cornerstone our profession,” Dr. Jonke said. “During this crisis, not all of us may be level-headed. This article is very timely and an important message to all dentists. Inspiring others is another skill of excellent leadership. Remaining unified allows us to achieve greatness during these uncertain times.”"

Circumcision, patient trackers and torture: my job in medical ethics; The Guardian, April 8, 2019

Julian Sheather, The Guardian; Circumcision, patient trackers and torture: my job in medical ethics

"Monday

Modern healthcare is full of ethical problems. Some are intensely practical, such as whether we can withdraw a feeding tube from a patient in a vegetative state who could go on living for many years, or whether a GP should give a police officer access to patient records following a local rape. 

Others are more speculative and future-oriented: will robots become carers, and would that be a bad thing? And then there are the political questions, like whether the Home Office should have access to patient records. My job is to advise the British Medical Association on how we navigate these issues and make sure the theory works in practice for patients and healthcare professionals."

What to tell patients when artificial intelligence is part of the care team; American Medical Association (AMA), February 13, 2019

Staff News Writer, American Medical Association (AMA); What to tell patients when artificial intelligence is part of the care team

"Artificial intelligence (AI) in health care can help manage and analyze data, make decisions and conduct conversations. The availability of AI is destined to drastically change physicians’ roles and everyday practices. It is key that physicians be able to adapt to changes in diagnostics, therapeutics and practices of maintaining patient safety and privacy. However, physicians need to be aware of ethically complex questions about implementation, uses and limitations of AI in health care.   

The February issue of the AMA Journal of Ethics® (@JournalofEthics) features numerous perspectives on AI in health care and gives you an opportunity to earn CME credit."

A.I. Shows Promise Assisting Physicians; The New York Times, February 11, 2019

Cade Metz, The New York Times; A.I. Shows Promise Assisting Physicians

"Each year, millions of Americans walk out of a doctor’s office with a misdiagnosis. Physicians try to be systematic when identifying illness and disease, but bias creeps in. Alternatives are overlooked.

Now a group of researchers in the United States and China has tested a potential remedy for all-too-human frailties: artificial intelligence.

In a paper published on Monday in Nature Medicine, the scientists reported that they had built a system that automatically diagnoses common childhood conditions — from influenza to meningitis — after processing the patient’s symptoms, history, lab results and other clinical data."

Facing Backlash, Chinese Scientist Defends Gene-Editing Research On Babies; NPR, November 28, 2018

Rob Stein, NPR; Facing Backlash, Chinese Scientist Defends Gene-Editing Research On Babies

"University of Wisconsin bioethicist Alta Charo, who helped organize the summit, issued an even harsher critique of He's work, calling it "misguided, premature, unnecessary and largely useless."

"The children were already at virtually no risk of contracting HIV, because it was the father and not the mother who was infected," she said.

"The patients were given a consent form that falsely stated this was an AIDS vaccine trial, and which conflated research with therapy by claiming they were 'likely' to benefit," Charo said. "In fact there is not only very little chance these babies would be in need of a benefit, given their low risk, but there is no way to evaluate if this indeed conferred any benefit."

She spoke after Harvard Medical School Dean George Daley alluded to He's claims as "missteps" that he worried might set back a highly promising field of research. "Scientists who go rogue carry a deep, deep cost to the scientific community," Daley said.

Still, Daley argued that He's experiment shouldn't tar the potential work of other scientists. "Just because the first steps into a new technology are missteps, doesn't mean we shouldn't step back, restart and think about a plausible and responsible path forward," Daley said.

"The fact that the first instance came forward as a misstep should in no way leave us to stick our heads in the sand and not consider the very, very positive efforts that could come forward," Daley said. "I hope we just don't stick our heads in the sand."

Daley stressed that the world hadn't yet reached a scientific consensus on how to ethically and safely use new gene-editing techniques to modify embryos that become babies.

But Daley argued that a consensus was emerging that "if we can solve the scientific challenges, it may be a moral imperative that it should be permitted." The most likely first legitimate use of gene-edited embryos would be to prevent serious genetic disorders for which there are no alternatives, Daley said.

"Solving and assessing these deep issues [is] essential," Daley says.

Daley also defended the fact that scientists have long relied on self-regulation to prevent the abuse of new technologies. He's claims represented "a major failure" that called for much stronger regulation and possibly a moratorium on such research, Daley said. "I do think the principle of self-regulation is defensible.""

Digital divide persists with online portals for cancer patients; Reuters, February 14, 2018

Lisa Rapaport, Reuters; Digital divide persists with online portals for cancer patients

"“Internet access is not uniform across populations,” said senior study author Dr. David Gerber, a researcher at the University of Texas Southwestern Medical Center in Dallas.

“There exists a `digital divide,’ with certain groups having lower access to broadband Internet than others,” Gerber said by email.

The sheer volume of information in recent years may be overwhelming patients and discouraging them from using these portals, Gerber said."

Big Settlement in Privacy Case Involving 2 Patients, HIV Data; Gov Info Security, May 24, 2017

Marianne Kolbasuk McGee, Gov Info Security; Big Settlement in Privacy Case Involving 2 Patients, HIV Data

"Sensitive Health Information

The high settlement amount paid by St. Luke's in a case involving privacy incidents impacting only two individuals reflects the sensitive nature of information that was breached.

"There is no doubt that OCR felt compelled to act due to the sensitivity of the PHI disclosed, that the organization should have been aware of the enhanced safeguards surrounding this type of PHI and there had been repeated occurrences of similar unauthorized disclosures," says privacy attorney David Holtzman of security firm CynergisTek.

"The message here is fix your problems when they happen," notes privacy attorney Kirk Nahra of the law firm Wiley Rein. "This was obviously a particularly sensitive piece of information, and it is possible that this also implicates a request for confidential communication or request for restriction in the HIPAA individual rights. So, while the [settlement] number may seem a bit high, this is both a repeated problem, and one that was not fixed, as well as a particularly harmful step.""

Rude Doctors, Rude Nurses, Rude Patients; New York Times, April 10, 2017

Perri Klass, New York Times; 

Rude Doctors, Rude Nurses, Rude Patients

"Just how much rudeness is there in the hospital, and who bears the brunt of it?

A few weeks ago I wrote about a study that looked at what happens to medical teams when parents are rude to doctors. In these studies of simulated patient emergencies, doctors and nurses working in the neonatal intensive care unit were less effective in teamwork and communication, and in their diagnostic and technical skills, after an actor, playing a parent, made a rude remark about the quality of the hospital."

'Could You Patent The Sun?'; New York Times, January 2017

Video, New York Times; 'Could You Patent The Sun?'

"Decades after Dr. Jonas Salk opposed patenting the polio vaccine, the pharmaceutical industry has changed. What does that mean for the development of innovative drugs and for people whose lives depend on them?"

Troubling examples of ‘pseudoscience’ at the Cleveland Clinic; Washington Post, 1/11/17

Daniel Summers, Washington Post; Troubling examples of ‘pseudoscience’ at the Cleveland Clinic

"People will understandably look for their own answers. Unfortunately, when no less than the president-elect is among those promulgating dangerous misinformation about vaccines, medical providers have to deal with a lot of false, misleading stuff their patients may find.

One way I deal with this is to give patients a list of resources that generally provide good, evidence-based advice. Though I can’t vet every single article they may publish, knowing a few sites that typically give clear, sound information is a valuable resource when patients ask.

Sadly, no matter how glowing its reputation or how superlative the care it routinely provides, I can’t include the Cleveland Clinic on that list. Knowing it promotes treatments that have no grounding in science, or that a patient could stumble upon a fearmongering article that makes baseless claims about the unspecified dangers of environmental toxins on its website, I can’t direct patients there in good faith. Considering its prominence as a renowned medical establishment, that’s a terrible shame.

Patent rights key to ensuring access to medication; Trib Live, 10/24/16

Robert A. Freeman, Trib Live; Patent rights key to ensuring access to medication:

" A United Nations panel recently released disastrous policy recommendations designed to increase access to medicines in developing countries. The panel ignored obvious solutions.

Secretary General Ban Ki-Moon originally tasked the UN High-Level Panel on Access to Medicines with remedying the “policy incoherence” between intellectual property rights and drug access. The panel predictably — and wrongly — viewed IP protections as a barrier to access rather than a bridge to medical innovation.

Undermining IP rights will not help patients in developing countries access medicines.

A 2016 Foreign Affairs study sought to determine whether strong patent protections increase the prices of drugs to developing countries. It found that patents were not key drivers of higher expenditures."

U.S. lawmakers demand investigation of $100 price hike of lifesaving EpiPens; Washington Post, 8/23/16

Ariana Eunjung Cha, Washington Post; U.S. lawmakers demand investigation of $100 price hike of lifesaving EpiPens:

"The medication itself isn’t expensive. Analysts calculate that the dosage contained in a single pen is worth about $1. It’s the company’s proprietary pen injector that makes up the bulk of the cost...

A profile in Fortune in 2015 described her rise in colorful terms:

Bresch, a 46-year-old who’s spent more than half her life at Mylan, has steered the company’s transformation from a quirky outfit run out of a West Virginia trailer to a global operator with 30,000 employees in 145 countries. Born into politics—her father, Joe Manchin, is a longtime West Virginia Democratic stalwart who’s now a U.S. senator—Bresch has mastered the regulatory world. Since becoming CEO in 2012, she’s overseen a major revenue increase; Mylan projects sales of up to $10.1 billion this year, up from $6.1 billion in 2011…

Under Bresch’s leadership, Mylan has also stumbled through a series of ethically messy mishaps and public relations gaffes. Mylan’s inversion took place just as uproar over the tactic reached a fever pitch on Capitol Hill. (Among the politicians who denounced the move was Bresch’s own father, though he later changed his mind.) Critics have called out the company for unusually high executive pay packages, questionable use of company jets, and murky relationships with board members. Then there’s “the Heather Bresch situation,” as she herself calls it, a scandal surrounding her executive MBA credentials—when you Google her name, the episode still ranks even higher than her official Mylan bio."

Making the Most of Clinical Trial Data; New York Times, 4/12/16

Editorial Board, New York Times; Making the Most of Clinical Trial Data:

"Some researchers may oppose sharing data they have worked hard to gather, or worry that others will analyze it incorrectly. Creating opportunities for collaboration on subsequent analysis may help alleviate these concerns.

Of course, any data sharing must take patients’ privacy into account; patients must be informed before joining a clinical trial that their data may be shared and researchers must ensure that the data cannot be used to identify individuals.

By making data available and supporting analysis, foundations, research institutions and drug companies can increase the benefit of clinical trials and pave the way for new findings that could help patients."

Karolinska Institute may reopen ethics inquiry into work of pioneering surgeon; Science, 1/29/16

Gretchen Vogel, Science; Karolinska Institute may reopen ethics inquiry into work of pioneering surgeon:

"A documentary on Swedish Television (SVT) has prompted the Karolinska Institute (KI) in Stockholm to consider reopening its investigation into possible misconduct by surgeon Paolo Macchiarini. After an investigation last year into Macchiarini’s work at KI, where he performed experimental trachea surgery on three patients, Vice-Chancellor Anders Hamsten concluded that the surgeon had not committed misconduct, although some of his work did “not meet the university’s high quality standards in every respect.” But the documentary has raised new concerns by suggesting that Macchiarini misled patients."