Patients who say they have Morgellons point to skin lesions as proof of their disease. But doctors believe the lesions are self-inflicted—that the condition is psychological, not dermatological.
By Katherine Foley
The Atlantic
Originally published January 18, 2015
Here is an excerpt:
When patients with these symptoms seek dermatological treatment, they’re usually told that they have delusions of parasitosis, a condition in which people are falsely convinced that they’re infested with parasites—told, in other words, that the crawling, itching sensations under their skin are only in their heads, and the fibers are remnants from clothing. Still, they pick away, trying to get the feeling out. According to Casey, most doctors refuse to even examine the alleged skin fibers and only offer anti-psychotic medication as treatment. It took her three years to find a dermatologist willing to treat her in any other way, and she and her husband had to drive all the way from California to Texas to see him.
The article outlining the conundrum is here.
Showing posts with label Medicine. Show all posts
Showing posts with label Medicine. Show all posts
Friday, February 13, 2015
Tuesday, January 20, 2015
Bioethics: why philosophy is essential for progress
By Julian Savulescu
J Med Ethics 2015;41:28-33 doi:10.1136/medethics-2014-102284
Here is an excerpt:
Ethics is concerned with norms and values. Its subject matter is the way the world ought to be or should be. It is about good and bad, right and wrong. Science is about the way the world is, was, will be, could be, would be. Ethics is about values; science is about facts. (Strictly, science is about natural facts. On realist views of ethics, ethics is about normative or evaluative facts.)
David Hume famously described this ‘fact–value’ or ‘is–ought’ distinction. One of his greatest contributions to ethics was to observe that values cannot be read straight off natural facts. To do so is what GE Moore described as the naturalistic fallacy. Science and ethics are completely different kinds of enterprises.
This distinction is essential to understanding the failure of much of bioethics and medical ethics. Even if science were complete and we knew everything about the world and ourselves, it would not answer the ethical questions of how we should live or whether equality is more important than maximising the good, or when we should die. The stated basis of the National Health Service is egalitarianism—equal treatment for equal need. But that is a highly contestable ethical principle.
The entire article is here.
J Med Ethics 2015;41:28-33 doi:10.1136/medethics-2014-102284
Here is an excerpt:
Ethics is concerned with norms and values. Its subject matter is the way the world ought to be or should be. It is about good and bad, right and wrong. Science is about the way the world is, was, will be, could be, would be. Ethics is about values; science is about facts. (Strictly, science is about natural facts. On realist views of ethics, ethics is about normative or evaluative facts.)
David Hume famously described this ‘fact–value’ or ‘is–ought’ distinction. One of his greatest contributions to ethics was to observe that values cannot be read straight off natural facts. To do so is what GE Moore described as the naturalistic fallacy. Science and ethics are completely different kinds of enterprises.
This distinction is essential to understanding the failure of much of bioethics and medical ethics. Even if science were complete and we knew everything about the world and ourselves, it would not answer the ethical questions of how we should live or whether equality is more important than maximising the good, or when we should die. The stated basis of the National Health Service is egalitarianism—equal treatment for equal need. But that is a highly contestable ethical principle.
The entire article is here.
Saturday, December 20, 2014
Bioethics in 2025: what will be the challenges?
Deborah Bowman, Professor of Bioethics, Clinical Ethics and Medical Law at St. George’s University of London
Sarah Chan, Research Fellow in Bioethics and Law and Deputy Director of the Institute for Science, Ethics and Innovation at the University of Manchester
Molly Crockett, Associate Professor of Experimental Psychology at the University of Oxford
Gill Haddow, Senior Research Fellow in Science, Technology and Innovation Studies at the University of Edinburgh
For its 2014 annual public lecture, the Nuffield Council on Bioethics had four speakers from different disciplines present their take on what will be the main challenges in and for bioethics in the near future. Topics touched on included how to make bioethics more open and inclusive as a discipline; what role for bioethicists in meeting future societal challenges; whether we will be able to develop a 'morality pill' in near future; and how it might feel for people to have electronic or other material transplanted into them in the future to help their bodies cope with longer lives.
Sarah Chan, Research Fellow in Bioethics and Law and Deputy Director of the Institute for Science, Ethics and Innovation at the University of Manchester
Molly Crockett, Associate Professor of Experimental Psychology at the University of Oxford
Gill Haddow, Senior Research Fellow in Science, Technology and Innovation Studies at the University of Edinburgh
For its 2014 annual public lecture, the Nuffield Council on Bioethics had four speakers from different disciplines present their take on what will be the main challenges in and for bioethics in the near future. Topics touched on included how to make bioethics more open and inclusive as a discipline; what role for bioethicists in meeting future societal challenges; whether we will be able to develop a 'morality pill' in near future; and how it might feel for people to have electronic or other material transplanted into them in the future to help their bodies cope with longer lives.
Tuesday, November 4, 2014
Doctors Tell All—and It’s Bad
By Meghan O'Rourke
The Atlantic
Originally published October 14, 2014
Here is an excerpt:
But this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.
To my surprise, I’ve now learned that patients aren’t alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story. A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments. Although we’re all aware of pervasive health-care problems and the coming shortage of general practitioners, few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades. These inside accounts should be compulsory reading for doctors, patients, and legislators alike. They reveal a crisis rooted not just in rising costs but in the very meaning and structure of care. Even the most frustrated patient will come away with respect for how difficult doctors’ work is. She may also emerge, as I did, pledging (in vain) that she will never again go to a doctor or a hospital.
The entire article is here.
The Atlantic
Originally published October 14, 2014
Here is an excerpt:
But this essay isn’t about how I was right and my doctors were wrong. It’s about why it has become so difficult for so many doctors and patients to communicate with each other. Ours is a technologically proficient but emotionally deficient and inconsistent medical system that is best at treating acute, not chronic, problems: for every instance of expert treatment, skilled surgery, or innovative problem-solving, there are countless cases of substandard care, overlooked diagnoses, bureaucratic bungling, and even outright antagonism between doctor and patient. For a system that invokes “patient-centered care” as a mantra, modern medicine is startlingly inattentive—at times actively indifferent—to patients’ needs.
To my surprise, I’ve now learned that patients aren’t alone in feeling that doctors are failing them. Behind the scenes, many doctors feel the same way. And now some of them are telling their side of the story. A recent crop of books offers a fascinating and disturbing ethnography of the opaque land of medicine, told by participant-observers wearing lab coats. What’s going on is more dysfunctional than I imagined in my worst moments. Although we’re all aware of pervasive health-care problems and the coming shortage of general practitioners, few of us have a clear idea of how truly disillusioned many doctors are with a system that has shifted profoundly over the past four decades. These inside accounts should be compulsory reading for doctors, patients, and legislators alike. They reveal a crisis rooted not just in rising costs but in the very meaning and structure of care. Even the most frustrated patient will come away with respect for how difficult doctors’ work is. She may also emerge, as I did, pledging (in vain) that she will never again go to a doctor or a hospital.
The entire article is here.
Friday, October 10, 2014
When Medicine Is Futile
By Barron Lerner
The New York Times
Originally published September 18, 2014
Here is an excerpt:
The medical futility movement, which argued that doctors should be able to withhold interventions that they believed would merely prolong the dying process, did not experience great success. Physicians declaring things to be “futile” sounded too much like the old system of medical paternalism, in which doctors had made life-and-death decisions for patients by themselves. It was this mind-set that bioethics, appropriately, had sought to correct. Patients (or their families) were supposed to be in charge.
The problem was that the new system did not account for one thing: Patients often demanded interventions that had little or no chance of succeeding. And physicians, with ethicists and lawyers looking over their shoulders, and, at times, with substantial money to be made, provided them.
Thursday, October 9, 2014
Panel Urges Overhauling Health Care at End of Life
By Pam Belluck
The New York Times
Originally posted on September 17, 2014
The country’s system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel concluded in a report released on Wednesday.
The 21-member nonpartisan committee, appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences, called for sweeping change.
“The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life,” said David M. Walker, a Republican and a former United States comptroller general, who was a chairman of the panel. “The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly.”
The entire article is here.
The New York Times
Originally posted on September 17, 2014
The country’s system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel concluded in a report released on Wednesday.
The 21-member nonpartisan committee, appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences, called for sweeping change.
“The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life,” said David M. Walker, a Republican and a former United States comptroller general, who was a chairman of the panel. “The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly.”
The entire article is here.
Saturday, January 18, 2014
Family, ethics, medicine and law collide in Jahi McMath’s life — or death
By Cathy Lynn Grossman
Religion News
Originally posted January 3, 2014
Is Jahi McMath, the 13-year-old whose entire brain has ceased to function, dead or alive?
Must doctors at a California hospital operate to prepare her for a move to a care facility in New York even though the hospital insists she is dead? No doctor can be compelled to treat the dead.
Or is she alive now and wanting to live on? Her mother, Nailah Winkfield, insists that removing the life-support machinery, which is performing all Jahi’s bodily functions, is the same as killing her daughter. Only a court order keeps Jahi still on life support, and that order expires on Tuesday (Jan. 7).
On Friday, a federal magistrate was expected to begin mediating the three-week-long dispute between Children’s Hospital & Research Center in Oakland and Jahi’s parents. But the battle goes beyond the courtroom, the hospital, and Jahi’s family because American society still struggles with defining death.
The entire article is here.
Religion News
Originally posted January 3, 2014
Is Jahi McMath, the 13-year-old whose entire brain has ceased to function, dead or alive?
Must doctors at a California hospital operate to prepare her for a move to a care facility in New York even though the hospital insists she is dead? No doctor can be compelled to treat the dead.
Or is she alive now and wanting to live on? Her mother, Nailah Winkfield, insists that removing the life-support machinery, which is performing all Jahi’s bodily functions, is the same as killing her daughter. Only a court order keeps Jahi still on life support, and that order expires on Tuesday (Jan. 7).
On Friday, a federal magistrate was expected to begin mediating the three-week-long dispute between Children’s Hospital & Research Center in Oakland and Jahi’s parents. But the battle goes beyond the courtroom, the hospital, and Jahi’s family because American society still struggles with defining death.
The entire article is here.
Tuesday, January 7, 2014
The Ethics of Chemical Castration (Part One)
By John Danaher
Philosophical Disquisitions: Institute for Ethics and Emerging Technologies
Originally posted December 15, 2013
Chemical castration has been legally recognised and utilised as a form of treatment for certain types of sex offender for many years. This is in the belief that it can significantly reduce recidivism rates amongst this class of offenders. Its usage varies around the world. Nine U.S. states currently allow for it, as well as several European countries. Typically, it is presented as an “option” to sex offenders who are currently serving prison sentences. The idea being that if they voluntarily submit to chemical castration they can serve a reduced sentence.
Obviously, this practice raises a number of empirical and ethical questions. Does chemical castration actually reduce recidivism? Is it ethically right to present a convicted sex offender with a choice between continued imprisonment or release with chemical castration? Is this not unduly coercive and autonomy-undermining?
The entire article is here.
Philosophical Disquisitions: Institute for Ethics and Emerging Technologies
Originally posted December 15, 2013
Chemical castration has been legally recognised and utilised as a form of treatment for certain types of sex offender for many years. This is in the belief that it can significantly reduce recidivism rates amongst this class of offenders. Its usage varies around the world. Nine U.S. states currently allow for it, as well as several European countries. Typically, it is presented as an “option” to sex offenders who are currently serving prison sentences. The idea being that if they voluntarily submit to chemical castration they can serve a reduced sentence.
Obviously, this practice raises a number of empirical and ethical questions. Does chemical castration actually reduce recidivism? Is it ethically right to present a convicted sex offender with a choice between continued imprisonment or release with chemical castration? Is this not unduly coercive and autonomy-undermining?
The entire article is here.
Monday, January 6, 2014
Should Medical Schools be Schools for Virtue?
By Daniel Sulmasy
The Journal of Internal Medicine
Originally posted in July, 2000 and still relevant today
Here is an excerpt:
As Branch writes, “Medicine, after all, is a moral profession.” Yet medicine is increasingly viewed as just another business, and the concept of medicine as a profession, as a “special” endeavor with a different set of moral obligations and expectations, has been denounced as elitist, self-serving, and detrimental to the spirit of the competitive marketplace. Some fear that the recent financial reorganization of health care, premised upon the notion that there is nothing special about medicine, poses a particularly grave threat to the essence of medicine as a profession. Others argue that the professionalism of medicine can be reconstructed in such a way that it can guard against the financial forces that threaten to undermine its moral potency.
The entire article is here.
The Journal of Internal Medicine
Originally posted in July, 2000 and still relevant today
Here is an excerpt:
As Branch writes, “Medicine, after all, is a moral profession.” Yet medicine is increasingly viewed as just another business, and the concept of medicine as a profession, as a “special” endeavor with a different set of moral obligations and expectations, has been denounced as elitist, self-serving, and detrimental to the spirit of the competitive marketplace. Some fear that the recent financial reorganization of health care, premised upon the notion that there is nothing special about medicine, poses a particularly grave threat to the essence of medicine as a profession. Others argue that the professionalism of medicine can be reconstructed in such a way that it can guard against the financial forces that threaten to undermine its moral potency.
The entire article is here.
Thursday, August 15, 2013
Increase in Urine Testing Raises Ethical Questions
By BARRY MEIER
The New York Times
Published: August 1, 2013
As doctors try to ensure their patients do not abuse prescription drugs, they are relying more and more on sophisticated urine-screening tests to learn which drugs patients are taking and — just as important — which ones they’re not.
The result has been a boom in profits for diagnostic testing laboratories that offer the tests. In 2013, sales at such companies are expected to reach $2 billion, up from $800 million in 1990, according to the Frost & Sullivan consulting firm.
The growing use of urine tests has mirrored the rise in prescriptions for narcotic painkillers, or opioids. But the tests, like earlier efforts to monitor opioid prescribing, have led to a host of vexing questions about what doctors should do with the information they obtain, about the accuracy of urine screens and about whether some companies and doctors are financially exploiting the testing boom.
The entire story is here.
The New York Times
Published: August 1, 2013
As doctors try to ensure their patients do not abuse prescription drugs, they are relying more and more on sophisticated urine-screening tests to learn which drugs patients are taking and — just as important — which ones they’re not.
The result has been a boom in profits for diagnostic testing laboratories that offer the tests. In 2013, sales at such companies are expected to reach $2 billion, up from $800 million in 1990, according to the Frost & Sullivan consulting firm.
The growing use of urine tests has mirrored the rise in prescriptions for narcotic painkillers, or opioids. But the tests, like earlier efforts to monitor opioid prescribing, have led to a host of vexing questions about what doctors should do with the information they obtain, about the accuracy of urine screens and about whether some companies and doctors are financially exploiting the testing boom.
The entire story is here.
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