Check this link out entitled “A Doctor’s Declaration of Independence; It’s time to defy health-care mandates issued by bureaucrats not in the healing profession.”  If you don’t want to read the article in its entirety, here are the key points that Dr. Daniel Craviotto mentioned in yesterday’s Wall Street Journal article.

Some of the disappointments in medicine today that he mentioned are as follow:

• Burden of mandated electronic-record by Medicare and Medicaid Services for participating in their plans and for reimbursements
• Significant Decline in Medicare and Medicaid reimbursement rates
• Time consuming board recertification in the various medical specialties
• Outside interference, and unnecessary scrutiny and coercion from outside forces

http://online.wsj.com/news/articles/SB10001424052702304279904579518273176775310

http://timesofindia.indiatimes.com/india/Row-over-clinical-trial-as-254-Indian-women-die/articleshow/34016785.cms

A month ago, I had the opportunity to visit one of the CDC’s exhibitions entitled, “Health is a Human Right: Race and Place in America” The exhibition examined challenges which made it difficult for certain minority groups and socially disadvantaged peoples to receive equal access to healthcare throughout history. The exhibit attempted to show that, whether due to socioeconomic and/or political factors, many groups of people in the United States are being forced to live without the basic resources that ensure health, including clean water, sanitation, housing, food, and health care. The purpose of this exhibit was to explain that health should be accessible to everyone, and that universal health should be provided to people regardless of their status, class, race, or gender. The exhibition emphasized that the aim of universal health should be to ensure that all people have equal and rights and access to health services without suffering from financial difficulty. However, this raises the ethical dilemma of whether or not providing universal healthcare alone, guarantees health and well-being. Do we have any social or moral responsibilities and obligations in other’s overall health? According to Gopal Sreenivasan, in his article, Health Care and Equality of Opportunity “one widely accepted way of justifying universal access to health care is to argue that access to health care is necessary to ensure health, which is necessary to provide equality of opportunity, but the evidence on the social determinants of health undermines this argument.” Sreenivasan further argues that “universal access to healthcare” and “actual health and well-being” are two different phenomena. His suggestion is that “instead of introducing a national health insurance scheme, [if] we had spent the same amount of money on equalizing the distribution of social status – then our society’s gradient in health would have been significantly reduced.”

What Sreenivasan points out is that well-being in terms of an individual’s health status, first requires a commitment of social investment for public goods because the socio-economic class is a deterrent in providing fair share of health to people. Sreenivasan explains that a “social determinant of health is a socially controllable factor outside the traditional health care system that is an independent partial cause of an individual’s health status.” For example, poverty alone is the cause of many unpleasant health problems; for the poor even small costs to visit a medical clinic can be devastating for the family’s financial situation; merely providing an equal amount of care to them would not be enough.  Sreenivasan’s argument implies that we should invest less on health and more on limiting the negative consequences of social determinants of health; the objective should be to tackle socioeconomic factors that create major discrepancies in health inequalities.

As was witnessed in the CDC exhibit, there are many political complexities preventing us from promoting and offering universal healthcare, we should still strive to achieve this goal. However, this should not be the only goal we strive for. As Sreenivasan states, offering healthcare alone will not create drastic improvements in the health of the general population. While we must offer healthcare, we must simultaneously battle the socioeconomic forces that worsen the health of the economically marginalized. If we can strive towards accomplishing these two goals, we can reverse the course of the history of healthcare and overall health of the general population.

Work Cited

Sreenivasan, Gopal. “Health Care and Equality of Opportunity”. The Hastings Center Report (2007). Pg 21-31.

http://www.un.org/millenniumgoals/poverty.shtml

I wanted to share an article on Professor Elena Conis of Emory University, whose research aims to understand how over time, history, especially environmental history, has led people to evaluate the risks and benefits associated with vaccines so differently. Enjoy!

http://news.emory.edu/stories/2014/04/er_mellon_fellows_profile_elena_conis/campus.html

“Preventive care carries a quasi-moralistic message that people and societies are responsible for their health and must shoulder certain disciplines in order to avoid disease” (Brody and Englehardt 299).  The idea of preventive medicine makes an individual in charge of his/her own health by preventing disease or illness before it ever occurs. Preventive care encourages a sense of responsibility in people by letting them take direct control of their own health. It promotes the idea that, avoiding bad things from happening is better than fixing the bad things after it happens. If bad things still occur, it, indirectly, holds an individual and society accountable for letting it happen at the first place.  However, as Brody & Englehardt say that since preventive care is not clearly medical, (prevention happens before medical intervention) it does not fall within the jurisdiction of influential scientific organizations. Moreover, scientific organizations emphasis more on statistics which makes it easy for them to report their findings and hence more resources are allocated to their programs.

According to Brody and Englehardt, many countries allocate money for fixing health problems as they occur rather than allocating it towards increasing resources so that these health problems can be avoided.  These countries’ healthcare system focuses on reactive medicine in which the symptoms are treated as they occur rather than working to prevent them from getting happening in the first place. Both culture and medicine in these countries have formed a relationship which is acceptable for the majority of their population.  It is difficult for these countries to ever come out of this cycle because it is much easier for them to report quantifiable findings for the cure of the sick. On the other hand, it could be not only difficult, but nearly impossible to quantify actions which may or may not prevent an illness. For this reason, even though, the benefits of preventive medicine are clear, they are not definitely measureable which makes it a less popular approach.

I believe that the global differences in medical practice, that Brody and Englehardt talk about, will continue to differ, until a joint consent is made to align them. Some of these countries are among the poorer nations where the governments constantly face a vicious cycle of disease and poverty. These places are in a need of the competencies and incentives so that their strategy can be shifted from reactive methodology to proactive mode of care.  Furthermore, an approach a country takes towards preventive health care is greatly influenced by their culture where each believes in their own practice method as being the best. For example, in the U.S, risk reducing mastectomies are patients’ choice and can be carried out for carriers of the BRCA mutation gene to prevent the risk of developing breast cancer. However, France only favors mastectomy if the risk factor is greater than 60% and that only if a woman is at least thirty years old (Payer 183). This is largely due to their perception of preventive mastectomy as a tragedy and not a celebration of an improved life.  It is therefore important to identify a bio cultural approach of healthcare, one that defines health in both biological and cultural methods, explaining how disease and societies are integrated. This way of understanding takes both societal, traditional views and perception of disease, and the way the diseases and illnesses are best cured using traditional and or biomedical healing.  By understanding this bio cultural approach, we can appreciate the benefits each have to offer and possibly use these benefits to better our and other health systems around the world.  With all said, what Brody and Englehardt refers to cannot be denied that, every individual and every society still needs to consider health in a moral sense and adopt self-control behaviors in order to avoid future health problems.

Work Cited

Brody, Baruch A. Bioethics: readings & cases. Englewoods Cliffs, N.J.: Prentice-Hall, 1987. Print.

Payer, Lynn. Medicine & culture: varieties of treatment in the United States, England, West Germany, and France. New York: H. Holt, 1988. Print.

A simple test will determine if a person will die of a medical cause within a 5 years period. A study found that high levels of four different molecules in the body: albumin, alpha-1-acid glycoprotein, citrate and very low-density lipoprotein particles, predicts death within a certain time. Researchers still have to find out how these 4 biomarkers are associated with the risk of death.

 http://fox2now.com/2014/03/10/test-may-some-day-predict-5-year-risk-of-death/

In the past decades, the doctrine of informed consent has slowly changed the medical practice form “paternalistic standard” to a more “patient centered” standard of care. Today, the topic of informed consent has become a center of controversy because it hardly remains what its original purpose was. When the idea of patient centered standard was first introduced after the historical case of Canterbury vs. Spence, Judge Robinson based his decision on one key point: “Autonomy rights” in which the patient has a right to participate in the decision making process of his own medical treatment.  In his decision, Robinson specified that the burden to educate the patient is on the physician; prior to any medical procedure, the physician should disclose to the patient, not only the nature of the procedure, but also the associated risks, alternatives treatments and potential benefits of the procedure. Hence, the primary aim of the informed consent was to involve and educate the patient about his own health care, and foster a dialogue between the physician and patient towards future treatment possibilities. However, today, the process of informed consent has lost its educational segment and is merely seen as a  process of signing a legal “release” in case of medical negligence.  This shift in the ideology of the process has caused both the physicians and patients to suffer and has hurt the entire medical profession in a big way.   Over the years, patients have become confused and paranoid about the whole informed consent practice and, ironically, by adding possible negative outcomes on the consents, physicians themselves have educated patients of many more medical liabilities than they were previously aware of. Today, patients feel the victims of the informed consent process, and many have lost respect for the medical field in general.  This is due to the fact that most informed consent processes are there to protect the interests of physicians and surgeons, and hardly any protect the patients and meet the needs of their families.

In order to regain the true essence of the informed consent, based on patient-physician trust, Physicians need to provide their patients with the proper information they need to know so that they also understand the possible consequences of their treatments. The ideal decision making process, according to Lidz et, al, should have four elements:  1. Information is disclosed to patients by their physician, 2. Physicians make reasonable efforts to explain the procedure to the patient and make sure that patient understands the procedure completely, 3. Patient makes the decision for or against the procedure, 4. Patient makes the decision willingly. In a New York Times article: Treating Patients as Partners, by Way of Informed Consent,  thttp://www.nytimes.com/2009/07/30/health/30chen.html?pagewanted=all, Dr. Eric D. Kodish,, chairman of bioethics at the Cleveland Clinic, said, “the choreography of informed consent, [is about]  how you make eye contact, sit down, build trust.”  Is it still possible to rebuild this trust based on mutual honesty, for solely ethical and medical reasons?

References

 Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972).

Charles W. Lidz, Ph.D., Alan Meisel, J.D., Marian Osterweis, Ph.D., Janice L. Holden, R.N., John H. Marx, Ph.D. and Mark R. Munetz, M.D. “Barriers to Informed Consent.” Arguing About Bioethics. Ed. Stephen Holland. London: Routledge, 2012. 93-104. Print.

Chen, Pauline. “Treating Patients as Partners, by Way of Informed Consent.” The New York Times. N.p., 30 July 2009. Web. 10 Feb. 2014. <http://www.nytimes.com/2009/07/30/health/30chen.html?pagewanted=all&_r=0>.

“Informed Consent.” Cagle Post RSS. N.p., n.d. Web. 9 Feb. 2014. <http://www.cagle.com/tag/informed-consent/>.