Ethics. Research. Community.

Blogging Ethics

Note: blog content is not currently included in EthicShare's Search Results.

07/25/2010 - 10:00am

On Thursday during a break in the cloudy/rainy weather in Vermont, I took the 3/4 mile hike up to Lake Pleiad, a mountain lake that's a favorite swimming spot. The weather was dicey and there was only one other person there, a large man with two large tattoos, who, I learned, had been a bouncer in a bar, but now now worked for a small manufacturing company.

I asked about the health insurance the company provided. Here's my reconstruction of what he said:It's a health savings account type of thing. I have a $5,000 deductible. It's a good deal because the employer puts some money into the savings account. The deductible is a lot of money, but I'd only have to spend it all if I went into the hospital. I'd rather take that risk and have a lower monthly premium, even though a 'lower premium' is still a lot! Doctor visits and tests don't come to all that much. I don't just take a doctor's word about things - I ask a lot of questions. 'What could this test show? Would the results make us do anything different? How important is it?' Sometimes they give me a good answer, and I'm satisfied, but sometime it seems like they didn't really have a good reason, and I don't do it. You've got to ask questions!"I asked him if the deductible got him to ask more questions. It did. "When you're laying out the money, you think about things more!"

I told him he'd made my day. He was doing just what the architects of high deductible health plans were hoping for. I said "if more people did what you do it would keep us doctors on our toes! We recommend a lot of things out of habit and they don't really need to be done. Do you encourage friends to ask questions the way you do?"

He did. A woman friend's gynecologist was recommending expensive tests on a regular basis. She didn't know why - "I just do what the doctor tells me I need to do." He said "you've got to ask!" When she did it turned out that the tests were really optional. She thanked him.

In 2009 approximately 23 million Americans had plans like the one my swimming companion had. If five percent asked questions the way he did that would be a million people. If that million persuaded five friends to do the same we'd be up to five million. To paraphrase the late Senator Everett Dirksen - "a million people here, a million people there - pretty soon we're talking real public education."

I spent thirty-five years of my practice life with a not-for-profit HMO. I think a group practice of that kind, in which patients and clinicians collaborate in planning the wisest way to use resources, is ideal. But that model didn't catch on widely, which is one reason consumer directed plans are selling like hotcakes.

I really admired and learned from my swimming companion. He was just a smart guy who thought for himself - not a health policy geek like me. If we had a groundswell of people like him who approached health care like prudent consumers it would be the strongest possible force for health reform!

07/24/2010 - 6:29pm

If you could live in a world that was just the way you wanted it to be, with specifications you’d chosen, customized and personalized to meet your every need and fulfill your fondest desires, would you spend all your time there? Or would you prefer to stay here, in the real world?

As computers continue to gain speed and power at the rate of Moore’s ‘law’, they are moving closer to the point where they will be capable of rendering a virtual environment that closely resembles the real world, so close that it may become hard to tell it apart from the real thing....

07/24/2010 - 6:06pm
More than half of those who responded to a recently concluded poll of IEET readers expect to be alive in the year 2100, aided by one or more forms of advanced technology.
07/24/2010 - 5:59am
The 20th Anniversary of the Americans with Disabilities Act is on Monday, July 26th.
07/23/2010 - 1:41pm

If sex makes you smarter via changes in synaptic strength following the act, can you get the same benefit from virtual sex, as long as your brain is convinced it is real at the time?


07/23/2010 - 11:56am

What’s the significance of academic tenure for research ethics?

How does tenure affect the ethics of researchers? What does it imply for professors who are members of the ethics boards charged with overseeing research?

There’s been a flurry of published discussion about academic tenure, this week.

See, for example:

All of the above is worthwhile reading. I think there are justified worries about the tenure system (or systems), though my view (not unbiased, as I am a tenured professor) is that the system still plays a role. But I also think the important question is not “whether” we should have a system of tenure, but rather just what that system should look like.

I only have this to add. When I got my first full-time, tenure-track job (but was not yet tenured), my Dean asked me what committee work I might want to take on. I told her there were 2 committees I refused to sit on before tenure. One was the Tenure and Promotion Committee. The other was the Research Ethics Board. I argued that no un-tenured professor should have to sit on such contentious committees. How could I exercise oversight over Professor Whomever’s research (or adjudicate his promotion to Full Professor) knowing that he or she could be sitting on the Tenure & Review Committee when I eventually came up for tenure myself? The Dean thought that was reasonable.

Tenure (along with other goodies handed out by university committees) is surely sometimes the subject of some old-fashioned academic mutual backscratching. But tenure is also at least sometimes a safeguard against such mutual backscratching, too.

07/23/2010 - 11:45am

A recent report from NEJM about a surviving husband to have the eggs of his dead wife harvested in order to create a posthumous child has raised the question of gender equity in the posthumous harvesting of gametes. With the...

07/23/2010 - 4:59am

The National Right to Life Committee held its annual convention in Pittsburgh late last month in Pittsburgh.  Burke Balch, an admirable speaker, looks at rationing elements in the health reform legislation. (CSPAN video at 47:00)

07/22/2010 - 10:33pm

The rapid development of the cognitive science of religion over the last 20 years has led to a renewed enthusiasm for anti-religious debunking arguments. The typical form of these is that w thinks that she/he is motivated to believe the...

07/22/2010 - 2:22pm

There is an excellent hospital right down the street from my law school: the Nemours / Alfred I. duPont Hospital for Children.  It is part of the largest network of children's hospitals and clinics in the country.  Driving back from Pittsburgh a few days ago, I saw a Nemours billboard that caught my eye:  "Our promise. To do whatever it takes."