Ethics

Avastin and the Meaning of Evidence

September 9, 2011
Avastin and the Meaning of Evidence

By Antonella Surbone MD PhD and Jerome Lowenstein MD

The recent hearings at the Food and Drug Administration regarding the revocation of approval for the use of Avastin in the treatment of breast cancer bring into sharp focus several very important issues in medicine today.

The pharmaceutical industry, armed with powerful new tools for deciphering the signaling mechanisms and mutations responsible for the development and progression of malignancies, has developed new therapies for treating cancer and other malignancies. The cost of development of each new…

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Does Medical School Erode Student Empathy?

August 10, 2011
Does Medical School Erode Student Empathy?

By Nandini Govil

Faculty Peer Reviewed

Empathy is an elusive concept, espoused by many as an integral component of effective doctoring. In the medical literature, empathy is defined as a physician’s ability to recognize and validate a patient’s experiences and perspectives,  and to convey this understanding back to the patient. A firm distinction is drawn between sympathy (an emotional attribute) and empathy (a cognitive skill that can be modeled, taught, and assessed).

Research indicates that physician empathy results in better patient compliance…

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Metaphysics of Medical Futility

March 11, 2011
Metaphysics of Medical Futility

By John J. Mercuri

Faculty Peer Reviewed

Noon: Alarms rang. The residents arrived. Equipment filled the room. The nurse manager called legal. Attending physicians hurried in and out. The family insisted that everything be done. The code lasted five hours and fifteen minutes. The room fell eerily silent when the patient died.

For weeks, the medical personnel who cared for this ninety-two year-old patient knew that she would never leave the hospital. Yet, for weeks, the patient…

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Off Label

November 19, 2010
Off Label

By Alexander Volodarskiy, MD

Faculty Peer Reviewed

In a press conference on April 27, 2010, Attorney-General Eric Holder announced that AstraZeneca had agreed to pay a $520 million fine to settle an investigation into the marketing practices of its blockbuster drug, quetiapine (Seroquel) . According to federal investigators, quetiapine, originally approved by the FDA in 1997 for the treatment of schizophrenia and bipolar mania, was promoted by AstraZeneca for use in unapproved (and far commoner) conditions, such as anxiety…

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From The Archives: Is Prescribing Placebos An Ethical Practice?

November 4, 2010
From The Archives: Is Prescribing Placebos An Ethical Practice?

Please enjoy this post from the Clinical Correlations archives first posted February 18, 2009

Commentary by Antonella Surbone, MD PhD FACP, NYU Department of Medicine, Clinical Correlations Ethics Section Editor

In October 2008, BMJ published a research article entitled “Prescribing placebo treatments: results of a national survey of US internists and rheumatologists.” Of 679 physicians who responded to a cross sectional mailed survey, over 50% reported having prescribed placebos on a regular basis. Placebos included varied from saline (3%), sugar pills (2%),…

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An Immigrant’s Story at Bellevue

September 3, 2010
An Immigrant’s Story at Bellevue

By Synphen H. Wu, PhD  

Faculty Peer Reviewed

Mr. C is a 46-year-old Chinese immigrant restaurant worker who came to Bellevue Hospital after two weeks of fatigue, malaise, right upper quandrant (RUQ) abdominal pain, and progressive jaundice. He was referred from a Chinatown clinic, where his blood tests showed hepatitis B surface antigen, a hepatitis B viral load of 133 million copies, and elevated liver transaminases and bilirubin levels, consistent with acute hepatitis B reactivation and fulminant hepatic failure.…

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Talk to Your Doctor: Direct-to-Consumer Advertising of Prescription Drugs, Part 3

August 13, 2010
Talk to Your Doctor: Direct-to-Consumer Advertising of Prescription Drugs, Part 3

By Ishmeal Bradley

 Faculty Peer Reviewed

In the first two parts of this article, we explored the historical and legal contexts of direct-to-consumer (DTC) advertising, the effects of these ads on prescribing behavior, and the economic incentives to advertise. In this final installment, we will examine what patients and physicians really think about these ads and offer one possible way to minimize the potentially harmful effects of DTC advertising.

 Perceptions about DTC Advertising

 Patient perceptions…

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Talk to Your Doctor: Direct-to-Consumer Advertising of Prescription Drugs, Part 2

August 6, 2010
Talk to Your Doctor: Direct-to-Consumer Advertising of Prescription Drugs, Part 2

By Ishmeal Bradley

Faculty Peer Reviewed

 In the first installment, we looked at the history behind consumer advertising of prescription drugs. We also explored the concept of commercial free speech and why this form of advertising is legal. To fully appreciate the controversy about direct-to-consumer (DTC) advertising, we must now examine the commercial effects of these ad campaigns. Do these ads really increase prescription volume and drug costs? Are both physicians and patients affected by the commercials they see…

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Talk to Your Doctor: Direct-to-Consumer Advertising of Prescription Drugs, Part 1

July 30, 2010
Talk to Your Doctor: Direct-to-Consumer Advertising of Prescription Drugs, Part 1

By Ishmeal Bradley, MD

Faculty Peer Reviewed

 Advertising is everywhere. That should come as no surprise to anyone who has lived in modern America. It is impossible to turn on the television, ride the subway, or even sort through the daily mail without coming across an ad for a new car, a soft drink, or the latest digital toy. These advertisements have only one goal: to entice you to buy their products. This is harmless enough when these ads…

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Revisiting the USPSTF Breast Cancer Screening Guidelines: Ethics, and Patient Responsibilities

May 6, 2010
Revisiting the USPSTF Breast Cancer Screening Guidelines: Ethics, and Patient Responsibilities

David Shabtai

Faculty Peer Reviewed

 In a bold move, the U.S. Preventive Services Task Force recently changed their breast cancer screening guidelines – recommending beginning screening at age 50 and even then only every other year until age 75. Bold, because the Task Force members are certainly aware of the media circus that ensued when in 1997, an NIH group issued similar guidelines, prompting comparisons to Alice in Wonderland. The new guidelines, recommend “against routine screening mammography in women…

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Physician Assisted Suicide: A Spiritual Challenge

April 30, 2010
Physician Assisted Suicide: A Spiritual Challenge

Commentary on  last week’s “Physician Assisted Suicide—Is now the time?” by Antonella Surbone, MD PhD FACP, Ethics Editor, Clinical Correlations.

Last week’s piece on Physician Assisted Suicide (PAS) by Dr. Juliana Eng addresses in simple and clear terms an issue that, at times, occupies the front pages of our newspapers or becomes the center of heated public debate or the theme of elaborated ethical argumentations. For long periods, however, the request of some of our patients to be helped in putting an end…

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Physician-assisted Suicide – Is Now the Time?

April 24, 2010
Physician-assisted Suicide – Is Now the Time?

Juliana Eng MD

Several months ago, the U.K. courts ordered Ken Starmer, Director of Public Prosecutions, to delineate the conditions under which his office would be likely or unlikely to prosecute people who helped friends or relatives kill themselves.  This list of conditions is intended to provide information so that those who wish to assist another commit suicide can make an informed decision.  Yet Section 2(1) of the Suicide Act of 1961 provides: “A person who aids, abets, counsels or procures…

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