Ethics

Advance Directives: A Move in the Right Direction

September 16, 2011
Advance Directives: A Move in the Right Direction

By Sara-Megumi Naylor

Faculty Peer Reviewed

“Tell me…If you were ever unable to make your own decisions about your medical care, is there someone you would trust to make those decisions for you?”

There is silence.

But then a response. We discuss. I record.

Then I proceed.

“I want to know…Have you given any thought to the goals of your hospital stay? I want to know what’s important to you.”

The only audible sounds in the quiet hospital room are the shallow breaths of my …

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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 …

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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 and  outcomes, and …

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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 remained full code status because her family insisted …

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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 and Alzheimer’s disease. As a result …

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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%), OTC analgesics (41%), …

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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. When he arrived at the ER, …

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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 about DTC advertising are dynamic and have become less favorable …

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