In New York, You Get the Shot Or Walk the Plank
As Art Caplan's most recent MSNBC column explains, New York is taking a hard line on health care workers getting their flu vaccinations this year. It's quite simple: get the shot or lose your job. Health care workers rallied in Albany, NY yesterday protesting that their rights were being violated by being forced to take the vaccine, but some ask: what about the rights of the hundreds of patients that they contact each day whom they could potentially infect by NOT taking the vaccine?
Ultimately, Caplan argues its a matter of professional ethics: put patients first, man up and get the shot. Even if it doesn't guarantee protection against every strain of flu, what do these healthcare workers have to lose--and they certainly have something to gain--the potential protection of their patients from giving them the flu.
To read more of Caplan's argument, click here, or read the argument below.
Summer Johnson, PhD
Health workers must get flu shot or quit
by Arthur Caplan, PhD
Enough already with the whining, moaning, demonstrating and protesting by health care workers. Doctors, nurses, respiratory therapists, nurses' aides, and anyone else who has regular contact with patients ought to be required to get a flu shot or find another line of work.
The California Nurses Association and the National Nurses Organizing Committee have issued statements that individuals should be able to refuse the vaccine. The New York State Public Employees Federation said that "vaccination for influenza is not as effective in the control of disease as vaccination for diseases such as polio, measles and mumps." Other health groups wanted to know why those who preferred to shun the shot could not simply wear masks.
Last week hundreds of people showed up in Albany, N.Y., at a rally to protest New York State's plan to require all state workers to get both an annual flu shot and a swine flu vaccine. Most at the rally said their rights were being infringed.'
Excuse me? What rights might those be? The right to infect your patient and kill them? The right to create havoc in the health care workforce if swine flu hits hard? The right to ignore all the evidence of safety and efficacy of vaccines thus continuing to promulgate an irrational fear on the part of the public of the best protection babies, pregnant women, the elderly and the frail have against the flu? Those rights?
Many hospitals in Illinois, Washington, Missouri, Georgia and Maryland are putting in place flu shot mandates. My own institution, the University of Pennsylvania Health System and its affiliated, top-ranked Children's Hospital are leading the way in getting mandates moving. Why? The answer is simple: The vaccine will save lives.
Only half get vaccine
The annual rate of health care workers getting flu shots has been hovering around 50 percent at most institutions for years. The evidence for the toll this low vaccination rate takes on patients and staff has been mounting year after year.
If you can get close to 100 percent vaccination rates you can cut patient death rates from flu by 40 percent. Sick days among doctors and nurses drop by about the same amount. Eleven babies died of swine flu during the last week of September alone, according to the Centers for Disease Control and Prevention. With a potentially potent form of swine flu on the horizon, those kind of grim statistics have made hospital infection disease experts sound the alarm to implement mandates to boost vaccination rates.
Nothing works as well as vaccines to prevent getting the flu and transmitting it others. Masks may help, but still 20 percent of those who wear them get sick. There is no evidence that vitamins, special diets, fresh air or any other alternative ideas does anything to make flu viruses less nasty. And all we really have to fight swine flu are ventilators, some drugs that may or may not work and the new vaccine.
The medical establishment has been recommending that kids get flu shots forever. The state of New Jersey just put into practice a law requiring flu shots for young schoolchildren in day care and preschool. The U.S. Armed Forces has no time for anyone who will not get a flu shot. If you want to legally immigrate to this country you have to roll up your sleeve. Why should health care workers be treated any differently?
I understand that there are a few people who have medical reasons not to get a flu shot. Those people are and should be exempt. But that is not the issue driving opposition to mandates. When there is push back it is based on the notion that the individual's rights are being trampled in the name of the common good.
Look, there are legitimate issues that ought to be debated whenever someone says you must do something to benefit others ranging from taxation to restrictions on driving under the influence. But health care workers' own code of ethics dictates that they put the interests of others -- their patients -- first.
Getting a flu shot is the least those who claim to be bound by professional ethics ought to do. It's time to man-up and protect those at risk in our hospitals and nursing homes, along with each other, and make getting a flu shot a part of the responsibility of being a healer.
"Academic Doping" is Just Plain Dumb (as Something to Fear)
The first media story I read about Dr. Vincent Cakic's Journal of Medical Ethics paper about the ethical concerns about academic doping I was able to shrug off as just one more enhancement story.
But after reading the 5th or 6th this week about Dr. Cakic's mind-boggling take on "academic doping", the most ridiculous argument made yet this year in an ethics paper had gained so much traction (in the media, at least) that it was time someone said that there is nothing new in his pill bottle.
I began to wonder if this is what neuroethics had degenerated to when I came across a summary of Dr. Cakic's argument in the Times Higher Education supplement, which quoted the author as saying, "As laughable as it may seem, it is possible that (urine testing of students) could very well come to fruition in the future."
Laughable? It's downright, dumb. First, what kinds of substances should we be testing students for when more than 4.4 million children in the US are diagnosed with ADHD and more than 50% taking some kind of drug like Ritalin, Concerta, Focalin or Provigil? Dr. Cakic are you ready to take urine samples of more than 2 million children? Get out your dipsticks and a whole lot of
Where do we draw the line between the children who "need" to be taking these medications and those who are taking perhaps slightly too large a dose or maybe really aren't quite ADD-enough to justify the medications they take and are simply enhancing their brains?
In other words, how will we know when we are dealing with a student who needs Provigil or Ritalin and one who is simply engaging in "cosmetic neurology", as Cakic calls it? Moreover, who are we (I'm using the royal "we" here) to tell college aged students or older high schoolers that they can't be in control of the functioning of their brain when we allow them to be in control of the functioning of their reproductive systems and other "cosmetic" aspects of their lives?
Is Cakic really advocating that schools should become like police states and prior to large standardized testing periods everyone has to go pee into a cup to ensure that everyone is neurologically au naturale? And what about the rest of the school year? Should students be subjected to random drug checks to ensure that their grades aren't jacked up by some pharmacological support?
The analogy that Dr. Cakic draws between doping in sport and "academic doping" is a false one. Olympians claim to be the very best in their sport through training and practice--and agree to a particular set of standards of what it means to be an Olympian who trains to achieve greatness of the human form sans enhancement. (However, even those boundaries of what is "natural" versus what is allowed through "enhancements" such as supplements and the like is being pushed further and further of late.)
Our children, however, do not claim to be "academic olympians". But thank goodness for people like Leon Kass and Dr. Cakic for offering another naive intuitionist account to guide us all for figuring out the difference between the morality of Princeton Review and the sin of Ritalin.
Summer Johnson, PhD
The AJOB Family of Journals Grows by Two!
Today, now available at editorial.bioethics.net, are The American Journal of Bioethics' new sibling journals, AJOB Neuroscience and AJOB Primary Research.
These latest additions to the AJOB family will begin publishing in 2010 and each have 4 issues per year of exciting new content written by the top scholars in the field.
AJOB Neuroscience, now its own freestanding journal, will be edited by Paul Root Wolpe and its associate editor, John Banja, focusing on a wide range issues in the brain sciences.
AJOB Primary Research will be edited by Alexander A. Kon and will publish original empirical research using a wide range of qualitative and quantitative research methods, public policy research, and other social science research.
Authors interested in submitting to any of the AJOB family of journals can now go directly to the new AJOB portal found at editorial.bioethics.net find all three AJOB journals and read more.
Be sure to stop by and see the editors of all the AJOB journals at ASBH this year to learn more about these exciting new publications, including changes to AJOB's format and its being published for a full 12 issues a year!
For any additional questions, please contact the editors at any time! We look forward to hearing from you and receiving your submissions soon.
Summer Johnson, PhD
Executive Editor, the AJOB family of journals
Stay Up-to-Date about H1N1 at pandemic.bioethics.net
WIth the launch this week of the national vaccination program for swine flu, debate is raging over whether children should be vaccinated, who should be first in line to receive the vaccine, and whether the program in general will be effective.
Is America ready for a nationwide flu vaccine drive?
Should parents be worried about vaccinating their children? Is it safe?
Has the H1N1 virus been overblown?
To read about a wide range of perspectives on these questions and many more, go to pandemic.bioethics.net for daily updates, commentary, and opinion from more than 250 readers in bioethics, health policy, the media and more.
Visit us today (and everyday) to learn more!
Summer Johnson, PhD
Nonsense. It's Good For You.
Who knew that "The Ministry of Silly Walks" and other such absurdities could actually strengthen our brains? Yes, it's true. Nonsense is good for your noggin.
But it isn't just the absurd, but the out of place, the "something that is off" sensor that is tripped in your brain, including a whole range of things from the inane (simple changing of patterns) to the insane (seeing a jackalope, perhaps?) that jars the brain from its normal routine into an entirely new way of thinking, says new research discussed today in the NYT.
So why does this matter? It suggests a number of things about the way in which our world ought to be structured if we want our brains to continue riding along the normal neurological highway, producing the same kind of thinking and solutions (or lack thereof to problems). But if in fact we want to jolt our brains into entirely new ways of thinking for the purposes of creative thinking, writing or other endeavors, that is, according to this research, more possible than we believed before. It is, in fact, the notion that putting one's self into a situation where they may encounter the absurd or unusual or simply non-patterned ways of thinking may in fact lead to new ways of seeing the world that is in fact rather revolutionary.
Creativity may follow disorientation. New ideas may follow chaos. Perhaps this should mean that Monty Python should be required viewing for all budding artists, writers, or anyone stuck in a rut?
Summer Johnson, PhD
Slapping Docs' Hands for Not Washing Them
That's the recommendation from the master of medical checklists Peter Pronovost of Johns Hopkins University and Robert Wachter of University of California at San Francisco, says the WSJ Health Blog.
Lack of accountability is the reason why a whole range of medical errors exist contend the pair, according to a NEJM article, including unnecessary infections.
With the H1N1 flu season on the brink, taking the precautions are even more necessary--so penalizing those who don't wash up has become even more important than usual.
The kinds of punishments proposed by Pronovost and Wachter include laying off health practitioners for up to a week for failing to wash their hands. While this may seem rather draconian under normal circumstances, in the time of a pandemic, letting these professionals know that hospitals mean business about hygiene may not be a bad idea.
However, laying off doctors in a pandemic when it may be a time for "all hands on deck" may not be the most sensible approach. Perhaps fines to these physicians and nurses would be a better approach.
Clearly something must be done to show them that hand washing is serious business; the question is how to enforce the rules and how best to ensure patients will not be put in danger by healthcare practitioners who may be lax about basic hygiene.
Summer Johnson, PhD
Right to Reform says Caplan
Published last week in the Journal of Clinical Investigation, Art Caplan discusses the "right to reform". What does this quite simple sounding phrase mean?
Well, those three words say a lot more than one might guess at first glance. In Caplan's argument, he claims that health reform both is all wrapped up and mired down in it quite a lot of ethics talk, values language, and moral commitments which both makes health reform so essential and, quite frankly, so difficult.
But that's why getting bogged down in the details and letting health reform "simply die under the weight of nitpicking, fear-mongering, sloganeering, and the invocation of details as obstructions to change" would be such a travesty.
As I read Caplan's argument, not only is there a right to health reform, but it is right to reform because all citizens deserve access to basic health care.
And I simply couldn't agree more.
Summer Johnson, PhD
Doc Goes "Up in Smoke" for Selling and Partaking in Medical Marijuana with "Patients"
Imagine, if you can, walking into your doctor's office, jumping up onto the paper lined table and the following dialogue occuring:
DOCTOR: "[Coughing] Whew. That's Kush stuff. That's OG Kush. Whew, that's some great potent herb. It's just good to be in California. Yeah. We could be in Oklahoma."The doctor then performs no medical examination or takes a medical history of you at all and deeming you worthy of your pot prescription says,
DOCTOR: "The herb is going to be in here. It's going to be mixing around. Hot air, we're going to catch it. It's just vaporizing. You don't burn it, so you're heating all the good stuff, but you're not creating all the poison that you do when you burn something."
This, ladies and gentlemen, is your California physician.
No, really, this isn't from the Onion. Or from the latest Cohen brothers movie. And I couldn't make up a story this good, even if I tried.
Southern California physician Dr. Tollette has been arrested for lighting up his medicinal herbs with his "patients" in complete contravention with California and federal law. Caught during a sting operation after being suspected for running more of a marijuana dispensary than a legitimate medical practice, as a news report stated it Dr. Tollette "recommended marijuana to just about anyone, as long as the price was right."
This very same news report described Dr. Tollette as having a man with a "very unique specialty [who] displays some questionable medical ethics." Really? I know of, well, no physicians who practice the specialty of marijuanatology.
No worries, Mr. Tollette is no longer a physician. He is serving time in federal prison having pled guilty to marijuana related offenses and Medicare fraud.
Unfortunately, cases like this give legitimate uses of medical marijuana a bad rap and make it an easy target. But if any one can't see that the former Dr. Tollette was a pure opportunist/drug dealer looking to make huge amounts of money from his medical licensure and the ability to dispense marijuana in California, then they simply aren't paying attention.
Summer Johnson, PhD
October Comes Early for AJOB!
Already live and available on bioethics.net is the October issue of The American Journal of Bioethics.
Featured this month on the cover is the topic of nanomedicine including an editorial by Dr. Summer Johnson on whether the era of nanomedicine is upon us, still galloping toward us, or likely simply never to arrive.
This editorial is in response in large part to a Target Article by Fritz Allhoff reviewing the broad spectrum of ethical issues in nanomedicine's "coming era".
Also in this month's issue of AJOB is an Target Article by Rentmeester and George discussing the morally complex clinical ethics cases when a psychiatric consult is requested by physicians.
Lastly, Gesundheit et al raise the question of "who is a terrorist?" and even when the definition is clear, they ask the question of scope and nature of the responsibilities of physicians to treat such persons, even against their own personal moral convictions.
To read more about the October issue of AJOB, click hear to read the entire Table of Contents. (Free copies of this issue will be available at the upcoming American Society for Bioethics and Humanities Annual Meeting in Washington, DC.)
Summer Johnson, PhD
Former Governor Embraces the "R-Word"--And It's About Time!
Former Governor Dick Lamm has come out to do something that most of us realists in the healthcare debate have done long ago: acknowledged that the "r-word"--rationing--is not a dirty word, and in fact, is something we already do in our health care system. Moreover, rationing is not something to fear as a result of any public healthcare option we would embrace as part of "Obamacare", but in fact rationing is a real part of the healthcare system we exist in each and every day. We simply accept it as part of a system that we fear changing and it is that stubbornness that will be our downfall.
In his commentary on the Huffington Post blog, Lamm makes the point clear and simple:
"The United States now has the worst form of rationing. We ration people by leaving them out of the system. We tell each other that this is indirect rationing, and apparently we find this morally easier to accept than direct rationing. A sin of omission is easier to live with than a sin of commission. But it is rationing in its cruelest form: the Institute of Medicine estimates that 20,000 Americans die each and every year simply because they lack health coverage."
So rather than steering clear of the r-word, Lamm calls a spade a spade and says that it's time to stop the very worst kinds of rationing--the morally unacceptable, indirect kinds that leaves people uninsured and out in the cold, and to explicitly ration where we can and must using whatever resources we have available.
I couldn't agree more. We are long past due to stop thinking of rationing as a dirty word. We already do it--indirectly and with disastrous results. If we did it explicitly, the outcomes are certain to be better.
Summer Johnson, PhD
