Life as an Extreme Sport

Category: Academics

Classes and coursework.

Friday Ethics Roundup

...and everything else, Academics, Bioethics

The good folks over at the AJOB blog have been a bit busy lately, and thus there’s not been as much discussion going on in the blog. However, Sean is apparently superhuman, requiring no sleep, and has been keeping up the Bioethics Newsfeed. I’ve been wanting to chitchat about some of the articles that he’s been finding, and although I’m basically talking to myself here, this is going to have to do.

First up is the whole Merck/Vioxx chaoscluster. It seems that Merck hired an independent firm to look over the Vioxx scandal, and see if Merck should have done things differently. Perhaps not at all surprising, the hired and paid for by Merck “independent council” found that Merck did no wrong, and couldn’t have known before 2004 that there were heart risks with Vioxx. Nevermind that the “investigation” didn’t find, discuss or disclose any documents, emails, or etc that hasn’t already been in the public domain these last two years. Or the fact that what is available to the public shows internal scientists worrying about the negative side effects of Vioxx as far back as 1997. Nope, Merck did a bangup job, and will continue operating as they have been.

I can appreciate that outside legal folk are saying that don’t look at an internal investigation skeptically (which, as an aside, is a word like awkward, so far as spelling goes) ’til you’ve looked at the data, but in this case, the outside legal person hasn’t seen the data, either. And how can you not take a look at the public evidence already available and go “wow, the company screwed the pooch, and then went back for seconds” ?

According to the NYTimes,

The main body of the report runs 180 pages, with 20 appendixes that include another 1,500 pages. Lawyers for Debevoise reviewed millions of pages of documents and interviewed more than 150 witnesses, including some outside scientists who consulted for the company. The investigation took 53,000 hours, according to Debevoise.

The report, however, has no narrative explaining how Raymond V. Gilmartin, Merck’s former chief executive, communicated with Dr. Edward M. Scolnick, its former chief scientist, or other senior scientists and executives at Vioxx during the years it was under development and then on the market.

Instead, it essentially consists of point-by-point rebuttals of the criticisms that scientists and plaintiffs’ lawyers have made against Merck since the company withdrew the drug, including contentions that Merck misled federal regulators and marketed the drug without properly disclosing its heart risks.

The specifics of the rebuttals are almost exactly the same as those offered by Merck’s defense team in the civil suits against the company. Hmm. Does that sound independent to you? ‘Scuz me whilst I wipe the sarcasm off my desk…

~*~

New Scientist has an interesting article about the link between psychological cleanliness and physical cleanliness. Basically, we have the urge to scrub sin away – physically. Called “the Macbeth effect”, for darlin’ Lady Macbeth’s “out damned spot” soliloquy (I need to get my wifi router set up – it’s amazing how much I rely on the ‘net for spelling), it was prompted by noticing that pop culture makes sinners wash (especially murderers). Their methodology as described in the article was certainly interesting, but it really raises more questions for me than simply saying “voila! we have a clear link and thus it shall be”; or in less dramatic terms, as Philip Tetlock said, “this final experiment establishes a link between moral and physical cleanliness.” That, I just don’t buy.

I’d like to see what level of “sin” (or shall we call it unethical or personally immoral behaviour?) is necessary to instigate this washing effect. Do we need to clean ourselves off when we lie? How big a lie? Is it only for something worse? Do people convicted of murder, the so called professionals, wash? What about people who rape? Rape victims certainly wash, scrub violently in an attempt to clean themselves, but is this their own perceived sin they’re washing away – guilt complex gone awry – or someone elses?

It simply seems too soon to tie a bow around this idea. It’s definitely intriguing, and I love it when culture and science slam together to provide something new, but I simply don’t see it as a finished, locked up and down, conclusion.

~*~

And finally, and personally, the DEA finally did something right for once, proposing

a formal rule that would allow doctors with patients who need a constant supply of morphine-based painkillers to write multiple prescriptions in a single office visit. Under the new rule, a doctor can write three 30-day prescriptions at a time — two of them future-dated — to be filled a month apart.

This means my life just got a lot easier. I cannot stress what a bitch it is to try to get into a busy specialists office every month, be charged for a 20 minute visit, all so the following conversation, which takes less than 5 minutes, can be had:
Doctor: So, how’s the pain?
Me: About the same. Not well managed, but I’m functioning.
Doctor: Okay, no prescription issues?
Me: Just running low.
Doctor: Okay, here ya go – see you next month.
Me: Danke!

This way I’ll be able to walk out with three months of prescription at once, and be responsible for filling and treating my pain on my own – which is how it should be. I’m the one who lives with this daily, and am the one who should be deciding how much and what I need, medicine-wise, to function. Three month visits are what’s recommended for most chronic pain problems, and now I can actually do that realistically and comfortably, instead of having to do the counting-ration once a month. Halle-fucking-lujah!

Late and Early

...and everything else, 2006 (NY), Academics, University at Albany

Insomnia struck tonight – I guess that’s what happens when I don’t take something to help me fall asleep. I’m running low on that arsenal, though, and can’t afford to pick up Lunesta on my own. I have to wait for both finaid and my prescription card to get here, and who knows how long that will take. So I thought, since I was sleepy, I’d just wait for the sleepy to become the sort of sleepy where, well, you go to sleep.

It’s 5:15am, and that hasn’t happened yet.

So on the one hand it’s late. I had a full day, too – the first day of class. I think I’ll enjoy it; phenomenology with Ron. It looks like it will be a good blend of familiar while also pushing what I know.

After class, I wandered through the graduate student office, chatted with a couple of people, and started to meet the other students. By some weird twist of fate, everyone I talked with today was also new, and we all seem to hit it off well. An added plus? We all have slightly overlapping, but very different interests. This means we compliment one another well; N~ will be able to help me with, say, political philosophy, while I can probably help Sa~ with phenomenology.

The important thing, though, is meeting people I like, and that I can talk to.

I played in the library after that, and I ended up bringing home a stack of books, a stack of books I don’t have to return until 2007. Anyone who remembers my bitching about the UW library policy for undergraduates doing research (essentially, nothing) will know how much this fills me with joy. And even better, I can have up to 200 books out at a time! Delicious freedom!

Anyhow, I did a couple of other things, and got home in time to eat dinner before my Weds night entertainment. I figured I’d be in bed around midnight, 1am at the latest. But that didn’t happen, and now it’s late.

It’s also early. We’ve ventured into and are soaking in that time of the morning I love, when the world is quiet and soft, and it seems like it can’t be complete without a cup of tea and perhaps a few biscuits at hand. It’s the dawn version of the gloaming, the world holding its breath as it waits for the sun. This is a wonderful time of day for me, and I’m always extremely productive during it. (So you’d think I’d consistently get up at this hour. The problem, of course, is that there’s so much on in the evening I enjoy, and I truly am still a night owl. What I need to do is be able to sleep from 8am – 2pm!) So I feel like I should do things, unpack things, organize and make right. I’d love to have everything set up here by Monday at the latest, but I don’t see that happening without serious energy or help. Naturally I feel like I should take advantage of this time of day and the energy and wholeness that comes with it.

Except, of course, the fact that my arm hurts when I even flex it (yet I still type; I know, I know), and the more base fact that I appear to have slipped into hallucinating slightly. It’s that sort of watery world hallucination, where you are suddenly seeing everything through 5 feet of slightly waving water. My senses are hyperalert, just…wrongly so. So in addition to the natural wonder of this time of day, I have the crystalline perceptions of a world slightly distant, shot with electric pain at every twitch.

And now, two cats, both insistently cuddling and purring. Perhaps I should rearrange things so that they have more room than the computer, and contemplate how I’d like to arrange my books – maybe I’ll get better perspective from a horizontal position. One that includes a squishy thing other than cat, and a a shawl knit from love and friendship.

Fin

...and everything else, Academics, Bioethics, ProSeminar 2006

Two weeks out, and my feelings about the bioethics course are still pretty much the same. It felt, largely, like a giant waste of time. It was such an area of potential, so many grand opportunities of could be, and I feel like it was wasted on a group of people who either didn’t want to be there or didn’t have the maturity for it (primarily the undergradate LIM students), or who wanted to be there but either had inaccurate expectations or no knowledge about, well, philosophy and bioethics.

While I don’t think that you should need a degree in, say, philosophy, to be in the program, I do think you need some philosophy background before taking a two week intensive course in bioethics, especially when that course is being taught by not only experts but the fathers of the field. We spent way, way too much time going over Philosophy 101 (not to mention History 101, and too many other 101s), and not enough actually delving into the material at hand. Additionally, having the additional LIM students meant having much, much too large a group, which negated the seminar aspect of the course and turned it into any other lecture class.

It’s not what I signed up for, it’s not what I was told about. And frankly, I don’t appreciate the underhandedness that went into it – we were told it was a seminar of graduate students, no more than 15-odd people, until the first day. “Oh, btw, we have undergraduates that are going to double the class size, too!” It was sneaky, and I think it was done because they knew people wouldn’t want to come into the program, otherwise.

This program needs revamping; I can only hope that actually ends up happening, and sooner rather than later.

Dax [August 16]

...and everything else, Academics, Bioethics, ProSeminar 2006

“No doctor is skilled enough to treat a man without his consent.”

This is an amazing experience. I’m not sure how else to categorize it. And for me, it’s intensely personal, as well. Pain management was nearly non-existent when Dax was injured, and has come forward leaps and bounds since the 1970s. And it is in large part through the activism of Dax and people like him that this has happened; awareness has increased to the point that those of us who suffer debilitating pain can receive the treatment we need, and can live relatively normal lives. I can’t imagine being asked to endure what Dax did, even for a day, and yet not only did he do it, but he emerged from it strong enough to continue arguing for the benefit of others.

I wondered in my last entry if Dax still felt the way he did the last time I’d read anything; that he still wished the doctors would have allowed him to die. After all, he has a successful life, a legal practice, a wife, friends. It took seven years for him to regain a quality of life he thought was worth living for, and that was simply too high a price to pay.

I can’t say I blame him. Sulfamonolode and wet to dry bandages aren’t used any more, considered too barbaric. And no wonder! A topical antiseptic across raw wounds that felt like pouring alcohol on or allowing bandages to dry and adhere to the wound to yank it off again. Debridement in a tank full of chlorox and water doesn’t sound fun, either; I wonder if they still use that? My one experience on a burn ward, during my pre-med days, there was actually a severely burned boy there; about 75% 3rd degree burns from a frat party gone wrong. He, at least, was being kept sedated and under wet wraps and this sort of…goop, for lack of better word, was covering his open wounds. Last I’d heard, he’d made a decent recovery.

Listening to what Dax had to go through, I am struck by the thought that, so often, what is done in medicine is not done with the best interest of the patient in mind. It’s done with the best interest of the health care professionals in mind, or the lawyers, or the hospital itself — but not the patient. The patient is simply there to endure whatever is being done to him or her, and even in this day and age there is so often no choice in what’s being done — being dismissed AMA is much harder than people make it sound like it is.

It also strikes me that Dax simply was not given the opportunity to communicate. Communication has been a recurrent theme this course, and this case is a consummate illustration of miscommunication.

Interestingly, Dax doesn’t think autonomy is a one-way street. He does feel that it’s two way, and that doc’s do not have a right to force treatment, just as patients don’t have the right to force doctors to perform procedures they don’t believe in. While, when I’m arguing for autonomy, I often find myself making similar argument, things like the controversy over the Plan B pill make me hesitate to throw my lot full in. If a woman desperately needs an abortion for, say, medical reasons, but the only person with any training for 100 miles has opted to no longer perform abortions, who is right? Whose autonomy reigns supreme? Autonomy might be a two-way street, but it’s still one where head-on collisions can and so often do occur. We really have got to move beyond autonomy as an answer; there is simply too much, too many situations, where it is not feasible, where it does not solve conflict.

He who controls the knowledge has power, and because of this Dax rather adamantly believes that doctors should not be the only ones with authority to perform certain procedures; they should not, in fact, control the knowledge. (And around here I’ve got scribbled in the margin that he has an excellent understanding of JS Mill, although of course I didn’t write down precisely what prompted that note.) It was, however, around here that Dax told his feeding tube story, and the joy in his voice as he talks about this, to this day, is amazing — and it’s because he had control.

Control is often an important issue for patients. They are in a situation without knowledge, where their body is out of their control, with doc’s operating on esoteric knowledge that, informed consent dreams aside, no patient can hope to immediately understand. As patient, you begin fighting for whatever you can control, in these situations — even if it is a small and simple thing. Not eating. Not having a feeding tube inserted.

As a person, then, in a place of both power and negotiating ability, it must be exceedingly important to remember to cede as much control as possible to the party who feels they are without (which, I would wager, is the patient the majority of the time).

The entire Dax case brings me back to wondering if informed consent is truly possible, and the old saw of whether or not you can truly give consent without having a medical degree? These days, especially, it seems like many doctors will just throw every possible amount of information and option at you, and leave you to figure out what to do — often with the aide of the ever-unreliable internet. I’m hearing more and more arguments against the idea, and that it’s simply a cop-out for doctors; I don’t know if I would go this far, but I do think it’s the sign of a litigious society that it’s such a major issue. Well, and I wonder if we shouldn’t coach it in terms of informed consent so much as proper information for consent.

I’m thankful I was able to thank Dax in person; as I’ve said, he’s someone who, stranger to me, has had a huge impact in the quality of my own life. I’m also glad I was able to clear up the misconception that I was Colleen; rather unpleasant to be confused for her, although given I was sitting behind her I understand why. But since I actually agree with most of what Dax says, and find myself squabbling over minutiae and splitting hairs (well, I’d argue that discussions of autonomy aren’t minutiae, but I will conceded that they are highly esoteric and not important to the everyday person), it was good to not have the association of “person with RSD” and “handicapped person” together.

Unfortunately, there are not a lot of answers in Dax’s presentation, as there are not in his case. The questions of autonomy, consent, and medical knowledge — they are still as much up in the air now as they ever were. Perhaps the difference is simply that they are indeed out in the air, being discussed and thought about, instead of not questioned at all.

The End [August 17-18]

...and everything else, Academics, Bioethics, ProSeminar 2006

Unfortunately, at this point in the week my pain issue kicked up to the point that I have few notes. Dr. Thompson, the intensivist, was exceedingly kind to us, in both our excessive questioning and tour of MICU/SICU. His offer to share his recent book was also kind, and something I plan on taking him up on.

The extreme cold in our classroom chased me away from AMC shortly later, and I went home to nap. Against my better judgment, I did join everyone for dinner — and am glad that I did. Sitting with Alicia, Glenn, and Sean at dinner was an amazing treat, and a lot of fun. It reawakened a bit of the passion that I was starting to miss, under bad sleep, stress, and pain. Unfortunately, it took its effect on me, and I spent the night with pain keeping me up, Lunesta be damned. When I did finally wake Friday morning, my right arm, shoulder to wrist, was locked firm against my body, and any attempt to move sent shattering, lightning pain through my body.

I was able to eventually get it under control, with judicious use of hot water and pain medication, and made it to campus barely in time for our presentation, which went as badly as I thought it would. I’ve kept most of my thoughts about the LIM students to myself, as well as project preparation, but I was exceedingly frustrated with the students I had to work with. They had no concept of time, no idea how to manage their presentation, and wouldn’t shorten what they had for anything; when I shortened their slides, they simply put them back in, or talked as though the slides were there anyhow. You simply cannot read 10 slides in 2 minutes, I don’t care how fast you speak. So of course, the end result was that both Peter and I had to shorten, or fully stop, what we were saying.

The audience critique of the presentation felt rough, too. Having Larry there was not easy, and I didn’t like feeling responsible for the misunderstandings of my team members — especially when they were misunderstandings that we’d argued over for nearly two weeks, and they simply would not listen.

Of course, when you’re in pain, everything is blue and cranky, which is definitely where I am right now. I’m sure, in a few days or weeks, when I’m back under proper pain management, I’ll have much fonder memories of the whole thing!