DMEJ
Duke Medical Ethics Journal
Fall 2022 Blog Highlights
Caroline Metz • October 18
"From new developments in mRNA vaccinology to targeted cancer treatments, the United States has made many strides in the medical and research fields. However, these advancements come with a history of unethical trials and experiments, one of which being the Tuskegee study of Untreated Syphilis.
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In the early 1900s, there was no known treatment for syphilis, a bacterial infection that can lead to death. In order to study the progression of syphilis, researchers from the U.S Public Health Service promised 600 African American men in Macon County, Alabama free medical care if they enrolled in the project in 1932. 399 of the men had latent syphilis, while the control group of 201 were free of syphilis. These men were told that they were being treated for “bad blood,” which was a common layman term used to generally describe different illnesses..."
Tochi Onuegbu • October 18
"Our eyes, an essential part of our sensory organs, allow us to perceive the rich and diverse world around us – but they are more powerful than we think. These mighty machines have the ability to alert us when there is a problem with an organ's function and even signify the onset of diabetes!
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The development of less life-threatening eye conditions, such as cataracts or glaucoma, is a sign of aging. If care isn’t taken, these conditions can progress to blindness. Fortunately, early identification, diagnosis, and treatment can prevent vision loss. In cases where the cataract or glaucoma is severe, a simple surgical procedure can allow the patient to regain sight and confidence in performing their day-to-day tasks. Yet, it is clear there are higher rates of preventable blindness, in marginalized communities, where access to healthcare is poor and there exists an overwhelming lack of resources. The correlation between marginalized communities and high poverty rates suggests that even if such resources were available, many patients would be unable to provide monetary provisions due to a lack of funding..."
Laura Wang • October 25
"Cleft lip and/or palate (CL/P), where the upper lip is divided at birth and can continue into the hard palate, is one of the most common congenital abnormalities worldwide. This condition affects one in 700 live births globally and is most common in Asia with 1 in 500 live births. Untreated, CL/P can lead to difficulties feeding, breathing, speaking, and hearing, but CL/P can be treated successfully through reparative surgery. Unfortunately, increased cleft lip risk has been found to disproportionately impact those with indicators of lower socioeconomic status, including lack of prenatal care and lower maternal education, and those living in low-resource areas face geographic and economic barriers to quality care access..."
Abby Cortez • October 25
"Henrietta Lacks is immortal. Or, more accurately, her genome is. The HeLa (short for Henrietta Lacks) cell line is one of the most important scientific tools of the past century. They all originate from the original sample taken from the cancerous cervical tumor of an African American woman in the 1950s. Prior to their discovery in 1951, scientists had never been able to preserve the life of human cells outside the body for a significant amount of time, something crucial to many research questions. Now, labs all around the world can grow HeLa cells, and many do.
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Since, HeLa cells have contributed to numerous scientific discoveries that have revolutionized medicine and molecular biology. HeLa cells were crucial in the development of the polio vaccine, in vitro fertilization, the discovery of human telomerase, and most recently the development of the vaccine for COVID-19..."
Jaden Sacks • October 27
"65 babies die every day in the second half of pregnancy in the US, which totals to 23,000 stillbirths annually in one of the most developed countries in the world. Although the rate of stillbirths has decreased in the US since 1990, it has recently begun to level off in the past two decades. From 2000 to 2015, the US stillbirth rate has decreased by only 0.4%, which shockingly contrasts the 6.8% drop in the Netherlands. This issue is awful and unacceptable, but it can be prevented if proper measures are taken.
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Stillbirth is defined as the loss of a baby anytime after 20 weeks of a pregnancy. Some likely causes and contributors to stillbirth include problems with the placenta, birth defects, infections, problems with the umbilical cord, high blood pressure disorders, and maternal medical problems. A research project that studied over 500 stillbirths over the course of 2.5 years also determined that women were more likely to have a stillbirth if they experienced stress before their delivery. Furthermore, the risk of stillbirths was doubled or tripled when the mother smoked tobacco, marijuana, took prescription painkillers, or used illegal drugs during pregnancy..."
Simone Nabors • November 1
"Most Americans who were alive and conscious during the 80s and 90s have some remembrance of the beginning of the AIDS crisis. For some, it was a distant truth that barely tapped into reality, or perhaps a karmic consequence for deviant “others.” For many members of the LGBTQ+ community, it was a period of terror and immense loss that has never been fully healed. Today, for every story we do hear, there are thousands that may never see the light of day.
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A commonly held sentiment is that we need to remember the AIDS crisis. This is absolutely true, but we do not often talk about why we need to remember it. If we fail to remember our past, we are doomed to repeat it. If we fail to learn from our present, we are doomed to become trapped in it. The AIDS epidemic is far from over. In 2021, 40 years after it was first reported, over 500,000 people died from AIDS-related illnesses globally. This anniversary of the ongoing crisis was met with the COVID-19 pandemic, which, despite growing public apathy, is also far from over. Looking back to the start of the AIDS epidemic, it is not only important that we accurately remember what happened but also that we learn from it. Today we are at a pivotal point, both in remembering the past and in learning from the present..."
Saisha Dhar • November 1
"It’s hard to concretely characterize the causes and effects of “trauma”, as it can take a variety of forms. Trauma can stem from adverse childhood experiences (ACEs), singular traumatic events, or historical and intergenerational consequences from deeply rooted societal structures. Generally, it is defined as a “response to a deeply distressing or disturbing event that overwhelms an individual’s ability to cope, causes feelings of helplessness, and diminishes their sense of self and their ability to feel a full range of emotions” (Routsis, 2022). Trauma has a large impact on health as it disturbs proper nervous system functioning—and for marginalized communities that often lack the support to heal, this can have severe downstream effects on other aspects of biological and social function. Because of a lack of trauma-informed healthcare systems, marginalized populations don’t receive adequate and equitable care, and are less likely to utilize healthcare overall. Righteously so, minorities also have mistrust in the western medical system because of the colonial, exploitative history of using people of color for the advancement of medicine. This sustains barriers to care that are exacerbated by the system’s oversight of trauma..."
Shubhika Munot • November 1
"Should scarce medical resources be provided to those who have waited the longest for them or require it the most? Should a 20-year-old be prioritized over an 80-year-old for a life-saving cure? Let’s say we have one hospital bed for every 1000 citizens or only 57,000 ventilators in a country of over 1.3 billion people [1]. Who gets precedence? Unfortunately, this is the very challenge that plagues many developing countries every day.
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How do we fairly allocate medical resources, especially when there is a critical shortage for them? This brings us to the conversation on the ethics of healthcare rationing, which has never been more imperative than today as we strive to recover from a global pandemic. A pandemic that has exposed the poor healthcare systems around the world, especially in my home country of India where systemic inequities are highly prevalent – whether this be the lack of primary care providers, low medical supplies, inadequate hospital infrastructure, or shortages of medical devices. Those who can least afford these limited resources are disadvantaged the most, while, the private healthcare sector continues to grow, providing for the urban rich. However, rationing simply based on socioeconomic status is evidently unfair, so here are some alternative approaches of distribution:.."
Jennifer Nguyen • November 7
"A health crisis is not urgent until privileged populations become casualties. Oftentimes, during these crises, privileged populations are helped at the expense of minority populations. For instance, the HIV/AIDS epidemic became a national calamity because heterosexual individuals, which composed the majority of the U.S. population at the time, feared that they would contract HIV/AIDS. Thus, because HIV/AIDS was believed to originate from homosexual individuals, homophobia spread in an attempt to protect heterosexual individuals, leaving homosexual individuals behind in the dust. For instance, healthcare workers like Dr. Hunter Handsfield promoted homophobia in order to protect heterosexual individuals like himself from the potential “threat” of homosexuals. Dr. Handsfield emphasized that because heterosexuals are at such a low risk, no matter how promiscuous they are, there must be “something special about gay sexuality with respect to disease transmission.1” Even when faced with evidence that heterosexual infections more than doubled in 1985,2 he and other health authorities did not believe the surge warranted a warning to heterosexual individuals that they, too, could sexually transmit HIV/AIDS.1..."
Anna Chen • November 7
"Poor mental health and mental illness have become increasingly prevalent in the United States. In 2019, about 20% of adults reported experiencing mental illness, representing over 50 million individuals.. This mental health crisis was further exacerbated by the COVID-19 pandemic, when many experienced social isolation, stress, grief, and financial struggles. WHO (World Health Organization) reported that the pandemic triggered a 25% increase in the prevalence of anxiety and depression worldwide. Among those affected, the mental health of certain racial/ethnic minority groups worsened relative to that of non-Hispanic white individuals. Specifically, there was a greater increase in mental illness reported for Black, Hispanic, and Asian adults. Furthermore, these groups are less likely to seek out mental health treatments and care. This underutilization of mental health services, especially among people of color, is a persistent and important issue in healthcare..."
Marshlee Eugene • November 13
"Black women are three times more likely to die from a pregnancy-related cause than white women, as reported by the Center for Disease Control. Preeclampsia and eclampsia, which are both terms for high blood pressure at different times during pregnancy, is a leading cause of death for black mothers, yet if diagnosed early, is easily manageable. According to the Population Reference Bureau, “Black women are five times more likely to die from pregnancy-related cardiomyopathy and blood pressure disorders than white women.” Why is a treatable condition causing disproportionate deaths of black mothers? Evidently, a gap exists in communication between patients in the doctors, in which a lack of an adequate diagnosis and/or treatment leads to increased rates of black maternal mortality. The following are potential factors that can contribute to higher rates of black maternal mortality..."
Meera Patel • November 14
"A year ago, the FDA fast-tracked a brilliant new therapy for Alzherimer’s disease. Alzheimer’s is a devastating neurological illness which causes slow cognitive decline over time, characterized by beta-amyloid plaques which surround neurons in the brain. This new drug, known as aducanumab, removed the plaques linked to the neurological devastation caused by Alzheimer’s disease. The only problem? There was no proof that aducanumab actually treated Alzheimer’s.
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Aducanumab looked promising at first. After all, it had been shown to remove beta amyloid plaques, a key hallmark of Alzheimer’s disease. However, in clinical trials, Aducanumab hadn’t been shown to reduce the symptoms of Alzheimer’s, nor slow down the progression of the disease significantly. In other words, the FDA had fast-tracked a therapy that wasn’t actually proven to treat Alzheimer’s..."
Olivia Kim • November 14
"There are over 427,000 undocumented immigrants enrolled in higher education in the U.S., and nearly 90% of them attend college as opposed to vocational school [1]. However, it is estimated that almost 1.6 of the 11 million undocumented immigrants in the U.S. are between ages of 16 to 24 years old [2]. In addition to greater socioeconomic opportunities, higher education is especially critical because many studies have found it to be a strong predictor of health outcomes.
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Documentation status has been identified as a social driver of health and risk factor: those without legal documentation status are more likely to have worsened health [3]. Among non-senior adults that are noncitizens in the U.S., 42% were uninsured in 2020 [4]. This lack of healthcare coverage for undocumented adults leaves many of them only able to access healthcare through Emergency Departments (EDs), Federally Qualified Health Centers (FQHCs), and local volunteer-run clinics [5]. Another way undocumented immigrants receive care is through clinics on college campuses. Most colleges in the U.S. require students to have health insurance and likely provide subsidized plans, so higher education is a great mechanism in which undocumented immigrants may achieve better health outcomes in the short and long term..."
Dhanasheel Muralidharan • November 14
"Throughout the COVID-19 pandemic, acts of violence towards peoples of Asian descendance increased dramatically, with extreme acts stemming from the misinformation and unjust racial stigmas propagated by various key figures throughout society. In response to this violence, Congress was put under pressure to provide some level of response in the form of some legislation in support of these peoples; thus arose the COVID-19 Hate Crimes Act, in the hopes of tackling the increased anti-Asian violence. However, while this violence stems from a source not too long ago, the disparities and discrimination that the Asian population has faced extends far beyond the visible eye..."
Kidest Wolde • November 14
"The American Health system is systematically entrenched with inequalities that have a significant disproportionate impact on people of color, as well as other minority groups. These inequalities include accessibility to services, poorer health results for some populations, and gaps in health insurance coverage. African Americans, specifically, suffer the effects of these health care discrepancies by great margins. Early on as the 1600’s, America has been founded upon a “white racial framing,” which is still perpetrated in society, evidently seen in healthcare discrepancies between races. The article “Systemic Racism and U.S. Health Care” written by Joe Faegin and Zinobia Bennefield elucidates the historical literature writing on medical and public health practice which produces and maintains structural discrimination that harm African Americans. From their research, they conclude discrimination, white socioeconomic resources, and racialized foundations in America—from centuries of segregation and continuous white oppression—restrict access of black Americans from sufficient health care. Systemic racism is an issue for several minority groups, referring to the practice or belief that have, whether by design or consequence, the effect of limited opportunities—of an individual or group—generally available because of attributed rather than actual characteristics. Systemic racism is a significant problem for health care for African Americans in that centuries of discrimination and segregation perpetrate biases infiltrate medical decisions and treatment for such minority group. If this problem subsists, then life and death seem to be predetermined by race in the United States, despite discrimination being outlawed in 1964..."
Rhiannon Eplett • November 21
"Healthcare providers, researchers, and average civilians alike would agree that the future of healthcare is precision medicine. Particularly with the rise in accessibility and accuracy of genetic testing, people can learn more about their health on a molecular level than ever before. People can test for genetic disease to personalize their care, to select the most effective drugs for their individual needs, and to identify the likelihood of developing a disease in the future. Access to personalized healthcare should be made easier and more inclusive as direct-to-consumer genetic testing increases and diversifies. However, much of the structure that already introduces health disparities between racial, ethnic, and socioeconomic groups has the potential to increase those disparities as genetic testing becomes more prominent..."
Zeqi Sun • November 21
"In human nature we have an intrinsic drive for progress and innovations when developing solutions to a challenge that has never been solved before. However, what is the use of such advances if 61% of the world’s population cannot afford to employ such innovations?
I am talking about breast cancer treatment.
Breast cancer is the most commonly diagnosed type of cancer among women worldwide and is the leading cause of cancer death in more than 100 countries. However, 61% of breast cancer patients find it hard or impossible to afford the care that will alleviate their pain. While we celebrate the invention of new high-tech breast cancer treatments, we often lose sight that such innovations are only helping a fraction of people around the world who are financially capable of investing in this type of care. But what about the majority of breast cancer victims? How can they get the care they need?..."
Marshlee Eugene • November 21
"As defined by the World Health Organization, health is “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.” In the past, mental health has received little attention due to the negative stigma surrounding it in various cultures and religions. Thus, individuals with mental health disorders were afraid to disclose their disorder publicly and speak about their symptoms. However, over time, mental health has played a more prominent role in public health discussions. As mental health issues and disorders become more “acceptable” in society, more people are becoming officially diagnosed with mental health disorders. Unfortunately, this increase in diagnoses has created a substantial gap between the supply and demand of mental health treatment services across the globe..."
Heiley Tai • November 21
"Very rarely are new drugs and therapeutics sold legally in the U.S. nowadays, unless they undergo a lengthy FDA approval process, oftentimes consisting of decades’ worth of rigorous testing. This, however, hasn’t always been the case. Many of the regulatory agencies and processes that exist today are direct results of disasters like the thalidomide tragedy that occurred in the 1950s and 60s, during which thousands of infants were born with, among other things, physical malformations, internal organ damage, or congenital heart disease as a result of the mothers being prescribed the drug thalidomide. Thalidomide, used today to treat multiple myeloma and leprosy, was previously prescribed to pregnant women to aid with nausea and other symptoms. It is now a known teratogen—a substance that, if a pregnant woman is exposed to, can interfere with normal fetal development and lead to congenital disorders.[1]..."
