DMEJ
Duke Medical Ethics Journal
Fall 2023 Blog Highlights
Anna Chen • October 15
"Healthcare visits no longer have to be in person. In fact, with a good camera, reliable internet connection, and some sort of electronic device, patients can easily set up a telemedicine appointment. As the name suggests, telemedicine refers to “the provision of remote clinical services, via real-time two-way communication between the patient and the healthcare provider, using electronic audio and visual means” (1). This transformative healthcare approach, although in use before the COVID-19 pandemic, witnessed an extraordinary surge in adoption during this unprecedented time. One study that looked at five states (Arizona, California, Maine, Mississippi, and Missouri) reported that the number of telehealth services increased from 2.1 million in the year prior to 32.5 million in the period between March 2020 and February 2021 (2). Even after the pandemic, telemedicine continues to be a prominent and essential tool in healthcare: McKinsey & Company's insights indicate that the utilization of telehealth services has stabilized at levels 38 times higher than that seen before the pandemic (3)."
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Meera Patel • October 15
"Flying cars. Robots that take your order. Buildings that float. The futuristic world of our imaginations has long been a faraway dream—but the technological revolution of the modern era has only just begun. While we may not have flying cars or floating buildings just yet, we are now able to change the human genetic code. We’re developing technologies that have the potential to make robots capable of surgeries, watches capable of detecting heart problems, and virtual reality capable of helping patients manage psychological trauma and overcome their conditions—and that’s just the tip of the iceberg. The future offers exciting new prospects in the field of healthcare, helping increase the number of lives saved on an unprecedented scale."​
Annie Villa • October 16
"A man in his 60’s walked out of Barnes-Jewish Hospital in July of 2023 with a brand new liver, saving him from his liver cancer and cirrhosis caused by hepatitis C.Who does he have to thank for this? While Dr. Adeel Khan and his trusted team of surgeons worked relentlessly to plan and execute a life-saving liver transplant, the true hero of this story may be the robot who performed the actual surgery."
Jack Rangel • October 29
"Smartwatches and fitness trackers have become exponentially more popular over the last few years, however, they present several ethical issues regarding privacy of health data. In 2021, a Pew Research Study found that 21% of Americans use smartwatches or fitness trackers (1). By the end of 2023, it is expected that there will be approximately 225 million smartwatch users (2). While there are dozens of different brands, the most common watches include the Apple Watch and Fitbit. Not only has this technology become a trendy way to check texts and time, but it also provides important health information. However, the increased use of wearable technology poses a critical question: is the personal health information stored by these devices kept secure?
The healthcare benefits of these smart devices are expansive. They can measure physical activity, heart rate, sleep, blood pressure, calories, stress levels, alert EMS after a fall, and more. There have even been several cases, such as with Heather Hendershot, where the health features have helped save lives by detecting abnormalities or automatically alerting EMS. For Hendershot, her Apple Watch alerted her of an extremely high blood pressure, and she was later diagnosed with hyperthyroidism, “a condition where the thyroid gland produces excess thyroxine hormone” (3)."
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Mariana Bouchan • October 29
"Robotic innovation in medicine has emerged as a pivotal advancement, revolutionizing patient care and surgical procedures by enhancing precision, improving outcomes, and expanding the scope of what is medically possible. In the early hours of 2022, Haytham Almunir was suddenly struck by a devastating stroke that left his hand paralyzed and his speech incoherent. It was later at UC Davis that the brilliant neurosurgeon, Dr. Ben Waldau, unveiled the harsh reality: a carotid stenosis, an insidious artery condition obstructing essential blood flow to his brain. After weighing different options, Almunir consented to the urgent placement of a stent, which holds the artery open. This operation was novel—it was the first stent at UC Davis to be placed by a new endovascular robot. Robots offer critical advancements to the field of surgery; surgeons are optimistic that robotic surgery assistance can reduce the chance that patients return with complications post-surgery. Surgeons maneuvered the robot to navigate a write past constriction in the artery and open it in order to add the stent. Almunir surprisingly shared, “Once I knew about the robot, I felt even more confident in the quality of my surgical care.”
Raphael Lee • October 29
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When somebody mentions going to the doctor, the common response is, “Are you feeling alright?” Typically, visiting a doctor is associated with feeling unwell. However as more people face health challenges every day, a modernized approach to healthcare known as personalized medicine is gaining prominence. The conventional healthcare model primarily concentrates on treating the disease or symptoms manifested in the patient. It often overlooks the complex web of factors that contribute to the development and progression of the disease. Recent technological advancements have made it possible to detect diseases in their early stages, offering an opportunity for early intervention and prevention."
Ella Andonov • October 31
"Imagine a giant football stadium, swarming with fans. Every single seat is filled up, and there are even people standing on the field and in the isles, just to be in that stadium. Now add 20,000 more people. That’s how many people were waiting for organ transplants in 2022.
Over 100,000 US patients each year are on a life-or-death organ transplant waiting list, but only around 40,000 transplants occur annually. For a majority of patients on that list, the wait for an organ is excruciating and can have a deadly toll, but the gap between the number of organ donors and the number of recipients is remaining relatively steady. When people are 16 and getting their driver's license, we can’t force them to check the ‘organ donor’ box. So, if we can’t increase the amount of donors, how can we fix this?
While we can’t increase the amount of human donors, we might be able to increase the amount of animal donors. Scientists have been experimenting with xenotransplantation, the transplantation of animal organs or tissue into a human. Within the past two years, there have been significant advances in this field including the first successful genetically modified pig heart transplant in 2022, at the University of Maryland School of Medicine, and the first successful pig kidney transplant in 2023, at NYU Langone. These are the first successful transplants in humans and with each new surgery, we continue to discover more and more about the human physiological response to animal organs."
Laura Wang • November 5
"Real-world data (RWD) is an emerging concept with a broad range of applications for studying patient health data including treatment safety and efficacy, short and long-term health outcomes, and disease burdens. RWD can include data from electronic health records, wearable technology, disease registries, patient-reported outcomes, social media, and various electronic health services and is a growing contributor to clinical and biopharma research on treatment efficacy. Traditional randomized control trials (RCTs) remain the gold standard for assessing treatment or diagnostic efficacy, but they often involve a homogenous population due to their strictly controlled inclusion criteria and limited sample sizes. Thus, RCTs can be limited in their ability to represent patient groups of minority backgrounds—including racial and ethnic minorities, patients with comorbidities, and patients with rare conditions."
Marshlee Eugene • November 5
"In the 1970s, Stanford University researchers created an AI system that asked doctors questions about a patient’s symptoms and generated a diagnosis. In the 1990s, AI algorithms began decoding X-rays, CT scans and MRI images to spot abnormalities that humans might miss. We have come a long way since then, but what if I told you that currently there is AI being developed that could predict the probability a patient would be affected by a certain ailment, or die?"
Bowen Kim• November 5
"On the 28th of September, 1928, Alexander Fleming returned home from his Scotland vacation to find his cultures of Staphylococcus bacteria invaded by a mystery mold. But to his surprise, Fleming found the mold to be inhibiting the growth of his bacteria. Within a few decades, Fleming used the antibacterial mechanisms of mold to provide revolutionary treatments. The world changed. Common infections no longer threatened the lives of humans and the average lifespan in industrialized countries increased by about thirty years. In 2011, Dr. Emmanuelle Charpentier and Dr. Jennifer Doudna discovered a relationship between repeated sequences of DNA and enzymes that cut DNA, or CRISPR. The world changed, again. Medicine went from treating symptoms to attacking the root of many illnesses, the human genome. However, because of the immense bioethical and social roadblocks, CRISPR demands a more careful evaluation by policymakers and researchers alike before widespread use. In the meantime, researchers should utilize the genetic readthrough capabilities of Fleming’s hundred-year-old phenomenon, antibiotics, as an alternative to CRISPR to treat underrepresented diseases in medicine and to provide ethically sound medical therapies."
Ayush Khanna • November 5
"Cold and uncomfortable metal recliner chairs, the screeching hums of drills, and blinding white lights comprise many kids’ worst nightmare – the dentist’s office. According to the Washington Post, 40 to 75 percent of people experience some form of anxiety when going to the dentist, often leading them to postpone or even cancel their appointments. This problem is particularly common in children, who’ve had poor dental experiences or consume media that portray dentists as scary. Addressing dental anxiety in children is crucial, as it can lead to improper teeth development and early tooth loss, underscoring the importance of effective treatment. Luckily, a technological remedy is growing increasingly popular: virtual reality."
Kiara Lavana • November 6
"As we enter an age increasingly characterized by the widespread digitalization of our society, it’s no surprise that technology is becoming fundamentally woven into the fabric of healthcare systems. From patient portals with electronic health records to health apps and telemedicine, technology’s integration into medicine remains ubiquitous in almost every facet of the field. This shift has not only promoted accessible medical services for patients, but also emerged as a panacea to the calls for distancing during the COVID-19 pandemic. However, despite the improved health outcomes that technology enables, we cannot turn a blind eye to the inherent inequality imbued into these advancements. Put simply, an increased reliance on digital tools has the potential to exacerbate disparities between those with access to technology and those without. As a society, we need to collectively confront the reality that technology is emerging as a new-age determinant of human health."
Clare Williams • November 12
"How can AI help us tackle the persisting problems in the medical field today? Can AI diagnose more accurately than a trained physician? What is AI not capable of accomplishing? As we near the end of 2023, these questions appear to be more relevant within the world of healthcare than ever before. As demonstrated by recent applications in the field of cardiology, AI has the potential to revolutionize preventative care and treatment, but only if utilized carefully and equitably."
Morgan Robinson • November 12
"This past summer I had the opportunity to witness the impact of technology in healthcare from a front row seat. I spent a month shadowing anesthesiologists at a prestigious hospital in New York City, where I saw procedures in the operating room ranging from brain surgeries to c-sections to robotic heart surgeries. I was fascinated by the expansive implementation of technology in these procedures, with unique machinery used for many complex surgeries."
Karisma Lavana • November 12
At the forefront of the technological revolution, unfolding in the landscape of healthcare, is the integration of robotics. Robots are beginning to transform the healthcare field both within and beyond the operating room. Robotic aids can streamline healthcare by improving surgical precision, enhancing rehabilitation through targeted exercises, and optimizing diagnostic procedures. This innovation meets precision within robotic-assisted surgeries, new procedures developed alongside our technological progress. Robots are becoming invaluable allies to surgeons, providing unprecedented levels of accuracy and control in the operating room.
During robotic surgery, a surgeon uses a specially trained robot and a high-definition, three-dimensional camera to perform the procedure. The camera magnifies the body tenfold, enhancing visualization and guiding the surgeon. Computer vision research is revolutionizing robotic surgery by enabling advanced image recognition and interpretation, allowing surgical robots to navigate with heightened precision, distinguishing vital structures rapidly, providing real-time feedback to surgeons for more informed decision-making during procedures.
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Sarah Croog • November 26
"A world in which expectant parents meet with scientists to determine their child’s height, hair color, and intelligence seems nightmarish; it is essentially eugenics disguised as societal advancement. Luckily, a society in which the fate of an individual is determined entirely by their genetic modifications is the premise of the movie Gattaca, not real life. A few years ago, this society was purely fictional. However, new technology has allowed gene editing to move beyond its science-fiction past into reality. In 2012, Jennifer Doudna and Emmanuelle Charpentier developed CRISPR-Cas9, a revolutionary tool for editing genes (“Jennifer A. Doudna,” 2020). This novel technology possesses the potential to cure treatment-resistant genetic diseases, giving patients a second chance at life."
George Nathanial • November 26
"Modern technology allows people to access and understand information at a level unprecedented in human history. In medicine, technological advances have been integral to our ability to create therapies, optimize and standardize care, and enable providers to connect with patients in the most remote areas. However, even though much of the country identifies as belonging to a minority group, a disproportionately large majority of clinical research is conducted among white patients.1 Thus, although technology has facilitated the dissemination of information and support, it has not translated into more inclusive and equitable clinical research recruitment and participation. "
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Race, Gender, and Medicine: Telehealth in Gynecological Care and the Emergence of Digital Navigators
Yvonne Bonsu • November 27
The integration of telehealth into healthcare systems has emerged as a transformative tool, particularly in addressing geographical and accessibility barriers for women in gynecological care. Telehealth, defined as the utilization of information and telecommunications technology in healthcare delivery, presents a promising avenue for expanding the reach of reproductive health services, including family planning, contraceptive services, and safety decision aids for survivors of intimate partner violence (IPV). However, as this technology is not yet widespread, various challenges, including digital illiteracy and limited buy-in from clinicians, hinder its potential impact. Telehealth also encompasses mobile health applications designed to gather patients’ health data, screening questionnaires, and educational materials. I must mention the inherent
sensitivity of health information when using telehealth programs, that could compromise patient privacy and ruin trust in healthcare systems, leading to legal and ethical consequences. In this blog I plan to bridge the importance of telehealth in gynecological care and the need for racial equity in access to it once its use becomes more widespread. I offer a new role of digital navigators in an effort to highlight that with new technological avenues, we must address current inequities.
Anna Chen • October 15
"From coffee enemas to tapeworm diet pills, Hollywood is truly no stranger to novel health fads. On November 8th, the FDA’s approval of Zepbound—a weight loss pill targeted towards people with obesity—reignited fiery discussion about the medication’s applications, along with the culture surrounding it.On paper, such pills are only prescribed for those with—or at risk of—Type 2 diabetes. Ozempic, the previously reigning version of this drug, uses a compound named semaglutide to suppress its users’ appetites, allowing them to feel less hungry and stay full for longer periods. With clinical studies showing an average 10% reduction in body fat, it’s clearly effective for its intended purpose. For some, this drug is worth any possible negative effects. For others, not so much."​
Rita Sangwan • December 8th
"Healthcare visits no longer have to be in person. In fact, with a good camera, reliable internet connection, and some sort of electronic device, patients can easily set up a telemedicine appointment. As the name suggests, telemedicine refers to “the provision of remote clinical services, via real-time two-way communication between the patient and the healthcare provider, using electronic audio and visual means” (1). This transformative healthcare approach, although in use before the COVID-19 pandemic, witnessed an extraordinary surge in adoption during this unprecedented time. One study that looked at five states (Arizona, California, Maine, Mississippi, and Missouri) reported that the number of telehealth services increased from 2.1 million in the year prior to 32.5 million in the period between March 2020 and February 2021 (2). Even after the pandemic, telemedicine continues to be a prominent and essential tool in healthcare: McKinsey & Company's insights indicate that the utilization of telehealth services has stabilized at levels 38 times higher than that seen before the pandemic (3)."
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