Curious Bioethics: August 20-Sept 3, 2023
🔪 Covid still sucks, better outcomes with female surgeons, ivermectin misinformation, parental rights, #PaleMaleData
In today’s curated collection, you’ll find:
🗞️Bioethics News: Female surgeon outcomes, fracking and rare cancer, ivermectin won’t go away, parental rights in Ohio
📚Recommended Reading: The Memory Picture; insurance denials will destroy you
🦉Educational Opportunities: AI and the #PaleMaleData problem
Hey there, Curious Human!
Sorry to have left you wondering why you didn’t get a delightful roundup of bioethics news on August 27.
As I mentioned in my last newsletter, Covid is BACK with a vengeance in California! While I’d avoided infection for all these years, I finally caught it this round.
I’ve been too tired to do much else besides sleep and wash my Paxlovid prescription down with electrolyte-sugar water. I’m glad I went with Paxlovid (to both reduce my symptoms now and the risk of long-covid) because even with treatment, this infection has knocked me on my ass. A week in and I finally have enough energy to feel antsy about being in bed so much, and not enough energy to do much more without feeling I need another nap. I’ve stayed isolated from my family, and while that’s getting old, it’s not quite over yet.
Who loves this whole thing? My dog, Sierra. She’s getting the most cuddles ever and never wants isolation to end.
Much as this virus has sucked, I am one of the lucky ones. I have health insurance and a responsive primary care doctor. Within hours of messaging the clinic, I had a video appointment, low co-pay prescriptions, and expert advice. I don’t worry I’ll lose my job over staying home sick. I have the physical space needed to protect my family from exposure. My capable partner has the rest of the house under control.
This is simply not the reality for most Americans.
🗞️ Bioethics in the News
Female surgeons have lower rates of long-term adverse outcomes than their male peers, study finds
In 2017, a study demonstrated that patients treated by women surgeons has improved outcomes 30 days post-op. A follow-up study published this week in JAMA Surgery looked at data from 90 days to one year, suggesting that patients treated by women surgeons have lower rates of adverse postoperative long-term outcomes including death compared to similar patients treated by male surgeons.
The team studied over 1 million patients having 25 elective and emergency surgeries.
Researchers also found that while in general patients had better outcomes with female surgeons, female patients fared far worse than expected and had higher rates of adverse postoperative events within a year when treated by male surgeons.
This study doesn’t say that male surgeons are bad surgeons. But there is something qualitatively different about how women surgeons care for patients compared to men. This may be surgical preparation, patient communication, or something else. Women surgeons frequently face unfavorable working conditions: less likely to receive referrals, work on high-complexity cases, and have less operative time, and are less likely to have leadership positions compared to their male counterparts.
Hospitals should take note and pay much closer attention to what women surgeons are doing well and support the hell out of them.
A Pennsylvania study suggests links between fracking and asthma, lymphoma in children
Children who lived closer to natural gas wells in heavily drilled western Pennsylvania were more likely to develop a relatively rare form of cancer, and nearby residents of all ages had an increased chance of severe asthma reactions
The study was not designed to determine whether drilling directly caused disease but combed through health records and determined how close patients lived to drilling sites.
In the cancer study, researchers found that children who lived within 1 mile of a well had 5-7x the chance of developing lymphoma compared with children who lived 5 miles or greater from a well.
For asthma, the researchers concluded that people with the breathing condition who lived near wells were more likely to have severe reactions while gas was being extracted compared with people who don’t live near wells. However, researchers said they found no consistent association for severe reactions during periods when crews were building, drilling and fracking the well.
The association with a rare pediatric lymphoma is a major finding. Raina Rippel, former director of the Southwest Pennsylvania Environmental Health Project, called the findings the “tip of the toxic iceberg and we are only just beginning to understand what is out there.”
Court revives doctors’ lawsuit saying FDA overstepped its authority with anti-ivermectin campaign 🙄
After I posted about being sick on X (Twitter), I was surprised to have so many comments asking why I wasn’t using ivermectin to treat myself. It’s amazing how long this crappy misinformation lives on and continues to propagate online. Despite significant evidence that ivermectin is ineffective against Covid, proponents remain active and aggressive. Just a few weeks ago, a false rumor circulated that the FDA had approved ivermectin for Covid.
Remember in 2021 when folks were taking horse ivermectin and poisoning themselves? Yeah, me too. That’s when the FDA began clearly and loudly spreading the message that the public should not attempt to take veterinary formulations of ivermectin.
Now, a New Orleans Federal appeals court has revived a lawsuit three physicians brought against the FDA regarding their language regarding ivermectin.
“FDA is not a physician. It has authority to inform, announce, and apprise—but not to endorse, denounce, or advise,” Judge Don Willett wrote for a panel that also included Jennifer Walker Elrod and Edith Brown Clement. “The Doctors have plausibly alleged that FDA’s Posts fell on the wrong side of the line between telling about and telling to.”
Plaintiffs include notorious Covid misinformation doc, Mary Talley Bowden, and ENT surgeon who lost her medical privileges at a Houston Methodist hospital due to spreading dangerous misinformation. In June, the Texas Medical Board filed a complaint against her for unprofessional conduct and violating standards of care.
An Ohio ballot measure seeks to protect abortion access. Opponents’ messaging is on parental rights
A proposed constitutional amendment in Ohio would enshrine abortion rights: “to make and carry out one’s own reproductive decisions.” Eager to flip the script on abortion messaging, anti-abortion groups continue to obfuscate the issue, attempting to distract voters with alternative “risks” related to parental rights and access to gender-affirming care.
Parental rights groups claim to aim to protect children from government interference but really come down to fringe parent groups’ desire to control everything about their children until the moment they turn 18. Mining parental rage for votes is nothing new, and the resurgence of the parental rights movement echoes campaigns from the 1990s.
What anti-abortion and parental rights advocates don’t want voters to understand is that Ohio has some of the most restrictive healthcare access for teenagers. Every year, when I teach adolescent healthcare ethics issues to medical and PA students, I use Ohio as a prime example of a place where it’s very hard to access healthcare if your parents don’t let you.
High-profile stories like Ethan Lindenberger’s journey to get vaccinated despite his parents’ refusal highlight how until a teen turns 18, they have few rights in Ohio. Pregnant teens in Ohio can be denied epidural pain relief if no parent is present to consent (like when the teen has run away from home) or if parents refuse to consent (sometimes as a punishment).
📚 Recommended Reading
The Memory Picture
Being able to prepare for death is a complicated luxury.
Whoever says Americans don’t talk about death has yet to meet my Soviet family. We’re all too superstitious, afraid to let death dance around our tongues as though saying it will make it happen sooner. We knock on wood. We spit over our shoulders. Sometimes we even wear those little evil eyes around our necks. When death can’t be denied, we’re terrified it will consume us. My family waited months to tell me my great-grandma had died because they didn’t want grief to distract me from my studies. But I am middle-aged now and it is my turn to absorb the pain while tying up loose ends.
I love this personal essay on a woman visiting her Ukrainian grandparents in San Francisco to help make funeral arrangements. It is a story about the conflicts - great and small - that define a family and the ways we deal with past and future grief.
It’s beautiful in the way that pain and grief can be beautiful.
If descriptions of war and combat injuries will be too much for you, go ahead and skip this one. (Or skim very liberally. )
I Set Out to Create a Simple Map for How to Appeal Your Insurance Denial. Instead, I Found a Mind-Boggling Labyrinth.
by Cheryl Clark
I’ve been a health care reporter for more than 40 years. And when I tried to figure out how to appeal insurance denials, I wound up the same way. And I didn’t even try to file an actual appeal.
~Cheryl Clark
If you’ve tried to appeal a denied claim through an insurance company and felt entirely defeated and depleted, you’re not alone. ProPublica’s Cheryl Clark explains why it’s so complicated for everyone.
🦉Educational Opportunities
No registration is required! Just go straight to YouTube for this on-demand bioethics education.
John Oliver's Last Week Tonight on Artificial Intelligence
Artificial intelligence is increasingly becoming part of our lives, from self-driving cars to ChatGPT. John Oliver discusses how AI works, where it might be heading next, and, of course, why it hates the bus. Dr. Joy Buolamwini from the Algorithmic Justice League appears and discusses how the #PaleMaleData problems with AI.
While this segment isn’t specifically about health, AI in the health sector continues to grow and these issues aren’t going to disappear.
That’s it!
As always, thanks for being curious!
Hit reply and let me know what ethics issues you are most curious about this week—I’d love to hear from you!
See you next week!
Be Well & Be Curious,
Alyssa