I am a Candidate for the College of American Pathologists' President-Elect, 2019-2021 term. My vision is here.

I am a Candidate for the College of American Pathologists' President-Elect, 2019-2021 term.  My vision is here.

Lancet. 2019 Feb 9;393(10171):570-578. doi: 10.1016/S0140-6736(18)32595-9.

Applying feminist theory to medical education.

Sharma M1.

Author information

1

Casey House, Toronto, ON, Canada; Department of Medicine, Women's College Hospital, University of Toronto, ON, Canada; Maple Leaf Medical Clinic, Toronto, ON, Canada. Electronic address: malika.sharma@mail.utoronto.ca.

Abstract

To adequately address gendered issues of sexual harassment, wage gaps, and leadership inequities, medical institutions must interrogate medical education. Feminist theories can help to understand how power operates within our classrooms and at the bedside. This scoping review maps the four main ways in which feminist theory has been applied to medical education and medical education research-namely, critical appraisal of what is taught in medical curricula; exploration of the experiences of women in medical training; informing pedagogical approaches to how medicine is taught; and finally, medical education research, determining both areas of inquiry and methodologies. Feminist theory has the potential to move clinicians and educators from theory to action, building bridges of solidarity between the medical profession and the community it is called to serve.

"In 1973, the story was voted by the Science Fiction Writers of America as one of the stories representing the 'most influential, important, and memorable science fiction that has ever been written'."

"Who Goes There" 

By John W. Campbell ­ as ­ Don A. Stuart


In 1973, the story was voted by the Science Fiction Writers of America as one of the stories representing the "most influential, important, and memorable science fiction that has ever been written". 

Aging Is a Communication Breakdown

Genes that can’t express themselves may be hallmarks of cancer.

BY JIM KOZUBEKMARCH 21, 2019

"How responsive and sensitive a gene is to the machinery regulating its DNA methylation—so called “entropic sensitivity”—is critical for a cell’s function. Stem cells may be highly responsive to this machinery, and hence very “plastic,” while the loss of sensitivity to this machinery, and thus the gene’s increasing rigidity, seem to be hallmarks of aging and cancer. Adult cells such as intestinal cells, or liver cells, need to maintain their responsiveness to this machinery and maintain their epigenetic memory of which genes to turn on, a task that depends on its ability to listen and respond to machinery that maintains it. But aging cells are less responsive to machinery that regulates their methylation status, and are more rigid, often having long blocks of methylated or un-methylated genetic regions. These long stretches of the genome can have a lot of entropy, meaning they can change at any time, quite independently from the machinery that normally regulates their methylation. As a result, genes may be far less adaptive to turn on or off as needed in response to various environmental stimuli (as genes are needed to do, as immune cells spring into action, neurons rewire, or as cells repair and fix themselves) but these long stretches of the poorly regulated genes may also be more susceptible to double-strand breaks and other forms of catastrophic damage that can lead to cancer."

Extended pleurectomy decortication for pleural diffuse malignant mesothelioma: "...a randomized trial showed no survival benefit for this operation over simple talc pleurodesis."

Transl Lung Cancer Res. 2018 Oct;7(5):556-561. doi: 10.21037/tlcr.2018.06.07.

Extended pleurectomy decortication: the current role.

Bilancia R1, Nardini M2, Waller DA3.

Author information

1

Department of Thoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.

2

Department of Thoracic Surgery, University Hospital of Catania, Catania, Italy.

3

Department of Thoracic Surgery, St Bartholomew's Hospital, London, UK.

Abstract

Extended pleurectomy/decortication (EPD) has been formally defined but there remain technical areas of debate between practitioners. This is partly attributable to the relative rarity of this operation which is largely confined to a small number of specialist centres. Nevertheless, there is a widespread acceptance that extended pleurectomy/decortication (P/D) is a realistic and favourable alternative to extrapleural pneumonectomy. There may, however, remain a small number of clinical cases where this more extensive operation may be indicated. Preservation of the lung has widened the selection criteria for this form of radical mesothelioma surgery but there remain important factors to consider when offering extended P/D. In many patients with poorer prognostic factors the less radical operation of video assisted partial pleurectomy may be preferable. However, a randomized trial showed no survival benefit for this operation over simple talc pleurodesis. The future for P/D may also lie in the outcome of the MARS2 randomized controlled trial which will report in the next few years. Meanwhile there is a clinical and ethical dilemma when asked to perform this operation outside of the context of a clinical trial in the face of the lack of high grade evidence. The role of P/D is in one respect expanding but this may be short lived pending the findings of its assessment against non-surgical treatment.

Surprise Medical Bills can be Solved by Competition - Not Federal Fiat

"In spite of ever-increasing premiums, insurance companies are raising deductibles, requiring patients to pay more out of pocket and cherry-picking covered services, doctors, and locations when defining what is considered your in-network options for care – sometimes even deciding that a hospital qualifies as in-network but its emergency physicians do not. As health plan networks have grown increasingly narrow, limiting patient access to in-network providers, the end result is a fractured healthcare system that has caused the incidents of balanced billing to skyrocket, and along with them – calls for action in Congress."

"The failure of the Affordable Care Act was, in part, due to its one-size-fits-all approach of putting the government at the center..."

A Cure Worse Than the Disease

"The failure of the Affordable Care Act was, in part, due to its one-size-fits-all approach of putting the government at the center of payment negotiations between providers and insurance companies. We know the results – increased premiums and deductibles and the increased frequency of surprise medical bills.

The new federal rules and government interference – i.e., blanket rate setting – in the Cassidy offering is a policy concoction that will destroy the flexibility and leverage provider networks need to negotiate the best rates for patients."

Americans aren't getting enough sleep and it's killing us

"Researchers at the University of Colorado, Boulder found in a study published in the current issue of “Current Biology” that the body’s metabolism has a very hard time recovering from sleep deprivation, with study subjects put on five pounds after five days of sleeping for only five hours a night. All-nighters push anxiety to clinical levels and even modest sleep reductions are linked to increased feelings of social isolation and loneliness."

Lancet. 2019 Mar 20. pii: S0140-6736(19)30024-8. doi: 10.1016/S0140-6736(19)30024-8. [Epub ahead of print]

Building a tuberculosis-free world: The Lancet Commission on tuberculosis.

Reid MJA1, Arinaminpathy N2, Bloom A3, Bloom BR4, Boehme C5, Chaisson R6, Chin DP7, Churchyard G8, Cox H9, Ditiu L10, Dybul M11, Farrar J12, Fauci AS13, Fekadu E14, Fujiwara PI15, Hallett TB2, Hanson CL7, Harrington M16, Herbert N17, Hopewell PC18, Ikeda C19, Jamison DT20, Khan AJ21, Koek I22, Krishnan N23, Motsoaledi A24, Pai M25, Raviglione MC26, Sharman A27, Small PM28, Swaminathan S29, Temesgen Z30, Vassall A31, Venkatesan N32, van Weezenbeek K33, Yamey G34, Agins BD35, Alexandru S36, Andrews JR37, Beyeler N38, Bivol S39, Brigden G15, Cattamanchi A18, Cazabon D40, Crudu V39, Daftary A25, Dewan P41, Doepel LK13, Eisinger RW13, Fan V42, Fewer S38, Furin J43, Goldhaber-Fiebert JD44, Gomez GB45, Graham SM46, Gupta D47, Kamene M48, Khaparde S49, Mailu EW48, Masini EO50, McHugh L51, Mitchell E52, Moon S53, Osberg M54, Pande T40, Prince L44, Rade K55, Rao R56, Remme M57, Seddon JA58, Selwyn C7, Shete P18, Sachdeva KS47, Stallworthy G59, Vesga JF2, Vilc V60, Goosby EP61.

Author information

1

Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA. Electronic address: michael.reid2@ucsf.edu.

2

School of Public Health, Imperial College London, London, UK; Faculty of Medicine, Imperial College London, London, UK.

3

Tuberculosis Division, United States Agency for International Development, Washington, DC, USA.

4

Department of Global Health and Population, Harvard University, Cambridge, MA, USA.

5

Foundation for Innovative New Diagnostics, Geneva, Switzerland.

6

Departments of Medicine, Epidemiology, and International Health, Johns Hopkins School of Medicine, Baltimore, MA, USA.

7

Bill & Melinda Gates Foundation, Seattle, WA, USA.

8

The Aurum Institute, Johannesburg, South Africa.

9

Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.

10

Stop TB Partnership, Geneva, Switzerland.

11

Department of Medicine, Centre for Global Health and Quality, Georgetown University, Washington, DC, USA.

12

The Wellcome Trust, London, UK.

13

National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Maryland, MA, USA.

14

Volunteer Health Services, Addis Ababa, Ethiopia.

15

Department of Tuberculosis and HIV, The International Union Against Tuberculosis and Lung Disease, Paris, France.

16

Treatment Action Group, New York, NY, USA.

17

Global TB Caucus, Houses of Parliament, London, UK.

18

Department of Medicine, University of California San Francisco, San Francisco, CA, USA.

19

Department of GLobal Health, Ministry of Heath, Labor and Welfare, Tokyo, Japan.

20

Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.

21

Interactive Research & Development, Karachi, Pakistan.

22

Global Health Bureau, United States Agency for International Development, Washington, DC, USA.

23

Resource Group for Education and Advocacy for Community Health, Chennai, India.

24

South African National Department of Health, Pretoria, South Africa.

25

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; McGill International TB Center, McGill University, Montreal, QC, Canada.

26

University of Milan, Milan, Italy; Global Studies Institute, University of Geneva, Geneva, Switzerland.

27

Academy of Preventive Medicine of Kazakhstan, Almaty, Kazakhstan.

28

Global Health Institute, School of Medicine, Stony Brook University, Stony Brook, NY, USA.

29

WHO, Geneva, Switzerland.

30

Department of Infectious Diseases, Mayo Clinic, Rochester, MI, USA.

31

Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands.

32

The Economic Times, Mumbai, India.

33

KNCV Tuberculosis Foundation, The Haag, Netherlands.

34

Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, Durham, NC, USA.

35

Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.

36

Institutul de Ftiziopneumologie Chiril Draganiuc, Chisinau, Moldova.

37

Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.

38

Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.

39

Center for Health Policies and Studies, Chisinau, Moldova.

40

McGill International TB Center, McGill University, Montreal, QC, Canada.

41

Bill & Melinda Gates Foundation, New Delhi, India.

42

T H Chan School of Public Health, Harvard University, Cambridge, MA, USA; Office of Public Health Studies, University of Hawaii, Mānoa, HI, USA.

43

Division of Infectious Diseases & HIV Medicine, Case Western Reserve University, Cleveland, OH, USA.

44

Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.

45

Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.

46

Department of Tuberculosis and HIV, The International Union Against Tuberculosis and Lung Disease, Paris, France; Department of Paediatrics, Center for International Child Health, University of Melbourne, Melbourne, VIC, Australia; Burnet Institute, Melbourne, VIC, Australia.

47

Revised National TB Control Program, New Delhi, India.

48

National Tuberculosis, Leprosy and Lung Disease Program, Ministry of Health, Nairobi, Kenya.

49

General TB control, New Delhi, India.

50

WHO, Nairobi, Kenya.

51

Office of the Secretary-General's Special Envoy on Tuberculosis, United Nations, Geneva, Switzerland.

52

International Institute of Social Studies, Erasmus University Rotterdam, The Hague, Netherland.

53

Department of Global Health and Population, Harvard University, Cambridge, MA, USA; Global Health Centre, The Graduate Institute Geneva, Geneva, Switzerland.

54

Linksbridge, Seattle, WA, USA.

55

Central Tuberculosis Division, WHO, New Delhi, India.

56

Ministry of Health and Family Welfare, New Delhi, India.

57

International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia.

58

Department of Medicine, Imperial College London, London, UK; Faculty of Medicine, Imperial College London, London, UK; Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa.

59

Seattle, WA, USA.

60

National TB Program, WHO, Chisinau, Moldova.

61

Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.

Why Black Women Need More Sleep, ASAP

"The Centers for Disease Control and Prevention (CDC) reports that one third of Americans are clocking fewer than the seven to nine hours of snooze time advised for adults. Poor quality of sleep plagues Black women even more than our counterparts and undermines our overall health. 'Blacks and Latinos tend to be poor sleepers, getting fewer than six hours on average per night—which is not enough, because poor sleepers are at greater risk for cardiovascular disease,' explains Girardin Jean-Louis, Ph.D., professor of population health and psychiatry at NYU Langone Health in New York City. Lack of shut-eye is also linked to diabetes, obesity, depression and a host of other chronic illnesses."

Continuum (Minneap Minn). 2019 Apr;25(2):537-542. doi: 10.1212/CON.0000000000000714.

Driving and Epilepsy: Ethical, Legal, and Health Care Policy Challenges.

Kass JS, Rose RV.

Abstract

Although the principle of autonomy allows patients to refuse interventions their physicians recommend, patients are not free to ignore legally mandated restrictions on driving, and physicians are ethically justified in constraining their patients' driving rights in compliance with state law. Furthermore, the standard of care for treatment of patients with epilepsy includes counseling about lifestyle modifications that promote patient safety and compliance with the law. Neurologists should not only counsel their patients with epilepsy about legally mandated driving restrictions but also document this counseling in the medical record. Failure to counsel and to document may result in legal liability if patients experience seizures while driving and injure either themselves or third parties. The neurologist's duty of care may be limited to the patient in some jurisdictions but may be extended to injured third parties in others. Furthermore, a patient's own contributory negligence may limit or completely foreclose recovery against the physician to varying degrees, depending on the state in which the injury occurred.

Hayek vs. Keynes - Rounds One and Two

Hayek vs. Keynes

Round One

Round Two

"Today, to be a 'person with obesity' is to be seen as diseased, regardless of overall health status and health-related behaviours."

Carrie Dennett

Why we must stop fat shaming, weight bias, and discrimination against people with obesity

• Obesity is wrongly regarded as a failing rather than a consequence of environment
• This stigma creates barriers to health care, as overweight people are less likely to return for treatment

"As with most health professionals who seek to avoid contributing to weight stigma, the authors use – and encourage – person-first language, pointing out that 'an obese person' is an identity that suggests personal responsibility (again, unfairly, because many factors determine body weight), whereas “a person with obesity” is a person with a disease.

Trouble is, person-first language ignores that the word 'obesity' is loaded with stigma no matter how you use it in a sentence. This is despite – or perhaps because of – the American Medical Association’s 2013 decision to classify obesity as a disease, going against the recommendations of its own Council on Science and Public Health. Today, to be a 'person with obesity' is to be seen as diseased, regardless of overall health status and health-related behaviours."

Heart - Crazy On You

Heart - Crazy On You

"Moral bioenhancement, nudge-designed environments, and ambient persuasive technologies may help people behave more consistently with their deeply held moral convictions..."

Sci Eng Ethics. 2019 Mar 21. doi: 10.1007/s11948-019-00099-y. [Epub ahead of print]

What Do We Have to Lose? Offloading Through Moral Technologies: Moral Struggle and Progress.

Frank LE1.

Author information

1

Department of Philosophy and Ethics, School of Innovation Science, Technical University of Eindhoven, 5612 AZ, Eindhoven, The Netherlands. L.e.frank@tue.nl.

Abstract

Moral bioenhancement, nudge-designed environments, and ambient persuasive technologies may help people behave more consistently with their deeply held moral convictions. Alternatively, they may aid people in overcoming cognitive and affective limitations that prevent them from appreciating a situation's moral dimensions. Or they may simply make it easier for them to make the morally right choice by helping them to overcome sources of weakness of will. This paper makes two assumptions. First, technologies to improve people's moral capacities are realizable. Second, such technologies will actually help people get morality right and behave more consistently with whatever the 'real' right thing to do turns out to be. The paper then considers whether or not humanity loses anything valuable, particularly opportunities for moral progress, when being moral is made much easier by eliminating difficult moral deliberation and internal moral struggle. Ultimately, the worry that moral struggle has value as a catalyst for moral progress is rejected. Moral progress is understood here as the discovery and application of new values or sensitization to new sources of harm.

Blank & Jones - Beyond Time

Blank & Jones - Beyond Time (HQ Remastered Official Video) original from 2000 !

All About That [Upright] Bass - Meghan Trainor Cover PMJ ft. Kate Davis

"Having all medical procedures, examinations, and histories performed by seasoned medical professionals would mitigate the risk but would also destroy the institution of medical education and lead to a shortage of trained professionals."

Indian J Med Ethics. 2018 Dec 12;-(-):1-5. doi: 10.20529/IJME.2018.100. [Epub ahead of print]

Nonmaleficence in medical training: Balancing patient care and efficient education.

Girdler SJ1, Girdler JE2, Tarpada SP3, Morris MT4.

Author information

1

Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY 10029, US,. sjgirdler@gmail.com.

2

New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA,. jeschaus@gmail.com.

3

Department of Orthopaedic Surgery, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA,. tarpada@mail.einstein.yu.edu.

4

Department of Orthopaedic Surgery, Northwell Health Long Island Jewish Medical Center, 550 1st Avenue, New York, NY 10016, USA,. mattmorris3391@gmail.com.

Abstract

The principle of nonmaleficence requires that every medical action be weighed against all benefits, risks, and consequences, occasionally deeming no treatment to be the best treatment. In medical education, it also applies to performing tasks appropriate to an individual's level of competence and training. Students, residents, and attending physicians alike maintain a beneficence-based responsibility to patients, and attending physicians have a fiduciary responsibility to educate younger generations of doctors. For medical education to progress, medical students and resident physicians must develop new skills throughout their time in training. Yet involving inexperienced students in delivering patient care can place the value of education and training in opposition to the bioethics values of patient-centred care and nonmaleficence by increasing the risk of harm to patients. Having all medical procedures, examinations, and histories performed by seasoned medical professionals would mitigate the risk but would also destroy the institution of medical education and lead to a shortage of trained professionals. For medical education to be successful, students and their supervisors must balance the principles of nonmaleficence with those of education in order to ensure excellence in both patient care and medical training. We present a broad discussion of the ethical dilemmas raised by the interaction of medical education and current patient care and suggest guideposts for training practices that satisfy the dual requirements of medical learning and patient-centred care.

Soda tax is no solution for child health problems

Soda tax is no solution for child health problems


"Instead of advocating for a measure that will raise grocery prices on families and jeopardize local business, we should work to provide consumers with information on how to best maintain a balanced diet and give parents the choices in foods and beverages they need to help their families thrive."

From Cass Sunstein: How administrative sludge protects us from our lack of self-control and impulsivity

Wading Through the Sludge

Cass R. Sunstein

"Administrative burdens might also be designed to counteract self-control problems and impulsivity. Small administrative burdens are frequently imposed online, with questions asking whether you are 'sure you want to' send an e-mail without a subject line, activate a ticket, cancel a recent order, or delete a file. Those burdens, usually coming from the private sector, can be extremely helpful in making people consider their decisions carefully. More broadly, a degree of sludge, imposed by public as well as private institutions, might make sense for life-altering decisions, such as marriage and divorce.

It is true that we might not always trust public officials—legislators and bureaucrats—to decide whether sludge is a good strategy for helping people to avoid reckless decisions. But it is hardly impossible, in light of high-stakes choices, to defend administrative burdens as an effort to promote reflection and to provide valuable information. The accessibility of abortion is a more controversial case, of course. People disagree about whether administrative burdens are a reasonable means of discouraging ill-informed or insufficiently considered abortion decisions, or whether they merely pressure women not to exercise their constitutional rights."

"...legislation drafted by Councilman Ben Kallos (D-Manhattan) makes water, milk[,] and 100 percent fruit or vegetable juice the 'default beverage option' in all kids’ meals served at restaurants."

New bill would ban soda as default drink in kids’ meals

"The legislation drafted by Councilman Ben Kallos (D-Manhattan) makes water, milk[,] and 100 percent fruit or vegetable juice the 'default beverage option' in all kids’ meals served at restaurants."

"...the reason society should not discriminate against people with obesity is because discriminating against people based on their appearance is wrong."

'Weight bias' affects how we talk about obesity — and it's making things worse

The report then goes on to state that society should not discriminate against people with obesity because it is a "predictable consequence of normal people interacting with obesogenic environments." In other words: Don't discriminate against people with obesity, because they can't help it. They're diseased.

However, the reason society should not discriminate against people with obesity is because discriminating against people based on their appearance is wrong. People of all shapes, sizes, shades and abilities are worthy of respect and fair treatment.

It doesn't help that the authors blame obesity on poor diet quality, albeit because of the modern food environment. This perpetuates the myth that fat people are fat because they eat a lot of fast food and other ultra-processed foods. This is far from a universal truth.

William Carney and Keith Sharfman: Will Aruba Finish Off Appraisal Arbitrage and End Windfalls for Deal Dissenters? We Hope So

Will Aruba Finish Off Appraisal Arbitrage and End Windfalls for Deal Dissenters? We Hope So

The corporate law world has been abuzz of late about the commendable effort by Delaware’s courts to scale back 'appraisal arbitrage': a trading strategy predicated on deal dissenters receiving via appraisal litigation more for their shares than the deal prices from which they dissent. For years, parties engaging in appraisal arbitrage enjoyed the opportunity to initiate essentially risk free appraisal litigation with substantial upside potential, because it was assumed by courts and litigants that 'fair value' entitled dissenters to at least the price of the deal they were rejecting and potentially more. But happily, this misunderstanding and misapplication of the law of appraisal now appears finally to have reached its end."