Thursday, September 16, 2010

Tuesday, 9/28 - The Ethics of Rationing

Update, 9/21:

Pranay recommends an article by Paul Farmer and Nicole Campos entitled "Rethinking Medical Ethics: A View from Below." The themes addressed dovetail quite nicely with Singer's "Famine, Affluence, and Morality," linked below.


Hello you,

To those of you who came to our first discussion meeting, thanks! You made it great. Next next week we'll be discussing a topic that expands on this week's conversation about the doctor, the patient, and those difficult end-of-life decisions: Rationing of care!

This topic approaches the issue with more of a policy edge, so we're expecting a bit more controversy this time around. Pranay and I will be facilitating. The main reading is an article by Peter Singer entitled, bluntly enough, "Why We Must Ration Health Care."

I will also include additional links for your reading pleasure.

For more work by Peter Singer, you can find more than you'll ever want to read here.  Two articles of particular note are "Famine, Affluence, and Morality," the essay which basically put him on the map of philosophical academia, and "The Animal Liberation Movement," which touches on what we talked about towards the end of today's discussion.

Here is an interview with Dr. Donald Berwick, the new Administrator of the Centers for Medicare & Medicaid Services, focusing on his thoughts regarding comparative effectiveness research and its relation to rationing.

For responses and rebuttals to Singer's perspective on rationing, see this article, "Barack Obama Will Ration Your Health Care" for a mainstream conservative take. Blogger John Greene directly responds to Singer's article in this post, again from a conservative standpoint.

For a decidedly libertarian viewpoint, see "The Market Does Not Ration Health Care," an article in Capitalism Magazine.

That should be plenty for now. If you have any suggestions for articles, discussion topics, or anything else, please contact me!


Wednesday, September 15, 2010

Tuesday, 9/21 - The Future of Primary Care

UPDATE, 9/17:

Member Justin Mutter recommends two articles on innovation in the delivery of primary care:
"Community Care of North Carolina: Putting Health Reform Ideas into Practice in Medicaid"
"Practice Redesign And The Patient-Centered Medical Home: History, Promises, And Challenges"


Hello friends,

Next Tuesday, the 21st, there will be a talk entitled "The Future of Primary Care in Academic Medicine" at noon in the MEB 3rd floor auditorium, and lunch will be served.

Needless to say, Pranay and I thought this would be a great opportunity for our group to learn about an important issue in health policy (and also be fed). So we are moving our regularly-scheduled discussion on Rationing to Tuesday the 28th.

But fret not if you really wanted to scratch that itch for health-economical issues, for here are a few articles to go with the lunch-lecture on The Future of Primary Care in Academic Medicine. It looks like a lot, but most of them are quite short and you can glean their point just from the headlines.

"Primary-Care Doctor Shortage May Undermine Reform Efforts" by Ashley Halsey III

"Delivering Better Primary Care" by Pauline Chen

"Increased primary-care interest not enough to affect physician-shortage trend" by Debra Beaulieu

"Doctors’ Hours Fall for a Decade, Adding to a U.S. Shortage" by Pat Wechsler

"Study: Primary Care Career Wealth Gap Totals Over $2.5 Million" by Shirley S. Wang

"General internists leaves practice sooner than internal medicine subspecialists, says ACP survey" (

As always, your comments, articles, topic suggestions, and everything else are very welcome.


Saturday, September 11, 2010

Tuesday, 9/14 - Hospice and end-of-life care

Hi everyone,

I'm starting to see a bit of buzz on Facebook of people who are finishing their exams, so now's a good a time as any to send out this week's article, entitled "Letting Go" by Atul Gawande:

It's a lengthy and comprehensive exploration of the current state of end-of-life medical care. Thanks to Justin Barr, who recommended it and will be facilitating Tuesday's discussion.

Some questions to guide your reading (your LOs, if you will):

1) What factors are affecting how patients and caregivers make difficult choices at the end-of-life?
2) What factors are influencing how doctors make treatment decisions in end-of-life circumstances?
3) What factors are contributing to the health care system's current approach to end-of-life care?
4) What are Dr. Gawande's recommendations for improving the state of end-of-life care?

If you find yourself in a time crunch and unable to do the reading, don't worry; we will do a 5-minute summary at the beginning of discussion so everyone's on the same page about the basic content.

Lastly, you can add to our group's momentum by doing any of the following:
-Sending topics and articles for discussion,
-Sending ideas for other activities,
-Being a discussion facilitator,
-Helping me manage the blog (, or
-Bringing your friends :)

So let me know about any of the above! Otherwise, see you Tuesday (or sooner)!


P.S. Counterpoint: A blogger at Discover Magazine argues that the notion that death gives life meaning ("The Most Dangerous Idea in the World").

Tuesday, September 7, 2010

Meeting Minutes - 9.7.2010

1. The purpose of the group is to become familiar with issues in bioethics and health policy and conversant in arguments from all sides, to gain a socio-political perspective on medicine, and to provide an avenue to explore our interests.

2. Meetings will be on Tuesdays in the Learning Studio over lunch (moved from the First Floor Lounge for more space).

3. Passed around the email list.

4. Gathered topics of interest and discussion facilitators.

Topics: organ markets, genetic engineering, stem cell research, human research, Unit 731, ethics of rationing, health reform bill, usage of expensive treatments/tests, euthanasia

Next week..
**September 14, 2010 - Hospice and end-of-life care – Facilitator: Justin Barr

5. Discussed opportunities for political engagement (Mike Hrdy).

6. Discussed health policy and conservative perspectives (Katarina Nguyen).

-Ground rules of discussion: respect person who is speaking; listen closely to discern perspectives; facilitator should be ideologically neutral but critically ruthless; goal is to evaluate the strengths and weaknesses of arguments.

Sunday, September 5, 2010

First Interest Meeting on Tuesday, September 7th

We'll be having our first interesting meeting on Tuesday, September 7th at noon in the First Floor Lounge of the new Medical Education Building.

At the meeting, we'll figure out basics like the topics people would like to discuss, how often we want to meet, and who might want to lead the discussions.

Shortly after that, we should have a draft schedule posted on this blog.

See you there!