Reaction to Cast6816's post

I agree with your first mini-paragraph about what it means to be a doctor. When we go to the doctor, we put our full faith and respect into the doctor's hand to help us get better. Also, I see that a patient is definitely inferior to the doctor; the doctor is in full control (both literally, figuratively, and emotionally). Doctors are always in control, whether from ER procedures to surgeries to childbirth. They are the ones making money, and they don't want to screw up.

I feel like we give doctors a lot of faith and they have a lot of pressure on them to perform the surgery correctly; if they don't, then a person can sue...resulting in a possible loss of his/her medical license.

~Chad S.

Syphillis Experimentation

When I first heard about this reading and part of unknown history, I was very shocked! I can't believe that this went on for 50 years, without the media hearing about it. I mean how did the media and other sources not hear about this "experimentation" down in Alabama.

I also found it weird that these "doctors" tested only African-Americans and not Whites. I think they tested AAs because they are inferior to us.  They had these men go through very painful exams. It was interesting that President Clinton apologized for what happened nearly 5 decades ago on behalf of the citizens and US government.

Now that I think about it, why was this tested only on men, and not women. I thought it was also racist that they tested AA men, just because of the myth that they have long penises and are very sexually active.

What happened in this article, and history, is exactly what this class is about...history of authority over people!!! I mean that they made the decisions for their patients, based on their own decisions, and not what was best for the patients!! The doctors even denied the AA men treatment from these surgeries.

Overall, this article, and part of history, was a very interesting story to read about.

~Chad S.

The patient-physician relationship

Over the course of the semester a lot of our talk has centered around authority. The inherent relationship between the physician as being in the dominant position towards his patient. Since the first Carlos reading we understand that to be a doctor is to be given a certain kind of authority/agency over someone else's body, and by extent to be a patient (or to be sick) is to be at the expense of such authority.

I think that before I started taking this class, it would have seemed counter intuitive to think of the relationship between patient and physician as one which shows a large disparity of power. But now it seems that not only is that relationship one of unbalanced power but that medicine has historically benefited from the fact that to be a patient is to be in a position of inferiority. To be at the mercy of medical authority.

I don't think I've ever really considered the idea of being diagnosed with an illness as being placed at the mercy of someone else's authority. But I do know that my experience with doctors has affirmed this claim. This has held true not so much in feeling exploited, but where I can most readily recognize this unbalance is in my gratefulness after receiving help. In my gratitude I have made the Doctor infallible and ceased all critical thinking. In my understanding of his years of medical training, intermixed with some fear, that the cycle of relationship of dominance is complete.

I guess this blog is an open question or something I will continue to consider as we go on. But I think that overall, one of the larger lenses which I'm starting to develop through these readings, is how the patient-physician relationship is structured, and how it it leaves the patient in a position of being susceptible to exploitation.

The question of ethics in medicine

We have been talking about ethics in class this past week and it got me interested in what kind of light the Hippocratic oath could shed on it. Ethics is defined as dealing with the general principles of right and wrong, as opposed to requirements of law. We talked about if a doctor is in the middle of surgery and he finds a problem that is not related to the surgery is it wrong if he treats it without your consent? This is what I found in the Hippocratic oath "Among the promises of the Hippocratic oath are to use the form of treatment best for the patient, to refrain from harmful actions, and to keep a patients private information confidential". So the truth is yes there are some instances such as if the matter is life threatening the doctors are allowed to treat you even if its not what you were originally being treated for. The reason doctors are able to do this is because of implied consent. So because you have already given consent for the first surgery if a life threatening issue is found they are allowed to treat you.

Guilt and Consent in Medicine and Family

An earlier post I read had mentioned whether guilting a patient into seeking help/treatment was ethical or not.  I broadly explained in my comment that I feel that it can be selfish of someone to use guilt to convince one to seek treatment, and that it dips in with the issue of consent.  I stand by this, and although a doctor or loved may use guilt to convince a patient to seek treatment for reasons of well-being, I believe that it is the patients choice at the end of the day.  We are all aware that we are going to die someday, and I think that it should be the individuals choice as to what they the next step should be, if there is any.  It should depend on if they are ready to receive treatment and try to fight their diagnosis, or if they have accepted it and feel the better option would just be to live out what time they have left.  Th doctor or loved ones can portray selfishness, which in most cases is out of love or concern, but I feel that pressuring them into a decision makes the matter ten times harder, as hard as it is to accept that an individual is sick and may not be around as long as their family and friends had planned for.

The Iodine 131 Experiment

In response to all of the other similar radiation experiment posts, I looked into one I discovered that took place in Alaska in the mid-1950's. Scientists from the Air Force were experimenting to see if Iodine could aide in the acclimatization of humans to cold. The Air Force scientists were not aware at the amount of ethical boundaries they crossed as they never gave full explanation of the potential of such an experiment on it's subjects. There is also a lot of gray area when it comes to whether or not consent was fully given. Any opinions when it comes to whether or not this experiment was sound, or in any way unethical?

http://www.hss.energy.gov/healthsafety/ohre/roadmap/achre/chap12_4.html

Women Doctors

Since we didn’t get to discuss the Ehrenreich reading as much and I wanted to bring up a point that worried me in the reading. Ehrenreich talks about how the medical industry is very male dominated, that unlike many countries in America Doctors are mostly male. That statement had me thinking and reviewing the many doctors I have had in the past and how, except for one thankful incident, all the doctors I’ve ever dealt with have been male. Now why is that, I have heard many young girls including little cousins claim that they want to be doctors and as they get older they follow through with the thought, but often end up in nursing school. Is there something preventing women from going on and being doctors? I read through several different articles about this, some about how it’s not worth it for women, and many saying being a mother and doctor don’t work, this one talks about many women having to be part time and this effecting patients and speaks in a way against women entering the field thinking they will be able to raise a family.

http://www.nytimes.com/2011/06/12/opinion/12sibert.html?pagewanted=all&_r=0 

But I pose the question what is keeping women away from being doctors?

-Joan Welch

Guatemala syphilis studies

I was searching for more information on the Tuskegee experiments and came across the Guatemala syphilis experiments in the 1940s. In Guatemala U.S. researchers infected prostitutes, soldiers, prisoners, and the mentally ill with syphilis, gonorrhea, or choncroid to test the new drug penicillin. The experiments in Guatemala were secret until a historian at Wellesley College in Massachusetts found records from Dr. John Cutler, who led experiments in Guatemala and was part of the Tuskegee experiments. The studies in Guatemala never issued the patients to consent to the experiments. “Researchers put their own medical advancement first and human decency a far second.” It is thought that 700 infected Guatemalans were treated and 83 of them had died. Today research companies are still testing out drugs on the poor. Do you think this should be acceptable? Drugs for AIDS and other trials are also being done in third world countries. Do you think we should be protecting only those in the developing world, or all human beings? Guatemala studies were very similar to those done in Tuskegee. I think it is important to shed light on the mistakes done in the past even outside of the U.S. to improve our medical institutions and progress.

http://www.cbsnews.com/8301-504763_162-20099804-10391704.html

http://abcnews.go.com/Health/guatemala-syphilis-experiments-shock-us-drug-trials-exploit/story?id=14414902

-emothersell

African American distrust in the Medical field

In reading Thursdays articles and considering the way in which the African American population has been viewed by medical authority I can't see how this population wouldn't have some distrust in the medical field. I'm not sure how much this still persists today, but I do also wonder if medical professionals still view African Americans as a diseased race. The relationship between doctors and African Americans may be based more on stereotypes than on reality, which may result in a self-fulfilling prophecy for this population. If both sides of the equation believe that the other person is untrustworthy or not worth looking past stereotypes then we are going to keep seeing a perpetuation of the same norms that have existed for quite some time, especially in the U.S.

Distrust of Health System keeps black males from getting care >This article I found explains some current statistics related to African American male distrust in the health care system related to control and masculinity.

Authority in Medicine

I find the whole idea of power and authority within different institutions very interesting. It's something that affects us all, whether we realize it or not. One of the institutions that holds the most power is medical; whether its hospitals or individual doctors. Medical discourse decides who and what is normal, and what is considered deviant. We saw this is Business of Being Born; doctors in the hospitals will decide when the woman should be induced and how long she is allowed to be in labor. They impose power and authority over the people in lesser positions than them, and can manipulate things to go how they want them to go. The women giving birth might have ideas of how she wants the birth to be, but in a moment of distress they might not be able to voice their opinion properly, or may give in to medical practices since their judgement may be impaired by stress or drugs like an epidural anesthesia.

This connects to what Walt from Breaking Bad feels when his wife wants him to go for treatment and he doesn't want to. Not seeking medical help may seem like the deviant act, but to him the deviance lies in being a cancer patient to begin with. He doesn't want to be stigmatized or defined by his illness. He expresses fear about being poked and prodded by doctors. He wants to sleep in his own home and feel like a normal part of society. Although it would be difficult to hear a loved one deny something that could help save their life, I do see where he's coming from. Sometimes it can feel as though we are at the mercy of healthcare professionals, and we don't always know better. We trust them because they are the experts. I am not anti- doctor whatsoever, but at times it does seem like trial and error. They may not have all the answers and certain procedures can feel like guinea pig tests. I do think some things should be done for the greater good, but like we said in class, there needs to be more done before hand to ensure medical honesty and consent, and avoid things being done last minute that are not in the best interest of the patient. Like the syphilis experiments showed us, even if "a few" people suffer from lack of consent or exploitation, that is too many. We need to make sure that things are being done for the right reasons and that people are't hurt in the medical process.





This cartoon made ma laugh and shows how, at times, the medical profession makes things more difficult than it has to be!

Defining Consent in Medicine

   In class, we discussed the morality of giving consent within the medical field.  It was brought up that an altered state of mind due to medication, panic, or stress, such as the women in Business of Being Born, could sway someone to grant consent for an intervention.  Taking tissue samples and performing test procedures without consent was also mentioned in class.  While I agree that ethics circles around all of this, I believe that in reality, anyone that sees a doctor is a test subject, regardless of consent.  Medical advancement can't be had without medical strife.  People visit the doctor and such because they are sick or diseased and need someone with the knowledge to resolve their situation help them.  But the doctor that provides the treatment or diagnosis is only able to do so due to his experiences with past patients.  Trial and error is a huge part of the medical field.  You only know if something works until you physically try it on another person.  Someone has to be the guinea pig and it's impractical to gain consent from thousands of willing test subjects to try every medical innovation ever.

Disease in Breaking Bad

Description:    For my artifact, I chose a famous scene from the television drama Breaking Bad.  The premise of the show is about a high school chemistry teacher named Walter White who is diagnosed with inoperable lung cancer and resorts to cooking and selling methamphetamines to financially support his family beyond his passing.  The two clips that I will show the class highlight and discuss a scene in which Walt has informed his family of his cancer and refuses to seek medical treatment for it.  At the time in the series, it is believed that Chemo therapy is the only option and will only prolong and ease Walt’s death.  In response to his refusal of treatment, Walt’s family hosts an intervention for his perceived poor judgment.  During the intervention, the family discusses financial limitations, familial obligations, and right to personal choice.

Analysis:         I chose this as my artifact because the premise of the show reveals the moral issue of committing a crime for a moral good (ie. Walt produces and disturbs illegal drugs [immoral] for a morally satisfying purpose [providing for his family.])  This was essentially the basic justification for the conduction of the Tuskegee Syphilis Study.  Although it was immoral to oppress the African American race to a medical case study, the published intentions of it were to attain more accurate medical knowledge and awareness of an outstanding disease.  I’m aware that the results the study was searching for may have indeed validated a form of scientific racism, but to me, the instance of the Tuskegee Syphilis Study poses the overall issue of moral injustice for the purpose of a conceived “greater good.”

            The scene from the episode exposes the authority imposed on Walt by his situation.  His wife makes note that their access to treatment is limited by their financial situation, much like African Americans during the time of the Tuskegee Study.  She also argues that Walt’s necessity to provide for and be loved by the family obligate him to seek treatment.  In all, the authority imposed on Walt in reinforced by the notion that he does not have any other option but to seek treatment to due to his restrictions.  The limited options that Walt has due to his circumstances are similar to African Americans in the study and the main reason why the pool of participants built up.

            An opponent to Walt’s subjugation to this authority is his sister-in-law Marie.  During the scene, she professes her support for Walt’s decision to refuse medical treatment, which propagates the same feeling among other family members.

            At the end of the scene, Walt basically states that he is refusing treatment because he wishes to not be subjugated by the authority that his circumstances bring.  He does not want to prolong an inevitable death for numbing purposes and would rather live out the remainder of his life in a manner which he prefers than to seek intervention and feel oppressed.

            I chose Walt’s story because it reflects shades of the stories of the Tuskegee Study participants.  Walt’s family initially feels that their financial situation gives them limited options.  He had been diagnosed with what was perceived as a serious threat, much like syphilis during the early twentieth century.  His resistance to health measures projects him as degenerate to his family.  It also adds to the idea of remaining untreated to a fatal disease when therapy is available, as Dr. Irwin Schatz points out.

Questions:

1. The concept of moral injustice for a greater benefit is used to legitimize the Tuskegee Study.  It is also a recurring idea in Breaking Bad.  Aside from the racial aspect, is it excusable to commit an injustice, such as the oppression of African Americans as an experimental subject in this instance, for the purpose of the acquisition of greater medical understanding and comprehension for the future?

2. Washington proposes an interesting hypothetical situation: “Imagine the global jubilation that would greet the announcement of a simple injection to sure AIDS.”  The emergence of penicillin was viewed in a similar way among syphilitics.  With that, is it immoral to deny someone access to a cure for a fatal disease if their financial situation will not allow them?  The idea of universal healthcare is debated often in this country and this situation falls right into that argument.

3. The committee that ended the study reported that the participants of it submitted voluntarily but were not fully informed of its dangers.  Washington argues that the committee addressed the wrong ethical issue and that never informing the participants that they were in an experiment to begin with was more immoral.  Which do you think is more immoral, the wrongful informing of the study’s dangers or existence to the participants?  Do you think even if they had know that they were part of a study that they would have refused to participate despite the chance that they could possibly still receive treatment to their disease?

4. Sharma argues that the Tuskegee Study lasted because it presented African Americans as a diseased race and that the Negro Project failed because it instead racialized syphilis due to the socioeconomic conditions of the time.  Do you think that the Negro Project failed because it revealed what medical scientists knew to be the true cause of syphilis among African Americans while the Tuskegee Study’s intent was to validate a form of scientific racism during a time of heated racial tensions?  Was the study performed to find results which validated scientific racism or was it performed to demonstrate racist conclusions that were already known?

Here are the links to the videos:

http://www.amctv.com/breaking-bad/videos/ep-5-gray-matter-highlight-minisode

http://www.amctv.com/breaking-bad/videos/inside-breaking-bad-the-talking-pillow

Authority Through Fear

An issue I'd like to discuss is how the United States is posing authority over it's citizens through fear. We've seen this through several examples; one being childbirth. As we saw in the film, The Business of Being Born, people were skeptical about midwifes because they were afraid of the complications that could happen. I feel that perhaps because we are always so aware of what could go wrong that we actually cause the complications to happen. Stress has a lot of impact on ones body and if a women keeps hearing negative things that could happen about there pregnancy then that in result could in return harm the baby.

Another good example of fear being used an instrument of authority is hospital care. No matter if your going in for the common cold or a heart surgery, I feel that we are all relying on the doctor to make us better and we give them the benefit of the doubt 99.9% of the time. We take what they give us because we are trained to think that they know more about the situation then we do. In certain aspects they most definitely do, for example a heart surgery  I don't think grandma has a green tea to help that one. But I do feel like we jump to the conclusion that doctors need to be the ones to fix everything wrong with us. Why? Because we're scared that what we do will be wrong and harm us even more. Once I went to the doctors for a head cold and they put me on medicine to help me get over it more quickly. Looking back now I remember feeling very tired all the time when I took the medicine. Maybe pushing my body to get over something quicker is not the best way to go about things. Trusting your own body and researching what the doctor is giving you/doing to you I think will perhaps lower the sense of fear we all feel.

The Power of Guilt

As we have seen in the past few classes, it was brought up of doctors talking about guilt. For instance we were talking about when the woman wants a natural birth, but she's having complications, and the doctors are telling her "We need to save you, for the good of the baby" I know that this method of guilting people to do brings up many other questions. And I know that usually for the baby, they are telling the truth. But sometimes, when there is a circumstance that doesn't have to deal with birth, some doctors will guilt people into doing something. For example with the cancer treatment on Breaking Bad. People are making him feel guilty when he says he doesn't want the treatment (his sister telling him she wants him to be alive and get treatment).

Some doctors usually use guilt to heal people, and of course to get a bigger paycheck. People also use guilt to fulfill their selfish aims. Do you think that using guilt is an ethical or unethical way to get a person to get a medical procedure done? In some instances  guilt should be used, especially with the birth process, but most of the time, guilt isn't needed.

In Response to "Procedures Without Asking"

I agree that just because a doctor changes there plan of action while treating a patient does not mean they are taking advantage of them. The body is very complex, and every person’s body can operate and react to things differently. Although we have huge benefits in the medical field and advanced technology, it does not mean that doctors know or can treat everything. Because of this, doctors must set up a plan based on a patients symptoms and problems, but there initial plan may not work causing them to go back to point A. This may happen many times before any progression is experienced, regression may even occur first. It is simply impossible for a doctor to know exactly what is wrong with a patient especially if it is a rare case or dealing with something more complicated then a common cold. Although I believe this to be the case today, do you think this was the same sort of case taking place with the Tuskegee Study? As for why doctors are often attacked for complication is because they are given such high standards, which are nearly impossible to live up to. A doctor’s main purpose should be to heal, but in some cases things may not be curable, and accidents may happen, but because so much is put into a doctors hands, lives, they are immediately the first to be blamed. It is sort of intriguing to think that doctors are the first ones we trust with our loved ones, and ourselves but once something goes wrong they are the first to be blamed, why do you think this is? 

Procedures without asking

Today in class we talked about doctors doing procedures on patients without their knowledge. I think that if a doctor has a chance to talk to a patients about what procedures they are doing before they do them they should. I also think that a doctor should inform the patient of other complications would arise and what steps could be taken if they were to happen. But I believe that when a  person gets rushed to the emergency room the doctors should be able to do what ever procedures they see fit to help that person survive. I also think that just because doctors decide to change their plan of action because after starting a surgery does not mean that they are taking advantage of the patient, it just means that the different action plan that better suits that patient. Why does it always seem that doctors are getting bashed for just trying to help save lives? Why do we always go straight to them being wrong just because people before them did wrong?

Cincinatti Radiation Experiments similarity

I wanted to become more informed on other medical experimentation that were occurring during the Tuskegee Syphilis Study, and even ones that happened in the latter. I had never heard about the Cincinnati Radiation Experiments before reading these articles. The experiment was conducted during the Cold War in a period of panic of a potential nuclear war across the country. It was shocking to see that terminally ill patients with cancer, a shocking 60% of them were African-Americans, were subjected to extreme forms of radiation on their entire body, not just where they had a cancerous tumor; just for the benefit of the country to see how radiation from a nuclear bomb would affect humans. In regards to consent, it mentions that many consent forms were forged or not signed at all. This government-funded experiment, 40 years after the beginning of the Tuskegee experiment, is just as unfathomable, if not more so. Isn't it bizarre that studies such as this one is not a common-known part of American history? I think that often people look at medical experiments as benefiting the victim, therefore justifying them because they don't really want to learn more about it. From these articles as well as the Tuskegee readings, it was interesting that medical professionals are held so high in status and appreciation by others, that instances such as these don't really even change people's views on doctors and scientists. We still assume that their interest in for the best and it will only benefit us, because after all, their job is to help us feel better isn't it?


http://www.nytimes.com/1994/04/11/us/cold-war-radiation-test-on-humans-to-undergo-a-congressional-review.html

http://targetedindividualscanada.wordpress.com/2011/08/30/cincinnati-radiation-experiments/

When Science and Medicine Cross The Line

Upon reading the documents about the research conducted in Tuskegee which essentially was a set of murders or different forms of torture to unknowledgable patients and volenteers who simply needed some support for their families. This is just one classic case with an unbelievable background to it where science and research lost sight of what and who is involved in the advancement of a professional field. From a personal perspective I can understand how easy it is to loss track of simple details when it comes to research such as that human beings are involved and they need to be given constant respect for their participation. Although for this past set of research it not only crossed the line but ran over a mile past it by leading up to other smaller sets of research which essentially killed their patients for conclusion purposes. This is one of the pieces of history that every single generation should learn about so the history such as this is never repeated again. Luckly in this modern age this type of medical horror is never repeated and if it is it is at least not on the same level as this point in history. However, I have one question to raise. If you were a research dedicating your life to finding one single conclusion to be positive do you think you  might forget the basic instinct of keeping basic human rights intact? 

-William Webster

Cover-Ups and Misinformation

The most appalling part of "A Notoriously Syphilis-Soaked Race", personally speaking, was the cover up engaged in by various factions after the public disclosure of the Tuskegee Syphilis Study. On the one hand, the malicious activities like neglecting key medical records are almost expected. The government is just trying to cover it's own back, though it does not make it excusable. More inexplicable are the actions taken by the committee. What would cause a group of medical professionals, some of whom were trying to do the right thing, to deliberately destroy evidence and snuff out the voices of many eyewitnesses? Was the cause purely circumstantial, stemming from the group? Was it indicative of a wider feeling of white or medical professional guilt over the acts committed in the study?

Also of interest is the fact that the participants in this study were not injected with syphilis but merely studied. The chapter mentions that the public is mildly misinformed about this subject. I must confess, I went through almost this entire chapter thinking that indeed the participants had been intentionally infected, until I read that fact. What's a bit disconcerting is the fact that I know I learned about the experiment earlier at some point in my schooling and only now am I aware of this fact. While the chapter concludes that the experiment will hopefully impart lessons about the past, it seems at least in my case, and in the case of some of my peers, there is still misinformation floating around our educational system. It may seem like a minor detail, but as the book cautions, false beliefs and fears can lead to aversions to certain topics and practices. In this case, it is black's concerns over manipulative treatments leading to fears of medical care. 

Releasing Statistics/Ethnic Medical Problems

After reading “A Notoriously Syphilis-Soaked Race” and “Diseased Race, Radicalized Disease”, there was an issue that caught my attention. Both articles talked about the release of statistics and data aimed at different races and genders affected by diseases, like Syphilis in this case. I feel that if the statistics are released, there can be a risk of exploitation in communities around the medical world. A link to a website is provided about the reported cases of syphilis in 2011. Is this a problem in presenting statistics based off of an ethnic group or race? Do you think the report is essential for public knowledge to prevent spreading of the disease even in present day?

http://www.cdc.gov/std/syphilis/stats.htm

Another point I thought would be interesting to debate was about how the white physicians were informed about the autopsies performed on those that were infected with the disease but not African-American physicians. This also appeared in the “Diseased Race” article from the presentations that the ASHA gave to the white communities and the African American communities. While the white communities were warned about the spread of Syphilis in the African American community, there was no warning about the spread of the same disease in the white community. Clearly the African-American community was obstructed from the truth about the diseases and the public was misinformed. Do you agree or disagree and why?

Darren Pope

Reaction to Meghan R's post and the Documentary

I think it's super interesting that Midwifery is making a somewhat comeback. I feel as though the comfortable nature of being in the home during such a big event appeals to people, and they're losing their interest in hospital care because it's almost uncomfortable now-a-days.

Personally, I think using a Midwife is such a great idea to choose over hospitals. All of the data from the article, and the individual's stories from the documentary made multiple good points in promoting Midwifery. The amount of money saved by staying at home, and the comfortable, intimate connection the mothers feel during their birth is what should be the norm. Going into a hospital is not only more expensive, but its a grim atmosphere to be in. 

The segments about the drugs used in hospitals were also eye opening, for me at least. It's kind of a scary thought to know that doctors use these drugs that contradict each other in a way that eventually leads to performing a c-section. It just seems so much less natural, and more of a health threat to go to a hospital during birth, which is contradictory in itself if you consider the original purpose of going to the hospital.