Tuesday, December 27, 2011

Ethical Principles in Research

One part of developing a narrative research study is applying to my institution for an Ethical Principles in Research Program number (EPRP). 

Perhaps I should back up. 
I'm putting together some ideas for this summer. I'd love to travel to Central America to see what I can learn about how to age with grace. I have been interested in this subject ever since I was able to grasp the vast differences between how people in Ukraine age and die versus how people in the United States age and die.

In Ukraine, elders are often taken back in by their children and nursing homes are virtually non-existent.
In Ukraine, elders are given chores and tasks to help support their family, whether chickens to look after or napkins to sew.
In Ukraine, people die at home without extreme or radical (often expensive) attempts to prolong life a few more months.
In Ukraine, people accept death as part of life and are able to talk about it with ease.

Note: all of the above are vast generalizations and not always true in Ukraine, just as the converse is not always true in the United States.

Anyhow, this fascination with the transition from life to death has lead me to pursue funding for a trip to Central America where I will be able to talk with and observe a third culture dealing with aging and dying. My institution will fund such an enriching trip so long as it meets basic requirements, such as being scientifically based and completely ethical. My proposed research will most likely be of narrative qualitative design with data being collected in interviews, photographs and documents. The ethical benchmark is tested by completing an EPRP education program and taking a test at the end.

The Ethical Principles in Research Program requires that I read the Belmont Report. This document was written by a panel of experts in 1976 after the full extent of the Tuskegee Airmen syphilis atrocities had been revealed. It seems to be a whole-hearted attempt at achieving more ethical research by applying the principles of "respect for persons", "beneficence", and "justice". I found their definition of justice to be particularly interesting. 

"Almost all commentators allow that distinctions based on experience, age, deprivation, competence, merit and position do sometimes constitute criteria justifying differential treatment for certain purposes. It is necessary, then, to explain in what respects people should be treated equally. There are several widely accepted formulations of just ways to distribute burdens and benefits. Each formulation mentions some relevant property on the basis of which burdens and benefits should be distributed. These formulations are(1) to each person an equal share, (2) to each person according to individual need, (3) to each person according to individual effort, (4) to each person according to societal contribution, and (5) to each person according to merit."

It is good to think with this recently ignored part of my brain about broad philosophical concepts such as justice. 
Here's another great quote, apparently one that Ron Paul has not read and thinks is a matter of belief rather than fact.
The Belmont Report goes on to speak to the application of the three comprehensive principles.
Application includes:

1. Informed consent (information, comprehension, voluntariness)
2. Assessment of risks and benefits
3. Selection of subjects.


"Injustice may appear in the selection of subjects, even if individual subjects are selected fairly by investigators and treated fairly in the course of research. Thus injustice arises from social, racial, sexual and cultural biases institutionalized in society. Thus, even if individual researchers are treating their research subjects fairly, and even if IRBs are taking care to assure that subjects are selected fairly within a particular institution, unjust social patterns may nevertheless appear in the overall distribution of the burdens and benefits of research. Although individual institutions or investigators may not be able to resolve a problem that is pervasive in their social setting, they can consider distributive justice in selecting research subjects."


Thursday, December 22, 2011

When medicine is overruled

So much of medicine is prevention. Now even things that we were trying to pin on genes are coming back to lifestyle. Check out this visual representation of cancer risks. It strikes me that most of these changes do not require doctors, yet failure to learn from this data results in the need for many doctors.

In another example of when doctors may not have enough sway to advocate for health, a team of surgeons donated their time to provide a kidney transplant to this man, yet were denied an operating suite by their hospital. Extremely frustrating that Republicans argue against a lifesaving and money-saving operation simply because this man is from Mexico. How can they claim Christian religion and say it's okay for undocumented immigrants to donate organs but not receive them?


"Organ registries do not record illegal status, but a study estimated that over a 20-year period noncitizens donated 2.5 percent of organs and received fewer than 1 percent."

"They should not get any benefit from breaking the law, especially something as expensive as organ transplants or dialysis," said Representative Dana T. Rohrabacher, Republican of California, who contends that care for illegal immigrants is bankrupting American health care and has sought to require that emergency rooms report stabilized patients for deportation unless they prove citizenship or legal residence.
"If they're dead, I don't have an objection to their organs being used," Mr. Rohrabacher added. "If they're alive, they shouldn't be here no matter what."

It sounds like the old "us vs. them" crap that has lead to immoral and unjust policies for all of recorded history...

Tuesday, December 13, 2011

Last week of the first semester. Positive thoughts

As I drove out to my last indoor soccer game of the semester last night along with fellow medical students, we talked a lot about the difficult and frustrating parts of medical school. It led me to think about how much easier it is to complain and vent about the frustrating parts of school rather than recognize all of the amazing things we are learning.

Today was our last day in the anatomy lab, though I'll go back for one more review visit before the final exam on Friday.

The physiology part of our final covers renal function and gastrointestinal secretion+absorption. The physiology is extremely interesting though I often don't have time to delve into the small details. Without the mechanistic details down to the smallest level, I often feel that the ratio of memorization/understanding gets too large. Looking forward to getting to NM for a little sunshine next week.

Time to pay attention to this radiology lecture again. Most of it is going over my head, but it is a good anatomy review.

Monday, December 5, 2011

The End of Merv Logging, for now...

I just can't keep up with blogging, logging and my journal. I end up shortchanging all of them.
I've read a number of interesting things recently, the most notable being my stopwatch.
Hopefully I'll clear it more often in the future.
here are the laps, and best guesses as to what they correspond to.
I run almost daily so these go back through all of November.

25:09 -- 11/3/11
34:56 -- 11/4
32:53 --  11/5
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44:34 -- 11/6
39:10 -- 11/7
36:50 -- 11/12
Didn't run much this week because my foot hurt after stepping on a giant rock on an old railroad bed.
-------------------------------
57:35 -- 11/13
12:17 AM shakeout --11/14
28:52 -- 11/15
41:12 --  11/16
27:05 --  11/17
25:39 --  11/18
1:03:31 -- 11/19
-------------------------------------
53:37 --11/20
12:21 AM shakeout

47:05 -- 11/22
Drove out to Mendon ponds with Gears and Mguy.
Didn't have much time because we had to get me back to school for end of semester orchestra concert.

23:41 -- 11/23
Quick graveyard loop before drive to Boston with classmates.

1:15:29
Thanksgiving day. Perfect and sunny in Providence, RI.
Some cool trail by the harbor.

36:26
Day after thanksgiving.
Run ended on closed open drawbridge. The bridge was closed to trains and open to boats. Good old relativity. Wish I had a camera because I climbed up quite high.

1:10:42
Glastonbury with Paul and friends.
Slowest run in months.
Thank goodness.
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47:47 --11/27
Pinnacle hill and area after long drive from Elo's to Rochester.

40:04 --11/28

41:09 -- 11/29

1:07:36 -- 12/1
Loop of Hill with Mguy.

29:45 -- 12/2
Lunchtime run with Gears.
Found the most industrial part of Rochester in mixed rain + snow.

1:21:01 -- 12/3
Long run with Gears. Abandoned railroad beds make for very flat runs. We kept it uptempo though...
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39:03 --12/4
Night run solo after preping for my hour long interview + physical exam tomorrow. I'm playing doctor and the whole thing is getting video taped.