bloody zombie hands grasping air

Considerations for a Zombie Apocalypse: The Definition of Death Among the “Walking Dead”

While there has been a great deal in the literature that discusses the ethics of neurologic, cardiopulmonary and biologic death in the context of organ donation, there has been very little attention to this application with regard to zombies. Zombies are often referred to as “living-dead” which creates both a scientific, operational, and ethical conundrum with regard to classification. To date, there is no definitive answer as to whether zombies are truly “dead” or whether they are “living” or that they exist along the spectrum of conscious to coma, from living to dead. In the event of a zombie apocalypse, it is currently unclear whether or not zombies could be considered suitable organ donors.

Zombies: A Definition and Brief History

Zombies are a class of “living dead” that also includes vampires, ghouls, mummies, and wights. The term “zombi” was reportedly first used by the poet Robert Southey in his description of Brazilian history. One of the earliest references to zombies dates back to Mesopotamia in the Descent of Ishtar when the goddess Ishtar threatens to “raise up the dead, and they shall eat the living.”

Since then, there have been hundreds, if not thousands, of descriptions of undead, zombies, and reanimated humans in comics, books, television programs, and movies. Some cultures have an extensive history of zombies, the most well-described and studied being the Haitian Zombies of Voodoo.

Zombies are further divided into subcategories: zombies reanimated by black magic (Voodoo), those created by sorcery (necromantic), viral- induced (Solanum) and those created by mutation from radiation (atomic). There have been case reports of drug-induced zombies, but these were later re-classified as this state was reversible without intervention. There is a movement to utilize the more descriptive terminology Ataxic Neurodegenerative Satiety Deficiency Disorder (ANSDS).

Culturally, the term differently-animated has been used as a more politically correct term for identifying zombies. The varied terms, means by which zombification can occur and the newer, more descriptive and politically correct terminology however, has done little in the way to describe the actual physiologic state of zombies. This requires a more in-depth analysis of what we do and do not know about zombie biologic and specifically neurologic function.

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hand with a pencil drawing on DNA results

Silver Spoons and Golden Genes: Designing Inequality?

A recent web series sparked controversy with the headline that “Designer babies aren’t futuristic. They’re already here.” The online articles make the case that disparate access to frozen embryo screening for debilitating diseases—sickle cell anemia, Tay-Sachs, or cystic fibrosis—is “designing inequality into our genes.”

The authors are right that reproductive technology isn’t open to everyone. A single cycle of in vitro fertilization (IVF)—the tool that combines sperm and egg in a lab—costs 57% of the average American’s annual income in 2018. The multiple cycles it usually takes to get a baby costs upwards of $100,000. Just fifteen states make insurers cover reproductive technology. Even these often limit coverage mandates to married couples unable to conceive, thereby denying equal benefits to non-traditional families.

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person wearing gloves holding HIV test

Southern Indiana’s HIV Outbreak: A Lesson on the Importance of Incentivizing HIV Testing

By 2015, major news outlets were reporting on what the CDC was calling “one of the worst documented outbreaks of HIV among IV users in the past two decades.” Between 2011 and 2015 over 200 people in southern Indiana’s Scott County acquired HIV. The primary source of the spread was the sharing of needles to inject opioid drugs. While the outbreak has now been contained, there linger many lessons to be learned from the tragedy that struck this small rural county in southeast Indiana.

Some of those lessons are about the havoc being wreaked on much of rural America by opioid abuse. But the lessons I’m focusing on here are the dangers of disincentivizing HIV testing, especially among high-risk populations like injection drug users. Read More

Medicine doctor and stethoscope in hand touching icon medical network connection with modern virtual screen interface, medical technology network concept

Data-driven Medicine Needs a New Profession: Health Information Counseling

By Barbara Prainsack, Alena Buyx, and Amelia Fiske

Have you ever clicked ‘I agree’ to share information about yourself on a health app on your smartphone? Wondered if the results of new therapy reported on a patient community website were accurate? Considered altering a medical device to better meet your own needs, but had doubts about how the changes might affect its function?

While these kinds of decisions are increasingly routine, there is no clear path for getting information on health-related devices, advice on what data to collect, how to evaluate medical information found online, or concerns one might have around data sharing on patient platforms.

It’s not only patients who are facing these questions in the age of big data in medicine. Clinicians are also increasingly confronted with diverse forms of molecular, genetic, lifestyle, and digital data, and often the quality, meaning, and actionability of this data is unclear.

The difficulties of interpreting unstructured data, such as symptom logs recorded on personal devices, add another layer of complexity for clinicians trying to decide which course of action would best meet their duty of beneficence and enable the best possible care for patients.

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What happens when a fertility clinic is responsible for destroying reproductive material?

A recent article in Marie Claire delved into the story of a Cleveland fertility clinic that lost 4,000 frozen eggs and embryos belonging to 950 patients and featured commentary by Bill of Health contributors. In the piece, “When Your Dreams of Motherhood Are Destroyed,” three Bill of Health/Petrie-Flom Center affiliates discussed some of the many legal challenges of this particular case, and others like it.

The story was reported by 

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A group of college students play jenga and drink beer

The Drinking Age and Law Enforcement on College Campuses

When I was a senior in college, after having worked for the Cornell University Police Department for four years, I hosted a town hall meeting to promote and improve the Blue Light Escort Service, a service which most colleges have to give students safe, free late-night walks home by law enforcement or affiliated personnel.

One of the key takeaways of the meeting, as I knew it would be, was that many students were unsure of the relationship of the escort service to enforcement of underage drinking laws: they were scared that if they were drunk underage and called for an escort, they would get in trouble.

This post is, in a sense, about a narrow issue: the effect of the national minimum legal drinking age (MLDA) of 21 on campus law enforcement. More broadly, however, it’s about a specific and often overlooked result of a legal framework that ostensibly-but-not-really makes criminals of the hundreds of thousands of college students who live on their own and are legally considered to be adults, for behavior that virtually all other adults engage in with laws that are virtually but not entirely unenforced.

It’s kind of a weird thing, if you think about it.

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Mary Mayhew: The New Anti-Medicaid Head of Medicaid

Mary Mayhew, a fierce opponent of Medicaid Expansion under the Affordable Care Act, was announced on October 15 as the new Deputy Administrator and Director of the U.S. Center for Medicaid and CHIP [Children’s Health Insurance Program] Services. As the House Ways and Means Committee Democrats put it in a recent tweet, the Trump Administration’s choice “is like hiring an arsonist to be a city’s fire chief.”

Mayhew spent years as commissioner of Maine’s Department of Health and Human Services under outgoing Governor Paul LePage. She stepped down in May 2017. After her time as commissioner, Mayhew pursued an unsuccessful race for Governor of Maine, coming in third in the Republican Primary this past June.

The Maine Department of Health and Human Services’ approach to Medicaid under Mayhew’s leadership does not exactly suggest she will take an expansive approach to Medicaid in her new role. According to the ACLU of Maine, enrollment in MaineCare, Maine’s Medicaid program, decreased by 37 percent during her time in office, eliminating coverage for about 80,000 people.

The state also dropped from 10th to 22nd in national health rankings.

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woman holding an ipad, looking concerned

What are the Ethics of Electronic Consent Forms?

While bioethics has generally understood technologies to be a source of ethical problems, there is relatively little reflection about issues associated with technology’s role in bioethics itself. The move towards electronic consent is one area in technology. While there is substantial research on consent and the consent process the gradual shift towards digital consent forms appears to have arrived without necessary bioethical reflection. What are the ethical implications of this shift?

Yet, there are other more compelling questions that this brings about: Could the digitization of consent forms support even more robust kinds of consent on the part of patients and research subjects? Given what we know about the gaps between the ideals of consent and the reality of consent in clinical and research settings, could electronic supports be used precisely in areas where consent “breaks down?” How might ethical aims be sustained or emboldened via systems?

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Development and Delivery of Drug Pricing Policy

We know that drug pricing is a critical issue across the globe.

The Petrie-Flom Center, along with Global Access in Action at the Berkman Klein Center for Internet and Society at Harvard University, will host a conference featuring fresh ideas for solutions from patient advocates, industry insiders, academic thought leaders, and administration officials.

Join us to engage with panels and keynotes where speakers will lead novel, interdisciplinary discussions in an effort to better address current challenges both in the U.S. and globally.

Confirmed speakers include Ronald Piervincenzi (CEO of the United States Pharmacopeial Convention), Sean Dickson (of the Drug Spending Research Initiative at The Pew Charitable Trusts), Hannah Kettler (Senior Program Officer, Industry Leadership Engagement and Thinkubator Lead at the Bill & Melinda Gates Foundation), Joe GroganAssociate Director, Health Programs, Office of Management and Budget), and many more. 

For a full conference schedule and to register, please click here!  Read More

neural web and female face

Privacy Regulation in the Age of Machine Learning

By Adrian Gropper

Will the machines use our own personal information against us? The answer depends on privacy regulations that are yet to be written.

I know that the current approach to privacy regulation, be it general as in GDPR or sectoral as in HIPAA, is not readily extensible to a world where the principal value of personal data is machine learning. It’s easier to follow my logic if you agree that technology costs are already low compared to the value of personal data. Buying your own AI is increasingly sensible. Then, who will teach your personal AI in school, at work, in your community? You and your doctor will both have personal AI. What is the role of intellectual property when the cost of personal data dominates the cost of your AI? How do you use your AI to license the use of your personal data by others? Standards will be essential to maximize the market for your personal data, whether it’s sold or donated for the public good. These personal data standards are less-than-welcome in a process dominated by enterprises. Nonetheless, thoughtful privacy regulation designed around machine learning will keep humans responsible for the machines.

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