Gavel and stethoscope.

How to Assess the Impact of Medical Ethics Education

By Leah Pierson

There has been too little evaluation of ethics courses in medical education in part because there is not consensus on what these courses should be trying to achieve. Recently, I argued that medical school ethics courses should help trainees to make more ethical decisions. I also reviewed evidence suggesting that we do not know whether these courses improve decision making in clinical practice. Here, I consider ways to assess the impact of ethics education on real-world decision making and the implications these assessments might have for ethics education.

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Cozy scottish kitten sleeps under blanket on a bed at home. Top down view.

Public Health: Got Sleep?

By Jack Becker

There are certain public health commercials that generations will always remember. For some, it’s the NHTSA’s “Drive Sober or Get Pulled Over” commercials. For others, it may be a “Think. Don’t Smoke.” commercial featuring a young Robert McElhenney. Younger generations have certainly seen “The Real Cost” campaigns, which have recently tackled vaping. And a personal favorite, Nickelodeon’s “Hidden Sugar” commercial will forever be iconic.

To the visionaries that permanently cemented the fact that “glucose, sucrose, dextrose, and maltose” are “all words that rhyme with gross” in minds across the country, here’s a new challenge: sleep deprivation.

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Basketball street player making a rear slam dunk.

Another Kind of Performance-Enhancing Drug in Sports: Substances That Improve Creativity

By Jack Becker

Discussions about performance-enhancing drugs (PEDs) are normally all about physical abilities. They revolve around PEDs that can alter strength, speed, stamina, recovery, and even stability. But if every sport were just a competition of physical traits, they’d be pretty boring.

Sports combine physical competition with competition of strategy, technique, and other non-physical components (to varying degrees). While players develop some of these individually, sports also involve coaches and trainers that develop new strategies and techniques without stepping onto the field. Innovations in these non-physical components can certainly enhance a player or team’s performance. So how do they fit into the PED discussion?

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Group of athletic adult men and women performing sit up exercises to strengthen their core abdominal muscles at fitness training.

Exercise Equipment Advertisements and Consumer Distrust

By Jack Becker

Are you ready to learn about “the most innovative piece of exercise equipment ever”? To take advantage of “the momentum of gravity to target your entire midsection”? Doesn’t everybody want to “lose those love handles nobody loves”? To finally “have the flat washboard abs and the sexy v-shape [they’ve] always wanted”? Within “just weeks, not months,” anybody can “firm and flatten their stomach.” And “best of all, it’s fun and easy and takes just three minutes a day.”

Despite its endorsement from an expert fitness celebrity and customer testimonials, you might be skeptical of the Ab Circle Pro’s claims. After all, can you really cut out five minutes from the iconic 8-Minute Abs routine?

Massive and misleading promises are an unfortunate reality for many exercise equipment advertisements. Illegitimate advertising claims can harm consumers and impact overall consumer trust, which creates an uphill battle for honest companies. The Federal Trade Commission (FTC) already regulates exercise equipment, but supplementing its efforts with more consumer education and industry self-regulation could be a winning combination to restore trust in the fitness industry.

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Empty nurses station in a hospital.

The AMA Can Help Fix the Health Care Shortages it Helped Create

By Leah Pierson

Recently, Derek Thompson pointed out in the Atlantic that the U.S. has adopted myriad policies that limit the supply of doctors despite the fact that there aren’t enough. And the maldistribution of physicians — with far too few pursuing primary care or working in rural areas — is arguably an even bigger problem.

The American Medical Association (AMA) bears substantial responsibility for the policies that led to physician shortages. Twenty years ago, the AMA lobbied for reducing the number of medical schools, capping federal funding for residencies, and cutting a quarter of all residency positions. Promoting these policies was a mistake, but an understandable one: the AMA believed an influential report that warned of an impending physician surplus. To its credit, in recent years, the AMA has largely reversed course. For instance, in 2019, the AMA urged Congress to remove the very caps on Medicare-funded residency slots it helped create.

But the AMA has held out in one important respect. It continues to lobby intensely against allowing other clinicians to perform tasks traditionally performed by physicians, commonly called “scope of practice” laws. Indeed, in 2020 and 2021, the AMA touted more advocacy efforts related to scope of practice that it did for any other issue — including COVID-19.

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Medical student textbooks with pencil and multicolor bookmarks and stethoscope isolated on white.

We Need to Evaluate Ethics Curricula

By Leah Pierson

Health professions students are often required to complete training in ethics. But these curricula vary immensely in terms of their stated objectives, time devoted to them, when during training students complete them, who teaches them, content covered, how students are assessed, and instruction model used. Evaluating these curricula on a common set of standards could help make them more effective.

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College football on grass field in afternoon sunlight

There’s More Than Rules in Regulating Concussions

By Jack Becker

The football world has used a variety of methods to make the sport safer: Compare modern football to football a century ago, when at least 18 people died playing the game in 1905 alone and Teddy Roosevelt had to intervene. In recent years, concussions and brain trauma have become football’s scarlet letter. While leagues have already made changes to prevent brain injuries, there’s more to be done.

This post considers the application of Lawrence Lessig’s New Chicago School approach to regulation to the prevention of concussions (and other types of brain damage generalized under the word “concussions” for simplicity) in football.

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Seltzer in glass and can.

Vizzy and Fortifying Alcoholic Beverages

By Jack Becker

A few years ago, a Bill of Health post titled Jelly Beans, Booze, and B-Vitamins proposed fortifying cheap wines, hard liquors, and malt liquors with thiamine (vitamin B1).

The post suggested this as a public health measure to prevent Wernicke-Korsakoff syndrome (WKS) in the homeless alcoholic population. Wernicke-Korsakoff syndrome is a debilitating neurological disorder caused by thiamine deficiency. The disorder is significantly more prevalent in those with chronic alcoholism (up to 80% of whom become thiamine deficient), and it’s preventable by boosting thiamine consumption. For this reason, advocates started promoting the idea of fortifying cheap alcohol with thiamine decades ago.

Jelly Beans, Booze, and B-Vitamins explains that this initiative is complicated by the fortification policy put forth by the U.S. Food and Drug Administration (FDA), under which the agency does “not consider it appropriate to add vitamins and minerals to alcoholic beverages.” (While FDA and the Alcohol and Tobacco Tax and Trade Bureau [TTB] share jurisdiction over alcoholic beverages, TTB has followed FDA’s public health expertise in the past and would likely do so in this situation as well.) FDA similarly discourages companies from fortifying snack foods to avoid misleading consumers about their health value.

While the thiamine-in-alcohol proposal hasn’t gotten far enough to warrant official consideration, there’s a new fortified alcohol product making waves in the market. And while the stakes aren’t quite as high, it’s still a hard issue — a hard seltzer issue.

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