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The case against shared decision-making – 2

Michel AccadAugust 17, 2018October 4, 2021Ethics, Medical practice, Philosophy15 Comments

(This is the second part in a series on shared decision-making. Click here for part 1)

A textbook case

I recently attended a cardiology conference where a speaker proudly presented a case of shared decision-making. It involved a young female athlete who had survived a cardiac arrest and was diagnosed as having an anomaly in her heart conduction system, putting her at risk for arrhythmia during exercise.

She had received an implantable cardioverter-defibrillator and the decision in question had to do with whether she could resume sports activities or not. The guidelines issued by the American Heart Association recommend that activities be strictly limited in intensity, but the evidence to support that recommendation is scant.

The cardiologist told the audience that he and the young woman met several times and had long conversations. He got to know her very well. He took the time to explain to her everything that medical science has revealed about the potential risks of a future cardiac arrest under the circumstances. Together, they imagined various scenarios of what might happen if one course of action or another was taken, and what impact the athlete might personally experience in terms of overall quality of life.

Finally, they jointly agreed on a decision.Continue reading “The case against shared decision-making – 2”

Jade Eggs and Francis Bacon

Michel AccadJune 3, 2018Articles, Medical science, Philosophy2 Comments

How do we know that a treatment is bunk and doesn’t even need to be tested to be disproved?

A recent blog post by obesity expert Jason Fung ads fuel to the fire in the debate that opposes the standard-bearers of “science-based medicine” to those whom they view as practicing or promoting “pseudoscience.”

Fung attacked the perennial debunkers and his blog post prompted an immediate riposte by Dr. David Gorski.

Anish and I tried to sort through the controversy.

Timestamps:

00:00 Jason Fung’s case against the debunkers
08:05 Anish’s criticism of Fung’s debunking
10:50 How do we know jade eggs don’t work?
13:20 Michel’s prior experience with being debunked by the debunkers
21:40 The occult, the religious, and the naturalistic in medicine
26:20 Medicine and science have 2 different aims; doctors ought to be clear about what health is
31:25 Are the debukers baconian? Do they know of the demarcation problem? Is there a solution to the question of knowledge?

The body language of assisted suicide

Michel AccadJanuary 2, 2017January 6, 2017Articles, Ethics, Philosophyphysician-assisted suicide3 Comments

Laws that allow assisted suicide restrict the provision of “aid-in-dying” drugs to patients whose mental status is not impaired and who are capable of sound judgment.

Medscape recently featured a video interview of Timothy Quill, the palliative care specialist and long-term assisted suicide activist. He is interviewed by the ethicist Arthur Caplan, and the two discuss the psychological evaluation of terminally ill patients who request physician-assisted suicide (PAS).

Several points made by Quill caught my attention.Continue reading “The body language of assisted suicide”

The brave new world of contemporary bioethics

Michel AccadSeptember 5, 2016December 13, 2016Ethics, Philosophymedical ethics8 Comments

A few months ago, I tweeted that today’s ethicists sometimes serve the function that sophists used to fulfill in Ancient Greece: to provide moral cover for the powerful. A “consensus statement” issued last week by a committee of philosophers and bioethicists brings some pertinence to my comment.

These international scholars–all from prestigious Western institutions–had met in June in Geneva, Switzerland to take up the question of conscientious objection in healthcare. Here are the first five points of their ten-point statement, published on the Practical Ethics blog of the University of Oxford philosophy department:Continue reading “The brave new world of contemporary bioethics”

Beauty, chemistry, and natural philosophy

Michel AccadAugust 11, 2016December 13, 2016Medical science, Philosophy6 Comments

About a year ago, Theral Timpson interviewed Stanford chemist Carolyn Bertozzi on his Mendelspod podcast. I only heard the show recently and enjoyed it. The title caught my attention: “Is the future of biology a return to chemistry?”

Bertozzi made some interesting comments about her field, which she regards as “the central science,” and Timpson probed her about her expectations for the place of chemistry in what is otherwise expected to be “the century of biology.”

The discussion was of interest to me for two reasons.Continue reading “Beauty, chemistry, and natural philosophy”

The mother of all medical errors

Michel AccadJuly 14, 2016December 13, 2016Ethics, Healthcare policy, Medical science, Philosophy2 Comments

A study published a couple of months ago in the BMJ made headlines for claiming that medical errors are the third leading cause of death. As expected, the reactions were swift and polarized.

For some, the study confirmed that the self-serving healthcare system is utterly careless about the welfare of patients. For others, the claim was complete hogwash, based on faulty methodology designed to justify further regulatory oversight.

The two positions are not necessarily mutually exclusive.Continue reading “The mother of all medical errors”

Risk factors, causes, and the diet-lipid hypothesis

Michel AccadJuly 1, 2016December 13, 2016Medical science, Philosophy4 Comments

I shared with a reader an editorial I co-wrote in 2010 entitled “Risk-Factor Medicine: An Industry Out of Control?” Subsequently we had the following e-mail exchange, which I thought might be of interest to other readers of Alert and Oriented. I was impressed by Robert’s comments and learned a few things from him and from the links he provided.

On April 29, 2016, Robert wrote:Continue reading “Risk factors, causes, and the diet-lipid hypothesis”

Book review: How Doctors Think

Michel AccadMay 4, 2016December 13, 2016Medical practice, Medical science, Philosophymedical decision-makingLeave a comment

Kathryn Montgomery’s How Doctors Think: Clinical Judgment and the Practice of Medicine is an excellent book that was brought to my attention by Dr. James Gaulte in the comment section of my post on phronesis. Indeed, much of Montgomery’s monograph deals with the Aristotelian concept of practical wisdom applied to clinical decision-making.

The author is Professor of Medical Humanities and Bioethics and Professor of Medicine at Northwestern University Feinberg School of Medicine. Her book is too rich to cover deeply in a short review, but I’d like to highlight some of its major strengths as well as a few minor weaknesses.

In the first part of the book, Montgomery thoroughly demolishes the notion that medicine is applied science.Continue reading “Book review: How Doctors Think”

Flexner versus Osler

Michel AccadApril 26, 2016December 13, 2016Healthcare policy, Medical science, Philosophymedical education5 Comments

In the introduction to a talk I gave at the Mises Institute this year, I noted how, in the early part of the twentieth century, a convergence of interests between social progressivists and ideological empiricists led to the publication of the Flexner report and the subsequent enactment of licensing laws.

That historical context is further treated in an outstanding article by Alfred Tauber, who was professor of medicine and philosophy at Boston University School of Medicine.

In “The two faces of medical education: Flexner and Osler revisited,” Tauber contrasts the radically different views these two men held about the ethos of medicine and the proper approach to medical education. It is ironic that the victorious position would be the one pushed by Flexner who, as Murray Rothbard put it, was “an unemployed former owner of a prep school in Kentucky…sporting neither a medical degree nor any other advanced degree.”Continue reading “Flexner versus Osler”

From reacting machine to acting person – part 2

Michel AccadApril 22, 2016September 10, 2021Medical science, Philosophy2 Comments

[This is part 2 of my paper presentation at AERC 2016 at the Mises Institute. Find part 1 here and the audio here.]

I would therefore like to entertain an interpretation of health rooted in the view that human beings are persons acting purposely, persons who select means to achieve chosen ends, which is the framework of praxeology.

Under a praxeological framework, I would distinguish external means such as land, labor, and capital, which are generally the concern of economic theory, from internal means, such as the physical and mental conditions of the person that allow him or her to pursue chosen ends.

Health, then, may be defined as the state that is present when a person’s physical and mental conditions allow the pursuit of his or her chosen ends. Disease, then, is the absence of health.Continue reading “From reacting machine to acting person – part 2”