Perspectives in Biology and Medicine最新文献

Health care has become increasingly digitized. Given that under-invested health systems and patient populations frequently have worse access to the newest innovations, there is concern that this digitalization may exacerbate preexisting health inequities. This article discusses the multiple ways that digital health may increase health inequities. Using case studies presented by digital health leaders in different roles and settings, it provides examples of how health systems can adopt and implement innovative tools to deliver care while centering health equity. The case studies highlight five guidelines that health-care systems should consider as they weigh the equity implications of adopting any digital tool: auditing benefits, institutional incentives, elevating frontline and patient perspectives, long-term community engagement, and protecting data.

Started in the 1960s with a commitment to justice, the community health center (CHC) movement emphasized that everyone deserves respectful, quality health care and that addressing social drivers of health is within the remit of health-care organizations. Sixty years on, the network of federally funded community health centers that developed from this movement remain committed to serving vulnerable populations in America as they set the standard for high-quality, wraparound primary care services. This essay draws on the authors' qualitative study of moral uncertainty in community health to show how CHC providers enact a commitment to justice as they both improve access to care and services and recognize their patients' humanity in a society where too many of them are "chewed up and spit out." CHCs' ability to enact justice, however, is limited in the US's fractured health-care system and profoundly unequal society, and their success and financial viability are not assured. In order for CHCs to fully enact their mission, it will take appreciating the key role they play in advancing health justice in America, and strong, savvy advocacy efforts.

In recent years, health systems throughout the United States have made public declarations committing to health equity. Yet clinicians in these systems often feel they are not set up to support equitable care. This discrepancy between proclaimed commitments and on-the-ground realities is one of the major reasons for the continued rise in clinician moral distress. Hospitals' mission statements are often multifaceted. Therefore, when one facet, such as research or education, is prioritized, another, such as health equity, may suffer. Do these represent conflicts of interests? Ethical dilemmas? What about the fiduciary responsibilities of a health system? How do those come into play when a hospital is deciding which aspects of its mission to prioritize? This article discusses hospital missions, values, and fiduciary responsibilities; characterizes the nature of the conflicts that arise when key aspects of these commitments and responsibilities are at odds; and offers hospitals and health systems insights for characterizing these conflicts when they arise. By assisting health systems to communicate better with their staff, the authors hope to propel systems further towards achieving health equity and concurrently decrease clinician moral distress.

Despite their benevolent intent, health-care delivery organizations often cause harm. While some harms are unavoidable in the course of doing business- and are perhaps morally justified-other harms constitute organizational wrongs, which are never justifiable. When a health-care delivery organization acts wrongly, the organizational wrong imbues individual employees with a responsibility to mitigate those wrongs. This article explores the question of individual responsibility in relationship to organizational wrongs and proposes strategies that complicit individuals can adopt to mitigate organizational wrongs.

In the 21st century, cancer remains shrouded in complex ways, imbued with sociocultural meanings that extend far beyond its clinical and biological aspects. The fear and anxiety surrounding cancer often prompt family and friends to respond with either excessive protection or emotional detachment, leaving patients feeling isolated and unsupported. This article challenges entrenched stereotypes, particularly cultural tendencies in India to conceal cancer diagnoses, associate the disease with karmic retribution, and view it through fatalistic and death-centered perspectives. Drawing on theories of pathography and restitution narratives, it offers an alternative perspective to the bleak and fatalistic portrayals of cancer commonly found in Indian cinema and popular culture. The article primarily focuses on Neelam Kumar's graphic memoir, To Cancer, with Love: A Graphic Novel (2017), while also engaging with its prose counterpart, To Cancer, with Love: My Journey of Joy (2015). The article investigates Kumar's subversion of conventional narratives of illness and powerful counter-narrative to the dominant discourse on cancer in India. As one of the pioneering graphic pathographies from India, Kumar's memoir presents a transformative and empowering perspective on the experience of cancer, challenging the societal norms that often stigmatize the disease.

This article introduces and analyzes a hitherto overlooked phenomenon, that of false fear in medicine. Closely aligned to cases of false hope, false fear is characterized by belief, aversion, and fixation components. Because false fear involves a fixation on an unlikely aversive outcome, it often causes harm to the person and others, and this makes intentionally causing false fear prima facie wrong. The author discusses some of false fear's sources in medicine and explains how physicians and other health-care practitioners may be blameworthy for not addressing false fear.

Jeremy Howick's The Power of Placebos (2023) invites readers to reconsider what counts as "real" effects in clinical medicine. The book resists the temptation to delve into the causal interpretation problem and instead asks an interesting question: how should clinicians act, given what's known about mind-body connections and increasing evidence of the importance of patients' beliefs and expectations? Howick argues that rituals, empathy, and meaning can exert biological force and therefore deserve to be studied, taught, and practiced with the same seriousness as drugs and devices. The pragmatic challenge is to design and test multicomponent interventions that harness placebo benefits while minimizing nocebo harm. If realized, the task for modern medicine would be to find new ways of ethically and transparently integrating effective care packages into practice. Doing so could not only help restore trust in medicine but also reclaim space that is too often ceded to unregulated actors and online influencers. While paradoxes and ethical quandaries remain, Howick's proposal merits serious consideration. It may help clinicians fulfill a deeper role in society as empathetic guides who foster healing by helping patients make meaning amid existential uncertainty.

This article explores the potential of narrative medicine to strengthen the democratic ethos in health care. The heart of narrative medicine is attentive listening, an often scarce resource in our democratic communities. By listening to those who are traditionally voiceless and disenfranchised-the sick, the disabled, the old, the frail-narrative medicine empowers vulnerable patients' voices against the dominant discourse of health professionals and contributes to treating the moral injuries inflicted on patients by epistemic and social injustice. In addition to helping to democratize decision-making in health care, attentive listening could also prove therapeutic for democracy itself, by challenging the abstract and disembodied style of our political systems and making room for the vulnerability and finitude of our human condition in the constitution of citizens.

The effects of climate change harms upon public health could be disastrous. Many have likened the urgency and peril associated with our global situation to living in a house on fire. This article uses the housefire metaphor to consider how public health teams and others can encourage actions that lessen climate-related harms. Using strategic narratives to disseminate communications may improve chances of this being achieved. The housefire metaphor expresses the urgency and our shared ownership of the climate situation, and it can be deployed to recommend feasible, remedial actions.

Current guidance from the American Society for Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG) indicates that body mass index (BMI) ought not be used alone for in vitro fertilization (IVF) exclusionary policies, but the reasons for using BMI alongside other criteria are less clear. This article aims to fill a gap in the literature on this point and follow the findings to a logical conclusion regarding the role of BMI in IVF policies of the future. The article discusses why BMI might be useful in IVF policies, explores evidence that other metrics may be sufficient to estimate population-level risk, and addresses whether policies ought to continue to use BMI. Because BMI has a morally problematic history, results in disproportionate outcomes along racialized lines, and has the potential to reinforce negative stereotypes, the article suggests that providers ought to replace BMI with other metrics.