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AMA Journal of Ethics

David L Katz
Diet is a universal influence on health and one of the major determinants of both years in life (longevity) and life in years (vitality). Diet is also a uniquely complex variable, encompassing nearly infinite variations in composition and concentration, making it difficult to study. Study design and the particular answers at which a given trial is aimed exert considerable influence on findings, and these, in turn, may be influenced by the biases and a priori preferences of researchers, funders, or commentators...
October 1, 2018: AMA Journal of Ethics
Adam Drewnowski, Jean-Pierre Poulain
Dietary changes that occur in response to economic development are collectively known as the nutrition transition . More specifically, diets built around staple cereals and tubers give way to diets with more animal products and more added sugars and fats. Although the proportion of dietary protein stays constant, plant proteins are replaced by animal proteins but in ways that are dependent on regional cultural, religious, and ethical concerns. The protein transition , viewed here as a subset of the broader nutrition transition, illustrates how dietary patterns in low- and middle-income countries are shaped by societal as well as by economic forces...
October 1, 2018: AMA Journal of Ethics
Jessica Fanzo
The United Nation's Sustainable Development Goals (SDGs) mark an important moment for the world to improve human capital through nutrition and health goal setting. While the Millennium Development Goals contributed to the reduction in the number of undernourished people, the agenda remains unfinished. We are at a crucial crossroads with malnutrition burdens and hunger not decreasing as fast as they should and sometimes increasing. There is a moral imperative to act on the SDGs for nutrition, and health systems and professionals working in those systems have significant roles to play in fulfilling the objectives set out by the goals-that is, in ensuring that all citizens have a chance to achieve their own development...
October 1, 2018: AMA Journal of Ethics
Sarah Reinhardt, Ricardo J Salvador
Health professionals have the opportunity and responsibility to apply their expertise to address the current trajectory of chronic disease in the United States. Half of American adults have one or more preventable chronic diseases, many of which are diet related, so it is critical that health professionals engage in public health prevention strategies. These can take the form of public and private sector partnerships. Food procurement-the processes through which institutions such as hospitals and schools purchase and serve food-offers powerful opportunities for health professionals to partner with public institutions to prioritize accessibility to nutritious, sustainable, and fairly produced food and to generate sustained benefit to population health...
October 1, 2018: AMA Journal of Ethics
Haley Swartz
Background: To explore the ethical and policy implications of produce prescription (Rx) programs, PubMed, Embase, and Scopus databases were searched for peer-reviewed literature on existing Rx programs in February 2018. Methods: A review of the literature identified 19 articles published on produce Rx programs; all were included in the review. Inclusion criteria were interactions between a medical professional and patient in a health care setting where a prescription for the consumption of fruits and vegetables was provided...
October 1, 2018: AMA Journal of Ethics
Gail Geller, Paul A Watkins
Context: Negative bias toward patients with obesity is an ethical challenge in patient care. Several interventions to mitigate medical students' negative weight bias have been tried but none with an explicit focus on ethics. Here we describe first-year medical students' attitudes toward obesity and our effort to improve their attitudes through an innovative ethics session embedded within the required course, "Obesity, Nutrition, and Behavior Change," at Johns Hopkins University School of Medicine...
October 1, 2018: AMA Journal of Ethics
Alexis K Walker, Elizabeth L Fox
In a 2015 paper published in the Journal of Bioethical Inquiry , bioethicist Henk ten Have identifies vulnerability as a "controversial topic in bioethics" and argues that bioethical attention to vulnerability comes at the expense of sufficient attention to the social structures that shape human life. In this paper, we situate ten Have's argument within the broader bioethical literature, emphasizing how critiques of vulnerability can enrich approaches in clinical settings, including in nutrition, where the concept of vulnerability is not foreign (eg, children are often labeled members of a vulnerable group)...
October 1, 2018: AMA Journal of Ethics
Nicole Civita
Occupational health issues are not just common for farmworkers; they are practically unavoidable. Farmworkers who seek treatment for work-related injury or illness are often unable to meaningfully reduce their exposure to risk factors without further jeopardizing their already fragile well-being and tenuous livelihoods. This case commentary addresses why and how physicians presented with patients who are ill because they work in agriculture should adjust their clinical practices to better meet the unique challenges faced by this patient population...
October 1, 2018: AMA Journal of Ethics
Stephanie Morain, Anne Barnhill
Eliminating formula giveaways ("banning the bag") has been embraced as a way to reduce the influence of formula marketing in hospitals and to increase breastfeeding rates among new mothers, but the policy raises ethical concerns in the mind of some, notably because it denies a useful benefit to mothers who have trouble affording formula. Hospital policies to promote breastfeeding, including banning the bag, should be sensitive to the economic and other costs associated with breastfeeding and should be consciously designed to make breastfeeding easier and not just to make formula feeding more difficult...
October 1, 2018: AMA Journal of Ethics
Annalynn Skipper
In this case, a physician wonders what he should do to help make nutrient-dense foods available in underserved neighborhoods. I argue that improving diets of people who live in food deserts is a complex problem at the intersection of culture, education, and economics that will require community partnerships and clinician self-education to solve.
October 1, 2018: AMA Journal of Ethics
Camillo Lamanna, Lauren Byrne
A significant proportion of elderly and psychiatric patients do not have the capacity to make health care decisions. We suggest that machine learning technologies could be harnessed to integrate data mined from electronic health records (EHRs) and social media in order to estimate the confidence of the prediction that a patient would consent to a given treatment. We call this process, which takes data about patients as input and derives a confidence estimate for a particular patient's predicted health care-related decision as an output, the autonomy algorithm ...
September 1, 2018: AMA Journal of Ethics
Sathyaraj Venkatesan, Sweetha Saji
Increasing reliance on statistics for treatment and clinical risk assessment not only leads to the reductive interpretation of disease but also obscures ambiguities, distrust, and profound emotions that are important parts of a patient's lived experience of illness and that should be regarded as clinically and ethically relevant. Enabling critique of the limitations of statistics and illustrating their hegemonic impact on the patient's experience of illness, graphic medicine emerges as a democratic platform where marginalized perspectives on illness experiences are vindicated...
September 1, 2018: AMA Journal of Ethics
Audrey Gray
This image seeks to iteratively represent themes related to the availability of life-saving and life-threatening medications. The photograph also suggests the importance of several ethical questions.
September 1, 2018: AMA Journal of Ethics
Samuel Rodriguez, Nick Love
The Precision Portrait is a mixed-media portrait illustrating the future of precision medicine and its ethical challenges.
September 1, 2018: AMA Journal of Ethics
Eric T Juengst, Michelle L McGowan
Efforts to conceptualize the application of human genomics to health care have displayed an evolving set of translational research goals. Under personalized genomic medicine , the aim was to individualize treatment and empower patients to take more responsibility for their own health. With the rise of interest in expert interpretation of multifactorial risk stratification, emphasis shifted to giving clinicians better tools and more authority to use them under the rubric of precision medicine . The statistical nature of risk stratification, in turn, led to the movement's importing public health goals and expanding its scope to precision prevention at the population level...
September 1, 2018: AMA Journal of Ethics
Brittany Hollister, Vence L Bonham
Precision medicine research initiatives aim to use participants' electronic health records (EHRs) to obtain rich longitudinal data for large-scale precision medicine studies. Although EHRs vary widely in their inclusion and formatting of social and behavioral data, these data are essential to investigating genetic and social factors in health disparities. We explore possible biases in collecting, using, and interpreting EHR-based social and behavioral data in precision medicine research and their consequences for health equity...
September 1, 2018: AMA Journal of Ethics
Cynthia E Schairer, Caryn Kseniya Rubanovich, Cinnamon S Bloss
Granular personal data generated by mobile health (mHealth) technologies coupled with the complexity of mHealth systems creates risks to privacy that are difficult to foresee, understand, and communicate, especially for purposes of informed consent. Moreover, commercial terms of use, to which users are almost always required to agree, depart significantly from standards of informed consent. As data use scandals increasingly surface in the news, the field of mHealth must advocate for user-centered privacy and informed consent practices that motivate patients' and research participants' trust...
September 1, 2018: AMA Journal of Ethics
Emily L Evans, Danielle Whicher
A learning health system provides opportunities to leverage data generated in the course of standard clinical care to improve clinical practice. One such opportunity includes a clinical decision support structure that would allow clinicians to query electronic health records (EHRs) such that responses from the EHRs could inform treatment recommendations. We argue that though using a clinical decision support system does not necessarily constitute a research activity subject to the Common Rule, it requires more ethical and regulatory oversight than activities of clinical practice are generally subjected to...
September 1, 2018: AMA Journal of Ethics
Rebekah Davis Reed, Erik L Antonsen
Humans exploring beyond low-Earth orbit face environmental challenges coupled with isolation, remote operations, and extreme resource limitations in which personalized medicine, enabled by genetic research, might be necessary for mission success. With little opportunity to test personalized countermeasures broadly, the National Aeronautics and Space Administration (NASA) will likely need to rely instead on collection of significant amounts of genomic and environmental exposure data from individuals. This need appears at first to be in conflict with the statutes and regulations governing the collection and use of genetic data...
September 1, 2018: AMA Journal of Ethics
Anava A Wren, K T Park
As clinicians have begun to provide targeted pharmacotherapy for children with inflammatory bowel disease (IBD), several ethical challenges have arisen. In this paper, we review 3 challenges related to applying a precision health approach to pediatric IBD populations: selection of a disease monitoring method, pharmacotherapy optimization, and economic considerations in clinical decision making.
September 1, 2018: AMA Journal of Ethics
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