Ruth Macklin, PhD
Ruth Macklin is a professor, department of epidemiology and population health, Albert Einstein College of Medicine, Bronx, NY. She blogs at the Doctor's Tablet.
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Latest articles
Physician voices
An episode pitting top administrators at the National Institutes of Health (NIH) against senior scientists at the organization serves as a vital reminder of the importance of academic freedom and the need to communicate and express concerns about scientific research.…
An episode pitting top administrators at the National Institutes of Health (NIH) against senior scientists at the organization serves as a vital reminder of the importance of academic freedom and the need to communicate and express concerns about scientific research.
NIH administrators prohibited two of its senior scientists from speaking out about a research study the scientists claim has serious flaws (Crystalloid Liberal or Vasopressors Early Resuscitation in …
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Is the National Institutes of Health stifling academic freedom?
Health policy
Late last year the New York Times reported that Dr. José Baselga, the chief medical officer of Memorial Sloan Kettering Cancer Center, had resigned for failing to disclose his conflicts of interest at professional meetings and in scientific and medical…
Late last year the New York Times reported that Dr. José Baselga, the chief medical officer of Memorial Sloan Kettering Cancer Center, had resigned for failing to disclose his conflicts of interest at professional meetings and in scientific and medical journals. The Times report says that Dr. Baselga — who also served as physician-in-chief at the center — “had failed to disclose millions of dollars in payments from health care companies in …
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How can we fix the research bias from industry sponsorship?
Conditions and diseases
The bedrock requirement to obtain informed consent before patients may be enrolled in research has been eroding. I’ve documented the different ways and different reasons for this several times over the years ("Informed Consent for Babies: When Experts Disagree," "Informed…
The bedrock requirement to obtain informed consent before patients may be enrolled in research has been eroding. I’ve documented the different ways and different reasons for this several times over the years (“Informed Consent for Babies: When Experts Disagree,” “Informed Consent in Infant Research: Ethical Problems Remain,” “Informed Consent in Comparative Effectiveness Research,” and “The Erosion of Informed Consent in Medical Research”). The latest example is a clinical trial of …
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The erosion of informed consent in medical research
Medical education
In a recent post, I wrote about the iCOMPARE research study that is comparing the effects of increasing medical residents’ consecutive duty hours with observing the currently prescribed limits on their shifts. According to the study protocol, the primary hypothesis…
In a recent post, I wrote about the iCOMPARE research study that is comparing the effects of increasing medical residents’ consecutive duty hours with observing the currently prescribed limits on their shifts. According to the study protocol, the primary hypothesis of the research addresses the safety of patients: that mortality under the increased residents’ duty hours will not significantly exceed patient mortality under the current mandated standard for medical residents on …
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Why a study of medical resident hours was unethical
Conditions and diseases
The case of Cassandra C., a 17-year-old in Connecticut who refused to continue receiving chemotherapy to treat her Hodgkin’s lymphoma, poses a genuine ethical dilemma. The dilemma stems from a conflict between two leading ethical principles. One principle, respect for…
The case of Cassandra C., a 17-year-old in Connecticut who refused to continue receiving chemotherapy to treat her Hodgkin’s lymphoma, poses a genuine ethical dilemma. The dilemma stems from a conflict between two leading ethical principles. One principle, respect for autonomy, calls for respecting individuals’ right to self-determination. In the medical context, that means allowing people to refuse medical treatment, even lifesaving therapy. The other ethical principle, beneficence, directs physicians and hospitals to …
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Forced chemotherapy in a teen: Exploring the ethics
Conditions and diseases
As we learn of new suspected cases of Ebola infection in the United States, causing worries among the population and renewed efforts by the Centers for Disease Control and Prevention to contain the epidemic. A student in the postgraduate course…
As we learn of new suspected cases of Ebola infection in the United States, causing worries among the population and renewed efforts by the Centers for Disease Control and Prevention to contain the epidemic.
A student in the postgraduate course in research ethics that I teach at Albert Einstein College of Medicine recently asked whether we could discuss the Ebola epidemic in class. Because I had prepared the syllabus for the course months ago, I hadn’t …
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The ethics of researching Ebola
Drugs and prescribing
Few medical interventions have been as successful as vaccines in improving public health. Whether they are childhood vaccinations, vaccines to prevent healthy adults from contracting influenza or the more recent HPV vaccine for adolescents, these preventive methods have resulted in…
Few medical interventions have been as successful as vaccines in improving public health.
Whether they are childhood vaccinations, vaccines to prevent healthy adults from contracting influenza or the more recent HPV vaccine for adolescents, these preventive methods have resulted in dramatic benefits for individuals and the public. We have only to think of the eradication of smallpox and the virtual eradication of poliomyelitis to see the enormous benefits vaccines can bring. …
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Curb the soaring costs of vaccines
Health policy
Doctors, hospitals and judges have over the years attempted to control the decisions of pregnant women. In a recent Florida case, it’s not clear whether the controllers sought to protect the fetus, the woman or both. They may have wanted…
Doctors, hospitals and judges have over the years attempted to control the decisions of pregnant women. In a recent Florida case, it’s not clear whether the controllers sought to protect the fetus, the woman or both. They may have wanted to protect the hospital from potential liability.
The case involved a 39-week-pregnant woman.
According to a press release issued by the National Advocates for …
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Hospitals should not control the decisions of pregnant women
Medical education
A new study poses one of the most vexing ethical questions concerning research with human beings: When is it acceptable to conduct research without the consent of the research subject? In emergency situations, patients often arrive at the hospital unconscious…
A new study poses one of the most vexing ethical questions concerning research with human beings: When is it acceptable to conduct research without the consent of the research subject?
In emergency situations, patients often arrive at the hospital unconscious or with severely impaired decision-making capacity. Progress in medical practice depends on results from carefully designed research; yet in these emergency cases such patients are unable to fulfill one of the …
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Conducting research without the consent of the research subject
Physician voices
One typically thinks of advances in medical science and technology as having unalloyed benefits. The ability to cure illness, the mitigation of pain and the possibility of making diagnoses that are more accurate are some of the uncontroversial results of…
One typically thinks of advances in medical science and technology as having unalloyed benefits. The ability to cure illness, the mitigation of pain and the possibility of making diagnoses that are more accurate are some of the uncontroversial results of medical progress. Yet as a new study of vegetative states demonstrates, such advances can raise ethical quandaries for physicians and the families of patients diagnosed as vegetative.
The …
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The advance directive impact of PET scans in vegetative states
Physician voices
With new revelations emerging every day about the botched execution of a prisoner in Oklahoma, even those who favor the death penalty (I am a strong opponent) may have some reservations about the way it is carried out. Despite the…
With new revelations emerging every day about the botched execution of a prisoner in Oklahoma, even those who favor the death penalty (I am a strong opponent) may have some reservations about the way it is carried out. Despite the uproar from both sides, I believe there are some major ethical considerations that have been overlooked in this case.
Setting aside for a …
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After the botched execution: It’s time to lift the veil of secrecy
Drugs and prescribing
The debate over e-cigarettes has been heating up. Are the smokeless, battery-powered, nicotine-dispensing devices a gateway to smoking for young people or a helpful way for smokers to quit? Public health experts can be found on both sides of the…
The debate over e-cigarettes has been heating up. Are the smokeless, battery-powered, nicotine-dispensing devices a gateway to smoking for young people or a helpful way for smokers to quit? Public health experts can be found on both sides of the debate.
An article in the New York Times cited two leading figures, Dr. Michael Siegler from Boston University and Dr. Stanton A. Glantz from the University of California, San …
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E-cigarettes lack scientifically based guidance
Physician voices
Numerous strategies by antiabortion groups to curb women’s constitutional right to abortion are frequently reported in the news, and come as no surprise. However, a recent development illustrates novel circumstances in which people are using legal maneuvers to conspire to…
Numerous strategies by antiabortion groups to curb women’s constitutional right to abortion are frequently reported in the news, and come as no surprise. However, a recent development illustrates novel circumstances in which people are using legal maneuvers to conspire to restrict medical decisions by patients and their families even when the right to abortion is not at issue.
On January 8, 2014, a front-page story in the New York Times …
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The wishes of the patient and family versus fetal rights
Conditions and diseases
Many people have heard of the company 23andMe; hundreds of thousands throughout the world have used the company’s Personal Genome Service (PGS), which provides a report that offers detailed information about an individual’s DNA. For $99, a consumer receives a…
Many people have heard of the company 23andMe; hundreds of thousands throughout the world have used the company’s Personal Genome Service (PGS), which provides a report that offers detailed information about an individual’s DNA. For $99, a consumer receives a test-tube kit from the company, fills the tube with saliva and sends it back. The company then performs a DNA analysis and provides information about the person’s health risks, ancestry …
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How should personal genetic tests be regulated?
Conditions and diseases
The very idea of living individuals selling body parts prompts revulsion in some people, while others may ask whether the price is right. A recent nbcnews.com article reported on an organ-transplant study conducted by Canadian researchers. It began with this…
The very idea of living individuals selling body parts prompts revulsion in some people, while others may ask whether the price is right.
A recent nbcnews.com article reported on an organ-transplant study conducted by Canadian researchers. It began with this finding: “Paying living kidney donors $10,000 to give up their organs would save money over the current system based solely on altruism—even if it only boosts donations by a conservative 5 percent.”
Actually, the …
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The ethics of paying living kidney donors
Physician voices
The use of gestational surrogates in India is a booming business, but is it ethical? This growing practice involves individuals and couples from countries in Western Europe, North America, Israel, Japan and elsewhere who work through brokers to have their…
The use of gestational surrogates in India is a booming business, but is it ethical?
This growing practice involves individuals and couples from countries in Western Europe, North America, Israel, Japan and elsewhere who work through brokers to have their genetically related offspring carried through pregnancy and birth by Indian women.
An estimated $500 million to $2.3 billion (U.S.) changes hands among commissioning couples, infertility clinics, brokers and Indian women who choose this way …
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Is the use of gestational surrogates in India ethical?
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