dr alex tang_ medical utopias

8/10/2019 Dr Alex Tang_ Medical Utopias

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Medical Utopias

Ethical Reflections aboutEmerging Medical

Technologies

Dr Alex Tang MD PhD

Consultant Paediatrician

KPJ Johor Specialist Hospital


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Living without pain, diseases or even dying

No more fertility or reproductive problems Delaying or defying the aging process

Personalized genomic medicine (P4 Medicine)

personalised, predictive, preventive, participatory

Optimize and enhance normal abilities

Medical Utopias


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EmergingTechnologies

ConsumerExpectation

Healthcareproviders

Healthcareprofessionals

Medical Utopias and

Emerging Technologies


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Respect for Autonomy

Beneficence

Non-maleficence

Justice

Biomedical Ethics Framework

Beauchamp and Childress; Principles Biomedical Ethics, OUP, 5th edition 2001


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1. Already in clinical applications (include phase 3

trials)2. Research fields at preclinical stages

3. Research fields at purely theological stages

Ethical areas of concern


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1. Already in clinical applications (include phase 3

trials)tissue engineering, bioelectronics,

health IT, genetic tests, drugs testing2. Research fields at preclinical stages -

reproductive cloning, germ line genome

modification, interventions in biological agingprocess

3. Research fields at purely theological stages

nanotechnology, virtual digital patient

Ethical areas of concern


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1. The emergence of the digital

patient (to be or not be be)

2. The direct to customer (DTG)

genetic screening

(to know or not to know)

3. The development of new

pharmaco-therapeutics

(to treat or not to treat)

Ethical Reflections on Emerging

Medical Technologies


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Medical Utopias


Technologies

1. The Emergence ofthe Digital Patient


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Health IT and

patient care

Ethical Reflection on

the Digital Patient


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Use and Characteristics of Electronic Health Record

Systems Among Office-based Physician Practices:

United States, 20012013

NCHS Data Brief Number 143, January 2014http://www.cdc.gov/nchs/data/databriefs/db143.htm

Percentage of office-based physicians with EHR systems:United States, 20012013

HITECH

Medicare and

Medicaid EHR

Incentive Programs


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Health IT

AdministrativeFunctionality

Health

ManagementFunctionality

Medical

DeviceFunctionality

Ethical Reflections: Digital Patient

FDASIA Health IT Report April 2014


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Is health IT the key to

better healthcare?

Ethical reflection


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One quarter of the hospitalizations (937admissions) had at least 1 ADE

9% resulted in serious harm, 22% in additional

monitoring and interventions, 32% ininterventions alone, and 11% in monitoring alone

Errors associated with ADEs: 61% ordering, 25%

monitoring, 13% administration, 1% dispensing,and 0% transcription

Nebeker JR, Hoffman JM, Weir CR, Bennett CL, Hurdle JF. High Rates of Adverse Drug Events in a Highly Computerized Hospital. Arch Intern Med.

2005;165(10):1111-1116. doi:10.1001/archinte.165.10.1111.

Adverse Drug Events (ADEs) in a Highly

Computerized Hospital (20 week period)


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Technology

People

ProcessOrganisation

ExternalEnvironment

Health IT Sociotechnical System

FDASIA Health IT Report April 2014


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Poorly designed health IT new hazards in analready complex system of health care delivery

Individual health IT components may meet theirstated performance requirements, yet thesystem as a whole may yield unsafe outcomes

Problematic events involving complex systems

often cannot be ascribed to a single causativefactor

Poor human-computer interactions can

contribute to serious injury and death

Issues in health IT

Sociotechnical System


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e-iatrogenesis

e-iatrogenic

Issues in health IT

Sociotechnical System


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Is health IT the key to better healthcare?

Data interoperabilitywill it ever be resolved?

Ethical reflection


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Health IT is a practical tool

not a replacement for quality patient care

Ethical reflection

Norman Rockwell,Saturday Post Archives


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Health IT and patient

care

Privacy, Confidentiality,Security

Ethical Reflection on

the Digital Patient


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Ethical reflection


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Most patients not aware of

their right to privacy and

confidentiality Cheaper and faster to

develop non-privacy aware

health IT software solutions Healthcare provider

consolidation

Hackers

Privacy, confidentiality, security: how

safe is the data?

Employers

Insurance companies

Law


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Is our healthcare providers

keeping their data secure?

Are we educating ourpatients on their privacy

rights?

Do we allow patient toaccess their own medical

records?

Data Protection Regulation

Ethical reflection


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Medical Utopias


Technologies

2. Direct to

Customers (DTC)genetic screening


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Direct To Consumer (DTC)

Screening Tests


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Scientific accuracy, clinical validity and utility of

genetic tests

Absence of and/or quality of pre- and post-test

counselling

Absence of individualized medical supervision

Lack of adequate consent procedures

Respect for privacy and confidentiality

Direct To Consumer (DTC)

Screening Tests


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What is to be done

about direct to

consumer (DTC)genetic screening

tests?

Role of regulating

direct to consumer

medical tests?

Ethical Reflections


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Medical Utopias

Ethical Reflections onEmerging Medical

Technologies

3. Development of new

pharmacotherapeutics


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Ethical Concerns on

Pharmacotherapeutics

Testing for

carcinogenicity

Pharmacogenomics


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Test for carcinogenicity

Short term in vitro

mutagenicity test

Lifespan in vivo tests in rodents

(two species)

12-24 months expensive

Testing of new drugs


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International Conference on Harmonisation of

Technical Requirements for Registration of

Pharmaceuticals for Human Use (ICH) approved

using genetic engineered rats for one species

short term lifespan studies in 1997

The validation was done in the 2000s byInternational Life Sciences Institute (ILSI)

Short term lifespan rodent studies


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How accurate are these studies using genetically

engineered rats?

How safe are the new drugs?

Ethical Reflections


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Ethical Concerns on

Pharmacotherapeutics

Testing for

carcinogenicity

Pharmacogenomics


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Design of clinical trails

Cost as a barrier to access

Professional standards of care

Ethical Concerns on

Pharmacogenomics


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EmergingTechnologies

ConsumerExpectation

Healthcareproviders

Healthcareprofessionals

Medical Utopias and

Emerging Technologies

Beauchamp and Childress; Principles Biomedical Ethics, OUP, 5th edition 2001

Respect for AutonomyBeneficence

Non-Maleficence

Justice


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Ethical Reflections

dr alex tang_ medical utopias

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