Personalized Medicine

Prompt: Personalized Medicine

Working in healthcare for the last 11 years I have found that once a provider gets used to a certain treatment, they prefer to stick with that treatment for multiple patients that present to their clinic with the same symptoms and issues. One example I have is when I personally had an appointment with physical therapy for my right shoulder and the muscle that runs from my neck to my rotator cuff. I had a friend that had pretty much the same symptoms and had gone to the same doctor I was getting ready to see. When I asked what the doctor did to help his situation, he looked at me, smiled and said, have you heard her “school of fish story.” He told me this story the doctor had told him about a procedure that he had done called dry needling. Essentially his story was that she told he the way dry needling works is when she puts the needle in, the muscle spreads out, kind of like a school of fish when you put your hand in the tank. So, I had my appointment and the doctor asked if I had ever heard of dry needling, and of course, my answer was no. The doctor then proceeded to tell me, almost verbatim, the story she had told my friend. Almost to a tee. I work in the behavioral health field, and I know that providers tend to see certain diagnosis that they feel comfortable with seeing, but in my opinion, what may work for one, may not work for all. Therefore, the provider should realize that, and modify their plan to fit the patients need.

Essentially that is what personalized medicine is. The field of medicine focuses on what is called a standard of care. Which means that Diagnosis A gets treatment plan A, and diagnosis B gets treatment plan B. Not really focusing on the actual patient themselves (McMullan, n.d.). McMullen (n.d.) states that personalized medicine is an approach emphasizes the ways in which your disease risks are unique and different. These disease risks are based on the predispositions written into your genome at birth (McMullen, n.d.). Salari & Larijani (2017) stated that personalized medicine means “the right drug should be prescribed for the right patient based on genetic data” (para. 1). Although Personalized medicine may present a better way of treating patients per their own genetic make-up. Salari & Larijani (2017) state that extensive changes in healthcare systems including the ethical changes are needed to overcome the ethical obstacles including the knowledge gap, informed consent, privacy and confidentiality and availability of healthcare services (para. 1).

The Ethical Issues for Society

Ethics and society outlook have been instrumental in shaping the way providers provide medical care to patients. A lot of focus has gone into ethical dilemmas and especially in my opinion, the public’s perspective. An example I have is on a special mission I traveled on, I had myself, a behavioral health tech, and two psychologists. The mission we were on started to be scrutinized mainly by the public and lawyers, so in the long run, our mission was cut short due to the ethical issues cited by what the public’s perception of what they thought we were doing. Psychology can be a difficult field in which ethical questions arise in many ways. Pozgar (2016) states that an ethical dilemma arises in situations where a choice must be made among unpleasant alternatives (pg. 35). The National Co-Ordinating Centre for Public Engagement (NCCPE) says ethical and social issue are present in everything, and healthcare is no different. They mention that discoveries that affect society, however major or minor, have ethical and social issues and the people engaged with the research have views about them, which includes the public (para. 1). When looking at the personal example above, what society said about the ethical issue behind our mission, raised enough concern in bigger organizations that eventually had us shut down operations early, in order to not risk any more ethical issues arising.

Ethical Issues for a Christian Healthcare Professional

Medical professionals face ethical issues and dilemmas on a daily basis. At times our judgment is clouded by the patient and the relationships that we have built with them that we want to provide the best care we can to them, and at times an ethical question may arise. For Christian providers, the dilemma is even harder in my opinion. Now a day you must be very careful with patients on how you portray your spirituality into your work. Pozgar (2016) states that religion serves a moral purpose by providing codes of conduct for appropriate behavior through revelations from a divine source (pg. 48). Spirituality, means that there is purpose and meaning to life, and normally refers to faith and a higher being (Pozgar, 2016). Christians, when determining what the right thing to do is for the patient often refer to the “do unto others as you would have them do unto you.” With the different interpretations of the meaning, there have been many churches with varying beliefs (Pozgar, 2016). This can at times pose a trying ethical dilemma for the Christian healthcare provider. Such Christian beliefs can affect a patient’s wishes for healthcare (Pozgar, 2016).

Should a Christian Participate

As noted above, many churches envision healthcare in different ways. For example, the Christian Science Church is a church that rejects modern medicine (Cornetta & Gunther-Brown, 2013). In my opinion, Christians in the church, must learn to accept modern medicine, or at least accept parts of it in emergent circumstances when it comes to healthcare. Cornetta & Gunther-Brown (2013) mentioned that in emergent cases this church should revise its statutes I order to allow parents to refuse medical treatment, except in situations where refusal will endanger the life of the child (pg. 310). When it comes to personalized medicine, some aspect in my opinion can be adopted by the Christian professional in order to “do unto others as they would want others to do unto them.” Also, doctors all go by the “do no harm” clause which I also feel can lead to ethical issues, but if there is ever a question, and the patient and Christian doctor do not feel comfortable, chaperones, or other doctors may be available in order to keep all parties happy and patient care flowing.

Cornetta, K., & Brown, C. G. (2013). Perspective: Balancing Personalized Medicine and Personalized Care. Academic Medicine : Journal of the Association of American Medical Colleges, 88(3), 309–313. doi 10.1097/ACM.0b013e3182806345

McMullan, D. (n.d.). What Is Personalized Medicine? Retrieved July 9, 2017, from Genome Mag: http://genomemag.com/what-is-personalized-medicine/#.WWRF6ojyvZs

National Co-ordinating Centre for Public Engagement. (2017). Retrieved July 9, 2017, from Ethical and Social Issues: https://www.publicengagement.ac.uk/plan-it/ethical-and-social-issues

Pozgar, G. D. (2016). Navigate 2 Premier Access for Legal aspects of health care administration (12th ed.). Burlington, MA: Jones & Bartlett

Salari, P., & Larijani, B. (2017). Ethical Issues Surrounding Personalized Medicine: A Literature Review. Acta Medica Iranica, 55(3), 209-217.

 

Discussion question #2

Prompt: Ethics of Healthcare Management

Top of Form

The human mind is a vast wealth of knowledge. People are always looking at questions that no one knows the answer to. Whether it is the question of how the earth was created, or where did man come from? People always have to have an answer for every question that they think of. There is no satisfaction of just saying, “I do not know.” With all of these topics comes ethical issues that some would say question the very question that is being asked. Many scholars, having pondered some of these same questions, have gone on yearlong journeys to understand and get some answers to the very questions that many had been asking. One of these journeys was the study and testing of Deoxyribonucleic Acid (DNA) molecules.

History of DNA testing

In 1866, the history of DNA started when a man named Gregor Mendel when he discovered genetics (DNA Worldwide Group Ltd., 2014). Mendel used pea plants to understand how genetics crossed one another and made something new. He coined the terms “dominate” and “traits” when talking about how the genetics of the pea plants combined (DNA Worldwide Group Ltd., 2014). Three years later, DNA was discovered when a man named Fredrich Miescher identified protein components of the white blood cells called nuclein (DNA Worldwide Group Ltd., 2014). Over the next one hundred years, scientist discovered how DNA linked to people looks, characteristics, and even disease. It was not until the 1990’s that human genome started to be mapped and studied for the sake of medicine (DNA Worldwide Group Ltd., 2014). The Human Genome Project changed the way that science looked at the DNA molecules, and that’s when scientist started to look at how mixing and forming DNA could produce clones of different species. When cloning began to take places is when huge ethical issue was questioned. Some thought that scientist was trying to play “God” and it raised a lot of concern with many people. I believe this was the first time that ethics were brought into this groundbreaking discovery.

The Ethical Issues for Society

“Each new genetic test that is developed raises serious issues for medicine, public health, and social policy regarding the circumstances under which the test should be used, how the test is implemented, and what uses are made of its result” (Institute of Medicine, 1994, p. 247). During my research, the number one ethical issue that I found is that there was no idea of how genetic testing would affect society for the long term. In the U.S., genetic testing is primarily used by individuals that want to gain insight into their genotype for medical or ancestry information (Pulst, 2000). There has been a big spike of DNA testing with websites like ancestory.com or 23andme. The ethical questions come into play when the questions of how the results are shared, who gets to see these results, and if the results are released to third parties for research. The reason that these are ethical issues because it can infringe on the rights of people. When I was looking at DNA testing, I started getting weary because I was wondering who would see my private and very intimate details of what I am made of. It is a scary thought to think that I could find out my whole genetic make-up from spitting in a tube. The thought of another person knowing or sharing information about myself, that I might not even understand, is probably the scariest part of it all. It is scary because it makes me question of how the information will be used against me or my family. Do not get me wrong, I know that there are laws out there that help keep people protected through the DNA testing process, but we all know that some people do not abide by the law.

Ethical issues for Christians

            For Christians, science has always been a touchy subject. Scientists are typically very logical and “matter of fact” type of people. They must see the facts in order to make decisions on just about anything. When God comes into question, scientists are either non-believers or without a should of a doubt believer. Many known scientists did not believe in God until they look for the “evidence” of where He existed or not. As a healthcare professional, there are times that I question medicine because I wonder whether God actually intended for us to know everything. For me, by asking that question, it makes me believe that we are not supposed to know all the answers to every question because we are not giving God full control of our lives. “Society has recognized for years that clinicians bring their own religious commitments to the clinical encounter” (Fanning & Clayton, 2009, p. 4). Ethical issues come up for Christians based on what their individual view is on a subject and whether they agree or disagree. When it comes to DNA testing, there is really no evidence on a definite answer of what the ethical issue is for Christians (Fanning & Clayton, 2009). The individual decides where they want to participate in DNA testing based on their own beliefs.

Conclusion

DNA testing has been a breakthrough in science but it brings a lot of questions about ethics, vulnerability, autonomy, and the law (Institute of Medicine, 1994). Science argues that DNA testing will help medicine, public health, and the great good of man. Christians argues that “playing God” is not what we are supposed to be doing. We should allow the only God to provide us with answers that we do not know. Isaiah 14:27 says, “For the LORD Almighty has purpose, and who can thwart Him? His hand is stretched out, and who can turn it back” (NIV). God is always reaching out to us. We should fully rely on Him to give us what we need in life and we should not be searching for answers that He does not provide. DNA testing is one of those answers that we can decide individual whether it would be the right choice of us. I know that if I ever thought about doing the testing, it would not be without a long discussion with my Father God.

 

References

DNA Worlwide Group Ltd. (2014). The history of DNA timeline. Retrieved from https://www.dna-worldwide.com/resource/160/history-dna-timeline on July 10, 2017.

Fanning, J. B., & Clayton, E. W. (2009). Introduction: Religious and Spiritual Issues in Medical Genetics. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics151C(1), 1–5. http://doi.org/10.1002/ajmg.c.30191

Institute of Medicine. (1994). Assessing genetic risks: implications for health and social policy. Washington, DC: The National Academies Press. https://doi.org/10.17226/2057

 

Pulst, S.M., MD. (2000). Ethical issues in DNA testing. Muscle & Nerve. 23(10). p. 1503-1507. Charlottesville, VA: John Wiley & Sons Inc. doi:10.1002/1097-4598(200010)23:10<1503::AID-MUS5>3.0.CO;2-V

Prompt: Personalized Medicine

Working in healthcare for the last 11 years I have found that once a provider gets used to a certain treatment, they prefer to stick with that treatment for multiple patients that present to their clinic with the same symptoms and issues. One example I have is when I personally had an appointment with physical therapy for my right shoulder and the muscle that runs from my neck to my rotator cuff. I had a friend that had pretty much the same symptoms and had gone to the same doctor I was getting ready to see. When I asked what the doctor did to help his situation, he looked at me, smiled and said, have you heard her “school of fish story.” He told me this story the doctor had told him about a procedure that he had done called dry needling. Essentially his story was that she told he the way dry needling works is when she puts the needle in, the muscle spreads out, kind of like a school of fish when you put your hand in the tank. So, I had my appointment and the doctor asked if I had ever heard of dry needling, and of course, my answer was no. The doctor then proceeded to tell me, almost verbatim, the story she had told my friend. Almost to a tee. I work in the behavioral health field, and I know that providers tend to see certain diagnosis that they feel comfortable with seeing, but in my opinion, what may work for one, may not work for all. Therefore, the provider should realize that, and modify their plan to fit the patients need.

Essentially that is what personalized medicine is. The field of medicine focuses on what is called a standard of care. Which means that Diagnosis A gets treatment plan A, and diagnosis B gets treatment plan B. Not really focusing on the actual patient themselves (McMullan, n.d.). McMullen (n.d.) states that personalized medicine is an approach emphasizes the ways in which your disease risks are unique and different. These disease risks are based on the predispositions written into your genome at birth (McMullen, n.d.). Salari & Larijani (2017) stated that personalized medicine means “the right drug should be prescribed for the right patient based on genetic data” (para. 1). Although Personalized medicine may present a better way of treating patients per their own genetic make-up. Salari & Larijani (2017) state that extensive changes in healthcare systems including the ethical changes are needed to overcome the ethical obstacles including the knowledge gap, informed consent, privacy and confidentiality and availability of healthcare services (para. 1).

The Ethical Issues for Society

Ethics and society outlook have been instrumental in shaping the way providers provide medical care to patients. A lot of focus has gone into ethical dilemmas and especially in my opinion, the public’s perspective. An example I have is on a special mission I traveled on, I had myself, a behavioral health tech, and two psychologists. The mission we were on started to be scrutinized mainly by the public and lawyers, so in the long run, our mission was cut short due to the ethical issues cited by what the public’s perception of what they thought we were doing. Psychology can be a difficult field in which ethical questions arise in many ways. Pozgar (2016) states that an ethical dilemma arises in situations where a choice must be made among unpleasant alternatives (pg. 35). The National Co-Ordinating Centre for Public Engagement (NCCPE) says ethical and social issue are present in everything, and healthcare is no different. They mention that discoveries that affect society, however major or minor, have ethical and social issues and the people engaged with the research have views about them, which includes the public (para. 1). When looking at the personal example above, what society said about the ethical issue behind our mission, raised enough concern in bigger organizations that eventually had us shut down operations early, in order to not risk any more ethical issues arising.

Ethical Issues for a Christian Healthcare Professional

Medical professionals face ethical issues and dilemmas on a daily basis. At times our judgment is clouded by the patient and the relationships that we have built with them that we want to provide the best care we can to them, and at times an ethical question may arise. For Christian providers, the dilemma is even harder in my opinion. Now a day you must be very careful with patients on how you portray your spirituality into your work. Pozgar (2016) states that religion serves a moral purpose by providing codes of conduct for appropriate behavior through revelations from a divine source (pg. 48). Spirituality, means that there is purpose and meaning to life, and normally refers to faith and a higher being (Pozgar, 2016). Christians, when determining what the right thing to do is for the patient often refer to the “do unto others as you would have them do unto you.” With the different interpretations of the meaning, there have been many churches with varying beliefs (Pozgar, 2016). This can at times pose a trying ethical dilemma for the Christian healthcare provider. Such Christian beliefs can affect a patient’s wishes for healthcare (Pozgar, 2016).

Should a Christian Participate

As noted above, many churches envision healthcare in different ways. For example, the Christian Science Church is a church that rejects modern medicine (Cornetta & Gunther-Brown, 2013). In my opinion, Christians in the church, must learn to accept modern medicine, or at least accept parts of it in emergent circumstances when it comes to healthcare. Cornetta & Gunther-Brown (2013) mentioned that in emergent cases this church should revise its statutes I order to allow parents to refuse medical treatment, except in situations where refusal will endanger the life of the child (pg. 310). When it comes to personalized medicine, some aspect in my opinion can be adopted by the Christian professional in order to “do unto others as they would want others to do unto them.” Also, doctors all go by the “do no harm” clause which I also feel can lead to ethical issues, but if there is ever a question, and the patient and Christian doctor do not feel comfortable, chaperones, or other doctors may be available in order to keep all parties happy and patient care flowing.

Cornetta, K., & Brown, C. G. (2013). Perspective: Balancing Personalized Medicine and Personalized Care. Academic Medicine : Journal of the Association of American Medical Colleges, 88(3), 309–313. doi 10.1097/ACM.0b013e3182806345

McMullan, D. (n.d.). What Is Personalized Medicine? Retrieved July 9, 2017, from Genome Mag: http://genomemag.com/what-is-personalized-medicine/#.WWRF6ojyvZs

National Co-ordinating Centre for Public Engagement. (2017). Retrieved July 9, 2017, from Ethical and Social Issues: https://www.publicengagement.ac.uk/plan-it/ethical-and-social-issues

Pozgar, G. D. (2016). Navigate 2 Premier Access for Legal aspects of health care administration (12th ed.). Burlington, MA: Jones & Bartlett

Salari, P., & Larijani, B. (2017). Ethical Issues Surrounding Personalized Medicine: A Literature Review. Acta Medica Iranica, 55(3), 209-217.

 

Discussion question #2

Prompt: Ethics of Healthcare Management

Top of Form

The human mind is a vast wealth of knowledge. People are always looking at questions that no one knows the answer to. Whether it is the question of how the earth was created, or where did man come from? People always have to have an answer for every question that they think of. There is no satisfaction of just saying, “I do not know.” With all of these topics comes ethical issues that some would say question the very question that is being asked. Many scholars, having pondered some of these same questions, have gone on yearlong journeys to understand and get some answers to the very questions that many had been asking. One of these journeys was the study and testing of Deoxyribonucleic Acid (DNA) molecules.

History of DNA testing

In 1866, the history of DNA started when a man named Gregor Mendel when he discovered genetics (DNA Worldwide Group Ltd., 2014). Mendel used pea plants to understand how genetics crossed one another and made something new. He coined the terms “dominate” and “traits” when talking about how the genetics of the pea plants combined (DNA Worldwide Group Ltd., 2014). Three years later, DNA was discovered when a man named Fredrich Miescher identified protein components of the white blood cells called nuclein (DNA Worldwide Group Ltd., 2014). Over the next one hundred years, scientist discovered how DNA linked to people looks, characteristics, and even disease. It was not until the 1990’s that human genome started to be mapped and studied for the sake of medicine (DNA Worldwide Group Ltd., 2014). The Human Genome Project changed the way that science looked at the DNA molecules, and that’s when scientist started to look at how mixing and forming DNA could produce clones of different species. When cloning began to take places is when huge ethical issue was questioned. Some thought that scientist was trying to play “God” and it raised a lot of concern with many people. I believe this was the first time that ethics were brought into this groundbreaking discovery.

The Ethical Issues for Society

“Each new genetic test that is developed raises serious issues for medicine, public health, and social policy regarding the circumstances under which the test should be used, how the test is implemented, and what uses are made of its result” (Institute of Medicine, 1994, p. 247). During my research, the number one ethical issue that I found is that there was no idea of how genetic testing would affect society for the long term. In the U.S., genetic testing is primarily used by individuals that want to gain insight into their genotype for medical or ancestry information (Pulst, 2000). There has been a big spike of DNA testing with websites like ancestory.com or 23andme. The ethical questions come into play when the questions of how the results are shared, who gets to see these results, and if the results are released to third parties for research. The reason that these are ethical issues because it can infringe on the rights of people. When I was looking at DNA testing, I started getting weary because I was wondering who would see my private and very intimate details of what I am made of. It is a scary thought to think that I could find out my whole genetic make-up from spitting in a tube. The thought of another person knowing or sharing information about myself, that I might not even understand, is probably the scariest part of it all. It is scary because it makes me question of how the information will be used against me or my family. Do not get me wrong, I know that there are laws out there that help keep people protected through the DNA testing process, but we all know that some people do not abide by the law.

Ethical issues for Christians

            For Christians, science has always been a touchy subject. Scientists are typically very logical and “matter of fact” type of people. They must see the facts in order to make decisions on just about anything. When God comes into question, scientists are either non-believers or without a should of a doubt believer. Many known scientists did not believe in God until they look for the “evidence” of where He existed or not. As a healthcare professional, there are times that I question medicine because I wonder whether God actually intended for us to know everything. For me, by asking that question, it makes me believe that we are not supposed to know all the answers to every question because we are not giving God full control of our lives. “Society has recognized for years that clinicians bring their own religious commitments to the clinical encounter” (Fanning & Clayton, 2009, p. 4). Ethical issues come up for Christians based on what their individual view is on a subject and whether they agree or disagree. When it comes to DNA testing, there is really no evidence on a definite answer of what the ethical issue is for Christians (Fanning & Clayton, 2009). The individual decides where they want to participate in DNA testing based on their own beliefs.

Conclusion

DNA testing has been a breakthrough in science but it brings a lot of questions about ethics, vulnerability, autonomy, and the law (Institute of Medicine, 1994). Science argues that DNA testing will help medicine, public health, and the great good of man. Christians argues that “playing God” is not what we are supposed to be doing. We should allow the only God to provide us with answers that we do not know. Isaiah 14:27 says, “For the LORD Almighty has purpose, and who can thwart Him? His hand is stretched out, and who can turn it back” (NIV). God is always reaching out to us. We should fully rely on Him to give us what we need in life and we should not be searching for answers that He does not provide. DNA testing is one of those answers that we can decide individual whether it would be the right choice of us. I know that if I ever thought about doing the testing, it would not be without a long discussion with my Father God.

 

References

DNA Worlwide Group Ltd. (2014). The history of DNA timeline. Retrieved from https://www.dna-worldwide.com/resource/160/history-dna-timeline on July 10, 2017.

Fanning, J. B., & Clayton, E. W. (2009). Introduction: Religious and Spiritual Issues in Medical Genetics. American Journal of Medical Genetics. Part C, Seminars in Medical Genetics151C(1), 1–5. http://doi.org/10.1002/ajmg.c.30191

Institute of Medicine. (1994). Assessing genetic risks: implications for health and social policy. Washington, DC: The National Academies Press. https://doi.org/10.17226/2057

 

Pulst, S.M., MD. (2000). Ethical issues in DNA testing. Muscle & Nerve. 23(10). p. 1503-1507. Charlottesville, VA: John Wiley & Sons Inc. doi:10.1002/1097-4598(200010)23:10<1503::AID-MUS5>3.0.CO;2-V

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