Case A 17-year-old girl returns to the rheumatology clinic for scheduled follow-up for systemic lupus erythematosus (SLE). She is accompanied by her mother and father. She has a history of autoimmune cytopenias and Class III lupus nephritis. She has responded well to treatment with mycophenolate mofetil and hydroxychloroquine and was successfully weaned off of prednisone…
Ethics Forum: Unexpected Ethical Issues in Private Practice, Clinical Research
Ethical issues that arise in the average rheumatology practice and in clinical research are often straightforward. The AMA Code of Medical Ethics and the Office Practice and Procedures Manual offer useful information.1 In research, the Protocol and Investigators Agreement spells out who you can enroll and how the trial must be conducted. But still—even when…
Ethics Forum: Pediatric Vaccination Refusals Raise Challenges for Physicians
The boy who could not walk: S.L. is a previously healthy 10-year-old boy who has not walked for three months. Physical examination reveals swollen wrists, knees, ankles and several toes. There is reduced hip range of motion and flexion contractures of both knees. He can stand with assistance, but is unable to take a single…
Authors Should Share Clinical Trial Data
NEW YORK (Reuters Health)—Authors should agree to share deidentified patient data as a condition for publication of a clinical trial report, according to a proposal from the International Committee of Medical Journal Editors (ICMJE). “Our patients generously and selflessly volunteer to participate in clinical trials on the promise that the knowledge gained will be used…
Ethics Forum: Physicians Face Ethical Quandary Discussing Poor Prognosis with Patients
Over the course of a month, you diagnose systemic sclerosis in two newly evaluated patients. Their responses to the news could not be more different. Patient 1 is a previously healthy 55-year-old man who is an avid bicyclist and skier. He presents with a several-month history of rapidly progressive skin tightening extending to the proximal…
Opinion: Insurance Companies Use Medically and Fiscally Irresponsible Formularies
Receipt of an unsolicited communication that a sweepstakes award has been won may con some people (especially, but not limited to, those underprivileged or undereducated as to legalities), but can’t fool all of the people all of the time. The names of the organizations and products involved are often marketing tool inventions, which imply special…
Ethics Forum: Personal Ethics Questions Surrounding RheumPAC Donations
Imagine you’ve just heard a compelling presentation urging all ACR members to contribute to RheumPAC, the ACR’s political action committee. RheumPAC’s mission is to support politicians who support issues important to rheumatologists. You are impressed by the role RheumPAC has played in a number of issues you support. Just as you’re writing a check, you…
Engaging Patients to Enhance Rheumatology Research
It takes a great deal of time and money to produce clinical practice guidelines for rheumatic diseases. No matter how well a treatment inhibits inflammatory cytokines, it won’t lower disease activity without one essential factor: patient compliance. “You can’t propose a treatment algorithm in your research that no patient would actually use,” says Veena Ranganath,…
Juvenile Idiopathic Arthritis: Parents Discuss Challenges, Support Rheumatologists Can Offer
One parent wishes that she could have consulted a crystal ball at the beginning of her daughter’s illness to have “some kind of idea of what we were in for. There are so many stages of letting go of the idea of what your little kid is in for in life, what they are going…
On Research Review Boards, Conflict-of-Interest Reporting Improves
(Reuters Health)—Many doctors who serve on hospital panels overseeing the ethics and safety of human research trials have industry relationships that may compromise their objectivity, but reporting these conflicts has become more common over the past 10 years, according to a new study. Physicians who serve on so-called institutional review boards (IRBs) may also be…
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