In addition to the impediments to consistent, high-quality care suffered by all incarcerated individuals, incarcerated patients with rheumatic disease face challenges specific to the treatment, management & monitoring of rheumatic conditions.
Ethical Concerns in Rheumatology Require Nuance
Patient autonomy in healthcare decisions and physician conflicts of interest are just two areas of ethical concerns that arise frequently in rheumatology. Dr. Kelly Weselman discusses ethical dilemmas and how to address them.
The Ethical Tug-of-War Over Biosimilar Adoption
The advent of biosimilar medications has offered the promise of significant cost savings for healthcare systems and patients. Biosimilars are highly similar versions of existing biologic drugs, providing a more affordable alternative once the original biologic patent expires. However, the adoption of biosimilars in the U.S. has been hampered by myriad roadblocks, many of which…
The 7 Virtues of Rheumatology We Should Cultivate
1949 was a momentous year—astronomer Fred Hoyle coined the term Big Bang, the North Atlantic Treaty Organization (NATO) was formed, and Rodgers and Hammerstein’s classic musical South Pacific opened on Broadway.1 Much less recognized was the publication of an essay by Richard Asher, FRCP, titled the “Seven Sins of Medicine.”2 Although it’s over 75 years…
Ethics Forum: The ACR Code in Practice
Ethical conduct is the cornerstone of any professional organization, particularly when its decisions have an impact on public health. The ACR recognizes the importance of upholding ethical standards and has established a Code of Ethics to guide its members. Here we explore the practical application of the ACR’s Code of Ethics.1 Manage Potential Conflicts Central…
Ethics Forum: The Current Landscape of Artificial Intelligence in Medicine
A handful of articles on artificial intelligence (AI) have graced the pages of this publication in the past six years, including one by Bharat Kumar, MD, in November 2022. Dr. Kumar highlighted the exciting potential of AI in rheumatology, including machine learning (ML) algorithms for the prediction of response to methotrexate and a predictive model…
Ethics Forum: Mitigation Tips for Health Disparities Among Rural & Indigenous Peoples
A common case scenario in our practice in North Dakota is a woman with rheumatoid arthritis on methotrexate monotherapy. She is a member of the Sisseton Wahpeton Oyate people and lives 90 miles from our rheumatology clinic. She currently has moderate disease activity, indicating the need for additional treatment. She does not have her own…
In the Wake of Dobbs v. Jackson Women’s Health Organization
Since the Supreme Court ruling in June 2022 overturning 50 years of precedent protecting abortion as a constitutional right (Dobbs v. Jackson Women’s Health Organization), states are enacting and implementing new laws to regulate abortion, and medical organizations and healthcare providers are assuming the large task of understanding what the new laws mean for their…
Conflicts of Interest in Guideline Development: What to Do When Everyone Has a Conflict
Avoiding real and apparent conflicts of interest is a fundamental principle of guideline development, but what should we do when every thought leader is conflicted? An example of this conundrum in rheumatology has been the ACR’s ongoing effort to establish guidelines for the management of lupus nephritis, which has been stymied by the fact that…
Ethics Forum: Has the Patient Asked for More Than Can Be Ethically Allowed?
The patient, a 76-year-old woman, had very active polyarticular rheumatoid arthritis (RA), despite triple therapy with conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs), low-dose corticosteroids and occasional intra-articular injections—the latter providing only transient symptomatic relief. She had elevated inflammatory markers and a 28-joint Disease Activity Score (DAS-28) score of 7.4. Because of the severity of her…
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