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.
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…
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: Regarding Chatbots in Rheumatology
Chatbots are not a new concept, but have recently gained popularity and traction. Launched in late 2022, ChatGPT (Chat Generative Pre-Trained Transformer) is a web-based platform designed to simulate interactive conversations and deliver real-time data. It has quickly become a tool that provides instantaneous information that can be more focused than a Google search.1 We,…
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…
Ethics Forum: Thoughts on Managing Electronic Communication with Patients
Recent proposals in the U.S. to bill for electronic communication with our patients could be seen as a refreshing but contested attempt to battle burnout rates in the present era. A fee for electronic communications between patients and clinicians also acknowledges the value of the clinician’s time and expertise. But is this ethical? Discussion Burnout…
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…
Ethics Forum: Billing, Burnout and Protected Non-Clinical Time
It’s 11 a.m. on a Wednesday. You see a new patient in your fellow’s clinic with impressive physical findings, including a prominent skin rash and deforming arthritis. The patient has been to many doctors and is frustrated that her condition remains undiagnosed and untreated. You thoroughly examine the patient, present her case to your attending…
Ethics Forum: Balancing Competing Interests to Meet Patients’ Needs
Scenario: A patient with rheumatoid arthritis (RA) presents for a follow-up visit. After addressing her inflammatory arthritis symptoms, medications and laboratory results, she is asked if she has any other questions, and she begins describing her chronic low back pain, which has become worse despite physical therapy (PT). She requests stronger medications because her RA…