Reflection 11/29

This week we talked about ethical guidelines and regulations when it comes to human subjects volunteering in research. When it comes to research there tends to be a vague area as to what needs to be disclosed and what does not. In the past, research has gone through trials and tribulations as patients are either pleased or not with their outcomes in a research trial. Misuse of volunteerism knowledge dates all the way back to Nazi Germany. In this time research experiments took place in concentration camps where vile tests were done on "volunteers" that left them most often in harms way. As war crimes were later reviewed, boards decided that there had to be regulations put in place in order to ensure the safety of research volunteers so that law suits and criminal trials would not have to occur. The Nuremberg Code was put into place that stated ten rules to follow in terms of mostly consent and qualifications to run the trial. Then the Belmont report came out to further explain these regulations. It focuses on respect for persons, beneficence, and justice. In terms of respect for persons this means that those who are subject to research are given the proper knowledge that they deserve and making sure that there opinions and choices are respected at all costs. For beneficence you look past respecting their opinions and choices and rather protecting their well being by doing no harm and maximizing possible benefits than minimizing possible harms.  Justice revolves around the idea that all are treated equally and that everyone gets what they deserve. All of this encompasses the basic needs that volunteers are given in order to run a proper experiment where there are mutual benefits for all. Something to get across to subjects is that they know all of what they are signing up for. They need to know that the research they will be involved in is not early access to the newest treatment or a last resort option, it is purely to find out the safety and efficacy of new potential treatments. It is common for there to be therapeutic misconception where volunteers see this research as optimistic when in the end it could not work and it could ultimately affect their quality of life from there on. Many volunteers think that all research is going to result in a wonder-drug, but this is rare to find. There is much that goes into making sure that each volunteer is fully aware of every single aspect of the research. A way to aid in this area is that search memos that are sent to potential volunteers, are approved by IRB's who take much time and effort to make sure that the memos follow all regulations. These memos must be at an eighth grade reading level so that the language is easily understood since not everyone understands the medical jargon that physicians and clinicians use. When it comes to research there is much that only those who were in creation of the information actually understand, they have to spend most of their time explaining to others why their research should be taken seriously and most importantly this applies to human subjects.
Another big thing we talked about was health insurance and its future. When it comes to looking at health insurance, the measures are in terms of quality, access, and cost. The system we have in the US though is very complex and has many players. This means that it can be hard to change it for the better or worse. Compared to other countries, the US has the worst functioning system in many areas but yet we spend the most on healthcare. The question is, why are we so advanced and spending so much but yet we comes in last in almost every sector? This can be due to the fact that our outcomes are so poor in terms of medical care. We have many medical errors and leading to much unhappiness for patients. On top of this our country excels in the aspect of wasteful spending. How our system mostly runs today is in terms of fee for service. This means that the only way that physicians or hospitals are getting paid is based on the services they provide; therefore the more services they provide the more they will get paid. This leads to doctors giving patients excess treatments that they do not need in order to treat them properly. They are overusing this unnecessary care because they want to make more money. One last reason that the system is struggling is because access is extremely poor. In the US, 90% of the population has insurance coverage, which is great, but this leaves 10% of the population without. We are the only high performing country that does not have all of its people under health insurance. This is mostly due to the fact that we are known for the reputation as individualists who can fend for themselves. Not everyone feels that they need it because they live under the impression that they can prevent health catastrophes from occurring. Now these issues have been around for a while and not much has been able to change. The country has enacted many programs but one that seems to be the best choice of action is medicare for all. This means that everyone in the US would have state and federal funded healthcare that derived from taxes. This program would mean that everyone would be covered which could ultimately decrease spending over all since the health of the population would better. Although there are many positives to the program there are also many negatives. Taxes would increase, more doctors would be needed, more pharmacists would be needed, professionals would want to be paid more, and insurance companies would go out of business so many would lose jobs. This all comes back to the idea that the system is so complex. There are many different players in this game and in order to please all of them a miracle program would need to be put into place. There are many small steps that we can take but the final goal is very hard to reach.