March Madness in Mathematics

            Entrepreneur Tim Kelley has a vision for academics, and he is starting to implement it. His vision is to turn academics into a version of competitive sports, pitting students and schools against each other electronically in a NCAA bracket type of competition. Right now, primarily the best students at the best schools are the ones competing in these NCAA-style math brackets, but Kelley hopes that this will one day allow all students to be paired up against others with whom they could be academically competitive (based on past scores) in head-to-head competitions. Kelley wants students to feel the glory of competition, so that they will be more motivated to improve. He also wants to make it possible for spectators to view the matches online live to bring acclaim to math departments and make others want to participate, as well.

            This idea stems from sports. Kelley recalled student-athletes pushing themselves to achieve their personal best times in crew, spurred on by competition with peers and their own previous scores. He designed this program to try to bring that same competitive spirit and drive to improve into the classroom.

            While in theory this seems like a great way to get kids excited about pushing themselves academically, it is still an experimental model. Many of the students currently using the program already compete academically. They travel around the country for mathematics competitions, and moving this onto an online instantaneous portal is not very different, just less expensive. However, moving this head-to-head competition model into the classroom will have less predictable outcomes. Will students who are doing poorly in school be encouraged to work harder by head-to-head competitions that involve instantaneous feedback, perhaps of having lost to a global peer, maybe even day after day? Or would that further deplete the student’s motivation and inspire them instead to give up? Would a student far behind grade level who beats another student who is far behind grade level be given a false sense of their progress? Or will they be spurred on to climb up the ranks to compete with higher ranked students? It is hard to predict how making learning into a spectator sport will influence students. After all, when some kids are bad at basketball, they quit and maybe have lower self-esteem, while others work harder until they succeed. How can both kinds of kids be served by this system, or how can teachers ensure that kids are encouraged not discouraged by this form of learning? With all of these unknowns, this form of learning is a risky experiment; is it ethical to risk jeopardizing some kids’ education and well-being by bringing constant competition with others into the educational environment?

http://www.usatoday.com/story/news/nation/2013/03/24/math-march-madness-competition/2010875/

The Unfeasibility of Zero Tolerance: How Physicians Deal with Discriminatory Patients

For decades, doctors have been banned from “[. . .] refusing to treat people based on race, gender and other criteria” (Associated Press)  However, the reverse scenario—patients refusing treatment from doctors based on prejudices (particularly racism)—has not been fully addressed.  Most medical professionals agree that when a patient refuses treatment from a physician based on race or ethnicity, that request should not be acquiesced.  Indeed, numerous healthcare organizations have independently mandated noncompliance with prejudicial patient demands.  But there is currently no law that enforces this nondiscrimination.  The American Medical Association has declared its plans to establish “Guidelines for Handling Derogatory Conduct in the Patient-Physician Relationship.”  This protocol would apply to “non-life threatening emergencies.”  But many medical cases, while not emergencies, present complicated circumstances in which there is no simple answer.  As a result, in practice, patients’ racist requests are often accommodated.

            At times, there may arguably be a justifiable reason for submitting to a patient’s demands even if they are based on racial preferences.  Recently, an African American nurse in Flint, Michigan accused the medical center where she works of agreeing to a white man’s command that no black hospital personnel handle his newborn who was in the intensive care unit.  Subsequently, no black nurses were assigned to the patient and a note reading “No African-American nurse to take care of baby” was included with the patient’s chart.  Why was the racist father’s command obeyed?  It likely had something to do with the fact that the father had flaunted his swastika tattoo to an attending nurse.  Thus the nurse who consented to the man’s demand may have felt threatened and was reluctant to protest because the man’s child could face the consequences. 

            In other cases, a patient is mentally handicapped or has undergone a traumatic experience and will feel severe anxiety or irritation when approached by a specific physician.  It is not uncommon that a rape victim will react with fear or apprehension upon encountering a physician or other well-intentioned hospital worker who happens to resemble the perpetrator of the assault.  Under these circumstances, it seems that even discriminatory demands should be accepted so as to avoid further mental or emotional distress.   

But even if a racist patient reluctantly accepts treatment from a previously harassed physician, that doctor still must cope with racist remarks and behaviors.  Most physicians believe that such inappropriate conduct, even if relatively minor, should not go unaddressed.  Instead, “Doctors should try to correct the patient who is making ignorant comments by using personality and, to some extent, their position of authority” (Miller).  By firmly yet respectfully disagreeing, a physician may retain composure while not succumbing to passivity.  However, in reality, few prejudices are going to be easily overturned.  Many patients who make discriminatory remarks are elderly.  Because they grew up surrounded by racism and have upheld their beliefs for decades, their prejudices are essentially irreversible.  Some have proposed temporarily withholding treatment to patients who continue to display racism.  This measure seems extreme since a physician’s foremost aim should be to help those individuals in need, despite their skewed beliefs.

Ultimately, a zero tolerance policy regarding prejudiced patients cannot be implemented in a hospital setting.  Studies have shown that patients who do not trust their physicians are unlikely to make full recoveries.  Thus if a patient continues to refuse treatment from a physician because he or she is black, Muslim or of some other discriminated-against group, hospital staff will eventually be forced to relent.  Though patients have the right to refuse medical treatment, hospitals have an obligation to care for patients, even unpleasant ones.     

http://www.bioethicsinternational.org/blog/2008/02/25/how-to-handle-a-prejudiced-patient-ama/

http://www.amednews.com/article/20130304/profession/130309980/7/utm_source=rss&utm_medium=&utm_campaign=20130325

http://www.chron.com/life/healthzone/article/Some-hospitals-grant-patients-racist-requests4302145.php

https://ssl3.amaassn.org/apps/ecomm/PolicyFinderForm.plsite=www.amaassn.org&uri=/ama1/pub/upload/mm/PolicyFinder/policyfiles/DIR/D-373.998.HTM

Better To Be Safe Than Sorry?

In a March 19 report by the Presidential Commission for the Study of Bioethical Issues, an ethics panel tentatively gave a green light for researchers to test an anthrax vaccination on children. This review was in response to a request from U.S. Health and Human Services Secretary Kathleen Sibelius after a 2011 bioterrorism preparedness exercise in San Francisco revealed that 8 million people would be affected by an anthrax attack, nearly a quarter of them children. The problem, as noted by agency officials, was that, if such an event of bioterrorism were to occur, there would be no protocols in place to treat children exposed to the bacteria. The current federal plan is the immediate distribution of antibiotics; however, this does not provide long-term protection as anthrax spores can pose an infection threat long after their initial release. The issue now is trying to find an acceptable dose of the vaccine for children. This is challenging because, although the vaccine has been in commercial production for the past 40 years and is used by adults in the military, there is no understanding of its effect on children.

However, a larger and perhaps more significant issue is the ethics surrounding this decision. Research with children is ethically distinct from other research, especially when the research in question promises no prospect of direct benefits for participants. Children are legally and ethically unable to consent to accept this burden. In addition, despite its use in adults, a 2008 study reveals that adults who receive the vaccination are prone to a number of serious side effects.

Supporters of this decision argue that the safety and security of children is the top priority in this effort, and with the chance of a bioterrorist attack, it is much better to be in a position of prevention before it happens rather than fixing the problem after it happens with lives at stake.

However, the support for this testing of the anthrax vaccine on children is dependent on a hypothetical situation that may never occur. In that case, the risks far outweigh the benefits, and this goes back to the question of whether there are direct benefits for participants of the study. It is one thing to test the vaccine on a soldier who may potentially face an anthrax-loaded shell. In that case, side effects such as itching, swelling, and soreness would hardly matter. On the other hand, to ask a child to test a vaccine because of such a risk is different and seems more ludicrous. Of all the real challenges that children face, like abuse, neglect, obesity, and suicide, the threat of an anthrax attack hardly seems to fit in that list, and according to Arthur Caplan, this kind of terrorist attack is “remote at best.”

How far do we go down the road of “what if…” conjectures? Human experimentation is a serious topic with serious consequences, and, especially when we are making the decision for children, the benefits better be worth the risks. In the case of the anthrax vaccination, I question whether such a hypothetical situation really deserves the application of the better-to-be-safe-than-sorry rule.

Sources:

http://www.usatoday.com/story/news/nation/2013/03/19/anthrax-vaccine-bioethics/1997167/

http://www.examiner.com/article/u-s-panel-tentatively-oks-testing-anthrax-vaccine-on-kids

http://vitals.nbcnews.com/_news/2013/03/19/17361790-bioethicist-no-chance-of-anthrax-vaccine-trials-in-kids?lite

Valium, Prozac, Zoloft... Harmful or Helpful?

It’s a fine line between cure, enhancement, and harm when it comes to certain innovative substances. Social context and public opinion shape the circumstances in which a drug is taken and even the effects it can have. Certain drugs are commonly accepted as being detrimental to one’s health - alcohol, hard drugs, highly addicting substances such as nicotine in cigarettes etc. However, when a new drug enters the market, it is unclear whether it is medicinal, recreational, beneficial or harmful. In the 1970s, Valium became increasing popular among middle-aged housewives, and at first was seen as a tool to help them cope with their daily frustrations. There was a shift in its place in society within the decade, when feminists started to voice their concern that Valium was being over-prescribed to women to subdue them into accepting their roles as passives housewives. Valium later became obsolete with the rise of new anti-depressants such as Prozac and Zoloft, which are commonly used today. Mood enhancing drugs always walk the line between harming and helping, since they are addressing psychological issues as opposed to physical ones. The new movie “Side Effects” (2013), directed by Steven Soderbach and written by Scott Burns, dramatizes the potentially catastrophic consequences of an anxiety-treating drug’s unexpected side effects. Are these mood-enhancing drugs a source of freedom from depression and daily stress or anxiety, or are they holding us back by thrusting us into a pleasant but flattened haze?

Sources:
"Happy Pills in America", David Herzberg, 2009
"Side Effects", Steven Soderbach, 2013