2019 marked a number of 50th anniversaries in the field of bioethics. Two of the biggest bioethics anniversaries included the 50th anniversary of Elizabeth Kubler-Ross’ On Death and Dying, which laid the groundwork for all end of life discussions and care delivered today (see: https://www.tandfonline.com/eprint/UYRGE3RPJPEKCDNHSIET/full?target=10.1080/15265161.2019.1674410)
Another major 50th anniversary was the founding of The Hastings Center (see: https://www.thehastingscenter.org/who-we-are/), which was the first bioethics think tank that began to publish and articulate important concepts for bioethics, and eventually led the field into various subspecializations, such as transplant ethics, research ethics or pediatric ethics – in which practitioners and scholars began to formulate applied ethical frameworks for particular fields. Similarly, Endocrine Ethics is a new subspecialization (see further).
The American Journal of Bioethics listed the top 10 bioethics stories of the years here (see: http://www.bioethics.net/2019/12/top-ten-bioethics-stories-of-2019/), many of which directly affect the practice of endocrinology, including the sweeping abortion restrictions that are now affecting the practice of reproductive endocrinologists who may have to rethink more preventative strategies, such as aggressive counseling about hormonal contraception, and creating greater restrictions regarding fertility treatment and the creation of high risk pregnancies that may not be allowed to be terminated in multiple states. The American Society of Reproductive Medicine strongly opposes so-called “personhood” laws that frame these new restrictions (see: https://www.asrm.org/about-us/media-and-public-affairs/public-affairs/asrm-position-statement-on-personhood-measures/).
Notwithstanding, the biggest Endocrine Ethics story of the year is also its oldest – access to insulin.The New England Journal of Medicine covered this story in November 2019 (see: https://www.nejm.org/doi/full/10.1056/NEJMp1909402), which is really more about the failings of the American healthcare system (which practices “healthism” and “wealthcare”) than it is about a diabetes crisis. The crisis is from the high cost of insulin leading to the rationing of insulin, which has put thousands of insulin-dependent diabetes patients at risk of dying from a disease we’ve been able to treat since 1921. In fact, access to insulin was one of the first uniquely endocrine ethics issues that emerged in the 20th century, and it seems we’ve come full circle. The precedent set by the co-discoverers of insulin (a wild research ethics story in its own right) of making insulin widely accessible by selling the patent for $1 to the University of Toronto, led to widespread accessibility of other wonder drugs years later, including the polio vaccine.
Other endocrine ethics stories dominating the news include the continuing controversies over treating well-differentiated thyroid cancers and Graves’ disease and a concerning spread of disinformation surrounding so-called “risks” of radioactive iodine that are unsubstantiated (see, for example: http://am2016.aace.com/presentations/thursday/T22%20&%20T53/ain_radioiodine_remnant_%20ablation.pdf). This has led to disparate standards of care, and many seasoned thyroidologists’ warning of the coming tsunami of patients who will present with iodine non-avid thyroid cancers because of the withholding of the standard of care.
Finally — as you can see, Endocrine Ethics Blog was a little less active in 2019 than in previous years, but that’s because one of the biggest Endocrine Ethics stories this year involved me: I founded in October 2019, along with three other colleagues, the first professional society for endocrine ethics issues: The Endocrine Ethics Association (see: www.endocrineethics.org). You will hear more about this organization in conjunction with this year’s Endocrine Society Meeting in March 2020.
In 2020, here’s to solving the insulin crisis so that thousands of insulin-dependent diabetes patients can see clearly for as long as possible.