Latest news with #ArtCaplan
Medscape
30-06-2025
- Health
- Medscape
Death Clock App Not Ready for Prime Time, Says Ethicist
This transcript has been edited for clarity. Hi. I'm Art Caplan. I'm at NYU's Division of Medical Ethics at our medical school. I came across a really interesting app called the Death Clock. It is exactly what it sounds like. It basically is an app where you feed in all your health information, personal information, social information — any fact about you — and it promises to tell you your death basically is a forecaster of when you're going to die. You might say, some people might have an interest in that. What's the issue? Well, I think there are many issues. Should a patient come and ask you about this, I think you'd be wise to be ready to answer in case this app or others like it that are coming take first problem is, can we accurately predict your death date, even given a whole array of personal information? I still don't think so. Having worked now for a while on geroscience, meaning what factors cause senescence — not diseases in old age, like Alzheimer's disease or Lewy body dementia, but just aging — we don't really understand why some people age at different rates. There's a disease called progeria where a 10-year-old can go through aging and end up looking like a 90-year-old at the age of 11. Then, there are clearly differences in the rates at which people age from midlife to old age. We don't understand them well, but we're learning. I think an app that says it can tell you your death date is not accurate. Some people aren't going to want to know their death date without getting counseling. If someone asks if they should buy the app, I think either that company or you, as the doctor, had better be prepared to counsel them about what it would mean if it predicted an early death or a death that's coming soon. Aside from fear and worry, what plans should they make?Should they fill out advanced directives? Should they not retire to Arizona sooner? They're going to want information and counseling, and somebody has to provide it to them, and I don't see this company doing that yet. People need to at least try to cope with bad news. Another reason the company says the app is interesting is it'll push you to make lifestyle changes that will extend your death they offer — I think it was for $50 a year, if I remember right — a program to counsel you, claiming to be targeted to your particular situation, so that you can live longer. I doubt that is necessary either. We all know how to counsel patients in terms of wanting to live simple steps. I don't mean simple to do, but I mean five or six rules that hold up: lose weight, more exercise, moderate drinking, wear your seatbelt, don't use recreational drugs in excess. We know what the tricks are if you want to add lifespan. I don't think you need to sign up for anybody's program yet. Probably the biggest worry I have is, who's going to get all this information? I don't trust this company not to resell. I don't trust this company to protect individual identity. Even if they tried, with hackers and accidents, having this private company control identifiable information — boy, I think that's a much bigger risk than any benefit you might get from having the death clock. Overall, I'm still not ready. I did take a peek at my own prediction. I've got some time left, which is good to know, but that was just curiosity so that I could talk to you about it. In general, I don't think this is ready for prime time. I do think the downsides still outweigh the benefits, so I would be pretty cautious before I set the death clock with a patient. I'm Art Caplan, at the Division of Medical Ethics at NYU Langone. Thanks for watching.
Medscape
24-06-2025
- Health
- Medscape
Hologram Doctor: Not Who I'd Like to Visit, Says Ethicist
This transcript has been edited for clarity. Hi. I'm Art Caplan. I'm at the Division of Medical Ethics, at NYU Langone Health System in New York City. I am not a hologram. What am I talking about? Well, a new cancer clinic in Tennessee is starting to offer to its patients a hologram doctor. Some of you will know what this is like. It's been used now in shows and performances, like at Sphere in Las Vegas. All of a sudden, you're able to go to a show by Michael Jackson, who is long since dead, but they can project him onto the stage. This is also true for other singers, performers, or even figures from the past. They're very realistic looking, and you feel like you're in the presence of maybe someone who's still alive. That technology is being touted as a way to improve care for people in rural areas. Many of those folks have to travel very far to get regular exams and surveillance from a doctor or a nurse. Some of them require a 3- or 4-hour drive. It's a real burden. It's hard for many of these people, some of whom are frail, older, or sick from the treatments themselves. It's hard for them to get there. The clinic has come up with this idea to make a hologram of a generic doctor, put that doctor in a studio with good lighting and good technology, and beam it out to the homes of these patients — or let them travel somewhere where the setup is a little more friendly that is maybe not 3 hours away. Maybe they could have studios that, for many people, are only an hour away. I see some benefit. I think doing video conferencing and that style of thing often is a little cold and distant. The lighting isn't good, and the sound may be bad. It's not a professional production, and it may not give you the nuance and the detail that you want to see if you're trying to do an exam. It's better, if you will, to have the higher-level tech. There are issues. One, in rural areas, we don't really have great Wi-Fi service. The rates of carrying detailed signals aren't that good. I'm not sure much of this is going to make it into a rural person's home. I still see travel required, which cuts back in some ways on the attractiveness. It may be better to send the actual doctor to four or five clinics once in a while than to try and rely on the hologram doctor going out to the rural patients at locations where the signal still is not going to be that great. I also worry that for much of this work, while you can see some things, you can't see other things. Yes, you can detect a rash, and sure, you could see certain things about certain skin cancers, but are we really ready to say that we can conduct an exam remotely on a cancer patient with complicated disease? I'm not sure. Again, I'm no oncologist, but it makes me nervous that a thorough exam would be something you could do. In a weird way, this might work better for dermatology. It might work better for certain kinds of family medicine practice, where someone's nervous about a rash, headache, or some symptoms that you could handle remotely. This patient group strikes me as maybe more complicated. The other problem is the legal situation is unclear. What would it mean to make an error? What would it mean to actually give bad advice or misdiagnose? Who's responsible? Who's going to be able to hold someone accountable? What if the patient really isn't comfortable and doesn't give you all the information that they might if it was face-to-face? In person, that whole area looks murky, unresolved, and even dangerous to practice in until the rules are laid out clearly about who's responsible for what and what the standard of care is for using this kind of technology. Are we going to see more of it in the future? I think so. Is it ready for prime time now to an underserved rural population? I'm not sure it's here yet. We'll have to keep an eye on it. Maybe improvements will come. Maybe our infrastructure for handling Wi-Fi and this kind of thing will improve, but for now, I'm not sure that the hologram doctor is the doctor that I'd want to visit. I'm Art Caplan, at the Division of Medical Ethics at NYU Langone Health Systems. Thanks for watching.
Medscape
06-06-2025
- Health
- Medscape
Restricting Kids' Cell Phone Use at School: Ethicist
This transcript has been edited for clarity. Hi. I'm Art Caplan. I'm at the NYU Grossman School of Medicine, where I'm the head of the Division of Medical Ethics. The state that I live in, Connecticut, has seen some very interesting legislative proposals recently around cell phone use. Many other states — New York, New Jersey, and many others — are having similar Connecticut one, I think, is the furthest along of them all. It becomes important because I think parents ask questions about cell phone use for their kids. What should I be thinking? Should I restrict it? Is it dangerous? What should I do? The state of Connecticut wants to help. First, they've proposed legislation to pull cell phones out of schools — at least kindergarten up through high school — to get the cell phones taken away from the kids so that they're not distracted and that they're paying attention to the teacher and also engaged in social interaction. Even more radically, there's a proposal in Connecticut, a bill that would ban in young children from being able to access social media platforms, iPads, cell phones, or whatever between midnight and 6:00 AM. Is this a good idea? A colleague of mine at NYU, Jonathan Haidt, wrote a book called The Anxious Generation . He believes that the rates we see of teenagers who are now experiencing anxiety, which has increased from 2010 to today from 1 in 10 to 1 in 4; the number of teenagers experiencing depression, which has gone up from 1 in 10 to 1 in 5; and even death by suicide, one of the leading causes of deathfor kids aged 15-24, have to do with social media. Harassment, peer pressure, and getting stalked and bombarded with messages that attack self-esteem, target young people, and make them feel bad about their bodies can absolutely create mental health disorders. Is there sufficient evidence in his book?Do we have sufficient evidence from other studies to say for sure it's the cell phone or the iPad that somebody's looking at late at night? I'm going to concede that we don't. There's suggestive evidence, but not really many gold-standard studies that say, yes, it's the cell phone, iPad, or computerand where they are on social media. On the other hand, I support these legislative efforts, like Connecticut's, to get the cell phones out of school, to get kids talking to one another, to get them paying attention more, and to do what we can to get them off [of their devices] in the middle of the night. I would look at it this way.[Cell phones] may be causing problems by giving access to disturbing social media outlets. Let's face it, social media is a cesspool at this point, a sewer all over the place, and the companies that run it are doing nothing to self-regulate it. If we're wrong, the worst that happened is [kids] are not online for certain parts of the day. I know parents sometimes say, well, what about if there's a shooting or an emergency at school? I think we can manage that. You can absolutely have teachers with cell phones. The staff can have cell phones. It's not that there wouldn't be any ability to alert the police or to allow some communication as necessary with the kids.I don't think the rarity of a school shooting, as much as we worry about it, is enough to say, yes, let's let the kids just get lost all day long at school in their cell phones. I also understand why people are asking how this is going to really be enforced. Maybe it will be possible at school when you ask the kids to turn the cell phones in and lock them up or put them in a pouch where the teacher has the code or is that enforceable at home at night? One of the things missing, I think, from these efforts in Connecticut and elsewhere to decrease access by young kids to social media is the use of parental controls. I think some social platforms do a pretty good job saying before you give that cell phone to your kid or let them have their own computer, you're going to be able to program it with social parental discretion controls. Other platforms don't seem to care. Let's set some standards and expectations about what parents could do and would be able to do to restrict access at different times. It's going to take an across-the-board effort from parents, government requirements, and a willingness of people who control social mediato try to make sure that kids aren't getting in trouble, but we have to really start to take steps. We've got a problem in just saying there's nothing we could do about it, like the horse is out of the barn. That's not a response. I support the Connecticut effort. We'll see. I don't think federal government's going to be moving in this area anytime seem oriented toward deregulation. I think many states may, and I think that's something that, as physicians, we should try to support. Less access to social media at certain times of the day and night is not a bad thing for kids. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of for watching.
Medscape
21-05-2025
- Health
- Medscape
Should Unvaccinated Patients Get Organ Transplants?
This transcript has been edited for clarity. Hi. I'm Art Caplan. I'm the head of the Division of Medical Ethics at NYU's Grossman School of Medicine in New York City. There is a huge controversy ongoing about Cincinnati Children's Hospital's decision not to put a 12-year-old girl on their heart transplant waiting list. The reason they didn't do it was thatshe has not been vaccinated against the flu and against COVID-19. This has led to a huge, angry backlash, part of the reason being that the young girl's mother, Jeneen Deal, is related by marriage to Vice President JD Vance's half-sibling, so she's part of a celebrity family. The couple — her parents — adopted her from China when she was 4, and they knew at the time that she had heart problems and was going to need a heart transplant. They've always taken her to Cincinnati because they believe that's the best place in their area for her to get care. They've had a long-standing, good relationship with the hospital, and I'm sure they're very angry that now they've got this challenge to getting her waitlisted to receive a heart. Those of you who know the heart transplant field know that for kids, it's tough to get a heart. It's very difficult because there are very few donors. That's partly because many of the donors for adults come from car accidents, gunshots, swimming pool accidents, that sort of thing. Younger children, happily,are not as likely to die in circumstances where they then become cadaver organ donors, so the organs are very scarce. What's going on? Well, the family says they don't want to vaccinate because it's against their religious beliefs. It's hard to know what those religious beliefs are because there are no major religions that oppose major religions — all that I'm familiar with — support vaccination as good for the individual to preserve their health and good for the community. What the hospital is doing in this situation has nothing to do with fights about whether a flu vaccine should be mandated or if schools can require going on here is that when you get a heart transplant, you have to take immunosuppressive drugs immediately and for the rest of your life. They tune down your immune system and make you very vulnerable to infections such as the flu, and they make it very likely that you could die if you got the flu, COVID-19, or other infectious diseases that normally we might be able to survive without getting vaccinated. The hospital is trying to be responsible and say that they don't want her to die if they transplant her. The way to maximize her chance of doing well with the heart is to give her vaccines, which will build up her immune system before they transplant her. That makes good sense to me. It also makes good sense to say that we don't want to waste a scarce heart on someone who's likely to get sick when other people are waiting in the queue — other kids not related to JD Vance — who are vaccinated and will do better. From a moral point of view, we want to steward the supply of scarce hearts responsibly and make sure they go to the child who's going to do the best with the heart and has the best chance at life. I do think it's right to say vaccination, in this instance, is something that the hospital really wants to medically indicated for this girl and anybody else on a waitlist anywhere for a transplant. That's not the same and shouldn't be mixed up with fights about mandatory vaccination to get into school. I think the hospital is asking for the right thing, and I hope that they stick to their guns on this oneand don't let misinformation or misunderstanding get in the way of doing what's best for the girl and doing what's best with the scarce supply of hearts. I'm Art Caplan, at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for walking.
Medscape
13-05-2025
- Health
- Medscape
Conscience Laws Detrimental to Medicine: Ethicist
This transcript has been edited for clarity. Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of Medicine. Of all things these days, conscience and the right to have conscientious objection has become a huge and divisive issue in medicine. As I'm sure many of you watching are aware, a number of states have passed conscience laws trying to grant rights to doctors to refuse to do things that they don't agree with morally. That's because many federal laws, such as the EMTALA law, which requires treatment in emergency rooms, have said that you have to do things that will stabilize a patient, and that might involve in some instances, an abortion, let's say, because the woman's life is in danger. Conscience laws that some states — red states — have put through basically say, no, you don't have to do that , a nd your conscience should take precedence both over that federal law and over what the patient might need. What's best is you do what is moral for you, and we're going back that decision up, particularly if it agrees with what we, as the state legislature in conservative red states, want to see happen. There are also blue state efforts to say that my state has banned something by law, and I don't want to see somebody put in a conscience statute so that I can do things that the legislature has said they're not going to allow, such as transgender surgery. Conscience has become a strange battleground because people are using it to try to evade laws thatthey deem either too restrictive when there are approved medical treatments but doctors don't want to do them, or at the other end are way too liberal, forcing somebody to do something by law that, as a matter of their values as a physician, they don't want to do. How do we sort all this out and where does conscienceleave us, as a physician or as a nurse, when dealing with patients? My view is very simple. I don't believe that state legislature should be telling doctors what to do or not to do when existing, approved medical treatments are out there. If physician associations and groups agree that there are instances in which abortion is indicated, if there are situations in whichphysician groups agree that it is appropriate to remove a feeding tube from a dying person, if physician groups have consensus and say that the data show day-after pills are safe and they can be administered in a doctor's office or even by telemedicine, then I think it should be doctors who decide what's going to happen with their patients. I think we've seen way too much push, both from the left and the right, to intervene with doctor-patient relationships. You may recall Florida once had a law proposed that said you can't discuss gun safety with your patients. That seems ludicrous to me. The legislature shouldn't be interfering in a public health matter like that. Idaho and some other states are considering laws that say they're going to ban the use of messenger RNA (mRNA vaccines). That means they don't like COVID vaccination, but mRNA vaccines are the future of cancer treatment. To put it another way, I'd rather have a doctor deciding what's appropriate for their patient than a person who's a real estate agent, has worked in farming, or has been a lawyer deciding, as a state legislator, what they think appropriate and medically useful care is going to be. Conscience is important. There is no doubt that we want to respect what doctors and nurses think is right and wrong, but what ought to come before conscience is the patient's best interest. If something controversial is still in the patient's best interest, that's what I think physicians, nurses, and medical associations all ought to be fighting for. Let's try to keep the state legislator out of the waiting room. Let's try to minimize the impact of politics on the practice of medicine, as it's going too far under the banner of conscience. Let's restore the integrity and, if you will, the sanctity of the doctor-patient relationship. I'm Art Caplan. I'm at NYU Grossman School of for watching.
