A hospital in the Lone Star State has decided that not everything should be bigger by regulating potential employees based on their body mass index (BMI).

However, under heavy criticism (yay puns), this hospital in Victoria, Texas, has ended the policy (or, in the very-not-eloquent words of Jezebel, “reverses the terribly dumb no fatties rule”).

The hospital’s CEO justified the policy by saying: “We have the ability as an employer to characterize our process and to have a policy that says what’s best for our business and for our patients.” In other words, it wanted its health workers to have professional personal appearances.

The BMI requirement for this rule is less than 35 (here’s a useful chart). This policy is not illegal in Texas, nor is it illegal in any state besides Michigan (its anti-weight discrimination law was enacted in 1976).

Basically, we have one side saying that obesity is unprofessional in a healthcare environment and another side saying that it isn’t and that if it is, it shouldn’t matter because that would be discrimination.

Is obesity a disability? A disease? A direct result of personal choices? Or an unfortunate condition caused by one’s financial background? Since it is likely a combination of all the above, it becomes complicated (remember the huge debate on whether airlines are obliged to provide two seats for the morbidly obese? That was a polarizing debate). In addition, unlike race, gender, and sexuality, it is controllable to a certain degree*. Being obese also has intrinsic negative health consequences that are not caused by society discrimination.

In my opinion, there is no question that this hospital is discriminating based on weight (the fact that this is technically legal in 49 states still shocks me) and the CEO might had as well admitted that he and the patients did not like looking at fat people.

But to what degree can a hospital require its employees to “look professional?” It certainly can forbid them from cursing or smoking or not wearing uniforms, but can they ban them from face tattoos? Eating fast food in front of the patients? Or smelling bad? How far can hospitals go before it becomes unethical? We also must keep in mind that a mission of all hospitals is to provide the patients the most comfortable environment possible.

If obesity is a result of personal choice, it certainly is not that different from smelling bad, and I am guessing that the CEO holds this view. As a society, we already “look discriminate:” we don’t ever see fat news anchors or obese clothing store clerks, and at this modern era, an obese person being elected as president is quite unimaginable. We “look discriminate,” we just don’t write them down (I can already see it: “The President of the United States of America must be a native-born U.S. citizen, lived in the U.S. for at least fourteen years, an age of at least 35 and BMI of at most 35”). If you have the option of hiring two people with the exact same expertise and one is obese while the other one is not, which one do you hire?

Obesity is not simply a result of personal choice, and this was one reason why the hospital’s discriminatory policy was rightfully under heavy attack. But the question still persists: How much can hospitals demand from their employees to ensure a quality environment for their patients?

*An interesting article Grace wrote about recently that looks at obesity at a different angle in case you missed it.

The deeper issue (believe it or not) lies beyond whether your apple juice is killing you.  Rather, I think this latest incident calls to question the intentionality and the repercussions of Dr. Oz’s proclamation.  Is it morally reprehensible that Dr. Oz is fanning the health hysteria if he truly believes it?  Debatable. Is it sad that so many Americans are brain-washed by what they see on TV? Definitely.

There are two interpretations of Dr. Oz’s intentionality.  Cynically speaking, he may know that arsenic levels in apple juice are safe and is inciting fear for the sake of yellow “televisionalism.”  In this case, I would argue that he deserves to be reprimanded for his publicity stunt.  More leniently (and more realistically) speaking, Dr. Oz may genuinely think that he is on to something.  After all, he is not a chemist and the FDA has been wrong before.  If this is the case, then his next steps are crucial to assessing his moral culpability.  For his credibility’s (and moral standing’s) sake he should retract his statement and call off his cult of fans who are attacking the FDA with a frenzy.

To see the news story and Dr. Oz’s response, click on the videos below:

Regardless of the intentionality, the repercussions of Dr. Oz’s warning distinguish it from analogous cases such as the Jenny McCarthy vaccination-autism scare.  Unlike the autism claim which scared many parents into refusing their children vaccinations, this recent is apple-juice hysteria is relatively innocuous.  Aside from apple-juice manufacturers, the general public will probably emerge unscathed.  So from a consequentialist viewpoint, perhaps Dr. Oz is off the hook after all.

The effects of the crusade against apple juice have yet to play out.  Maybe the same parents who refused to vaccinate their children because of autism will now boycott apple juice.  Maybe, the FDA will be forced to print “safe levels of arsenic” on all bottles of juice.  Maybe Dr. Oz will declare apple juice safe and apologize with his winning smile.  Or maybe, America will realize on its own that apple juice is not out to kill us…seriously.

Dr. Victor Tapson – a researcher and faculty member here at Duke – has been unfavorably singled out in a report produced by the Senate Finance Committee because of his financial ties to pharmaceutical company Sanofi.

Dr. Victor Tapson, via DukeHealth.org

It’s definitely not out of the ordinary for a medical researcher to act as a sort of pharmaceutical sponsor – giving presentations on behalf of certain drugs in return for large sums of money. In fact, as the Duke Chronicle reported last December, the University is proud of its policies regarding such relationships. However, in a presentation to the Federal Drug Administration, Tapson allegedly did just what these policies try to prevent – he showed undue bias in favor of a Sanofi product while conveniently failing to mention his $260,604 tie to the company.

In theory, these relationships between medical companies and researchers should act benignly, especially because people’s health and medical safety are on the line. It would have to act, though, in such a way that, in every instance, the doctors would simply present the facts of the products when asked by an outside party – unlike when a company like Gatorade gives an athlete millions of dollars to drink, breathe and sweat the sports beverage, though its health benefits are actually limited.

However, can a doctor suppress the fact that a company is giving him $200,000 and present 100-percent unbiased facts when he is speaking on behalf of that company? Look at it from the other side, too – would a company continuously fork out hundreds of thousands of dollars to have their drug promoted as having something like “dangerous side effects” or as being “not much better than the competing brand?”

At first glance, this idea of pharmaceutical sponsorship seems to be negative on all accounts. In truth, however, the line separating right and wrong on this issue is hazy. Although Tapson’s case is a clear, irresponsible and surface-level display of conflict of interest, the problem has deep and tangled roots.

Assume there is a doctor who, despite the large check he may receive, promotes a drug to the best of his ability with honesty and integrity – his audience members are still not aware of the bias that the pharmaceutical company is slyly feeding them. As a 2010 New Yorker article discussed, an epidemic of selective scientific reporting is surfacing – when a researcher reports the best or the most groundbreaking results of an experiment, even though those outcomes might not statistically be the norm. Many researchers even skip repeat trials for fear of disappointment. The article lists several popular medicines, like Zyrtec, that have had this kind of invalid promotion – and all of this happens before the information even reaches the sponsor doctor.

Pharmaceutical companies and researchers are not immune to the effects of capitalism – they fight for limited government regulation; they make choices that will increase profits; they have a drive to develop the first and the best and the cheapest products, and they craftily advertise so they are seen in a better light than competing companies. If we were to question the morality of this seemingly skewed version of the scientific method, a concept always held to high standards of integrity, we would also have to question the foundations of capitalism. But we must also look at the benefits of developing medicines in an entrepreneurial manner – new medicines are constantly being imagined, researched and developed, a process that would be slowed significantly if it was over-regulated by the Food and Drug Administration.

Cases like Tapson’s happen because of personal greed, encouraged in a free market society – and this greed drives our economy and encourages innovation, and too much government regulation might prevent growth and stifle incentive. However, companies – particularly those who claim to protect our health – should have internal regulations that preserve its integrity from the moment someone has an idea to the day the idea reaches the hands of the consumer, all while maintaining the company’s market competitiveness.

Photo credit: Sebastianlund via Flickr

In the era of aging baby boomers, we are concerned about many things: the death of social security, the rise of medical costs, and the overcrowding of nursing homes.  One thing that I am sure we have not considered is the rise of robots.

Yes, you heard (read) me correctly – robots.  According to a February 3^rd BBC News article, Japan is pioneering `a caretaker robot for the elderly.  Ri-Man is his name, and he is currently on the market!

Given the declining birthrate, loosening family ties, and strict immigration laws, nursing home workers are in high-demand in Japan.  Leave it up to Toyota and Honda to decide that in addition to automated vehicles, they could produce automated nannies as well!  Ri-Man may be native to Japan, but he could soon be looking after of our baby boomers.  The U.S is also in dire need of elderly care-takers.

Although I was initially very excited by the technology behind Ri-Man, I quickly grew unsettled by the idea.  At first, I couldn’t pinpoint the source of my uneasiness.  After all, robots are appliances, and I use appliances all the time.  My coffee-maker brews my coffee, my microwave heats up my ramen, my straightener tames my hair – I even use an electric toothbrush for goodness sake!  So, why am I so bothered by Ri-Man when I am perfectly content to have technology assist me in every other aspect of my life?

The answer is actually quite straightforward.  I am not disconcerted by what Ri-Man does, but rather who he takes care of. In an age when technology can replace almost anything, I think it is still callous to assume that robots are adequate substitutes to look after our parents and grandparents.

Robots can’t replace human love, human attention, or human touch.  Although Ri-Man can take your pulse, measure your blood pressure, and administer your medication, he can’t talk to you about your day, empathize with your pain, or show genuine affection.  Social isolation in nursing homes not only increases loneliness, but also has adversely affects health.  (See “The Relationship of Social Engagement to Psychological Well-Being of Older Adults in Assisted Living Facilities” for more information).

A line needs to be drawn.  If we allow robots to take care of our elderly, will we allow robots to teach our kids?  Will we allow robots to raise our kids?  Will we allow robots to do our jobs?  Will we allow robots to serve as our girlfriends/ boyfriends? (See Robot Girlfriend)

Call me old-fashioned, but sorry, Ri-Man, I don’t believe technology should be omnipotent.