“Ozempic Runs Low for Diabetes Patients as Weight-Loss Use Surges” by Peter Loftus, The Wall Street Journal, February 22, 2023
Drugs like Ozempic have become so popular among people seeking to lose weight that they are now in short supply for patients with diabetes who depend on the medicines. (https://www.wsj.com/articles/ozempic-runs-low-for-diabetes-patients-as-weight-loss-use-surges-286bf21a)
“What Happens When You Stop Taking Ozempic?” by Alex Janin, The Wall Street Journal, February 27, 2023
People who stopped taking semaglutide gained back, on average, two-thirds of the weight they lost within a year, according to a study published in August 2022 in the journal Diabetes, Obesity, and Metabolism. Novo Nordisk funded the trial. (https://www.wsj.com/articles/ozempic-wegovy-stop-weight-loss-ea925ae1)
Ozempic, a drug used to control blood sugar and reduce the risk of heart problems in people with type II diabetes, has been in short supply because of its weight-loss effects. The active ingredient, semaglutide, is an analog to the hormone that tells the body when to make insulin. In 2021, the FDA approved Wegovy, a semaglutide drug, specifically for weight loss. (Ozempic is approved for type II diabetes but is used off-label for weight loss.) Both the short-term side effects and the long-term effects of taking semaglutide are not fully known. Some people experience serious and discomforting gastrointestinal side effects, while others do not. Often when people get off semaglutide, they end up gaining the weight back.
Ethics Question: Is this another case of therapy becoming an enhancement?
“Big Tech Was Moving Cautiously on AI. Then Came ChatGPT” by Nitasha Tiku, Gerrit De Vynck, and Will Oremus, The Washington Post, January 27, 2023
The surge of attention around ChatGPT is prompting pressure inside tech giants including Meta and Google to move faster, potentially sweeping safety concerns aside, according to interviews with six current and former Google and Meta employees, some of whom spoke on the condition of anonymity because they were not authorized to speak. (https://www.washingtonpost.com/technology/2023/01/27/chatgpt-google-meta/)
“In an AI Arms Race, Ethics May Be the First Casualty” by Scott Rosenberg, Axios, January 31, 2023
As the tech world embraces ChatGPT and other generative AI programs, the industry’s longstanding pledges to deploy AI responsibly could quickly be swamped by beat-the-competition pressures. Why it matters: Once again, tech leaders are playing a game of “build fast and ask questions later” with a new technology that’s likely to spark profound changes in society. (https://www.axios.com/2023/01/31/chatgpt-ai-arms-race-ethics-competition)
“How Doctors Use AI to Help Diagnose Patients” by Sumathi Reddy, The Wall Street Journal, February 28, 2023
At Mayo Clinic’s cardiology department, doctors use an artificial-intelligence program to help detect new heart problems. Elsewhere, a group of primary-care doctors is using it to help identify an eye condition that can lead to blindness. Several hospitals are using it to catch patients at risk for sepsis. (https://www.wsj.com/articles/how-doctors-use-ai-to-help-diagnose-patients-ce4ad025)
Two types of artificial intelligence appeared in the headlines during the first quarter of 2023: large language models and pattern detectors. Both involve using algorithms to sift through large data sets. Large language models (LLMs) like Microsoft’s ChatGPT (released in November 2022) or Google’s Bard (released in March 2023) use content cobbled together from websites and social media to respond to user questions. LLMs can respond to prompts, write papers (or articles!), admit when it is wrong, and interact with telehealth users. But as part of LLM’s programming, it scrapes data from across the internet indiscriminately. Wired had an article about ChatGPT being banned in some European countries because of privacy concerns. Also, chatbots are being used to provide mental health advice, but critics question whether a bot can provide the kind of care that is patient-specific and requires a certain level of empathy. Stanford University researchers found that ChatGPT was great at passing the medical board exams, but terrible at adapting recommendations for real-life medical situations.
Another use of AI is algorithms that can learn (i.e., machine learning) how to recognize patterns so that it can identify genomic patterns, concerning features in medical imaging, or characteristics that would make a persona good (or bad) fit for a company. Clinicians have already been using AI to assist in identifying hard-to-detect breast cancers in a mammogram image. In some cases, AI works well, but the algorithm is only as good as the data it has been given. If an unusual case shows up, or if the algorithm has only been given data from a certain ethnicity or demographic, then there is a risk of false positives or false negatives.
Ethics Questions: Is this a case of overhyping a technology that runs the risk of being misapplied? Is “artificial intelligence” a misnomer? What do we gain or lose by using AI for human tasks?
“Abortion Pills Can Now Be Offered at Retail Pharmacies, F.D.A. Says” by Pam Belluck, The New York Times, January 3, 2023
For the first time, retail pharmacies, from corner drugstores to major chains like CVS and Walgreens, will be allowed to offer abortion pills in the United States under a regulatory change made Tuesday by the Food and Drug Administration. The action could significantly expand access to abortion through medication. (https://www.nytimes.com/2023/01/03/health/abortion-pill-cvs-walgreens-pharmacies.html)
“Abortion Pill Mifepristone Will Remain Available for Now, Supreme Court Says” by Mark Sherman, The Associated Press, April 21, 2023
The Supreme Court on Friday [April 21] preserved women’s access to a drug used in the most common method of abortion, rejecting lower-court restrictions while a lawsuit continues. The justices granted emergency requests from the Biden administration and New York-based Danco Laboratories, maker of the drug mifepristone. They are appealing a lower court ruling that would roll back Food and Drug Administration approval of mifepristone. (https://apnews.com/article/supreme-court-abortion-pill-mifepristone-access-f781488016640bf571faf36096339ea4)
Since Roe v. Wade was overturned last summer, the media has reported on the responses of state legislatures and stories of women who were unable to get an abortion or medical care for miscarriage, even though the most restrictive states have exceptions for medical necessity.
Medical or chemical abortions involve ending a pregnancy by taking a two-pill regimen up to 10 weeks post-implantation. The pills are mifepristone and misoprostol. In January, the FDA lifted some restrictions on mifepristone. Before the beginning of 2023, mifepristone could only be dispensed by certain pharmacies, certified doctors, or clinics. Now, retail pharmacies can dispense mifepristone if patients have a prescription.
In April, though, a federal judge in Texas issued a preliminary injunction stating that the FDA’s original approval of mifepristone in 2000 was invalid. On the same day as this ruling, a judge in Washington State issued a preliminary injunction for a different court case that challenged the FDA’s restrictions on mifepristone, saying the medication should be more easily obtained. The U.S. Supreme Court eventually decided against restricting mifepristone while the Texas case goes through the appeals process.
“Ignoring Experts, China’s Sudden Zero-COVID Exit Cost Lives” by Dake Kang, The Associated Press, March 24, 2023
When China suddenly scrapped onerous zero-COVID measures in December, the country wasn’t ready for a massive onslaught of cases. Hospitals turned away ambulances, crematoriums burned bodies around the clock, and relatives hauled dead loved ones to warehouses for lack of storage space. Chinese state media claimed the decision to open up was based on “scientific analysis and shrewd calculation,” and “by no means impulsive.” But in reality, China’s ruling Communist Party held off on repeated efforts by top medical experts to kickstart exit plans until it was too late, The Associated Press has found. (https://apnews.com/article/zero-covid-exit-china-reopening-investigation-05e1bf6d14e3b77ade26b719093ac43b)
After protests and public unrest over restrictive Covid-19 measures and the subsequent economic fallout, Beijing announced that it would lift all “zero-Covid” policies in December 2022. This announcement came ahead of the Chinese New Year, which began on January 21 and is often a heavy travel season. In January, satellite imagery of overwhelmed hospitals and crematoriums showed the hazardous effects of heavy-handed restrictions to contain a pathogen that is followed by a hands-off, abrupt opening leading to mass exposure to a vulnerable population. The Associated Press published a report in March, based on interviews and internal documents, outlining how Chinese CDC officials and epidemiologists had recommended a gradual opening, even submitting a 100-page document with details on how to safely re-open in March 2022. However, for largely political reasons, General Secretary Xi Jinping spearheaded the decision to maintain “Zero-Covid.” Once public unrest hit a tipping point, all restrictions were suddenly lifted without any warning. Hospitals were without supplies and many people were still unvaccinated, particularly among the elderly. Deaths were undercounted and underreported. Cremation reports, which are usually published quarterly, were no longer published, with one city removing all cremation reports dating back to 2020. This was followed by an aggressive propaganda campaign to censor online posts about lockdowns and Covid. As of this writing, the Chinese Communist Party is working to re-write history, framing the government as having done everything “exactly right.”
Ethics Question: How do we respond to known human rights abuses by governing authorities in other countries?
“Telehealth Patients Are Scrambling for In-Person Care amid Crackdown on Online Controlled Substances” by Katie Palmer, STAT News, January 17, 2023
When the pandemic hit, and mental health care providers were in short supply, patients like Catherine flocked to telehealth—and in many cases, obtained prescriptions for controlled substances that previously could only be prescribed in person. But as those channels close, many of them are facing the challenge of transferring their prescriptions to in-person providers. (https://www.statnews.com/2023/01/17/adhd-drug-telehealth-done-cerebral-prescription-access/)
“A Fraught New Frontier in Telehealth: Ketamine” by Chris Hamby, The New York Times, February 20, 2023
As the gap between medical treatment and online shopping has narrowed, already-thorny debates over the proper balance between availability and safety have become increasingly urgent. The ketamine boom is a particularly fraught case study of this new reality because of the drug’s powerful effects and the vulnerable patients drawn to it: typically those with severe depression or other mental health conditions who have not responded to traditional therapies. (https://www.nytimes.com/2023/02/20/us/ketamine-telemedicine.html)
“Adult ADHD Is the Wild West of Psychiatry” by Yasmin Tayag, The Atlantic, April 14, 2023,
The problem is that America has no standard clinical guidelines for how doctors should diagnose and treat adults with ADHD—a gap the CDC has called a “public health concern.” (https://www.theatlantic.com/health/archive/2023/04/adult-adhd-diagnosis-treatment-adderall-shortage/673719/)
One of the after-effects of the Covid-19 pandemic is the normalization of using telehealth services for everything from pediatric visits to therapy for mental health. However, there are little to no regulations on telehealth, including whether the drugs that online providers prescribe are appropriate for the patient receiving them. The CDC reported that there was a 10% increase in adult prescriptions for Adderall during the first year of Covid. Meanwhile, children and students are unable to fill their prescriptions. One company, Cerebral, evaluated adults for ADHD among other ailments. Reportedly, after only a half-hour session, 97% of adults were prescribed drugs. The DEA has proposed rules to restrict rampant prescribing, including in-person diagnosis. Congress is evaluating telehealth providers for distributing controlled substances.
Ethics Question: Is this good medicine, or is telehealth run amok? Are adults prescribed drugs that they do not need (with harmful side effects) while their actual struggles are not being adequately addressed?
1. The Next State of COVID Is Starting Now (https://bioethics.com/archives/68865)
2. Tattoos Do Odd Things to the Immune System (https://bioethics.com/archives/69129)
3. Psychedelics Open Your Brain. You Might Not Like What Falls In. (https://bioethics.com/archives/68052)
4. Longevity Seekers Embraced This Drug. But Does It Actually Fight Aging? (https://bioethics.com/archives/69379)
5. Adult ADHD Is the Wild West of Psychiatry (https://bioethics.com/archives/69560)
6. Denied by AI: How Medicare Advantage Plans Use Algorithms to Cut Off Care for Seniors in Need (https://bioethics.com/archives/68879)
 Matt Burgess, “ChatGPT Has a Big Privacy Problem,” Wired, April 4, 2023, https://www.wired.com/story/italy-ban-chatgpt-privacy-gdpr/.
 Mohana Ravindranath, “Chatbots Are Creating Thorny Ethical Questions about Transparency in Mental Health Care,” Stat News, January 23, 2023, https://www.statnews.com/2023/01/23/mental-health-chatbot-chatgpt/.
 Casey Ross, “What the Early Tests if ChatGPT in Medicine Miss the Mark,” Stat News, April 3, 2023, https://www.statnews.com/2023/04/03/gpt-4-chatgpt-health-care-medical-exams/.
 Samuel Oakford et al., “Satellite Images Show Crowds at China’s Crematoriums as Covid Surges,” The Washington Post, January 9, 2023, https://www.washingtonpost.com/investigations/2023/01/09/china-crematorium-covid-deaths/.
 Wenxim Fan and Shen Lu, “China Seeks to Write Its Own History of Battle with Covid-19,” The Wall Street Journal, April 12, 2023, https://www.wsj.com/articles/china-seeks-to-write-its-own-history-of-battle-with-covid-19-1f6f8939.
 This was the question posed by the New York Times article on Ketamine.