The Reclassification of Disease and Evolving Stigma: A Case Study of GLP-1 Agonists
Author: Chase DeLong, MS4
The development of novel treatments has greatly reshaped the stigma of corresponding disease states, such as allowing previously taboo diagnoses like cancer to be discussed and managed. In other cases, like the creation of selective serotonin reuptake inhibitors (SSRIs) and other psychoactive medications, treatments gave credence to the biochemical model of conditions like depression and anxiety that were previously attributed to failures of individual personality.
The rapid expansion of GLP-1 agonists for weight loss management has greatly changed the perception of obesity as a chronic disease, rendering it increasingly modifiable. As chronic disease becomes increasingly treatable, such success raises a “reclassification problem” with consequential changes in personal responsibility for medical intervention. Obesity has been framed as biologically complex and structurally mediated. However, effective pharmacotherapy risks reframing obesity as a highly correctable state and potentially transforms clinical compassion into an expectation of compliance. This is further complicated by the complex interplay of medical and social stigma of diseases like obesity, with both GLP-1 agonists and bariatric surgery being stigmatized as an “easy way out” for individuals combating obesity. While the decreased invasiveness and increased efficacy of novel interventions like GLP-1 agonists make such treatments more accessible and improve stigma by supporting the multi-metabolic state of obesity, there is an increased risk of stigma towards individuals who choose not to undergo such treatments.
By analyzing the evolving stigma of illnesses like cancer with the introduction of medical innovations, this evaluation aims to project the likely path the stigma of obesity and weight-management treatments will follow. This talk also aims to discuss the ultimate question of “when does a gold standard treatment become an expectation?” and raise conversation on balancing patient autonomy and bodily independence with evidence-based treatment guidance and patient advocacy.
Image Before Encounter: Shaping Clinical Perception and Ethical Engagement
Author: Samhita Kotapati, MS1
Patient advice to clinicians is often to see the patient as a whole, yet little direction is given on how. One practice worthy of attention is viewing radiological test results before the clinical encounter — a recognized standard of care. However, this standard produces limitations that carry significant ethical weight. Psychologically, physicians subject themselves to anchoring bias and premature closure, increasing the risk of misdiagnosis.
Philosophical and ethical frameworks offer explanations that extend beyond clinical practicality. Levinas employs the term le visage — not as an anatomical structure, but as the vulnerability and irreducible alterity of the Other. Interpreting test results before encountering the patient's visage is an act of totalization, in which the patient must actively advocate to overcome the clinician's pre-formed thinking. Michel Foucault traces the development of the "medical gaze" between the 1770s and 1830s, describing a transition from the patient's subjective experience to the objective pathology of their body. This shift creates a profound power asymmetry — for Foucault, knowledge is power, and the physician possesses intimate knowledge of the patient's interior body that the patient does not yet have about themselves. Additionally, both patient and clinician lose valuable insight when the body-as-person is reduced to body-as-image, a distinction developed by Merleau-Ponty. Reviewing tests before encounter prioritizes the objective body over the lived one, displacing the embodied encounter entirely. Susan Sontag reinforces this concern, arguing that the camera, which appears to bring us closer to reality, distances us from it. The body becomes something to be photographed and read rather than touched and inhabited. Medical education compounds this effect: images of suffering are taught as pathology and data, breaking moral neutrality.
Taken together, reviewing tests before the clinical encounter carries an ethical cost — one defined by distorted perception, power asymmetry, and the displacement of the embodied encounter.
The Impact of State-Level Abortion Restrictions on Individual Residency Decisions and the Future of OB/GYN Access
Author: Anna Rifkin, MS1 and Margaret Maynard, MS1
Background: In recent years, US politics have increasingly shaped the practice of medicine and the structure of medical training. Policies restricting access to services such as abortion and gender-affirming care have introduced new variability in clinical environments across different states. While a variety of factors have traditionally influenced medical students’ decisions for residency programs, including geographic preferences, program fit, reputation, and quality of residents, politics may play an increasing role in the process. Some studies have analyzed whether there is a possible correlation between a state’s abortion policies and number of residency applications, and have found a significant correlation in fields such as pediatrics, family medicine, emergency medicine, and obstetrics and gynecology (OB/GYN). OB/GYN is particularly likely to experience short- and long-term consequences, as abortion is a key component of comprehensive reproductive healthcare and a required element of residency training under national accreditation standards.
Thesis: The current landscape of state-level abortion policies will impact students’ personal decisions for where to pursue OB/GYN residency training.
Discussion: This added layer to medical students’ residency program decision making process introduces several ethical dilemmas. Emerging data suggest a decline in OB/GYN residency applications to states with abortion restrictions. For residents seeking comprehensive training, concerns may include procedural competency, a diminishing pool of OB/GYN mentors, and fear of legal exposure when providing patients with standard of care. Downstream effects include disparities in physician workforce distribution, declining program reputations, and declining reproductive healthcare access.
Conclusion: As policies increasingly intersect with graduate medical education, residency program selection becomes not only a professional decision but also an ethical and political one. Most importantly, downstream effects extend beyond trainees to the communities they serve. Understanding these dynamics is essential to anticipating the long-term implications for the field of OB/GYN and reproductive healthcare access.
When the Scientist Is the Patient: The Ethics of Publishing Self-Experimentation
Author: Jatin Singh, MS1, Anurag Aka, MS1, and Josh Patel, MS1
The history of medicine is marked by significant instances of self-experimentation, ranging from John Hunter’s self-inoculation with gonorrhea in 1764 to Dr. Barry Marshall’s ingestion of H. pylori in 1984. Although these cases yielded critical scientific breakthroughs, including many Nobel Prizes, they underscore an ethical dilemma that arises when the roles of researcher and subject converge.
The 2024 case of Dr. Beata Halassy, a virologist who treated her own recurrent breast cancer with untested oncolytic viruses, brings the ethics of self-experimentation into recent focus. Despite achieving remission through a documented, scientific approach, her findings faced rejection from thirteen journals due to ethical concerns regarding publication. This case highlights a central question: should the ethical nature of self-experimentation dictate the publishability of its results?
Analysis through the pillars of autonomy, beneficence, nonmaleficence, and justice yields a gray area. Dr. Halassy exercised autonomy as an informed expert, and her work promotes beneficence by potentially introducing a life-saving treatment option for recurrent breast cancer. However, the risks to nonmaleficence and justice are significant. Publishing n-of-1 results in this way may inadvertently legitimize unproven treatments and encourage patients without scientific expertise to bypass evidence-based care.
Current ethical frameworks governing human research were not designed with self-experimentation in mind, and no consensus exists to fill that gap. Current literature indicates that most institutions lack consistent policies on self-experimentation, suggesting the deeper problem may not be the practice itself but the absence of structured ethical frameworks. A pragmatic path forward may involve streamlined and voluntary ethics review that enables transparent publication while mitigating downstream harm. Ultimately, researchers will continue to self-experiment - the more pressing ethical question is whether suppressing their findings does more harm than sharing them.
