Publications

2017
Options for Increasing the Supply of Transplantable Organs
Segal JB, Truog R. Options for Increasing the Supply of Transplantable Organs. Harvard Health Policy Review. 2017. Publisher's VersionAbstract

Society’s need for transplantable organs dwarfs its supply. Every day 22 Americans die while waiting for an organ to become available for transplantation. The scarcity of organs requires rationing, but merely because a strategy would improve organ availability does not mean it is ethically justified. In this article, we highlight options for increasing the supply of transplantable organs, and explore ethical constraints such as respect for autonomy, avoiding harm, and limitations related to the necessity for rationing.

options_for_increasing_the_supply_of_transplantable_organs.pdf
Segal JB. Prioritizing Patients: How Algorithms Can Promote Just Resource Allocation. Harvard Medical School Bioethics Journal. 2017;1 (1). Publisher's VersionAbstract
Early successes have buoyed enthusiasm for potential big-data applications in medicine. Algorithms, powered by predictive analytics, can leverage big data to compute prognoses on a minute-by-minute basis. However, designing and using computer programs specifically to provide clinicians with support for clinical decisions in real-time—in the context of scarce medical resources—has ethical implications, which are examined here. Given that computers are free from limitations of human judgment, I argue that, if they are designed specifically to ration care with respect to specified moral and social norms, big data algorithms can promote just allocation of scarce medical resources.
prioritizing_patients_bioethics_journal.pdf
2016
Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316 (21) :2214-2236. Publisher's Version
Segal BJ, Bouffard MA, Schlaug G. Characteristic Neuroimaging Abnormalities of Korsakoff Syndrome. JAMA Neurology. 2016. Publisher's Version doi:10.1001/jamaneurol.2016.1843.pdf
Segal JB. Inherited proclivity: When should neurogenetics mitigate moral culpability for purposes of sentencing?. Journal of Law and the Biosciences. 2016;3 (1) :227-237. Publisher's VersionAbstract

Certain genes and neurobiology (‘neurogenetics’) may predispose some people to violent behavior. Increasingly, defendants introduce neurogenetic evidence as a mitigating factor during criminal sentencing. Identifying the cause of a criminal act, biological or otherwise, does not necessarily preclude moral or legal liability. However, valid scientific evidence of an inherited proclivity sometimes should be considered when evaluating whether a defendant is less morally culpable for a crime and perhaps less deserving of punishment.This Note proposes a two-pronged test to understand whether
and when neurogenetic evidence should be considered to potentially mitigate an individual’s culpability for criminal behavior.The first prong normatively assesses whether a defendant meets a threshold of having meaningfully managed his risk of harming others based on what he knew, or should have known, about his own proclivities to violence. The second prong considers the admissibility of the evidence based on whether the specific neurogenetic proclivity claimed by the defendant is relevant and adequately supported by science so as to be reliable. This proposed two pronged test, beginning with an ethical threshold and followed by a scientific hurdle, can help judges and juries establish when to accept arguments for neurogenetic mitigation at sentencing, and when to reject them.

Inherited proclivity (PDF)
2015
Segal JB. The Most Common Illness: A Review and Case Study from Harvard Medical School. Harvard Medical Student Review. 2015;2 (1) :5-18. Publisher's VersionAbstract

 The average adult experiences two to five common colds each year. Summed up, people spend more than a year of life suffering from the illness. This article presents a brief report from an outbreak at Harvard Medical School followed by a review of what is currently known about the common cold. An emphasis is placed on illustrative experiments. Despite decades of research, hand washing remains the best method for preventing infection.

HMSR_Segal_5-18
Segal JB, Arevalo JB, Franke MF, Palazuelos D. Reducing dosing errors and increasing clinical efficiency in Guatemala: first report of a novel mHealth medication dosing app in a developing country. BMJ Innovations. 2015;1 :111-116. Publisher's VersionAbstract

Background: Medication errors are known to be a widespread problem affecting patient safety and treatment efficacy. We were approached by a Guatemalan clinic interested in piloting an app to aid their junior clinicians in correctly calculating medication dosages.

Methods: We programmed a medication-dosing app using CommCare. In a prospective study among junior physicians at a small high-throughput clinic, we primarily assessed the app's dosing accuracy and efficiency. Secondarily, we measured the app's usability and effect on patient-centredness.

Results: Six clinicians aged 21–24 tested the app. Among 366 prescriptions, dosages were 40% more likely to be correct when calculated using the app (relative risk: 1.39; 95% CI 1.16 to 1.68; p=0.0005). Accuracy improved from 64.7% (N=156) to 92.4% (N=210). Using the app in a time-constrained context improved clinician efficiency by over 20% with a decrease in average consultation time of 1.5 min (p<0.0001) to 5.23 min on average (N=178). However, questionnaires revealed most clinicians did not believe the app improved efficiency, and none thought its recommendations were ‘always accurate’. No change in patient-centredness was observed (N=167).

Conclusions: The app was shown to be safe and efficient. Making this app available to junior physicians may significantly improve patient safety by enhancing dosing accuracy. This study demonstrates that dosing apps can be an efficacious means of decreasing medication errors in developing countries. We found that different strategies to introduce novel apps to providers might improve providers’ trust in the technologies and thereby make apps more efficacious.

bmj_innov-2015-segal-111-6.pdf
2014
Segal JB. Swept Into the River. Harvard Magazine. 2014. Publisher's Version
2011
Pope WH, Jacobs-Sera D, Russell DA, et al. Expanding the diversity of mycobacteriophages: insights into genome architecture and evolution. PloS one. 2011;6 (1) :e16329.
Segal JB. The Rational Aren’t Rich. Intuitions. 2011;8 :45-49.Abstract

This paper presents a variation of Newcomb’s problem to bring out how, faced with a Newcomb problem, a causal decision theorist will undertake an action with the best possible payout (given their circumstances) while an evidential decision theorist will be presented with better options and will make—arguably—a less rational decision. This shows how the Newcomb problem is one in which a rational agent will simply not be presented with the options that can lead to the best possible outcome. The prominent protestation, “if you’re so smart, why aren’t you rich?” should be set aside as an objection to causal decision theory. 

intuitions_2011.pdf