For this episode, we are joined by Kadija Ferryman, an anthropologist who studies equity and policy in health risk prediction technologies. Dr. Ferryman is Faculty at the Berman Institute of Bioethics and Assistant Professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.

Dr. Ferryman traces her path into studying technology through a cultural anthropology lens, beginning with an early curiosity about how different cultures define illness and disease. She explains how the cultural anthropology focus on beliefs, values, and power structures shapes the way she examines modern health technologies. Using examples like the sequencing of the human genome, she highlights how different scientific communities drew strikingly different conclusions from the same discovery, revealing deeper tensions about race, biology, and social meaning that continue to influence biomedical research.

Building on this foundation, Dr. Ferryman explores how bias becomes embedded in everyday health technologies, from pulse oximeters to clinical risk prediction algorithms. She describes how known inaccuracies of pulse oximeter readings for darker-skinned individuals persisted for decades and became especially visible during the COVID-19 pandemic. Extending these concerns to emerging areas like generative AI, she raises important questions about how biased data can shape both clinical care and healthcare systems more broadly. At the same time, she offers a more nuanced perspective: these flawed technologies can also serve as powerful windows into the inequities of our society and as opportunities to rethink how ethics is integrated into medicine and technological development.

Ferryman K, Mackintosh M, Ghassemi M. Considering Biased Data as Informative Artifacts in AI-Assisted Health Care. N Engl J Med. 2023 Aug 31;389(9):833-838.

Ethical Guidelines for AI:

https://healthaipartnership.org/health-equity-across-the-ai-lifecycle-heaal

https://www.chai.org/

https://nam.edu/our-work/programs/leadership-consortium/health-care-artificial-intelligence-code-of-conduct/

Select other publications by Dr. Ferryman:

Collins BX, Bélisle-Pipon JC, Evans BJ, Ferryman K, Jiang X, Nebeker C, Novak L, Roberts K, Were M, Yin Z, Ravitsky V, Coco J, Hendricks-Sturrup R, Williams I, Clayton EW, Malin BA; Bridge2AI Ethics and Trustworthy AI Working Group. Addressing ethical issues in healthcare artificial intelligence using a lifecycle-informed process. JAMIA Open. 2024 Nov 15;7(4):ooae108.

Shachar C, Drabo EF, Iwashyna TJ, Ferryman K. Addressing Racial and Ethnic Bias in Pulse Oximeters-A Wicked Problem. JAMA. 2025 Feb 18;333(7):563-564.

Ferryman K, Crews DC, Drabo EF, Iwashyna TJ, Kane O, Jackson JW. Adherence to FDA Guidance on Pulse Oximetry Testing Among Diverse Individuals, 1996-2024. JAMA. 2025 Feb 18;333(7):631-632

Also mentioned on the show: Joy Buolamwini Coded Bias

In this episode, we are joined by Dr. Katherine Peeler, founding director of the Peeler Immigration Lab, to discuss her longstanding empirical work on human rights and US immigration systems. Dr. Peeler is an Associate Physician in Pediatrics at the Boston Children's Hospital and Assistant Professor of Pediatrics, Global Health and Social Medicine at Harvard Medical School. She is a faculty member of the Harvard Medical School Center for Bioethics. Dr. Peeler describes her longstanding interest in building an evidence base of health effects of human rights abuses as a means of changing policy. Her interest in this field was initially sparked by the work of Paul Farmer and Partners in Health and their mission to improve direct care to patients. She was drawn specifically to challenges facing asylum seekers in the US and shifted towards policy work with Physicians for Human Rights. She founded the Peeler Lab during the COVID pandemic out of concern for people facing the pandemic in detention. Her lab has focused on writing for a public and policy audience to improve conditions and health of immigrants. More recently, her work has focused on solitary confinement in Immigration and Customs Enforcement (ICE) facilities. She painstakingly documents the multiple human rights violations, record number of deaths in these facilities, and violations of United Nations (UN) minimal standards for treatment of detained individuals. Policies for solitary confinement or "restricted housing" meet UN criteria for torture. She outlines strategies that States and local governments can employ to improve oversight and limit expansion of these facilities. The episode wraps up with a discussion of the role of bioethicists to forge common language across opposition and help parties understand shared values and have more productive conversations.

Peeler Lab: https://peelerimmigrationlab.hsites.harvard.edu/

Publications:

"Praying for Hand Soap and Masks:" Health and Human Rights Violations in U.S. Immigration Detention during the COVID-19 Pandemic.”

“Endless Nightmare” Torture and Inhuman Treatment in Solitary Confinement in U.S. Immigration Detention (2024)

Cruelty Campaign: Solitary Confinement in US Immigration Detention

In this episode, our previous guest Dr. Daphne Martschenko returns with her co-author Dr. Sam Trejo to discuss their new book What We Inherit: How New Technologies and Old Myths Are Shaping Our Genomic Future.

Dr. Martschenko is an Assistant Professor at the Stanford Center for Biomedical Ethics, where she studies how to promote ethical and socially responsible conduct in human genetics and engages the public around controversial science. Dr. Trejo is an Assistant Professor of Sociology at Princeton University whose work examines how social and biological factors jointly influence human development, with a focus on educational and health inequality.

Their collaboration began in graduate school, where they approached genomic research from different intellectual traditions. Dr. Trejo, trained at Stanford, became involved with researchers studying polygenic scores, which are genetic indices linked to social and behavioral outcomes. A controversial talk and an unfortunate reply‑all email situation sparked debate about whether this work risked echoing eugenic ideas. His advisor encouraged him to connect with Dr. Martschenko.

Dr. Martschenko, who earned her PhD at Cambridge, was studying how genomic scientists understood their motivations, responsibilities, and the risks of their work. More skeptical of the field’s claims and concerned about premature industry applications, she, like Dr. Trejo, was frustrated by polarized academic debates in which opposing sides rarely engaged productively. Their shared desire for more constructive dialogue shaped their collaboration and ultimately their book. In this work, they discovered more common ground than expected. Although disagreements remained, that didn’t hinder their ability to think together about regulatory frameworks that should be in place.

They highlight two myths that distort public understanding of genomics:

• The Destiny Myth—the belief that genes unilaterally determine life outcomes, historically used to justify harms such as involuntary sterilization.

• The Race Myth—the false idea that humanity is divided into discrete biological races whose genetic differences explain behavioral or social outcomes, a misconception that has fueled discriminatory policies and continues to underlie white supremacist ideologies.

Their work aims to help the public interpret genomic data and understand both its promise and limits. They note that polygenic scores remain a “black box”: even when predictive in certain contexts, their biological pathways are unclear and may operate differently across environments. Their remaining differences center on how scientific advances might counter—or inadvertently reinforce—social harms, and where scientific effort should be focused to meaningfully reduce health disparities.

Find their book here: https://press.princeton.edu/books/hardcover/9780691237756/what-we-inherit?srsltid=AfmBOoppBsKJ5iKykfO2MzqGseQw_3EF028_8tMTrAB9G0trgMdqIUSe

Other joint publications: https://pubmed.ncbi.nlm.nih.gov/35047864/

https://pubmed.ncbi.nlm.nih.gov/37695009/

https://pubmed.ncbi.nlm.nih.gov/34493865/

Season 9 is off to an exceptionally strong start with our recent discussion with Dr. Nicholas Freudenberg, Distinguished Professor Emeritus of Public Health at the City University of New York (CUNY) School of Public Health. Dr. Freudenberg is Senior Faculty Fellow and co-founder of the CUNY Urban Food Policy Institute (www.cunyurbanfoodpolicy.org). He is a leading expert in Commercial Determinants of Health, authoring two key books in the field; At What Cost: Modern Capitalism and the Future of Health (Oxford, 2021) and Lethal but Legal: Corporations, Consumption, and Protecting Public Health (Oxford, 2014 and 2016). He was a contributor to the landmark Lancet series on the topic: https://www.thelancet.com/series-do/commercial-determinants-health.

Commercial Determinants of Health can be understood as the ways that market actors influence health and disease globally. Commercial Determinants of Health are related to Social Determinants of Health and Political Determinants of Health, which together form a system that influences patterns of human health and disease. The term developed in the early 2000s, emerging from an earlier concept of Corporate Determinants of Health, recognizing that a small number of multinational global corporations dominate the world economy. Dr. Freudenberg explains that changing behavior of businesses and corporations can achieve public health gains at a much greater scale that traditional individual behavioral change approaches, citing successful policies regulating the tobacco industry and smaller gains changing the business opportunities to favor alternatives to the fossil fuel industry. One of the largest commercial determinants of health is the food industry, where there are multiple opportunities for change. Dr. Freudenberg discusses the importance of coordination between activists and public health professionals to counterbalance the influence of corporations on policy. What is the role of bioethicists? Listen and find out!

Bibliography:

https://www.annualreviews.org/content/journals/10.1146/annurev-publhealth-052220-020447

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00011-9/abstract

https://global.oup.com/academic/product/at-what-cost-9780190078621?cc=us&lang=en&

https://global.oup.com/academic/product/lethal-but-legal-9780199937196?cc=us&lang=en&

We close out Season 8 with a very special episode that is particularly poignant in this holiday season when people of many faiths are called to reflect on our core values. We are joined by Reverend Jackson who is currently the Associate Conference Minister for Justice and Witness Ministries in the Central Atlantic Conference in the United Church of Christ. Reverend Jackson has been the pastor at the United Church of Christ of Seneca Valley in Germantown, Maryland since 2016. She earned her Master of Divinity degree in 2012 from Wesley Theological Seminary. She also holds a Master of Social Work from Fordham University and a Bachelor's in Social Relations and Public Policy from Michigan State University.

In this conversation, Reverend Jackson discusses the evolving role of sanctuary churches in the context of immigration and the legal risks they face. Since the withdrawal of federal guidance designating protected locations such as churches went into effect, it is more difficult for churches to provide sanctuary for refugees at risk for being deported to dangerous and life-threatening situations. A coalition of religious organizations has since brought a lawsuit against the Department of Homeland Security arguing that this policy violates the right to expression of faith and freedom of religion.

Reverend Jackson discusses the theological and moral imperative to support immigrants that arises from multiple biblical texts, and the calling on Christians to take risks for their faith. Reverend Jackson advocates for a proactive approach to community involvement and the need for churches to educate themselves about local laws and the realities of immigration. Churches must advocate for their rights to practice their faith without government interference. She reminds us that love for one's neighbor is a core tenant of Christian faith. The biblical texts clearly demonstrate that this imperative applies to all people around us, regardless of status.

Links to organizations proving support to immigrants:

https://www.ilrc.org

https://unitedwedream.org

This month we are joined by Dr. Karen Meagher, Assistant Professor of Health Justice and Bioethics at the Lewis Katz School of Medicine at Temple University. Recently, Dr. Meagher was the Associate Director of public engagement in the Biomedical Ethics Research Program at the Mayo Clinic. Her research focuses on public health ethics and social implications of advances in microbial and human genetics. She has a PhD in philosophy from Michigan State University. From 2012-2016 she worked as a senior policy and research analyst on the staff of president Barak Obama’s Presidential Commission for the study of bioethical issues.

Listen in as Dr. Meagher shares her career journey starting with her undergraduate interest in the philosophy of science and social influences of how science gets done. She describes how she was drawn to the growing field of public health ethics, which blossomed in the early 2000s with increasing publications and dedicated journals. Dr. Meagher describes her Virtue Ethics orientation to public health ethics and shares the inside scoop on what it is like to serve on a Presidential Commission.

Later in her career, embedded with Mayo clinic biobank, Dr. Meagher describes her experiences with public engagement with community and how bioethicists can be a bridge between basic scientists and the community when grappling with difficult ethical dilemmas like those dealing with broad consent for future research with banked specimens.

Finally, we delve into a discussion of how Dr. Meagher’s work on antimicrobial resistance led her to engage in concepts of One Health Policy, which recognizes the interdependence of people, animals and the environment. She highlights the importance of breaking down silos between researchers in different sectors and how bioethics can bridge disciplines and create shared moral language, while also centering engagement of communities to help define these problems from different perspectives.

Selected publications of Dr. Meagher’s which were referenced in the podcast can be found here:

Meagher KM. Can One Health Policy Help Us Expand an Ethics of Interconnection and Interdependence? AMA J Ethics. 2024 Feb 1;26(2):E162-170. doi: 10.1001/amajethics.2024.162. PMID: 38306206.

https://pubmed.ncbi.nlm.nih.gov/38306206/

Meagher KM, Curtis SH, Gamm KO, Sutton EJ, McCormick JB, Sharp RR. At a Moment's Notice: Community Advisory Board Perspectives on Biobank Communication to Supplement Broad Consent. Public Health Genomics. 2020;23(3-4):77-89. doi: 10.1159/000507057. Epub 2020 May 12. PMID: 32396907.

https://pubmed.ncbi.nlm.nih.gov/32396907/

Meagher KM. Considering virtue: public health and clinical ethics. J Eval Clin Pract. 2011 Oct;17(5):888-93. doi: 10.1111/j.1365-2753.2011.01721.x. Epub 2011 Aug 11. PMID: 21834841.

https://pubmed.ncbi.nlm.nih.gov/21834841/

Meagher KM, Lee LM. Integrating Public Health and Deliberative Public Bioethics: Lessons from the Human Genome Project Ethical, Legal, and Social Implications Program. Public Health Rep. 2016 Jan-Feb;131(1):44-51. doi: 10.1177/003335491613100110. PMID: 26843669; PMCID: PMC4716471.

https://pubmed.ncbi.nlm.nih.gov/26843669/

We are thrilled that this podcast is airing right after the 2025 American Society for Bioethics and Humanities meeting. It is based on a 2024 ASBH workshop “Remaking Bioethics Together.” Our guests are Stephen Molldrem, PhD, assistant professor and the research program director in Bioethics and Health Humanities at the University of Texas Medical Branch School of Public and Population Health, Krishna Chokshi, MD, associate professor of medicine in the division of hospital medicine at the Mount Sinai Hospital in NYC, Jonathan Shaffer, PhD, assistant professor in the department of sociology at the University of Vermont and Zackary Berger, MD, PhD, associate professor at the Johns Hopkins Bloomberg School of Public Health and in the division of general internal medicine at the Johns Hopkins School of Medicine. Our guests discuss what led them to organize that workshop, beginning with an appreciation of how the principlist, individualist approach of bioethics falls short in addressing systemic challenges to equitable healthcare. Dr. Shaffer shared how his interest in remaking bioethics stems from observations of the focus on “fringe science” in ASBH meetings and the relative absence of more politically oriented moral theorizing. He discusses how sociological frames can help think about the production of shared norms and moral values. Drs. Berger and Chokshi discuss clinical systems ethics failures and what it would mean for Bioethics to think of Capitalism as an object of moral inquiry and to consider organizational ethics in relationships between Academic Medical Centers and communities. We discuss how the “imagined neutrality” of the field of Bioethics has evaporated in the recent overlapping crises of academic medicine. Dr. Molldrem discussed political organizing and the need to take power and its functioning seriously. At the 2025 ASBH meeting last week, this group took the next steps to begin organizing the field by recognizing threats and opportunities and considering resources at our disposal to effect change. Next steps include fostering scholarship around these ideas, considering methods of institutional change within bioethics institutions and collaborating within and across disciplines to foster change. Please reach out to us or our guests if you are inspired to join this crucial work.

We welcome everyone back from a beautiful summer to kick off Season 8 with Julia O'Brien, the "grandmother" of geographic information systems (GIS). O'Brien was the Federal Emergency Management Agency (FEMA) Region II Special Geospacial Coordinator before her retirement in 2023. She worked in remote sensing and GIS for over 30 years. Before that she was the Senior Project Manager for a New York City project to complete an accurate GIS dataset for NYC, culminating in the Citywide Street Centerlines (CSCL) database.

O'Brien walks us through the importance of GIS in disaster management and how it allows leaders to understand what infrastructure may be in the path of storms or flooding in order to prepare adequately for natural disasters. She discusses the role that FEMA plays to support states and localities during manmade and natural disasters. We delve into how proposed cuts to federal funding will affect institutional knowledge that is critical for disaster relief during this time of increased frequency and severity of disasters due to climate change. O'Brien highlights the importance of diversity in planning for disaster response needs. Finally, she discusses the importance of aid services provided by agencies like FEMA and USAID, noting that when a government does not meet the needs of the people, it will not be supported.

This episode of Bioethics in the Margins features a panel of bioethicists: Danielle Pacia of The Hastings Center, Sana Baban of UMass Chan Medical School, J. Wesley Boyd of Harvard Medical School, and Ryan Dougherty of Kaiser Permanente. They are the co-authors of a national survey exploring the role of social justice in their field, published in the American Journal of Bioethics: Empirical Bioethics. In this conversation, the authors discuss their key findings on what social justice obligations bioethicists feel they have, the concept of "social bioethics," and the duty of the field to address systemic injustice. We start by defining the term "social justice" and discussing how it relates to the four principles of bioethics. We spend some time unpacking the methods of the study including strengths and limitations. The main finding - that >80% of bioethicists surveyed believe that social justice should be part of their work - is contextualized by exploring how social justice can add information and objectivity to our work. The episode ends with some reflections by the authors on how we can move forward in the field with these important tools.

Work cited in this episode:

Pacia DM, Baban SS, Fletcher FE, Mithani Aziz Z, Cooper JF, Boyd JW, Dougherty RJ. A Survey of Attitudes Toward Social Justice Obligations in the Field of Bioethics. AJOB Empir Bioeth. 2025 Apr 17:1-12. doi: 10.1080/23294515.2025.2474915. https://pubmed.ncbi.nlm.nih.gov/40244571/

Fletcher, F. E., Ray, K. S., Brown, V. A., & Smith, P. T. (Eds.). (2022). A critical moment in bioethics: Reckoning with anti-black racism through intergenerational dialogue. Hastings Center Report, 52(S2), S1-S68. https://doi.org/10.1002/hast.1363

Pierson, L., Gibert, S., Orszag, L., Sullivan, H. K., Fei, R. Y., Persad, G., & Largent, E. A. (2024). Bioethicists today: Results of the views in bioethics survey. The American Journal of Bioethics, 24(5), 4-22. https://doi.org/10.1080/15265161.2024.2323869

Dougherty RJ, Fins JJ. Toward a Social Bioethics Through Interpretivism: A Framework for Healthcare Ethics. Camb Q Healthc Ethics. 2024 Jan;33(1):6-16. doi: 10.1017/S0963180123000452. Epub 2023 Aug 25. PMID: 37622652. https://pubmed.ncbi.nlm.nih.gov/37622652/

Dr. Carlos Smith, a general dentist and ethicist, is the Associate Dean of Ethics and Community Engagement and an Associate Professor in the Department of Dental Public Health and Policy at Virginia Commonwealth University School of Dentistry. His work focuses on professional identity formation, dental ethics, and oral health justice. In this episode, Dr. Smith discusses his unique path blending dentistry, theology, and bioethics. He begins by discussing the importance of seeing other Black health professionals in his community and observing the professional contentment of dentists while exploring career options. He also cites the crucial piece of advice of one mentor who encouraged him to see the paths of dental school and seminary as not an either/or, but a both/and. Dr. Smith encourages us to think about some of the basic principles in bioethics – beneficence and maleficence – with a broader lens. For example, he talks about the professional duty to understand the reality of racism of all forms in order to think about harms and benefits more systematically and wholistically. He also pushes the envelope on the long-standing medical ethical imperative to place patients’ interests above physicians’ interests by pointing out that the political interests of patients should also be placed above the political interests of health professionals in order to uphold that principle with integrity and trustworthiness. Dr. Carlos provides some clear-headed definitions of diversity and equity and engages with Kirk and Amelia on a must-listen discussion of the ethical dilemmas institutions are facing regarding the precise use of language in this political climate and the critical need to engage with communities and to advocate during these times.

Works cited in the podcast can be found here:

Teeth, by Mary Otto https://a.co/d/j68ePPQ

Smith, C. S., Kennedy, E., Quick, K., Carrico, C. K., & Saeed, S. (2021). Dental faculty well-being amid COVID-19 in fall 2020: A multi-site measure of burnout, loneliness, and resilience. Journal of Dental Education, 85(12), 1956-1965. https://pubmed.ncbi.nlm.nih.gov/34780060/

Smith, C. S. (2023). Applying a systems oriented ethical decision making framework to mitigating social and structural determinants of health. Frontiers in Oral Health, 4, 1031574. https://pubmed.ncbi.nlm.nih.gov/37521174/

Smith, C. S., & Simon, L. E. (2025). To do good and refrain from harm: Combating racism as an ethical and professional duty. The Journal of the American Dental Association, 156(2), 91-94. https://pubmed.ncbi.nlm.nih.gov/39269381/

Smith, C. S. (Guest Editor). (2021). A Clarion Call to Leaders in Dentistry - A Professionalism Ethic for Diversity, Equity, and Inclusion. Journal of the American College of Dentists, 88(2), 1-48. https://issuu.com/college1920/docs/ejacd_vol88-2_2021-07-22_f/s/12896517

Smith, C. S. (Guest Editor). (2021). The Beauty of Many Voices: Unlocking A Growth Mindset Towards Diversity and Inclusion. Journal of the American College of Dentists, 88(3), 1-48. https://issuu.com/college1920/docs/ejacd_vol88-3_10-21_f4/s/13713999