By Dan Meyers
(November, 2014) The
new director of the University of Colorado Center for Bioethics and
Humanities will be a thought leader, a liaison to the community and even
an art gallery boss. Matthew Wynia, MD, a specialist in infectious
diseases, particularly AIDS, comes to the job eager to learn the local
landscape and lay a foundation for the future of the center, which
represents a commitment by the Anschutz Medical Campus to the human side
of health care.
Q: What example do you use to illustrate for people how you think about ethics in health care?
few years back I had a patient who relied on several HIV medications.
For a few months she was so low on cash for copays that she skipped the
meds. Soon, she was hospitalized with AIDS-related pneumonia. The stay
likely cost $50,000 or more.
There are reasons to consider
charging patients a drug copay, to give them some “skin in the game”
around health care spending decisions. But for her, charging a copay for
these particular medications was both medically and ethically wrong,
and making her think twice about filling her prescriptions was a
terrible business decision, since those meds were keeping her out of the
This case shows how health care, policy and ethics
connect. It’s intersections like these— between health care and
bigger-picture issues—that have interested me for a long time and will
be even more of a focus for me now.
Say more about the connection between health care and the bigger picture.
can’t disentangle what it means to be a health professional, or to be a
person with an illness, from the rest of what it means to be human.
Health humanities and bioethics are about examining the experience of
being a health professional or an ill person. And because we are social
creatures, these explorations often have to consider how health care
fits into larger community concerns and dynamics.
This is why
bioethics ends up grappling with issues like: How do you manage the care
of people who need dialysis but are here illegally? How should we
handle new cancer drugs that provide small marginal benefits but that
are extremely expensive? And many other topics that are contentious and
How did you become interested in this area?
I was an undergraduate at the University of Oregon my majors were
biology and philosophy. I was aiming for medical school. For my
undergraduate degree, I had to write a thesis. I started reading about
bioethics and ended up writing about the topic of paternalism in
medicine. Ever since, I’ve been fascinated by trying to understand the
unique relationships between health professionals and the patients and
communities we serve.
What drew you to CU and this role?
groundbreaking work of CU in interprofessional education and training
was a big draw. There are also a number of individuals here whom I’ve
known for some time, and whose work I’ve admired, and I’m excited by the
opportunity to join them.
CU also has a unique role, not only
within Colorado but also in the region and nationally, which makes it
appealing for building a program in humanities and bioethics with a
focus on public engagement and policy issues.
How do you begin a job like this, especially coming from outside Colorado?
spend my first months listening and learning, creating a foundation to
build on. I want to identify ways to engage not just the Anschutz campus
but also the broader community in discussions and presentations.
care is getting complicated, and CU is launching into the realm of
personalized medicine. Peering into patients’ genetic makeup leads to
both precision care and questions about privacy. Does all that point to
the kind of work the center does?
Certainly. I would also say
that, in addition to privacy concerns, there are very complex and
interesting interactions between issues at the level of the individual
and community. Many personal health issues have strong connections to
broader forces such as economics, community and politics.
obesity. There are genetic factors at play, but there are also factors
related to the microbiome—the trillions of bacteria that live on and
inside us. The microbiome is connected to personalized medicine because
it seems to affect epigenetics, which is how our genes are activated or
deactivated. But the microbiome is also related to the environment and
policy decisions, and decisions by health professionals about antibiotic
use, and so on.
Then, superimposed on these issues, there are
many social factors that impact obesity in individuals, like whether you
have a grocery store in your neighborhood, whether it’s safe for you to
get out and exercise, the types of advertisements there are in your
What’s more, these individual and social
factors are so intertwined that we shouldn’t look at them too much in
isolation. Your social environment affects what you eat; what you eat
affects your microbiome; your microbiome affects your genes; your genes
make you fat. That’s obviously a huge oversimplification but still it
would be a mistake to look only at the last step in that cascade.
Some might think of changes in health care as being driven by technology. You seem to be saying there’s a lot more to it.
personal medical issues today are no longer easily resolved with purely
technical knowledge. They require weighing values, assessing priorities
and making decisions where there might not be one right answer for
everyone. For these types of questions, which some have called “wicked
problems” and others call “complex adaptive challenges,” multiple types
of expertise must be involved in figuring out the best way forward.
includes the expertise that members of the public bring to the
conversation. As the health care system continues to evolve, it seems
clear there will be an increasing push for public and individual engagement
in health issues that we used to simply entrust to health
professionals. I see the role of the university and the center as
critical to bringing all those voices together in a forum.
word “humanities” is in the title of the center you now lead. You
oversee an art gallery and the site for lectures and discussions in the
Fulginiti Pavilion. How does that tie in to health care?
humanities are central to the mission. Literature, art, music, film—all
are ways of connecting with the human experience of being in the health
care environment, whether as a patient or a professional. All convey
the type of knowledge and understanding you often can’t get from a
The arts and humanities program, under Dr. Tess Jones’
direction, has traditionally been a very strong part of the portfolio
of activities at the center, and I see that continuing and even growing
as we move forward.
Define what success will look like in the coming year.
the next year, which is a transition year for me, success will be the
development of a clear, shared vision for the work of the center and how
it fits into the university and the larger community. I’ll be working
closely with the deans of the schools, the centers on campus, the
bioethics center’s Community Advisory Board, the core faculty and staff,
and other stakeholders to make a plan for growth that makes sense to
And I will be looking for ways to measure the
effectiveness of what we’re doing. I’m a big believer in measurement,
even when what you are trying to measure might seem nebulous. For
example, much of my research to this point has focused on figuring out
how to measure the ethical climate of health care organizations.