Dr. Shamsa Kanwal is an aesthetic physician and Consultant Dermatologist with over 10 years of experience in clinical practice and research. One ethical dilemma I encountered involved the rising popularity of IV NAD+ therapy for anti-aging and skin health. While NAD+ plays an important role in cellular repair and metabolism, I found the clinical evidence for intravenous use in aesthetic settings to be limited. Despite high patient interest, I chose not to introduce it in my clinic until more peer-reviewed research supports its safety and efficacy. Balancing innovation with ethical responsibility is essential in aesthetic medicine. In this case, I prioritized transparency and evidence-based care over trends, reinforcing patient trust and professional integrity.
During my pediatric dental residency, I worked on a study measuring how children responded to different forms of sedation. A challenge surfaced when we reviewed cases involving children with developmental delays. Some team members felt their responses should be excluded because they didn't align with typical behavior benchmarks. Others, including me, believed that excluding them would ignore a key part of the population we serve. We brought the issue to the ethics committee. After a detailed review, we decided to include every case but separate the data into subgroups. This allowed us to keep the research valid while recognizing the differences in behavioral responses. It also gave practitioners more reliable data when treating neurodivergent patients. Pediatric research often forces you to choose between simplified results and honest ones. When you exclude certain groups for convenience, you create studies that fail to reflect the realities of clinical practice. Every patient matters, not just the ones who make the data easier to interpret. If research doesn't reflect the diversity of the children we treat, it loses value. We don't get to pick and choose who counts. We serve all children, and our work should reflect that. Ethical research starts with asking who might be ignored and making sure they aren't.
While developing a grant proposal for a community health program, we faced competing ethical priorities between participant privacy and data transparency requirements from funders. The research involved vulnerable populations who needed anonymity protection, yet funders demanded detailed demographic reporting to justify their investment. I navigated this by creating a tiered consent process that allowed participants to choose their level of data sharing while ensuring we could still demonstrate program impact through aggregated, de-identified metrics. The key was transparent communication with all stakeholders about our ethical framework upfront, similar to how effective grant proposals clearly outline methodology and safeguards before implementation begins. We ultimately satisfied both ethical obligations and funder requirements by developing innovative reporting mechanisms that protected individual privacy while providing compelling evidence of community outcomes. This experience reinforced that ethical research and successful fundraising aren't mutually exclusive when you prioritize participant welfare and maintain honest dialogue with funders about realistic expectations and alternative approaches. That's how impactful grants fuel mission success.
In my training at the College of Dentistry, NYU, I was working on a case series of cosmetic dental restorations. All patients had signed consent forms to permit the use of their pictures for educational purposes. As we went through the photos, there were quite a number with full facial features. Even after slight cropping, the people were easily recognizable. That created an ethical dilemma. A few believed that written consent was sufficient. Others perceived risk potential but wished to proceed. I disagreed with both. Patients entrust us to safeguard their confidentiality, particularly when their identity is attached to their treatment. I chose to delete or digitally alter the images to safeguard each patient's anonymity. We utilized close-up imagery and clinical simulations as alternatives. That choice pushed back our timeline and irritated some collaborators. But it was in line with a better standard of care. It doesn't end up protecting patients when treatment does. It continues into research, publishing, and teaching. I've applied the same strategy to every photograph, case study, and presentation I've done since then. Ethical choices in dentistry are not just about clinical methods. They are all about respect, restraint, and judgment. In making a decision between academic merit and patient confidentiality, I opted for the one that upheld trust. I still do.