Here’s this week’s (slightly abridged) edition. Enjoy!
First, some announcements from Steve Latham:
- The Hastings Center is working with TEDMED to bring more attention and deeper understanding to the Great Challenges of Health and Medicine, a Robert-Wood-Johnson-sponsored program dealing with persistent problems in health and medicine. Addressing those problems requires thoughtful questions about why these problems have been intractable and suggestions for solving them—and The Hastings Center is helping to curate the questions submitted. Submit your comments about the Great Challenges here.
- Also, a reminder to check out the Hastings Center’s new blog, Over 65, a blog by and for “seniors seeking solutions for healthcare and security.”
- Take a look at Bioethics Bites, a website of the Oxford Centre for Neuroethics, funded by the Wellcome Trust. It features 10 really interesting bioethics interviews with philosophers including Patricia Churchland, Baroness Onora O’Neill, Jeff McMahan, Peter Singer and more. This should not, but will, be confused with Bioethics Bytes, a not-terribly-recently-updated site from the University of Leicester, containing valuable multimedia resources for bioethics teaching.
- And Steve has his own blog: A Blog on Bioethics.
Here are Carol Pollard‘s selected articles for this week: click here.
Upcoming Events @ Yale
Wednesday, October 17
THE FIRST ANNUAL SHEP NULAND LECTURE
Time: Wednesday, October 17 at 5 PM
Location: 77 Prospect St, room A002
Speaker: Albert R. Jonsen, PhD Co-director, Program in Medicine and Human Values, California Pacific Medical Center, San Francisco
Topic: Humanities are the Hormones: From Osler to Nuland
Rudd Center Seminar
Time: 12:30 PM
Location: 309 Edwards St, conf room
Speaker: Ellen Wartella, PhD, Al-Thani Professor of Communication, Professor of Psychology, Professor of Human Development and Social Policy, Director of the Center on Media and Human Development, Northwestern University
Topic: Media Characters: The Unhidden Persuaders in Food Marketing to Children
Thursday, October 18
Perspectives on Medicine Lecture
Time: 1 PM
Location: Hope 110, 315 Cedar St.
Speaker: Patricia Dillon, MA, MPH, State Representative–District 92 (New Haven) Assistant Majority Whip
Topic: Healthcare and Public Policy
Conferences & Off-Campus Events
The Food and Drug Administration in the 21st Century
The Petrie-Flom Center is pleased to announce plans for this year’s annual conference: “The Food and Drug Administration in the 21st Century.” This one and a half day event will take place Friday and Saturday, May 3-4, 2013, at Harvard Law School in Cambridge, Massachusetts. If you are interested in participating in the conference as a presenter, please send an abstract of the paper you would plan to present to petrie-flom@law.harvard.edu as soon as possible, but not later than Monday, December 10, 2012. Conference papers need not be law review style or length. For additional information, please see the full announcement/call for proposals. Please contact Holly Fernandez Lynch, Executive Director, Petrie-Flom Center, with any questions: hlynch@law.harvard.edu, 617.384.5475.
Calls for Papers & Nominations
In the News
Assisted Suicide
Swiss Assisted Suicide Laws to Not Necessarily Promote Desire for Death. Science Daily. 9 October 2012.
A study published in Frontiers in Psychology for Clinical Settings shows that while current Swiss law does not necessarily increase the desire for assisted suicide, patients wish to discuss the option with their physician. Ralf Stutzki, researcher at the University of Basel Institut für Bio- und Medizininethik, interviewed 33 Swiss patients with Amyotrophic Lateral Sclerosis (ALS) to assess their attitudes towards assisted suicide. Continue reading…
Hartocollis, Anemona. Changing Her Mind, a Queens Woman Decides to Remain on Life Support. New York Times. 6 October 2012.
A terminally ill Queens woman who won a court battle against her parents to allow a hospital to disconnect a breathing tube has decided that she wants to live out the rest of her life, the woman’s lawyer said Saturday. Continue reading…
Drugs & Pharmaceuticals
Schwarz, Alan. Attention Disorder or Not, Pills to Help in School. New York Times. 9 October 2012.
When Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall. The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools. Continue reading…
Dooren, Jennifer Corbett and Timothy W. Martin. Doctors Rethink Use of Custom Pharmacies. Wall Street Journal. 9 October 2012.
The outbreak of a rare form of meningitis is prompting some doctors to rethink their use of a specialized type of pharmacy that created steroid injections tied to 119 illnesses and 12 deaths. MedStar Health, a health-care provider that includes Georgetown University and Washington Hospital Center in Washington, D.C., said it is reconsidering its currently limited use of compounding pharmacies, which create alternative versions of medicines, such as liquid forms of pills. “I think the whole [health-care] industry is going to undergo some serious internal rethinking,” said Bonnie Levin, assistant vice president for pharmacy services at MedStar. Continue reading…
Food & Nutrition
Stoller-Conrad, Jessica. How Does Public Data About Heart Attack Treatment Change It? NPR. 9 October 2012.
Every year, hundreds of thousands of Americans turn to stomach-shrinking bariatric procedures, hoping for extreme weight loss. All of these reduced appetites might seem like bad news for the restaurant business, but surgeon-distributed food discount cards aim to make dining out cheaper and more practical for gastric bypass patients. Continue reading…
Health Care
Hensley, Scott. How Does Public Data About Heart Attack Treatment Change It? NPR. 10 October 2012.
Measurement has long been a cornerstone of quality improvement, whether it’s on the factory floor or the hospital ward. And making the quality scores of doctors and hospitals publicly available is central to the idea that health care can become a service that patients shop for intelligently. The results can also ratchet up professional peer pressure for improvement. But does public reporting lead doctors and hospitals to game the system by withholding care from the sickest patients? Continue reading…
Law and Bioethics
O’Neil, Julian. Marie Stopes private abortion clinic to open in Belfast. BBC. 11 October 2012.
The service, run by Marie Stopes, will operate in the centre of Belfast from 18 October. It says it will provide terminations within Northern Ireland’s current legal framework – abortions are not illegal but are very strictly controlled. An anti-abortion group has called for the clinic to be shut down, but Abortion Rights welcomed its opening.Northern Ireland, unlike the rest of the UK, is not covered by an Abortion Act. Continue reading…
Medical Ethics
St. Jude Riata Heart-Device Flaws Known for Years. Wall Street Journal. 10 October 2012. In December 2010, St. Jude Medical Inc. STJ +0.66% issued a warning letter to doctors: Wires inside Riata defibrillator leads—cables that connect the heart to implantable defibrillators—were sometimes breaking through their insulation from the inside out. Continue reading…
Public Health
Doucleff, Michaeleen. After Ebola Fades, What Happens To The Quarantined? NPR. 5 October 2012.
The outbreak was relatively small in the end. Twenty-four got sick. But 17 of them died. The disease stayed isolated to a small region of western Uganda. By comparison, back in 2000 Uganda suffered an outbreak that sickened more than 400 people and claimed 224 lives. To curb the recent outbreak, health workers quarantined over 40 people suspected of infection with the virus. For these people, Hartl says, getting back to a normal time will take some time. Continue reading…
Research Ethics
Greenfieldboyce, Nell. Debate Heats Up About Contentious Bird Flu Research. NPR. 9 October 2012.
What was supposed to be a 60-day moratorium on certain experiments involving lab-altered bird flu has now lasted more than eight months. And there’s no clear end in sight. Researchers still disagree on how to best manage the risks posed by mutant forms of highly pathogenic H5N1 bird flu. The altered viruses are contagious between ferrets, which are the lab stand-in for humans. The fear is that these germs could potentially cause a deadly flu pandemic in people if they ever escaped the lab. Continue reading…
Thomas, Katie. Glaxo Opens Door to Data on Research. New York Times. 11 October 2012. GlaxoSmithKline plans to open up much of its drug research in an apparent effort to deflect criticism that important information gathered in clinical trials often does not see the light of day. Continue reading…
Technology
Stoller-Conrad, Jessica. In-Depth Genome Analysis Moves Toward The Hospital Bed. NPR. 5 October 2012.
Whole genome sequencing has become an essential tool for researchers. But slow speeds and high costs have helped keep the technology from becoming a routine diagnostic test for doctors. Continue reading…
Hafner, Katie. Redefining Medicine with Apps and iPads. New York Times. 8 October 2012.
Dr. Alvin Rajkomar was doing rounds with his team at the University of California, San Francisco Medical Center when he came upon a puzzling case: a frail, elderly patient with a dangerously low sodium level. Continue reading…
Body Politic. The Economist. 6 October 2012.
Slowly, and in some quarters grudgingly, the influence of genes in shaping political outlook and behaviour is being recognized. Continue reading…
In the Journals
Ascoli, Micol; Palinski, Andrea; Owiti, John A.; De Jongh, Bertine; Bhui, Kamaldeep, S. The culture of care within psychiatric services: tackling inequalities and improving clinical and organizational capabilities. Philosophy, Ethics, and Humanities in Medicine. September 2012.
Introduction: Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service.
Results: These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes.
Conclusion: Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery. Continue reading…
Boothe, Katherine. Richard A. Jr. How the Pace of Change Affects the Scope of Reform: Pharmaceutical Insurance in Canada, Australia, and the United Kingdom. Journal of Health Politics, Policy and Law. June 2012.
When policy change is considered, what determines its success or failure? Why do plans for broad reforms often fall short, and why do certain types of change become more difficult over time? This article addresses these questions by examining health policy development in Canada, Australia, and the United Kingdom — specifically, why Canada alone failed to adopt nationwide, public pharmaceutical insurance. It demonstrates that the pace of change has significant implications for the scope of policy development. It provides new mechanisms to explain why incremental reforms stall based on the reciprocal relationship between elite ideas and public expectations and suggests that similar factors can explain how barriers to policy change develop and the conditions under which those barriers may be overcome. Continue reading…
Tshikala, Tomi; Mupenda, Bavon; Dimany, Pierre; Malonga, Aime; Ilunga, Vicky; Rennie, Stuart. Engaging with research ethics in central Francophone Africa: reflections on a workshop about ancillary care. Philosophy, Ethics, and Humanities in Medicine. August 2012.
Research ethics is predominantly taught and practiced in Anglophone countries, particularly those in North America and Western Europe. Initiatives to build research ethics capacity in developing countries must attempt to avoid imposing foreign frameworks and engage with ethical issues in research that are locally relevant. This article describes the process and outcomes of a capacity-building workshop that took place in Kinshasa, Democratic Republic of Congo in the summer of 2011. Although the workshop focused on a specific ethical theme – the responsibilities of researchers to provide health-related care to their research participants – we argue that the structure of the workshop offers a useful method for engaging with research ethics in general, and the theme of ancillary care encourages a broad perspective on research ethics that is highly pertinent in low-income countries. The workshop follows an interactive, locally driven model that could be fruitfully replicated in similar settings. Continue reading…
Van der Burg, Simone; Verweij, Marcel. Maintaining Trust in Newborn Screening: Compliance and Informed Consent in the Netherlands. Hastings Center Report. September 2012.
Newborn screening consists of taking a few drops of blood from a baby’s heel in the first week of life and testing it for a list of disorders. In the United States and most countries in Europe, newborn screening programs began in the 1960s and 1970s with screening for phenylketonuria (PKU), a rare metabolic disease that causes severe and irreversible mental retardation unless treated before problems arise. As knowledge about rare diseases expanded and new screening technologies were introduced—such as the tandem mass spectrometer and high-performance liquid chromatography—the same blood sample could be used to test for a whole list of disorders. In general, screening programs in most countries have tended to expand, but in different countries they have expanded in different ways. Regulation also varies. In some states, screening is mandatory, whereas in others—Wyoming and Maryland—parents are asked for their informed consent. Germany and France have adopted an explicit informed consent procedure, whereas other European countries have a more informal “opt-out” procedure that does not require signing an informed consent form. Whether newborn screening requires informed consent is an ongoing issue in bioethics. In this article, we will focus on the tension between informed consent and the problem of compliance in newborn screening. Asking for informed consent—allowing parents to opt out—is often thought to pose a threat to compliance. Building on the work of Onora O’Neill on informed consent and trust, however, as well as on work she coauthored with Neil Manson, we will argue that informed consent procedures may actually help maintain trust in newborn screening and may therefore support compliance. Continue reading…
Opinion
Ars Technica
Timmer, John. A not-so-simple twist of fate: Nobel awarded for stem cell reprogramming. October 8, 2012.
Two sets of experiments, performed 40 years apart, have been recognized with today’s Nobel Prize in Physiology or Medicine. Cambridge University’s John Gurdon won for showing that adult cells contain all the genetic information necessary to create every tissue in the body. That work set the stage for Shinya Yamanaka, who demonstrated that a relatively simple process could convert adult cells into embryonic stem cells. That development is already opening new avenues of research, and it holds the promise of new ways to repair tissues damaged by injury or disease. Continue reading…
Los Angeles Times
MacDonald, Glen. Climate-change denial getting harder to defend. October 4, 2012.
The United States experienced the warmest July in its history, with more than 3,000 heat records broken across the country. Overall, the summer was the nation’s third warmest on record and comes in a year that is turning out to be the hottest ever. High temperatures along with low precipitation generated drought conditions across 60% of the Lower 48 states, which affected 70% of the corn and soybean crop and rendered part of the Mississippi River nonnavigable. Arctic Sea ice declined to a record low, and a surface thaw swept across 97% of the Greenland ice cap. Continue reading…
Sapolsky, Robert. Brain science’s day in court. October 2, 2012.
Scientists and social scientists tend to avoid one another. But when they pool their expertise, things can get interesting. One case in point is the growing collaboration between neuroscience and criminology. Continue reading…
New York Times
Colopy, Cheryl. Age-old fixes for India’s water. October 8, 2012.
India’s monsoon rains are retreating this week, a delayed end to a yearly wet season that has become ever more unpredictable as a result of global warming. Of all the challenges that face India, few are more pressing than how it manages water. In vast cities like New Delhi, where showers and flush toilets have become necessities for a rapidly expanding middle class, groundwater has been depleted. New Delhi once had many ponds and an open floodplain to absorb the monsoon and replenish aquifers; now the sprawling city has more concrete and asphalt than it has ponds and fields to absorb water. Continue reading…
K. Vega & K. Galloway. Three strikes of injustice October 8, 2012.
In 1994, California voters passed the harshest three-strikes law in the country. Soon after, stories began to emerge about people receiving life sentences for petty crimes such as stealing a pair of gloves or a slice of pizza. Such cases challenged the commonly held belief that the law applied only to violent criminals. Continue reading…
Editorial. Out of control compounding of drugs. October 9, 2012.
The meningitis outbreak that has sickened at least 119 people and killed 11 of them has laid bare a disturbing lack of regulatory oversight of pharmacies that mix drug compounds and ship them around the country. Unless Congress passes legislation to strengthen the hand of the Food and Drug Administration, the public will continue to be at risk from contaminated products. Continue reading…
Slate
Blumgart, Jake. Guys, go to the doctor. October 9, 2012.
My friends have had all kinds of romantic and sexual experiences. Some have spent years in devoted relationships, followed after a breakup by a frenzy of new partners. Others focus on serious dating with an eye toward the aisle. Then there is the rake who leapt from his window (first floor) to escape a jealous lover, but later found love, monogamy, and a shared apartment. And, oh, the open relationships I’ve seen. Continue reading…
Stern, Mark Joseph. Darwin was responsible for Hitler, Stalin, and Pol Pot. October 11, 2012.
At my conservative private school in the South, evolution was the science that dare not speak its name. My sixth grade biology teacher told us it was “just a theory that you don’t have to believe.” In 10th grade, a classmate skipped a lecture on natural selection because, in her words, “I don’t want to believe we come from monkeys.” One teacher had a book in the back of her classroom entitled A Complete History of the Human Race. It began with Adam and Eve. These people viewed Darwin as a kind of biologist Iago, whispering lies into our ears and coaxing us toward damnation. Science was sinful; religion (specifically, evangelical Baptism) was truth. Ignore the Neanderthal skeleton behind the curtain. Continue reading…
Saletan, William. The Healer. October 9, 2012.
Shinya Yamanaka, a scientist at Kyoto University, loved stem-cell research. But he didn’t want to destroy embryos. So he figured out a way around the problem. In a paper published five years ago in Cell, Yamanaka and six colleagues showed how “induced pluripotent stem cells” could be derived from adult cells and potentially substituted, in research and therapy, for embryonic stem cells. Today, that discovery earned him a Nobel Prize, shared with British scientist John Gurdon. But the prize announcement and much of the media coverage missed half the story. Yamanaka’s venture wasn’t just an experiment. It was a moral project. Continue reading…
