Yale Friday Newsletter 03/08/13

Schell Center Panel Discussion
Time: 6:10 PM
Location: 127 Wall St, room 128
Speakers: Dr. Elisa Hoven, Research Scientist, University of Marburg; Post-Doctoral Fellow, Center for International Peace and Security Law, University of Cologne; and Visiting Fellow, Harvard Humanitarian Initiative, Harvard University
Mareike Feiler, Fellow and PhD candidate University of Marburg, and Visiting Fellow, Harvard Humanitarian Initiative, Harvard University
Saskia Scheibel, Fellow, University of Marburg, and Visiting Fellow, Harvard Humanitarian Initiative, Harvard University
Topic: Victims’ Participation at the Khmer Rouge Tribunal – Experiences and Challenges

Thursday, March 21

Perspectives in Medicine Lecture
Time: 1 PM
Location: 315 Cedar St, room 110
Speaker: Ann Partridge, MD, MPH, Founder and Director, Program for Young Women with Breast Cancer; Director, Adult Survivorship Program and Lance Armstrong Foundation Clinic,
Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Associate Professor of Medicine, Harvard Medical School
Topic: Cancer Survivorship: The Challenges of Care After Treatment

Conferences & Off Campus Events 

Harvard University Program in Ethics and Health is pleased to invite you to attend the 8th Annual International Bioethics Conference,  April 18 and 19, 2013, “Universal Coverage in Developing-Country Health Systems:  Ethical Dilemmas”.  The keynote address will be given by Julio Frenk, Dean, Harvard School of Public Health.  The conference will be held at The Inn at Longwood Medical, 342 Longwood Avenue, Boston, MA.  Open to all. Space limited. Registration required. No fee. Can Universal Coverage be achieved in even the world’s lowest-income countries? China’s recent health reform, which in three years has extended health coverage to 95% of Chinese citizens, including innovative financing initiatives in some of the poorest provinces, has focused the attention of governments of low-income countries on UC. The World Health Organization’s annual report of 2010, Health Systems Financing: The Path to Universal Coverage identified the prospects for UC in even the least-developed countries and sparked an international effort to pursue this once-elusive goal. While maintaining a constructive and optimistic frame of mind is essential for progress toward UC, it is necessary also to identify the key ethical dilemmas arising in trying to extend the health system to all with so few resources. The choices are unavoidable: between goals of UC (including financial protection against catastrophic medical expenses; health; and personal and national overall wellbeing); between dimensions of UC (who is covered; what is covered; what share of costs are covered); and trade-offs within and between each of these. Each country will resolve these dilemmas in its own way. Our hope is that this conference will enhance their capacity for ethical deliberation in UC, so that the ethical choices can be made responsibly and thoughtfully. Please visit the conference website to register and for more information: https://peh.harvard.edu/events/2013/universal_coverage/

Grants, Fellowships, & Jobs

National Center for Ethics in Health Care, Veterans Health Administration, Department of Veterans Affairs, 2013 Internship: Seattle, WA Office  The National Center for Ethics in Health Care (NCEHC) invites applications for the 2013 Ethics in Health Care Internship Program. The NCEHC is a VHA national program office that supports the largest integrated health care delivery system in the nation by addressing issues in clinical, organizational, and research ethics.  Interns will work in close collaboration with the NCEHC’s multidisciplinary team of professionals. The internship program provides unique opportunities for individuals with a career interest in applying ethics in a health care organization to gain on-the-job experience. Interns will work on projects selected in discussion with the local site coordinator. In addition to project work, interns are exposed to a range of clinical, organizational and research ethics issues through participation in ongoing activities of the NCEHC. To learn more about the National Center for Ethics in Health Care, visit our Web site at www.ethics.va.gov. GENERAL REQUIREMENTS:  All applicants must have earned an undergraduate degree prior to the start of the internship (preferably with some coursework in health care ethics or a related field).  Applicants entering or currently enrolled in a graduate degree program should be studying ethics, organizational behavior, business, health services, quality improvement, program evaluation, quantitative sciences or a closely related field. U.S. citizenship is required for all applicants. Candidates with quantitative analytical experience in empirical bioethics, health care evaluation, or quality improvement will have priority. Familiarity with SPSS, SAS or STATA is required.  SCHEDULE:  Most of the internships start in June and are 10 weeks in duration.  However, different schedule requests will be considered.  COMPENSATION:  For a 10-week, full-time internship, the salary total is approximately $4,000.  Housing and benefits are not provided.  HOW TO APPLY:  Submit a letter of interest describing your related education and experience, your resume, and the attached application form.  Send these via e-mail (preferred) or fax for receipt no later than April 1, 2013, to: steven.spickler@va.gov or Fax: (202) 632-8456. SELECTION:  Applications will be reviewed and interviews conducted by April 15, 2013.  All applicants will be notified regarding selection by May 1, 2013.

The Bristol-Myers Squibb Foundation, the philanthropic arm of Bristol-Myers Squibb, is accepting applications for strategic initiatives that help address health disparities in four key areas: HIV/AIDS in Africa; hepatitis in Asia; serious mental illness in the United States; and cancer in Central and Eastern Europe.

Other Items of Interest

MOLST (Medical Orders for Life Sustaining Treatment) is on the Connecticut radar screen.  The Connecticut General Assembly Public Health Committee is holding a public subject matter hearing on Raised Bill #6521 – https://www.cga.ct.gov/2013/TOB/h/pdf/2013HB-06521-R00-HB.pdf  (which will establish a MOLST Pilot Project) on Friday, March 15^th @ 10:30 am in Room 1D of the Legislative Office Building, Hartford.  Sign-in to testify will begin @ 9 am. Connecticut is the only New England state without any enacted or pilot MOLST/POLST initiative.  As recently as this past June, Connecticut had no recognized initiative going forward.  We are now on the National POLST Paradigm Project map as a “developing state.”  See www.polst.org . We want to ask for your support & assistance in letting others know that MOLST is on the horizon & that any & all help, through contacting legislators, offering written or live testimony, or mere presence at the hearing, would give substance to recognizing that there is a void in end-of-life care. Live testimony will be limited to 3 minutes.  10 copies of prepared testimony must be made available at the time of testifying.  However, you may email your testimony, & any accompanying documents, to PHC.Testimony@cga.ct.gov by 5 pm, March 14^th, if which case you do not need to print up copies of your testimony.  The legislators will pull it up off their laptops while you are testifying.  Written testimony can be submitted directly to PHC.Testimony@cga.ct.gov .  Please be certain to include your name, address, & bill #6521 in any written testimony.

Articles of Interest 

In the News

Featured Article

Sifferlin, Alexandra. Listen: Nurse Refuses To Give CPR To Dying Woman. Time. 4 March 2013. On Tuesday morning, 87-year-old Lorraine Bayless collapsed in the dining room of Glenwood Gardens’ independent living facility. When the nurses called 911, dispatcher Tracey Halvorson attempted to instruct them on giving Bayless CPR. The nurses, however, refused, despite pleading from Halvorson. Bayless would later die. Halvorson pleads, “I don’t understand why you’re not willing to help this patient. Is there anybody that works there that’s willing to do it?” Continue reading…

Drugs & Pharmaceuticals

McNeil, Donald G. Jr. African Trial of H.I.V. Drugs Fails. New York Times. 4 March 2013.

Scientists on Monday reported failure in a large African trial of three different ways to protect women against H.I.V. The failure was due not to the methods — two different pills and a vaginal gel — but to the fact that the women did not use them consistently. Continue reading…

Markoff, John. Finding Hidden Side Effects, With Web Search Data. New York Times. 6 March 2013.
Using data drawn from queries entered into Google, Microsoft and Yahoo search engines, scientists at Microsoft, Stanford and Columbia University have for the first time been able to detect evidence of unreported prescription drug side effects before they were found by the Food and Drug Administration’s warning system. Continue reading…

Health Care

Tavernise, Sabrina. Caesarean Deliveries Vary Widely, Study Finds. New York Times. 4 March 2013.

The rate of Caesarean deliveries, the most common operating-room procedure performed in the United States, varies drastically among hospitals across the country, a new study has found, ranging from 7 percent of all births at the hospital with the lowest share of Caesarean deliveries to 70 percent at the hospital with the highest rate. Continue reading…

Law and Bioethics

Thomas, Katie. Justices to Take Up Case on Generic Drug Makers’ Liability. New York Times. 4 March 2013.

The injuries that Karen Bartlett suffered after taking a mild pain pill are enough to make anyone squeamish. She spent almost two months in a burn unit, and months more in a medically induced coma. The reaction permanently damaged her lungs and esophagus and rendered her legally blind. Ms. Bartlett sued Mutual Pharmaceutical Company, which made the drug she took, a generic pill, arguing that the drug’s design was dangerous and defective. During her trial in 2010 in Federal District Court in Concord, N.H., her burn surgeon described her experience as “hell on earth,” and a jury awarded her $21 million. An appeals court upheld the verdict. Continue reading…

Eckholm, Erik. Arkansas Adopts Strictest Abortion Law in the U.S. New York Times. 6 March 2013.
In the sharpest challenge yet to Roe v. Wade, Arkansas adopted Wednesday what is by far the country’s most restrictive ban on abortion, at 12 weeks of pregnancy, around the time that a fetal heartbeat can be detected by abdominal ultrasound.  Continue reading…

Medical Ethics

Conaboy, Chelsea. Study authors: On medical school conflict of interest policies, more enforcement needed. Boston Globe. 28 February 2013.
Students at Brown University’s Alpert Medical School are prohibited from accepting gifts or meals from pharmaceutical companies and drug salespeople. Yet, when she was training in a primary care clinic, student Reshma Ramachandran said drug salespeople stopped by often — sometimes four times each week — bringing lunch for the staff. The realities of practice clashed with her school’s policy. Continue reading…

Public Health

Brown, David. AIDS researchers and global health community ponder a reported cure. 4 Washington Post. March 2013.
AIDS researchers, advocacy organizations and global health officials spent Monday trying to determine whether the report that a baby girl born in Mississippi was cured of the infection is a therapeutic breakthrough or a scientific curiosity. Even if the report proves true, aggressive HIV treatment starting at birth has no obvious relevance to adults, who are by far the biggest age group infected each year. Even in newborns it may be of little practical use, as nearly all mother-to-child infections can be prevented by a simpler strategy that isn’t yet fully implemented around the world. Continue reading…

Kotz, Deborah. BPA may increase asthma risk in kids but tough to avoid. Boston Globe. 1 March 2013.
Once again, the infamous chemical bisphenol A (BPA) has been linked to an increased risk of a health problem: this time asthma in kids. Excess exposure to BPA, which interferes with the body’s production of certain hormones, has already been linked to increased obesity risks in kids as well as a heightened likelihood of heart disease, diabetes, and kidney disease later in life. It’s been banned from baby bottles and removed from the lining of infant formula cans, but is still used in other hard plastics and to coat metal cans. Continue reading…

Nir, Sarah Maslin. Questions Emerge About the Mold That Hurricane Sandy Left Behind. New York Times. 1 March 2013.
The threat of widespread infestation has provoked a mix of specific health concerns and more abstract feelings that the forward momentum of recovery is being undermined, one patch of fungus at a time. The debate about how best to attack the problem has been hampered by the somewhat ambiguous science on its harmfulness. Many studies link mold to the aggravation of respiratory illnesses, but there are no conclusive findings that mold is toxic. Continue reading…

Reproduction

Cohen, Elizabeth. Surrogate offered $10,000 to abort baby. CNN. 6 March 2013.

Most surrogacies have happy endings, and this one should have too — with a couple welcoming a new baby into their home and Kelley enjoying her fee, plus the satisfaction that she’d helped another family. Instead, it ended with legal actions, a secretive flight to another state, and a frenzied rush to find parents for a fragile baby. Continue reading…

Research Ethics

Cyranoski, David. Stem cells cruise to clinic. Nature. 27 February 2013.
In the seven years since their discovery, induced pluripotent stem (iPS) cells have transformed basic research and won a Nobel prize. Now, a Japanese study is about to test the medical potential of these cells for the first time. Made by reprogramming adult cells into an embryo-like state that can form any cell type in the body, the cells will be transplanted into patients who have a debilitating eye disease. Continue reading…

Technology

Jarvis, Brooke. Twitter becomes a tool for tracking flu epidemics and other public health issues. Washington Post. 4 March 2013.
Twitter users send around 500 million tweets a day, an endless fire hose of information about how people feel, what they’re doing, what they know and where they are. For epidemiologists and public health officials, it’s a potential gold mine of data, a possible way to track where disease is breaking out and how it spreads, as well as how best to help — but only if they can figure out how to find the useful signal amid all that noise. Continue reading…

Dr. Seldon, I presume. The Economist. 23 February 2013.
Data from social networks are making social science more scientific “FOUNDATION”, a novel by Isaac Asimov from the golden age of science fiction, imagines a science called psychohistory which enables its practitioners to predict precisely the behaviour of large groups of people. Continue reading…

In the Journals

Block, Andrew R. Presurgical Psychological Screening: Understanding patients, improving outcome. American Psychological Association. 2013.
The success of many surgical procedures depends not only on the skill of the surgeon and the use of state-of-the-art technology, but also on the actions and characteristics of the patient. Patients’ emotional and psychosocial concerns, health-related behaviors, outcome expectations, and compliance with treatment regimen can all strongly influence the ultimate effectiveness of surgery. Thus, mental health professionals are increasingly called upon to perform presurgical psychological screening (PPS) to ensure that patients are given the treatments most likely to be effective, while reducing the chances of worsening their conditions. Each chapter in this book examines psychosocial influences on surgery for a specific medical condition. In general, the earlier chapters represent those areas in which PPS is already in common use: organ transplantation, spinal surgery, bariatric surgery, and pain control procedures. Conditions in which PPS is being used with increasing frequency represent the next group of chapters: stem cell and bone marrow implantation, deep-brain stimulation for Parkinson’s disease, surgery for temporomandibular joint disorder, reconstructive surgery, breast surgery, and gynecologic surgery. The final chapters examine conditions for which PPS is beginning to be used but has not come into wide acceptance: carpal tunnel syndrome and cosmetic surgery. Drawing on both research and clinical experience, the authors explain how to conduct PPS, communicate results to patients and surgeons, and identify possible pre- or postsurgery interventions to mitigate risk factors and maximize the likelihood of surgical success. Case studies and a discussion of bioethics are included. The Afterword suggests future directions for the field. Continue reading…

Brown, Mark. No Ethical Bypass of Moral Status in Stem Cell Research. Journal of Bioethics and Medical Ethics. July 2011.
Recent advances in reprogramming technology do not bypass the ethical challenge of embryo sacrifice. Induced pluripotent stem cell (iPS) research has been and almost certainly will continue to be conducted within the context of embryo sacrifice. If human embryos have moral status as human beings, then participation in iPS research renders one morally complicit in their destruction; if human embryos have moral status as mere precursors of human beings, then advocacy of iPS research policy that is inhibited by embryo sacrifice concerns renders one morally complicit in avoidable harms to persons. Steps may be taken to address these complicity concerns, but in the final analysis there is no alternative to achieving clarity with respect to the moral status of the human embryo. Continue reading…

Brugger, Christian E. D. Alan Shewmon and the PCBE’s White Paper on Brain Death: Are Brain-Dead Patients Dead? Journal of Medicine and Philosophy. 2013.
The December 2008 White Paper (WP) on “Brain Death” published by the President’s Council on Bioethics (PCBE) reaffirmed its support for the traditional neurological criteria for human death. It spends considerable time explaining and critiquing what it takes to be the most challenging recent argument opposing the neurological criteria formulated by D. Alan Shewmon, a leading critic of the “whole brain death” standard. The purpose of this essay is to evaluate and critique the PCBE’s argument. The essay begins with a brief background on the history of the neurological criteria in the United States and on the preparation of the 2008 WP. After introducing the WP’s contents, the essay sets forth Shewmon’s challenge to the traditional neurological criteria and the PCBE’s reply to Shewmon. The essay concludes by critiquing the WP’s novel justification for reaffirming the traditional conclusion, a justification the essay finds wanting. Continue reading…

Garret, Jermey R. Marriage and the Well-Being of Children. Official Journal of the American Academy of Pediatrics. March 2013.
Children’s well-being has become the focal consideration in legal and public policy debates regarding same-sex marriage. In this article, we critically examine and rebut the central moral argument made by opponents of same-sex marriage: that the state should not license any domestic arrangement other than “traditional marriage” because doing so would be detrimental to children’s well-being. Although many have challenged the empirical premise that children raised by same-sex couples fare worse than children in other arrangements, we focus primarily on the normative premises for exclusively licensing traditional (that is, monogamous, heterosexual) marriage. We argue that even if the empirical support for its claims was strong, the argument is morally insufficient for denying state recognition to other types of relationships. Importantly, we affirm the state’s vital role in promoting children’s well-being. We question, however, the approach of delegitimizing certain relationships as a means to that end. Instead, we argue, the state should encourage and support individuals who want to care for children, presume that any couple or individual is capable of adequate child-rearing, and ensure that all adults who are raising children (whether married or not) have the material resources and support necessary to be good parents. Such a policy would (1) set a reasonable minimal threshold for state recognition, (2) be vigilant in identifying cases falling below this threshold, and then (3) either assist or disqualify underperforming arrangements. It would also, appropriately, decouple arguments about legitimate and illegitimate types of relationships from arguments about what is best for children. Continue reading…

Opinion

Ars Technica

Mattise, Nathan. Mississippi doctors “functionally cure” a toddler of HIV. March 3, 2013.
Mississippi doctors are reporting they have “functionally cured” a two-year-old child of HIV, according to findings presented at the Conference on Retroviruses and Opportunistic Infections (CROI) today. “Functionally cured” in this scenario means the child is now without detectable levels of virus and has not demonstrated any signs of the disease after 10 months without antiretroviral therapy. It’s the first well-documented case of such results in an infant and only the second person overall documented with a cure. The first occurred in 2012 as Timothy Brown, later known as “the Berlin Patient,” was cured through a bone marrow stem transplant. Continue reading…

Los Angeles Times

Editorial. Now’s the time to expand Medi-Cal. March 4, 2013.
The 2010 healthcare reform law has three interlocking goals: to expand insurance coverage, improve the quality of care and slow the rise of healthcare spending. The first goal is the costliest, requiring federal and state governments to extend public and private insurance plans to millions of people who can’t afford to pay the full price. Yet bringing them under the insurance umbrella is crucial to improving the quality, efficiency and cost-effectiveness of their care. Continue reading…

New York Times

Editorial. The intriguing case of a baby cured of HIV. March 4, 2013.

Doctors have apparently cured a baby infected with H.I.V., the virus that causes AIDS, with an aggressive treatment of drugs starting a day after the baby was born. If confirmed by further analysis, this would be the first time a person has been cured with simple drug treatments, making a lifetime of antiviral therapy unnecessary. Continue reading…

Editorial. A word gone wrong. March 2, 2013.
This Wednesday is the fifth annual “day of awareness” in a national campaign to stop the use of the word “retarded” and its variants. As a medical label for people with intellectual and developmental disabilities, the R-word used to be neutral, clinical, incapable of giving offense. But words are mere vessels for meaning, and this one has long since been put to other uses. Continue reading…

Editorial. Breeding bad bugs. February 28, 2013.
Study after study has found that the practice of feeding subtherapeutic doses of antibiotics to livestock to enhance growth is a threat to public health because it can lead to the breeding of antibiotic-resistant organisms, rendering essential drugs useless against disease-carrying organisms. Now there is alarming new evidence that unchecked antibiotic use in Chinese livestock farming has led to antibiotic-resistant genes in bacteria. China produces and uses more antibiotics than any other country, and nearly half the antibiotics it uses are fed to livestock. Continue reading…

Slate

Plait, Phil. Antiscience bill dies in Kansas. March 7, 2013.
I have some good news on the climate change denial front, kind of. A thinly disguised antiscience bill recently died in the Kansas legislature. This was another one of those “teach the strengths and weaknesses of science” things that sounds fair enough until you actually, y’know, read it. Continue reading…

Wiegand, Megan. Recycled sewage. March 7, 2013.
It wasn’t the bands that were the problem. Earlier that year, Austin had laid sod in Zilker Park, home of the annual fall festival, after years of dust problems, including one gritty festival infamously known as the “dust bowl.” In keeping with the city’s environmentally friendly ways, Austin used a locally made compost called Dillo Dirt when laying the new grass. But a day of heavy rain and tens of thousands of festival-goers turned Zilker’s lush lawn into a mud pit. Dads toting Texas-orange camping chairs, hipsters decked out in impractical vintage, and college students in bikinis and rain boots all shared the same traumatized, confused expression as they waded into the chocolate-pudding-like sludge: What is that smell? The park was ripe with the scent of human waste. Continue reading…

Upton, John. Worst air pollution in the world. March 5, 2013.
I wake up and suck a bowl of charred asbestos through a dirty bong. Well, that’s what it feels like most winter mornings when I open the door of the fourth-floor New Delhi apartment that I currently call home. Fog-drenched clumps of soot, ozone molecules, and microscopic bundles of nitrogen oxides flow down my trachea and into my chest, where some become lodged. Some of these particles might give me lung cancer. Others will enter my bloodstream, further inflaming old ankle and finger injuries. The airborne detritus puts me in danger of contracting bronchitis, asthma, a lung infection, even hypertension and dementia. Continue reading…

Saletan, William. The trouble with bondage. March 4, 2013.

Is S&M going mainstream? It looks that way. Twenty to 30 years ago, surveys suggested 10 to 15 percent of Americans had tried it at least once. Five to 10 percent had engaged occasionally in BDSM—an umbrella term for bondage, dominance/submission, and sadomasochism. Fewer embrace it as a lifestyle or identity: Even in big cities, attendance at BDSM conventions is said to be only 1,500 to 2,000. But in the last year, the Fifty Shades of Grey trilogy has sold more than 65 million copies. The membership of FetLife, a social networking site for BDSM enthusiasts, has doubled to nearly 2 million. Sales of books and equipment have increased. So has attendance at BDSM events. BDSM-related Internet searches (domination, master, sex slave, sadism) went up 70 to 80 percent. College groups devoted to “kink,” largely BDSM, gained official recognition at Tufts and Harvard. Pillars of the media establishment—ABC, Fox News, the New York Times—are exploring the rise of kink in unflinching detail. Continue reading…

Washington Post

Editorial. Virginia ignores neediest by obstructing Medicaid expansion. March 7, 2013.
Virginia Gov. Robert F. McDonnell (R), under attack by his erstwhile conservative allies for having overseen the enactment of a desperately needed tax increase for transportation, is trying to protect his right flank by vowing not to permit any expansion of Medicaid while he is governor. We salute Mr. McDonnell for his guts on the transportation bill, but on Medicaid he is posturing. Even under the most aggressive scenario, the state would not be in a position to expand Medicaid before July 2014 — six months after Mr. McDonnell leaves office. Continue reading…

Editorial. Making the centers for Medicare & Medicaid services nonpartisan. March 7, 2013.
Once upon a time, the Defense Department and the Social Security Administration reigned as the budgetary giants of the federal bureaucracy. But as health-care costs have grown and Washington has taken on more financial responsibility for them, a once-obscure civilian agency has surpassed them both: the Centers for Medicare & Medicaid Services, or CMS, which is part of the Department of Health and Human Services. In fiscal year 2011, CMS spent $962 billion on Medicare and Medicaid, about a quarter of all federal outlays that year. Continue reading…