Tag: case studies

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Zika Timeline of Events

Zika Timeline of Events

February 14, 2017

Even though the Zika virus did not make national headlines until November 2015 when Brazil declared a national emergency after reporting an abnormally high number of cases of babies born with microcephaly or Guillain-Barré syndrome, the virus was actually first identified in 1947 in a rhesus monkey in the Zika forest of Uganda. Zika is a mosquito-borne disease that shows mild-to-moderate symptoms in adult humans. Its symptoms are similar to dengue fever and chikungunya. The first human case of Zika was found in Uganda and The United Republic of Tanzania in 1952.

In the intervening sixty years, some cases of Zika were found throughout western Africa and Asia. However, these populations seemed to have a fairly good immunity to the disease. It was not until the virus hit the Pacific Islands in 2007 that it became an outbreak. In 2013, a Zika outbreak occurred in several more Pacific Island nations, and it was during this time that Zika was suspected of causing neurological and autoimmune problems.

By March 2015, Brazil reported an illness that expressed a skin rash, and by May, Brazil confirmed that Zika was in the country. In July, they found that certain neurological disorders correlated with Zika infection, but this was isolated to the state of Bahia. Then, in October, Brazil reported an inordinate number of cases of microcephaly among newborns, and declared a national emergency in November. Meanwhile, cases of Zika were increasingly reported throughout northern South America and Central America. By January 2016, researchers had drawn preliminary links to pregnant mothers infected by Zika and babies born with microcephaly.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Problematic Pharmaceutical Pricing as an Investor Collective Action Problem?

The U.S. Senate Special Committee on Aging recently released its report Sudden Price Spikes in Off-Patent Prescription Drugs: The Monopoly Business Model that Harms Patients, Taxpayers, and the U.S. Health Care System (hereinafter Report).  Using four companies as case studies—Turing Pharmaceuticals, Retrophin, Valeant Pharmaceuticals International, and Rodelis Therapeutics—this Report specifically investigates one corner of recent drug pricing controversies: dramatically increased prices on old off-patent pharmaceuticals.  Per the Report, these companies pursued a business model that sought to “identify and acquire off-patent sole-source drugs over which they could exercise de facto monopoly pricing power, and then impose and protect astronomical price increases.”[1]

For a variety of reasons, these particular price increases are morally troubling.  It’s not just that these increases may be exploitative.  The plain human consequences of these businesses’ brazen, yet seemingly legal, decisions are gravely concerning.  These corporate actions harm patients in need of the companies’ drugs, the families and physicians who care for those patients, and the healthcare system that helps pay the tab.

What’s driving this morally concerning behavior?  A common refrain points to weak government regulation.  No doubt improvements can be made, but a significant and seemingly oft overlooked part of the answer may point to investors.  What role have investors played in pricing controversies and what role ought they to play?

The Report suggests that prominent shareholders were often in contact with the senior management of the investigated pharmaceutical companies.  These investors, even if not outright encouraging price increases, at least appear complacent.  Examples include:

  • A partner from Broadfin Capital, a major investor in Retrophin Inc.,

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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In the Journals – January 2017 by Anna Zogas

Welcome to a new year of Somatosphere’s In the Journals section! Here are some of the articles available in January 2017. Enjoy!

Medical Anthropology

Chronic Subjunctivity, or, How Physicians Use Diabetes and Insomnia to Manage Futures in the United States
Matthew Wolf-Meyer & Celina Callahan-Kapoor

Prognostication has become central to medical practice, offering clinicians and patients views of particular futures enabled by biomedical expertise and technologies. Drawing on research on diabetes care and sleep medicine in the United States, in this article we suggest that subjectivity is increasingly modeled on medical understandings of chronic illness. These chronic conceptions of the self and society instill in individuals an anxiety about future health outcomes that, in turn, motivate practices oriented at self-care to avoid negative health outcomes and particular medical futures. At its most extreme, these anxieties of self-care trouble conceptions of self and social belonging, particularly in the future tense, leading patients and clinicians to consider intergenerational and public health based on the threats that individual patients pose for others.

Decoding the Type 2 Diabetes Epidemic in Rural India (open access)
Matthew Little, Sally Humphries, Kirit Patel & Cate Dewey

Type 2 diabetes mellitus is an escalating public health problem in India, associated with genetic susceptibility, dietary shift, and rapid lifestyle changes. Historically a disease of the urban elite, quantitative studies have recently confirmed rising prevalence rates among marginalized populations in rural India. To analyze the role of cultural and sociopolitical factors in diabetes onset and management, we employed in-depth interviews and focus groups within a rural community of Tamil Nadu.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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JHU Projects Explore Ethical Challenges

Hub Staff Report/Crossposted from the HUB

 


 

“Why is it that most of the university’s focus on contemporary ethical issues is concentrated on health care, public health, and the biomedical sciences? Surely other professions and other disciplines also face important real world ethical issues—shouldn’t Hopkins faculty, staff, and students be addressing these issues as well?”

 

That question, posed by Johns Hopkins University trustee Andreas Dracopoulos to the Berman Institute of Bioethics, helped inspire and drive the JHU Exploration of Practical Ethics program, a grant program to fund research into interdisciplinary fields of ethics.

 

“IT IS EASY FOR US TO STAY AWAY FROM ISSUES LIKE WHAT WE’RE TALKING ABOUT TODAY. BUT IT IS IMPORTANT FOR US TO GRAPPLE WITH THESE ISSUES IN A THOUGHTFUL WAY, AND TO HAVE OUR OWN THOUGHT LEADERS COME TOGETHER.”

Sunil Kumar, JHU provost

The program provided funds for nine projects—some of which are still under way—that examine issues relating to criminal justice, higher education, economics, and environmentalism. At a symposium Tuesday, those projects were presented to members of the university community.

 

“Andreas’ provocative question—and it was provocative—set in motion a process of exploration among university leadership initiated by [JHU] President [Ronald J.] Daniels,” said Ruth Faden, the former director of the Berman Institute, in her remarks opening the symposium. “The goal of this process is to assess whether the university should expand its footprint beyond the traditional territories of bioethics and take on the full range of ethical challenges facing society.”

 

     Jon Spaihts, screenwriter of Passengers, and Prometheus, hosts the symposium

 

Some of the projects centered on ethical dilemmas surrounding climate change and pollution.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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In the Journals – December 2016, Part I by Livia Garofalo

Here is the first part of our December article roundup. Three journals have special issues this month (abstracts in the post below):

Enjoy reading (and what’s left of the holidays)!

American Anthropologist

The Contingency of Humanitarianism: Moral Authority in an African HIV Clinic

Betsey Behr Brada

One consequence of the recent expansion of anthropological interest in humanitarianism is the seeming obviousness and conceptual stability of “humanitarianism” itself. In this article, I argue that, rather than being a stable concept and easily recognizable phenomenon, humanitarianism only becomes apparent in relation to other categories. In short, humanitarianism is contingent: it depends on circumstance and varies from one context to another. Furthermore, its perceptibility rests on individuals’ capacity to mobilize categorical similarities and distinctions. One cannot call a thing or person “humanitarian” without denying the humanitarian character of someone or something else. Drawing on research conducted in clinical spaces where Botswana’s national HIV treatment program and private US institutions overlapped, I examine the processes by which individuals claimed people, spaces, and practices as humanitarian, the contrasts they drew to make these claims, and the moral positions they attempted to occupy in the process. More than questions of mere terminology, these processes of categorization and contradistinction serve as crucibles for the larger struggles over sovereignty, inequality, and the legacies of colonialism that haunt US-driven global health interventions.

Scripting Dissent: US Abortion Laws, State Power, and the Politics of Scripted Speech

Mara Buchbinder

Abortion laws offer a point of entry for “the state” to intervene in intimate clinical matters.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Xenobiology and environment

PDF-logoSynthetic biology and xenobiology could be great tools for improving the environment, but there must be a balance in which the pursuit of benefits for humans is combined with respect for nature and its laws.

On 15th May 2015, Pope Francis published his encyclical Laudato si, in which he gave his views on the problem of environmental pollution that is devastating our planet, and how it affects not only nature, but ourselves, especially the most disadvantaged.

The problem of pollution, over-exploitation of resources and the global warming caused by these is being studied from different perspectives. One of these is the drive for research into new methods that can help us to obtain clean energy that will allow us to continue our development, obtain more resources for food and industry without depleting the planet, and methods for decontamination and repair of damaged ecosystems. Xenobiology could have a huge impact on all these projects in the future.

Xenobiology is a young discipline within synthetic biology that is at the forefront of some of the proposed projects. Xenobiology aims to add letters to the natural genetic alphabet to be able to obtain new words, and to write a story different the one told to us by nature. In the words of Floyd E. Romesberg, one of the principal investigators in the expansion of the genetic alphabet: “If you’re given more letters, you can invent new words, you can find new ways to use those words and you can probably tell more interesting stories” (Callaway, 2014).

A transformation of biology such as that envisaged by xenobiology still presents risks and certain ethical questions, but at the same time, it represents a new way to overcome our environmental problems.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Zika Virus Can Keep Growing in Infant Brains Even After Birth: U.S. CDC

December 13, 2016

(Reuters) – U.S. researchers have found evidence of the Zika virus replicating in fetal brains for up to seven months after the mother became infected with the virus, and they showed the virus can persist even after birth, according to a study published on Tuesday. The findings confirm earlier observations from case studies suggesting that the mosquito-borne Zika virus can grow in fetal brains and women’s placentas.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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David Shoemaker, Responsibility from the Margins, Oxford University Press, 2015

David Shoemaker’s highly innovative and intricately argued new book draws on much of his previous work together with substantial original material to form a detailed and cohesive treatment of responsibility. The book is engaging, crisp, and admirably clear. It is marvelously ambitious in its strategy and framework, engagement with multiple literatures, and decidedly novel approach to Strawsonian theory. Moral philosophers, psychologists, clinicians and practitioners, and anyone who has ever wondered about “marginal agents” – people with dementia, autism, (manic-)depression, OCD, and psychopaths – will find much to entice them in this thorough and accessible treatise.

Shoemaker’s starting point – the phenomenon he aims to explain – is the observation that many of us feel a certain ambivalence toward marginal agents of the sort mentioned above. When we interact with or read case studies of marginal agents, we feel a “profound unease,” which Shoemaker diagnoses as caused by the fact that “these agents seem worthy of some responsibility responses but not others, which suggests that they are responsible in some ways but not in others” (3). This is the foundational premise of the entire book. For Shoemaker, responsibility responses include but are not at all limited to the standard praise, blame, and resentment; admiration and contempt, approval and disapproval, pride and shame, anger and regret are all brought in under this unusually wide conception of responsibility responses (a point I’ll return to in my final remarks). The idea is that psychopaths may deserve contempt but not anger, patients with dementia may deserve admiration but not resentment, and so on and so forth.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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In the Journals – October 2016 by Livia Garofalo

Here is our “In the Journals” roundup for October. In addition to a rich selection of abstracts, also of interest this month are a Special Issue of Osiris on the “History of Science and Emotions” and two recent articles by Fernando Vidal on brains in literature and cinema (linked below). Enjoy!

 

Theory & Psychology 

Desire, indefinite lifespan, and transgenerational brains in literature and film

Fernando Vidal 

Even before the brain’s deterioration became a health problem of pandemic proportions, literature and film rehearsed the fiction of brain transplantations that would allow an aging person to inhabit a younger body, so that successive surgeries may result in that person’s immortality. Such fiction makes the brain operate like an immaterial soul that does not undergo physical decline. This article examines that fiction as elaborated in Hanif Kureishi’s The Body and several films in connection with older fantasies that articulate desire, eternal youth, and personal immortality, with philosophical discussions about brain and personhood, and with people’s assimilation of neuroscientific idioms into their views and practices of personal identity. In conclusion it discusses how, in contrast to philosophical approaches that tend to focus on self-consciousness, first-person perspectives, and individual autonomy, fiction may contribute to direct attention to relationality as constitutive of personhood.

SubStance 

Frankenstein’s Brain: “The Final Touch”

Fernando Vidal 

 

Critical Public Health

A critical examination of representations of context within research on population health interventions

Jean Shoveller, Sarah Viehbeck, Erica Di Ruggiero, Devon Greyson, Kim Thomson and Rodney Knight

Research that fulsomely characterizes context improves our understanding of the processes of implementation and the effectiveness of interventions to improve the health of populations and reduce health inequalities.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Introducing New Deliberative Scenario and Facilitator Guide from the Bioethics Commission: “MMR Vaccination in a Local Immigrant Community”

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has released two new educational materials, Deliberative Scenario: MMR Vaccination in a Local Immigrant Community and Facilitator Guide for Deliberative Scenario: MMR Vaccination in a Local Immigrant Community. This new deliberative scenario and facilitator guide build on the work of two of the Bioethics Commission’s reports, Ethics and Ebola: Public Health Planning and Response (Ethics and Ebola) and Bioethics for Every Generation: Deliberation and Education in Health, Science, and Technology.

This deliberative scenario and facilitator guide draw from contemporary ethical questions and are designed to provide public health professionals with the means to integrate bioethics into public health practice. As outlined in Bioethics for Every Generation, democratic deliberation is a method of decision making that can help groups to identify reasonable options for action when faced with questions or complex topics without a clear consensus about the way forward.

Deliberative Scenario: MMR Vaccination in a Local Immigrant Community highlights contemporary ethical questions about the administration of measles, mumps, and rubella (MMR) vaccinations in immigrant communities, including challenges that might arise when MMR vaccination requirements are linked to access to community resources. This deliberative scenario presents an outline of ethically challenging situations that can be incorporated into deliberation process, providing public health professionals with the opportunity to practice the decision-making method.

The Facilitator Guide for Deliberative Scenario: MMR Vaccination in a Local Immigrant Community includes specific instructions for facilitating deliberations for the situations outlined in this deliberative scenario. This facilitator guide provides public health professionals with specific instructions for facilitating deliberations about the potential social, economic, and cultural effects of vaccination policies on an immigrant community.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.