Tag: hiv/aids

Bioethics Blogs

In the Journals – December 2016, Part II by Anna Zogas

Here is the second part of our article roundup for December (find the first set of articles here). Happy reading, and happy new year!

New Genetics and Society

Redrawing the boundary of medical expertise: medically assisted reproduction and the debate on Italian bioconstitutionalism
Volha Parfenchyk

In 2004, the Italian Parliament passed a controversial law on medically assisted reproduction (Law 40/2004). The Law obliged clinicians to create a maximum of three embryos during one in vitro fertilization (IVF) cycle and transfer them simultaneously into the patient’s uterus. With this “three embryo” standard, the Parliament sought to secure the realization of rights of IVF embryos. Drawing on the concepts of boundary-work and bioconstitutionalism, this article explores the role that the constitutional obligations of the Italian State towards its citizens, including IVF embryos as its new “citizen subjects,” played in how it envisaged and demarcated the professional boundaries of medical expertise. It argues that the latter depended upon how it balanced its commitments to protect the rights of IVF embryos and those of adult citizens. As such, the demarcation of the jurisdictional boundaries of medical expertise, and the definition of constitutional rights, formed two sides of the same governing project.

Traveling questions: uncertainty and nonknowledge as vehicles of translation in genetic research participation
Klaus Hoeyer

In this paper, I argue that uncertainty and nonknowledge, and not just research results, can be important vehicles of translation through which genetic research participation comes to affect the lives of research participants. Based on interviews with participants in a genetic research project, I outline epistemic, emotional, relational and moral implications of research participation.

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.

Bioethics Blogs

BioethicsTV (November 2016) Continued: Further commentary on Informed Consent

by Abhi Amarnani

Chicago Med (Season 2, Episode 8, 11/10/16).

A December 1st BIOETHICSTV blog post briefly mentioned, Season 2, Episode 8 of Chicago Med. The post notes that the episode dealt with the issues of informed consent in brief. I felt that a more in-depth discussion of these issues was warranted. Consider the storylines in the episode: A young girl with a developmental disorder needs cardiac surgery. Her condition forces her mother to question whether the girl can make decisions for surgery. Second, Nurse April was coughing at the end of episode 7, and viewers learned that she is diagnosed with multidrug resistant tuberculosis (TB). Adding to this challenge is a confirmation of pregnancy. Her colleagues question her personal autonomy when she considers refusing treatment. Third, a patient dying from kidney disease is not allowed by hospital policy and law to accept a transplant from his HIV+ brother. The message is that death from organ failure is preferable to a longer life with HIV. By the end of the episode, Dr. Manning leaves a syringe on the table stating: “If you already had HIV, the procedure would be legal,” insinuating a workaround – that if the patient infects himself with his brother’s blood, then the transplant can happen. The donor and recipient acknowledge fully informed consent that receiving an HIV positive organ will infect him, but here the informed consent consideration comes up against the “do no harm” principle of medicine and United Network for Organ Sharing (UNOS) policy.

In the first storyline, a friendly, bubbly and trusting teenage girl, Karina, enters the hospital with cardiac issues.

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.

Bioethics Blogs

Book Forum – Hervé Guibert’s Cytomegalovirus: A Hospitalization Diary by Eugene Raikhel

A quarter-century after it was written, Hervé Guibert’s Cytomegalovirus reads both as a vital document of a particular moment in the history of the HIV/AIDS epidemic and as a wonderfully spare account of the banal humiliations and little triumphs of hospitalization in the shadow of a then-terminal illness.  Republished with a luminous Introduction by David Caron and a wide-ranging and erudite Afterword by Todd Meyers, this slim volume is by turns poignant, humorous, and startling. We are very pleased to bring you a set of commentaries on Cytomegalovirus.

Catherine Belling
Northwestern University, Feinberg School of Medicine

Thomas Cousins
Stellenbosch University

Lukas Engelmann
CRASSH

Amy Moran-Thomas
MIT

Download it on Scribd (pdf):

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.

Bioethics Blogs

Leadership. Commitment. Hype. December 1, 2016 Today is World AIDS Day. It is, in fact, the …

December 01, 2016

by Sean Philpott-Jones, Chair, Bioethics Program of Clarkson University & Icahn School of Medicine at Mount Sinai

Leadership. Commitment. Hype.

Today is World AIDS Day. It is, in fact, the 29th annual World AIDS Day, which is held every year on December 1st to honor the 35 million people who have died from the disease and to support the 40 million who currently live with HIV/AIDS. The theme for this year’s event, at least according to the US federal government? “Leadership. Commitment. Impact.” You’ll have to excuse me if I scoff openly at the audacity of that motto.

Let’s consider the leadership and commitment of our politicians in fighting HIV/AIDS. When AIDS was first identified in 1981, it was seen as a disease that primarily affected socially marginalized populations, notably gay men, injection drug users and immigrants from poor Caribbean countries like Haiti. As long as it was confined to those ‘undesirable’ groups, there was no need for upstanding American citizens to pay it much heed. Following the lead of then-President Ronald Reagan – who didn’t even mention the word ‘AIDS’ publicly until 1985, and then only sparingly — politicians and other members of his conservative administration largely ignored the looming public health crisis.

American leadership failed when it was needed the most, by refusing to tackle the nascent AIDS crisis with measures like comprehensive education, blunt messaging and active promotion and widespread distribution of condoms. Had federal officials not been so afraid of ruffling conservative feathers, it is entirely possible that the HIV/AIDS epidemic might have be thwarted then and there.

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.

Bioethics Blogs

Simplifying HIV Treatment: A Surprising New Lead

Caption: PET/CT imaging reveals a surprisingly high concentration (yellow, light green) of key immune cells called CD4 T cells in the colon (left) of an SIV-infected animal that received antibody infusions along with antiviral treatment. Fewer immune cells were found in the small intestine (right), while the liver (lower left) shows a high level of non-specific signal (orange).
Credit: Byrareddy et al., Science (2016).

The surprising results of an animal study are raising hopes for a far simpler treatment regimen for people infected with the AIDS-causing human immunodeficiency virus (HIV). Currently, HIV-infected individuals can live a near normal life span if, every day, they take a complex combination of drugs called antiretroviral therapy (ART). The bad news is if they stop ART, the small amounts of HIV that still lurk in their bodies can bounce back and infect key immune cells, called CD4 T cells, resulting in life-threatening suppression of their immune systems.

Now, a study of rhesus macaques infected with a close relative of HIV, the simian immunodeficiency virus (SIV), suggests there might be a new therapeutic option that works by a mechanism that has researchers both excited and baffled [1]. By teaming ART with a designer antibody used to treat people with severe bowel disease, NIH-funded researchers report that they have been able to keep SIV in check in macaques for at least two years after ART is stopped. More research is needed to figure out exactly how the new strategy works, and whether it would also work for humans infected with HIV. However, the findings suggest there may be a way to achieve lasting remission from HIV without the risks, costs, and inconvenience associated with a daily regimen of drugs.

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.

Bioethics News

Controversy swirls around AIDS drug in UK

When a conservative Christian journalist writes a story about a highly-praised AIDS drug headlined “Killing Grandma for Gay sex” and an AIDS activist describes it as a “profit-driven sex toy for rich Westerners”, you know that you’ve uncovered an ethical controversy.

This month the UK’s National Institute for Health and Care Excellence (NICE) issued a published an evidence summary on the use of Truvada, a lucrative Gilead drug for HIV pre-exposure prophylaxis (PrEP). In a number of other countries, Truvada has already been rolled out as a way of keeping gay men safe from infection with HIV. If taken every day, it prevents infection – a kind of pharmaceutical condom.

The controversy in the UK is not so much over whether it works, but whether it should be government funded. “There is little doubt that Truvada is effective in reducing HIV acquisition in high-risk people who are HIV-negative,” says the NICE advice.. “However, issues relating to uptake, adherence, sexual behaviour, drug resistance, safety, prioritisation for prophylaxis and cost-effectiveness are also important to consider, especially at a population level.

In August, the High Court ruled that the UK’s National Health Service had to supply Truvada because children with cystic fibrosis, amputees and blood cancer victims could be disadvantaged. It would cost the NHS up to £20 million a year. Outraged critics said that the money would be better spent on treatments for sick people rather than healthy people engaging in risky behavior.

On a public health level, there are concerns about whether the men could commit to taking the drug regularly.

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.

Bioethics Blogs

Sex and Other Sins: Public Morality, Public Health, and Funding PrEP.

Guest Post by Nathan Emmerich

In the UK, a recent high-court decision[1] has reignited the debate about whether or not Pre-exposure Prophylaxis (PrEP) should be provided to those who are deemed to be at high-risk of contracting HIV.[2] Despite the fact that NHS England is now appealing,[3] it was a fairly innocuous decision: having suggested that they were barred from funding PrEP, the court ruled that it would be legal for the NHS to fund PrEP and that they should therefore consider doing so.3

What is less innocuous are debates about whether or not access to PrEP should be publicly funded at all. Whilst individuals report being able to buy a month’s supply online for around £45,[4] the annual cost of the drug to the NHS could be more than £4,000 per patient. Although this may seem a relatively exorbitant expense, it makes economic sense to provide PrEP; doing so could prove to be cheaper than providing treatment[5] to those who would otherwise become HIV positive.

Despite this sound economic rationale, the media, or certain sections of it, have predictably focused on one particular group who are candidates for the drug as they are at higher risk of contracting HIV: homosexuals. In particular, the debate has centred on promiscuous gay men or, to use the academic term, men who have sex with men. This includes individuals who regularly have sex with new partners, as well as those who engage in protected and unprotected group sex.

Perhaps as a result of this focus, the view that public funds should not be used for PrEP[6] seems fairly widespread.

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.

Bioethics Blogs

In the Journals — September 2016, part II by Aaron Seaman

And, now, part two of September’s journal posting! (Part one is here.)

Medical Anthropology Quarterly

“I Hope I Get Movie-star Teeth”: Doing the Exceptional Normal in Orthodontic Practice for Young People

Anette Wickström

Orthodontics offer young people the chance to improve their bite and adjust their appearances. The most common reasons for orthodontic treatment concern general dentists’, parents’ or children’s dissatisfaction with the esthetics of the bite. My aim is to analyze how esthetic norms are used during three activities preceding possible treatment with fixed appliances. The evaluation indexes signal definitiveness and are the essential grounds for decision-making. In parallel, practitioners and patients refer to self-perceived satisfaction with appearances. Visualizations of divergences and the improved future bite become part of an interactive process that upholds what I conceptualize as “the exceptional normal.” Insights into this process contribute to a better understanding of how medical practices intended to measure and safeguard children’s and young people’s health at the same time mobilize patients to look and feel better. The article is based on an ethnographic study at two orthodontic clinics.

Huichol Migrant Laborers and Pesticides: Structural Violence and Cultural Confounders (open access)

Jennie Gamlin

Every year, around two thousand Huichol families migrate from their homelands in the highlands of northwestern Mexico to the coastal region of Nayarit State, where they are employed on small plantations to pick and thread tobacco leaves. During their four-month stay, they live, work, eat, and sleep in the open air next to the tobacco fields, exposing themselves to an unknown cocktail of pesticides all day, every day.

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.

Bioethics Blogs

The Age of the Superbug September 22, 2016 Just yesterday, the United Nations General Assemb…

September 22, 2016

by Sean Philpott-Jones, Chair, Bioethics Program of Clarkson University & Icahn School of Medicine at Mount Sinai

With all of the media hullaballoo about Hillary Clinton’s pneumonia, Donald Trump’s physical exam, Brangelina’s impeding divorce, and poisoned Skittles, you may have missed one of the biggest and most important health stories of this year.

Just yesterday, the United Nations General Assembly held a day-long meeting in New York City to discuss one of the most deadly threats to human health since the bubonic plague: antibiotic-resistant bacteria. This is only the fourth time in history that the General Assembly has met to address a health issue, having met twice in 2011 to talk about HIV/AIDS and chronic diseases, respectively, and again in 2014 to discuss the West African Ebola outbreak.

Antibiotic-resistant bacteria pose an even greater threat than Ebola, HIV/AIDS, and heart disease combined. According to the US Centers for Disease Control and Prevention (CDC), antibiotic-resistant forms of common bacteria like E. coli, Staphylococcus aureus, Streptococcus pneumoniae, andMycobacterium tuberculosis – among others – infect nearly 2 million people a year in the United States, killing at least 25,000.

Worldwide, the number of people infected is several magnitudes greater; an estimated 750,000 people died from antibiotic-resistant infections in 2015. Within just a couple of decades, that number is expected to increase by nearly 1500%, yielding over 10 million “superbug”-related deaths annually by 2050.

Antibiotic-resistant infections will soon account for one-third of all deaths globally, a startling turnabout from 1967. That year, thanks to the widespread use of antibiotics and still effective public immunization programs, then Surgeon General William Stewart famously stated that, “the time has come to close the book on infectious diseases.

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.

Bioethics Blogs

War Metaphors in Health Care: What Are They Good For?

by Kayhan Parsi, JD PhD

Protest singer Edwin Starr powerfully asked in the early 1970s: “War, what is it good for?” Apparently, it’s good enough to use in a variety of metaphorical turns of phrase. The war on poverty. The war on cancer. The war on Alzheimer’s. The war on drugs. The war metaphor seems irresistible. How else to elevate a social problem and make it the object of our intense focus and attention, not to mention financial support? These metaphors figure prominently in many areas of public life. Take policing. As scholars Peter Kraska and Victor Kappeler have stated about the use of military metaphors in policing: “The ideological filter encased within the war metaphor is ‘militarism,’ defined as a set of beliefs and values that stress the use of force and domination as appropriate means to solve problems and gain political power”. Similarly, health care is replete with militaristic metaphors. Cancer garners the most intensely militaristic metaphors. We often say that someone lost their battle with cancer. Yet cancer is not alone. As Nie and colleagues argue in this month’s target article, such militaristic metaphors are commonly found in the world of HIV cure and research. Why do we continue to use such militaristic metaphors in health care?

Thinking and speaking in metaphors is such a part of being human that it’s almost unremarkable to us. Philosopher Mark Johnson and linguist George Lakoff have made significant contributions in our understanding of how metaphorical thinking shapes our morality and our moral understanding has persuasively argued that we think imaginatively about our moral problems and that our thinking is inevitably metaphorical.

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.