Tag: public health

Bioethics Blogs

A more ethical form of HIV criminalization

HIV has been criminalized throughout the history of the epidemic, or to be more exact, people living with HIV and their behaviors have been a persistent focus of criminal law. This was undoubtedly due in part to the fact that HIV initially was untreatable and infection (for the vast majority) spelt death. It was terrifying. But it wasn’t just an understandable public health reaction. Criminalization is not necessarily a wise way of controlling an epidemic, as it can be counterproductive, driving underground persons potentially subject to the laws. And there is no way of getting around that those disproportionately affected by HIV (especially in the USA), were considered ‘undesirables’ by many in the public and those leaders they voted for. Criminalization also reflected a moral panic against homosexuals and injection drug users. So, because it was not really based on solid public health principles or scientific evidence in the first place, it is unsurprising that states made laws covering actions highly unlikely to lead to transmission (like spitting or oral sex), fail to take the use of new prevention technologies (PreP, use of antiretrovirals) into account, and often don’t take into consideration the intention to cause harm. What is perhaps more surprising (and depressing) is that many of these laws are still on the books.  

I am thinking that HIV criminalization should not be abolished, but pointed in a better direction. Let me back up. For a few years now, I have been working on a NIH-funded project on the social and ethical dimensions of HIV cure research.

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

Paid Sick Days: The Better Way

Kelly Holloway describes how changes to business practices concerning sick days can be beneficial for workers’ health and the economy.

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Most employees understand the case in favour of paid sick days. If you do not have them, you probably have to choose between staying home sick and losing pay or going to work sick and putting other people’s health at risk. But the steadfast counter argument to the campaign for paid sick days is that businesses suffer, especially small businesses. And when businesses suffer, the economy suffers.

A newly formed alliance, the Better Way to Build the Economy Alliance, is challenging the argument that legislated paid sick days are bad for the economy. It is doing so by bringing together employers who feel that paid sick days are actually good for businesses. More than that, the alliance claims that decent working conditions and a better minimum wage are good for the economy. This alliance of businesses and community leaders is helping to prove that investments like paid sick days and better wages result in higher levels of employee productivity and customer satisfaction.

“In a small business, you know your employees, and it’s rare, rare, that someone will abuse a paid sick day,” says Paul Hayman from Five Walls Realty in Guelph. “In fact, in my experience most of the time you have to tell someone to go home because they’re feeling sick.”

Toronto, 2016. Photo Credit: Kelly Holloway

Hayman, along with other employers, is featured in the Better Way videos, launched earlier this month.

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

Teaching Medical Anthropology by Ari Gandsman

In the decade since becoming a full time professor, medical anthropology has been one of my core courses. I have taught it seven times.  Although the basic structure of the course remains similar, emphases have shifted over time. Perhaps I can best highlight the evolution of the course through a discussion of readings I use since readings are the backbone of a syllabus.  Even though I generally do not follow texts closely since I see lectures as overlapping but also supplemental and complimentary to readings, I try to mirror topics that they will be reading about, often highlighting a general theoretical literature or approach while the students read a single illustration.

Starting from the beginning, my history of medical anthropology remains the same, focusing on when “medicine” was subsumed into broad and now antiquated anthropological categories of magic and witchcraft. I never stray far from Evans-Pritchard’s Witchcraft, Oracles & Magic Among The Azande, an apparent professional contractual obligation for meAlthough I have given them the entire ethnography [the abridged in print edition] to read twice in the past, I have more lately just given them a short excerpt, often “The Notion of Witchcraft Explains Unfortunate Events.” I once also used W.H. Rivers Medicine, Magic and Religion but, although fascinating and of historic importance, it proved esoteric for an undergraduate course.  When I first started teaching, I tried to include more on non-Western medical systems, including using ethnographies on Traditional Chinese Medicine or Tibetan medicine. More recent students may be disappointed that I do not delve further into non-Western medical systems, what many students with hazy ideas of the discipline may think a medical anthropology course should almost entirely consist of.

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

Governments Should Fight Corporations, Not Collaborate With Them

Our former Greenwall Fellow, Jonathan Marks, delivers a TED talk that challenges this conventional wisdom, showing how governments can jeopardize public health, human rights and the environment when they partner with industry

Source: Bioethics Bulletin by the Berman Institute of Bioethics.

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

Individually-randomized controlled trials of vaccines against the next outbreak

Guest Post: Nir Eyal, Marc Lipsitch

Paper: Vaccine testing for emerging infections: the case for individual randomisation 

The humbling experience of international response to Ebola taught the world a thing or two on preparing for Zika and for other emerging infections.

Some of those lessons pertain to vaccine development against emerging infections. One lesson was that vigorous vaccine development should start long in advance of outbreaks. CEPI, the Coalition for Epidemic Preparedness Innovations, was recently launched with an initial investment of half a billion US dollars from the Gates Foundation, Britain’s Wellcome Trust and the governments of Japan, Norway and Germany. There is also growing recognition that best practices on vaccine testing should be developed prior to outbreaks, from a study methodology viewpoint.

By contrast, in Zika, ethical guidelines on response in general and on an aspect of vaccine testing were created only once the pandemic erupted. Shouldn’t ethical disputes, e.g. on trial design for vaccine candidates, be ironed out in advance of emerging infections?

One persistent ethical question in vaccine testing pertains to individually-randomized control in efficacy trials. At the height of the 2014-5 Ebola outbreak, individually-randomized controlled trials were much maligned. Our paper at the Journal of Medical Ethics sets out to defend that approach for vaccine efficacy testing in emerging infections, including highly fatal and untreatable ones in developing countries.

Nearly everyone agrees that scientifically, individually-randomized controlled trials are the gold standard of clinical research. But during the Ebola outbreak, ethicists, leaders, and humanitarian workers opposed them. For testing vaccine against a highly fatal infection without approved drugs or vaccines, they deemed these designs unethical.

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

Expert Advisory Committees & Conflict of Interest

Jean-Christophe Bélisle-Pipon, Louise Ringuette, and Bryn Williams-Jones describe a five-step approach for managing conflicts of interest in public health decision-making.

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On a regular basis, shocking news filters into the media about conflicts of interest within public organizations that contribute to policy-making. When such allegations are proven true, public scepticism about whether public interests or commercial interests inform policy-making increases.

Public health decision-making, especially in areas of complex science, is generally supported by expert advice. One such area is publicly-funded immunization. In Canada, the National Advisory Committee on Immunization is an advisory body to the Public Health Agency of Canada, while the provinces and territories rely on advice from local expert advisory committees.

Members of immunization expert advisory committees have an important role to play in guiding public health decision-making, particularly with regard to the selection of vaccines and the scheduling of immunizations. Given this important role, independence and transparency are expected. One mechanism for promoting independence is a robust, publicly available conflict of interest policy.

We suggest a simple five-step approach for better managing conflicts of interest.

First, ask the right questions and identify red flags. What are the interests at stake and for whom?

For example, consider situations where one or more committee members receive(s) significant funding from industry. Are there external interests, as a result of this funding, that may influence the committee’s mandate and activities? This concern applies to private companies with products or business activities related to immunization, or with connections to certain advocacy or interest groups.

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

Health in All Policies: Unfunded mandate?

By Joshua Waimberg, JD Beginning in the early 2000s, there was a push in the public health world for jurisdictions and localities in the United States to adopt a Health in All Policies (HiAP) approach similar to recent initiatives in … Continue reading

Source: Bill of Health, examining the intersection of law and health care, biotech & bioethics.

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

Toxicologist Aims To Label Ethical Standards

Toxicologist Alan Goldberg knows what an industrial pig nursery should look and smell like. So one with no pigs, no slop, and no aroma was certainly surprising. Goldberg toured such a sanitized—and possibly staged—facility in 2006 while he was part of the 15-member Pew Commission on Industrial Farm Animal Production, tasked to examine how industry practices impact human health, animal welfare, the environment, and rural communities.

 

The facilities with actual animals in them told a different tale. He recalls one poultry shed in Arkansas that housed 45,000 chickens clustered on a dirt floor that had likely not been cleaned since before the last harvest. Inside, the potent mix of nitrous oxide and ammonia, a byproduct of the chicken feces and urine, made the commissioners’ eyes burn. “The word the Pew Commission used to describe the conditions we saw was ‘inhumane.’ Personally, I would say ‘cruel,’” says Goldberg, a professor of environmental health and engineering at the Bloomberg School of Public Health and the founding director of the school’s Center for Alternatives to Animal Testing.

 

THE PHILOSOPHY BEHIND THE PROJECT IS TO CREATE A TEMPLATE OF ETHICAL STANDARDS FOR THE FOOD INDUSTRY AND BETTER INFORM CONSUMERS ABOUT THEIR CHOICES.

In its 2008 landmark report, the commission condemned the state of industrial production and made sweeping recommendations, including the ban of nontherapeutic anti­biotics, improved management of food animal waste to lessen contamination of waterways, and the phasing out of intensive animal confinement.

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

Jeff Kahn on WYPR Midday

 

Jeffrey Kahn, PhD, MPH,  Andreas C. Dracopoulos Director of the Johns Hopkins Berman Institute of Bioethics, appears regularly on WYPR’s Midday show with Tom Hall to discuss pressing ethics issues related to current scientific and technological advances.

 

His next appearance will be Wednesday, April 5th at noon. (Listen live online) Prof. Kahn and Tom Hall will discuss the case of Henrietta Lacks, the poor black tobacco farmer who died of cancer in 1951, and whose cancer cells were taken for research without her or her family’s permission – Ms. Lacks is also the subject of a new film, The Immortal Life of Henrietta Lacks, debuting on HBO Saturday, April 22nd at 8pm

 

Here is an archive of Prof. Kahn’s appearances on Midday with Tom Hall:

 


New Report Sets Guidelines for Genome Editing

February 15, 2017

Genome editing, that is the ability to make additions, deletions, and alterations to the genome of a human or animal, is not a new. Scientists have been experimenting with it in labs for a while to better understand the way some diseases and disabilities work. But now a new report released yesterday from the National Academy of Sciences and the National Academy of Medicine sets international guidelines for genome editing. New editing tools like CRISPR have opened up the doors for more lab and clinical research projects. The scientists behind the report hope their guidelines will serve as a roadmap to help other scientists avoid the ethical concerns associated with gene editing.

 

Bioethics With Dr.

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

Federal Court Dismisses Constitutional Attack on Uniform Determination of Death Act

The U.S. District Court for the Eastern District of California has dismissed the second amended complaint by the family of Israel Stinson against the California Department of Public Health.

The path that Israel took — through five hospitals in two co…

Source: bioethics.net, a blog maintained by the editorial staff of The American Journal of Bioethics.

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.