Tag: radiation

Bioethics Blogs

Don’t Let Your Physician Tell You What To Do Without Finding Out Your Goals

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A recent study of men with early-stage prostate cancer found no difference in 10-year death rates, regardless of whether their doctors actively monitored the cancers for signs of growth or eradicated the men’s cancers with surgery or radiation.

What does this study mean for patients? Based on research we have conducted on prostate cancer decision-making, the implications are clear: Patients need to find physicians who will interact with them the way a good financial counselor would, taking the time to understand them well enough to help them find the treatment that fits their goals.

Imagine a couple in their 40s who ask a financial counselor for advice on retirement planning, and the counselor tells them how much to invest in domestic and foreign stocks versus bonds versus real estate without asking them about their goals. A good counselor would find out what ages the couple wishes to retire at, what kind of retirement income they hope to live off of, how much risk they are willing to take to achieve their goals, and how devastated they would be if their high return investments go south, forcing them to delay retirement or reduce their retirement spending.

Far too often in medical care, physicians don’t behave like good financial counselors–they give treatment recommendations without taking the time to understand their patients’ goals. Consider early-stage prostate cancer, a typically slow-growing tumor that is not fatal for the vast majority of patients who receive the diagnosis. In some men, the tumor lies indolent for decades.

For that reason, men sometimes choose to monitor their cancers–have their doctors conduct regular blood tests or biopsies to see if the tumor is beginning to spread.

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

Pricey New Treatment Roils Issues of How to Treat Prostate Cancer

(Kaiser Health News) – Men hoping to avoid some side effects of prostate cancer treatment are shelling out tens of thousands of dollars for a procedure whose long-term effects are unknown and insurers, including Medicare, won’t pay for. Proponents say high-intensity focused ultrasound (HIFU) can have fewer negative side effects than surgery or radiation, while giving some patients another option between actively watching their cancer and those more aggressive steps. Critics, however, say the procedure is being oversold, leading some patients to get a treatment they don’t need.

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

Secrecy, Security, & Science

In 1994, before the Berman Institute of Bioethics at Johns Hopkins was established, Ruth Faden was asked to consult the US Department of Energy (DOE) on reports of government-sponsored radiation-related medical research on citizens without their knowledge. At the time, Faden was a professor at the Johns Hopkins School of Hygiene and Public Health, teaching medical ethics. Shocked by the accounts of widespread radiation experiments on unknowing, unconsenting citizens, Faden suggested that the DOE needed an independent investigation, and it should not be limited to that department alone.  Secretary of Energy Hazel O’Leary and President Bill Clinton agreed, and asked Faden to lead the investigation as chair of the White House Advisory Committee on Human Radiation Experiments (ACHRE).  Faden assembled her ideal interdisciplinary staff of historians, clinicians, philosophers, lawyers, and scientists who went on to work together the committee named by Pres. Clinton for 18 months before issuing its report on October 3, 1995.

 

On October 5, 2016, Johns Hopkins will host a day-long symposium to consider the committee’s work and its impact in the 20 years since the release of its report. Members of the ACHRE committee and staff will reflect on the seminal report, its impact since 1995 and into the future on topics including the regulation of human-subject research, considerations around remedies for past wrongs, and the use of historical information to make moral judgments about the past.

 

According to a New York Times story published in 1994 shortly after President Clinton established ACHRE, Faden said the most difficult task for the committee would be deciding what standard of ethics to measure the experiments against.

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 one by Aaron Seaman

Welcome to part one of September’s journal post. We start off with a few special issues, which have been highlighted earlier, followed by a great batch of interesting articles for fall reading. Enjoy!

Transcultural Psychiatry – “Practical Anthropology for a Global Public Psychiatry

Medical Anthropology – “Nonsecular Medical Anthropology

New Genetics & Society – “Private, the Public, and the Hybrid in Umbilical Cord Blood Banking

 

Appetite

The traditional food of migrants: Meat, water, and other challenges for dietary advice. An ethnography in Guanajuato, Mexico

Carolyn Smith-Morris

The term “traditional diet” is used variously in public health and nutrition literature to refer to a substantial variety of foodways. Yet it is difficult to draw generalities about dietary tradition for specific ethnic groups. Given the strong association between migration and dietary change, it is particularly important that dietary advice for migrants be both accurate and specific. In this article, I examine the cultural construct of “traditional foods” through mixed method research on diet and foodways among rural farmers in Guanajuato, MX and migrants from this community to other Mexican and U.S. destinations. Findings reveal first, that quantitatively salient terms may contain important variation, and second, that some “traditional” dietary items –like “refresco,” “carne,” and “agua” – may be used in nutritionally contradictory ways between clinicians and Mexican immigrant patients. Specifically, the term “traditional food” in nutritional advice for Mexican migrants may be intended to promote consumption of fresh produce or less meat; but it may also invoke other foods (e.g.,

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

‘Testing in the East’: an episode in Cold War bioethics

In 2013 the influential German magazine Der Spiegel published an expose about clinical trials conducted by Western drug companies in East Germany during the Cold War. The magazine reported that at least 50,000 people had been test subjects for around 900 studies done by manufacturers that included leading companies from Switzerland, the United States, and West Germany. Fifty hospitals were sites of the research, including the prestigious Charite in East Berlin. The principle motivation for the East Germans was money: they desperately needed hard currency for their failing medical system. For their part the companies appreciated the far greater efficiency of recruitment in the East, and paid the East Germans up to 800,000 West German marks per study.

The agency responsible for setting up these contracts? The notorious Stasi, the East German secret police force that included hundreds of thousands of paid agents and hundreds of thousands of more informants.

Der Spiegel’s series about the drug trials contained language and themes familiar to many landmark bioethics cases. The revelations were described as a scandal that used the oppressed East Germans as human guinea pigs, including deaths and injuries that had not been properly reported, the indiscriminate use of low-birthweight infants and depressed patients, inadequate informed consent, powerful drug companies and physicians largely eager to cooperate in spite of the occasional protest. Complete with interviews with former test subjects and regretful doctors, the study had all the elements of a classical bioethics case study that could take its place along with the U.S. Public Health Service’s Tuskegee syphilis study; the Guatemala sexually transmissible disease experiments; and some of the well-documented human radiation, biological, and chemical warfare experiments in the U.S.

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

A-list clash over embryos

The acrimonious fight over frozen embryos between Hollywood celebrities Sofia Vergara and Nick Loeb is due in court again in January in California and could set an important legal precedent.

The Modern Family TV star and the financier created frozen embryos in 2013 when they were living together. They signed an agreement that both had to agree if the embryos were placed in a surrogate mother. However, they split up in 2014. When Loeb proposed the surrogate mother option, Vergara refused. She was content to leave them frozen. “More than a mother, a baby needs a loving relationship of parents that get along, that don’t hate each other,” she said in a TV interview. “I wouldn’t want to bring kids to the world that is already set against them. It would be so selfish.” 

Ever since Loeb has been waging a legal and public relations battle to get custody of the embryos. At the moment Loeb’s lawyers have asked a judge to fine Vergara for refusing to sit for a deposition.

Loeb is desperate to make his case plausible. “I think the misconception is that people don’t know the difference between an embryo and an egg,” Loeb explained earlier this year. “A lot of people think I’m trying to steal her eggs and they don’t realize that an embryo is half mine — half my DNA and half her DNA. It’s actually a human being.”

The legal status of frozen embryos differs from state to state. At the trial in January, Loeb’s lawyers will claim that the agreement the couple signed is invalid.

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

Presenters’ Additional Reflections on Bioethics Advisory Bodies

Presenters at today’s Bioethics Commission meeting continued their discussion on the impact of bioethics advisory bodies. Future efforts in bioethics and health policy can take into account lessons learned from the experiences of advisory bodies before them.

In the third session of the day, the Bioethics Commission heard from a variety of speakers considering the past, present, and future impact of such groups. Presenters included Ruth Macklin, Distinguished University Professor Emerita in the Department of Epidemiology and Population Health at the Albert Einstein College of Medicine and Harold T. Shapiro, President Emeritus and current Professor of Economics and Public Affairs at Princeton University. In addition, the commission heard from Rebecca Dresser, Daniel Noyes Kirby Professor of Law at Washington University in St Louis, and Eugenijus Gefenas, Chairperson, Bureau of the Intergovernmental Bioethics Committee for the United Nations Educational, Scientific and Cultural Organization (UNESCO).

Ruth Macklin previously presented before the Bioethics Commission during Meeting 6 on the topic of international research ethics. Today, she spoke of her time on the Advisory Committee on Human Radiation Experiments (ACHRE) (1994-1995) under President Clinton. She also spoke about her membership as a staff consultant on NBAC, and the challenges of writing reports while commission members were changing their minds about recommendations. She spoke about maintain intellectual and moral integrity, when writing on behalf of others’ views.

Harold T. Shapiro drew from his time as Chair on the National Bioethics Advisory Commission under President Clinton (1995-2001) and as a member of the Council of Advisors on Science and Technology under President George W.

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

Do the EPA Exposure Studies Violate Do No Harm and Informed Consent?

by Craig Klugman, Ph.D

A government agency recruits elderly and sick patients for an important research study. In a controlled environment, subjects are exposed to airborne pollutants at levels many times higher than found in the real world. Some pollutants are considered so dangerous that the FDA considers any exposure to be dangerous.

Such a scenario may sound like a historical case study of human subjects abuse, but such studies are actually the subject of an 18-month review by the EPA on ethical conduct of research. Such studies are not a secret. In fact, a 2000 article in the journal Environmental Health Perspectives talks about the benefit of exposing people to pollutants at controlled doses in controlled environments. The last meeting of the review committee was August 24, 2016.

Subjects are consented to participate in the experiments, but the EPA’s own inspector general has questioned whether potential subjects truly understood the risks and whether researchers immediately and properly reported all adverse events. Specifically, the inspector general refers to a study of 81 subjects, exposing them to airborne particles and diesel exhaust fumes in 2010 and 2011. The concerns range from lack of review board approval and notification of study modifications, to addressing risks differently to different subjects in the same study, to a lack of procedures for reporting and acting on adverse events.

The public health benefits of this research are important for answering how much exposure is safe as well as what are the effects of exposure at various levels to a diverse pool of people (based on age, ethnicity, health status).

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

New Approach Could Make Bone Marrow Transplants Safer

June 7, 2016

(Medical Xpress) – Bone marrow transplantation currently is the only curative therapy for these blood diseases. But, for the new, transplanted stem cells to do their work, the faulty stem cells must first be “evicted” or killed. Accomplishing that requires patients endure chemotherapy and radiation—a vicious assault on the body with life-long consequences. In a study recently published in the journal Nature Biotechnology, HSCI researchers at Harvard University and Massachusetts General Hospital (MGH), in collaboration with Boston Children’s Hospital and Dana Farber Cancer Institute, have developed a non-toxic transplantation procedure using antibodies to specifically target blood stem cells in mice, an approach they hope will make blood stem cell transplants for these patients far less toxic.

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

Bioethicists learn from history

Now that I’ve had my rant about the Belmont Report’s year of publication, I can turn to the more substantive arguments of Barron Lerner and Arthur Caplan’s recent essay, “Judging the Past: How History Should Inform Bioethics.” These scholars wisely argue against simplistic condemnations of past behavior, yet they also reject the other extreme of attributing all past misbehavior to the age rather than the individual. By understanding what choices were open to actors in the past, we can better assess the morality of their actions and the choices that we ourselves face.

[Barron H. Lerner and Arthur L. Caplan, “Judging the Past: How History Should Inform Bioethics,” Annals of Internal Medicine 164, no. 8 (April 19, 2016): 553–57, doi:10.7326/M15–2642.

Lerner (who holds a PhD in history as well as an MD) and Caplan recite several of the usual human subjects horror stories: Nazis, Tuskegee, Willowbrook, Jewish Chronic Disease Hospital. (Sanjay Srivastava will be glad to know that poor Stanley Milgram gets a pass this time.)

They offer a twist, however, in insisting that not all the perpetrators of these misdeeds were “monsters from an alien past.” Rather, they draw on recent scholarship, including works by such eminent historians as Allan Brandt and Susan Reverby, to demand that we understand the context in which people acted immorally, including the crucial question of who supported or challenged the decisions now judged unethical.

They note, for instance, that “many students of bioethics may be surprised to learn that even though the Macon County [Alabama] Medical Society was predominantly African American by the late 1960s, it continued to approve the Tuskegee study.

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.