May 2009
Sometimes a Title Says It All: "Kass Backwards"
The editors here at The American Journal of Bioethics have been none too kind to Leon Kass, but none have been quite as harsh as Scott McLemee from InsideHigherEd.com in his piece titled, "Kass Backwards".
Below are a few choice excerpts from McLemee's perspective piece on Kass's NEH Jefferson lecture:
Kass invoked the "wisdom of repugnance" a few years before he joined an administration that treated the willingness to torture as a great moral virtue -- meanwhile coddling bigots for whom rage at gay marriage was an appropriate response to "the violation of things we hold rightfully dear."Now, as it happens, some of us do indeed feel disgust at one of these practices, and not at the other. We also suspect that Kass's aphorism about the shallowness of souls that have forgotten how to shudder would make a splendid epigraph for the chapter in American history that has just closed.
In short, disgust is not quite so unambiguous and inarguable an expression of timeless values as its champion on the faculty of the University of Chicago has advertised. Given a choice between "deep wisdom" and "reason's power fully to articulate," we might do best to leave the ineffable to Oprah.
And so last week's Jefferson lecture was, perhaps, an encouraging moment, in spite of everything. With it, Leon Kass was saying farewell to Washington for, with any luck, a good long while. Maybe now he can spend some time catching up with the range of work people in the humanities have actually been doing. At very least he could read some Martha Nussbaum.
Then he might even pause to reflect on his own role as hired philosopher for an administration that revived one of the interrogation techniques of the Khmer Rouge. The wisdom of repugnance begins at home."
Summer Johnson, PhD
Pucker Up!
Ladies, how much risk of lead exposure would you be willing to undergo for ruby red lips? Is it even something to be concerned about? Well, it depends on who you ask. According to the NYT, a debate is ensuing at the FDA over lead suspected in tubes of women's favorite shades of lip color.
A recent study found that 1/3rd of lipsticks had in excess of the acceptable limit of lead allowed for candy, raising the question of whether women puckering up is putting them at risk for lead exposure. Cosmetics companies blame only the reddest of red shades--many of which they no longer make--and now assure us that it's safe to slather on the lip color. But advocacy groups are not so sure. It might be a good idea for FDA, who is completely lacking in any regulation for lead limits for lipsticks, to develop some guidelines in this area.
But is this really a public health risk? Doesn't most women's lipstick come off on their morning coffee cups long before they have a chance to ingest it any other way? Shouldn't we be more worried that our coffee mugs are going to get lead poisoning rather than ourselves? However, there are those who believe that there is no safe level of lead exposure--and for them, all lipsticks should be right out--at least until the data is in--but that could take years.
To me, this seems like much ado about nothing--or just one more reason to go after the cosmetic industry for a less than minimal risk of exposure for the very same women who may be exposed to lead at work, in their homes, the soil or from the imported Chinese toys with which their children play.
At the very least, until the data is in, there seems to be no reason to toss your gloss--except maybe the reddest of reds. For now, pucker up!
Summer Johnson, PhD
"Hidden Health Taxes" Neither Ethical Nor Sustainable
It seems as though we don't have much choice when it comes to health care. Either we are going to pay what the most recent research is calling a "hidden health tax" of something on the order of $1,017 per year to cover the health care costs of the uninsured, at least that's what Families USA is telling us (says WSJ) or we can pony up the money through tacking on an additional tax on the goods we routinely buy through something like a Value Added Tax (VAT) like they do in Europe and ensure healthcare for all--no matter what.
It would seem to me that in a democracy we would be better off having an open dialogue about the kinds of taxes we want to pay in order to get the kind of healthcare we want rather than being forced against our will to pay a hidden tax for those who must receive care anyway in emergency rooms because no one will be denied care. De facto, we have universal healthcare and all Americans pay for it via a certain kind of tax--we just do it blindly.
It would seem to me that the time has come for us to open our eyes and to stop paying "hidden taxes" for the absolute worst type of health care possible and to guarantee health for all. Whether we institute some kind of value added tax or some other way of paying for universal access to health care is another matter, but the bottom line is that silently shifting the costs of care for the uninsured to those who can pay is neither ethical nor sustainable. What it will take to make it end is the only remaining question.
Summer Johnson, PhD
Will Your Tweets Keep You Healthy Or Make You Sick?
Google has been tracking flu trends to monitor disease outbreaks for some time, but with the most recent outbreak of swine flu, social media has taken on a new role in the monitoring of health in our lives.
Not only did we, here at bioethics.net, decide to create pandemic.bioethics.net on Facebook, to keep people up-to-date about what was happening in the news about the swine flu pandemic, but countless other government agencies and private websites, Facebook pages, and Twitter sites popped up seemingly overnight to alert us about what was going on in the world with the dreaded swine flu.
As the WSJ put it today, "health data proves contagious on social media."
But what is the goal? Sure, it's great that the CDC has finally joined the 21st century and now has a Facebook page (months after AJOB created its page, mind you). But what is the purpose of the page? For those interested in public health to chat about public health topics? Or is it the goal of the CDC to disseminate information through the page? At present, it remains unclear.
So what's next? Will Peggy Hamburg twitter us from the FDA the next time that there is salmonella in pistachios or e.coli in our hamburgers? Such real-time information about our nation's health could be great--but it could just send us into even more of a panic than having CNN blasting 24/7 in every airport and public space in America.
Is this really how we want our nation's public health or drug information disseminated? Frankly, I'm doubtful. The viral nature of Twittering itself means that false information can spread out of control rapidly meaning that disinformation or outright lies can spread just as quickly as truth--leading to panic and the worried well just as easily as helpful information about how to contain the spread of pandemics or what contaminated foods are safe or are not safe to eat.
While the democratic nature of Twittering and Facebook may be empowering, it also is dangerous if left completely to its own devices and without any other checks or balances or input from other kinds of media or authoritative sources against which tweets and Facebook posts are checked.
Like with anything, consider the source. Triangulate. But then, twitter away. Post early and often. Contribute to the dialogue. But remember--don't believe every tweet you read. Unless, of course, it comes from Richard Besser or Peggy Hamburg.
Summer Johnson, PhD
How Free Riding Can Get Your Child a Free Ride To the Emergency Room
These days parents are often more afraid of the immunizations that their children are asked to take than of the diseases they are intended to prevent. These parents believe that their children will be protected from diseases like pertussis, measles or the mumps because of something called "herd immunity"--put simply, because everyone else's child gets vaccinated it's unlikely that a child near mine will get any one of these diseases and thus give it to my unvaccinated child. That way, I avoid having to expose my child either to the disease or the risky vaccine.
The most recent research, though, suggests that this logic may be tragically flawed and that these free riding parents who are trying to benefit from the rest of society's vaccinated kids may in fact end up with sick kids after all. According to the L.A. Times Booster Shots blog, recent research published in Pediatrics found that 11% of all pertussis cases in the entire Kaiser Permanente system were the result of unvaccinated kids.
In short, herd immunity is not enough. The question parents have to ask themselves is: is the fear of vaccine harm greater than the fear of pertussis? Given that it is the most commonly reported vaccine-preventable cause of death for children under the age of 5 years, I would think parents might want to think twice about refusing vaccines when mortality is so easily prevented.
Summer Johnson, PhD
Dr. Hamburg, Divest Thyself
One of the wealthiest of the Obama administration appointees, Dr. Margaret Hamburg, has to offload her stock pretty quickly--apparently that's what comes from being married to a very successful hedge fund manager and holding a wide range of health and other medical related stock, says the Wall Street Journal. The new FDA chief is going to take a pretty significant pay cut--going from about $10 million per year to her yearly salary at FDA of $150,000.
Many of Dr. Hamburg's stocks, as well as her husband's, were inherited--but even those must go, including holdings in Johnson and Johnson, pharmaceutical benefits management company, Medco, and Merck. The good news: Hamburg gets to keep her family farm, even though animal issues and vet meds are covered by the FDA, so long as decision-making at the farm is done by someone else.
Summer Johnson, PhD
Caplan: Court has the Right to Insist on Chemo
Art Caplan writes in his MSNBC column today that the courts have the right to intervene in a case where a highly curable cancer is being prevented by the refusal by parent and child to undergo treatment--regardless of the reason. Daniel's age and developmental disabilities prevent him from giving informed consent and his mother's actions border on, if are not actually child abuse.
To read more, keep reading below or click on this link to read the column at MSNBC.
Opinion: Court has the right to insist on chemo
Government should make sure kids with lethal but treatable ills get care
The case of Daniel Hauser, the 13-year-old boy who has a highly fatal form of cancer, took a sad turn this week. Hauser's mother, Colleen, took the boy and fled the family's Sleepy Eye, Minn., home after a court-ordered X-ray on Monday showed a nasty tumor growing in Daniel's chest. Running away with Daniel to avoid medical treatment for him is a terribly dangerous and irresponsible thing to do.
The cancer will probably kill him unless he receives chemotherapy. The parents had allowed a round of chemotherapy to be given, and that had proven very effective in shrinking his tumors. But now that his mother has seen that chemo is tough to endure, she wants to follow the beliefs of the Nemenhah Band, a small group based in Weaubleau, Mo., which advocates healing methods tied to some Native American practices. It is important to know that Daniel's dad, Anthony Hauser, does not agree and wants his wife and son to come home. And the head of the Nemenah Band is also urging the mom to bring Daniel back to Minnesota.
Daniel himself is too young to know whether he agrees with his mother's desire to follow the beliefs. In addition, the boy has developmental disabilities that make it impossible for him to read and limit his understanding. He is not in any position to dissent from what his mother is doing.
Situation pits privacy against child abuse
What makes this case and others like it so morally difficult to assess is that it involves the clash of two moral goods. Daniel's mother is trying to do what she believes is right for her son and wants the privacy and the freedom to act on her beliefs. Doctors who have seen Daniel and know he has a type of cancer that they can cure with almost 95 percent success want to help him. They know their treatment is sometimes awful for a patient to endure, but they also know that the success rate in following alternative methods of healing for this type of cancer is next to zero.
There are those who argue that no one has any business telling Colleen Hauser how to deal with her son. Put aside the fact that her husband does not agree. Should families be free to do whatever they want with the children in the name of religious or spiritual belief?
The moral answer is no.
We recognize that parents can and sadly sometimes do abuse or neglect their children. What is a bit harder to recognize is that they can do so in the name of religious or spiritual beliefs.
Children have been told at age 10 or 11 that their religion demands they be married off to church elders. Children have been seen by their parents as possessed by demons and beaten within an inch of their lives. Children can be told that it is God's will that they die miserable and suffering from diabetes, meningitis or a twisted intestinal tract. Many have undergone excruciating deaths.
In all of these cases, parents are doing what they think best according to their religious or spiritual views. But that does not make these actions any the less abuse of innocent and dependent children. The government absolutely has a role to play in protecting kids in these circumstances. Not by kicking in the door of the parent's house, but, by having a local court review the facts, hear testimony and then make a decision about limiting parental and religious freedom.
Critics' rhetoric nothing but hyperbole
Let's knock off all the rhetoric flying around about the government crushing parental rights and religious freedom in cases like that of Daniel Hauser. It is only after a court hearing by an impartial judge who knows local values that a court order might be written to override parental authority. Anyone who looks at the 52-page decision of the judge who ordered treatment for Daniel will realize that critics who yak on about cops kicking in the door of helpless parents trying to follow their religion are engaging in nothing but irresponsible hyperbole.
So there have to be limits to religious freedom when it comes to kids. When do those limits justify ordering treatment for a kid like Daniel?
Answering this question requires paying attention to three other questions. First, is the disease life-threatening or likely to produce severe disability if left untreated? Second, is there a treatment proven to be effective and one that would be recommended by the overwhelming majority of medical specialists? And can the young patient participate in any way in the decision to refuse care -- and articulate reasons for doing so?
Not all cases work this way. A 17-year-old who has been through three liver transplants and faces a fourth with almost no chance of survival should be able to say no even when his parents want the operation done. A young girl dying of cancer for which only a highly experimental and unproven treatment exists should not receive it if her parents say no -- the odds are too long. But a child with lethal but treatable ailments -- such as diabetes, meningitis, severe asthma, bee sting allergy, Hodgkin's lymphoma, an obstructed intestinal tract or other lethal conditions -- should not be asked to die in the name of parental refusals of proven effective treatment.
Daniel Hauser is such a child. His mom should listen to her husband and religious leader and bring him home. Daniel can get through the chemotherapy. He will need a loving and supportive family to do so. His family can work with his doctors to make that happen. I hope they do.
To Nap or Not to Nap--That is the Question
A recent editorial in the New England Journal of Medicine, titled ""To Nap or Not to Nap", suggests that the verdict is still out on the value of reducing the number of hours that medical residents work and its relationship between improved outcomes for patients, says the WSJ Health Blog.
Nevermind that it's inhumane to have a medical resident working a 100+ work week and falling asleep over their patients or reading charts bleary eyed, but, according to this editorial at least, the data doesn't show that patients have better health outcomes when residents work 80 hours a week or less as compared to when they work hundreds of hours.
So will the restriction be lifted? I doubt it. Recently, the IOM recommended that in addition to the overall work week limit the consecutive number of hours that resident can work should be limited to just 16.
As far as I am concerned, if pilots are only allowed to fly for so long without taking a break, physicians, particularly fledgling ones, ought to be allowed to take a nap every once in a while. The financial advantages to the medical centers notwithstanding (free labor is good) residents should not have to work under artificial conditions, as in conditions that would never occur once they are out of residency or fellowship and in their own practices.
Give residents a break--literally--and we will all be better off.
Summer Johnson, PhD
Chemo Teen and Mom on the Run--How It Could Have Been Prevented
By now, almost everyone in America has probably heard the story of Daniel Hauser and his fight to refuse chemotherapy for his Hodgkin's lymphoma. The most recent wrinkle is that when it appeared that Daniel would be forced to get chemo, he and his mother skipped town, apparently now on their way to Mexico, to avoid enforcement of the court-ordered treatment.
While on the face of it, this would appear to be a case of cultural sensitivity and respecting the religious views of the parents (and presumably the child) who does not want these toxic substances put in their son's body. But wait--Daniel Hauser had chemotherapy once before. Why did the parents not raise the same objection during the first round of chemo?
The answer is because this isn't at all a case of respecting religious views of anyone involved. Even if it were primarily the issue, in most cases where there is a clearly effective treatment and the risk of non-treatment is death, the courts would rule just as they did to order treatment regardless of religious views of the parents.
Moreover, based on recent media reports, Hauser cannot read and his ability to give informed consent may be significantly impaired by that fact and the strong role that his parents have played in controlling medical information regarding his treatment.
Daniel Hauser's story is really one of scared parents and an even more scared teenage boy who doesn't want to face the difficult road of treating Hodgkin's. This is no small problem, of course, but had either son or parents been honest about the heart of the issue there would have never been any need for judges debating about the rights of parents to make religious objections to medical care, treks to California (and maybe Mexico), or any of what looks like it could be a protracted battle.
This entire morass could have been avoided had the parents and their son been honest about their real fears of chemotherapy and specialists trained to deal with these issues would have counseled them and provided perspective that persons in their situation would find difficult to have. Leaving the court system out of it would have been a huge help in diffusing a situation already rife with high emotions and tensions between the medical community and the family.
Ultimately, no one knows how this case will turn out, but ultimately someone--whether it is the courts or the Hausers will not get what they want out of this situation. What we really hope for, of course, is that Daniel Hauser will live.
Summer Johnson, PhD
Have We Become Too Dependent On Our Medicine Cabinet?
Christian Science Monitor is asking an important question: "Have we become too dependent on our medicine cabinet?" Medical ethicists, physicians, and even patients and their advocates who are growing increasingly concerned about the reliance that Americans place upon their pharmaceuticals to make them well. My questions is: "What's the real worry?"
Debates about enhancement in genetics and sports and other fields have abounded for years, but when the enhancements are as convenient as popping one's morning pills, the opportunity to better one's self almost seems too easy. And with dramatic effects ranging from improved cognition and memory to enhancing sexual performance, it seems almost too good to pass up. However, when the pills we are popping dramatically effect our brains, deeper moral questions arise.
But for all the hoopla about should otherwise healthy adults or teenagers take brain enhancing drugs, it would seem to come down to a very straightforward issue: given the fast-paced, completely distracted, Twitter-filled, Facebook-crazed, Blackberry, iPhone, Cloud Computing world in which we live, doesn't it only make sense that we might need a little cognitive assistance to keep all of these widely disparate, but crucial data streams straight in our heads? Why else, for example would 10% of college students report taking cognitive enhancing drugs? They arguably are the most "hooked in" of all in terms of technology, and once "real life" hits them--some cognitive enhancement is certainly to be on the menu.
Critics describe a "slide toward a more drugged society" where people are "more dependent on the pill bottle". As opposed to what? A society with millions of neurologically fried, cognitively lagging individuals unable to keep up with the rapid advances in technology and information flowing at them daily, and incapable of dealing with the demands of an increasingly competitive marketplace in terms of employment and more hardly seems like a better option. (Yes, there are justice concerns associated with this view, but that is true for access to any new therapy or enhancement or technology in medicine.)
Given the choice, and given where society is headed and that it shows no signs of slowing or reversing, the morally responsible stance to take is actually to promote the use of cognitively enhancing drugs for a society that is outpacing what our brains can handle. If the only option is to fall behind or rely upon the medicine cabinet, I vote for cracking open a pill bottle.
Summer Johnson, PhD
In Memoriam
Rabbi Gerald I. Wolpe died on Monday after a battle with pancreatic cancer. Rabbi Wolpe was one of the nation's most prominent rabbis as well as a bioethicist.
Rabbi Wolpe's "second career", as it is sometimes described, was in bioethics, which focused on medical education and ethical caregiving, says the Philadelphia Inquirer, the latter of which he faced in his own life. His involvement in bioethics was wide and varied from consulting on the television drama "Grey's Anatomy" to teaching medical students to serving as an advisor to a wide range of scholarly, public and social institutions.
Rabbi Wolpe is survived by his wife, four sons, who include AJOB associate editor Paul Root Wolpe, and eight grandchildren. He is certain to be missed not only by his family but by all of those who knew him.
Summer Johnson, PhD
Lose Your Job, Keep Your Drugs
According to Judith Graham at the Chicago Tribune's Triage blog, Pfizer has created a new program to allow the unemployed--and thus uninsured--to keep access to their prescription drugs for one year.
The cynics will say, of course, that the program is designed to keep brand loyalty for patients while they are out of work, off the insurance rolls, and struggling to make ends meet. The slightly less cynical view is that it is good PR for a company that is still raking in billions and can afford to give a way a few Lipitor prescriptions.
But, in my view, the reality is that this is probably the very best time for Pfizer to give away prescriptions for Lipitor and Viagra and a wide array of other drugs and it will come at probably very little cost to them. Although in the past, very few Americans took advantage of COBRA plans offered through their employer, now they are subsidized heavily through President Obama's stimulus package for the next 9 months. This is likely to mean that a significant number of severed employees will have health insurance. Those without COBRA benefits or who could not even afford the subsidized benefits should get free drugs from Pfizer. Other pharmas should follow suit as well.
But whether or not Obama's stimulus subsidized COBRA is why they chose now to start this program really isn't the issue. Whatever Pfizer's motives or however many people actually participate the good that is done is what matters--people in need get the drugs that they need. That is what is important.
Summer Johnson, PhD
Do You Want Fries with That?
One of the oldest jokes around for those trained in philosophy includes a punch line about serving fries at insert name of favorite fast food restaurant. Well, it would appear at, at least in the UK, the view of one columnist about the value of philosophy degrees, thanks to the marketability of being a bioethicist, is markedly different--although wholly and utterly wrong.
I was more than surprised to read from The Independent yesterday in its Careers Advisor column the following query: "I am considering a degree in philosophy but am concerned about how it will be seen by employers. Can you help?"
What was even more shocking was the following answer: "Demand for the type of skills honed in three years of studying philosophical tradition is growing - in the NHS, for instance, medical ethics committees and training courses for staff are on the increase." Jobs for philosophers as bioethicists in the UK are aplenty? Who knew? Unemployed philosophers on this side of the pond--book a ticket now on Virgin Atlantic!
Of course, this statement seems incredibly misleading--for anyone who knows anything about bioethics knows that training in philosophy alone does not qualify one to serve on a hospital ethics committee or to be a "card-carrying bioethicist"--whatever that means. The requisite practical skills in clinical ethics which include actual hands on consultation or policy making practice are not something that coursework in ancient greek philosophy or metaphysics or even moral philosophy will prepare one to do.
I find it provocative that the columnist would try to advance such a claim in the UK or anywhere else in the world for that matter, but ultimately it's just wrong. It would not be any more true there than it would be here. An undergraduate from Northwestern or Boston University would be no more qualified to be a clinical ethicist at your local hospital than a recent graduate of University College London or Oxford.
Nice try, Careers Advisor, but you aren't fooling this bioethicist. Let's hope you didn't convince any young Brits that a career in philosophy will qualify them for a wide and deep pool of jobs in the NHS either.
Summer Johnson, PhD
For a discussion of bioethics and its comparison to philosophy as an academic discipline and a discussion of the question "Will Bioethics Take the Life of Philosophy?", read the editorial by Glenn McGee
7% of Pediatric Hospitals Lacking DCD Policies. Call In the Clinical Ethicists! Wait. We Already Did.
Recent surveys have found that 7% of pediatric hospitals lack a policy regarding the criteria for donating organs after cardiac death, says a recent study published in JAMA, according to Medpage Today. What is perhaps more troubling, according to this research, is among the 93% of hospitals that have policies, there exists a hodgepodge of criteria and policies that fail to address in many cases the key ethical concerns at the heart of the DCD issue.
My favorite finding: 25% of DCD policies in the hospitals surveyed failed to MENTION informed consent. I'm sure they just forgot to write down that slightly important criterion. No big deal, right?
Of course, just because a written policy, per se, does or does not mention a certain issue doesn't mean that something like informed consent doesn't take place. But it does make one more than a little concerned that the hospital in which one's child is being cared for forgot to include one of the central tenets of Western medicine and one of the key aspects of respecting persons and their wishes (even posthumous) in the healthcare setting.
When 25% of hospital ethics committees (who presumably at least help to draft these policies) can forget to mention something as critical as informed consent, one can only wonder: what else did they forget? This study outlines a number of those areas where the variations in policies are quite dramatic. This study highlights the concerns related to not only significant variability in DCD policies but also the quality of hospital ethics committees and their policy formation in pediatric hospitals around the nation.
Summer Johnson, PhD
Elsevier and Its Many "Advertorials"
In fact, they love them so much that they had an entire division devoted to making money off of the pharmaceutical industry's need to publish poser peer-reviewed journals and phony editorials, aka "advertorials". According to BoingBoing, Elsevier had an entire imprint comprised of 6 journals that were published for pharma.
Why'd they do it? The obvious answer is: MONEY. There could be no other good reason. What Elsevier didn't think about was, of course, how much in PR these "advertorials" would cost them when a respected academic publisher was found to be the handmaiden of the pharmaceutical industry, publishing puff-pieces and fake peer-review journals alongside the real deal.
I'm sure Elsevier will weather this storm, but I would charge academics to think about the journals in which they publish much more closely now and for doctors to question the source much more carefully. It would appear that publication in a journal doesn't mean what it used to in the medical literature--thanks to decisions like those made at Elsevier.
Summer Johnson, PhD
Center for Practical Bioethics Celebrates 25 Years
Today in Kansas City leaders in the field of bioethics gather to celebrate the 25th anniversary of the Center for Practical Bioethics. Topics at the Bioethics Symposium range from organ donation after cardiac death by AJOB's own associate editor, David Magnus of Stanford University to ethical and social issues relating to autism by AJOB's editor-in-chief, Glenn McGee, Director of the Institute on Ethics and Autism.
To read more about today's symposium, click here.
To listen to reflections on "A Quarter Century of Bioethics" by the Center's Director, Myra Christopher, listen here.
Summer Johnson, PhD
Version 3.0: pandemic.bioethics.net
Award-winning Target Articles, Editorials, and Open Peer Commentaries from The American Journal of Bioethics are available now at pandemic.bioethics.net. Click on the links below for direct access or visit us at pandemic.bioethics.net
Resources:
Pandemic Influenza Ethics Initiative Resources from the Veterans Health Administration's National Center for Ethics
News:
WHO: Up to 2 Billion People Might Get Swine Flu
The Worst Emerging Disease of All
Debating the Wisdom of 'Swine Flu Parties'
Global Flu Cases Top the 2,000 Mark
Blogs:
More Ethics Dilemmas Incubate as Swine Flu Pandemic Threatens
Are Journalists Class Clowns on Swine Flu Coverage?
Adrian Gonzalez on Swine Flu in Mexico
Jane Parry on Flu
Summer Johnson, PhD
Victims and Vectors
If you haven't read enough about pandemics and ethics or the swine flu yet (and seriously who hasn't read enough about this), the OUP Blog is recommending some additional reading written by philosophers Leslie Francis and Peggy Battin, as well as Jay Jacobson and Charles Smith called Patients as Victim and Vector: Ethic and Infectious Disease.
The book, published last October, discusses important issues in thinking about patients as both victims of infectious disease outbreaks but also the carriers of those same diseases.
The blog post, written by Francis and Battin talks about the current H1N1 outbreak and apply their ethical approach to the current public health crisis.
Such a framework is one of the few ethical frameworks available to thinking about pandemics and is important for everyone interested in these infectious disease and ethics to consider.
Summer Johnson, PhD
UPDATE: Your Source for Swine Flu and Ethics: pandemic.bioethics.net
Award-winning Target Articles, Editorials, and Open Peer Commentaries from The American Journal of Bioethics are available now at pandemic.bioethics.net. Click on the links below for direct access or visit us at pandemic.bioethics.net
News:
Flu Fighters?
Experts: Tamiflu, Relenza work on swine flu but only sickest may get it
Blogs:
Caplan: No Hype in Flu Response
Politicians are Not Public Health Officials But They Play Them On TV!
Caplan: No Hype In Flu Response
Art Caplan writes today in his MSNBC column: "overall, the resources, attention and response to the H1N1 swine flu outbreak have been absolutely appropriate." Do you agree? Go to pandemic.bioethics.net to post your own reactions to Caplan's column.
To read the entire column read more after the break or click here.
Summer Johnson, PhD
Opinion: World's flu response was hardly hype
Despite a few missteps, reaction to potential pandemic was on target
Just when you thought the swine flu epidemic was going to be the story of the decade, the saga appears to be coming to an end.
Sure, there are still new cases being reported around the world. And the focus of monitoring for any nasty mutations in the swine flu virus is shifting to the southern hemisphere, where winter -- flu's favorite season -- is about to begin.
Still, it seems fairly certain that the spread of the H1N1 virus is not nearly as fast, pervasive or lethal as had been feared. The time for Monday-morning quarterbacking has arrived: Was the swine flu pandemic just a lot of hype or did the world mount a credible response to a very real threat and tamp it down?
There certainly were elements of hype in the media tsunami that accompanied the first reports of deaths in Mexico from a mysterious new flu. Few in the media clearly stated that the World Health Organization's six-stage pandemic flu scale alerts have much more to do with the spread than the intensity of the epidemic.
And, sadly, the outbreak was used as excuse for racism, including calls to arrest all Mexicans living illegally in the United States and China's detention and quarantine of persons with Mexican passports -- many of whom had not been anywhere near Mexico in years.
But overall, the resources, attention and response to the H1N1 swine flu outbreak have been absolutely appropriate.
Mexico was slow in responding to the new virus. Once it got its act going, the Mexican government did an impressive job of communicating to the public, encouraging flu-killing behavior like hand-washing and banning large public gatherings. We all owe a debt of gratitude to Mexico for slowing the epidemic down enough to let the rest of the world respond.
The U.S. government, Canada, New Zealand, the European Union, WHO and many other governments and institutions did a good, hype-free job on a number of fronts.
They got the word out about hand-washing and coughing into your sleeve, staying home if sick and keeping an eye on people who might be ill at school or on a plane.
Stored supplies of antiviral drugs were moved quickly and showed some impact against the virus. Gene hunters nailed down the makeup of the new virus rapidly. Cases from around the world were reported to CDC and WHO, permitting reasonable tracking of the disease location, those affected and the impact of treatment on those who did catch the virus.
The media -- print, Internet, television, radio -- all pounded home the proper messages: Wash your hands, stay away from sick people, don't panic. They never did figure out what to say about masks but, that flub aside, they really did a credible job educating the public about a fairly complex story.
What are the take-home lessons from the great swine flu scare of 2009?
First, there will be other viruses. This strain has not shown the lethal power that public health officials feared. Another strain might. And more are coming. Viruses don't lollygag.
Second, we need better worldwide surveillance of deaths and outbreaks. The virus got started in Mexico because few expected an outbreak there, the local authorities were distracted by a ferocious drug war and it's likely unsanitary practices were allowed to flourish at large pig farms.
There are still places in the world where viruses can get a foothold without anyone knowing until it is too late. That number must be reduced to zero.
Third, we don't have enough capacity to make flu vaccine. This is in part because we don't take plain old, seasonal flu seriously despite the fact that it kills a half million people worldwide every year.
Most of those deaths are preventable with flu shots. Too many people -- including doctors, nurses and nursing home aides -- don't get them. If everyone were vaccinated, we would have to make more ordinary flu vaccine. Then, when a really nasty new virus showed up, we would have enough capacity to make a lot more swine or avian flu vaccine because the same factories produce both seasonal and targeted vaccines.
Finally, we need to be ready to coordinate our pandemic plans. A few plans were trotted out by various companies, counties, provinces, states, governments, agencies, institutions, hospitals, professional associations and schools. The problem? They're not all on the same page. In the event of a widespread, deadly outbreak, they must be in sync.
It is easy to yell "hype" when this pandemic seems to be a bit of a fizzle. Think again. A fairly good worldwide response in terms of action and communication should make us all feel a bit less worried when the next viral mutant appears. And important lessons were learned -- we can do even better next time.
AJOB Articles Available Now at pandemic.bioethics.net
Award-winning Target Articles, Editorials, and Open Peer Commentaries from The American Journal of Bioethics are available now at pandemic.bioethics.net. Click on the links below for direct access or visit us at pandemic.bioethics.net or on Facebook.
Politicians are NOT Public Health Officials, But They Try to Play Them on TV!
After Vice President Joseph Biden's gaffe last week when he appeared on the Today Show about not taking public transportation such as subways and airplanes out of concern for being in confined spaces due to the swine flu, he's making up for it now.
Visit msnbc.com for Breaking News, World News, and News about the Economy
According to the L.A. Times Top of the Ticket blog, the V.P. proudly hopped on the Amtrak train in Wilmington this morning to show his confidence for riding in small, confined spaces. Biden, known to be a religious train rider for his 36 years in the Senate, obviously isn't going to let swine flu get him down, his comments about subways and airplanes not withstanding.
Of course, public health officials from the CDC and even the White House Press Secretary scrambled to reassure Americans that it is more than okay to take public transportation and that isolation is only necessary if one has flu symptoms.
My advice: let the public health officials give the advice about swine flu isolation and let the V.P. keep to foreign affairs and other matters of state. Otherwise, we'll all be scared to be on the Amtrak next to Vice President Biden!
Summer Johnson, PhD
Politicians are NOT Public Health Officials, But They Try to Play Them on TV!
After Vice President Joseph Biden's gaffe last week when he appeared on the Today Show about not taking public transportation such as subways and airplanes out of concern for being in confined spaces due to the swine flu, he's making up for it now.
Visit msnbc.com for Breaking News, World News, and News about the Economy
According to the L.A. Times Top of the Ticket blog, the V.P. proudly hopped on the Amtrak train in Wilmington this morning to show his confidence for riding in small, confined spaces. Biden, known to be a religious train rider for his 36 years in the Senate, obviously isn't going to let swine flu get him down, his comments about subways and airplanes not withstanding.
Of course, public health officials from the CDC and even the White House Press Secretary scrambled to reassure Americans that it is more than okay to take public transportation and that isolation is only necessary if one has flu symptoms.
My advice: let the public health officials give the advice about swine flu isolation and let the V.P. keep to foreign affairs and other matters of state. Otherwise, we'll all be scared to be on the Amtrak next to Vice President Biden!
Summer Johnson, PhD
Politicians are NOT Public Health Officials, But They Try to Play Them on TV!
After Vice President Joseph Biden's gaffe last week when he appeared on the Today Show about not taking public transportation such as subways and airplanes out of concern for being in confined spaces due to the swine flu, he's making up for it now.
Visit msnbc.com for Breaking News, World News, and News about the Economy
According to the L.A. Times Top of the Ticket blog, the V.P. proudly hopped on the Amtrak train in Wilmington this morning to show his confidence for riding in small, confined spaces. Biden, known to be a religious train rider for his 36 years in the Senate, obviously isn't going to let swine flu get him down, his comments about subways and airplanes not withstanding.
Of course, public health officials from the CDC and even the White House Press Secretary scrambled to reassure Americans that it is more than okay to take public transportation and that isolation is only necessary if one has flu symptoms.
My advice: let the public health officials give the advice about swine flu isolation and let the V.P. keep to foreign affairs and other matters of state. Otherwise, we'll all be scared to be on the Amtrak next to Vice President Biden!
Summer Johnson, PhD
AJOB Editors' Blog: A Swine Flu Review
Just recap what we have written so far here at blog.bioethics.net:
Caplan: Controlling the Swine Flu Means Looking to Simple, Not Sexy, Lessons from the Past
The Two Ruths Say Wash Your Hands and Don't Panic.
From 1918 to 1976 to Today: A Swine Flu Memoir
Summer Johnson, PhD
Your Source for Swine Flu and Ethics: pandemic.bioethics.net
Launched today, pandemic.bioethics.net is your leading source for bioethics news, commentary and scholarship related to swine flu (H1N1), vaccine research, public health policy and more.
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Available starting today also via our website, AJOB and Taylor and Francis have made available all pandemic-related publications for a six-month period. Links to those publications are available at blog.bioethics.net and pandemic.bioethics.net.
To learn more and to join in on the dialogue, visit us on Facebook, bookmark our URL, or select any of the links above.
Summer Johnson, PhD
Sham Doctor Performed Real Surgeries
He must look old for his age. Otherwise it's almost inexplicable how a 22-year-old Oregon man was able to convince multiple patients that he was a physician, when he has no medical training. The fake physician went so far as to dispense medications and even to perform minor surgeries on at least three of them, reports UPI.
Through a combination of referrals from an accomplice and making house calls, Scott Hanson was able to get away with this for almost eight months, authorities say.
Maybe the next time you go to see a new physician, in addition to getting a physician's referral, perhaps you should ask to see their diploma if it is not already hanging on the wall.
Summer Johnson, PhD
Merck Makes Phony Peer-Review Journal
It's a safe guess that somewhere at Merck today someone is going through the meeting minutes of the day that the hair-brained scheme for the Australasian Journal of Bone and Joint Medicine was launched, and that everyone who was in the room is now going to be fired.
The Scientist has reported that, yes, it's true, Merck cooked up a phony, but real sounding, peer reviewed journal and published favorably looking data for its products in them. Merck paid Elsevier to publish such a tome, which neither appears in MEDLINE or has a website, according to The Scientist.
What's wrong with this is so obvious it doesn't have to be argued for. What's sad is that I'm sure many a primary care physician was given literature from Merck that said, "As published in Australasian Journal of Bone and Joint Medicine, Fosamax outperforms all other medications...." Said doctor, or even the average researcher wouldn't know that the journal is bogus. In fact, knowing that the journal is published by Elsevier gives it credibility!
These kinds of endeavors are not possible without help. One of The Scientist's most notable finds is a Australian rheumatologist named Peter Brooks who served on the "honorary advisory board" of this "journal". His take: "I don't think it's fair to say it was totally a marketing journal", apparently on the grounds that it had excerpts from peer-reviewed papers. However, in his entire time on the board he never received a single paper for peer-review, but because he apparently knew the journal did not receive original submissions of research. This didn't seem to bother him one bit. Such "throwaways" of non-peer reviewed publications and semi-marketing materials are commonplace in medicine. But wouldn't that seem odd for an academic journal? Apparently not. Moreover, Peter Brooks had a pretty lax sense of academic ethics any way: he admitted to having his name put on a "advertorial" for pharma within the last ten years, says The Scientist. An "advertorial"? Again, language unfamiliar to us in the academic publishing world, but apparently quite familiar to the pharmaceutical publishing scene.
It is this attitude within companies like Merck and among doctors that allows scandals precisely like this to happen. While the scandals with Merck and Vioxx are particularly egregious, we know they are not isolated incidents. This one is just particularly so. If physicians would not lend their names or pens to these efforts, and publishers would not offer their presses, these publications could not exist. What doctors would have as available data would be peer-reviewed research and what pharmaceutical companies produce from their marketing departments--actual advertisements.
Summer Johnson, PhD
