Get Published | Subscribe | About | Write for Our Blog    

Blog.

Monthly Archives:

In the Vancouver Olympics, Canada is tied for the most gold medals as of this writing. Will Canada also "own the podium" when it comes to providing a clear and effective voice for ethical human research?Recall that, in a previous post, I mentioned that...

Full Article

In the Vancouver Olympics, Canada is tied for the most gold medals as of this writing. Will Canada also "own the podium" when it comes to providing a clear and effective voice for ethical human research?Recall that, in a previous post, I mentioned that...

Full Article

What's the difference between testing a typical small molecule drug, and testing a novel cell therapy strategy? And where might the latter raise ethical challenges that the former doesn't? These questions are extensively discussed in my book, and given human drama in a recent story by Jennifer Couzin-Frankel in the Feb 12, 2010 issue of Science ("Replacing an Immune System Gone Haywire").

Couzin-Frankel describes the numerous difficulties that researchers have faced in attempting to validate autologous bone marrow transplantation for the treatment of (often nonlethal but highly debilitating) autoimmune disorders like type 1 diabetes, Crohn's disease, and multiple sclerosis. The idea of this procedure is to "reset" the immune system by purging patients of their bone marrow cells, and then returning healthy bone marrow to them. The approach has shown some promise for certain autoimmune disorders. However, response is highly variable and unpredictable, and validating and applying bone marrow transplantation for autoimmune disorders is beset by numerous ethical and logistical difficulties.

A major one is the risk-benefit balance: bone marrow transplantation requires exposing patients to the dangers of the transplantation procedure (6.6% mortality in one report of lupus patients). And yet, the procedures appear to work better in patients whose disease is not yet advanced. Testing the procedure therefore requires recruiting more or less healthy, at risk patients (sometimes children) into studies that expose them to serious risk of mortality. Clinicians understandably balk at referring their patients to such studies, making recruitment very difficult.

A second challenge is funding: many of these approaches involve using the patient's own bone marrow cells. There is nothing to patent-- and hence, little commercial interest in bone marrow transplantation for autoimmune disorders. This deprives this promising line of research needed resources.

And all this creates the perfect storm for a series of ethical challenges not directly addressed in this article (but covered in my book and articles): the siting of such studies in low and middle-income settings. Prohibitive costs, plus extreme difficulty recruiting patients who are otherwise eligible for somewhat effective and extremely expensive monoclonal antibody therapies, makes the siting of such trials in economically disadvantaged settings very attractive. This gives rise to what I have elsewhere called "expedient" justification for recruitment. Not surprisingly, then, one of the first trials of the procedure was performed in Brazil, and the article closes by mentioning that ongoing trials involving high-income country researchers are recruiting from São Paulo, Prague, China, and Argentina. This is good news if people in those settings have a reasonable prospect of having widespread and affordable access to bone marrow transplantation once it becomes validated. But it is troubling indeed if people in these countries will be bearing considerable burdens for the sake of knowledge benefits that will primarily (or most expeditiously) accrue to patients in high-income settings. (photo credit: Wellcome Images, Compact Bone, 2009)

Full Article


PhotoGlennMcGee.112309.JPG

First published in the St. Louis Post-Dispatch and then the Washington Post, Glenn McGee makes the provocative claim that American Catholics aren’t any more likely to follow the most recent edict from the Vatican that Catholics should not use IVF for reproduction than they are heeding admonitions against using birth control.

The statistics say that only 4% of married Catholic couples use natural family planning–so what do you think the rest of them are using? So to extrapolate, what do you think that Catholic couples having trouble with fertility are going to do? Listen to Rome and not have a child or go see a fertility specialist and use reproductive technologies?…

Full Article


At last we’ve found a few minutes to assemble the archive of The American Journal of Bioethics Editors’ blog through 2007 and publish them in an accessible venue. If you get nostalgic for the days when we translated documents about the Korean stem cell scandal, or those glorious years of the neocon bioethics movement, drop by and shuffle through thousands of posts on every topic in bioethics. Especially the “this didn’t really happen, did it?” chapter in the history of bioethics: who can forget, for example, that sunny morning when the President’s Commission on Bioethics’ chairman lobbied in the Senate Chambers bearing a paper copy of “the Bush 2nd term agenda for bioethics?”

Back then, everyone else had to identify that they weren’t an editor, except, um, the editor.…

Full Article

Why do patients cooperate with medical researchers? So asks sociologists Mary Dixon-Woods and Carolyn Grant in a study analysis appearing in the June 2009 issue of Social Science and Medicine. You might think the answer is simple: they think they will...

Full Article


Texas nurse Anne Mitchell has won a victory for whistleblowers everywhere after being sued under Texas law for reporting the physician she worked for as being malpracticable using confidential information.

He said that she had ruined his reputation, that she was malicious and had inappropriately used records to which she had access. I mean, how dare she? She’s a nurse! What is she doing looking through those medical records?

Apparently this doctor wouldn’t know a lot about medical ethics and records. He had previously been dinged by the Texas Medical Board in 2007 for $1,000 and “continuing medical education in the area of ethics, medical records and the treatment of obesity.”

1_Nurse_Acquitted.sff_300.jpg

Mitchell in her letter had claimed a set of 6 additional, more recent violations.…

Full Article


What do you do when you are a Catholic hospital in value conflict? Ignore the Pope or ignore the indigent, the needs of American Catholics for birth control and abortions, and healthcare generally in conflict with the edicts of Rome?

It’s a tough call, but according to Jacob Appel today on the Huffington Post the saving grace is that doctors in these hospitals are still bound by the same ethical guidelines regardless of the kind of hospital they are working in, Catholic or not.

And thank goodness, I would really hate to have the Pope governing my healthcare decisions. So if you have to go to a Catholic healthcare institution, be glad that there are medical ethics guidelines for your healthcare professionals.…

Full Article


PhotoGlennMcGee.112309.JPG

Well, your first answer chould be, “Doesn’t everyone?”

But if the actual answer is, “I haven’t a clue”, then click on this link.

McGee, the John B. Francis Chair in Bioethics at the Center for Practical Bioethics, will discuss how science is giving us an opportunity, if not to actually live forever, to live an additional 25, 50, or 100 years in his inaugural lecture on February 24th at 6 PM.

But before you grab for that stem cell smoothie, McGee will ask his audience to grapple with many of the questions, not only of can we but of ought we extend our lives.…

Full Article


As Arthur Caplan tells us in this week’s MSNBC column, one bad study and a zealot’s pursuit of a theory can lead an entire movement and entire generation of parents astray. This is, in effect, what Andrew Wakefield did with his now thoroughly debunked theory about the link between MMR vaccines and autism.

To read the column on the web, click here or read it in its entirety below.

Summer Johnson, PhD

How a zealot’s word led us astray on autism
A dozen years ago, a British physician named Dr. Andrew Wakefield published a paper in the prestigious medical journal The Lancet that did immeasurable harm to children.…

Full Article