Tag: public health ethics

Blog Posts (11)

January 6, 2017

Exercise is good for you and High Heels are not: Health Reports on the Obvious

In a quest for health news which might spark some meaningful topic worth sharing with the Bioethics community, I was repeatedly dismayed at the number of articles offering relatively little useful information at all. In fact, there seemed to be a surprising number of articles that offer scientific support for topics that might be tempting for a superficial glance, but do not add meaningfully to the much broader well-being of individuals and communities. I strongly support using any tools necessary to disseminate health information to persons who may benefit from evidence based health information, but the focus of this effort ought to address more meaningful goals of medicine and human welfare.

An article published in Substance Use and Misuse points out that of the over 15,000 individuals there was no significant relationship between alcohol consumption and physical activity (PA) study link. This article offers common sense health advice for future efforts: “Prevention programs to increase PA levels from low to moderate combined with a reduction of alcohol intake in men who regularly drink alcohol should be considered.” This conclusion is based on the finding that persons who drink heavily also have lower physical activity levels. Hardly seems groundbreaking. Yet, if there had been a correlation suggesting that heavy drinkers are also quite physically active, what would this offer as a useful nugget of health information? Don’t worry about heavy alcohol consumption?

Studying the long term effect of wearing high heel shoes has also gained attention in the media and academic literature. Though, in fairness, I suppose someone has to study it so we can provide evidence based practice considerations to persons who develop foot or ankle problems, or are required to wear high heels as part of a work uniform. “One condition known to compound the difficulty of walking is the use of high heeled shoes.”  study link #2.  I believe all who have worn high heels are likely to agree on this point. The piece does offer some considerations about blood flow to the lower extremities, which could be helpful to physicians treating patients with high heeled related ambulatory difficulties, so a relevant factor in advising patients. Nonetheless, it seems a bit startling that such research is surfacing in the media to answer this question for consumers.  A recent New York Times blog (blogs.nytimes.com/2015/06/17) titled “Reducing the frequency of wearing high-heeled shoes and increasing ankle strength can prevent ankle injury in women” leads off with a critique of having a character run from Jurassic dinosaurs while she is wearing high heels, and offers evidence for negative effects of long term high heeled shoe wearing. Just in case there was any doubt, the article concludes with sound advice for not wearing high heels as the footwear of choice if escaping a fast moving deadly animal.

Media is a powerful too, and so is scientific inquiry. I believe the public can digest more meaningful discussions of health related matters than those which confirm common sense.

 The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

 

 

December 7, 2016

TEDxFordhamUniversity: Lesson in Bioethics Given by Golden Girls | Dr. Elizabeth Yuko

As one of the most groundbreaking sitcoms of all time, The Golden Girls introduced a range of bioethical issues on the show regarding medicine, the human body and women’s health. In this TEDx Talk, Dr. Elizabeth Yuko, a Fordham University Center for Ethics Education  fellow and adjunct professor, discusses how influential Golden Girls was, and still is, … More TEDxFordhamUniversity: Lesson in Bioethics Given by Golden Girls | Dr. Elizabeth Yuko
November 28, 2016

Fordham RETI Fellow Discusses Addiction with U.S. Surgeon General on NPR

Earlier this month, the United States Surgeon General issued a report declaring substance use disorders, like addiction, the “most pressing public health crises of our time.” The report called the country to action to both help those struggling with the chronic illness of addiction and change how addiction in the U.S. is perceived as a “criminal justice problem” rather than … More Fordham RETI Fellow Discusses Addiction with U.S. Surgeon General on NPR
November 11, 2016

Ethics & Society Newsfeed: November 11, 2016

President-Elect Trump and Ethics Trump and Pence on science, in their own words Donald Trump and Mike Pence’s career and campaign track record of false claims about science, rejection of research conclusions and dangerous rhetoric on misconceptions such as vaccines and autism … Continue reading
September 30, 2016

Ethics & Society Newsfeed: September 30, 2016

Technology and Ethics Tech Giants Team Up To Tackle The Ethics Of Artificial Intelligence The Partnership on Artificial Intelligence to Benefit People and Society, consisting of Amazon, Facebook, Google, Microsoft and IBM (with Apple in talks to join), weighs in on the … Continue reading
March 10, 2016

A Shot of Hope: Efforts to Address the Opioid Addiction Crisis

According to the American Society of Addiction Medicine, drug overdose is the leading cause of accidental death in the US with close to 50,000 deadly overdoses in 2015 alone.  Opioid addiction accounted for nearly 20,000 of these and heroin alone was a factor in just over 10,500 deaths. The magnitude of opioid abuse related hospitalizations, sales of prescription pain killers and deaths have increase exponentially between 1999 and 2008 according to ASAM. Increased access to Narcan (naloxone) to reverse life threatening effects of opioid for first responders has now expanded to making Narcan available to the general public as well. In some areas, Narcan can be purchased without a prescription by family members and friends who expect they may need to quickly rescue a loved one. While I support this program because it can and will likely save lives, it does not address the need for effective rehabilitation of persons who suffer the all-consuming and devastating effects of opioid addiction. Regulations which will allow persons with opioid addictions to be detained involuntarily in health care setting are also being discussed, but pose some dilemmas as well.

Massachusetts Governor Charlie Baker has taken a strong stand to help limit access to the powerful pain medication by placing statutory limits on the quantity of opioid pain medication that can be prescribed to a patient to a 72 hour supply the first time opioids are prescribed to them – with exceptions.  Physicians have had a mixed response according the October 2015 Boston Globe article. Some cite that placing prescribing restrictions on prescribing pain killers is an invasion of the state into the doctor-patient relationship and dismisses the clinical judgment of physicians to discern a given patient’s need for pain relieving medications. Others indicate that this is a public health matter and deserves statutory supports as have other issues that post a risk to the wellbeing of the population at large. Who is helped and who is harmed by restricting opioid prescriptions and providing naloxone without a prescription to the public? It seems these are just the tip of the iceberg in terms of a robust program for addressing the opioid addiction crisis in the US. Prevention will be more complicated than limiting the supply that flows from a physicians prescription pad and rescue will ultimately require more than easily access to Narcan.

 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

May 8, 2015

Use of Unproven Interventions is Never Obligatory

<p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">I recently read a paper written by my colleagues at Alden March Bioethics Institute entitled “</span><a style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;" href="/Academic/bioethics/documents/White%2C_Gelinas_%26_Shelton_New_Pub.pdf">In Particular Circumstances Attempting Unproven Interventions and Circumstances is Permissible and even Obligatory</a><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">”. </span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">I do not entirely agree with my colleagues. I do not disagree that there are some very limited circumstances in which unproven interventions are warranted nearly all of which are in the research or compassionate use context. The recent Ebola crisis is an example of that where the use of monoclonal antibodies against the Ebola virus was consistent with theory and prior scientific precedent. However we must balance that against the harm done. The consumption of available ZMapp antibody in compassionate use likely precluded the opportunity to conduct clinical trials in a timely manner to determine if it actually did provide any benefit. Had it been used to prove efficacy it could have justified the investment necessary to prepare it large quantity and let future physicians and patients make informed decisions on its use. Moreover the manner in which the compassionate use was implemented, nearly exclusively available to US and European health care workers and barely any availability to Africans could hardly be considered just. During the next Ebola outbreak we may be faced with the same circumstances because we still do not really know its efficacy. There is now enough ZMaap available to conduct trials and these have been initiated but there may not be enough patients available to conduct them.</span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong><span style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"> </span></p>
February 2, 2015

Immunization Idiocy

<p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">I knew that I was going to write this blog post about the news concerning the resurgence of measles and its relationship to the dangerous and misguided anti-vaccination movement. The difficulty was with all the lunacy out there I did not quite know where to start. I grew up in the era prior to vaccination against childhood diseases. I had measles, mumps, rubella and chicken pox. I remember the fear people had of these infectious diseases and even as a child I was aware of how welcome these immunizations were when they became available. It seems absolutely inconceivable that decades later people are advocating against vaccines and placing their children and others at risk of infection with potentially devastating diseases.</span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">There now seems to be a perfect storm of parents making poor choices for their children, a few vocal physicians giving bad advice, a staggering number of ill-informed celebrities saying truly stupid things, and political cowardice and hypocrisy failing to react appropriately. Let’s talk about the history leading to this unfortunate circumstance. Keep in mind that in the year 2000 measles was considered to have been vanquished in the US. There were a few dozen cases all contracted by people who had travelled overseas. However, these few cases were not transmitted to others because the rate of immunization was so high, despite the high level of contagiousness. This circumstance has now changed with people forgoing the vaccinations and like-minded people creating communities with high levels of the unvaccinated.</span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.0400009155273px; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.0400009155273px; font-size: 12px;"> </span></p>
October 29, 2014

Quarantine: The politics are as real as the science

<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Implementation of medical quarantines in America brings into conflict various legitimate arguments regarding who, if anyone, should have the authority to restrict movements of citizens.</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">Quarantines are not new, but they exist now in a world with new dangers and new opportunities for abuse.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">In teaching medical students in recent years, it became apparent that many students found the concept of a home quarantine to be abhorrent.</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">Many were aghast at the concept that a patient could be restricted from daily activities, and found it an egregious violation of civil liberties and ethical conduct.</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">Interestingly, these views were often </span><span style="line-height: 19.0400009155273px; text-decoration: underline;">not</span><span style="line-height: 19.0400009155273px;"> mitigated substantially when students were informed that, in former days, quarantines were fairly common in this country and elsewhere.</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">In a world before the Internet in which home confinement was really quite restrictive, medical quarantines for diseases such as small pox, tuberculosis, or even measles were not uncommon.</span><span style="line-height: 19.0400009155273px;"> </span><span style="line-height: 19.0400009155273px;">Such quarantines were usually imposed by a local health official.</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">In addition, many families self-quarantined, or at least avoided exposure to potential sources of disease.</span><span style="line-height: 19.0400009155273px;"> </span><span style="line-height: 19.0400009155273px;">For example, some people used to avoid many summer activities for fear of contracting polio.</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">Due largely to the development of vaccination, many of the diseases that would have invoked a quarantine in earlier years are no longer of concern, and the concept of quarantine has become a bit anachronistic, even in a world that offers many portals that would seemingly make confinement less onerous.</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">But the topic of quarantine requires renewed consideration in the world of today.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
April 11, 2014

Does More Information Help Us Settle Factual Disputes?

<p>In my <a href="/BioethicsBlog/post.cfm/public-health-education-is-presenting-the-facts-enough">last blog</a> I alluded to the effect of an assumed point of view, particularly a set of ideological set of assumptions around which a community is organized, has on the way we interpret data about how we perceive risks and benefits and make decisions about a range of issues.  I was applying this perspective to public health perspectives such as the risks of gun ownership and forgoing vaccinations. In this blog, I will sketch out a theoretical approach for how humans process and understand information a bit more and conclude with some questions for my next blog about how to understand the obligations of those who are in the best positions to understand public health data, such as the better educated and healthcare workers.</p> <p class="MsoNormal">We often assume that most people are capable of coming to objective and fair beliefs and reasonable decisions about various empirical topics, e.g. the effects of climate change, if only we have access to valid, scientific information.  Thus, we often further assume that the goal of having more enlightened people to make more enlightened decisions about public health issues, or for that matter political issues and most other issues of public interest, is simply a matter of bringing to bear more complete and clear knowledge for people to understand. This is the assumption that Dan Kahan (a law and psychology professor from Yale Law School) and his research team calls the “More Information Hypothesis”. However recent research shows that this hypothesis is simply not true—in fact the more information people on opposite sides of an issue get, the more divided and intractable the conflict becomes. The simple fact of making more information accessible clearly does not resolve most public issues that are connected to well-established ideological and philosophical perspectives.</p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>

View More Blog Entries

Published Articles (2)

American Journal of Bioethics: Volume 11 Issue 5 - May 2011

Mobile Contact Tracing and Counseling for STI's: There's Not an App for That

American Journal of Bioethics: Volume 10 Issue 11 - Nov 2010

Review of Brad Spellberg, Rising Plague: The Global Threat from Deadly Bacteria and Our Dwindling Arsenal to Fight Them