Quiz Jan 31

Research

Today in Bioethics we'll talk "research." Things like clinical trials and research involving animals and their rights, and genetics, and epidemiology. We'll look at the funding gap between what we need to cure and where our research dollars are actually going, and at the moral imperative of genuine and informed consent. We'll look at disturbing instances of fraudulent and dishonest research. And we'll consider Peter Singer's claims about "speciesism."


The future of research is a daunting source of apprehension and speculation. Michael Sandel and Bill McKibben have aired serious concerns about genetic and other "enhancement" research as potentially catastrophic for our capacity to achieve or even recognize "meaningful" lives. Enhanced may not mean improved.

1. Name one of the basic requirements agreed upon by all codes devised to protect individuals from malicious research.

2. What decree states that consent must be gained in all experimentation with human beings?

3. Name one of four areas of research discussed in the book.

4. Which famous contemporary ethicist is a sharp critic of speciesism?

5. Name one of four R's used in international legislation pertaining to animal rights in research?

6. Dilemmas in epidemiological research illiustrate what general point?

7. What did Hwang Woo-suk do?

8. What is the term for altering the numbers in a calculation to make the hypothesis more convincing, with no justification form the research findings for such members?

9. What categories of human enhancement does Campbell enumerate, and what does he identify as its "extreme end"?

10. What is the "10/90 Gap"?

DQ:

• Can there really ever be "fully informed" voluntary consent, given the many unknown variables and unpredicted consequences involved in most research?
• Discuss: "Trials of pharmaceuticals may be driven as much by commercial considerations as by the likelihood of real therapeutic gain." 122
• What concerns do you have about the use of animals in medical research? Is speciesism one of them? 10 medical breakthroughs due to animal testing... PETA... Touring an animal research facility
• What limits, if any, would you like to see imposed on genetic research and the uses to which it may be put?
• Were ethical improprieties committed in the case of Henrietta Lacks, whose cells (HELA cells) were harvested without her consent? (Rebecca Skloot... BBC...CBS...)
• If "dreams of perfect health by the better-off will determine the research agenda" in the future, resulting in soaring health care costs and greater health "enhancement" opportunities for the wealthy, what should be done to insure adequate attention to "the health problems of most of the world's population"? 129
• Should we be worried about a "Prozac revolution" and a "brave new world" of somatically-induced apathetic bliss? 130
• Would you give special priority to any of Campbell's five enhancement categories (130)? Is "Transcendence"-style enhancement beyond the realm of reasonable concern (given the considerable monied interest of people like Larry Page)? 
• Comment: "Why would we want such a 'posthuman' future? Are our lives better if we become physically stronger or more agile, or have an increased intelligence, or live for centuries?" 131
• Is the outsourcing of clinical drug trials to developing countries ethically defensible? 132
• How would you propose making research priorities "aligned to the needs of the majority"? 133
• Is it likely that biobanks and other communitarian initiatives will in the future "prioritize health research according to need rather than profit," particularly in the U.S.? Would you support such a reprioritizing? How?
• Have you seen Sicko? Care to share a review? Or of Michael Moore's latest doc'y?

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Also of note:

To enhance your SuperBowl experience-

I’m the Wife of a Former N.F.L. Player. Football Destroyed His Mind.
By EMILY KELLY FEB. 2, 2018. Continue reading the main story

&

	The New York Times (@nytimes)
2/3/16, 6:05 AM N.F.L. Great Ken Stabler Had Brain Disease C.T.E. nyti.ms/1R1vYYw

& see Against Football: One Fan's Reluctant Manifesto
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A Doctor’s Painful Struggle With an Opioid-Addicted Patient https://nyti.ms/2GBDmIR==
Michael Chabon, The Recipe for Life, New Yorker 2.5.18.
“You want to be a doctor, too?” the patient asks me, pushing up his left shirtsleeve the way my father has instructed him to do. He is an older man with jowls and a silvery crewcut, wearing a short-sleeved shirt and a necktie, and he is pinned to a kitchen chair by the boulder of his abdomen. The tap drips water into a cup in the kitchen sink. The smell of the patient’s dinner lingers, raw meat and fat against cast iron.

When I don’t immediately reply to his question, the patient looks up at my father, who has come to his home this evening to conduct an insurance physical. My father reaches into his black bag for his sphygmomanometer, unrolls the cuff, and uncoils the rubber tubing. Like many young doctors not long out of medical school, he supplements his income with these in-home exams. After putting in a full day as a pediatrician at the Phoenix Indian Hospital, where he has been posted by the U.S. Public Health Service, he comes home just long enough to shower and shave for a second time, change his shirt and tie, and grab a quick bite. Then he heads back out to perform exams for one of the big insurance companies, often taking me with him. Sometimes, as we did earlier tonight, we forgo dinner at home and stop at our favorite restaurant, a Mexican place called Ricardo’s.

“Cute little guy,” the patient says to my father in a confidential tone, then calls to me, parked in a corner on another kitchen chair, “You want to be a doctor, eh? Just like your daddy?” Trying again—maybe I didn’t hear him the first time.

I take my sphygmomanometer out of my black bag. Unlike my father’s, with its rubberized canvas cuff, sturdy squeeze bulb, and steel-and-glass gauge, mine is made entirely of brightly colored thin plastic, like my Taylor hammer, my otoscope, my syringe, and the stethoscope that I wear dangling like a pendant necklace, the way my father does, with the earpieces pincering my neck. My black bag is plastic, too, a flimsy, lightweight affair with none of the pachyderm heft and dignity of my father’s. The mouth of my father’s bag opens and closes smoothly on the hinges of a secret armature, clasped by a heavy brass tongue that slides home with a satisfying click. Mine pops open when you flip a plastic tab that has begun to shear loose and will soon snap off. A vial of candy “pills” was the sole advantage that my black bag possessed over my father’s, but I have long since prescribed and administered them to myself. The empty vial rolls around at the bottom of the bag.

I hunch my shoulders, racked with the dreadful hope that the patient will invite me to come over and “check” his blood pressure. I squeeze the bulb of my gimcrack instrument. I don’t feel that the word “cute” suits either me or the gravity of the situation. On my previous outings, a few patients have allowed me to pretend to stick them with my needleless needle and to hear their heart beat through my sham stethoscope. There is nothing that I want more than for my presence to be taken seriously, and nothing that can render me more painfully aware of my fraudulence. The truth is, I don’t especially want to be a doctor when I grow up. Or, rather, I’ve come to understand that while my presence at these house calls may be cute, or amusing, it is in no way promising:I know that I am not really cut out for the job.

Based partly on direct observation and partly on his tales of his own medical prowess, I have already formed the impression that my father is an excellent doctor. Though he will, in other ways, disappoint, disillusion, or unfavorably surprise me in the coming decades, this impression will stand. In his hospital tales, my father stars as a first-rate diagnostician with a near-Holmesian power for inferring rare or easily missed pathologies from the slightest of symptoms. As a small boy, I have no way (and no desire) to disprove these claims; I have to take his word for them. (Though I have observed that, whenever a patient on a TV show like “Marcus Welby, M.D.” or “Ben Casey” presents with odd symptoms, my father always makes what proves to be the correct diagnosis long before the first commercial break.)

But I have been an eyewitness to a number of displays of my father’s other remarkable skill as a doctor, one that mysteriously is never the focus of his storytelling: an uncommon gift for reassurance, for making his patients feel that he registers and sympathizes with their pain or discomfort and their anxieties about treatment itself; that he is really listening to them, really seeing them... (continues)==
For people with severe health anxiety, the Internet can be a terrible place
Searching online for health information can magnify the pool of potential problems to worry about, and researchers use the term “cyberchondria” to describe the interplay between health searches and health anxiety. By Emily Sohn
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It's the birthday of the first woman to graduate from medical school, Elizabeth Blackwell, born on this day in Bristol, England, in 1821. She wanted to become a doctor because she knew that many women would rather discuss their health problems with another woman. She read medical texts and studied with doctors, but she was rejected by all the big medical schools. Finally the Geneva Medical College (which became Hobart College) in upstate New York accepted her. The faculty wasn't sure what to do with such a qualified candidate, and so they turned the decision over to the students. The male students voted unanimously to accept her. Her classmates and even professors considered many medical subjects too delicate for a woman, and didn't think she should be allowed to attend lectures on the reproductive system. But she graduated, became a doctor, and opened the New York Infirmary for Women and Children. WA Feb3

• Researchers are seeking drugs that can slow the rate of aging and the development of the debilitating chronic ailments that typically accompany it.

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IACUC - Institutional Animal Care and Use Committee

The Institutional Animal Care and Use Committee (IACUC) is a regulatory body comprising MTSU faculty who are appointed by the University's President through the recommendations from the Institution's Faculty Senate. The IACUC is responsible for reviewing the activities that involve the use of animals to enforce humane & ethical practices to be adopted by the University employees. MTSU adopts the following minimum requirement for the Committee's constitution thereby complying with the requirements of both USDA and PHS...

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Neil Gorsuch wrote the book on assisted suicide. Here’s what he said.

Not since 2006 has the Supreme Court taken up a case involving “death with dignity” legislation — the handful of state laws that allow people to end their lives with the help of a physician. That year, the court handed a victory to death with dignity advocates, ruling that the attorney general could not bar doctors in Oregon — the first state to pass such a law — from giving terminally ill patients drugs to facilitate suicide.

It was only the third time the court had heard a case challenging such statutes, and the six-member majority tread lightly, recognizing the sensitivity of the issue.

“Americans are engaged in an earnest and profound debate,” the majority wrote, quoting from a previous opinion, “about the morality, legality, and practicality of physician-assisted suicide.”

That debate is far from resolved today — and it’s one Neil Gorsuch, President Drumpf’s nominee to the high court, will surely be eager to weigh in on, should he win confirmation.

Gorsuch, a 49-year-old federal appeals court judge from Colorado, was tapped by Drumpf on Tuesday to replace Justice Antonin Scalia, who died last year after three decades on the Supreme Court. Aside from his bona fides as a lawyer and a jurist — which may all but guarantee a favorable vote in the Senate — Gorsuch has cultivated something of an expertise in assisted suicide and euthanasia in his legal career.

[Drumpf picks Colo. appeals court judge Neil Gorsuch for Supreme Court] 

In 2006, the year he was nominated to the federal bench, he released a heavily researched book on the subject titled “The Future of Assisted Suicide and Euthanasia.” The front cover looks almost like a Tom Clancy novel, with purple all-caps block text set against a black background. But the book itself is a deep, highly cerebral overview of the ethical and legal debate surrounding the practices... (continues)