Yale Friday Newsletter – 12/07/12

Enjoy this week’s Friday Newsletter from Yale’s Interdisciplinary Center for Bioethics.  As always, slightly edited for our readership.

Center Director Steve Latham shares the following:

And Associate Director Carol Pollard shares her great selection of this week’s articles: click here.

Bioethics Center Events

 Monday, December 10 at 4:15 PM

Special Tech & Ethics Panel Discussion
Location: 77 Prospect St, room A002

Panelists: Dirk Jameson, Lt. General U.S. Air Force, Ret.

     Dennis Gormley, University of Pittsburgh

     Oona Hathaway, Yale Law School

     Wendell Wallach, Yale Interdisciplinary Center for Bioethics

Moderator: Stephen Latham, Director, Yale Interdisciplinary Center for Bioethics
Topic: Terminating the Terminator: A Proposal for an Executive Order Limiting the Development of Autonomous Killing Machines

Wednesday, December 12 at 4:15 PM

Tech & Ethics group
Location: 77 Prospect St, room A002
Speaker: Ellen Matloff, Research Scientist in the Department of Genetics, and Director of Cancer Genetic Counseling, Yale Cancer Center/Yale School of Medicine
Topic: Direct-to-Consumer Genetic Testing: Helpful, Harmful or Pure Entertainment?

This Week on Campus

Conferences & Off-Campus Events

Grants & Fellowships

Harvard Medical School/Brigham and Women’s Hospital Fellowship in Pharmaceutical Law and Health Services Research

The Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital Department of Medicine and Harvard Medical School invites applications for a new postdoctoral fellowship in pharmaceutical law and health services research. Areas of focus include regulation, intellectual property, and comparative effectiveness, as well as the development, approval, and evidence-based use of drugs, devices, vaccines, procedures, or diagnostics. Applications are invited from scholars with doctoral degrees (M.D., J.D., Ph.D., Pharm.D., or equivalent) or who will complete such training by July 2013. Fellows will have an appointment at Harvard Medical School, receive close mentorship from faculty members in the Division, and engage in one or more projects intended to start their careers in law and public health research. Appropriate candidates will also be able to enroll in the Harvard School of Public Health summer Clinical Effectiveness Program with the option to pursue a Master’s degree in public health. Deadline is March 1, 2013. Email Aaron Kesselheim, M.D., J.D., M.P.H. at akesselheim@partners.org for more information.

Centers for Water Research on National Priorities Related to a Systems View of Nutrient Management

Solicitation Closing Date: January 15, 2013, 11:59:59 pm Eastern Time
The U.S. Environmental Protection Agency (EPA) as part of its Science to Achieve Results (STAR) program is seeking applications to establish Centers to conduct water research and demonstration projects that are innovative and sustainable using a systems approach for nutrient management in the Nation’s waters. This Request for Applications (RFA) is soliciting proposals that take a systems view of nutrient management.  A systems view of nutrient management considers every potential link in the breadth of possibilities that may influence water quality.  These involve societal and technological considerations and may include, but are not limited to:  local resources, prevailing land uses, watershed health, manure management, energy costs, municipal wastewater treatment, in-building water reuse, or nutrient resource recovery.  A systems view would also consider valuation of monetized and non-monitized possible co-benefits and consequences (e.g., decreased sediment runoff, improved recreational value) which may be part of a nutrient management program.

Proposed research areas should include:

  • Science to achieve sustainable and cost effective health and environmental outcomes as part of water management.
  • Demonstration projects to support efficacy of water management systems with and beyond current technology and information at appropriate scales.
  • Community involvement in the design, acceptance and implementation of nutrient management systems.

Successful applicants will develop a multi component framework for research and development activities with a systems view of nutrient management. This framework will support restoration of watersheds; promote attainment of designated uses; encourage water reuse and recovery; provide environmental, economic and social benefits; and identify associated costs across community cohorts including those of limited means. Eligible applicants include public nonprofit institutions/organizations (includes public institutions of higher education and nonprofit hospitals) and private nonprofit institutions/organizations (includes private institutions of higher education and nonprofit hospitals) located in the U.S.  State, local, and tribal governments are not eligible to apply under this solicitation. However, cooperative partnerships among the eligible lead grant recipient with academic, state, local, tribal and non-profit organizations to conduct research, development and field application of innovative water management are strongly recommended as they are important for successful applications. All applications should demonstrate community engagement as part of their project design. Collaboration amongst institutions/organizations is key to carrying out the water management research and demonstration envisioned in this RFA.  Organizations with complementary capacities can provide the integrated and multi-disciplinary research, development and demonstration of innovative and sustainabile research and development necessary for this RFA. Groups of two or more eligible applicants may choose to form a consortium and submit a single application for this assistance agreement.  The application must identify which organization will be the recipient of the assistance agreement and which organizations(s) will be subawardees of the recipient.  Click here for more information. You are invited to attend an EPA hosted Webinar for potential applicants to our RFA for Centers for Water Research on National Priorities Related to a Systems View of Nutrient Management. The webinar will be held on December 13, 2012, 2:30-3:30 pm EST.  You will learn about the major research elements of the RFA, administrative, electronic filing, eligibility, and peer review concerns, and will be able to get answers to frequently asked questions.

Calls for Papers & Nominations

Employment Opportunities

Commission Accepting Applications for a Public Health Scientist

The Presidential Commission for the Study of Bioethical Issues advises the President on bioethical issues that emerge from advances in biomedicine and related areas of science and technology. The Commission works with the goal of identifying and promoting policies and practices that ensure scientific research, health care delivery, and technological innovation are conducted in an ethically responsible manner. he Commission staff performs original, archival and literature-based research, as well as policy analysis to inform the deliberations of the Commission. The current topic under consideration by the Commission is the ethics of the development of medical countermeasures in children. In order to fulfill our mission, we are recruiting for a PhD-level public health scientist with strong writing skills who has demonstrated interest or experience in bioethics or ethics. Anticipated work will include research, writing, meeting preparation, and other projects as needed. This person should currently reside in or be willing to relocate to Washington, DC and be able to work full time. Applications will be accepted through close of business January 11, 2013.

Please send cover letter, resume, 1-2 writing sample(s), and 3 references with contact information to:

Esther Yoo
Committee and Staff Affairs
Presidential Commission for the Study of Bioethical Issues
1425 New York Avenue, NW C-100
Washington, DC 20005
Esther.Yoo@Bioethics.gov

Applications by email are preferred.

In the News

Liptak, Adam. Supreme Court to Look at a Gene Issue. New York Times. 30 November 2012.

Supreme Court announced on Friday that it would decide whether human genes may be patented. The case the court added to its docket concerns patents held by Myriad Genetics, a Utah company, on genes that correlate with increased risk of hereditary breast and ovarian cancer. Continue reading…

Disability

Davidson, Joe. Lack of Autism Coverage Leaves Parents Upset. The Washington Post. 4 Decmeber 2012.

At first glance, the Office of Personnel Management’s decision to permit the Federal Employees Health Benefits Program (FEHBP) to cover a certain autism treatment next year seemed like an important step forward. More than 30 states already mandate insurance coverage of Applied Behavior Analysis (ABA), so it appeared that Uncle Sam is finally catching up. Continue reading…

Kelland, Kate. Disability expected to rise as more premature babies survive. Reuters. 4 December 2012.  Little progress has been made in improving the long-term health of extremely premature babies, and with pre-term births on the rise across Europe, rates of serious disability are likely to increase, doctors said on Wednesday. A decade of advances in medicine mean more babies born at between 22 and 26 weeks gestation manage to survive, but rates of severe health complications remain as high as they were in 1995, according to research by neonatal specialists in Britain. Continue reading… 

Drugs & Pharmaceuticals

Battista, Judy. Drug of Focus is at Center of Suspensions. New York Times. 1 December 2012.  The first time Anthony Becht heard about Adderall, he was in the Tampa Bay locker room in 2006. A teammate who had a prescription for the drug shook his pill bottle at Becht. “ ‘You’ve got to get some of these,’ ” Becht recalled the player saying. “I was like, ‘What the heck is that?’ He definitely needed it. He said it just locks you in, hones you in. He said, ‘When I have to take them, my focus is just raised up to another level.’ ”Continue reading… 

Stein, Rob. Genome Sequencing For Babies Brings Knowledge And Conflicts. NPR. 3 December 2012.

When Christine Rowan gave birth prematurely in August, her new baby was having problems breathing. So Rowan brought her daughter, Zoe, to the Children’s National Medical Center in Washington, D.C., for genetic testing. “It’s funny because when we first had the testing done, we didn’t even really think about the fact the testing was going to lay out all of her DNA,” says Rowan, 32, who lives in Northern Virginia. But while Rowan and her husband were waiting for the results, questions started popping into their heads. Continue reading…

Binge-drinking gene discovered. BBC. 3 December 2012.

Scientists believe some people have a gene that hard-wires them for binge drinking by boosting levels of a happy brain chemical triggered by alcohol. The gene – RASGRF-2 – is one of many already suggested to be linked with problem drinking, PNAS journal reports. Continue reading… 

Health Care

Creswell, Julie and Reed Abelson. A Hospital War Reflects Bind for Doctors in the U.S. New York Times. 30 November 2012.

For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments. Continue reading…

Law and Bioethics

Stempel, Jonathan. Court voids drug rep’s conviction, cites free speech. Reuters. 3 December 2012.

A divided federal appeals court on Monday threw out the conviction of a sales representative for promoting off-label use of a prescription drug, a ruling that could make it harder for the government to police how drugs are marketed and sold. Continue reading…

Rose, Joel. New York, Orthodox Jews Clash Over Circumcision. NPR. 3 December 2012.

An ancient circumcision ritual is at the center of a present-day legal battle in New York.  The New York City Department of Health wants to require parental consent for a controversial circumcision practice, which it says can spread the herpes virus. But several Jewish organizations are suing to block the new rule, which they say violates their freedom of religion. Continue reading…

Medical Ethics

Hallman, Ben. Doctors Who Advise Wall Street Investors Operate in Ethical Grey Zone. Huffington Post. 27 November 2012.

Once upon a time on Wall Street, the enterprising trader looking for a nugget of inside information about a public company worked the phones, developed sources at law firms and pestered friends and family for tips. According to allegations made in a recent $276 million insider trading fraud lawsuit — and several other high-profile cases in recent years — the aspiring fraudster now has an easier path: hire an “expert network” company to find those sources.Continue reading…

Schultz, David. Medical Residents Work Long Hours Despite Rules. NPR. 5 December 2012.

More than 10 years after she was a internal medicine resident, Dr. Vineet Arora still thinks about how her shifts used to end. She says the best shift change was one that didn’t require her to transfer single patient to the next bunch of residents. “A good sign out was ‘nothing to do,’ ” she recalls. “When I trained, you worked here until your work was done.” Continue reading…

Reproduction

Gallagher, James. Fertility treatment ‘asthma link.’ BBC. 5 December 2012.

Children born after fertility treatments, such as IVF, may have a slightly higher chance of developing asthma, research suggests. In a study of more than 13,000 UK children, five-years-olds were about twice as likely to have asthma if they were not conceived naturally. Continue reading…

Technology

Battle ready? The Economist. 17 November 2012.

With its deafening explosions, searing fires, dismembered corpses and stench of death, war pushes everyone it touches to the brink. Most recover naturally. Some, though, suffer psychological injuries that do not heal. The names of these injuries have changed. Once they were known as shell-shock; then as battle fatigue; then as combat stress reaction. Now, the preferred term is post-traumatic stress disorder. But whatever they are called, they are worryingly common. About 17% of American troops returning from Iraq and 11% of those coming back from Afghanistan suffer from them. Continue reading…

Hafner, Katie. For Second Opinion, Consult a Computer. New York Times.  3 December 2012.

The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data. And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare. Continue reading…

In the Journals

Carter, Adrian. Emerging neurobiological treatments of addiction: Ethical and public policy considerations. Addition Neuroethics.  2012.

Neuroscience promises to revolutionize society’s ability to assist addicted individuals to abstain from using drugs and, more controversially, to provide a cure for addiction. However, addiction is a highly stigmatized condition that elicits strong moral and political responses. Addiction treatment also serves both therapeutic and criminal justice aims that can influence how medical technologies are used. It is therefore important that society considers the socio-ethical context in which these technologies will be used. This chapter identifies several ethical and social imperatives when considering the use of emerging neurotechnologies. It is important that they are used with the primary aim of treating an individual, and are rigorously evaluated for safety and efficacy in the same way as other medical interventions. Clinicians, policy makers and addicted individuals need to understand that these treatments will not be magic bullets that obviate the need for well-resourced treatment programs and ongoing psychosocial support. Continue reading…

Garchar, Kim. Imperfection, practice and humility in clinical ethics. Journal of Evaluation in Clinical Practice. September 2012.

In this essay, I provide a description of the discipline of ethics using the philosophies of Aristotle and the American pragmatist John Dewey. Specifically, I argue that ethics is an active undertaking that is ambiguous and pluralistic. I then normatively prescribe the way in which clinical ethicists ought to approach their work in medicine. Rather than endeavouring to become, or behaving as if they are, experts, clinical ethicists must be humble. They must practise ethics. That is, they must admit ethics is the study and pursuit of the good life but that this study and pursuit occurs imperfectly in the face of problematic situation. Continue reading…

Hall, Wayne. Technical, Ethical and Social Issues in the Bioprediction of Addiction Liability and Treatment Response. Addition Neuroethics. 2012.

Advances in research on genetic and neurological biomarkers for alcohol and nicotine dependence may improve the prevention and treatment of addiction. This chapter reviews research on genetic screening for addiction liability and the use of genetic information to select addiction treatments (pharmacogenetics) for alcohol and nicotine dependence, and discusses the ethical and public policy issues that may arise from the use of these technologies. It considers whether genetic information maybe misused by third parties to discriminate against individuals, “medicalize” drug use, increase stigmatization and discrimination of drug-dependent people, be subversively used by marketers of addictive commodities to undermine effective public health strategies to reduce population-level harms from alcohol and cigarettes, and be prematurely commercialized in the form of direct-to-consumer tests. Evaluations of the future utility of genetic, pharmacogenetic and neuroimaging prediction in the field of addiction require substantial investments in research and development and health services evaluation. Continue reading…

Lipworth, Wendy. Meaning and value in medical school curricula. Journal of Evaluation in Clinic Practice. September 2012.

Rationale, aims and objectives: Bioethics and professionalism are standard subjects in medical training programs, and these curricula reflect particular representations of meaning and practice. It is important that these curricula cohere with the actual concerns of practicing clinicians so that students are prepared for real-world practice. We aimed to identify ethical and professional concerns that do not appear to be adequately addressed in standard curricula by comparing ethics curricula with themes that emerged from a qualitative study of medical practitioners. Method: Curriculum analysis: Thirty-two prominent ethics and professionalism curricula were identified through a database search and were analyzed thematically. Qualitative study: In-depth, semi-structured interviews were conducted with 20 medical practitioners. Participants were invited to reflect upon their perceptions of the ways in which values matter in their practices and their educational experiences. The themes emerging from the two studies were compared and contrasted. Results: While representations of meaning and value in ethics and professionalism curricula overlap with the preoccupations of practicing clinicians, there are significant aspects of ‘real-world’ clinical practice that are largely ignored. These fell into two broad domains: (1) ‘sociological’ concerns about enculturation, bureaucracy, intra-professional relationships, and public perceptions of medicine; and (2) epistemic concerns about making good decisions, balancing different kinds of knowledge, and practicing within the bounds of professional protocols. Conclusions: Our findings support the view that philosophy and sociology should be included in medical school and specialty training curricula. Curricula should be reframed to introduce students to habits of thought that recognize the need for critical reflection on the social processes in which they are embedded, and on the philosophical assumptions that underpin their practice. Continue reading…

Opinion

The Age Australia

Medew, Julia. Surgery waiting times to double. December 5, 2012.

Elective surgery waiting lists are likely to ”explode” due to funding cuts at Victorian hospitals and no patient will be spared longer waits, including children and cancer patients, surgeons warn. Continue reading…

Ars Technica

Mattise, Nathan. APA to drop “Asperger’s syndrome” from its diagnostic manual. December 3, 2012.

The American Psychiatric Association will publish a new diagnostic manual in May 2013 and this edition will contain the APA’s first major rewrites in 20 years according to the Associated Press. A group of psychiatric board trustees met Saturday outside of Washington, DC to approve the changes. Continue reading…

The Independent

 Barker, Memphis. Step one in the organ donation crisis. December 5, 2012.

Going by surveys, there’s no real need to talk about organ donation. 90 per cent of people agree: when or – let’s be optimistic for once – if we die, making healthy organs available for transplant is the right thing to do. Funny then, when skin comes to scalpel, just 24 per cent of UK citizens are registered donors. Less funny by far – falling through this gap between principle and practice are the 1,000 patients who die from organ failure each year, and the 8,000 others left to wait in limbo. Continue reading…

Los Angeles Times

Editorial. Keeping California’s kids healthy. December 2, 2012.

In a bid to cut the state’s healthcare bills, the Brown administration will begin shuttering the Healthy Families insurance program for low-income children on Jan. 1. More than 850,000 kids will be shifted over the course of the year into HMOs that participate in Medi-Cal, California’s version of the federally subsidized Medicaid program. It may be too late now for the Legislature to rescue Healthy Families from its untimely and potentially disruptive end, even though lawmakers are heading to Sacramento on Monday to begin a special session devoted to healthcare issues. But state lawmakers and federal Medicaid officials should do as much as they can to ensure that these children’s parents won’t be left scrambling desperately to find a doctor or a dentist when their kids need one. Continue reading…

Editorial. Defending the insanity defense. November 28, 2012.

The Supreme Court refused this week to review the murder conviction of an Idaho man who was prevented by state law from offering an insanity defense. The court’s abdication of its responsibility encourages other states to dismantle a central principle of Anglo-American law: that a defendant should not be held criminally responsible when mental illness makes it impossible for him to tell right from wrong. Continue reading…

New York Times

Editorial. Ultimate culpability for a mine disaster. November 28, 2012.

Federal prosecutors have signaled a bold new move up the corporate ladder in their investigation of the Upper Big Branch mine disaster that killed 29 West Virginia coal miners in 2010. A former executive of Massey Energy, which ran the mine but has since been acquired by another company, has been accused of criminal conspiracy in hiding lethal safety violations at Massey mines and tipping off mine supervisors to spot inspections. Continue reading…

Douthat, Ross. More babies, please. December 1, 2012.

In the eternally recurring debates about whether some rival great power will knock the United States off its global perch, there has always been one excellent reason to bet on a second American century: We have more babies than the competition. Continue reading…

 Seattle Times

Editorial. Physician group’s compelling case for over-the-counter birth control. December 3, 2012.

Women’s health groups long have advocated for making oral contraceptives available over the counter. Their argument received a significant boost this month from the American College of Obstetricians and Gynecologists, whose physicians issued an opinion affirming the benefits of providing pills without a prescription outweighed the risks. Continue reading…

Washington Post

Editorial. Saving taxpayer money on Tricare. December 2, 2012.

In the politics of defense spending, cutting expensive weapons programs plays the role that taxing the wealthy plays in the overall fiscal debate. Though undoubtedly necessary to any credible plan, it is far from sufficient. Yet advocates often talk as if reining in Pentagon spending is all about wasteful weapons. Continue reading…

Editorial. A yea on disabilities. December 2, 2012.

The United States has made great progress over the past two decades in opening opportunities for people with disabilities. Many other countries lag far behind. That’s why the U.S. Senate ought to ratify a U.N. treaty on rights for people with disabilities, a vote that’s scheduled for Tuesday. Continue reading…

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