Faculty Bibliography

BACKGROUND: The creation of each edition of the Diagnostic and Statistical Manual (DSM) of psychiatry has proven enormously controversial. The current effort to revise the 'bible' of disorder definitions for the field of mental health is no exception. The controversy around DSM-5 reached a crescendo with the announcement from National Institute of Mental Health (NIMH) that the institute would focus efforts on the development of their own psychiatric nosology, the Research Domain Criteria (RDoC) (NIMH, 2013). DISCUSSION: The RDoC seem to be structured around the concern that the only way to find objectivity in the classification of diseases or disorders in psychiatry is to begin with biology and work back to symptoms. Values infuse medical categories in various ways and drive practical considerations about where and how to divide up constellations of already agreed upon symptoms. SUMMARY: We briefly argue that all nosologies are infused with values and, while we should continue to sharpen the psychiatric nosology, normativity will permeate even the strictest biologically based taxonomy; this need not be a bad thing.

"The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others." J.S. Mill, On Liberty "Liberty consists in the freedom to do everything which injures no one else" Declaration of the Rights of Man and of the Citizen "The right to swing my fist ends where the other man's nose begins." Oliver Wendell Holmes David Ropiek in his useful essay on how society should respond to the risks created by those who choose not to vaccinate themselves or their children does a very useful job of identifying the enormous costs in money and health that non-vaccinators create. (1) He also pinpoints the many factors that drive vaccine resistance locating them not in a misunderstanding of the facts but, in fears and negative emotions. (1) It is important to pay attention to his message since frequently those who want to try to reduce vaccine hesitation or outright non-vaccination behavior put their faith in education and resort to an invocation of the facts about the value of vaccines when it is fear and emotions that must be addressed. (2.)

In 2008, Alberta Roman Catholic Bishops' discouraged in-school HPV vaccination because: "a school-based approach to vaccination sends a message that early sexual intercourse is allowed, as long as one uses 'protection.'" The publicly funded Calgary Catholic School District Board voted against in-school HPV vaccine administration. In 2009, vaccine uptake was 70% in Calgary public schools and 18.9% in Calgary Catholic schools. To physician-citizens who requested in-school vaccination, the elected school trustees repeatedly responded that they were "directed" by the bishop. When trustees refused to hear from the city's chief oncologist, a citizen's group was created and held a June 2012 media event to help overturn the ban. The Board remained intransigent until the citizen's group threatened legal action, former senior administrators pressured the Board, Pediatrics reported that the HPV vaccine had no effect on sexual behavior, and the bishop told trustees that they could consult school councils. 87% (91/104) of school councils approved in-school HPV vaccine administration. On November 28, 2012, the Board permitted the HPV vaccine, four years after first requested by public health officials. This paper outlines a successful health campaign that may serve as a model for addressing unwarranted concerns about community health programs dedicated to improving public health.

Air pollution has been found to cause significant global mortality, with 6.8 million excess deaths attributed to air pollution each year, and similarly large numbers of exacerbations of asthma, chronic obstructive pulmonary disease, and cardiovascular diseases. Epidemiological research has identified associations, and experimental human exposure has provided critical information on dose-response relationships of adverse effects caused by controlled human exposure to individual pollutants. Human exposures further enable examination of the relationship of adverse effects such as symptoms and pulmonary function changes to presumed mechanisms of disease revealed through analysis of bronchoalveolar lavage fluid obtained from the lower respiratory tract. In this Perspective, we analyze the ethics of human exposure, the importance of the information gained, and the risks of such exposure. We find that these studies appear to have been done with proper approval of institutional review boards, were done with informed consent from the participants, and have rarely been associated with serious adverse events.

One area in which money alone doesn't rule the day in America is transplantation. Since 1984, the nation's system for deciding who gets scarce organs for transplant has relied both on the ability to pay and a rule-based, physician-determined rationing system. It's about as close as the country has ever come to making tough decisions about who gets life-saving therapy. Here, Caplan shares the case of ten-year-old Sarah Murnaghan who recently put that system to its most severe test ever

Development of novel prognostic, diagnostic, and treatment options will provide major benefits for millions of patients with acute or chronic respiratory dysfunction, cardiac-related disorders, esophageal problems, or other diseases in the thorax. Allogeneic organ transplant is currently available. However, it remains a trap because of its dependency on a very limited supply of donated organs, which may be needed for both initial and subsequent transplants. Furthermore, it requires lifelong treatment with immunosuppressants, which are associated with adverse effects. Despite early clinical applications of bioengineered organs and tissues, routine implementation is still far off. For this review, we searched the PubMed, MEDLINE, and Ovid databases for the following keywords for each tissue or organ: tissue engineering, biological and synthetic scaffold/graft, acellular and decelluar(ized), reseeding, bioreactor, tissue replacement, and transplantation. We identified the current state-of-the-art practices in tissue engineering with a focus on advances during the past 5 years. We discuss advantages and disadvantages of biological and synthetic solutions and introduce novel strategies and technologies for the field. The ethical challenges of innovation in this area are also reviewed.