Faculty Bibliography

A 2013 poll in The New York Times found that three-quarters of Americans have concerns about genetically modified organisms (GMOs) in their food; most are worried about health effects. Thirty-seven percent of those with worries fear that GM foods cause cancer or allergies

Clinical genomics is poised for a rapid expansion but more work must be done to build a supporting ethical infrastructure.

Caplan cites some criticisms of the newly revised Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association--DSM-5. The DSM is often described as the bible of the mental health field--and unfortunate misnomer that leaves it open to attack as a compendium of divinely inspired truths about human behavior. The most common criticism in the reviews and books is that DSM-5 proliferates diseases beyond the boundaries of common sense

Rates of nonmedical exemptions from school immunizations are increasing and have been associated with resurfacing clusters of vaccine-preventable diseases, such as measles. Historically, state-level school immunization policies successfully suppressed such diseases. We examined state immunization exemption regulations across the United States. We assessed procedures for exempting schoolchildren and whether exemption rates were associated with the complexity of the procedures. We also analyzed legal definitions of religious objections and state legislatures' recent modifications to exemption policies. We found that states with simpler immunization exemption procedures had nonmedical exemption rates that were more than twice as high as those in states with more-complex procedures. We also found that the stringency of legal definitions of religious exemptions was not associated with exemption procedure complexity. Finally, we found that although there were more attempts by state legislatures to broaden exemptions than to tighten them in 2011-13, only bills tightening exemptions passed. Policy makers seeking to control exemption rates to achieve public health goals should consider tightening nonmedical exemption procedures and should add vaccine education components to the procedures by either mandating or encouraging yearly educational sessions in schools for parents reluctant to have their children vaccinated.

Comparative effectiveness research has the potential to dramatically improve patient care while reducing costs. In the absence of good evidence about which treatment is best for particular patients, decision making too often hinges on exogenous factors such as advertising and detailing by pharmaceutical companies, what a physician first learned to do, insurance coverage, and local custom. Without good evidence about what is best among competing but generally accepted clinical options, it is often a challenge for physicians to identify the best course of care. A great deal of effort is under way to make it easier and less expensive to . . .

The success of deep brain stimulation (DBS) for movement disorders and the improved understanding of the neurobiologic and neuroanatomic bases of psychiatric diseases have led to proposals to expand current DBS applications. Recent preclinical and clinical work with Alzheimer's disease and obsessive-compulsive disorder, for example, supports the safety of stimulating regions in the hypothalamus and nucleus accumbens in humans. These regions are known to be involved in addiction and overeating associated with obesity. However, the use of DBS targeting these areas as a treatment modality raises common ethical considerations, which include informed consent, coercion, enhancement, threat to personhood, and manipulation of the reward center. Pilot studies for both of these conditions are currently investigational. If these studies show promise, then there is a need to address the ethical concerns related to the initiation of clinical trials including the reliability of preclinical evidence, patient selection, study design, compensation for participation and injury, cost-effectiveness, and the need for long-term follow-up. Multidisciplinary teams are necessary for the ethical execution of such studies. In addition to establishing safety and efficacy, the consideration of these ethical issues is vital to the adoption of DBS as a treatment for these conditions. We offer suggestions about the pursuit of future clinical trials of DBS for the treatment of addiction and overeating associated with obesity and provide a framework for addressing ethical concerns related to treatment.

Despite novel medications and other therapeutic strategies, addiction to psychotropic substances remains one of the most serious public health problems worldwide. In this review, beginning with an introduction of deep brain stimulation (DBS), we highlight the importance of the nucleus accumbens (NAc) in the context of the reward circuitry and addictive behavior. We will provide a short historic overview of other neurosurgical approaches to treat addiction and describe the experimental and preclinical data on DBS in addiction. Finally, we call attention to key ethical issues related to using DBS to treat addiction that are important for future research and the design of clinical trials.