Faculty Bibliography

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.

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.

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.

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

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.

Advances in the field of synthetic biology are creating many new practical applications. These new applications raise novel regulatory challenges. Biotechnological innovation was first addressed by the United States (US) National Institutes of Health (NIH) at the advent of recombinant DNA research.1 Today, synthetic biology requires consideration of the ethics and risks involved in the governance of an applied technology that spans national borders and has applications in a wide variety of sectors. Because approaches to governance vary by nation and sector, and can range from precautionary to prudent, it is necessary to consider the context from which different approaches arise if there is to be any successful move towards universal governance