Faculty Bibliography

Evidence-based decision making (EBDM) is a tool to assess the value of medical interventions by weighing costs and health outcomes that has increasingly been applied to vaccines. However, many of the ethical considerations that support EBDM when used to evaluate therapeutic care do not readily translate to prevention. This mismatch can result in policy decisions that produce unanticipated negative consequences, including public resistance. In its emphasis on quantifiable outcomes, EBDM invokes the ethical principle of rule-utilitarianism, which values the optimal long-run balance of benefit over harm. Vaccines raise a number of competing ethical concerns in ways that individual medical treatments do not. They rely on widespread compliance for effectiveness, which can limit individual autonomy, emphasize population over individual effects, which can obscure the imperative of beneficence to help the vulnerable, require a just allocation process within populations, and sometimes challenge strong social norms. For EBDM to effectively guide vaccine policy makers, such as the Advisory Committee on Immunization Practices (ACIP) in the United States, an ethical foundation is needed that systematically considers all relevant values and transparently places vaccination recommendations in the context of social norms and individual concerns.

Caplan talks about the importance of the Patient Protection and Affordable Care Act, which became law on March 23, 2010. Not a single Republican in the House or Senate voted in favor of either bill. In fact the Republicans used health-reform legislation to great effect in getting a good number of the Democrats who had supported it thrown out of office in the midterm elections. It is not clear why many Republicans hate this bill--other than that it strikes many of them as an extension of government power. Put aside the fact that the potpourri of programs in the US already make the government the biggest player by far in American health care, and no member of the GOP seriously proposes to privatize any of these

Caplan talks about a new program to jump-start the development of new drugs and therapies. Francis Collins, director of the National Institutes of Health (NIH), has announced a plan to create a new program to jump-start the development of new drugs and therapies. The new National Center for Advancing Translational Sciences will have the mission of trying to bring promising basic NIH research closer to clinical trials. To make this happen, cuts in other NIH programs will have to be made. One program, the National Center for Research Resources, which awards grants to fund researchers and equipment, is on the chopping block

Some forms of stem cell research involving the use of embryos require embryo destruction to extract a stem cell. Others, involving cloning, require transferring a full set of genes from an adult cell into an egg. Both procedures have received heavy criticism from those opposed to embryo destruction or embryo creation by a technique other than sex. While there's a good deal of focus on the problems generated by the power of money in generating bias in science and medicine, the battle over stem cell research makes very clear that religious views can also be a huge source of distortion and bias. Here, Caplan talks about the ongoing debate about stem cell research in the US

Caplan relates the story of a pregnant woman who attempted to kill herself by swallowing a rat poison. Her life was saved but it resulted to the death of the baby after she gave birth. She was arrested , charged with murder and attempted feticide, and sent to jail. Prosecutors called her a "cold-blooded" murderer. If convicted, she will get a minimum sentence of forty-five years. The death penalty or life in prison without parole are also possibilities. This story is disturbing not just because it is unconscionable to prosecute as a murderer a pregnant woman who tried to kill herself, but because it is likely that the case was brought to make a point in the ongoing national battle over abortion

On Tuesday, a federal advisory panel, the National Science Advisory Board for Biosecurity, recommended that university scientists who have submitted articles on how to modify a flu virus to two very prestigious journals delete critical information from them before publishing. The papers describe how to alter bird-flu virus to be more infectious and potentially nastier

Some conservatives, disability advocates and right-to-lifers see rationing afoot when people like me try to turn the conversation toward how best to manage your dying. They think that by encouraging these discussions, it's simply a way to get old folks to save the federal government some money by slyly tricking them into saying that they don't want a lot of medical care if they are terminally ill. Not only are they wrong, they are being unethical

Picking on someone as being "not religious enough" for high office or on a religion as being insufficiently pious to produce a viable candidate for any office -- from county sheriff to president -- is intolerant bias, simply out of bounds in American political discourse

Dr. Conrad Murray has been found guilty of involuntary manslaughter in the death of Michael Jackson. It hardly could have been otherwise. The mere fact that Murray used a highly dangerous and difficult to manage drug, propofol, to treat Jackson's insomnia showed that he was acting in an irresponsible way. Even highly trained anesthesiologists in hospitals know they have to be extra careful with that drug