Faculty Bibliography

Deadly Choices: How the Anti-Vaccine Movement Threatens Us All, by Paul A. Offit, and The Panic Virus: A True Story of Medicine, Science, and Fear, by Seth Mnookin, is reviewed

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

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

BACKGROUND: Clinical practice guidelines (CPGs) serve as standards of care in practice, quality improvement, and reimbursement. The extent of conflicts of interest (COIs) in cardiology guideline production has not been well studied. Herein, we describe the scope of COIs in CPGs. METHODS: We examined the 17 most recent American College of Cardiology/American Heart Association guidelines through 2008. Using disclosure lists, we cataloged COIs for each participant as receiving a research grant, being on a speaker's bureau and/or receiving honoraria, owning stock, or being a consultant or member of an advisory board. We also cataloged the companies and institutions reported in each disclosure. "Episode" describes 1 instance of participation in 1 guideline by 1 person. "Individual" describes 1 person who may be involved in multiple episodes. "Company" describes a commercial or industry affiliation reported by an individual in a single episode. Analysis involved descriptive statistics and correlation analyses (Pearson correlation coefficient, chi(2) and R(2)). RESULTS: Fifty-six percent of the 498 individuals reported a COI, corresponding to 56% of the 651 episodes. Being a consultant or member of an advisory board was the most common type. The percentage of episodes involving a COI varied between guidelines (range, 13%-87%). The number of episodes per individual was associated with both presence and number of disclosures (P < .001 for both comparisons). Of 478 companies, the number per guideline ranged from 2 to 242 companies (mean, 38 companies). One company was the most frequently reported company in 7 of 17 guidelines. CONCLUSION: Conflicts of interest are prevalent in cardiology guidelines, but there seems to be a significant number of experienced experts without COIs.

AIM: Determine predictors of support of a mandatory seasonal influenza vaccine program among health care workers (HCWs). SCOPE: Cross-sectional anonymous survey of 2443 (out of 8093) randomly selected clinical and non-clinical HCWs at a large pediatric network after implementation of a mandatory vaccination program in 2009-10. RESULTS: 1388 HCWs (58.2%) completed the survey and 75.2% of respondents reported agreeing with the new mandatory policy. Most respondents (72%) believed that the policy was coercive but >90% agreed that the policy was important for protecting patients and staff and was part of professional ethical responsibility. When we adjusted for attitudes and beliefs regarding influenza and the mandate, there was no significant difference between clinical and nonclinical staff in their support of the mandate (OR 1.08, 95% C.I. 0.94, 1.26). CONCLUSIONS: Attitudes and beliefs regarding influenza and the mandate may transcend professional role. Targeted outreach activities can capitalize on beliefs regarding patient protection and ethical responsibility.

Improving the management of potential organ donors in the intensive care unit could meet an important public health goal by increasing the number and quality of transplantable organs. However, randomized clinical trials are needed to quantify the extent to which specific interventions might enhance organ recovery and outcomes among transplant recipients. Among several barriers to conducting such studies are the absence of guidelines for obtaining informed consent for such studies and the fact that deceased organ donors are not covered by extant federal regulations governing oversight of research with human subjects. This article explores the underexamined ethical issues that arise in the context of donor management studies and provides ethical guidelines and suggested regulatory oversight mechanisms to enable such studies to be conducted ethically. We conclude that both the respect that is traditionally accorded to the prior wishes of the dead and the possibility of postmortem harm support a role for surrogate consent of donors in such randomized controlled trials. Furthermore, although recipients will often be considered human subjects under federal regulations, several ethical arguments support waiving requirements for recipient consent in donor management randomized controlled trials. Finally, we suggest that new regulatory mechanisms, perhaps linked to existing regional and national organ donation and transplantation infrastructures, must be established to protect patients in donor management studies while limiting unnecessary barriers to the conduct of this important research.