Faculty Bibliography

Competing visions for health reform in the United States and renewed interest in health technology assessment (HTA) have led to fierce national debates about the appropriateness of rationing. Because of a limited supply of organs, kidney transplantation has always required rationing and overt discussion of the ethics that guide it, but the field of transplantation has also contended recently with internal calls for a new rationing system. The aim of the Life Years from Transplantation (LYFT) proposal is to allocate kidneys to patients who obtain the greatest survival benefit from transplantation, which would lengthen the lives of kidney transplant recipients but restrict the ability of older Americans to obtain a transplant. The debate around the LYFT proposal reveals the ethical and policy challenges of identifying which patients should receive a treatment based on the results of cost-effectiveness and other HTA studies. This article argues that attempts to use HTA for healthcare rationing are likely to disadvantage older patients. Guiding principles to help ensure that resources such as kidneys are justly allocated across the life span are proposed.

In the wealthy nations of the world, access to implantable cardiac rhythm management devices is widespread. In many underserved low- and middle-income countries (LMIC), where cardiovascular disease is fast becoming a major public health problem, access is often limited. Reuse of pulse generators was practiced regularly in some European nations in the 1990s with good results. It is performed in LMIC, although the rates of device reuse are unknown. The available literature suggests there is no increased risk of morbidity or mortality with the reuse of devices. Donations of pacemaker and defibrillator pulse generators from developed nations constitute an important source of devices for the poor in LMIC. There are opportunities to increase this supply, but logistical barriers and legal and ethical concerns must be addressed. With proper sterilization, meticulous chains of custody, and advance directives for device handling (pacemaker/defibrillator living wills), patients in LMIC who would otherwise lack access to these devices could benefit from their reuse.

AIM: We surveyed physicians' opinions and acceptance of influenza immunization. SCOPE: A web-based survey was sent to all physicians in two academic departments during spring 2009. RESULTS: 227 (40.5%) physicians responded. Physicians who frequently cared for high-risk patients self-reported higher immunization rates than physicians with infrequent contact (P=0.0002). There were no significant differences in immunization rates between emergency medicine (EM) and internal medicine (IM), between those with and without children at home, nor by age group. A majority (84.6%) supported mandatory vaccination. IM physicians were more supportive of mandates than EM physicians (P<0.0001). CONCLUSION: Self-reported immunization rates were high among study physicians. Acceptance of mandatory vaccination was substantial, but varied by specialty.

There is increasing pressure for neuroscientists to communicate their research and the societal implications of their findings to the public. Communicating science is challenging, and the transformation of communication by digital and interactive media increases the complexity of the challenge. To facilitate dialogue with the public in this new media landscape, we suggest three courses of action for the neuroscience community: a cultural shift that explicitly recognizes and rewards public outreach, the identification and development of neuroscience communication experts, and ongoing empirical research on the public communication of neuroscience.

Chaplan comments on the latest trend of reproductive technology, where doctors put more than one embryo. No clinic should be putting more than two or three babies into even a younger patient who has already shown she can create children through success in previous rounds of in vitro fertilization. If the only way to prevent such outrageous treatment is to pass a law penalizing any doctor who implants numerous embryos under such circumstances, then let's get such a law passed