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Knowledge and Attitudes Toward Covid-19 and Vaccines Among a New York Haredi-Orthodox Jewish Community

Carmody, Ellie R; Zander, Devon; Klein, Elizabeth J; Mulligan, Mark J; Caplan, Arthur L
The Covid-19 pandemic has exposed the difficulty of the US public health system to respond effectively to vulnerable subpopulations, causing disproportionate rates of morbidity and mortality. New York Haredi-Orthodox Jewish communities represent a group that have been heavily impacted by Covid-19. Little research has examined their experience or perceptions toward Covid-19 and vaccines. We conducted a cross-sectional, observational study to explore the experience of Covid-19 among Haredim. Paper surveys were self-administered between December 2020 and January 2021 in Haredi neighborhood pediatricians' offices in Brooklyn, New York. Of 102 respondents, 43% reported either a positive SARS-CoV-2 viral or antibody test. Participants trusted their physicians, Orthodox medical organizations, and rabbinic leaders for medical information. Knowledge of Covid-19 transmission and risk was good (69% answered ≥ 4/6 questions correctly). Only 12% of respondents would accept a Covid-19 vaccine, 41% were undecided and 47% were strongly hesitant. Independent predictors of strong vaccine hesitancy included believing natural infection to be better than vaccination for developing immunity (adjusted odds ratio [aOR] 4.28; 95% confidence interval [CI] 1.23-14.86), agreement that prior infection provides a path toward resuming communal life (aOR 4.10; 95% CI 1.22-13.77), and pandemic-related loss of trust in physicians (aOR 5.01; 95% CI 1.05-23.96). The primary disseminators of health information for self-protective religious communities should be stakeholders who understand these groups' unique health needs. In communities with significant Covid-19 experience, vaccination messaging may need to be tailored toward protecting infection-naïve individuals and boosting natural immunity against emerging variants.
PMID: 33999317
ISSN: 1573-3610
CID: 4876672

Promoting COVID-19 vaccine acceptance: recommendations from the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA

Omer, Saad B; Benjamin, Regina M; Brewer, Noel T; Buttenheim, Alison M; Callaghan, Timothy; Caplan, Arthur; Carpiano, Richard M; Clinton, Chelsea; DiResta, Renee; Elharake, Jad A; Flowers, Lisa C; Galvani, Alison P; Lakshmanan, Rekha; Maldonado, Yvonne A; McFadden, SarahAnn M; Mello, Michelle M; Opel, Douglas J; Reiss, Dorit R; Salmon, Daniel A; Schwartz, Jason L; Sharfstein, Joshua M; Hotez, Peter J
Since the first case of COVID-19 was identified in the USA in January, 2020, over 46 million people in the country have tested positive for SARS-CoV-2 infection. Several COVID-19 vaccines have received emergency use authorisations from the US Food and Drug Administration, with the Pfizer-BioNTech vaccine receiving full approval on Aug 23, 2021. When paired with masking, physical distancing, and ventilation, COVID-19 vaccines are the best intervention to sustainably control the pandemic. However, surveys have consistently found that a sizeable minority of US residents do not plan to get a COVID-19 vaccine. The most severe consequence of an inadequate uptake of COVID-19 vaccines has been sustained community transmission (including of the delta [B.1.617.2] variant, a surge of which began in July, 2021). Exacerbating the direct impact of the virus, a low uptake of COVID-19 vaccines will prolong the social and economic repercussions of the pandemic on families and communities, especially low-income and minority ethnic groups, into 2022, or even longer. The scale and challenges of the COVID-19 vaccination campaign are unprecedented. Therefore, through a series of recommendations, we present a coordinated, evidence-based education, communication, and behavioural intervention strategy that is likely to improve the success of COVID-19 vaccine programmes across the USA.
PMID: 34793741
ISSN: 1474-547x
CID: 5049462

Phantom premise and a shape-shifting ism: reply to Hassoun

Ferguson, Kyle; Caplan, Arthur
PMID: 33963070
ISSN: 1473-4257
CID: 4868172

Current COVID-19 vaccine trials in high-income countries: are placebo-controlled trials ethical?

Dal-Ré, Rafael; Caplan, Arthur L
PMID: 34375757
ISSN: 1469-0691
CID: 5006152

Parental consent for vaccination of minors against COVID-19

Shevzov-Zebrun, Nina; Caplan, Arthur
PMID: 34598821
ISSN: 1873-2518
CID: 5039742

Helpful Lessons and Cautionary Tales: How Should COVID-19 Drug Development and Access Inform Approaches to Non-Pandemic Diseases?

Lynch, Holly Fernandez; Caplan, Arthur; Furlong, Patricia; Bateman-House, Alison
After witnessing extraordinary scientific and regulatory efforts to speed development of and access to new COVID-19 interventions, patients facing other serious diseases have begun to ask "where's our Operation Warp Speed?" and "why isn't Emergency Use Authorization an option for our health crises?" Although this pandemic bears a number of unique features, the response to COVID-19 offers translatable lessons, in both its successes and failures, for non-pandemic diseases. These include the importance of collaborating across sectors, supporting the highest-priority research efforts, adopting rigorous and innovative trial designs, and sharing reliable information quickly. In addition, the regulatory response to the pandemic demonstrates that lowering standards for marketing authorization can result in increased safety concerns, missed opportunities for research and treatment, and delays in determining what works. Accordingly, policymakers and patient advocates seeking to build on the COVID-19 experience for non-pandemic diseases with unmet treatment needs should focus their efforts on promoting robust and efficient research designs, improving access to clinical trials, and facilitating use of the Food and Drug Administration's existing Expanded Access pathway.
PMID: 34665689
ISSN: 1536-0075
CID: 5043252

Ethical considerations regarding COVID-19 vaccination for transplant candidates and recipients

Parent, Brendan; Caplan, Arthur; Mehta, Sapna A
Solid organ transplant (SOT) candidates and recipients were not included in the COVID-19 vaccine trials that have justified vaccine administration to millions worldwide and will be critical to ending the pandemic. The risks of COVID-19 for SOT candidates and recipients combined with data about this population's response to other vaccines has led to transplant centers recommending vaccination for their candidates and recipients in accordance with guidance from major transplant organizations. Relevant ethics considerations include: weighing the low risk of vaccination causing transplant complications against potentially limited antibody response of vaccines for transplant recipients; the equitable distribution of vaccines among vulnerable populations; the duty to steward and respect organs as limited resources; the duty to support vaccination; and patient autonomy. Vaccinated transplant patients and candidates should also consider participating in research studies to better understand the efficacy and potential long-term risks in this patient population. There are difficult scenarios, like timing transplant after second vaccine dose, when to administer the second dose to a partially vaccinated candidate who gets an organ match, whether to vaccinate a recent transplant recipient with low exposure risk and which vaccine to use. Here we provide ethics considerations for vaccinating different groups within the transplant population.
PMID: 34241923
ISSN: 1399-0012
CID: 4950372

Risk Compensation and COVID-19 Vaccines [Editorial]

Trogen, Brit; Caplan, Arthur
PMID: 33646837
ISSN: 1539-3704
CID: 4802412

Being fair to participants in placebo-controlled COVID-19 vaccine trials [Letter]

Dal-Ré, Rafael; Orenstein, Walter; Caplan, Arthur L
PMID: 33903751
ISSN: 1546-170x
CID: 4873732

Ethics of Artificial Intelligence in Medicine and Ophthalmology

Abdullah, Yasser Ibraheem; Schuman, Joel S; Shabsigh, Ridwan; Caplan, Arthur; Al-Aswad, Lama A
BACKGROUND:This review explores the bioethical implementation of artificial intelligence (AI) in medicine and in ophthalmology. AI, which was first introduced in the 1950s, is defined as "the machine simulation of human mental reasoning, decision making, and behavior". The increased power of computing, expansion of storage capacity, and compilation of medical big data helped the AI implementation surge in medical practice and research. Ophthalmology is a leading medical specialty in applying AI in screening, diagnosis, and treatment. The first Food and Drug Administration approved autonomous diagnostic system served to diagnose and classify diabetic retinopathy. Other ophthalmic conditions such as age-related macular degeneration, glaucoma, retinopathy of prematurity, and congenital cataract, among others, implemented AI too. PURPOSE/OBJECTIVE:To review the contemporary literature of the bioethical issues of AI in medicine and ophthalmology, classify ethical issues in medical AI, and suggest possible standardizations of ethical frameworks for AI implementation. METHODS:Keywords were searched on Google Scholar and PubMed between October 2019 and April 2020. The results were reviewed, cross-referenced, and summarized. A total of 284 references including articles, books, book chapters, and regulatory reports and statements were reviewed, and those that were relevant were cited in the paper. RESULTS:Most sources that studied the use of AI in medicine explored the ethical aspects. Bioethical challenges of AI implementation in medicine were categorized into 6 main categories. These include machine training ethics, machine accuracy ethics, patient-related ethics, physician-related ethics, shared ethics, and roles of regulators. CONCLUSIONS:There are multiple stakeholders in the ethical issues surrounding AI in medicine and ophthalmology. Attention to the various aspects of ethics related to AI is important especially with the expanding use of AI. Solutions of ethical problems are envisioned to be multifactorial.
PMID: 34383720
ISSN: 2162-0989
CID: 5010852