Ethics Survey: Drug testing remains a clinical tug of war

Behavioural Net, 18 May 2017
Author: Julie Miller
“In recent weeks, the American Society of Addiction Medicine (ASAM) prepared comprehensive guidelines on drug testing within the continuum of care. The goal is to present evidence-based recommendations for the frequency and application of testing, which payers and providers can adopt as best practices. It’s significant because up until now, there was no true consensus. And there’s also no denying that some treatment operators have aimed to maximize their profit streams through the overuse of testing and subsequent billing of insurance companies.”
Find article here.

The Ethics of Clinical Trials Research in Severe Mood Disorders

Bioethics. May 2017. doi:10.1111/bioe.12349
Authors: Nugent, A. C., Miller, F. G., Henter, I. D. and Zarate, C. A.
“Mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD), are highly prevalent, frequently disabling, and sometimes deadly. Additional research and more effective medications are desperately needed, but clinical trials research in mood disorders is fraught with ethical issues. Although many authors have discussed these issues, most do so from a theoretical viewpoint. This manuscript uses available empirical data to inform a discussion of the primary ethical issues raised in mood disorders research.”
Find article here.

Some Social Scientists Are Tired of Asking for Permission

NYT, 22 May 2017
Author: Kate Murphy
“Who gets to decide whether the experimental protocol — what subjects are asked to do and disclose — is appropriate and ethical? That question has been roiling the academic community since the Department of Health and Human Services’s Office for Human Research Protections revised its rules in January.”
Find article here.

Health Care Complaints Commission v Kennedy [2017] NSWCATOD 72

Decision date: 16 May 2017
“PROFESSIONS AND TRADES –— health practitioner — whether conduct particularised amounts to “improper and unethical” conduct — whether conduct admitted or found proven amounts to professional misconduct — appropriate protective orders practitioner found guilty of professional misconduct.”
Find decision here.

Navigating the ethical clash between access to health information and proprietary databases

MedicalXpress, 15 May 2017
Source: Baylor College of Medicine
“Sharing medical information, including genomic data, has the potential to benefit public health. However, companies that generate that information have a legal right to protect it as a trade secret. Legal and ethical conflict exists between individuals’ right to access their personal health information and the protection of these trade secrets. The data gathered from these genetic tests can provide important insights when making an individual diagnosis or pursuing clinical treatments, thereby having a direct impact on patient care. On the other hand, if companies and innovators are able to keep certain pieces of data and their processes secret, they are more easily able to recover their investment in the project and use it to finance new diagnostic tests.”
Find article here.

Novartis, slammed by Korean scandal, tweaks its ethics, compliance policies

FiercePharma, 15 May 2017
Author: Eric Sagonowsky
“Rocked by a corruption scandal in Korea and facing a kickbacks probe in Greece, Novartis says it’s strengthening and simplifying its global ethics and compliance approach. Last month, Korean authorities handed out a $50 million fine and suspended coverage on several Novartis meds in relation to a bribery probe in the country. Novartis employees conducted a kickbacks scheme through medical journal-sponsored meetings, with the total spent on bribes estimated to be $2.3 million, according to officials. Last year, Novartis agreed to a $25 million settlement with U.S. authorities to put to rest a bribery investigation in China.”
Find article here.

How to rein in the widening disease definitions that label more healthy people as sick

The Conversation, 16 May 2017
Authors: Ray Moynihan, Rita Horvath
“Medical panels are constantly changing diagnostic cut-offs and lowering thresholds to classify many conditions and diseases. Those changes determine whether we or our loved ones receive a diagnosis that might help us – by, for example, giving us access to a life-saving treatment – or harm us – by bringing the anxiety, cost and danger of an unneeded medical label.”
Find article here.

Toward Responsible Human Genome Editing

JAMA 2017; 317(18):1829-1830
Authors: Richard O. Hynes; Barry S. Coller; Matthew Porteus
“The speed at which the science is advancing raises important questions about human genome editing, such as how to balance potential benefits against risks of unintended harms, how to regulate the use of genome editing and incorporate societal values into policy decisions, and how to respect the diverse perspectives of individuals, nations, and cultures that will influence whether and how to use these technologies. A new report from the US National Academies of Sciences and Medicine addresses these questions and makes recommendations for the application and oversight of human genome editing in 3 major settings.”
Find article here.

The Unusual Case of Ian Paterson and Criminally Harmful Surgery

BMJ Blog, 9 May 2017
Author: Iain Brassington
“The “obscure motives” that compelled Paterson may forever remain a mystery but it is interesting that the charges against him relate only to patients he treated in his private practice. This enabled the prosecution to create a narrative that suggested that financial gain could have been the motivating factor for Paterson’s crimes. Without greed as a possible motive his actions are baffling, and the prosecution’s case, in alleging that surgery which Paterson argued was performed in the patient’s best interests actually constituted GBH or unlawful wounding, would be more challenging because of the medical context of the allegations. Importantly, the medical exception to the criminal law – the principle that consensual surgery carried out by qualified professionals is legitimate (“proper medical treatment”) – means that there is an assumption that harm caused by surgery is not a matter for the criminal law because it is a risk that we accept in order to enjoy the benefits of surgical medicine.”
Find article here.

Conflict of Interest: Why Does It Matter?

JAMA 2017;317(17):1717-1718
Author: Harvey V. Fineberg
“Preservation of trust is the essential purpose of policies about conflict of interest. Physicians have many important roles including caring for individual patients, protecting the public’s health, engaging in research, reporting scientific and clinical discoveries, crafting professional guidelines, and advising policy makers and regulatory bodies. Success in all these functions depends on others—laypersons, professional peers, and policy leaders—believing and acting on the word of physicians. Therefore, the confidence of others in physician judgment is of paramount importance. When trust in physician judgment is impaired, the role of physicians is diminished.”
Find article (part of a series of articles on conflict of interest in medicine) here.