Committee supervises ethics of human testing

By Madison Pauly
The Dartmouth
Published on Monday, February 25, 2013

From new cardiology studies to students that go overseas and want to interview people, the Committee for the Protection of Human Subjects answers ethical questions about human research at Dartmouth. The committee is an interdisciplinary group of experts and community members who analyze the risk posed to participants by Dartmouth-affiliated researchers’ studies.

As Dartmouth’s incarnation of a federally-mandated institutional review board, the committee analyzes proposals for research on human subjects from Dartmouth-Hitchcock Medical Center and the Veterans Affairs Medical Center in White River Junction, as well as the College’s graduate and undergraduate departments.

While all studies involving human participants are subject to review by the committee, those that receive funding from sources other than the government must pay a review fee to the committee office.

A division of the Provost’s Office, the committee is financed in part by federal funds allocated to Dartmouth for research. Accordingly, its review process follows federal policies to ensure “respect for persons, beneficence and justice,” according to a Department of Health and Human Services report.

Major areas of ethical concern include the research’s medical relevance, involvement of vulnerable populations, its informed consent process and use of deception, said assistant provost for research Liz Bankert, a member of the committee.

The current federal regulations were last revised in 1991 and often fail to give adequate ethical guidance on modern research questions, said Bankert, who also serves on a national research ethics advisory committee.

The entire story is here.

End-of-Life Care Improves But Costs Increase, Study Finds

by E.J. Mitchell
The Medicare News Group
Originally published July 12, 2013

Improvements in end-of-life care have occurred rapidly for Medicare patients but costs have increased, according to a new Dartmouth Institute brief that was released today. The study revealed that beneficiaries in their last six months of life spent fewer days in the hospital and that more patients received hospice services in 2010 compared to 2007.

However, Medicare spending for chronically ill patients at the end of life increased more than 15 percent during that time period, while the consumer price index rose only 5.3 percent.

The data from the brief, which is through the Dartmouth Atlas Project, also found that in 2010 compared to 2007:

• patients were less likely to die in the hospital;
• patients were as likely to spend time in intensive care units (ICUs) during the last six months of life;
• the variations in end-of-life care at some academic medical centers quickly changed;
• patients spent more days in hospice care; and
• patients were more likely to see more than 10 physicians during the last 6 months of life.
• The Dartmouth Atlas brief found that across hospitals improvement was variable, with some experiencing rapid change while others showed little improvement.

The entire article is here.

What happens to whistleblowers?

By David Nather
Politico
Originally published June 13, 2013

Edward Snowden might want to talk to a slew of recent national security leakers who learned a lesson the hard way: whistleblowing comes at a price.

Thomas Tamm, the DOJ attorney who told the New York Times about the National Security Agency’s surveillance program in 2004, struggled to stay employed for the five years he was under federal investigation.

And he was one of the lucky ones. Thomas Drake, a former National Security Agency official who helped expose a wasteful NSA surveillance program without privacy protections, is working in an Apple store.

And Matt Diaz, the Navy lawyer who secretly sent a list of Guantanamo Bay prisoners to a New York civil rights firm, was disbarred and now does non-legal work for the Bronx public defender’s office.

Snowden is still on the run, but he is expected to be extradited to the United States, eventually, and most likely charged with a crime.

If Snowden’s life turns out like other national security whistleblowers, his life will never be the same — leaving him to grapple with huge legal bills, poor job prospects, and a notoriety that will never really go away.

The entire story is here.

Guantanamo Bay: A Medical Ethics–free Zone?

George J. Annas, J.D., M.P.H., Sondra S. Crosby, M.D., and Leonard H. Glantz, J.D.
June 12, 2013
DOI: 10.1056/NEJMp1306065

American physicians have not widely criticized medical policies at the Guantanamo Bay detainment camp that violate medical ethics. We believe they should. Actions violating medical ethics, taken on behalf of the government, devalue medical ethics for all physicians. The ongoing hunger strike at Guantanamo by as many as 100 of the 166 remaining prisoners presents a stark challenge to the U.S. Department of Defense (DOD) to resist the temptation to use military physicians to “break” the strike through force-feeding.

President Barack Obama has publicly commented on the hunger strike twice. On April 26, he said, “I don't want these individuals [on hunger strike] to die.” In a May 23 speech on terrorism, the President said, “Look at our current situation, where we are force-feeding detainees who are . . . on a hunger strike. . . . Is this who we are? . . . Is that the America we want to leave our children? Our sense of justice is stronger than that.” How should physicians respond? That force-feeding of mentally competent hunger strikers violates basic medical ethics principles is not in serious dispute. Similarly, the Constitution Project's bipartisan Task Force on Detainee Treatment concluded in April that “forced feeding of detainees [at Guantanamo] is a form of abuse that must end” and urged the government to “adopt standards of care, policies, and procedures regarding detainees engaged in hunger strikes that are in keeping with established medical professional ethical and care standards.” Nevertheless, the DOD has sent about 40 additional medical personnel to help force-feed the hunger strikers.

The ethics standard regarding physician involvement in hunger strikes was probably best articulated by the World Medical Association (WMA) in its Declaration of Malta on Hunger Strikers. Created after World War II, the WMA comprises medical societies from almost 100 countries. Despite its checkered history, its process, transparency, and composition give it credibility regarding international medical ethics, and its statement on hunger strikers is widely considered authoritative.

The entire article is here.

Thanks to Gary Schoener for this lead.

In Bed with our Clients: Should Psychotherapists Play Matchmaker or is this Plain Old Erotic Transference?

By Keely Kolmes, PsyD.
http://drkkolmes.com

Last January, there was an opinion piece in the New York Times, written by Richard Friedman on whether therapists should play Cupid for clients, basically performing as a matchmaker, setting them up on dates. The article focused primarily on the fantasies that some clinicians have about wanting to do this and the potential issues that could come up regarding transference. It did not speak directly to erotic transference, but I think this is a key component of such a question.

Following the article, HuffPost Live did a segment on which I was one of four guests interviewed about our points of view on the issue. As expected, the show included diverse opinions and even had the one clinician, Terah Harrison, who has expanded her practice to include matching services.

Another clinician, Dr. Lazarus, argued passionately that we are "uniquely well positioned" to make such matchmaking recommendations to our clients. Jeff Sumber agreed it was unethical but he admitted to having such strong fantasies about fixing up his clients that he'd deliberately scheduled people in hopes they might meet. (I imagine his clients are now wondering as they arrive for therapy if the person leaving is someone he has chosen for them?)

Guess which role I played on this segment? Yes, I was the conservative fuddy-duddy talking ethics, dual relationships, and risk management.

The entire story is here.

Five Ethical Mistakes To Avoid with Clients on the Internet

This is a brief overview of common mistakes to avoid with online psychotherapy.  If nothing else, this short video should help a psychologist contemplating providing online psychotherapy services.





From the Australian Counseling Association.

Could intranasal oxytocin be used to enhance relationships?

Research imperatives, clinical policy, and ethical considerations

By O. A. Wudarczyk, B. D. Earp, A. J. Guastella & J. Savulescu

Abstract

Purpose of review. 

Well-functioning romantic relationships are important for long-term health and well-being, but they are often difficult to sustain. This difficulty arises (in part) because of an underlying tension between our psychobiological natures, culture/environment, and modern love and relationship goals. One possible solution to this predicament is to intervene at the level of psychobiology, enhancing partners’ interpersonal connection through neurochemical modulation. This article focuses on a single, promising biobehavioral sub-system for such intervention: the attachment system, based largely upon the expression of the neuropeptide oxytocin. Could the exogenous administration of oxytocin—under the right conditions—be used to facilitate relational or marital well-being?

Recent findings.

If so, it would require considerable forethought. Recent research complicates the popular image of oxytocin as a universal social enhancer or ‘love hormone’ and shows that it may exert a variety of different effects, at different dosages, on different people, under different circumstances. Accordingly, we discuss what is known about oxytocin, including its“good” and “bad” effects on human behavior and on higher-order functional processes.

Summary.

Building upon animal-model, human preclinical, and clinical findings, we outline a proposal for the use of oxytocin in the therapeutic neuroenhancement of contemporary romantic relationships. Highlighting key targets for future research along the way, we then conclude by discussing some of the clinical and ethical considerations that would pertain to the implementation of this knowledge in applied settings.

Key Points

* Intranasal oxytocin may hold promise for the therapeutic neuroenhancement of modern relationships. Oxytocin has “good” and “bad” effects, however, that may be different for different individuals and couples depending upon a range of personal, interpersonal, and contextual factors.

* Large-scale clinical trials with adequate sample sizes, and that include both males and females, are needed to fill in a range of “gaps” in existing knowledge. Chronic administrations and ecologically valid study designs should be top research priorities.

* The imminent prospect of neurochemical modulation of interpersonal relationships should inspire the development of general ethical guidelines for the responsible use of such technology. These guidelines should emphasize autonomy, consent, and personal and interpersonal well-being.

* As is the case with any new area of biomedical research, practical, moral, and clinical-policy considerations must be addressed in tandem with any progress made on scientific and theoretical fronts.

The entire article is here.

The Value of Role Reversal

Guest Post by Rebecca Dresser, Washington
BMJ Group Blogs
Originally posted on June 20, 2013

"Not so long ago, medical researchers had a habit of using themselves as guinea pigs.  Many scientists saw self-experimentation as the most ethical way to try out their ideas.  By going first, researchers could test their hypotheses and see how novel interventions affected human beings.

Today we rely on a more systematic process to decide when to begin human testing, with experts and ethicists evaluating when a trial is justified.  But a modified version of self-experimentation still makes sense.

People who conduct human research, as well as those serving on research ethics boards, can learn a lot from volunteering for studies.  Just as doctors learn from personal experience as patients, scientists and ethicists learn from personal experience as subjects.

Looking at study requirements and the consent process from the subject’s point of view can be quite educational.  I discovered this myself when I was given the option of enrolling in a cancer treatment trial.  I had never before realized that enrolling in a trial can delay the start of treatment, because of the extra appointments and procedures research enrollment can require.  Nor had I realized that because cancer trials take years to finish, subjects in those trials may lose an opportunity to receive new drugs that emerge during that time.  I’ve spent three decades writing about research ethics and serving on research review boards, but I learned new things once I had to decide whether to become a subject myself.

No one should be forced to participate in research, of course.  But I encourage research professionals to consider becoming subjects themselves (not necessarily in their own trials, but in studies conducted by others).  This modern version of self-experimentation might give researchers and ethicists a better sense of what people need to know before enrolling in a study.  It might also give scientists and review committees a deeper understanding of the risks, inconveniences, and benefits that subjects experience in research."

Rebecca’s paper “Personal Knowledge and Study Participation” is now available online first here.

The Limits of Moral Argument: Tamler Sommer presents at TEDx

Tamler Sommers is an Assistant Professor of Philosophy at the University of Houston and holds a joint appointment with the Honors College. His research and teaching are in the areas of ethics, political philosophy, and the philosophy of law, specializing in issues relating to free will, moral responsibility, punishment, and revenge.

Uploaded on December 17, 2011





The link to this video will be kept in the Audio and Video Resource page of this site.