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Sound Ethics
Sound Medicine
 Sound Medicine is produced by the Indiana University School of Medicine and WFYI Public Radio. Host Barbara Lewis interviews medical experts on a wide range of current issues in medicine, from Alzheimer research to the West Nile virus. Joining Ms. Lewis each week are faculty co-hosts from the IU School of Medicine: Drs. Steven Bogdewic, David Crabb, Eric Meslin, Kathy Miller, and Ora Pescovitz.
The program educates and encourages listeners to make sound health decisions. It's also a forum for health issues affecting local communities.
Sound Ethics
Sound Ethics is a monthly feature of Sound Medicine. Eric Meslin, Director, Center for Bioethics, joins host Barbara Lewis and others to discuss the ethical implications of the latest medical news and research. Past shows have addressed issues ranging from euthanasia to medical errors.
Podcasts of recent and archived shows can be downloaded from the Sound Medicine website - http://soundmedicine.iu.edu/
Topic Guides
On July 14-15, 2008 the Association for State and Territorial Health Officials, the Indiana State Department of Health, and the Indiana University Center for Bioethics hosted a summit on pandemic influenza planning for public health officials across the country. On the 16th a separate meeting was held focusing on issues specific to Indiana’s preparation for pandemic influenza. In this episode of Sound Medicine, Eric M. Meslin, Ph.D., director of the IU Center for Bioethics, discusses the goals of the upcoming summit and gives a brief overview of the ethical issues to consider in pandemic influenza planning. To listen to this episode of Sound Ethics, download a free podcast from the Sound Medicine website: http://soundmedicine.iu.edu/segment.php4?seg=1690
This bibliography addresses the main topics discussed in the July 13, 2008 episode of Sound Ethics: ethical issues in patient access to care in the event of a pandemic influenza, including the prioritization and allocation of scarce medical resources; healthcare workforce management, balancing the conflicting needs of healthcare workers to attend to their families and to the public during a pandemic; and the legal issues that arise in a pandemic, including a health care worker’s duty to work and the state’s authority to limit individual liberties in the interest of public health.
Links to websites devoted to pandemic influenza are also included for further research.
Triage and Altered Standards of Care:
Agency for Healthcare Research and Quality. Altered Standards of Care in Mass Casualty Events. AHRQ Publication No. 05-004; April, 2005. http://www.ahrq.gov/research/altstand/altstand.pdf
Agency for Healthcare Research and Quality. Providing mass medical care with scarce resources: A community planning guide. AHRQ Publication No. 07-0001; February, 2007. http://www.ahrq.gov/research/mce/mceguide.pdf
Berlinger N and Moses J. Five people you meet in a pandemic—and what they need from you today. Bioethics Backgrounder [Hastings Center]; 2007. http://www.thehastingscenter.org/pdf/Pandemic-Backgrounder-The-Hastings-Center.pdf
Centers for Disease Control and Prevention, Ethics Subcommittee of the Advisory Committee to the Director. Ethical guidelines in pandemic influenza. 2007 Feb 15. http://www.cdc.gov/od/science/phec/panFlu_Ethic_Guidelines.pdf
Christian MD, Hawryluck L, Wax RS, et al. Development of a triage protocol for critical care during an influenza pandemic. CMAJ. 2006 Nov 21;175(11):1377-81. [PMID:17116904] [Free Full Text]
Public Health Agency of Canada, Centre for Infectious Diseases Prevention and Control (CIDPC). Canadian pandemic influenza plan for the private sector. Her Majesty the Queen in Right of Canada; 2006. 610 p. [Online version | PDF - 6.51 MB]
McGorty EK, Devlin L, Tong R, Harrison N, Homes M, Silberman P. Ethical guidelines for an influenza pandemic. NC Med J. 2007 Jan-Feb;68(1):38-42. [PMID:17500430 | PDF - 196 KB]
New York State Workgroup on Ventilator Allocation in an Influenza Pandemic. Allocation of ventilators in an influenza pandemic: Planning document [Draft for public comment]; March 15, 2007. [PDF - 309 KB]
United States Department of Health and Human Services. Pandemic influenza plan: Supplement 3, healthcare planning. 2007. [Online version | PDF - 184 KB]
United States Department of Health and Human Services, United States Department of Homeland Security. Guidance on allocating and targeting pandemic influenza vaccine. Oct 2007. [PDF - 1.83 MB]
World Health Organization, Department of Communicable Disease/Surveillance and Response/Global Influenza Programme. WHO global influenza preparedness plan: The role of WHO and recommendations for national measures before and during pandemics. World Health Organization; 2005. [WHO/CDS/CSR/GIP/2005.5 - PDF 260 KB]
Healthcare Workforce Management:
Ehrenstein BP, Hanses F, Salzberger B. Influenza pandemic and professional duty: family or patients first? A survey of hospital employees. BMC Public Health. 2006 Dec 28;6:311. [PMID:17192198] [Free Full Text]
Occupational Safety and Health Administration. Pandemic influenza preparedness and response for healthcare workers and healthcare employers. U.S. Department of Labor [OSHA 3328-05]; 2007. [PDF - 405 KB]
Rhyne JA. Likely ethical, legal, and professional challenges physicians will face during an influenza pandemic. NC Med J. 2007 Jan-Feb;68(1):51-3. [PMID:17500435] [PDF - 202 KB]
Tzeng HM. Nurses’ professional care obligation and their attitudes towards SARS infection control measures in Taiwan during and after the 2003 epidemic. Nurs Ethics. 2004;11(3):277-89. [PMID:15176641]
The Law:
Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities. Model state emergency health powers act [A draft discussion as of December 21, 2001]. Dec 2001. [PDF - 89 KB]
Gostin LO, Sapsin JW, Teret SP, et al. Model state emergency health powers act: Planning for and response to bioterrorism and naturally occurring infectious disease. JAMA. 2002 Aug 7;288(5):622-28. [PMID:12150674]
Gostin LO. Public Health Law In An Age Of Terrorism: Rethinking Individual Rights and Common Goods. Health Aff (Millwood). 2002 Nov-Dec; 21(6):79-93. [PMID:12442842] [Free Full Text]
Indiana Code 25-1-9. Health professions standards of practice. http://www.in.gov/legislative/ic/code/title25/ar1/ch9.html
For Further Research:
Although electroconvulsive therapy (ECT) is currently used successfully in a clinical setting, the therapy has a controversial past. In addition to the many negative portrayals of ECT in film and fiction, including Ken Kesey's novel One Flew Over the Cuckoo's Nest, public perception may have been influenced by the questionable experimental use of the therapy in medical research during the post-WWII era. These experiments included those which were partly funded by the CIA during the 1950s and the early 1960s as a part of the agency's MK-ULTRA program. The MK-ULTRA program explored methods of mind-control by experimenting with LSD and ECT. Donald Ewen Cameron, as Director of the Allan Memorial Institute of McGill University, oversaw an academic research project partly funded by this CIA initiative. Cameron's research (1957-1964) involved the use of high-powered ECT treatments with mentally ill, anxious, and depressed patients. Cameron experimented with ECT to "depattern" the brain and, thereafter, used other techniques, called "psychic driving", in an attempt to re-pattern the brain.
In this episode of Sound Ethics, Eric Meslin talks with Dr. Steven Jay, a professor of public health at the IU School of Medicine. In 1965, while Dr. Jay was a medical student on a visiting fellowship at McGill, he witnessed the end of this use of ECT. A brief bibliography (below) focusing on the use of ECT in D. Ewen Cameron's research is followed by a broader list of publications addressing the ethical issues of electroconvulsive therapy in medicine and research.
D. Ewen Cameron, ECT and the CIA:
Cleghorn RA and Silverman B. D. Ewen Cameron, M.D., F.R.C.P.[C]. CMAJ 1967; 97 (16):984-6. PMID:4861213 [Free Full Text]
Farnsworth CH. Canada will pay guinea pigs of 50's. NY Times (Print) 1992:A9. PMID:11647931 | CiteULike [Excerpt]
Moreno JD. Undue risk: secret state experiments on humans. New York: W.H. Freeman and Co., 2000. Find book ...
Rubenstein LS. Psychiatric experimentation: the lessons of history. J Calif Alliance Ment Ill 1994; 5 (1):22-4. PMID:11653310
Rubenstein LS. Standards of accountability for consent in research. Account Res. 1996;4(3-4):197-206. PMID:11654515 | CiteULike [Excerpt]
Schell BH. The ominous shadow of the CIA has imprinted itself on the brain research community. J Calif Alliance Ment Ill 1994; 5 (1):38-40. PMID:11653317
Sibbald B. Quebec tackles electroconvulsive therapy issue. CMAJ 2003; 168 (12):1583. PMID:12796349 [Free Full Text]
Thomas G. Journey into madness: the true story of secret CIA mind control and medical abuse. New York: Bantam Books, 1989. Find book ...
Weinstein HM. Psychiatry and the CIA: victims of mind control. Washington, DC: American Psychiatric Press, 1990. Find book ...
ECT - Ethical Issues, History, and Attitudes:
Fink M. Convulsive therapy: a review of the first 55 years. J Affect Disord 2001; 63 (1-3):1-15. PMID:11246075 [Abstract]
Fink M. Is the practice of ECT ethical? World J Biol Psychiatry 2005; 6 Suppl 2:38-43. PMID:16166022 [Abstract]
Gazdag G, et al. Regressive and intensive methods of electroconvulsive therapy: a brief historical note. J ECT 2007; 23 (4):229-32. PMID:18090693 [Abstract]
Hilton C. An exploration of the patient's experience of electro-convulsive therapy in mid-twentieth century creative literature: a historical study with implications for practice today. J Affect Disord 2007; 97 (1-3):5-12. PMID:16887198 [Abstract]
Hirshbein L and Sarvananda S. History, power, and electricity: American popular magazine accounts of electroconvulsive therapy, 1940-2005. J Hist Behav Sci 2008; 44 (1):1-18. PMID:18196545 [Abstract]
Lauber C, et al. Can a seizure help? The public's attitude toward electroconvulsive therapy. Psychiatry Res 2005; 134 (2):205-9. PMID:15840423 [Abstract]
Lebensohn ZM. The history of electroconvulsive therapy in the United States and its place in American psychiatry: a personal memoir. Compr Psychiatry 1999; 40 (3):173-81. PMID:10360611 [Abstract]
Linington A and Harris B. Fifty years of electroconvulsive therapy. BMJ 1988; 297 (6660):1354-5. PMID:3146363 [Free Full Text]
Reisner AD. The electroconvulsive therapy controversy: evidence and ethics. Neuropsychol Rev 2003; 13 (4):199-219. PMID:15000226 [Abstract]
Rose D, et al. Patients' perspectives on electroconvulsive therapy: systematic review. BMJ 2003; 326 (7403):1363. PMID:12816822 [Free Full Text]
Rose DS, et al. Information, consent and perceived coercion: patients' perspectives on electroconvulsive therapy. Br J Psychiatry 2005; 186:54-9. PMID:15630124 [Abstract]
Taylor S. Electroconvulsive therapy: a review of history, patient selection, technique, and medication management. South Med J 2007; 100 (5):494-8. PMID:17534086 [Abstract]
Thompson JW, et al. Use of ECT in the United States in 1975, 1980, and 1986. Am J Psychiatry 1994; 151 (11):1657-61. PMID:7943457 [Abstract]
Search the Literature:
This Sound Ethics topic guide addresses shows broadcast on two dates – April 6 ( Sound Ethics: Medicines in the Developing World) and May 4, 2008.
Premise: The WHO estimates that 10 million people die annually (mostly in developing countries) because they do not have access to existing medicines and vaccines. There is a growing consensus that both private industry and universities have a role in improving access to drugs within low- and middle-income countries.
In the April 6 episode Eric Meslin, Ph.D., discusses with Alan Breier, M.D., Vice President for Medical and Chief Medical Officer, Eli Lilly and Co., the role of industry in improving access to essential medicines. Breier also shares Lilly's efforts to extend access to medication, efforts exemplified by the Lilly MDR-TB Partnership, a program that works with the WHO to provide medications and training for the prevention and treatment of Multi-Drug Resistant Tuberculosis.
In the forthcoming May 4 episode, Eric Meslin, Ph.D, discusses with Caroline Rouse, a second year student at the Indiana University School of Medicine, the role universities can play in building better access to medicines. Rouse, a member of the Indiana University chapter of Universities Allied for Essential Medicines, also shares the aims and activities of this advocacy group.
Essential Medicines:
Hogerzeil HV. Essential medicines and human rights: what can they learn from each other? Bull World Health Organ. 2006 May;84(5):371-5. Epub 2006 May 17.
PMID: 16710546
MSF Campaign for Access to Essential Medicines. http://www.accessmed-msf.org/
Pécoul B. New drugs for neglected diseases: from pipeline to patients.
PLoS Med. 2004 Oct;1(1):e6. Epub 2004 Oct 19.
PMID: 15526054
Pécoul B, Chirac P, Trouiller P, Pinel J. Access to essential drugs in poor countries: a lost battle? JAMA. 1999 Jan 27;281(4):361-7.
PMID: 9929090
Quick JD. Essential medicines twenty-five years on: closing the access gap. Health Policy Plan. 2003 Mar;18(1):1-3.
PMID: 12582103
Quick JD, Hogerzeil HV. Ten best readings in ... essential medicines. Health Policy Plan. 2003 Mar;18(1):119-21.
PMID: 12582115
World Health Organization. Topics: Essential Medicines. http://www.who.int/topics/essential_medicines/en/
World Health Organization. WHO Model Lists of Essential Medicines. Accessed March 2008 from http://www.who.int/medicines/publications/essentialmedicines/en/
World Health Organization. Equitable access to essential medicines: a framework for collective action. WHO Policy Perspectives on Medicines. March 2004.
[PDF - 135 KB]
Patents, Pharmaceuticals and the Role of Universities:
Patents, Pharmaceuticals and the Role of Industry
Attaran A. How do patents and economic policies affect access to essential medicines in developing countries? Health Aff (Millwood). 2004 May-Jun;23(3):155-66.
PMID: 15160813 | [PDF - 252 KB]
Calon F. Nonpatentable drugs and the cost of our ignorance. CMAJ. 2006 Feb 14;174(4):483-4.
PMID: 16477060
Danzon PM, Towse A. Differential pricing for pharmaceuticals: reconciling access, R&D and patents. Int J Health Care Finance Econ. 2003 Sep;3(3):183-205. Review.
PMID: 14625999 | [PDF 124 KB]
Novas C. What is the bioscience industry doing to address the ethical issues it faces? PLoS Med. 2006 May;3(5):e142. Epub 2006 Apr 4.
PMID: 16573362
Pogge T. Montréal statement on the human right to essential medicines. Camb Q Healthc Ethics. 2007 Winter;16(1):97-108.
PMID: 17345971 | [PDF 86.1 KB]
Yamin AE. Not just a tragedy: access to medications as a right under international law. Boston Univ Int Law J. 2003 Fall;21(2):325-71.
PMID: 16514750 | [PDF 163 KB]
Search the Literature:
In this episode, Sound Ethics: Who Owns Research Data?, Eric M. Meslin, Ph.D., director of
the IU Center for Bioethics, and Andrew Vickers, Ph.D., a biostatistician at
Memorial Sloan Kettering Cancer Center, discuss Vickers’ New York Times
essay questioning the reluctance of some researchers to share their raw data, even
after the results have been published.
Academic Publications:
How to encourage the right behaviour. Nature. 2002 Mar 7;416(6876):1.
[Editorial].
PubMedID:11882850 |
doi:10.1038/416001b
Altman DG, Cates C. Authors should make their data available. BMJ. 2001
Nov 3;323(7320):1069-70. [Comment].
PubMedCentralID:11691772 [Free, full text]
Doyle DJ. Understanding the open access data movement. Can J Anaesth.
2007 Nov;54(11):949-50. [Comment].
PubMedID:17975243 |
cja-jca.org
Eysenbach G, Sa ER. Code of conduct is needed for publishing raw data.
BMJ. 2001 Jul 21;323(7305):166.
PubMedCentralID:11463695 [Free, full text]
Fienberg SE. Sharing statistical data in the biomedical and health
sciences: ethical, institutional, legal, and professional dimensions. Annu
Rev Public Health. 1994;15:1-18. [Review].
PubMedID:8054076 |
doi:10.1146/annurev.pu.15.050194.000245
Hutchon DJ. Publishing raw data and real time statistical analysis on
e-journals. BMJ. 2001 Mar 3;322(7285):530.
PubMedCentralID:11230070 [Free, full text]
Kirwan JR. Making original data from clinical studies available for
alternative analysis. J Rheumatol. 1997 May;24(5):822-5. [Editorial].
PubMedID:9150066 |
Connotea [Excerpt]
Nagelkerke NJ, Bernsen RM, Rizk DE. Authors should publish their raw
data. Int Urogynecol J Pelvic Floor Dysfunct. 2007 Dec;18(12):1387-90.
[Editorial]. PubMedID:17876487 |
doi:10.1007/s00192-007-0464-z
Reidpath DD, Allotey PA. Data sharing in medical research: an empirical
investigation. Bioethics. 2001 Apr;15(2):125-34.
PubMedID:11697377 |
doi:10.1111/1467-8519.00220
Vickers AJ. Whose data set is it anyway? Sharing raw data from randomized
trials. Trials. 2006;7:15. [Editorial].
PubMedCentralID:16704733 [Free fulltext]
Vogeli C, Yucel R, Bendavid E, Jones LM, Anderson MS, et al. Data withholding and the next generation of scientists: results of a
national survey. Acad Med. 2006 Feb;81(2):128-36.
PubMedID:16436573 |
academicmedicine.org [abstract]
News and Other Sources:
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