Ethical Considerations for the Clinical Oncologist in an Era of Oncology Drug Shortages

Shortages of injectable drugs affect many cancer patients and providers in the U.S. today. Scholars and policymakers have recently begun to devote increased attention to these issues, but only a few tangible resources exist to guide clinical oncologists in developing strategies for dealing with drug shortages on a recurring basis. This article discusses existing information from the scholarly literature, policy analyses, and other relevant sources and seeks to provide practical ethical guidance to the broad audience of oncology professionals who are increasingly confronted with such cases in their practice. We begin by providing a brief overview of the history, causes, and regulatory context of oncology drug shortages in the U.S., followed by a discussion of ethical frameworks that have been proposed in this setting. We conclude with practical recommendations for ethical professional behavior in these increasingly common and challenging situations

The Lara Phenomenon: Powerful Female Characters in Video Games

The content of games is an understudied area in social scientific research about video games. The purpose of the present study is to contribute to the understanding of the portrayal of gender and race in games. Previous research on game content has revealed that stereotypical masculine characters dominate video games and that those characters are generally White. Nowadays, quite a few video games have women in leading parts; Tomb Raider's Lara Croft is the prototypical example. In our study we investigated the so-called 'Lara phenomenon,' that is, the appearance of a competent female character in a dominant position. We also studied the portrayal of men and the race of both male and female characters. We did a content analysis on the introductory films of 12 contemporary video games. Our results show that female characters appeared as often in leading parts as male characters did. They were portrayed with a sexualized emphasis on female features. Most game characters belonged to the dominant White race, the heroes exclusively so

Valuing nonfatal health risk as a function of illness severity and duration: Benefit transfer using QALYs

We estimate willingness to pay for small reductions in the risk of suffering nonfatal health conditions using a stated-preference survey fielded to an internet panel that is representative of the adult US population. Health conditions are described using a generic health utility system (EQ-5D). Estimated WTP is proportional to the stated reduction in probability of illness and independent of small differences in baseline risk, consistent with conventional economic theory, and is an increasing but highly concave function of the severity and duration of the illness. WTP to reduce nonfatal health risks can be estimated as a function of the severity and duration of the effect, but the relationship is not linear as assumed by the common practice of multiplying the expected QALY gain by a constant monetary value per QALY. WTP to reduce risk to another person in the household is significantly larger than to reduce risk to oneself, approximately 150 percent larger for an adult and 200 percent larger for a child

Diminishing willingness to pay per quality-adjusted life year: valuing acute foodborne illness

International audienceWe design and conduct a stated-preference survey to test whether willingness to pay (WTP) to reduce risk of acute illness is proportional to the corresponding gain in expected quality-adjusted life years (QALYs). For the short-term illnesses we consider, proportionality is required by economic theory if QALYs measure utility for health. Proportionality implies a constant WTP per incremental QALY and that WTP is proportional to changes in both health quality and duration of illness. WTP is elicited using double-bounded, dichotomous-choice questions in which respondents (randomly selected from the United States general adult population, n = 2,858) decide whether to purchase a more expensive food to reduce the risk of foodborne illness. Health risks vary by baseline probability of illness, reduction in probability, duration and severity of illness, and conditional probability of mortality. The expected gain in QALYs is calculated using respondent-assessed decrements in health-related quality of life if ill combined with the duration of illness and reduction in probability specified in the survey. We reject the hypothesis that WTP is proportional to the change in expected QALYs and find diminishing marginal WTP for severity and duration of illness prevented. Our results suggest that individuals do not have a constant rate of WTP per QALY, which implies that cost-effectiveness analysis using cost per expected QALY gained and measures of population health that assume a constant value per life year or QALY are not consistent with economic welfare theory

Valuing Morbidity Risk: Willingness to Pay per Quality-Adjusted Life Year

We estimate willingness to pay for small reductions in the risk of suffering a range of morbid health conditions using a stated-preference survey fielded to an internet panel that is representative of the US population. The adverse health conditions are described using a generic health utility system (EQ-5D). Estimated WTP is significantly associated with the reduction in probability of illness and with the severity and duration of the health condition. The variation of WTP with severity and duration is much smaller than proportionate, which implies that WTP to reduce risk is not equal to the expected loss in quality adjusted life years (QALYs) multiplied by a constant monetary value per QALY. WTP to reduce risk to another person in the household is significantly larger than to oneself, approximately 70 percent larger for an adult and 190 percent larger for a child

Integrated Disturbance Observer-Based Robust Force Control

For robotic tasks that involve combined transmitting and contact force control, achieving high-performance motion control while ensuring stable environment contact is difficult. Among the factors that affect the quality of this force control, we may account vibrations due to misalignment in the mechanical components, actuator inaccuracies, non-linear effects of friction, and backlash. All the above factors can be collectively considered as force disturbances. Towards high-performance motion control and contact stability, a novel integrated disturbance observer (IDOB) is proposed. The IDOB uses force sensor measurements with position measurements and a plant model to isolate and robustly suppress the effects of force disturbances within the plant without compromising contact stability. This is applied here to a force control system to demonstrate the enhanced force control performance in free space and in contact. The passivity, robust stability, and disturbance rejection of the proposed IDOB are compared with those of existing force controllers, with and without force-based DOBs. Finally, actual experiments are conducted in free space and contact under various interaction conditions, showing that the IDOB improves transmitting force control and disturbance suppression performances. Moreover, peak collision force is reduced while maintaining contact stability with stiff environments