Bioethics

Public health has made enormous contributions to global health through policies and interventions. However, public health measures have also increased human suffering through policies of forcedsterilization, mandatory screening of vulnerable populations, detention of people with infectious diseases, and the quarantine and social isolation of “sick” people or communities. Until recently, the values and ethics that public health is based on have been assumed to be “good” and have not been subject to critical analysis. In the last decade, however, bioethicshas shifted its attention from the clinic to the public sphere, and many of the ethical issues raised by public health have become the focus of both philosophical and empirical study. Bioethicsin public health addresses the tension between local and global health needs; the role of the community in decision making; the duties, obligations, and limitations of the state in relation to the provision of health care; the targeting of vulnerable populations by interventions aimed at preventing disease; and the nature and importance of ethical principles and rights in health care. This bibliography provides a collection of resources that address the ethical theories, theoretical frameworks, key concepts, and practices of public health

Bioethics

Public health has made enormous contributions to global health through policies and interventions. However, public health measures have also increased human suffering through policies of forcedsterilization, mandatory screening of vulnerable populations, detention of people with infectious diseases, and the quarantine and social isolation of “sick” people or communities. Until recently, the values and ethics that public health is based on have been assumed to be “good” and have not been subject to critical analysis. In the last decade, however, bioethicshas shifted its attention from the clinic to the public sphere, and many of the ethical issues raised by public health have become the focus of both philosophical and empirical study. Bioethicsin public health addresses the tension between local and global health needs; the role of the community in decision making; the duties, obligations, and limitations of the state in relation to the provision of health care; the targeting of vulnerable populations by interventions aimed at preventing disease; and the nature and importance of ethical principles and rights in health care. This bibliography provides a collection of resources that address the ethical theories, theoretical frameworks, key concepts, and practices of public health

Resource recovery and remediation of highly alkaline residues : a political-industrial ecology approach to building a circular economy

Highly alkaline industrial residues (e.g., steel slag, bauxite processing residue (red mud) and ash from coal combustion) have been identified as stocks of potentially valuable metals. Technological change has created demand for metals, such as vanadium and certain rare earth elements, in electronics associated with renewable energy generation and storage. Current raw material and circular economy policy initiatives in the EU and industrial ecology research all promote resource recovery from residues, with research so far primarily from an environmental science perspective. This paper begins to address the deficit of research into the governance of resource recovery from a novel situation where re-use involves extraction of a component from a bulk residue that itself represents a risk to the environment. Taking a political industrial ecology approach, we briefly present emerging techniques for recovery and consider their regulatory implications in the light of potential environmental impacts. The paper draws on EU and UK regulatory framework for these residues along with semi-structured interviews with industry and regulatory bodies. A complex picture emerges of entwined ownerships and responsibilities for residues, with past practice and policy having a lasting impact on current possibilities for resource recovery

Clarifying the costs of conflicts of interest

Over the past two decades, a deep suspicion has emerged in the healthcare community about the influence of private industry – particularly the pharmaceutical industry – over doctors, researchers, regulators and policymakers [1, 2]. In response to the perceived threats posed by conflicts of interest (COI), there have been calls for a range of measures including stricter disclosure statements, more transparency, and tighter regulation of medical and industry interactions [3]. Not surprisingly, such demands tend to be resisted by the pharmaceutical industry, and by a subset of clinicians and researchers who believe that claims of adverse industry influence are overblown [4]. One such example is the recent article by Barton, Stossel and Stell in the International Journal of Clinical Practice [5]. Barton et al. argue that concerns about COI are exaggerated and unsupported by empirical evidence, and that demands for regulation and transparency distract medical professionals, researchers and policymakers from their primary task – improving patient outcomes. Furthermore, they suggest that if there is no evidence that patient outcomes are negatively affected by COI, then there is no cause for concern. They claim that the ‘conflict of interest movement has failed to substantiate its central claim that interactions between physicians, researchers and the medical products industry cause physicians to make clinical decisions that are adverse to the best interests of their patients.’ The medical community and bioethicists in particular, should therefore stop worrying about COI.NHMRC Project Grant (APP1059732

Health professionals as vendors: the commercial erosion of evidence and ethics

With the discussion paper from the ongoing Review of Pharmacy Remuneration and Regulation still open for public input, there is an opportunity to reflect on how the services currently delivered by community-based pharmacies in Australia can be improved. Some of the questions up for discussion concern the ways in which pharmacists and patients navigate pharmacists’ dual roles as retailers and dispensers. In the post below, bioethicists Wendy Lipworth, Christopher Mayes and Ian Kerridge discuss what is at stake when therapeutic and commercial boundaries are blurred, and deliver a warning to other health professionals who might consider the addition of merchandising to their professional portfolios

Conflicts of Interest in Neoliberal Times: Perspectives of Australian medical students

In this paper we report on the findings from six focus groups conducted with Australian medical students. The focus groups discussed students’ perceptions of conflicts of interest and the influence of commercial values in health care and medical education. Our research revealed that students were aware of a number of structural influences that affected the medical education they received and that had the potential to shape their attitudes and practices as they progressed in becoming a doctor. We found that the pressures of educational workload and anticipated career trajectories tended to have an individualising effect that limited the perceived possibility of collective action and response to structural influences. We interpreted these findings through the lens of neoliberal governmentality to articulate the way commercial interests are negotiated and normalised by medical students. Based on these findings, we suggest that medical education should not only explicitly alert students to effects of political and commercial influences on the healthcare system, but also encourage the collective agency of students and strategies that do not place unrealistic expectations on individuals to effect structural change. KEYWORDS: Neoliberalism, conflicts of interest, medical education, medical students, ethicsThis work was supported by the National Health and Medical Research Council [grant number 1059732]

The political and ethical challenge of multi-drug resistant tuberculosis

This article critically examines current responses to multi-drug resistant tuberculosis and argues that bioethics needs to be willing to engage in a more radical critique of the problem than is currently offered. In particular, we need to focus not simply on market-driven models of innovation and anti-microbial solutions to emergent and re-emergent infections such as TB. The global community also needs to address poverty and the structural factors that entrench inequalities—thus moving beyond the orthodox medical/public health frame of reference.in part funded by the NHMRC CRE for TB Control [CRE1043225

Joe Hockey’s medical research fund is nothing more than a distraction

Health is a basic requirement for an individual to lead a good life. Without health you have nothing; when we are sick, it’s difficult to work, to care for others, to participate in the things we enjoy. We seek treatment so we can get back to our normal lives. Because health is so important to our wellbeing, there is widespread agreement— including among ethicists —that a fair and accessible healthcare system is something that we should pursue. And although the Australian healthcare system is far from perfect, it has provided universal access to healthcare for almost 40 years. A universal healthcare system – one that is open to everyone, whether or not they can afford to pay – is a basic feature of a good and just society. Tony Abbott and Joe Hockey want us to panic about a "budget emergency", including the idea that our current health system is unsustainable. Rising healthcare costs pose a challenge to governments everywhere. But this is not a new problem, and will not bring about economic or social catastrophe any time soon. This amplified threat is being used to justify measures that are now well known: introducing co-payments for GP fees; disestablishing Medicare Locals; transferring health agencies to the department of health with reduced funding; and stripping $80bn in funding from the states, particularly in health and education. This will not only force the states to increase their own goods and services taxes, but reduce the public services they can afford to provide. It will end universal access to health care, make Medicare a mere "safety net", overwhelm hospitals, and increase the inequities that are increasingly a feature of Australian society

Semantic context and visual feature effects in object naming: an fMRI study using arterial spin labeling

Previous behavioral studies reported a robust effect of increased naming latencies when objects to be named were blocked within semantic category, compared to items blocked between category. This semantic context effect has been attributed to various mechanisms including inhibition or excitation of lexico-semantic representations and incremental learning of associations between semantic features and names, and is hypothesized to increase demands on verbal self-monitoring during speech production. Objects within categories also share many visual structural features, introducing a potential confound when interpreting the level at which the context effect might occur. Consistent with previous findings, we report a significant increase in response latencies when naming categorically related objects within blocks, an effect associated with increased perfusion fMRI signal bilaterally in the hippocampus and in the left middle to posterior superior temporal cortex. No perfusion changes were observed in the middle section of the left middle temporal cortex, a region associated with retrieval of lexical–semantic information in previous object naming studies. Although a manipulation of visual feature similarity did not influence naming latencies, we observed perfusion increases in the perirhinal cortex for naming objects with similar visual features that interacted with the semantic context in which objects were named. These results provide support for the view that the semantic context effect in object naming occurs due to an incremental learning mechanism, and involves increased demands on verbal self-monitoring