Ethical Issues in AIDS Research

There is a need for carefully controlled and scientifically rigorous research studies of the acquired immunodeficiency syndrome (AIDS). The morbidity and mortality associated with AIDS patients and the public health concerns for control of this epidemic have distorted the usual process of research. The Institutional Review Board at Boston City Hospital is suggested as an appropriate mechanism for clarifying the distinctions between research and innovative therapies and for assuring the protection of this vulnerable population of research subjects. This article addresses ethical concerns relating to the time frame of research, drug and antibody testing, vaccine trials, and questions of justice in micro- or macro-allocation. The unique problems in AIDS research with informed consent and confidentiality are discussed. Finally, the need is outlined for careful balancing of individual welfare and rights and those of society

Struggling to Meditate: Contextualising Integrated Treatment of Traumatised Tibetan Refugee Monks

As a result of the recent resurgence of violence in the Tibetan Autonomous Region, the Boston Center for Refugee Health and Human Rights has an increased patient demographic: Tibetan refugee monks. Diagnosed by their amchis (traditional healers) as having a srog-rLung (life-wind) imbalance and presenting with posttraumatic stress disorder (PTSD), they struggle with their contemplative meditation, which—as a central focus of their daily lives— normally comes with ease. In this article, we consider the pathological implications of the highly relevant Buddhist context for this dual diagnosis. Specifically, we contextualize the classification of ‘religious impairment’ as well as the significance of ongoing persecution of the devoutly religious for trauma therapy. We then draw upon spiritually oriented Eastern therapies as well as the confluence of specific paradigmatic practices to properly address these intricacies in devising an effective holistic healing approach to the dual PTSD/srog-rLung diagnosis

Frozen Ethics: Melting the Boundaries between Medical Treatment and Organ Procurement

When Renee Fox, medical sociologist and noted historian of organ transplantation, first learned of the proposal to use non-heart-beating cadavers as organ sources more than 25 years ago, she was appalled. She labeled the proposal the most elaborately macabre scheme for obtaining organs that I have encountered, adding that it borders on ghoulishness. She saw the procedure as beyond the pale of the medically decent, morally allowable, and spiritually acceptable (Fox 1993, 232). But medically decent has seldom gotten in the way of procuring organs for transplant, and we now seem to be on the verge of adopting an uncontrolled version of organ procurement from a non-heart-beating cadaver. In their commentary describing this new procedure (uncontrolled donation after circulatory determination of death or uDCDD), Arjun Prabhu, Lisa Parker, and Michael DeVita seek to normalize uDCDD by pairing it with an equally disturbing, highly experimental, long-shot emergency intervention for cardiac arrest due to exsanguination (emergency preservation and resuscitation or EPR) (Prabhu et al 2017). They argue that the central ethical question presented by uDCDD is how a hospital can avoid the appearance of conflicts of interest when proposing both uDCDD and EPR. A more fundamental ethical question, we suggest, is whether either of these procedures both done without informed consent on minority communities whose members will be used as human guinea pigs-should be done at all

Circulating cardiac troponin I levels measured by a novel highly sensitive assay in acute decompensated heart failure: insights from the ASCEND-HF trial

Background: Circulating cardiac troponin levels (cTn), representative of myocardial injury, are commonly elevated in heart failure (HF) and related to adverse clinical events. However, whether cTn represents a spectrum of risk in HF is unclear. Methods: Baseline, 48–72 hour, and 30 day plasma cTnI was measured by a novel highly-sensitive assay in 900 subjects with acute decompensated HF (ADHF) in ASCEND-HF. Multivariable models determined the relationship between cTnI and outcomes. Results: The median(interquartile range) cTnI was 16.4 (9.3-31.6) ng/L at baseline, 14.1 (7.8-29.7) ng/L at 48-72 hours, and 11.6 (6.8-22.5) ng/L at 30 days. After additional adjustment for amino terminal pro-B-type natriuretic peptide (NT-proBNP) to established risk predictors, both baseline and 48-72 hour cTnI were associated with higher risk for death or worsening HF prior to discharge (OR 1.25, P=0.03 and OR 1.43, P=0.001, respectively). However, only cTnI at 30 days was associated 180-day death (HR 1.25, P=0.007). There were no curvilinear associations between changing cTnI and clinical outcomes. Conclusions: Circulating cTnI level was associated with clinical outcomes in ADHF, but these observations diminished with additional adjustment for NT-proBNP. Although they likely represent a spectrum of risk in ADHF, these findings question the implications of changing cTnI levels during treatment

Medical ethics in the shadow of the Holocaust: the Nazi doctors, racial hygiene, murder and genocide

Lecture by Michael A. Grodin, M.D., Director of the Project on Medicine and the Holocaust and Professor of Health Law, Bioethics, and Human Rights at Boston University School of Public Health and School of Medicine, held April 17, 2012 at the University of New Hampshire, as part of the lecture series entitled Medical Ethics and Human Subject Research in the Shadow of the Holocaus