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Biomedical subjects

Richard A Epstein

Publications and source records attributed to Richard A Epstein.

12 recordsLinked to original sources
PubMed2005

Disparities and discrimination in health care coverage: a critique of the Institute of Medicine study.

The 2003 Institute of Medicine (IOM) study on Unequal Treatment takes the strong position that many of the current disparities in health care by race are attributable to forms of conscious and unconscious discrimination by health care providers. The study, however, is flawed by imprecise definitions of discrimination that fail to distinguish between differences in treatment due to breakdown in communications and differences in the treated population that are prompted by invidious motives of health care providers. It is doubtful that hidden forms of discrimination are prevalent in a profession whose professional norms are set so strongly against it. In addition, the IOM relies too uncritically on similar studies in unrelated fields to show the ostensible forms of discrimination. These errors have adverse social consequences. A false diagnosis of discrimination where none exists will send a false signal to members of racial minorities that may induce them to avoid receiving needed medical care and instead pursue costly and ineffective remedial devices that will take away funds better spent on providing direct health care.

Bias↗
PubMed2004

Inside information: Financial conflicts of interest for research subjects in early phase clinical trials.

In recent years, several research subjects have told us that they had bought or intended to buy stock in the companies sponsoring the clinical trials in which they were enrolled. This situation has led us to ask what, if any, are physician-investigators' scientific, ethical, and legal responsibilities concerning research subjects who choose to buy stock in the companies sponsoring the clinical trials in which they are participating. Although the scope of this problem is unknown and is likely to be small, this commentary examines the scientific, ethical, and legal concerns raised by such activities on the part of research subjects enrolled in early phase clinical trials. In addition, this commentary also outlines the basis for our opinion that research subjects involved in an early phase clinical trial should avoid the financial conflicts of interest created by trading stock in the company sponsoring the clinical trial.

Clinical Trials, Phase I as Topic↗
PubMed2004

Inpatient and residential treatment effects for children and adolescents: a review and critique.

As residential group care has become a less exclusively milieu-based therapy and more a "tapestry of therapies" that involves individual, group, and family therapy, psychopharmacology, intensive case management, special education services, therapeutic recreational activities, and a residential milieu based on therapeutic principles, the practice of providing detailed descriptions of the type of treatment has deteriorated. One might argue, however, that the need for their provision has become ever more important as the calls for improving the scientific quality of the outcome research have become more strident. This is especially true of detailed descriptions of the therapeutic underpinnings involved in the creation and maintenance of a therapeutic residential environment. As Trieschman and his colleagues discussed, a therapeutic residential environment is a place in which residents spend most of their time and have many potentially therapeutic interactions with peers and direct-care staff members.

Adolescent↗
PubMed2003

Let the shoemaker stick to his last: a defense of the "old" public health.

The traditional forms of public health law were directed largely toward communicable diseases and other externalities, such as pollution, with negative health impacts. The more modern view treats any health issue that affects large numbers of individuals as one of public health, which would include such problems as obesity and diabetes. This paper examines the constitutional evolution of the public health principle from the narrower to the broader conception. It then argues that the narrower conception better defines the appropriate scope of coercive government intervention than does the broader definition, which could easily authorize interventions in economic affairs whose indirect effects are likely to reduce overall social wealth and freedom, and with it the overall health of the population.

Forecasting↗
PubMedDate not supplied

Reducing drug prices.

Explore the source record for details and available documents.

Cost Control↗
PubMedDate not supplied

It did happen here: fear and loathing on the vaccine trail.

Adverse publicity that placed undue emphasis on a possible connection between autism and the measles-mumps-rubella (MMR) vaccine and vaccines containing thimerosal made parents in the United Kingdom reluctant to allow their children to receive the vaccine. The same concerns have played themselves out in the U.S. Food and Drug Administration's decision to recommend removal of thimerosal from other vaccines, even as the individual autism claims have been rejected. That recommendation, based on unsubstantiated safety concerns, reveals a deep-seated institutional overreaction that is more likely to cost lives than to save them.

Autistic Disorder↗