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PubMed1988

The syphilis epidemic and its relation to AIDS.

This article presents an overview of the history of medical and public health responses to syphilis in the 20th-century United States and briefly evaluates the relevance and significance of these approaches for the AIDS epidemic. The parallels are numerous: they relate to science, public health, civil liberties, and social attitudes concerning sexually transmitted infection. The strengths and limits of past approaches to controlling sexually transmitted diseases are explored as a possible guide for AIDS policy.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Smallpox revisited?

This article reviews the history of smallpox and ethical issues that arise with its threat as a biological weapon. Smallpox killed more people than any infectious disease in history--and perhaps three times more people in the 20th Century than were killed by all the wars of that period. Following a WHO-sponsored global vaccination campaign, smallpox was officially declared eradicated in 1980. It has since been revealed that the Soviet Union, until its fall in the early 1990s, manufactured tens of tons of smallpox for military purposes. A worry is that some of this may have fallen into the hands of "rogue" nations or terrorists. Current U.S. debate questions whether smallpox vaccine should therefore be made available to the American public, which--like the rest of the world--now lacks immunity. Because the vaccine is considerably dangerous, public dialogue cannot resolve this matter if evidence material to the likelihood of attack is classified (i.e. secret). I conclude by recommending numerous future areas for ethics research related to the weaponization of smallpox.

Biological Warfare↗
PubMed1988

Human immunodeficiency virus test evaluation, performance, and use. Proposals to make good tests better.

Human immunodeficiency virus (HIV) tests are essential for detecting asymptomatic infection and are helpful in confirming the diagnoses of acquired immunodeficiency syndrome-related complex and acquired immunodeficiency syndrome. Nonetheless, many aspects of their use remain controversial, partly because of concerns about test accuracy. This article reviews the scientific basis for the evaluation, performance, and use of the most commonly employed HIV assays. Current test performance could be improved by better standardization of test procedures and institution of mandatory proficiency testing and licensure of clinical laboratories that perform HIV testing. Test utility could be enhanced by sequencing tests more appropriately and by interpreting test results in conjunction with the clinical purpose for which the test is being used and the characteristics of the population under study. Finally, HIV tests should be evaluated in a manner that minimizes spectrum and referral bias and inadequate reference standard confirmation, problems that have affected the evaluation of current tests.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The OIG's model compliance program.

Home care agencies face never-ending and hard-to-track list of rules. The Office of the Inspector General has provided guidelines for agencies on implementing a voluntary compliance program to prevent fraud, abuse, and waste. Through the development of internal controls, which promote adherence to federal and state laws, agencies safeguard themselves from problems.

Adult↗
PubMed1977

Comparative study of prospective surveillance and voluntary reporting in determining the incidence of adverse drug reactions.

The results of a hospitalwide voluntary reporting program for adverse drug reactions (ADRs) was compared with the results of a short-term, intensive, prospective surveillance program conducted by a pharmacist on a medical and a surgical patient care unit of a large teaching hospital. Data generated by the voluntary system were collected for a 45-day period; for the prospective surveillance, data were collected for 21 days. Strict definitions on the categories of probability, severity and mechanism of adverse reactions were employed. The incidence of definite and probable ADRs in the voluntary system was 0.08%; for prospective surveillance, the incidence was 7.2% (5.9% of 85 surgical patients and 9.0% of 67 medical patients). The incidence of ADRs in the prospective study, based on patient-drug exposures, was 1.0%. In the prospective study, patients experiencing ADRs received significantly more medications than those not experiencing ADRs. The operation of an ADR monitoring and reporting system for the purpose of maintaining incidence data was not judged to be cost effective. Periodic prospective surveillance programs on representative patient population samples may be valuable in determining true incidence figures.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1986

Ethical dilemmas in workplace health promotion.

In less than a decade, workplace health promotion programs designed to promote employee health and help reduce the high cost of health insurance premiums paid by business and industry have proliferated. Notwithstanding the latent benefits and cost savings that corporate management expects to gain from the investment in such programs, it is argued that workplace health promotion is not without potential misuse and that its goals and methods ought not to be above ethical scrutiny. Drawing on earlier work, we discuss how workplace health promotion may pose ethical problems related to social justice, protection of privacy, and social control. The attendant moral dilemmas for the professional whose responsibility it is to develop and implement such programs are also presented.

Ethics↗
PubMed1987

Medicalization and its discontents.

This paper raises the question of the ethically proper balance in health care policy between the medical-clinical-high technology model of health service and the grass-roots, community based or traditional models of care. Paradoxical imbalances between the two approaches are traced to political, economic or prestige factors. Case studies examined include the hospitalization of non-contagious leprosy patients while protecting the anonymity of AIDS-infected prostitutes, medical resistance to the adoption of a clinical role by Community Cancer Centers, and the continued preference in some quarters for elaborate (and often delayed) hospital treatment for such problems as infant diarrhea, despite the availability of much simpler solutions, as in the case of the widely successful oral rehydration therapy. A balanced approach to world health problems, we argue, rests not on inflationary lowering of health care standards to achieve nominal victories, nor on stainless steel high technology panaceas but on mobilizing resources around human needs.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Use of live animals in the curricula of U.S. medical schools in 1994.

In 1994, the AAMC surveyed the 126 U.S. medical schools to obtain data on live-animal use in the undergraduate medical curriculum. The questions focused entirely on the use of live animals in teaching laboratories that are either required or optional parts of the undergraduate medical curriculum. Seventy-seven of the 125 responding schools used live animals in one or more courses; of the required courses, animals were most often used in physiology courses (49 schools), followed by surgical clerkships (21) and pharmacology courses (13). Although these data show that the majority of schools used live animals in their curricula, the data also show that the majority of schools did not use live animals as part of the teaching of any specific course of discipline in 1994. The animals most often used were dogs (54 schools) and pigs (12). Forty-three of the 77 schools that used live animals offered a variety of alternatives to their use. The respondents' data indicate a steady decline in the number of schools using live animals in teaching labs since before 1982. The reasons most often reported for discontinuing live-animal use were expense, changes in curriculum or curriculum focus, and lack of time, faculty, or space. Several other reasons were also listed, but live animals' value in teaching was seldom a factor. Only 15 schools indicated they had experienced harassment, protests, or legal actions arising from their use of live animals in the previous two years.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Experimentation↗