Mortality and Morbidity Weekly Report for June 18 2010

This issue leads with a report on emergency room visits involving non-medical use of certain prescription drugs. It cites a significant increase not only in mortality (death) rates involving such non-medical uses, but also of morbidity (illness) rates.

Some interesting statistics:

  • 1.6 million visits for non-medical use of all drugs (prescription as well as non-prescription) in 2004
  • 2 million such visits in 2008
  • In both 2004 and 2008, illegal drugs accounted for 1 million of these visits
  • The increase, therefore, between 2004 and 2008 was accounted for by an increase in the non-medical use of prescription drugs
  • Most common prescription drugs involved in these ER visits: oxycodone, hydrocodone, methadone (all opioid analgesics); benzodiazepines also saw a near-100% increase

Questions: What steps should be taken to bring these numbers down, if any? Do the numbers show special cause for concern?


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The Use of Prenatal Dexamethasone

Prenatal Dexamethasone Use Questioned – TIME


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New Issue of Cambridge Quarterly of Healthcare Ethics

Volume 19, Issue 3, July 2010
Articles Include:

“Guest Editorial: Ignoring the Social and Cultural Context of Bioethics Is Unacceptable” by Renée Fox and Judith P. Swazey, 278-281.

“Japanese Childhood Vaccination Policy” by Peter Doshi and Akria Akabayashi, 283-289.

“Mental Health Acts in Canada” by Alister Browne, 290-298.

“Bioethics In Iceland” by Vilhjálmur Árnason, 299-309.

“Transatlantic Issues: Report from Scotland” by David M. Shaw, 310-320.

“Autonomy, Human Dignity, and the Right to Healthcare: A Dutch Perspective” by Martin Buijsen, 321-328.

“‘Liberty, Solidarity, Fairness’: A Personal View of the French Healthcare System” by Michel Roth, 329-333.

“Current Changes in German Abortion Law” by Daniela Reitz and Gerd Richter, 334-343.

“Capacity and Consent in England and Wales: The Mental Capacity Act Under Scrutiny” by Peter Herissone-Kelly, 344-352.

“‘Indigenizing’ Bioethics: The First Center for Bioethics in Pakistan” by Aamir M. Jafarey and Farhat Moazam, 353-362.

“Commanding the ‘Be Fruitful and Multiply’ Directive: Reproductive Ethics, Law, and Policy in Israel” by Daniel Sperling, 363-371.

“The Englaro Case: Withdrawal of Treatment from a Patient in a Permanent Vegetative State in Italy” by Sofia Moratti, 372-380.

“The Cultural Context of End-of-Life Ethics: A Comparison of Germany and Israel” by Silke Schicktanz, Aviad Raz, and Carmel Shalev, 381-394.

“Developing a Model of Healtcare Ethics Support in Croatia” by Ana Borovečki, Ksenija Makar-Ausperger, Igor Francetiĉ, Sanja Babić-Bosnac, Bert Gordijn, Norbert Steinkamp and Stjepan Orešković, 395-401.

“The Case: The ‘Ashley Treatment’ Revisited” by Ruchika Mishra, 407.

“Commentary: What Kind of Fire or Whose Feet?” by John J. Paris and M. Patrick Moore, 407-411.

“Commentary: Calibrating the Moral Compass” by Ian R. Holzman, 411-413.

“Commentary: Who Should Take on the Responsibility of Decisionmaking?” by Nafsika Athanassoulis, 413-415.

“Commentary: Weighing the Balance” by Amnon Goldworth, 415-416.

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Latest Issue of New England Journal of Medicine

Articles Include:

“Incentives for Drug Development – The Curious Case of Colchicine” by A. S. Kesselheim and D. H. Solomon.

“Health Care Reform and Primary Care – The Growing Importance of the Community Health Center” by E. Y. Adashi, H. J. Geiger, and M. D. Fine.

“The Cost Implications of Health Care Reform” by J. Gruber.

“The Public’s Response to the 2009 H1N1 Influenza Pandemic” by G. K. SteelFisher, R. J. Blendon, M. M. Bekheit, and K. Lubell.

“Standard of Care – In Sickness and in Health and in Emergencies” by G.J. Annas.

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Should this be the last generation?

Another provocative piece by Princeton bioethicist Peter Singer. Click on the first link for the article and the second link for his response to reader comments.

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Latest Issue of American Journal of Bioethics

Articles Include:

“Ethical Rules, Policies, or Guidance?” by Ruth Macklin, 1-2.

“The Case for Evidence-Based Rulemaking in Human Subjects Research” by Benjamin Sachs, 3-13.

“Ethical Rules for Human Subjects Research” A Case Where the ‘is’ Must Inform the ‘Ought’” by Alexander A. Kon, 14-15.

“Public Trust as a Policy Goal for Research With Human Subjects” by David B. Resnik, 15-17.

“In Defense of Valid Design as a Policy Rule” by Emily L. Evans, 18-19.

“A Third Way: Ethics Guidance as Evidence-Informed Provisional Rules” by Kirstin Borgerson and Joseph Millum, 20-22.

“An Absence of Evidence in ‘Evidence-Based Rulemaking’” by Jason Gerson and Steven N. Goodman, 22-23.

“Is There a Case for a Distinction Between Ethics and Policy?” by David Hunter, 24-25.

“How to Do Research Fairly in an Unjust World” by Angela J. Ballantyne, 26-35.

“Fair Benefits in Developing Countries: Maximin as a Good Start” by Ruth Macklin, 36-37.

“Why Adopt a Maximin Theory of Exploitation?” by Alan Wertheimer, Joseph Millum, and G. Owen Schaefer, 38-39.

“Multiple Forms of Exploitation in International Research: The Need for Multiple Standards of Fairness” by Jeremy Snyder, 40-41.

“One Size Does Not Fit All: Toward ‘Upstream Ethics’?” by Vural Ozdemir and Bartha Maria Knoppers, 42-44.

“Practical and Political Problems With a Global Research Tax” by David B. Resnik, 44-45.

“The Perverse Consequences of a Proposed Global Tax on Research” by Chris MacDonald and Nancy Walton, 46-47.

“Human Rights: The Normative Engine of Fairness and Research in Developing Countries” by John McMillan, 47-49.

“International Research and Positive Obligations: Are They ‘Transaction Specific’?” by John Rossi, 49-51.

“For-Profit Clinical Trials in Developing Countries – Those Troublesome Patient Benefits” by Udo Schuklenk, 52-54.

“Justice in the Application of Science: Beyond Fair Benefits” by Alex John London, 54-56.

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Futility of Treatments: Should an Ethics Committee Make Futility Decisions?

This has become a significant issue in NY State as well. The Family Health Care Decisions Act — which took effect on 1 June 2010 — requires ethics review committees to make some decisions. Is it ever appropriate to take medical decision-making out of the hands of patients and physicians?

Here are some resources on the FHCDA:

Additional Information on Medical Futility:

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