The History of Institutional Review Boards

Along the lines of our discussion regarding research ethics, Dr. William Schneider (Professor of History, Indiana University) provides an overview of the events and developments that led to the establishment of federal rules and regulations concerning research, including the Institutional Review Boards. This article addresses the Nuremberg Code, the Thalidomide Tragedy, the Declaration of Helsinki, the Henry Beecher article in the NEJM, the USPHS memo on review boards, and the Tuskegee Syphilis Study.

http://www.iupui.edu/~histwhs/G504.dir/irbhist.html

dialysis for illegal immigrants

Interesting article published today in the L.A. Times about dialysis treatment for illegal immigrants in California and other states:

http://www.latimes.com/news/la-me-dialysis29-2008oct29,0,5272809,full.story

If Mexico can only provide Toribio treatment if she is able to provide enough cash, should U.S. hospitals treat her? Deporting her to Mexico may likely result in renal failure and death from the lack of viable treatment, but treating her here will create a "burden" for tax paying Californians. The article mentions that the United States can't treat the world, especially for dialysis, which can be costly. But is the U.S. treating the world, or simply helping a marginalized group fleeing economic and social struggle?

I am of the opinion that it is the moral obligation of our country to provide treatment for illegal immigrants, though seemingly costly. And for those who have "embraced their inner capitalist" dialysis treatment outside of the ER is cheaper, so really everybody wins...but not quite.

Of course, the argument remains that we ought to instead deport illegal immigrants-after all they are NOT Americans and DO NOT have the birthrights which come with being born on American soil. I do not think that this perspective is without merit. It solves the problem, in a sense. The economic burden is lifted off taxpayer’s shoulders, and hospitals don't have to worry about long term costly treatment, just enough treatment to get the patient back to their home country-that patch of soil on which they were born. Yet in reality, the problem isn't solved, because the problem is human suffering. Toribio would not be magically cured upon flying into Mexican airspace. It is in the interest of all humanity, perhaps physicians most of all, to prevent suffering which can be avoided.

Many who feel inwardly perturbed by the prospect of treating illegal immigrants with tax dollars understand something very important: the healthcare system isn't working properly. Treating Toribio and other illegal immigrants isn't right because the system is wrong: we need a means of absorbing marginalized individuals like Toribio for the long term, in a manner that will not create an unsustainable burden. But for now, how can we send a patient to preventable death?

Dr. Elioda Tumwesigye at 12pm, TODAY

Physicians for Human Rights is bringing Dr. Elioda Tumwesigye, a member of the Ugandan Parliment and chair of the Ugandan government's HIV/AIDS committee, to UCSD today!

Location: Price Center, Sungod Lounge, Gallery B

Time: 12pm (we'll walk over after lecture)

He will be sharing insights on the strides that the US global AIDS response (PEPFAR) has made in addressing these issues, as well as the need for evidence-based prevention policies that put human rights before ideological politics. In collaboration with the Health Action AIDS Campaign at Physicians for Human Rights, Dr. Tumwesigye will also discuss ways to join a movement fighting AIDS.

Discussion Prompt 2

The following article provides an historical overview of human-subjects research. In your discussion, please address the implications that the lack of oversight and ethical standards in past human-subjects research has had on the trust of vulnerable populations and how this affects your role as a physician serving these communities. Other topics to address include: the risks and benefits to health associated with human-subjects research, current ethical concerns regarding human-subjects research, and the role legislation should play in regulating human-subjects research.

The historical, ethical, and legal background of human-subjects research.

http://www.rcjournal.com/contents/10.08/10.08.1325.pdf

Discussion Prompt

Thank you to those who have already made posts of important resources and information (Hershey, Amy, Chuong & Jimmy).

To initiate your dialogue, please respond to the posts Amy and Hershey created regarding Propositions 3 & 4 and the presidential candidates, respectively, by discussing the potential health care and health status implications of current and pending legislation, as well as the policies and past voting histories of the two presidential candidates. Other topics to consider are the direct and indirect health implications of the following repealed initiatives: Initiative 08-0004 Bans Human Embryonic Stem Cell Research, and Initiative 08-0009 Marijuana Legalization.

For summaries, visit http://www.sos.ca.gov/elections/elections_j.htm#failed

WHO 2008 Report

Today the World Health Organization released their 2008 Report. It focused a lot on the disparities of health care from country to country but also citizen to citizen within the same country. The emphasis was on Primary Care, universal care, leadership and an emphasis on preventative measures to cut worldwide health care costs. Though the report is a behemoth, at 148 pages, there is lots in there probably worth reading about. At the very least, I'd recommend reading over the summary of the report. Or take a look at the table of contents for the actual report and read up on the sections that are particularly interesting to you.

The report can be found:
http://www.who.int/whr/2008/whr08_en.pdf

The summary can be found:
http://www.who.int/whr/2008/summary.pdf

There are lots of other interesting links, including a speech by the director of the WHO, and some really cool comparisons of country's GDP per capita vs health care spending per capita (much like the TED videos we watched).
http://www.who.int/whr/2008/en/index.html

For the country comparisons, click on the link under Primary Healthcare in Action.

I'm sure there are millions of reviews of the report out there too (or at least there will be in near future).

Tracking Legislation

It looks like some of you beat me to it, but to help you track current legislative policies and gather information about past legislation, I have compiled a list of resources to get you started.

Tracking the U.S. Congress
http://www.govtrack.us/congress/subjects.xpd
This is a tool to follow the status of federal legislation. You can subscribe to web feeds or email updates to keep up with the latest activity in Congress. This link provides you with a list of bills in Congress organized by subject and popularity, including immigration, abortion and health insurance.

California Pan-Ethnic Health Network (CPEHN)
http://www.cpehn.org/issues.php
Mission: To improve access to health care and eliminate health disparities by advocating for public policies and sufficient resources to address the health needs of the community. CPEHN's website allows you to track the progress of priority bills for the 2008 legislative session, such as those that are:
Achieving Equity Through Place-Based Solutions
Expanding Access to Health Care
Increasing Access to Nutritious Food
Increasing the Diversity of the Health Care Workforce
Ensuring Cultural and Linguistic Competency
Improving Our School Health Centers

Ballot Measure Update – California Secretary of State
http://www.sos.ca.gov/elections/elections_j.htm#2008General
This site lists ballot measures that have qualified for this year’s general election. In addition, you will find a list of initiatives that are currently circulating for possible placement on the next ballot, failed to qualify, were withdrawn, or are pending at the Attorney General's Office.

California Ballot Initiatives Database
http://holmes.uchastings.edu/cgi-bin/starfinder/0?path=calinits.txt&id=webber&pass=webber&OK=OK
University of California Hastings College of the Law maintains a comprehensive, searchable database of information on California ballot initiatives from 1911 to the present. The database contains the full text of the initiatives, accompanying material relating to their filing & qualification, related legal and legislative history, and digital images of pertinent documents.

California Ballot Propositions Database
http://holmes.uchastings.edu/cgi-bin/starfinder/0?path=calprop.txt&id=webber&pass=webber&OK=OK
University of California Hastings College of the Law also maintains a comprehensive, searchable database of California ballot measures from 1911 to the present. The Hastings site also offers PDF versions of ballot pamphlets from 1911 to the present.

Kaiser Daily Health Policy Report
http://www.kaisernetwork.org/daily_reports/rep_hpolicy.cfm
This site provides a list of daily headlines on health-related issues connected with legislation, including health coverage & access, presidential candidate health care proposals, state policies, report briefs, and opinion pieces. You can also sign up for email alerts to get this information sent to you directly.

Kaiser Health Disparities Report: A Weekly Look at Race, Ethnicity and Health
http://www.kaisernetwork.org/daily_reports/rep_disparities.cfm
This is a great resource to monitor current issues related to health disparities as well as for accessing archives. Categories include: Politics & Policy, Public Health, Culture-Based Care, and Initiatives. You can also sign up for daily or weekly e-mail alerts.

Some more thought-provoking data!

As the heat of the Presidential Debate on last Tuesday and the up coming election, I think Hershey hit the right target to start off with the candidates’ health plans. I totally agree with Amy about evaluating the issue and taking stance on this issue. I already decided who will be my president anyway! However, for those who are still debating on this; especially about the health plans, please keep these facts in mind:

Only 30 of 50 states have a dedicated office of minority health.

Nearly one-third of the states report mortality data using a "white-other," "black-white," or "black-white-other" racial breakdown.

States with the highest proportion of minorities had physician workforces that were the least reflective of their demographic composition.

There are no consistent association between the four performance measures and either state fiscal capacity or percentage of minorities in the state.

Overall that is the reason we are taking this course. These are from an old (2005) paper that I found from the Policy Journal of Health Sphere.

You can read it here: http://content.healthaffairs.org/cgi/content/full/24/2/388

Chuong

California Propositions

Thanks for posting that Hershey. I just received my absentee ballot in the mail, and it's definitely a good time to evaluate and think about our stance on things, if we haven't done so already. I thought I'd also throw in California's health-related propositions. In addition to the waiting period/parental notification proposition (Prop 4) we discussed last week, there is also one about funding for Children's Hospitals (Prop 3). Granted, Prop 4 is the more controversial proposition, and can have a big impact on the adolescent population and the doctors that treat them, but it's also important to think about how this state uses its money.

Here is some info and links for fact sheets/arguments:
Prop. 3: Funding for Children’s Hospital Projects Authorizes $980 million in general obligation bonds for construction, expansion, remodeling, renovation, furnishing, and equipping of eligible children’s hospitals. Fiscal Impact: State cost of about $2 billion over 30 years to pay off both the principal ($980 million) and interest ($933 million) costs of the bonds. Payments of about $64 million per year.
Prop 3 Facts and Analysis
Prop 3 Arguments: for and against

Prop. 4: Waiting Period and Parental Notification Before Termination of a Minor’s Pregnancy Changes the California Constitution to prohibit abortion for an unemancipated minor until 48 hours after a physician notifies the minor’s parent, legal guardian, or, in limited cases, substitute adult relative. Provides an exception for medical emergency or parental waiver. Fiscal Impact: Potential unknown net state costs of several million dollars annually for health and social services programs, court administration, and state health agency administration combined.
Prop 4 Facts and Analysis
Prop 4 Arguments: For and Against


Amy

Which Healthcare Plan is better: Obama's or McCain's?

While that is a bit of a loaded question, I figured I would at least send out a link with some information on both candidates plans and what the American Academy of Family Physicians thinks about them. Just like the AMA I am pretty sure the AAFP doesn't endorse any one plan, but I know a lot of classmates in PRIME--and not in PRIME--have been looking for an analysis from physicians' (albeit mostly focused on primary care) points of view. Thanks and I hope this helps or at least provides greater information to make you a more educated voter. :-).

http://www.aafp.org/online/en/home/publications/news/news-now/inside-aafp/20080910campaign-health-plans.html

See you tomorrow,
Hershey