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Ethical Standards and the Marketing of Prescription Drugs
The pharmaceutical industry has come under intense criticism in recent years. One poll found that 70% of the sample agreed that drug companies put profits ahead of people. Is this perception accurate? Have drug companies traded ethics for profits and placed people at risk?
In Profits before People? Leonard J. Weber exposes pharmaceutical industry practices that have raised ethical concerns. Providing systematic ethical analysis and reflection, he discusses such practices as compensating physicians for serving as speakers or consultants, providing incentives to physicians to enroll patients as subjects in clinical research, and advertising prescription drugs to the public through the mass media. Weber's critique of the industry is stern. While acknowledging that new industry guidelines are promising, he finds much room for improvement in the way drug companies market their products. Yet Weber makes a strong case that profits and ethics can coexist and that they are not mutually exclusive.
In an effort to understand the proper place of commerce in disseminating information about new drugs, the book aims to clarify basic responsibilities and to help identify sound ethical practices. It recognizes that ethics and law are not the same, that "having a right" is different from "doing the right thing," and that taking ethics seriously means recognizing that the law does not answer all questions about what is right. Weber points the way to more demanding standards and better practices that might begin to restore confidence in the drug industry.
LSD from Clinic to Campus
LSD's short but colorful history in North America carries with it the distinct cachet of counterculture and government experimentation. The truth about this mind-altering chemical cocktail is far more complex—and less controversial—than generally believed. Psychedelic Psychiatry is the tale of medical researchers working to understand LSD’s therapeutic properties just as escalating anxieties about drug abuse in modern society laid the groundwork for the end of experimentation at the edge of psychopharmacology. Historian Erika Dyck deftly recasts our understanding of LSD to show it as an experimental substance, a medical treatment, and a tool for exploring psychotic perspectives—as well as a recreational drug. She recounts the inside story of the early days of LSD research in small-town, prairie Canada, when Humphry Osmond and Abram Hoffer claimed incredible advances in treating alcoholism, understanding schizophrenia and other psychoses, and achieving empathy with their patients. In relating the drug’s short, strange trip, Dyck explains how concerns about countercultural trends led to the criminalization of LSD and other so-called psychedelic drugs—concordantly opening the way for an explosion in legal prescription pharmaceuticals—and points to the recent re-emergence of sanctioned psychotropic research among psychiatric practitioners. This challenge to the prevailing wisdom behind drug regulation and addiction therapy provides a historical corrective to our perception of LSD’s medical efficacy.
Diagnosis in Contemporary Society
Over a decade after medical sociologist Phil Brown called for a sociology of diagnosis, Putting a Name to It provides the first book-length, comprehensive framework for this emerging subdiscipline of medical sociology. Diagnosis is central to medicine. It creates social order, explains illness, identifies treatments, and predicts outcomes. Using concepts of medical sociology, Annemarie Goldstein Jutel sheds light on current knowledge about the components of diagnosis to outline how a sociology of diagnosis would function. She situates it within the broader discipline, lays out the directions it should explore, and discusses how the classification of illness and framing of diagnosis relate to social status and order. Jutel explains why this matters not just to doctor-patient relationships but also to the entire medical system. As a result, she argues, the sociological realm of diagnosis encompasses not only the ongoing controversy surrounding revisions to the Diagnostic and Statistical Manual of Mental Disorders in psychiatry but also hot-button issues such as genetic screening and pharmaceutical industry disease mongering. Both a challenge and a call to arms, Putting a Name to It is a lucid, persuasive argument for formalizing, professionalizing, and advancing longstanding practice. Jutel’s innovative, open approach and engaging arguments will find support among medical sociologists and practitioners and across much of the medical system.
Law, Policy, and Ethical Issues
From the cloning of Dolly the sheep a decade ago to more recent advances in embryonic stem cell research, new genetic technologies have often spurred polemical, ill-informed debates. Perhaps nowhere is this more evident than in the field of reproductive genetics, where difficult bioethical issues are distilled into sound bites and far-fetched claims for easy public consumption. The underlying complexities of reprogenetic research and practice are often drowned out by the noise. In this thoughtful and informed collection, Lori P. Knowles and Gregory E. Kaebnick bring together bioethicists from the United States, Canada, and the United Kingdom to examine the ethical and policy quandaries created by new genetic technologies. Featuring an overview of the field’s history (including lessons to be learned from eugenics), comparisons of international and domestic governmental regulations, and discussions of how the market and public opinion affect research, this book considers both the risks and the benefits of combining genetic and reproductive technologies. Concluding with a cautionary call for increased regulation, Reprogenetics introduces fact, history, and reason into a public discussion of complex and vexing issues.
Beyond the Bad-Apple Approach
Public Policy, Biotechnology, and the Kass Council
Several presidents have created bioethics councils to advise their administrations on the importance, meaning and possible implementation or regulation of rapidly developing biomedical technologies. From 2001 to 2005, the President's Council on Bioethics, created by President George W. Bush, was under the leadership of Leon Kass. The Kass Council, as it was known, undertook what Adam Briggle describes as a more rich understanding of its task than that of previous councils. The council sought to understand what it means to advance human flourishing at the intersection of philosophy, politics, science, and technology within a democratic society. Briggle's survey of the history of U.S. public bioethics and advisory bioethics commissions, followed by an analysis of what constitutes a “rich” bioethics, forms the first part of the book. The second part treats the Kass Council as a case study of a federal institution that offered public, ethical advice within a highly polarized context, with the attendant charges of inappropriate politicization and policy irrelevance. The conclusion synthesizes the author's findings into a story about the possible relationships between philosophy and policy making. A Rich Bioethics: Public Policy, Biotechnology, and the Kass Council will attract students and scholars in bioethics and the fields of science, technology, and society, as well as those interested in the ethical and political dilemmas raised by modern science.
Heated debates are not unusual when confronting tough medical issues where it seems that moral and religious perspectives often erupt in conflict with philosophical or political positions. In The Sanctity of Human Life, Jewish theologian David Novak acknowledges that it is impossible not to take into account the theological view of human life, but the challenge is how to present the religious perspective to nonreligious people. In doing so, he shows that the two positions—the theological and the philosophical—aren't as far apart as they may seem. Novak digs deep into Jewish scripture and tradition to find guidance for assessing three contemporary controversies in medicine and public policy: the use of embryos to derive stem cells for research, socialized medicine, and physician-assisted suicide. Beginning with thinkers like Plato, Aristotle, Kant, and Nietsche, and drawing on great Jewish figures in history—Maimonides, Rashi, and various commentators on the Torah (written law) and the Mishnah (oral law)—Novak speaks brilliantly to these modern moral dilemmas. The Sanctity of Human Life weaves a rich and sophisticated tapestry of evidence to conclude that the Jewish understanding of the human being as sacred, as the image of God, is in fact compatible with philosophical claims about the rights of the human person—especially the right to life—and can be made intelligible to secular culture. Thus, according to Novak, the use of stem cells from embryos is morally unacceptable; the sanctity of the human person, and not capitalist or socialist approaches, should drive our understanding of national health care; and physician-assisted suicide violates humankind's fundamental responsibility for caring for one another. Novak's erudite argument and rigorous scholarship will appeal to all scholars and students engaged in the work of theology and bioethics.
Rhetoric, Politics, and Trust in Breast Cancer Research
How Science Is Solving Modern Medicine's Most Perplexing Problem
Once the stuff of science fiction, neural prosthetics are now a reality. Research and technology are creating implants that enable the deaf to hear, the blind to see, and the paralyzed to move. Shattered Nerves takes us on a journey into a new medical frontier, where sophisticated, state-of-the-art medical devices repair and restore failed sensory and motor systems. In a compelling narrative that reveals the intimate relationship between technology and the physicians, scientists, and patients who bring it to life, Victor D. Chase explores groundbreaking developments in neural technology. Through personal interviews and extensive research, Chase introduces us to the people and devices that are restoring shattered lives, from implants that enable the paralyzed to stand, walk, feed, and groom themselves, to those that restore bladder and bowel control, and even sexual function. Signals from the brains of paralyzed people are captured and transformed to allow them to operate computers. Brain implants hold the potential to resolve psychiatric illnesses and to restore the ability to form memories in damaged brains. This timely and important book also explores troubling boundaries between restoration and enhancement, where implants could conceivably endow the able-bodied with superhuman capabilities. Chase concludes this fascinating book with a provocative question: Just because we can, does that mean we should?
Spiritual Perspectives and Clinical Practice
To what extent should spiritual information be part of patients’ medical assessments? How should physicians respond when patients refuse life-saving care on religious grounds? Should doctors pray with their patients? Questions such as these raise deeper ones about the goals of medicine and the nature of healing. In a set of engaging and candid essays, The Soul of Medicine explores the role and influence of spirituality in clinical practice, professionalism, and medical education. The contributors to this volume approach this topic from their own spiritual perspectives—Jewish, Christian, Muslim, Buddhist, Hindu, New Age/Eclectic, secular, Jehovah’s Witnesses, and Christian Scientist. Their thought-provoking essays produce rich insights not only into the needs of patients who share these same world views but also into how spirituality influences the practice of medicine. When their own spiritual issues arise in medical practice, physicians rely on their professionalism, ethics, and education. To better understand how various world views are incorporated into clinical work, doctors must ask themselves—as these contributors have—a series of important questions: What insights about life and healing does your faith provide? How does it challenge or reinforce contemporary medicine? How do you assess and address spirituality in clinical practice? How do your own beliefs influence your interactions with patients? The Soul of Medicine encourages medical students and practitioners to recognize the spiritual dimensions of medicine, to consider how these dimensions inform their own education and practice, and to be compassionate about their patients’—and their own—religious beliefs.