Friday, April 18, 2014
Inquirer Daily News

Ethics

POSTED: Sunday, April 6, 2014, 6:30 AM
Dr. Bernard Rollin, a Colorado State University professor and leading scholar in animal rights and animal consciousness. (William A. Cotton)

There are few issues in the public sector today that affect us all in the way that industrial animal agriculture does. We all eat, and almost all of the food we consume is produced by this system. Not only aren’t most of us aware of the nature of the system that provides us with our food sources (for most Americans, it is as if food appears magically on our plates every day), but most of us certainly aren’t aware of the impact that the system has on the public’s health. From the pesticides that impact us and our environment, to the concentrated animal feeding operations (CAFO) that house many of the animals we eat, to the overuse of antibiotics throughout agriculture, our health and environment is ever at risk.

On Tuesday, renowned philosopher and ethicist Dr. Bernard Rollin from Colorado State University will be giving a lecture at the Academy of Natural Sciences on the history, ethics and public health impact of industrial animal agriculture. Dr. Rollin's free public lecture, which begins at 6 p.m., is entitled "This Ain't Agriculture: How Industrial Agriculture Hurts Animals and the Public's Health." The talk will examine the impact of industrial animal agriculture on animals, humans, and the environment, and proposes ways to improve this system and make it more sustainable. The event is co-sponsored by the Program for Public Health Ethics & History at the Drexel University School of Public Health (I am director of this program), the Center for Science, Technology and Society at Drexel, and the Academy of Natural Sciences.

Dr. Rollin is an expert in this area and has worked closely with both government and corporate interests with the goal of improving the current agricultural system. His 1982 book, Animal Rights and Human Morality, now in its third edition, is a classic in the field, and he has authored over 500 papers and 17 books, the most recent of which is the autobiographical Putting the Horse Before Descartes: My Life's Work on Behalf of Animals. Most recently, he served on the Pew National Commission on Industrial Farm Animal Production, which in 2008 released a series of landmark reports on the public health, environmental, social and animal welfare issues implicated in industrial animal agriculture.

POSTED: Wednesday, March 19, 2014, 5:30 AM
Filed Under: Addiction | Ethics | History | Medication
Shortly after a 48-hour bout of immobilizing back pain and a visit to the emergency room where he received Percocet, my husband went to his primary care doctor to discuss managing the continuing pain and numbness. What he encountered took him aback. Perhaps concerned about “drug-seeking behavior,” the primary care physician commented offhandedly that back pain eventually goes away; the physician failed to do a physical examination, asked no questions about his level of pain or work situation, and offered no suggestions for dealing with the numbness or a recurrence. When asked about pain medication, his physician gave him a bottle of naproxen (which he was already taking) with no instructions regarding appropriate dosage. After two weeks and no further treatment, the pain began to subside; nine months later the numbness and tingling had diminished.

My husband’s experience could have simply been an unfortunate encounter with a busy physician. Or it could be symptomatic of a new attitude towards pain patients and prescription opioids by primary care and public health practitioners. With increasing deaths from overdoses since the early 2000s, public health concern over the abuse of prescription opioids for pain management has mounted. Last month's tragic death of actor Philip Seymour Hoffman from an overdose has heightened awareness of the social burden of addiction and raised anxieties about prescription opioids as “gateway” drugs to heroin.

In 1996, the Food and Drug Administration approved OxyContin, a potent pain reliever marketed by Purdue Pharmaceuticals in a long-acting time-release capsule that industry promotional materials claimed would minimize abuse. Within a few years, however, reports of abuse, addiction, and death from overdose of OxyContin surfaced, and the Drug Enforcement Administration kicked into gear, lobbying for more intensive regulation and surveillance of prescription opioids. Public health and medical experts joined the DEA and the FDA in promoting heightened state oversight of medical providers, pharmacies, and manufacturers. Primary care practices revised their policies towards chronic pain patients to include pain contracts – written agreements intended to discourage abuse by them or others – profiling of “drug-seeking behavior,” frequent office visits, calls for “evidence-based” practice, and urine toxicology screening. The discussion soon moved from concerns over the addictive properties of OxyContin to calls to dramatically limit such widely prescribed opioids as Vicodin and Percocet

POSTED: Tuesday, March 4, 2014, 6:30 AM
Filed Under: Addiction | Ethics | Michael Yudell | Smoking
FILE - In this Wednesday, July 17, 2013 file photo, Marlboro cigarettes are on display in a CVS store in Pittsburgh. The nation's second-largest drugstore chain says it will phase out cigarettes, cigars and chewing tobacco by Oct. 1 as it continues to focus more on health care. The move will cost the Woonsocket, R.I., company about $2 billion in annual revenue. (AP Photo/Gene J. Puskar, File)

Last month's announcement by CVS/Pharmacy that it would “stop selling cigarettes and all tobacco products at its more than 7,600 stores nationwide by October 1, 2014” has focused attention on the role that retail outlets play in their sale. If other major retailers were to follow CVS/Pharmacy’s lead, perhaps we could push already declining rates of tobacco use even lower (currently, fewer than 1 in 5 Americans smoke cigarettes).

In the wake of the CVS move, to put pressure on other tobacco-selling retailers, 26 prominent health groups have issued an open letter, calling on drug stores and other retailers to stop selling tobacco products. Recent studies have shown that reasons for the voluntary abandonment of tobacco sales are complex: retailers identified the obvious relationship between tobacco use and disease and death, regulatory pressures, an enhanced image, and already declining tobacco sales among the drivers of change. In their 2011 study published in BMC Public Health, Patricia McDaniel and Ruth Malone, highlight the importance of such changes, writing that “voluntary retailer abandonment of tobacco sales both reflects and extends social norm changes that have problematized tobacco…”

Let’s hope that ongoing pressure on tobacco-selling retailers can continue to transform social norms around tobacco’s sale and use.

POSTED: Friday, January 31, 2014, 6:30 AM

When Pennsylvania and 24 other states opted out of—or delayed opting into—the Medicaid expansion, they put a lot of lives on the line. Hundreds of thousands of Pennsylvanians would have gained health insurance on Jan. 1 had the state accepted the federal money offered under the Affordable Care Act. Instead, less than a month earlier, Gov. Corbett proposed an alternative plan using federal dollars to subsidize commercial insurance plans that is so complex and requires so many waivers of federal law that even the governor didn’t project it could start until Jan. 1, 2015. Approval of the draft form that was released to the public is extremely unlikely.

Now comes a study, published on the Health Affairs blog,that reveals the consequences. “We estimate the number of deaths attributable to the lack of Medicaid expansion in opt-out states at between 7,115 and 17,104,” the authors write. In Pennsylvania, the annual estimated death toll ranges from 398 to 1,491. That’s right. We have rejected the chance to save lives and health. That is immoral.

It is also fiscally stupid. Medicaid expansion would be entirely paid for by the federal government for three years–2014, 2015, and 2016, so Pennsylvania will get no more than two of them–and phasing down to 90 percent in 2020. And it saves money for the states.

POSTED: Wednesday, December 18, 2013, 6:30 AM

Update: A California judge on Tuesday, Jan. 7, issued a final verdict that added another $50 million to what the companies must pay.

On Monday, a California judge ordered three corporations —Sherwin-Williams, NL Industries, and ConAgra—to contribute $1.1 billion into a state-run fund to clean up lead paint hazards in 10 California cities and counties.

The ruling,  in a case that was originally filed in 2000, calls attention to lead paint as an ongoing and urgent public health risk. As Santa Clara Superior Court Judge James P. Kleinberg wrote in his decision, “white lead carbonate and the paint in which it is a key ingredient are harmful particularly to children,” “there is no safe level of lead in the blood,” “lead paint causes significant physical harm to individuals which has lasting effects,” and “there is a clear and present danger that needs to be addressed.” All of these facts have been well-known to the scientific community for a long time. Here in Philadelphia we have been witnessing the effects of lead-ridden housing for decades; every year thousands of children in the city and suburban counties are poisoned by lead.

POSTED: Tuesday, October 1, 2013, 6:30 AM
Filed Under: Ethics | Poverty
Yesenia Cruz, 33, a homeless woman, slept during a sit-in at a city government office during an August protest on behalf of women and children seeking placement in shelters. (Alfred Lubrano / Staff)

To avoid confusion, I want to make clear that this blog is not about abortion. Repeat:  This is not a blog about abortion.

What I am interested in is a discussion about other issues that are very much a part of the modern day movement for reproductive justice and too often get short shrift in policy debates. Reproductive Justice is a movement founded by women-of-color activists who focus on the rights to have children, to not have children, and to parent children in safe and healthy environments. The roots of this framework are in the human right to make fundamental personal decisions related to having babies, forming families, and parenting.  Importantly, the justice framework explicitly recognizes a societal and governmental obligation to support individual decision-making and create the conditions that allow individuals to carry out key life decisions, including choices about how, when, and with whom to become pregnant or raise a child.

On a national and global scale, laws and policies benefit and support some parents by, for example, giving tax breaks for child care and education costs, while they discourage procreation and parenting by others through devices like capping public benefits, failing to provide paid leave from employment, or even encouraging sterilization for some women. Beyond the legal system, societies tend to be less accepting of some people’s choices of whether or how to bear and beget. For instance, an undocumented immigrant who gives birth to a child on American soil may be accused of giving birth to a so-called “anchor baby” – a pejorative term used to refer to children born in the United States to non-citizen mothers in order to create a pathway to citizenship for their parents. Young women who give birth while still in high school or college are subject to various penalties, including being asked to leave their schools or being forced to leave because of a lack of support. There are those who strongly believe that lesbian, gay, bisexual and transgender people should not have or raise children, and many state laws either fail to protect LGBT people from discrimination in access to the tools of assisted reproduction or fail to help create stability for families created by same-sex couples.

POSTED: Wednesday, August 21, 2013, 6:30 AM
Filed Under: Ethics | History | Mental Illness
Piper Chapman, played by Taylor Schilling, in the critically acclaimed new Netflix series "Orange is the New Black."

Have you seen Netflix’s new critically acclaimed series Orange is the New Black?

If you haven’t, you should.

The series, based on the real life experiences of Piper Kerman, who served over a year in federal prison for her involvement in a drug trafficking scheme, offers a gripping look at life for women behind bars.


POSTED: Tuesday, August 13, 2013, 6:30 AM
Filed Under: Ethics | Michael Yudell | Statistics
"Robot X-treme" by Andrew Joseph Smith, who is diagnosed with Asperger's Syndrome. Andrew started drawing just before 18 months of age. (Gallery at Children's Hospital of Philadelphia's Center for Autism Research)

Every so often a science news story comes along proclaiming that we are on the cusp of a revolutionary new understanding of autism spectrum disorders. In the past few years, research showing that genes, environmental factors, or some combination of the two cause or contribute to the development of autism have cycled through the media. Yet today we still know so frustratingly little about what causes autism and what the best treatments for it are. Never mind that we have a long way to go in providing consistent and first-rate services for all autistics (both children and adults at all points on the spectrum) and their families.

I don’t want to sound too cynical, because there are many researchers hard at work making progress in these areas. But I will say that the media still largely fails autistic people, their families, and the general public in reporting on autism. And although scientists do have a responsibility for how their research is communicated to the public, the presentation of that research also requires a deft pen, computer, tablet, or whatever your writing instrument of choice is.

Exhibit A: a story from Sunday’s New York Times by veteran science writer Gina Kolata—“Autism’s Unexpected Link to Cancer Gene”—which highlights research connecting the gene PTEN to a role in both the development of cancer and autism.

About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, MPH Doctoral candidate and Research Associate, Center for Nonviolence and Social Justice, Drexel University
Janet Golden, PhD Professor of history, Rutgers University-Camden
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