With celebrity comes duties: Jenny McCarthy, Oprah Winfrey, and the ethical burden of a soapbox.

At White Coat Underground, PalMD explores the question of what kind of responsibilities might fall on celebrities, especially those who use their soapboxes in a way that exceeds the tether of their expertise. The particular celebrities under examination are Jenny McCarthy, who has used her celebrity to spread her views on the proper treatment and prevention of autism, and Oprah Winfrey, who has used her media empire to give McCarthy a soapbox with more reach.
Pal writes:

Jenny claims an expertise based on her personal experience. Whether one views themselves as an expert is largely irrelevant, unless others so christen them. In Jenny’s case, various fake experts have helped promote her status as an expert (making her a 2nd generation fake expert?) and she has embraced this status.
Being a public figure confers a certain status in our society, whether or not it should. It gives one great reach and influence. While Jenny’s putative lack of intelligence certainly makes her susceptible to having her status used by others, it does not absolve her of her responsibilities. She has made a conscious choice to use her status to spread a message, and has chosen to listen to some experts over others. The moral culpability is hers. …
When it comes to medical issues, the only thing consistent about Oprah is her own inconsistency. It appears that she christens experts based on her personal preference rather than any objective criteria. This is a problem. Oprah’s influence is inversely proportional to her ability to choose good experts, which is a troubling trend. One thing she is good at is picking a winner; Dr. Phil may or may not be a good therapist, but he’s great TV. Time will tell whether Jenny is equally lucrative, but Oprah doesn’t pick losers, so we’re likely to be seeing Jenny under Oprah’s banner for a long time to come.

Rather than hewing to close to the specifics of Jenny McCarthy or Oprah Winfrey, I’d like to raise the questions more generally:

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Using analogies in ethical reasoning.

One of the things we’d like to be able to do with our powers of ethical reasoning is tackle situations where we’re not immediately certain of the right thing to do (or, for that matter, of the reason why the plan someone else is advocating strikes us as wrong).
A common strategy (at least in an ethics class) is to whip out an ethical principle or rule, try to apply it to the situation you’re pondering, and see what it tells you to do: What can I do here that respects the humanity of others and of myself? or, Which of the available courses of action maximizes benefits and minimizes harms (taking into account, of course, that benefits and harms to others matter just as much as benefits and harms to me)? The disadvantages of this strategy is that most of the ethical principles that yield clear judgments in decision scenarios also encounter decisions where they seem to break and give absurd judgments.
An alternative strategy is to take the situation we’re puzzling over and consider how similar or dissimilar it is from one or more cases for which our ethical judgments are clear. This strategy of using paradigm cases to guide our ethical responses to situations that deviate somewhat (but not too much) from the paradigm cases is called casuistry.

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Living within your ethics: animal research and medical care.

From time to time, when we’ve talked about people who object to research with animals on ethical grounds, the claim has been made that it is hypocritical for people with these objections to avail themselves of modern medicine. Our drugs and surgical interventions, after all, are typically the result of research that includes animal research.
Occasionally, a response like this is made: There is no reason to opt out of the existing treatments, since the animal suffering that went into that research cannot be undone. Given that these past animals suffered, the knowledge produced from their suffering should not be wasted. However, it would not be ethical to cause further animal suffering the the development of new medical treatments.
I have never found this sort of response especially persuasive. The other day, I thought of a pair of potentially analogous situations that may illustrate why not.

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Evaluating an article in the Journal of Medical Ethics.

At White Coat Underground, PalMD considers an article from the Journal of Medical Ethics. The article (L. Johnson, R. B. Stricker, “Attorney General forces Infectious Diseases Society of America to redo Lyme guidelines due to flawed development process,” Journal of Medical Ethics 2009; 35: 283-288. doi:10.1136/jme.2008.026526) is behind a paywall, but Pal was kind enough to send me a copy.
Pal writes:

I have a strong interest in medical ethics, although I’m not an ethicist myself. Still, I’m generally familiar with the jargon and the writing styles. This piece reads like no ethics article I’ve ever seen. It is basically an advocacy piece for the concept of chronic Lyme disease, and starts from an entire set of problematic assumptions.

I know very little about Lyme disease, and I have no horse in the race in the controversy about whether chronic Lyme disease exists, if so what it is, and how it might be treated.
I am, however, an ethicist with a strong interest in ethical issues connected to the building and use of scientific knowledge. So I told Pal I’d have a look at the article.
Here’s the abstract:

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Fake journals versus bad journals.

By email, following on the heels of my post about the Merck-commissioned, Elsevier-published fake journal Australasian Journal of Bone and Joint Medicine, a reader asked whether the Journal of American Physicians and Surgeons (JPandS) also counts as a fake journal.
I have the distinct impression that folks around these parts do not hold JPandS in high esteem. However, it seems like there’s an important distinction between a fake journal and a bad one.

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A warning for the herpeto-unctuous.

It seems that some people respond to public concern about swine flu and its spread by trying to sell you stuff. This stuff is not limited to face masks and duct tape, but includes products advertised to prevent, diagnose, or treat swine flu, but whose claims of safety and efficacy do not have a basis in evidence.
In other words, snake oil.

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Flu pandemic ethics: rationing scarce resources.

In an earlier post, I pointed you toward the preliminary report (PDF here) issued by the Minnesota Pandemic Ethics Project this January. This report sets out a plan for the state of Minnesota to ration vital resources in the event of a severe influenza pandemic.
Now, a rationing plan devised by an ethics project is striving for fairness. Rationed resources are those scarce enough that there isn’t enough to go around to everyone who might want or need them. If someone will be left out, what’s a fair way to decide who?
Let’s have a look at the rationing strategies discussed in the draft report:

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