The headlines bring news of another scientist (this time a physician-scientist) caught committing fraud, rather than science. This story is of interest in part because of the scale of the deception — not a paper or two, but perhaps dozens — and in part because the scientist’s area of research, the treatment of pain, strikes a nerve with many non-scientists whose medical treatment may have been (mis-)informed by the fraudulent results.
From Anesthesiology News:
Category Archives: Medicine
Animal rights activist takes drugs tested on animals.
I’m not a regular reader of the Huffington Post, but I received a pointer to an article there that strikes me as worthy of comment.
The article, Why I Take Animal-Tested Drugs, was written by Simon Chaitowitz, the former Communications director for the animal rights group Physicians Committee for Responsible Medicine.
From the title, you might expect a defense of animal-tested drugs, or at least a coherent explanation for why the author is taking them. However, what the article actually offers is condemnation of the use of animals in biomedical research, and even a claim that animal-tested drugs and medical interventions contributed to the author’s cancer.
Tracking flu through online search queries.
This morning, I was made aware (by my better half) of the existence of Google Flu Trends. This is a project by Google to use search terms to create a model of flu activity across the United States. Indeed, the results have been good enough that they were reported in a Letter in Nature [1] back in November 2008 (but with a correction published online 19 February 2009). From that letter:
Language barriers and human subjects research.
Over at On Becoming a Domestic and Laboratory Goddess, Dr. Isis looks at challenges of opening up participation in human subjects research to potential subjects who are not fluent English speakers:
When one enters the university hospital here at MRU, there are a number of skilled and qualified translators that are available to help patients that can’t dialogue in English to communicate with health care staff. They are able to sufficiently translate documents to allow a patient to provide some reasonable level of consent (my M.D. blog buddies can debate the quality of said consent). There is no infrastructure like this in research at most major research universities. Consent forms are written in English. Even if I could provide verbal translation for this man, it would not be ethical for him to sign a document in a language he cannot read himself and understand. Thus, it all more or less becomes a moot point. Beyond that, while I am a fluent Spanish speaker, I am not a qualified medical interpreter. I have no idea how to say “indwelling arterial catheter.” Babelfish says it’s, “catéter arterial dejado en un órgano.” I know that can’t be right, but who am I to question Babelfish?. Even if I were completely confident saying, “We are studying the physiological effect of [Dr. Isis’s favorite stimulus] on vascular function” in Spanish, it’s not the best use of my time as a researcher (unless one of you folks want to write me in for 10% effort, and then I will make sure I learn to say it).
So, the question is, is there an ethical issue here at all … ? The National Institutes of Health mandate the inclusion of minorities in human research studies. In our area, members of the major minority groups often do not speak fluent English. However, the translation of study documents and the hiring of an interpreter to help with the consent is expensive and I have never known an investigator to include a translator in a budget when they could have a technician. Furthermore, if you are willing to translate a consent form into one language, what about all of the other languages that might be spoken in the area around where the study is being conducted, no matter how rare? Indeed, most people I know make the decision that the ability to understand and communicate in English at a 6th grade level is a criteria for participation.
Yet, if the ability to speak English is a criteria for participation, then we by default fail to include particular groups in research cohorts. We’re back to research cohorts being comprised of middle-aged white men.
(Bold emphasis added.)
It looks to me like there is an ethical issue here. Plus, I think I see a scientific issue. Together, the two kinds of issues make me think that tackling the issue of translation should be a priority for researchers (and for the agencies funding their work).
Medical interpreters, societal commitments, and the challenges of footing the bill.
Over at The White Coat Underground, PalMD looks at the ways in which delivering good health care to deaf patients depends on providing good interpreters — and notices the difficulty of making this happen:
How do we approach this as a society?
Item 1: Deaf people have special needs with regards to interactions with the health care system.
Item 2: The government mandates that proper interpreters be provided for doctor visits.
Item 3: Neither patients nor doctors can afford to provide this service.
Now don’t go telling me that “all you rich doctors can afford to get the interpreter”—we most emphatically cannot. That is a simple fact, and if you don’t believe me, then you don’t. Epur, si moeve.
There is not a great deal of support for an expensive government mandate that would pay for interpreters for the deaf. How do we provide this critical service?
I think the way Pal has framed this is exactly right — this is a question that is an ethical challenge to us as a society. Given the limits on what any of us can accomplish as individuals, what are we committed to doing collectively? What ought we commit to do collectively? And what does this say about what goods we regard as necessities to a good life — or about which members of society we believe are entitled to partake of this good life?
Dispatch from the sickroom.
Owing to the fact that children are vectors of disease, three out of four members of the Free-Ride household have been feverish, achy, sneezy, sleepy, and grumpy for the past few days. (It’s not clear yet whether the progression of this bug will include other dwarves.)
Since I’m still kind of dopey, in lieu of a content-ful post, I’m offering some random musings from the sickbed.
Seen elsewhere in the intertubes.
While the ScienceBlogs upgrade was underway, a shiny new Bloggingheads diavlog was posted, featuring yours truly and PalMD.
Mostly we talked about medical ethics, with some time spent on ethical issues around research with human subjects.
Help jailed AIDS researchers in Iran.
You know what makes an already scary world a lot scarier? When a government decides it’s a crime for disease researchers to do their job.
From Declan Butler:
Iran has summarily tried two of the nation’s HIV researchers with communicating with an “enemy government,” in a half-day trial that started and ended on 31 December in Tehran’s Revolutionary Court. There will be no further court hearings, and a verdict is expected within days.
The brothers, Arash and Kamiar Alaei, who have achieved international acclaim for their progressive HIV-prevention programme, have been held in Tehran’s notorious Evin prison since their arrest last June (see Nature story, subscription required). Kamiar, the younger of the brothers, holds a master’s degree from the Harvard School of Public Health and was to have resumed doctoral studies at the University of Albany’s School of Public Health in New York. Arash, former head of international education and research cooperation at the Iranian National Research Institute of Tuberculosis and Lung Disease, runs a clinic in Tehran. The brothers are not thought to have been politically active. …
In August, the prosecutor publicly accused the men of fomenting a velvet revolution, arguing that they had collaborated with other scientists around the world, including some in the United States, attended international AIDS conferences, and met frequently with AIDS NGOs. “Those are not crimes, that’s good medicine,” says [Physicians for Human Rights spokesman Jonathan] Hutson, adding that it has casts a chilling effect on academic collaboration between Iran and the rest of the world. In December, the US National Academies suspended visits to Iran after the temporary detention of one of its officials in Tehran.
It’s not clear from all this whether the “crime” for which the Alaei brothers are being held is communicating scientific information with other researchers (which is part of how scientists together solve scientific puzzles like the causes and cures of diseases), or whether it is bothering to focus on HIV and its treatment in the first place.
Anesthesiology and addiction.
There’s an interesting story on The New Republic website at the moment, “Going Under” by Jason Zengerle, that relates the sad story of a young anesthesiologist’s descent into addiction. What I find interesting about it is the larger questions it raises about why this particular anesthesiologist’s story is not so unusual. Indeed, the article offers an:
Observation: Anesthesiologists seem to suffer from addiction in greater numbers than physicians in other specialties.
And, it lays out
Three hypotheses as to why this might be so:
A serious contender for dumbest excuse of 2008.
He defended the views he expressed in many of his radio programs and said that, because he consulted for so many drugmakers at once, he had no particular bias.
“These companies compete with each other and cancel each other out,” he said.
The New York Times on psychiatrist and former radio host, Dr. Frederick K. Goodwin, whose NPR program “The Infinite Mind” was cancelled after it was discovered that Goodwin failed to disclose more than $1 million in income received for giving marketing lectures for drugmakers.
Dr. Goodwin seems a little unclear on the concept of conflict of interest.