Policy and Ethics

An international team of medical experts recently published a global call to action in Science Translational Medicine in an effort to curb the unethical, unsubstantiated use of stem-cell based therapies driving medical tourism. Such ill-advised “stem cell” treatments have led to pediatric deaths in Germany, blindness in the United States, the closure of Italy’s Stamina Foundation to name a few as well as a variety of untoward effects given their lack of rigorous testing for safety and efficacy. 

With high price tags, so-called “stem-cell” clinics are designing therapies without evidence that serve to do harm, be ineffective, prey on the most vulnerable—potentially curtailing their ultimate treatment choices...

An abundance of caution, we have all heard the phrase. And while there are nuances, its gist is, for this particular situation we are extra careful. And in what situations does that apply? For the most part, situations in which there is a remote chance of a catastrophic outcome that puts its thumb on the scale when measuring risk and benefit. But like the thumb on the grocery scale, it throws off the whole enterprising of weighing choices and often has stealth costs of its own. These hidden costs can take the form of resources such as time and money. Most egregiously, they can infringe upon our rights. The quarantining of health care workers possibly exposed to Ebola was out of an abundance of caution. There is a cost to the scientific enterprise when we make decisions about our public...

Aside from eroding the invaluable doctor-patient relationship by monopolizing the clinician’s time for data entry, fragmenting access between institutions when patient sharing is commonplace and functioning more as a billing platform than a therapeutic asset, electronic medical records (EMRs) have not lived up to their promise. Though the concept seems like a panacea, patients and doctors don’t live in a theoretical world. They live in a real one. 

In this real world, each action has consequences. Some good, some bad. Hence, why the actual implementation of such a disruptive force as EMRs need also be held accountable for the adverse effects it generates. This...

There is a theoretical relationship between a nation’s wealth and the amount of pollution it emits.

Because a poor country has little manufacturing and few power plants, pollution is low. As the nation develops, perhaps by burning fossil fuels to produce electricity and operating manufacturing facilities to generate exports, it becomes wealthier. At the same time, however, it pollutes more than it ever has before.

Eventually, as the country becomes even wealthier, the people demand a cleaner environment. What was once a luxury (clean air and pure water) is demanded as a right. As a result, new regulations are enforced, cleaner technologies are implemented, and pollution decreases.

This pattern, known as the...

Dear CDC,

Yesterday a Texan named Tom called our office for some advice about his pain, so the call went to me. I told him I'd be happy to do whatever I could to help him. In retrospect, it was an empty promise.

The conversation was awful. Not only was his story difficult to hear, but the sum total of help I was able to give him was zero. Tom is just one of many collateral casualties of a brutal war against Americans in pain, which was orchestrated by the "Narcotic Nazis" at the CDC. I've read many stories about legitimate pain patients being denied opioid drugs, but it was profoundly upsetting to actually speak with one. Tom appeared to be nothing more than a fine man who did nothing wrong except...

I have repeatedly written about the vital need to stop one-size-fits-all approaches to complicated medical conditions and health policy as well as how important regional nuance is to solving these and more issues like healthcare-associated infections (HAIs). Identifying the unique interactions, behaviors and exposures of a community drives the en vogue "population health" trend from a patient perspective while optimizing the culture, complexity and effectiveness of local institutions and personnel.

So, when I recently attended the Committee on Reducing Infection...

It reads like a headline from The Onion. Alas, it is real: “EU court: Vaccines can be blamed for illness without scientific evidence,” writes CNN.

The EU court’s ruling was based on the case of a Frenchman who accused a hepatitis B vaccine manufacturer for causing his multiple sclerosis. (Vaccines do not cause multiple sclerosis.) The court’s decision is Kafkaesque:

“The EU's highest court said that if the development of a disease is timely to the person's receiving a vaccine, if the person was previously health [sic] with a lack of history of the disease in their family and if a significant number of disease cases are reported among people receiving a certain...

Today, comments close on a proposed set of USDA rules changes related to approval of genetically-engineered products - and the Trump administration is honoring its commitment to using evidence-based thinking regarding agricultural policy.

As I wrote in Chicago Tribune last week, approval of products engineered using modern science rather than simply modified using older, less precise techniques like mutagenesis, have to go through an approval process trapped in the last century. It makes little sense. Popular crops have long been altered with the use of agrobacterium, "nature's genetic engineer", which was...

"Honesty is such a lonely word.
Everyone is so untrue.
Honesty is hardly ever heard.
And mostly what I need from you."

Billy Joel, 1979

If Billy Joel's smash hit from 1979 was playing on Pandora at the 2015 meeting of the International Agency for Research on Cancer (IARC), it fell upon deaf ears. Although the stated purpose of the meeting was to determine the carcinogenic status of glyphosate (the active ingredient in the weed killer Roundup), the agency may have selectively excluded exculpatory data, according to a new investigative report by Reuters.  

This is hardly the first time that the ethics of IARC,...