Back Issue: Vol.7 No.3 (Summer 2021)
ISSN 2474-2309
Research Ethics
- Ryan Pferdehirt, D.Bioethics
Address correspondence to: Ryan Pferdehirt, D.Bioethics. Director of Membership and Ethics Education – Center for Practical Bioethics. Instructor of Bioethics – Kansas City University. 1111 Main Suite 500. Kansas City, MO 64105. Office: 816.979.1350. Email: rpferdehirt@practicalbioethics.org
Pages: 1-7
The descriptions and labels healthcare providers place upon patients can greatly determine the quality and availability of the healthcare they receive. When that patient is given the label nonadherent or noncompliant within healthcare, it can have a detrimental impact on the patient. But patient adherence is a more complicated issue than can be express with a binary determination; is or is not, yes or no. Therefore, additional terminology should be utilized to properly convey the patient’s participation status when the patient does not fully engage in care. This paper proposes the implementation of additional qualifying language: involuntary nonadherence and voluntary nonadherence. Involuntary nonadherence is defined as when the patient desires to participate in care but is unable to do so because of factors outside of his/her control. These could involve inadequate means of transportation, difficulties with schedule flexibility, etc. These patients are demonstrating nonadherence by current standards but would participate if circumstances allowed – outside pressures are influencing the decision to be nonadherent. Contrast that with voluntary nonadherence, defined as when the patient gives informed refusal to participate, and the patient is fully able to participate but actively chooses not to. This additional qualifying language could ensure protection for patients from being labeled and potentially dismissed due to circumstances outside of their control.
- Shobi Venkatachalam MD, Mohammed Al-Jumayli MD
Address correspondence to: Shobi Venkatachalam MD. Department of Internal Medicine, Nazareth Hospital, Pennsylvania, PA 19152. Email: shobi.venkatachalam@mercyhealth.org
Mohammed Al-Jumayli MD. Department of Hematology/Oncology, Moffitt cancer center, Tampa, FL 33612. Email: Mohammed.AlJumayli@moffitt.org
Pages: 8-28
Studies show marked disparities in the relative risk of cancer death between Black Americans and White Americans even after adjusting for the stage at diagnosis and age. This may be explained by disparities in different aspects of cancer care including providing equal screening opportunities, availability of proper treatment options and inclusivity in clinical trials. To our knowledge, our study is the first descriptive study on Black disparities in targeted therapy clinical trials. We collected data on Black inclusivity from pivotal clinical trials as well as trials of special interest involving targeted therapies in some of the commonly encountered cancers. Our results show that most targeted therapy trials included in our review were multinational including some participating countries with very few or no Blacks and therefore had very poor Black representation with an average of around 1-3%. Also, some trials lacked transparent data on the racial demographics raising concerns on the generalizability of data when extrapolated to treat the Black population. We have reviewed existing literature on differences in cancer biology and host biology depending on the race and end with suggestions to improve Black inclusivity in clinical trials.
- Jimmy Mond M.D. Ph.D., Jeffrey Gruenglas, DHSC(C), MBE, MA
Address correspondence to: Jimmy Mond M.D. Ph.D. Chief Scientific Officer/Chief Medical Officer, ADMA Biologics.
Jeffrey Gruenglas, DHSc(c), MBE, MA. Senior Director, Government Affairs and Health Policy, ADMA Biologics; College of Arts and Sciences, Boston University. Email: jgruen@bu.edu
Pages: 29-37
More than 400,000 sexual assaults are reported annually in the United States in females and males above the age of 12. Victims are likely to include members of vulnerable populations such as the disabled, homeless persons, and immigrants. Victims of such assaults are at heightened risk of contracting the Hepatitis B virus (HBV) from their assailant. Unfortunately, approximately two-thirds of people with chronic HBV are unaware of their own status, exposing for victims the risk viral transmission, disease-related cirrhosis, and hepatocellular carcinoma. Victims are also at increased risk for posttraumatic stress disorder (PTSD). Although immediate vaccination of the assaulted victim is recommended, protective levels of antibody are not present for fourteen days post vaccination. Complementary treatment with a Hepatitis B immune globulin (HBIG), however, may provide immediate protective serum concentrations. Prompt prophylactic therapeutic intervention may not only protect patients from risk of infection but may also prevent the effects of PTSD by providing victims with psychological and emotional benefit. Yet, existing Centers for Disease Control and Preventions (CDC) recommendations for suspected HBV infection in sexual assault patients recommend initiating immunoprophylaxis only in cases where the perpetrator’s HBsAg status is known, a guideline that perpetuates inequities and injustice for those equally subject to the harms of sexual assault. This paper presents an ethical assessment of prophylactic treatment for sexual assault patients suspected of HBV exposure. In the absence of equitable guidelines, we argue for the clinician’s duty to rescue sexually assaulted patients from future harm and to protect the public through mitigation of transmission using currently available and evidence-based treatment modalities. The paper concludes with an ethical foundation to advocate for modification of current guidelines in view of existing prophylactic regimens.
Case studies
- Evangel Sarwar, Eunice Kimunai, Salome Mshigeni
Address correspondence to: Evangel Sarwar. Lecturer, Health Science Department, California State University San Bernardino, California, USA. Email: Evangel.Sarwar@csusb.edu
Eunice Kimunai. Healthcare Subject Matter Expert, Defense Health Agency/Department of Defense, Virginia, US. Email: kimunaieunice@gmail.com
Salome Kapella Mshigeni. Assistant Professor, Health Science Department, California State University San Bernardino, California, USA. Email: Salome.mshigeni@csusb.edu
Pages: 38-50
According to WHO, one of the most effective ways to protect people against COVID-19 is with the use of vaccines. As academic institutions prepare to fully re-open in the fall of 2021 and COVID-19 vaccines being readily accessible to all ages twelve and older in the U.S., college students are also getting ready to go back to normal campus operations for traditional in-person education. This raises the need to assess students’ attitudes toward the COVID-19 vaccines by identifying and addressing reasons for their hesitancy. One major threat to the impact of vaccination in preventing disease and deaths from COVID-19 is low utilization of vaccines by some groups. We conducted a pilot study and interviewed 55 undergraduate science students enrolled in summer school in 2021. The majority of the students were female, younger, Hispanic, or Latino, and at the junior or senior level. More than half of them have been vaccinated (62%) and indicated that it is important to attend classes while vaccinated (75%). While there were a variety of reasons for hesitancy ranging from lack of concern to lack of initiative, 17% of participants stated that religion played a role in their decision. Evidence-based recommendations strategies based on religion, ethical, and social implications are provided.