Sufficient Scruples

Bioethics, healthcare policy, and related issues.

November 9, 2005

Preventive Intervention Trials: Ethical Issues

by @ 6:09 pm. Filed under General, Autonomy, Provider Roles, Access to Healthcare, Biotechnology, Global/Community Health, Healthcare Politics

There is a widely-remarked study published in the November PLoS Biology (the open-source online journal that is rapidly building a reputation for itself). The study was a prospective longitudinal study of the role of male circumcision in reducing HIV infectivity. That is, adult black South African men who were intending to become circumcised were recruited into the study and randomized into “trial” and “control” groups; the trial groups were offered free circumcision at the beginning of the study, and the control group was asked to wait until the end, when they would be given circumcision if they still wanted it. They were tested for a variety of sexually-transmitted infections, and offered condoms, sexual health counseling, and referrals to free clinics attached to the project for treatment for STIs they encountered during the study period. The study was intended to run for almost 2 years, but was stopped early by the data committee (a monitoring group separate from the researchers that reviews the data periodically, without informing the researchers of their findings - to avoid compromising the “double blind” nature of the study - unless the data show a clear, statistically significant difference between the experimental and control arms of the study, at which time the “blind” is broken and the researchers are informed); it was found that a significant difference in HIV infection was developing between the two groups, and the conclusion was reached that circumcision reduces the risk of female-to-male HIV transmission by 60%.

This is the first study of its kind, and the results are clearly valuable. However, the conduct of the trial has raised serious ethical questions. The trial illustrates many of the concerns surrounding medical research, particularly involving preventive measures (where by definition the trial essentially consists of waiting for subjects to contract the disease), and in cases where researchers from developed nations conduct experiments on residents of less-developed countries that would not be possible, or permitted, in their own countries. In this case, the researchers themselves made what seem clearly to be good-faith efforts to recognize those tensions and deal with them, but still did not succeed in avoiding controversy. A closer look at the controversy illustrates some of the pitfalls of these situations.
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Don’t - I Say, Don’t Rely on Our Highly Healthy Grape Juice For Your Pandemic Needs

by @ 3:50 pm. Filed under General, Healthcare Politics

Welch’s Grape Juice is plumbing new depths of hypocritical “denials” of magical health properties in substances they just can’t seem to stop talking about in the context of the curing of terrible diseases. Sinking to the level of marketing strategies for quack “diet supplements”, they announce in bold letters on their Web site that “Welch’s grape juice does not provide protection against the avian flu.” This by itself makes sense, except that nobody in their right mind would expect that Welch’s grape juice would provide protection against avian flu - so mentioning it in that context obviously serves no purpose other than raising in consumers’ minds the possibility that it does provide such protection. Welch’s is thus marketing grape juice along much the same lines, and with the same scientific evidence, as Laetrile.

And, after they’ve gotten your attention (for the disease their product, remember, absolutely does not cure), what happens when you click the convenient link they provide? They tell you all about the ways their product can cure that disease:

Welch’s Grape Juice does not provide protection against the avian flu.

While we are aware of recent research on resveratrol and the inhibition of influenza viruses, no research has studied the effects of drinking Welch’s 100% Grape Juice made from Concord grapes on the avian flu. Because of this limited information, we cannot recommend the use of our product in this area. We do know, however, that Welch’s 100% Grape Juice is abundant in a number of natural antioxidant compounds, of which resveratrol is just one, that may contribute to good health in many ways. Decisions on how to manage conditions like the avian flu should be made in consultation with a physician.

This is just shameless manipulation, but, of course, everything they say is technically true. So, in the spirit of scientific accuracy characterized by the Welch’s corporation, and out of a sincere concern for your health, let me assure you that:

Welch’s Grape Juice does NOT give you syphilis, no matter what you’ve heard to the contrary.

Any statements that Welch’s Grape Juice is contaminated with aborted fetal remains are entirely groundless.

While it is true that consuming dangerously large amounts of Welch’s Grape Juice can lead to asphyxiation, vomiting, or blood-sugar imbalances, the Welch’s Grape Juice company does not regard these dangers as requiring a product package warning at this time.

So far, there are NO confirmed, peer-reviewed studies published in respectable scientific journals that prove conclusively that Welch’s Grape Juice causes cancer.

Hat tip: AJOB/bioethics.net

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