HBS 32,35,36

Question 1

The four Principles

Answer 1

4 standards by which to adhere in all ethical situations that may occur in medicine, to overcome differences of religion, philosophy, opinion, etc.

Beneficence
Justice
Respect for Autonomy
Non maleficence

Question 2

Autonomy

Answer 2

The right of a person to think, act and decide for themselves-to make their own decision regarding what they shall do, what shall be done to them, and what should happen to them.

Question 3

Beneficence

Answer 3

The moral responsibility to act for the benefit of others. This is not merely avoiding harm, but promoting welfare of patients.

Question 4

Justice

Answer 4

Justice refers to the obligation to provide fair, equitable, and appropriate treatment to patients. There are, however many theories of justice, including utilitarianism, libertarian, communitarian, egalitarian,

Question 5

Non Maleficence

Answer 5

Taking sufficient care to avoid doing harm by either malpractice or negligence. Harm can be caused intentionally or non intentionally and includes offense, injury, pain, suffering, incapacitation, death.

Question 6

Paternalism

Answer 6

The intentional overriding of a patient’s preferences by coercion, deceit or omission, as justified by the intention to preventing harm or representing the patient’s best interest.

Question 7

Factors that contribute to health inequities in developing countries:

Answer 7

Wealth
Sanitation
Access to healthcare
Education
Political stability
Access to healthy food and clean water

Question 8

Factors that contribute to health inequities within countries

Answer 8

socioeconomic class
gender
occupation (manual vs professional)
education

Question 9

Theory to explain inequities within developed countries: Artefact

Answer 9

Health and social class are artificial variables used in an attempt to measure a social phenomenon.

Question 10

Theory to explain inequities within developed countries: Social darwinism

Answer 10

The healthy are naturally selected into higher classes. Poor health brings about poor economic conditions.

Question 11

Theory to explain inequities within developed countries: Structuralist

Answer 11

Poverty and social class are determinants of health. Economic condition have a direct affect of health.

Question 12

Theory to explain inequities within developed countries: Cultural/behavioral

Answer 12

Cultural beliefs/values within classes contribute to health.

Question 13

Current theory on health inequities

Answer 13

Detrimental health affects of SES differences in childhood can be overcome by higher paying jobs in adulthood. Health disadvantages begin in adulthood when economic disadvantage is maintained.

Increasing disparity has significant effects health and health service.

Question 14

Lower class contributions to health inequalities

Answer 14

Job insecurity = stress
Childhood deprivation = malnutrition
Housing = cold, mold, crowded
Education = poor health decisions (stds)

Question 15

4 Levels of health determinants

Answer 15

1. Economic/political/environmental
2. Social/community context
3. Health related behavior
4. Individual (age, sex, genes)

Question 16

Relative risk example

Answer 16

If you have high cholesterol and take provastatin, you reduce your risk of death by 22%.

This means that 32/1000 people died when taking pravastatin, compared to 41/1000 people who died not taking it.

Question 17

Absolute risk example

Answer 17

Pravastatin reduced the number of people who die from high cholesterol from 41/1000 to 32/1000. The difference is 9/1000 = 0.9%.

Pravastatin reduces risk of dying from high cholesterol by .9%

Question 18

Number Needed to Treat (NNT) example

Answer 18

NNT = 1 divided by absolute risk population.

1/.009 = 112.

this means that 112 people must be treated to save 1 life.

Question 19

Relative risk perception of oral contraception and thrombosis

Answer 19

The pill increases chances of thrombosis by 100%. This relative risk sounds bad, but the absolute risk was only 1/7000 compared to 1/14000.

Question 20

Clinical trial/study

Answer 20

Any investigation in human subjects intended to discover or verify the clinical, pharmacological or pharmacodynamic effects go an investigational product, and/or to identify any adverse reactions, or to study absorption, distribution, metabolism, and excretion with the aim of ascertaining its safety and efficacy.

Question 21

Research steps in a clinical trial

Answer 21

Develop study concept
Secure funding
Prepare protocol
Obtain ethical approval
Setup study
Conduct study
Close study
Analyse data
Communicate the results

Question 22

James Lind

Answer 22

Discovered Vitamin C scurvy cure by performing a research trial on sea.

Question 23

The Tuskegee Syphilis study

Answer 23

Black men in Alabama with syphilis were not given penicillin treatment so that researchers could see what happened. Participants never gave their consent to participate in the experiment.
1932-1973

Question 24

Thalidomide

Answer 24

Morning sickness drug sold across the world in late 1950s. 10,000 children born with birth defects.

Question 25

Nuremberg Code

Answer 25

Research ethics code established ofter Nazi experimentation during WW2.

States that participants must be competent, provide consent, willing, understanding of the risks, and able withdraw at any time.

Question 26

Declaration of Helsinki

Answer 26

2013. Established ethical principles for medical research involving human subjects. The new gold standard.

Question 27

International council on harmonization

Answer 27

1990. Established international standards for research procedure and reliability. Prior, research was not trusted from country to country. Research had to be redone to confirm its validity. So harmonizing research standards internationally improves research efficiency.