Comparison of Public Health and Clinical Research Ethics

Comparison of Public Health and Clinical Research Ethics How Does Public Health Research Ethics Differ From Clinical Research Ethics? Zoheb Rafique INTRODUCTION: The field of biomedical ethics arose in late 1960s in the response to some emerging ethical dilemmas and issues of that era. This field for many years focused on dilemmas generated by the high technology medicine, rather than on the issues of the population health and the ethical problems of public health programs. The discipline Bioethics received the initial stimulus from abuses and issues of human subject’s research, also the emergence of patient’s rights movement, and the drama of high technology medicine. The Research involving human subjects has often been a central ethical issue and problem for the biomedicine for at least hundred (100) years now, and particularly since the World War 2. Just as the public health is broad in the scope, the range of the ethical issues in this field is uncommonly wide, and encompassing the ethics in the public health as well as ethics of public health (1). In past twenty (20) years, the research base of the clinical ethics has gaine d tremendous strength appreciably. However the main research opportunities didn’t come under broad heading of the clinical ethics, but instead through the specific programs such as human genome project and end of life movement (2). In this paper, I will discuss the differences between public health research ethics and clinical research ethics. DISCUSSION: The Public health research ethics include ethics regarding the community participation in the research, while the clinical research ethics include the ethics regarding the clinical patient research. This is major difference between these two scenarios, now I will discuss it in detail. Most of the research has focused on the clinical and the experimental medicine (efficacy, safety and the mechanism of action, and also regulatory issues to general neglect of the public health dimensions. The Public health ethics, which is defined as identification, analysis, and the resolution of the ethical problems occurring in the public health practice and also research, and it, has different domains than those of the medical ethics. The ethical concerns in the public health often relate to dual obligations of the public health professionals to apply and acquire the scientific knowledge that aimed at restoring and also protecting public’s health while respecting the individual autonomy. Ethi cs in the public health involves interplay between safeguarding welfare of individual, as in medicine, and the public health goal of protecting public welfare. Some other ethical concerns in the public health relate to need to ensure just distribution of the public health resources. The Public health ethics has broad scope that includes the ethical and the social issues arising in the health promotion and the disease prevention, the epidemiological research, and also public health practice. The main professional roles of the epidemiology are design and the conduct of the scientific research and public health application of the scientific knowledge. This includes reporting the research results and also maintaining and promoting the health in communities. Also in carrying out the professional roles, the epidemiologists often encounter many ethical issues and some concerns that require the careful consideration. Many of those issues have been highlighted and addressed in literature on ethics in the epidemiology and the public health including the ethics guidelines. The Ethical and the professional norms in the epidemiology have also been clarified in the ethics guidelines for the epidemiologists and often the public health professionals. The Ethics guidelines such as those developed for Industrial Epidemiology Forum, International society for the Environmental Epidemiology, and American college of the Epidemiology also provide useful accounts of the epidemiologists’ obligations to the research participants, employs, society, and colleagues (3). The Epidemiologic studies can provide the descriptive data that can lead scientists later to develop some intervention that can result in the reduction in morbidity and mortality; the health education program can be one of the multiple interventions that together reduce the risks and also ill health. The argument here, however, is that the public health programs, studies, or interventions, must be designed with the awareness of relationship between that program and ultimate reduction in the morbidity and mortality. The Public health programs may result in high employment, as well as some less tangible benefits such as coalition building and strengthening of the communities. Today, the public health practitioner use some tools in addition to the epidemiology to register their work, still aiming primarily on community wide, also typically prospective methods and approaches to improve health. In addition, the practitioners investigate the outbreaks, provide health education, conduct contact tracing, and also other preventive interventions, and organize research related to the public health (4). The Public health agencies require the identifiable health information for conducting different public health activities. The increasing number of the functions, including the public health Surveillance, and outbreak and incident investigations and program implementation, and some direct health services, s uch as the clinical public health activities and services and the research, maintenance, and the storage of the personal health information. The Successful execution of all these functions depends on the data quality and the accessibility. Heightened security is very necessary and paramount to maintain the public confidence; also good health care and it depends on the patients providing the accurate and sensitive information to their care providers in a very timely manner. Placing restrictions on the data acquisition, use, and the disclosure also poses some risks, particularly if those restrictions impede acquisition of the key surveillance data, which would otherwise be used to prevent the disease, investigate the causation, and enable the interventions to protect the exposed population. Additionally, electronic data could potentially permit real time public health Surveillance and also can facilitate the faster emergency response (5). Advances in the science, technology and the bi omedical research have pushed the boundaries of Belmont principles and stimulating the need for the communities to be involved in informed consent process. Changes in the Food and the Drug Administration regulations allow the waivers of the informed consent in life threatening emergencies. The rights of the unconscious participants are assumed to be accorded degree of the protection through mechanism of the â€Å"Community Consultation† which requires the prior consultation by the investigators and the institutional review board with the community representatives and public disclosure to affected community both before and after that research (6). Now I will discuss the clinical research ethics, and we will see how it is different from public health research ethics. Taking into account the sound and the increasing emphasis of recent years that the experimentation in man must precede the general application of the new procedures in the therapy, and also there is reason to fear that these requirements and the resources might be greater than supply of the responsible investigators. Medical schools and the university hospitals are increasingly dominated by the investigators. Every young man knows that he will never be promoted to some tenure post, and to a professorship in a major medical school, unless he has proved himself as an investigator. If the ready availability of the money for conducting the research is added to this fact, one can see how great the pressures are on the ambitious young physicians (7). A taxonomy was developed for the clinical ethics research, based on the method rather than the clinical area. This divided research in different terms of whether it used theoretical or any empirical methods. First, we will see the theoretical methods of the clinical ethics research. Philosophy (e.g., How should the decisions on setting the priorities be made legitimate and also fair?). Law (e.g., what practices in setting the priorities in regional hea lth authority might constitute discrimination?). Policy (e.g., what policy should the governments follow in funding the new technologies in medicine?). Now let’s see the empirical methods of clinical ethics research. Social Sciences (e.g., how do the regional health authorities in the developing countries make the decisions on setting the priorities?). Decision analysis (e.g., How do you trade-off considerations of equity and efficiency in the decisions on setting priorities?). Clinical epidemiology (e.g., what are the criteria used to allocate the liver transplant?). Health services research (e.g., how does the delivery of the cardiac surgery vary by patient gender and ethnicity?). Within empirical research (both in ethics and more generally), there is some growing recognition that the quantitative methods alone are not adequate. Since many of the phenomena examined by the ethics researchers are deeply entwined into fabric of professions, organizations, and the human lives, qualitative methods have begun to play an important role. For example, one investigator performed the observational research on how physicians discuss do-not-resuscitate orders and also advance care planning. The role of the qualitative methods is both increasing and broadening to include not only the content analysis but also grounded theory, the ethnography, and the case study designs. When we review the field of the clinical ethics a decade from now, we hope that the focus will have shifted from the ethics courses, committees and the consultants to an understanding on the part of most physicians and medical students that ethics is an inherent and inseparable part of the good clinical medicine. We hope that clinical ethics will have achieved its rightful place at the interstices of relations between the patients who are sick and physicians who profess to be able to heal and comfort them. Clinical ethics has made progress towards this vision in the past some years. The challenge re mains for the research into ethical issues to become a mainstream concern for the funding agencies around the World. CONCLUSION: In conclusion, it is stated that although public health research and clinical research are different from each other, but ethical dilemmas are faced by both and also they are same in many situations. While considering the public health research ethics, the researcher must show respect for community’s culture, also take community input on the protocol development, and ensure that research is useful to community, and should respect the community’s knowledge and the experience, and ensure that the informed consent is correctly taken before starting any of the research (8). While considering the clinical research ethics, two components are most important, the first being the informed consent. The statement that informed consent has been obtained has very little meaning unless the participant or his/her guardian is capable of understanding what is to be undertaken and unless all of hazards are made clear. If these are not known this, too, has been stated. Secondly, there is more reliable safeguard provided by presence of intelligent, informed, compassionate, conscientious, and responsible investigator. REFERENCES: 1. Daniel Callahan and Bruce Jennings. Ethics and Public Health: Forging a Strong Relationship. American Journal of Public Health 2002; Vol 92, No. 2: 169-176. 2. Peter A Singer Et Al. Clinical Ethics Revisited. BMC Medical Ethics 2001; 2:1. 3. Steven S Coughlin. Ethical issues in epidemiologic research and public health practice. Emerging Themes in Epidemiology. BioMed central 2006; 3:16. 4. Nancy E. Kass. An Ethical Framework for Public Health. Public Health Matters. 5. Julie Myers Et Al. Privacy and Public Health at Risk: Public Health Confidentiality in the Digital Age. American Journal of Public Health 2008; Vol 98, No. 5:793-801. 6. Sandra Crouse Quinn. Protecting Human Subjects: the Role of Community Advisory Boards. American Journal of Public Health 2004; Vol 94, No. 6:918-922. 7. Henry K. Beecher. Ethics and Clinical Research. The New England Journal of Medicine 1966; Vol 274, No. 24:1354-1360. 8. C. Weijer and E.J. Emanuel. Protecting Communities in Biomedical Research. Science. Policy Forum: Ethics 2000; Vol 289:1142-1144.

Personal Response William Butler Yeats Essay

â€Å"William Butler Yeats deals with an interesting variety of subjects and his poetry is full of powerful images and impressive descriptions. Discuss.† Submitted by Hollie McLaughlin. I very much enjoy reading the poetry of William Butler Yeats. What I like about the poetry is the multi-faceted man who emerges. In Inisfree he is the searching, restless 25 year old, looking to nature as a kind of redemptive force. In ‘September 1913’ he is the ardent political critic of the soul-destroying materialism. In ‘Easter 1916’ he is again many-sided, the man who commemorates the great heroes and is able to confess he was wrong about their existence, as well as the man painfully aware of war’s wastage of youthful potential. My favourite, ‘The Wild Swans at Coole’, is Yeats as the disillusioned man whose â€Å"heart is sore†, the man of â€Å"unrequited love†, the man aware of mortality. In ‘Sailing to Byzantium’, Yeats symbolises universal man in search of meaning and permanence amid the transience of life. Who couldn’t be intrigued by this man! In ‘The Lake Isle of Inisfree’, Yeats echoes for me, the longing we all experience at times to escape the urban jungle, the â€Å"pavements grey†. This grim image of oppression is something many people have to face worldwide. A frequent reoccurrence in the poetry of William Butler Yeats is his idea of an idyllic utopia. I quite liked the discrepancy between his two blissful paradises. In ‘The Lake Isle of Inisfree’ he speaks of the bucolic lifestyle found in Ireland. This poem represents Yeats’ Irish heritage. â€Å"I hear it in the deep heart’s core†. The second poem in which Yeats depicts a great fondness of a particular place is ‘Sailing to Byzantium’. It is said that Yeats has always had a profound interest in the Greek civilisation of Byzantium. There is a great contrast presented between these two ideal worlds of his, these being a sort of mythical place in comparison to a mere county Sligo. In my opinion, I believe that Yeats is a master of rhyme. When reading his poems, they tend to flow very easily off your tongue. I find this can make a person who doesn’t particularly like reading poetry, feel it to be quite simple and enjoyable to read. His poems never seem forced, they don’t sound artificial or contrived. It is as if he didn’t even plan out his poetry and  what he was going to write, he just grabbed a pen and allowed the poem to write itself with ease. The poem which I think is the best example for Yeats’ rhythmic quality of writing is ‘The Lake Isle of Inisfree’. Here, I find the rhythm to be almost hypnotic, with the use of long vowel sounds and long slow lines throughout. This hypnotic rhythm carries you away to a dream world, an idyllic utopia. I also find that the last two lines in Yeats’ poem ‘September 1913’ captures his sense of hopelessness and disillusionment with the Ireland of 1913. â€Å"But let them be, they’re dead and gone, they’re with O’Leary in the grave†. I very much enjoyed Yeats’ use of repetition throughout his poetry. From sentence to sentence he often repeats words. Some examples of this may be found when reading the poem ‘The Lake Isle of Inisfree’. â€Å"I will arise and go now and go†¦Ã¢â‚¬  â€Å"And I shall have some peace there for peace comes dropping slow†¦Ã¢â‚¬  â€Å"Was it for this the wild geese spread, for this that all the blood was shed.† Yeats is often famed for adhering to his use of a strong complex personal mythology which he illustrates throughout his poems by the means of symbolism. Symbols appear in a number of Yeats’ poems and this is a thing that I quite like about his poetry, there are deeper meanings behind the words you read. The complexities of these symbols vary between poems but for the most part they are used to portray or add to the portrayal of the transience of time. Firstly a very simple symbolic message can be observed in the poem â€Å"The Wild Swans at Coole†. As Yeats ponders the transience of time and recounts how it has passed him, he exemplifies the messages through the elegant, youthful swans. I believe this is the one exception to the above statement as the metaphor of the swans is very clear cut. â€Å"And scatter wheeling in great broken ring.† â€Å"Upon their clamorous wings.† The swans seem to show little exertion in what they are doing, which Yeats uses to amplify his lack of physical strength and ability as he is but an ageing man. The theme of time and the use of symbols can be seen at numerous points throughout the poem ‘Sailing to Byzantium’. Although admittedly this poem is, to a great extent, more complex than ‘The Wild Swans at Coole’. I feel no shame in admitting that this poem is a lot more difficult to fully comprehend and it took more time to understand the symbols and the meaning of the poem in its entirety. In the title, I think that the use of the word  Ã¢â‚¬Ëœsailing’ doesn’t mean to be sailing literally, but instead he uses it the mode of transport that is sailing as a metaphor of the journey of ageing. This poem represents Yeats’ journey through life, as he is approaching old age. â€Å"An aged man is but a paltry thing, / A tattered coat upon a stick.† Yeats becomes yet again captivated by the idea of aging and symbols present themselves once more in ‘Sailing to Byzantium’ as he looks to solidify himself for eternity. Two symbols are directly related to his obsession with the transience of time and ideas of immortality. First of all there is the â€Å"perne in a gyre†, which, because of its circular nature, will never stop spinning. Circles are also often associated with continuity of life. The second symbol is not mentioned by name, but instead inferred while discussing the products of â€Å"Grecian goldsmiths†. These goldsmiths produced some of the greatest ornaments of all time, which even today are still preserved. Yeats did not want to ever become reincarnated into the body of another living thing, but to remain beautiful and eternal in an object such as a piece of artwork. The symbols Yeats uses are personally my favourite aspects of his poetry as they force you to think deeper into the meaning of what he is actually trying to say or depict. And finally one great thing about the poetry of William Butler Yeats is his use of ordinary, everyday language. I feel that his use of quite simple and non-complex words results in there being a wider range of people reading his poetry. He takes ordinary language and arranges it in a way that gives them an almost poetic rhythm. An example may be seen in the line â€Å"the trees are in their autumn beauty, the woodland paths are dry.† In the poem ‘The Wild Swans at Coole’. In conclusion, I feel that Yeats does deal with a wide range of different topics, with the use of powerful imagery and impressive descriptions. Yeats’ unique pessimism resonates through the well-crafted lines of his work which effectively portray his sometimes equivocal views. The poetry of William Butler Yeats intrigues me greatly, particularly because of his use of symbols throughout and I very much enjoy ruminating on the meanings within.

Alzheimer’s Disease - Physiological Psychology Essay

Diana Beharry PSY350: Physiological Psychology Alzheimer’s Disease Professor Candice Ward March 20, 2011 Introduction In 1901, a fifty one year old woman named Frau Auguste D. was admitted to a psychiatric hospital in Frankfurt, Germany. She had an unusual bunch of symptoms. While she had no history of prior psychiatric illness, her husband had noticed that Frau D. was becoming increasing paranoid, hallucinatory, agitated, disoriented, and having increasing difficulties with language functions and memory. In the hospital, Auguste D. was a patient of Alois Alzheimer, a German neurologist who had a particular interest in the microscopic analysis of brain disorders. He describes the clinical features of Auguste D. condition and†¦show more content†¦Once in the synapses, the impulses triggers the release of chemical messages called neurotransmitters; which then bind to receptors on the receiving cell as the transmission of the impulse repeated again. The message or impulse continues traveling from one neuron to the next throughout the body until it reaches its destination as it rel ays a signal. All of this activity happens in less than a split second and without conscious thought. At the end of this process, the brain has the task of interpreting the message and making the decision as to what to do with this new information. (Carlson, 2011.Pg.45-52) In people with Alzheimer’s, the neurons become disabled. For starters, Alzheimer’s interferes with the neurons ability to produce energy they need to do their work, a process known as metabolism. Neurons derive energy from the oxygen and glucose which is available through the bloodstream. Without this energy, neurons can no longer communicate with each other and carry impulses to other neurons. They also lose the ability to repair themselves, which ultimately causes them to die. Exactly what interferes with the functioning of the neurons is unclear, and the rate at which the disease progresses also varies from one person to another. Neuofibrillary tangles which is a tau protein that gives neurons the ir structure by binding to microtubules in a cell andShow MoreRelatedMusic Is The Most Influential Real Life Application Of Music Psychology971 Words   |  4 Pagesactively participate in the production of music or passively listen to it (Wilson, 1987). Music psychology aims to explain musical behaviour through the understanding of various cognitive processes including perception, performance and memory (Tan, Pfordresher Harrà ©, 2010). The increasing fascination with the relatively new branch of science has generated the question as to whether studying music psychology is useful. 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Essay on The Confederate Battle Flag Heritage or Hate

Xxxxx Xxxxxxx Zzzzzzz Zzzzzzzz English 102 September 12, 2012 The Confederate Battle Flag: Heritage or Hate The Confederate Battle flag is one of the most recognized symbols in the United States. It is not always a welcome symbol in today’s society. Take for instance the state of South Carolina having to remove it from its statehouse on April 12, 2000. The reason it is not always welcome is because people often misinterpret its true meaning. It is not a symbol of hatred but, a symbol of southern pride and honor. The pride and honor of all the men and women who carried it the flag into battle fighting for what they believed in, Southern independence. The reason that people think that the Confederate flag is a racist symbol is†¦show more content†¦In the south the people had a very different way of life. Most were poor farmers with the exception of large plantation owners who were very wealthy. These plantation owners white and black alike used slave labor to grow and harvest their crops. There was almost as many black plantation owners as there were white. In Charlestown, South Carolina there were more than 100 free black men who owned slaves. Slave labor was a big part of the South’s economy. Cotton was the South’s number one cash crop. The only way they could make good money was to sell to the highest bidder. The highest bidder was not always the industries of the North. Most of the time the south would sell their crops to other countries such as England and France, and then in return they would buy their goods from these other countries. That is the reason these countries backed the south in the war. The north did not like the idea that the southern states were trading with foreign countries because they were losing out on a lot of money. The southern states were cutting the north out of the trade cycle completely. So, how does the north stop this? 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