1
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Jassar S, Adams SJ, Zarzeczny A, Burbridge BE. The future of artificial intelligence in medicine: Medical-legal considerations for health leaders. Healthc Manage Forum 2022; 35:185-189. [PMID: 35354409 PMCID: PMC9047088 DOI: 10.1177/08404704221082069] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Artificial Intelligence (AI) is becoming increasingly common in healthcare and has potential to improve the efficiency and quality of healthcare services. As the utility of AI expands, medical-legal questions arise regarding the possible legal implications of incorporating AI into clinical practice. Particularly, the unique black box nature of AI brings distinct challenges. There is limited guidance addressing liability when AI is used in clinical practice, and traditional legal principles present limitations when applied to novel uses of AI. Comprehensive solutions to address the challenges of AI have not been well established in North America. As AI continues to evolve in healthcare, appropriate guidance from professional regulatory bodies may help the medical field realize AI’s utility and encourage its safe use. As the options for AI in medicine evolve, physicians and health leaders would be prudent to consider the evolving medical-legal context regarding use of AI in clinical practices and facilities.
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Affiliation(s)
- Sunam Jassar
- College of Medicine, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Scott J Adams
- Department of Medical Imaging, 6846University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Saskatchewan, Canada
| | - Brent E Burbridge
- Department of Medical Imaging, 6846University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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2
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Zarzeczny A, Radu L. Introducing an Organ Donor Registry is Saskatchewan. HRO-ORS 2021. [DOI: 10.13162/hro-ors.v9i2.4598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
On 3 September 2020, Saskatchewan launched an organ donor registry that allows participants 16 years and older to register their intent to be an organ donor either online or using a paper form. Saskatchewan has historically performed poorly at a national level with low rates of organ donations. Saskatchewan's new registry is intended to increase the numbers of organ donors in the province, while also helping to modernize its organ donation system and ease donation conversations with families. Saskatchewan's introduction of this registry brought the province in line with other provinces and territories across Canada that use similar systems, and provided a response to the surge in public interest around organ donation that followed the Humboldt Bronco bus crash tragedy and related ``Logan Boulet Effect.'' The 2019-2020 and 2020-2021 provincial budgets included dedicated funding for the development and launch of the registry, which was accompanied by a media campaign to increase public awareness. Though it is too early to evaluate the success of the registry, early indications suggest donation rates will be a key evaluation metric. Registries are commonly thought to help increase public awareness of, and support for, organ donation, but improving Saskatchewan's organ donation rates will likely also require companion measures to strengthen the culture and practice of donation in the province.
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3
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Zarzeczny A, Radu L. Introducing an Organ Donor Registry is Saskatchewan. HRO-ORS 2021. [DOI: 10.13162/hro-ors.v9i2.4669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
On 3 September 2020, Saskatchewan launched an organ donor registry that allows participants 16 years and older to register their intent to be an organ donor either online or using a paper form. Saskatchewan has historically performed poorly at a national level with low rates of organ donations. Saskatchewan's new registry is intended to increase the numbers of organ donors in the province, while also helping to modernize its organ donation system and ease donation conversations with families. Saskatchewan's introduction of this registry brought the province in line with other provinces and territories across Canada that use similar systems, and provided a response to the surge in public interest around organ donation that followed the Humboldt Bronco bus crash tragedy and related ``Logan Boulet Effect.'' The 2019-2020 and 2020-2021 provincial budgets included dedicated funding for the development and launch of the registry, which was accompanied by a media campaign to increase public awareness. Though it is too early to evaluate the success of the registry, early indications suggest donation rates will be a key evaluation metric. Registries are commonly thought to help increase public awareness of, and support for, organ donation, but improving Saskatchewan's organ donation rates will likely also require companion measures to strengthen the culture and practice of donation in the province.
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4
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Zarzeczny A, Babyn P, Adams SJ, Longo J. Artificial intelligence-based imaging analytics and lung cancer diagnostics: Considerations for health system leaders. Healthc Manage Forum 2020; 34:169-174. [PMID: 33297774 DOI: 10.1177/0840470420975062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Lung cancer is a leading cause of cancer death in Canada, and accurate, early diagnosis are critical to improving clinical outcomes. Artificial Intelligence (AI)-based imaging analytics are a promising healthcare innovation that aim to improve the accuracy and efficiency of lung cancer diagnosis. Maximizing their clinical potential while mitigating their risks and limitations will require focused leadership informed by interdisciplinary expertise and system-wide insight. We convened a knowledge exchange workshop with diverse Saskatchewan health system leaders and stakeholders to explore issues surrounding the use of AI in diagnostic imaging for lung cancer, including implementation opportunities, challenges, and priorities. This technology is anticipated to improve patient outcomes, reduce unnecessary healthcare spending, and increase knowledge. However, health system leaders must also address the needs for robust data, financial investment, effective communication and collaboration between healthcare sectors, privacy and data protections, and continued interdisciplinary research to achieve this technology's potential benefits.
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Affiliation(s)
- Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, 6846University of Regina, Regina, Saskatchewan, Canada
| | - Paul Babyn
- Department of Medical Imaging, Saskatchewan Health Authority, Saskatoon City Hospital, Saskatoon, Saskatchewan, Canada.,Department of Medical Imaging, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Scott J Adams
- Department of Medical Imaging, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Justin Longo
- Johnson Shoyama Graduate School of Public Policy, 6846University of Regina, Regina, Saskatchewan, Canada
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5
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Zarzeczny A, Tanner C, Barfoot J, Blackburn C, Couturier A, Munsie M. Contact us for more information: an analysis of public enquiries about stem cells. Regen Med 2019; 14:1137-1150. [DOI: 10.2217/rme-2019-0092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: This study examines online enquiries received by two prominent stem cell science initiatives operating in different geographical jurisdictions. Materials & methods: Combined quantitative and qualitative analysis undertaken of internet-based queries (n = 1047) received by Stem Cells Australia and EuroStemCell from members of the public over a two-year period (May 2014–2016). Results: Findings reveal striking similarities between the two datasets and highlight the range of uncertainties, priorities and needs of those seeking information about stem cells online. Conclusion: Sustained and in-depth tailored guidance is needed to effectively meet the diverse stem cell-related information-based needs of communities internationally. Such efforts should be prioritized by regenerative medicine research initiatives and organizations, given the trust and hope diverse publics appear to place in these groups.
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Affiliation(s)
- Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, SK, S4S 0A2, Canada
| | - Claire Tanner
- Department of Anatomy & Neuroscience, Center for Stem Cell Systems, The University of Melbourne, Parkville, Victoria, Australia
| | - Jan Barfoot
- EuroStemCell, MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Clare Blackburn
- EuroStemCell, MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Anna Couturier
- EuroStemCell, MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, EH16 4UU, UK
| | - Megan Munsie
- Department of Anatomy & Neuroscience, Center for Stem Cell Systems, The University of Melbourne, Parkville, Victoria, Australia
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6
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Bubela T, Kleiderman E, Master Z, Ogbogu U, Ravitsky V, Zarzeczny A, Knoppers BM. Canada's Assisted Human Reproduction Act: Pragmatic Reforms in Support of Research. Front Med (Lausanne) 2019; 6:157. [PMID: 31355201 PMCID: PMC6636215 DOI: 10.3389/fmed.2019.00157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/24/2019] [Indexed: 12/20/2022] Open
Abstract
Canada's Assisted Human Reproduction Act is long overdue for Parliamentary review. We argue that the current regulation of research using human reproductive materials is not proportionate, not responsive to the uncertain threats posed to human and environmental health and safety, and is not considerate of diverse values in a democratic society. We propose tailored regulatory carve-outs for in vitro research for currently prohibited activities, such as gene editing, and for the exercise of Ministerial Discretion for access by Canadians to experimental in vivo interventions that are currently prohibited, such as mitochondrial replacement therapy. Our recommendations are bounded by constitutional constraints that recognize political and practical challenges in keeping oversight of this research under Federal jurisdiction, whether conducted in academic or private sectors. The proposed nuanced regulatory scheme should be overseen by a new national Agency, modeled on a blend of the Canadian Stem Cell Oversight Committee and Assisted Human Reproduction Canada.
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Affiliation(s)
- Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Erika Kleiderman
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montreal, QC, Canada
| | - Zubin Master
- Mayo Clinic Center for Regenerative Medicine, Rochester, MN, United States.,Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, United States
| | - Ubaka Ogbogu
- Faculties of Law, Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Vardit Ravitsky
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, SK, Canada
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montreal, QC, Canada
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7
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Caulfield T, Marcon AR, Murdoch B, Brown JM, Perrault ST, Jarry J, Snyder J, Anthony SJ, Brooks S, Master Z, Rachul C, Ogbogu U, Greenberg J, Zarzeczny A, Hyde-Lay R. Health Misinformation and the Power of Narrative Messaging in the Public Sphere. Canadian Journal of Bioethics 2019. [DOI: 10.7202/1060911ar] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Numerous social, economic and academic pressures can have a negative impact on representations of biomedical research. We review several of the forces playing an increasingly pernicious role in how health and science information is interpreted, shared and used, drawing discussions towards the role of narrative. In turn, we explore how aspects of narrative are used in different social contexts and communication environments, and present creative responses that may help counter the negative trends. As traditional methods of communication have in many ways failed the public, changes in approach are required, including the creative use of narratives.
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8
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Zarzeczny A, Atkins H, Illes J, Kimmelman J, Master Z, Robillard JM, Snyder J, Turner L, Zettler PJ, Caulfield T. The stem cell market and policy options: a call for clarity. J Law Biosci 2018; 5:743-758. [PMID: 31143461 PMCID: PMC6534752 DOI: 10.1093/jlb/lsy025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, SK S4S 0A2, Canada
| | - Harold Atkins
- Ottawa Hospital Research Institute, Ottawa Hospital & University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Jonathan Kimmelman
- Biomedical Ethics Unit/Social Studies of Medicine, McGill University. Montreal, QC H3A 1X1, Canada
| | - Zubin Master
- Biomedical Ethics Research Program, Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Julie M Robillard
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Leigh Turner
- Center for Bioethics, School of Public Health, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Patricia J Zettler
- Centre for Law, Health and Society, College of Law, Georgia State University, Atlanta, GA 30302, USA
| | - Timothy Caulfield
- Faculty of Law and School of Public Health & Health Law Institute, University of Alberta, Edmonton, AB T6G 2H5, Canada
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9
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Ogbogu U, Zarzeczny A, Baltz J, Bedford P, Du J, Hyun I, Jaafar Y, Jurisicova A, Kleiderman E, Koukio Y, Knoppers BM, Leader A, Master Z, Nguyen MT, Noohi F, Ravitsky V, Toews M. Research on Human Embryos and Reproductive Materials: Revisiting Canadian Law and Policy. ACTA ACUST UNITED AC 2018; 13:10-19. [PMID: 29595433 PMCID: PMC5863866 DOI: 10.12927/hcpol.2018.25401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Research involving human embryos and reproductive materials, including certain forms of stem cell and genetic research, is a fast-moving area of science with demonstrated clinical relevance. Canada's current governance framework for this field of research urgently requires review and reconsideration in view of emerging applications. Based on a workshop involving ethics, legal, policy, scientific and clinical experts, we present a series of recommendations with the goal of informing and supporting health policy and decision-making regarding the governance of the field. With a pragmatic and principled governance approach, Canada can continue its global leadership in this field, as well as advance the long-term health and well-being of Canadians.
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Affiliation(s)
- Ubaka Ogbogu
- Assistant Professor, Faculties of Law and Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB
| | - Amy Zarzeczny
- Associate Professor, Johnson-Shoyama Graduate School of Public Policy, University of Regina, Regina, SK
| | - Jay Baltz
- Senior Scientist and Professor, Ottawa Hospital Research Institute, Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Patrick Bedford
- Manager of Clinical Translation and Regulatory Affairs, Centre for Commercialization of Regenerative Medicine (CCRM), Toronto, ON
| | - Jenny Du
- Research Trainee, Faculty of Law, University of Alberta, Edmonton, AB
| | - Insoo Hyun
- Associate Professor, Department of Bioethics, Case Western Reserve University, Cleveland, OH
| | - Yasmeen Jaafar
- Research Trainee, Faculty of Law, University of Alberta, Edmonton, AB
| | - Andrea Jurisicova
- Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Investigator, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON
| | - Erika Kleiderman
- Academic Associate, Centre of Genomics and Policy, Faculty of Medicine, Human Genetics, McGill University, Montreal, QC
| | | | - Bartha Maria Knoppers
- Professor and Director, Centre of Genomics and Policy, Faculty of Medicine, Human Genetics, McGill University, Montreal, QC
| | - Arthur Leader
- Professor of Reproductive Medicine, Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
| | - Zubin Master
- Associate Consultant II, Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Minh Thu Nguyen
- Academic Associate, Centre of Genomics and Policy, Faculty of Medicine, Human Genetics, McGill University, Montreal, QC
| | - Forough Noohi
- PhD Candidate, Centre of Genomics and Policy, Faculty of Medicine, Human Genetics, McGill University, Montreal, QC
| | - Vardit Ravitsky
- Associate Professor, Bioethics Programs, School of Public Health, University of Montreal, Montreal, QC
| | - Maeghan Toews
- Lecturer, Faculty of Law, University of Adelaide, Adelaide, AU
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10
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Abstract
Although a growing body of literature has emerged to study medical tourism and address the policy challenges it creates for national health care systems, the comparative scholarship on the topic remains too limited in scope. In this article, we draw on the existing literature to discuss a comparative research agenda on medical tourism that stresses the multifaceted relationship between medical tourism and the institutional characteristics of national health care systems. On the one hand, we claim that such characteristics shape the demand for medical tourism in each country. On the other hand, the institutional characteristics of each national health care system can shape the very nature of the impact of medical tourism on that particular country. Using the examples of Canada and the United States, this article formulates a systematic institutionalist research agenda to explore these two related sides of the medical tourism-health care system nexus with a view to informing future policy work in this field.
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Affiliation(s)
- Daniel Béland
- Johnson Shoyama Graduate School of Public Policy, 101 Diefenbaker Place, Saskatoon, SK S7N 5B8 Canada
| | - Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, 101 Diefenbaker Place, Saskatoon, SK S7N 5B8 Canada
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11
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Sipp D, Caulfield T, Kaye J, Barfoot J, Blackburn C, Chan S, De Luca M, Kent A, McCabe C, Munsie M, Sleeboom-Faulkner M, Sugarman J, van Zimmeren E, Zarzeczny A, Rasko JEJ. Marketing of unproven stem cell-based interventions: A call to action. Sci Transl Med 2018; 9:9/397/eaag0426. [PMID: 28679655 DOI: 10.1126/scitranslmed.aag0426] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 11/06/2016] [Accepted: 02/27/2017] [Indexed: 11/03/2022]
Abstract
Commercial promotion of unsupported therapeutic uses of stem cells is a global problem that has proven resistant to regulatory efforts. Here, we suggest a coordinated approach at the national and international levels focused on engagement, harmonization, and enforcement to reduce the risks associated with direct-to-consumer marketing of unproven stem cell treatments.
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Affiliation(s)
- Douglas Sipp
- Riken Center for Developmental Biology, 2-2-3 Minatojima Minamimachi, Kobe 650-0047, Japan. .,Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.,Global Initiatives, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.,Riken Center for Advanced Intelligence Project, 1-4-1 Nihonbashi, Chuo-ku, Tokyo 103-0027, Japan
| | - Timothy Caulfield
- Faculty of Law and School of Public Health, 461 Law Centre, University of Alberta, Edmonton, Alberta T6G 2H5, Canada.,Faculty of Law and School of Public Health, 461 Law Centre, University of Alberta, Edmonton, Alberta T6G 2H5, Canada
| | - Jane Kaye
- Department of Public Health, University of Oxford, Oxford, UK
| | - Jan Barfoot
- Medical Research Council Centre for Regenerative Medicine, School of Biological Sciences, University of Edinburgh, 5 Little France Drive, Edinburgh EH16 4UU, UK
| | - Clare Blackburn
- Medical Research Council Centre for Regenerative Medicine, School of Biological Sciences, University of Edinburgh, 5 Little France Drive, Edinburgh EH16 4UU, UK
| | - Sarah Chan
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Nine Bioquarter, 9 Little France Road, Edinburgh EH16 4UX, UK
| | - Michele De Luca
- Center for Regenerative Medicine "Stefano Ferrari," Department of Life Sciences, University of Modena and Reggio Emilia, Via G. Gottardi 100, 41125 Modena, Italy
| | - Alastair Kent
- Genetic Alliance UK, Level 3 Barclay House, 37 Queen Square, London WC1N 3BH, UK
| | - Christopher McCabe
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada
| | - Megan Munsie
- Centre for Stem Cell Systems, Department of Anatomy and Neuroscience, School of Biomedical Science, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Level 2, Kenneth Myer Building, 30 Royal Parade Parkville, 3010 Victoria, Australia.,Education, Ethics, Law and Community Awareness Unit, Stem Cells Australia, University of Melbourne, Level 2, Kenneth Myer Building, 30 Royal Parade Parkville, 3010 Victoria, Australia
| | | | - Jeremy Sugarman
- Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Esther van Zimmeren
- University of Antwerp, Faculty of Law, Research Group Government and Law, Venusstraat 23, 2000 Antwerp, Belgium
| | - Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, 110-2 Research Drive, Regina, Saskatchewan S4S 7H1, Canada
| | - John E J Rasko
- Sydney Medical School, University of Sydney, Sydney, Australia. .,Gene and Stem Cell Therapy Program, Centenary Institute, Sydney, Australia.,Department of Cell and Molecular Therapies, Royal Prince Alfred Hospital, Level 2, Building 89, Missenden Road, Camperdown, New South Wales 2050, Australia
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12
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Murdoch B, Zarzeczny A, Caulfield T. Exploiting science? A systematic analysis of complementary and alternative medicine clinic websites' marketing of stem cell therapies. BMJ Open 2018; 8:e019414. [PMID: 29490963 PMCID: PMC5855243 DOI: 10.1136/bmjopen-2017-019414] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/02/2018] [Accepted: 01/09/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify the frequency and qualitative characteristics of stem cell-related marketing claims made on websites of clinics featuring common types of complementary and alternative medicine practitioners. The involvement of complementary and alternative medicine practitioners in the marketing of stem cell therapies and stem cell-related interventions is understudied. This research explores the extent to which they are involved and collaborate with medical professionals. This knowledge will help with identifying and evaluating potential policy responses to this growing market. DESIGN Systematic website analysis. SETTING Global. US and English-language bias due to methodology. MAIN OUTCOME MEASURES Representations made on clinic websites in relation to practitioner types, stem cell therapies and their targets, stem cell-related interventions. Statements about stem cell therapies relating to evidence of inefficacy, limited evidence of efficacy, general procedural risks, risks specific to the mode of therapy, regulatory status, experimental or unproven nature of therapy. Use of hype language (eg, language that exaggerates potential benefits). RESULTS 243 websites offered stem cell therapies. Many websites advertised stem cell transplantation from multiple sources, such as adipose-derived (112), bone marrow-derived (100), blood-derived (28), umbilical cord-derived (26) and others. Plant stem cell-based treatments and products (20) were also advertised. Purposes for and targets of treatment included pain, physical injury, a wide range of diseases and illnesses, cosmetic concerns, non-cosmetic ageing, sexual enhancement and others. Medical doctors (130), chiropractors (53) and naturopaths (44) commonly work in the clinics we found to be offering stem cell therapies. Few clinic websites advertising stem cell therapies included important additional information, including statements about evidence of inefficacy (present on only 12.76% of websites), statements about limited evidence of efficacy (18.93%), statements of general risks (24.69%), statements of risks specific to the mode(s) of therapy (5.76%), statements as to the regulatory status of the therapies (30.86%) and statements that the therapy is experimental or unproven (33.33%). Hype language was noted (31.69%). CONCLUSIONS Stem cell therapies and related interventions are marketed for a wide breadth of conditions and are being offered by complementary and alternative practitioners, often in conjunction with medical doctors. Consumer protection and truth-in-advertising regulation could play important roles in addressing misleading marketing practices in this area.
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Affiliation(s)
- Blake Murdoch
- Faculty of Law, Health Law Institute, University of Alberta, Edmonton, Canada
| | - Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada
| | - Timothy Caulfield
- Faculty of Law, Health Law Institute, University of Alberta, Edmonton, Canada
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13
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Illes J, Sipp D, Kleiderman E, Benjaminy S, Isasi R, Lomax G, Master Z, McCormick J, Ogbogu U, Ravitsky V, Robillard JM, Rossi F, Wilson B, Zarzeczny A. A blueprint for the next generation of ELSI research, training, and outreach in regenerative medicine. NPJ Regen Med 2018; 2:21. [PMID: 29302357 PMCID: PMC5677945 DOI: 10.1038/s41536-017-0026-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 01/10/2023] Open
Abstract
Regenerative medicine has attracted the interest of scientists, physicians, and patient communities, and as well as policy-makers and the broader public given related ethical, legal, and social implications. Here we examine past initiatives in the ethical, legal and social implications arena in regenerative medicine, and offer our views on actionable priorities for the future in six key areas: capacity building, policy, engagement with industry, resaerch ethics, communication, and community building.
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Affiliation(s)
- Judy Illes
- National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Douglas Sipp
- RIKEN Center for Developmental Biology, Kobe, Japan.,Keio University School of Medicine, Tokyo, Japan.,Keio Global Research Institute, Tokyo, Japan
| | - Erika Kleiderman
- Centre of Genomics and Policy, McGill University, Montreal, QC Canada
| | - Shelly Benjaminy
- National Core for Neuroethics and Department of Experimental Medicine, University of British Columbia, Vancouver, BC Canada
| | - Rosario Isasi
- John T. Macdonald Foundation Department of Human Genetics, University of Miami, Coral Gables, FL USA
| | - Geoff Lomax
- California Institute of Regenerative Medicine, Oakland, CA USA
| | - Zubin Master
- Alden March Bioethics Institute, Albany Medical College, Albany, NY USA
| | - Jennifer McCormick
- Department of Humanities, Pennsylvania State College of Medicine, Hershey, PA USA
| | - Ubaka Ogbogu
- Faculties of Law and Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB Canada
| | - Vardit Ravitsky
- Bioethics Program, School of Public Health, University of Montreal, Montreal, QC Canada
| | - Julie M Robillard
- National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Fabio Rossi
- Department of Medical Genetics, University of British Columbia, Vancouver, BC Canada
| | - Brenda Wilson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON Canada
| | - Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, SK Canada
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14
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Zarzeczny A, McNutt K. Wicked policy issues in regenerative medicine and the need to explore new avenues for public engagement. Regen Med 2017; 12:749-752. [DOI: 10.2217/rme-2017-0108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina S4S 0A2, Canada
| | - Kathleen McNutt
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina S4S 0A2, Canada
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McNutt K, Zarzeczny A. Leveraging social media in the stem cell sector: exploring Twitter's potential as a vehicle for public information campaigns. Regen Med 2017; 12:753-764. [DOI: 10.2217/rme-2017-0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Our aim in this project was to explore Twitter's potential as a vehicle for an online public information campaign (PIC) focused on providing evidence-based information about stem cell therapies and the market for unproven stem cell-based interventions. Methods: We designed an online, Twitter-based PIC using classic design principles and identified a set of target intermediaries (organizations with online influence) using a network governance approach. We tracked the PIC's dissemination over a 2-month period, and evaluated it using metrics from the #SMMStandards Conclave. Results: Participation was limited but the PIC achieved some reach and engagement. Conclusion: Social media based online PICs appear to have potential but also face challenges. Future research is required to better understand how to most effectively maximize their strengths.
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Affiliation(s)
- Kathleen McNutt
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Saskatchewan S4S 7H9, Canada
| | - Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, University of Regina, Regina, Saskatchewan S4S 7H9, Canada
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Affiliation(s)
- Timothy Caulfield
- Health Law Institute, Faculty of Law (Caulfield), University of Alberta, Edmonton, Alta.; Johnson Shoyama Graduate School of Public Policy (Zarzeczny), University of Regina, Regina, Sask.
| | - Amy Zarzeczny
- Health Law Institute, Faculty of Law (Caulfield), University of Alberta, Edmonton, Alta.; Johnson Shoyama Graduate School of Public Policy (Zarzeczny), University of Regina, Regina, Sask
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Snyder J, Adams K, Chen YY, Birch D, Caulfield T, Cohen IG, Crooks VA, Illes J, Zarzeczny A. Navigating physicians' ethical and legal duties to patients seeking unproven interventions abroad. Can Fam Physician 2015; 61:584-e298. [PMID: 26175363 PMCID: PMC4501596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Jeremy Snyder
- Associate Professor in the Faculty of Health Sciences at Simon Fraser University in Burnaby, BC.
| | - Krystyna Adams
- Doctoral candidate in the Faculty of Health Sciences at Simon Fraser University
| | - Y Y Chen
- Doctoral candidate in juridical science in the Faculty of Law at the University of Toronto in Ontario
| | - Daniel Birch
- Associate Professor in the Department of Surgery at the Universityof Alberta in Edmonton
| | - Timothy Caulfield
- Canada Research Chair in Health Law and Policy and Professor in the Faculty of Law and the School of Public Health at the University of Alberta
| | - I Glenn Cohen
- Professor of Law at Harvard Law School in Cambridge, Mass
| | - Valorie A Crooks
- Associate Professor in the Department of Geography at Simon Fraser University
| | - Judy Illes
- Professor of Neurology and Canada Research Chair in Neuroethics at the University of British Columbia in Vancouver
| | - Amy Zarzeczny
- Assistant Professor in the Johnson-Shoyama Graduate School of Public Policy at the University of Regina in Saskatchewan
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Caulfield T, Kamenova K, Ogbogu U, Zarzeczny A, Baltz J, Benjaminy S, Cassar PA, Clark M, Isasi R, Knoppers B, Knowles L, Korbutt G, Lavery JV, Lomax GP, Master Z, McDonald M, Preto N, Toews M. Research ethics and stem cells: Is it time to re-think current approaches to oversight? EMBO Rep 2014; 16:2-6. [PMID: 25476708 DOI: 10.15252/embr.201439819] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Kalina Kamenova
- Health Law Institute, University of Alberta, Edmonton, AB, Canada
| | - Ubaka Ogbogu
- Faculty of Law and Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Amy Zarzeczny
- Johnson-Shoyama Graduate School of Public Policy, University of Regina, Regina, SK, Canada
| | - Jay Baltz
- Ottawa Hospital Research Institute and Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada
| | - Shelly Benjaminy
- National Core for Neuroethics, University of British Columbia, Vancouver, BC, Canada
| | | | - Marianne Clark
- Health Law Institute, University of Alberta, Edmonton, AB, Canada
| | - Rosario Isasi
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Bartha Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Lori Knowles
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Gregory Korbutt
- Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - James V Lavery
- Centre for Ethical, Social & Cultural Risk, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Geoffrey P Lomax
- California Institute for Regenerative Medicine, San Francisco, CA, USA
| | - Zubin Master
- Alden March Bioethics Institute, Albany Medical College, Albany, NY, USA
| | - Michael McDonald
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health University of British Columbia, Vancouver, BC, Canada
| | - Nina Preto
- Engage Associates Consulting Group, Vancouver, BC, Canada
| | - Maeghan Toews
- Health Law Institute, University of Alberta, Edmonton, AB, Canada
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Zarzeczny A, Clark M. Unproven stem cell-based interventions & physicians' professional obligations; a qualitative study with medical regulatory authorities in Canada. BMC Med Ethics 2014; 15:75. [PMID: 25315976 PMCID: PMC4203963 DOI: 10.1186/1472-6939-15-75] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/07/2014] [Indexed: 12/02/2022] Open
Abstract
Background The pursuit of unproven stem cell-based interventions (“stem cell tourism”) is an emerging issue that raises various concerns. Physicians play different roles in this market, many of which engage their legal, ethical and professional obligations. In Canada, physicians are members of a self-regulated profession and their professional regulatory bodies are responsible for regulating the practice of medicine and protecting the public interest. They also provide policy guidance to their members and discipline members for unprofessional conduct. Methods We conducted semi-structured telephone interviews with representatives from six different provincial Colleges of Physicians and Surgeons in Canada to discuss their experiences and perspectives regarding stem cell tourism. Our focus was on exploring how different types of physician involvement in this market would be viewed by physicians’ professional regulatory bodies in Canada. Results When considering physicians’ professional obligations, participants drew analogies between stem cell tourism and other areas of medical tourism as well as with some aspects of complementary alternative medicine where existing policies, codes of ethics and regulations provide some guidance. Canadian physicians are required to act in the best interests of their patients, respect patient autonomy, avoid conflicts of interest and pursue evidence-based practice in accordance with accepted standards of care. Physicians who provide unproven treatments falling outside the standard of care, not in the context of an approved research protocol, could be subject to professional discipline. Other types of problematic conduct include referrals involving financial conflict of interest and failure to provide urgent medically necessary care. Areas of ambiguity include physicians’ obligations when asked for information and advice about seeking unproven medical treatments, in terms of providing non-urgent follow-up care, and when asked to support efforts to go abroad by providing tests or procedures in advance that would not otherwise be medically indicated. Conclusions Specific policy guidance regarding the identified areas of tension or ambiguity may prove helpful for physicians struggling with these issues. Further consideration of the complex interplay of factors at issue in how physicians may (should) respond to patient demands related to unproven medical interventions while meeting their professional, legal and ethical obligations, is warranted.
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Affiliation(s)
- Amy Zarzeczny
- Johnson-Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada.
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Abstract
The concept of medical necessity plays a central role in many healthcare systems, including Canada's, by helping determine which healthcare services will receive funding. Despite its significance in health policy frameworks, medical necessity has proven to be notoriously difficult to define and operationalise. A shift toward a more personalised and genetically-informed approach to the provision of healthcare seems likely to heighten associated policy challenges. One of the stated goals of personalised medicine is to save healthcare systems money by facilitating the use of less and more effective treatments. However, any cost saving potential may ultimately be thwarted by physicians' legal and ethical obligations, given that physicians will inevitably be required to implement and define the bounds of genetically-informed medical necessity for their patients.
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Affiliation(s)
- Timothy Caulfield
- Health Law Institute, University of Alberta, Edmonton, Alberta, Canada
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Pullman D, Zarzeczny A, Picard A. "Media, politics and science policy: MS and evidence from the CCSVI Trenches". BMC Med Ethics 2013; 14:6. [PMID: 23402260 PMCID: PMC3575396 DOI: 10.1186/1472-6939-14-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 02/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2009, Dr. Paolo Zamboni proposed chronic cerebrospinal venous insufficiency (CCSVI) as a possible cause of multiple sclerosis (MS). Although his theory and the associated treatment ("liberation therapy") received little more than passing interest in the international scientific and medical communities, his ideas became the source of tremendous public and political tension in Canada. The story moved rapidly from mainstream media to social networking sites. CCSVI and liberation therapy swiftly garnered support among patients and triggered remarkable and relentless advocacy efforts. Policy makers have responded in a variety of ways to the public's call for action. DISCUSSION We present three different perspectives on this evolving story, that of a health journalist who played a key role in the media coverage of this issue, that of a health law and policy scholar who has closely observed the unfolding public policy developments across the country, and that of a medical ethicist who sits on an expert panel convened by the MS Society of Canada and the Canadian Institutes of Health Research to assess the evidence as it emerges. SUMMARY This story raises important questions about resource allocation and priority setting in scientific research and science policy. The growing power of social media represents a new level of citizen engagement and advocacy, and emphasizes the importance of open debate about the basis on which such policy choices are made. It also highlights the different ways evidence may be understood, valued and utilized by various stakeholders and further emphasizes calls to improve science communication so as to support balanced and informed decision-making.
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Affiliation(s)
- Daryl Pullman
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, St. John's, NL A1B 3V6, Canada.
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Master Z, Zarzeczny A, Rachul C, Caulfield T. What's missing? Discussing stem cell translational research in educational information on stem cell "tourism". J Law Med Ethics 2013; 41:254-268. [PMID: 23581669 DOI: 10.1111/jlme.12017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Stem cell tourism is a growing industry in which patients pursue unproven stem cell therapies for a wide variety of illnesses and conditions. It is a challenging market to regulate due to a number of factors including its international, online, direct-to-consumer approach. Calls to provide education and information to patients, their families, physicians, and the general public about the risks associated with stem cell tourism are mounting. Initial studies examining the perceptions of patients who have pursued stem cell tourism indicate many are highly critical of the research and regulatory systems in their home countries and believe them to be stagnant and unresponsive to patient needs. We suggest that educational material should include an explanation of the translational research process, in addition to other aspects of stem cell tourism, as one means to help promote greater understanding and, ideally, curb patient demand for unproven stem cell interventions. The material provided must stress that strong scientific research is required in order for therapies to be safe and have a greater chance at being effective. Through an analysis of educational material on stem cell tourism and translational stem cell research from patient groups and scientific societies, we describe essential elements that should be conveyed in educational material provided to patients. Although we support the broad dissemination of educational material on stem cell translational research, we also acknowledge that education may simply not be enough to engender patient and public trust in domestic research and regulatory systems. However, promoting patient autonomy by providing good quality information to patients so they can make better informed decisions is valuable in itself, irrespective of whether it serves as an effective deterrent of stem cell tourism.
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Affiliation(s)
- Zubin Master
- Alden March Bioethics Institute, Albany Medical College
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Abstract
The increasing popularity of functional neuroimaging technologies in multiple disciplines has gained attention from within and outside the field of neuroscience. As the scope of research employing functional neuroimaging technologies broadens, there appears to also be a growing concern about the use of these technologies and the related social, ethical and legal issues. These concerns have been coined 'neuroskepticism'. First, we review how the term neuroskepticism has been previously used and defined. Second, we examine review and commentary articles published in journals with top impact factors, probing the presence and evolution of neuroskepticism within these articles. Results demonstrate a wide, but expected, range of issues associated with functional neuroimaging. It also appears that neuroskepticism is increasing as functional neuroimaging technologies gain popularity, which may indicate the presence of a classic Gartner Hype Cycle.
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Affiliation(s)
- Christen Rachul
- Health Law and Science Policy Group, Law Centre, University of Alberta, Edmonton, AB, Canada T6G 2H5.
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Abstract
Neuroimaging research covers a wide range of intriguing issues from revealing brain structures to investigating what happens in our brain when we lie. The field appears to be thriving, but skepticism and alertness to the various ethical, scientific, policy and philosophical challenges associated with it also appear to be on the rise. One particularly complex issue concerns what to do with incidental findings that emerge during the course of neuroimaging research. Research ethics boards (REBs) play a central role in research oversight. In this paper, we will consider some of the potential issues associated with REB liability in negligence in the context of incidental findings in neuroimaging research.
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Affiliation(s)
- Amy Zarzeczny
- Health Law and Science Policy Group (HeaLS), University of Alberta, Edmonton, AB, Canada T6G 2H5
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Abstract
While the clinical promise of much stem cell research remains largely theoretical, patients are nonetheless pursuing unproven stem cell therapies in jurisdictions around the world--a phenomenon referred to as "stem cell tourism." These treatments are generally advertised on a direct-to-consumer basis via the Internet. Research shows portrayals of stem cell medicine on such websites are overly optimistic and the claims made are unsubstantiated by published evidence. However, anecdotal evidence suggests that parents are pursuing these "treatments" for their children, despite potential physical and financial risk. Physicians are in a unique position as they can be expected to be involved in, or privy to, such decisions. In this paper, we consider what duties physicians may have toward minor patients whose parents/guardians wish to engage in stem cell tourism on their behalf. We use the Canadian perspective to address the broadly relevant issues raised by this trend.
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Affiliation(s)
- Amy Zarzeczny
- Health Law Institute, University of Alberta, Edmonton, Alberta, T6G 2H5, Canada
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Affiliation(s)
- Timothy Caulfield
- Faculty of Law and School of Public Health, Health Law Institute, University of Alberta, Edmonton, Alberta, Canada.
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