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Vaccines Don't Save Lives, Vaccination Does
Published in Norman Begg, The Remarkable Story of Vaccines, 2023
Health economics is also important. No country has a limitless health budget, so when a new vaccine comes along, the government must decide whether or not to prioritise it. This is a poisoned chalice. It’s easy enough to work out the cost of a vaccination programme, but what price do you put on someone who dies, or has a lifelong disability because they didn’t get vaccinated? Health economists try to take this into account by measuring quality of life, the duration of illness and disability, health service utilisation and so on, but inevitably there is an element of subjectivity. If you just take the healthcare costs into account, the return on investment doesn’t look nearly as good as if you include the wider costs. For example, when a child gets chickenpox, they will be off school for a week or two, so one of the parents has to stay at home, which impacts their economic productivity. The child will then give it to their siblings, so the cycle is repeated. Most of the economic benefit of chickenpox vaccination is preventing these indirect costs. Luckily, most vaccines are relatively inexpensive, so health economic analyses are usually positive. Wealthier countries will usually adopt a new vaccine sooner or later, but it can take many years for some vaccines to get into the national vaccination calendar. In the UK, the only vaccine that has not yet been recommended for all children is chickenpox. On the other hand, the UK was the first country in the world to recommend meningitis vaccine for all babies; this is because the UK had one of the highest rates of disease in the developed world.
Obtaining Consent
Published in Robert Wheeler, Clinical Law for Clinical Practice, 2020
The court found that objectively, the reasonable patient in Mrs T's position would (following the necessary disclosure) have either rejected surgery or sought a second opinion. Subjectively, taking her evidence into account, the court concluded the same thing. Similarly, if Mrs T had sought a second opinion, the reasonable advice that she would have obtained would have led her to refuse surgery. The court also explored the extent to which subjective factors relating to the patient that the surgeon is dealing with are relevant. The starting position is the test in Montgomery*; whether, ‘…in the circumstances of the particular case, a reasonable person in the patient's position would be likely to attach significance to the risk’. This combines the objective standard of the reasonable patient with the subjectivity of the person in the particular case. The judge identified characteristics which may not be self-evident in a clinic, such as a patient's ability to deal with pain, or their need to continue employment, or the effects of a coincidental crisis such as divorce or bereavement, and in addition, the implications for mobility and treasured sports and hobbies. To this could be added difficulties with their dependent children's education or impending homelessness or prosecution. Any of these may render a normally resolute person temporarily more fragile and, in turn, less willing to run a risk.
The Doctor-Centred Medical Care
Published in Shamit Kadosh, Asaf Rolef Ben-Shahar, Incorporating Psychotherapeutic Concepts and Interventions Within Medicine, 2019
Shamit Kadosh, Asaf Rolef Ben-Shahar
The patient-centred approached developed out of a need to fully recognise the patients as people. It derived from an understanding that people need to feel recognised and seen as people in order to cooperate and relate effectively. The patient-centred approach has done exactly that, yet it had omitted an important factor—the doctor as a person, the physician’s subjectivity.
Pharmacological management of digital ulcers in systemic sclerosis - what is new?
Published in Expert Opinion on Pharmacotherapy, 2023
Ariane L. Herrick, Mariana Philobos
Defining DUs. The World Scleroderma Foundation definition of a DU [9] is as follows: ‘Loss of epidermal covering with a break in the basement membrane (which separates dermis from epidermis). It appears clinically as visible blood vessels, fibrin, granulation tissue and/or underlying deeper structures (e.g. muscle, ligament, fat) or as it would appear on debridement.’ However, the definition of DUs has been the subject of much debate [10] and the lack of agreement by experts on what is and what is not a DU has hampered drug development. This is because the number of DUs, ‘net DU burden’ and/or DU healing (or a combination thereof) is/are usually the primary or main secondary end-point(s) in clinical trials. The subjectivity inherent in clinician opinion poses challenges when assessing treatment efficacy.
The Importance of Defining Actionability as Related to Disclosure of Secondary Findings Identified in Research
Published in The American Journal of Bioethics, 2022
In conclusion, we suggest that the research team return the secondary finding of likely Klinefelter syndrome to Mr. Robinson. This argument is grounded primarily in the lack of explicit discussion in the consent as to what is considered “urgently important.” We emphasize the inherent subjectivity of this phrase both from the perspective of the researchers and the participants. In a case such as this, where there is subjectivity in what may impact a person’s medical care, researchers should give opportunity to the individual to make their own decisions regarding the relevance of these findings and should defer to the patient’s interpretation over their own. Likewise, we argue that there are medical implications, beyond fertility assessment, associated with Klinefelter syndrome for Mr. Robinson that may benefit from prompt and appropriate referral. In this scenario, the researchers should disclose the likely Klinefelter syndrome diagnosis of Mr. Robinson, with the caveat that the finding requires clinical confirmation.
Gender affirmation and social exclusion amongst trans women of color in Australia
Published in International Journal of Transgender Health, 2022
Jane M. Ussher, Alexandra Hawkey, Janette Perz, Pranee Liamputtong, Jessica Sekar, Brahmaputra Marjadi, Virginia Schmied, Tinashe Dune, Eloise Brook
Increasingly in qualitative research, researchers are seeking to acknowledge the situated nature of their research through a process of reflexivity, engaging in critical self-reflection into the ways in which researchers’ social backgrounds, assumptions, positioning and behavior may shape the research process as a whole (Finlay & Gough, 2003; Shaw, 2010). The research team (authors and research assistants) and the stakeholder advisory group included individuals who were cisgender and trans, men and women, from CALD and non-CALD cultural communities, across sexual identities – heterosexual, lesbian, gay and queer. At each stage we considered the ways in which our own subjectivity may have shaped the research process, including the research questions, the design, data collection, analysis and the translation of findings. However, the views of team members who were trans women of color were often given priority, due to their lived experience and insight. For example, in the analysis process, the complex meanings attached to gender affirmation, and distress associated with difficulties in accessing hormones, were identified by trans community stakeholders. In translating the findings, the decision to develop an online exhibition of the photovoice images, accompanied by women’s stories (Ussher, Hawkey, & Perz, 2020), was influenced by information about accessibility and format provided by trans community stakeholders.