The Ethics, Limits, and Potential Harm of Naming Names

The Supreme Court in its 2014 decision in Burwell v. Hobby Lobby broadly expanded so-called religious freedom protections in the Religious Freedom Restoration Act (“RFRA”) by striking down a provision of the Affordable Care Act requiring employers to provide health insurance coverage for certain methods of contraception. In doing so, the Court opened the floodgates for employers to claim an exemption based upon any “sincerely held” religious belief. Without inquiry into the sincerity of that belief, businesses and corporations are free to adopt or assert beliefs that could lead to increased discrimination against employees. This is especially troublesome for marginalized groups like the LGBT community, which is already on the receiving end of discrimination under the pretext of religious exemptions. To correct any future misuse of these exemptions, Congress should amend RFRA to permit courts to assess the belief being asserted and contrast it with the potential harm if an exemption is allowed. The purpose of RFRA is to ease the burden faced by people of faith forced to go against their religious beliefs if they obey a certain statute. Easing this burden should focus on heady moral dilemmas, not mere inconveniences. Amending RFRA can ensure it maintains its initial purpose of protecting religious freedom, while not being used as a tool to perpetuate discrimination.

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‘The face of the programme’: How local clinicians shape decisions about eligibility for a national caregiver support programme in the USA

Journal of Health Services Research & Policy ◽

10.1177/1355819620983371 ◽

2020 ◽

pp. 135581962098337

Author(s):

Nina R Sperber ◽

Rebecca Bruening ◽

Joshua Dadolf ◽

Katherine Miller ◽

Jennifer Henius ◽

...

Keyword(s):

Social Services ◽

Interdisciplinary Teams ◽

Assessment Tools ◽

Assessment Process ◽

Therapeutic Relationships ◽

Veterans Health ◽

Health Administration ◽

Eligibility Criteria ◽

Caregiver Support ◽

Potential Harm

Objective To examine the causes of variation for determining clinical eligibility for a national caregiver programme in the US Veterans Health Administration (VHA) and so help inform standardization of clinical eligibility assessment for support and establish conditions for more consistent caregiver experiences across the country. Methods We used mixed methods, including a national survey of caregiver support coordinators (CSCs) across VHA medical centres, semi-structured interviews with a purposive sample of 53 CSCs and interdisciplinary team members, and observations of four VHA medical centre sites. Results A majority (70%) of CSCs across VHA medical centres reported that they used interdisciplinary teams to conduct assessments. Interdisciplinary teams were seen to help mitigate potential harm to therapeutic relationships from eligibility decisions. Survey respondents reported using a range of assessment tools provided by the national VHA Caregiver Support Program office, but participants expressed concerns that the tools did not necessarily effectively assess clinical need. Some local sites had developed innovative person-centered approaches, in which the assessment process provided an opportunity to assess veterans’ holistic clinical needs, in contrast to a programme-centered approach, which focused on assessing whether veterans/their caregivers meet eligibility criteria. Conclusion Discretion by those involved in making decisions on programme eligiblity is important for implementing a national social services programme based on clinical need. Interdisciplinary teams can help mitigate potential harm to therapeutic relationships. Discretion allows for innovation. This work has implications for setting policy in other programme contexts in which applying eligibility criteria requires clinical judgment.

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Prehospital Diagnosis of Shortness of Breath Caused by Profound Metformin-Associated Metabolic Acidosis

Healthcare ◽

10.3390/healthcare9010074 ◽

2021 ◽

Vol 9 (1) ◽

pp. 74

Author(s):

Pietro Elias Fubini ◽

Laurent Suppan

Keyword(s):

Metabolic Acidosis ◽

Hospital Setting ◽

Blood Gases ◽

Shortness Of Breath ◽

Potential Harm ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Common Causes ◽

Prehospital Diagnosis ◽

Gas Measurement

Shortness of breath is a common complaint among patients in emergency medicine. While most common causes are usually promptly identified, less frequent aetiologies might be challenging to diagnose, especially in the pre-hospital setting. We report a case of prehospital dyspnoea initially ascribed to pulmonary oedema which turned out to be the result of profound metformin-associated metabolic acidosis. This diagnosis was already made during the prehospital phase by virtue of arterial blood gas measurement. Pre-hospital measurement of arterial blood gases is therefore feasible and can improve diagnostic accuracy in the field, thus avoiding unnecessary delay and potential harm to the patient before initiating the appropriate therapeutic actions.

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Acute electronic vapour product whole aerosol exposure of 3D human bronchial tissue results in minimal cellular and transcriptomic responses when compared to cigarette smoke

Toxicology Research and Application ◽

10.1177/2397847320988496 ◽

2021 ◽

Vol 5 ◽

pp. 239784732098849

Author(s):

Gary Phillips ◽

Lukasz Czekala ◽

Holger P Behrsing ◽

Khalid Amin ◽

Jessica Budde ◽

...

Keyword(s):

Cigarette Smoke ◽

Recovery Time ◽

Beat Frequency ◽

Transcriptomic Response ◽

Potential Harm ◽

Aerosol Exposure ◽

Cell Culture Systems ◽

Computational Sciences ◽

Potential Risks ◽

Reduced Toxicity

The use of electronic vapour products (EVPs) continues to increase worldwide and with advances in cell culture systems, molecular biology and the computational sciences there is also accumulating evidence of their potential reduced toxicity and reduced potential harm when compared to cigarette smoke. To further understand the potential risks and health effects associated with exposure to EVP aerosols we have assessed the cellular and transcriptomic response from a commercially available lung tissue culture system (MucilAirTM) following a single sub-cytotoxic exposure to cigarette smoke and the equivalent nicotine delivered dose of EVP aerosol. The transcriptomic, cellular (cilia beat frequency (CBF) and percent active area (%AA), trans epithelial electrical resistance (TEER), histology) and cytokine release were assessed at 4- and 48- hours following recovery from air, EVP aerosol (8.4% V/V: mybluTM blueberry flavour, 2.4% nicotine) and 3R4F smoke (3.5% V/V: exposure). No pathological changes were observed at either recovery time point from any exposure. Air and EVP aerosol exposure had no effect on CBF, %AA nor TEER at 48 hours. Exposure to cigarette smoke resulted in a decrease in TEER, an increase in CBF and the release of proinflammatory cytokines at both recovery time points. Although the number of significantly expressed genes was minimal following exposure to EVP aerosol, exposure to 3R4F smoke resulted in a significant upregulation of several disease relevant pathways. These data provide evidence that following an acute exposure to EVP aerosol there is significantly less damage to lung cells in culture than the equivalent, nicotine based, dose of cigarette smoke.

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Paternal prescription medication before conception: A retrospective cohort study of all births in Denmark 1997–2017

Scandinavian Journal of Public Health ◽

10.1177/1403494820987468 ◽

2021 ◽

pp. 140349482098746

Author(s):

M.J. Wensink ◽

S. Rizzi ◽

T.K. Jensen ◽

N.E. Skakkebaek ◽

Y. Lu ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Selective Serotonin Reuptake Inhibitors ◽

Sperm Quality ◽

Prescription Medication ◽

Pain Medication ◽

Potential Harm ◽

Generational Effects ◽

Medication Exposure

Aim: To study what medication fathers are being prescribed in the months preceding conception. Methods: A retrospective cohort study of Danish national registries, comprising all births in Denmark 1997–2017 (1.3 million births). Time trends and absolute levels of paternal prescription medication in the 6 months prior to conception were assessed. While all medications were examined ( N = 1335), we focused on the main medication groups, medications that have increased in use over time, and medications for which previous evidence exists of an effect on sperm quality. Results: The average number of prescriptions increased over the study period (from 0.75 prescriptions to 0.82 per birth). Polypharmacy (three or more prescriptions) increased from less than 8% to 10% of fathers. The use of pain medication, proton-pump inhibitors, selective serotonin reuptake inhibitors and some inhalants have all increased markedly over the last 20 years. Conclusions: Potential harm to the offspring done by paternal medication may present an increasing problem. As paternal medication exposure is increasing, examination of generational effects, such as major birth defects, is necessary.

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Healthy, safe and responsible: the modern female traveller

Tropical Diseases Travel Medicine and Vaccines ◽

10.1186/s40794-021-00141-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Irmgard L. Bauer

Keyword(s):

Health Knowledge ◽

Medical Advice ◽

Personal Hygiene ◽

Health Issues ◽

High Quality ◽

Potential Harm ◽

Travel Information ◽

Travel Health ◽

Mental Health Issues ◽

Potential Risks

AbstractOne-half of all travellers are women; yet, there is a distinct lack of detailed travel health knowledge on topics of unique relevance to women. While there is medical advice relating to stages in the female lifecycle, it neglects women-specific practical aspects despite their ability to harm travellers’ health and cause inconvenience. This paper discusses comprehensively three major aspects of travel as they relate to women. First, it suggests the management of personal hygiene, bodily functions, menstruation and sexual behaviour, and alerts to the limited knowledge on travel mental health issues.Second, apart from travelling in a female body with its specific demands, being a woman requires special attention to safety and security. Within various travel contexts, women have many opportunities for minimising potential risks.Finally, guided by travel medicine’s acknowledgment of its role in the concept of responsible travel, this article goes beyond the usual general statements and broad advice and offers detailed and practical suggestions on how the female traveller can contribute to the overall goal of minimising any potential harm to fellow humans and the natural environment. Recognising the scarcity of women-specific travel information, pathways to better education, and a range of suggestions for urgent research facilitate the provision of high-quality travel health care tailored specifically to women’s needs.

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Potential Harm of Maltodextrin‐Coated Cadmium Sulfide Quantum Dots in Embryos and Fetuses

Toxicology - New Aspects to This Scientific Conundrum ◽

10.5772/64653 ◽

2016 ◽

Author(s):

Jorge Reyes-Esparza ◽

Janet Sánchez-Quevedo ◽

Antonieta Gómez-Solís ◽

Patricia Rodríguez-Fragoso ◽

Gerardo González De la Cruz ◽

...

Keyword(s):

Quantum Dots ◽

Cadmium Sulfide ◽

Potential Harm

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Using electrodermal activity to validate multilevel pain stimulation in healthy volunteers evoked by thermal grills

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00102.2020 ◽

2020 ◽

Vol 319 (3) ◽

pp. R366-R375

Author(s):

Hugo F. Posada-Quintero ◽

Youngsun Kong ◽

Kimberly Nguyen ◽

Cara Tran ◽

Luke Beardslee ◽

...

Keyword(s):

Tissue Injury ◽

Electrodermal Activity ◽

Pain Scale ◽

Potential Harm ◽

Electric Pulses ◽

Stimulation Level ◽

Highly Correlated ◽

The Brain ◽

Different Levels ◽

Assessment Research

We have tested the feasibility of thermal grills, a harmless method to induce pain. The thermal grills consist of interlaced tubes that are set at cool or warm temperatures, creating a painful “illusion” (no tissue injury is caused) in the brain when the cool and warm stimuli are presented collectively. Advancement in objective pain assessment research is limited because the gold standard, the self-reporting pain scale, is highly subjective and only works for alert and cooperative patients. However, the main difficulty for pain studies is the potential harm caused to participants. We have recruited 23 subjects in whom we induced electric pulses and thermal grill (TG) stimulation. The TG effectively induced three different levels of pain, as evidenced by the visual analog scale (VAS) provided by the subjects after each stimulus. Furthermore, objective physiological measurements based on electrodermal activity showed a significant increase in levels as stimulation level increased. We found that VAS was highly correlated with the TG stimulation level. The TG stimulation safely elicited pain levels up to 9 out of 10. The TG stimulation allows for extending studies of pain to ranges of pain in which other stimuli are harmful.

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