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Biomedical subjects

Jeffrey P Kahn

Publications and source records attributed to Jeffrey P Kahn.

At least 19 recordsLinked to original sources
PubMed2006

The incidentalome.

Explore the source record for details and available documents.

Biomedical Research↗
PubMed2005

How much does quality mental health care profit employers?

OBJECTIVE: Employers provide most American mental health benefits and are increasingly cost conscious. However, commonplace anxiety and depressive disorders have enormous economic and workplace performance costs. METHODS: We performed multiple literature searches on several areas of pertinent research (and on key articles) covering the past 5 years. RESULTS: Substantial research exists about anxiety and depression costs, such as performance and productivity, absenteeism, presenteeism, disability, physical disability exacerbation, mental health treatment, increased medical care costs, exacerbating of physical illness, and studies of mental health care limitations and cost-offset. Research addressing the potential value of higher quality mental health care is limited. CONCLUSIONS: Commonplace anxiety and depressive disorders are costly in the workplace. Employers and researchers remain largely unaware of the value of quality care and psychiatric skills. Effective solutions involve the increased use of psychiatric skills and appropriate treatment.

Anxiety↗
PubMed2004

Creating a stem cell donor: a case study in reproductive genetics.

During the nearly 10 years since its introduction, preimplantation genetic diagnosis (PGD) has been used predominantly to avoid giving birth to a child with identified genetic disease. Recently, PGD was used by a couple not only to test IVF-created embryos for genetic disease, but also to test for a nondisease trait related to immune compatibility with a child in the family in need of an hematropoetic stem cell transplant. This article describes the case, raises some ethical and policy issues, highlights gaps in U.S. policy, and finally makes some recommendations for addressing advancing genetic and reproductive technologies.

Advisory Committees↗
PubMed2003

Successful hematopoietic stem cell transplantation for Fanconi anemia from an unaffected HLA-genotype-identical sibling selected using preimplantation genetic diagnosis.

The only proven cure for Fanconi anemia (FA)-associated bone marrow failure is successful allogeneic hematopoietic stem cell transplantation (HSCT). However, HSCT with donors other than HLA-identical siblings is associated with high morbidity and poor survival. Therefore, we used preimplantation genetic diagnosis (PGD) to select an embryo produced by in vitro fertilization (IVF) that was unaffected by FA and was HLA-identical to the proband. The patient was a 6-year-old girl with FA and myelodysplasia previously treated with oxymetholone and prednisone. After her parents underwent 5 cycles of IVF with intrauterine transfer of 7 embryos over a span of 4 years, successful pregnancy ensued. Twenty-eight days after delivery, the patient underwent transplantation with her newborn sibling donor's HLA-identical umbilical cord blood hematopoietic stem cells (HSCs). Neutrophil recovery occurred on day 17 without subsequent acute or chronic graft-versus-host disease. Currently, 2.5 years after transplantation, the patient is well and hematopoiesis is normal. In summary, we have described the first successful transplantation, using IVF and PGD, of HSCs from a donor selected on the basis of specific, desirable disease and HLA characteristics. The medical, legal, and ethical issues involved with this approach are discussed.

Child↗
PubMed2003

American College of Epidemiology Ethics Guidelines: foundations and dissemination.

Epidemiology is a core science of public health, focusing on research related to the distribution and determinants of both positive and adverse health states and events and on application of knowledge gained to improve public health. The American College of Epidemiology (ACE) is a professional organization devoted to the professional practice of epidemiology. As part of that commitment, and in response to concerns for more explicit attention to core values and duties of epidemiologists in light of emerging issues and increased scrutiny of epidemiology, the College developed, adopted, and published a set of Ethics Guidelines. The structure of the ACE ethics guidelines is in four parts: (1) a brief statement of core values and duties of epidemiologists, coupled with the virtues important to professional practice; (2) concise statements of key duties and obligations; (3) exposition of the duties and obligations with more applications; and (4) a brief summary and conclusion. The Guidelines have been published on the ACE website and in the official College journal Annals of Epidemiology. The guidelines contain (and maintain) core elements that define the discipline of epidemiology and its fundamental duties, but they are also intended to be dynamic and evolving, responsive to a changing professional and social environment.

Codes of Ethics↗
PubMed2003

Three views of organ procurement policy: moving ahead or giving up?

The supply of organs for transplant remains inadequate to meet the needs of waiting patients, in spite of many programs and approaches to increase rates of donation. Over the years there have been numerous proposals to introduce schemes that would move toward the outright sale of organs. Three articles in this issue of the Journal propose methods for increasing organ supply--two by moving toward a market approach and the third by advocating a change in social culture. All three suffer from shortcomings, including the endorsement and encouragement of the exploitation of those who may offer organs. Although the shortage of organs must be addressed, the social price of a market in organs is too high, and proposals to encourage a rethinking of social responsibility are unlikely to be effective.

Coercion↗
PubMed2002

Risk and responsibility: ethics, Grimes v Kennedy Krieger, and public health research involving children.

The legal case of Grimes v. Kennedy Krieger Institute, Inc, has raised concerns in the public health research community regarding the acceptable level of risk in research involving children, parental authority for informed consent, and exploitation of research subjects for the benefit of public health. We provide an overview of the case and discuss the impact of the court's decision and its possible effect on future research protection policies and practices.

Child↗
PubMed1991

Genetic harm: bitten by the body that keeps you?

... We must attempt to explain, how, if ever, our existence may harm us. To address this and the other questions raised, I propose to examine what constitutes harm and whether it makes sense to say that our genetic makeup may harm us. To do this I will describe three approaches to the problem of describing the status of negative effects our genes have upon us, which I have named the "technical harm" view, the "constitutive" view, and the "harmful conditions" view. On the technical harm view, the standard definitions of harm are applied to genetic disposition in an attempt to couch genetic defects or flaws in terms of harming. The constitutive view rejects applying the concept of harm to genetic disposition on the grounds that it is impossible to separate genetic disposition from individual identity. Lastly, the harmful conditions view, which I conclude is the most successful of the three, focuses on the tendency of certain genetic dispositions to cause harm in the future and thus avoids what I will argue are the "context" shortcomings of the other two approaches. To conclude the discussion I will very briefly analyze the ramifications of a harmful conditions view for the concept of genetic disease and the prospects for genetic counseling, gene therapy, and reproductive decision making.

Altruism↗
PubMed1991

Commentary on Zohar's "Prospects for 'genetic therapy' -- can a person benefit from being altered?

In his paper on the effects of Prenatal Genetic Intervention (PGI) on personal identity, Noam Zohar comes to a conclusion about genetic makeup and the uses of gene therapy quite different from the one I reach in another piece in this issue. Zohar's argument rests on the contention that personal identity changes with alteration of the genome, following what I have identified as the "constitutive" view. To see that this is the pillar supporting the weight of his argument, consider the following. Questions of identity aside, how can it be that altering the genome of children suffering from Lesch-Nyhan syndrome or Tay-Sachs disease so that they now produce the enzyme that they formerly lacked does not benefit them? Clearly, if their identities were not changed, such individuals would in fact realize great benefit from PGI, since the devastating bad effects of the genetic flaw would be avoided. Such a change would certainly make the altered individuals better off, that is, it would benefit them. On this, Zohar and I do not disagree. Persistence of identity through such genetic change is the sticking point.

Altruism↗