Currently browsing posts about: Ethics

May 11 2012

FDA panel recommends approval of another iffy weight-loss drug

I was riveted by an article in today’s New York Times about the latest decision of an FDA drug advisory panel.

The panel voted to approve a new weight-loss drug, lorcaserin.  The vote was mixed: 18 for approval, 4 against, and 1 abstention. The majority felt that the benefits outweighed the risks and that even if there were risks, “new tools are needed to treat a major health problem.”

The benefits are worth a look.

  • People taking the drug lost an average of  5.8% of their body weight in a year, compared to 2.5% for people taking a placebo.  This difference is below the FDA’s standard for approval which requires a 5% difference.
  • Among those taking the drug, 47% lost at least 5 percent of their weight after a year, whereas only 23% of those taking the placebo did so.  This meets a second FDA standard for approval.

What about the risks?  The drug:

  • Causes tumors in rats (although perhaps at higher doses than might be taken by people).
  • Damages heart valves (in the same way the withdrawn drug, Fen-Phen, did).

Also in the Times is a piece by Dr. Danielle Ofri on her experience with patients who want weight-loss drugs.

She quotes from an essay called “Lemons for Obesity” by Dr. Michael S. Lauer, who was a minority voter on the FDA panel that approved the weight-loss drug Qnexa earlier this year.

The weight-loss field is strewn with lemons, more so than other areas of medicine, Dr. Lauer argues. Because of the enormous potential market for these drugs — two-thirds of American adults are overweight or obese — pharmaceutical companies rush new drugs to market after conducting only small clinical trials. The F.D.A. and doctors are complicit in the process, Dr. Lauer says, leaving the population at large to act essentially as guinea pigs.

Shares of the maker of the drug nearly doubled after the decision.  The Times reported that “Arguments by investors have been passionate.”

People who cannot easily lose weight are desperate for help.

But is it ethical to put them at this kind of risk?

Mar 28 2012

The ethics of meat-eating: A feminist issue?

Staunch feminist that I am, I am greatly enjoying the fuss over the all-male judging panel for the New York Times’ contest calling on “carnivores to tell us why it’s ethical to eat meat.”  The Times’ ethicist, Ariel Kaminer, announced the contest in Sunday’s magazine:

So today we announce a nationwide contest for the omnivorous readers of The New York Times. We invite you to make the strongest possible case for this most basic of daily practices.

We have assembled a veritable murderer’s row of judges — some of the most influential thinkers to question or condemn the eating of meat: Peter Singer, Michael Pollan, Mark Bittman, Jonathan Safran Foer and Andrew Light.

In the graduate course in food ethics I taught at NYU a couple of years ago, I had the class read:

  • Peter Singer and Jim Mason’s The Ethics of What We Eat: Why Our Food Choices Matter
  • Michael Pollan’s critique of Singer’s views in The Omnivore’s Dilemma
  • Jonathan Safran Foer’s critique of Pollan in Eating Animals.  

I also had them read a scientific paper on the nutritional benefits of adding meat to the diets of children in developing countries (Whaley et al.  J Nutrition 2003;133: 3965s–3971s).

Discussions, to say the least, were lively.

As for the other two: Mark Bittman writes eloquently about ethical issues in food choice for the New York Times.  Although I am not familiar with the work of Andrew Light, a quick Google search reveals that he writes about the ethics of climate policy.

All happen to be white men.

On her blog, the “vegan-feminist intellectual” Carol Adams,  author of The Sexual Politics of Meat, says:

Here’s the crux of the problem, our culture is heavily invested in the identification of meat eating with manliness…. How could an intelligent woman miss the fact that her own panel of “ethicists” is male-dominated and that such a choice is, itself, an ethical issue?

Michele Simon writes on her blog, Appetite for Profit:

When I asked why all the judges were male, Kaminer replied that she couldn’t find one female expert in food ethics with a fraction of the name recognition of the men. She argued that the famous male judges would bring far more attention to the contest, and in turn get more people to consider the ethics of meat eating.

Full disclosure: Michele puts me first in her list of ten women who should have been considered.

You can see why I am amused, no?

If you want to enter this contest—and please do!—send written entries of no more than 600 words to ethicist@nytimes.com. Entries are due by April 8.

Dec 23 2011

United Nations’ Special Rapporteur vs. the World Trade Organization

On December 19, Food Chemical News reported that Pascal Lamy, secretary-general of the World Trade Organization (WTO) “traded blows” with  United Nations’ Special Rapporteur on the Right to Food, Olivier De Schutter, over the role of trade in food security.

As far as I can tell, the “blows” were figurative, not literal, but the debate was real.   De Schutter had written a report questioning whether greater trade liberalization—the goal of WTO—could deliver on food security (for the basis of this debate, see below).

“Developing countries are rightly concerned that their hands will be tied by trade rules,” De Schutter said, and called for higher tariffs and targeted farm subsidies to stimulate local food production.   He labeled the “WTO’s vision as “outdated. … The right to food is not a commodity, and we must stop treating it that way.”

For some time now, I’ve been following the De Schutter’s work, not least because he is using the office of Special Rapporteur as a bully pulpit from which to promote healthier and more sustainable and equitable food systems throughout the world.

De Schutter, among other things, is my occasional colleague at NYU.

Olivier De Schutter (LL.M., Harvard University ; Ph.D., University of Louvain (UCL)), the UN Special Rapporteur on the right to food since May 2008, is a Professor at the Catholic University of Louvain and at the College of Europe (Natolin). He is also a Member of the Global Law School Faculty at New York University and is Visiting Professor at Columbia University.

As Special Rapporteur, he is supposed to

Report both to the UN General Assembly (Third Committee) and to the Human Rights Council on the fulfillment of the mandate…In addition to addressing structural issues threatening the full enjoyment of the right to food, the Special Rapporteur may send communications to governments, called letters of allegation, in urgent cases brought to his attention by reliable sources.

Professor De Schutter has used this office to produce a remarkable succession of reports and position papers on a broad range of topics related to food, agriculture, and human and environmental health:

Take a look at the documents listed under these categories.  They are a terrific resource for anyone interested in the human right to food.

As for De Schutter vs. WTO, see:

Aug 18 2011

How’s this for an ethical dilemma?

My post of several days ago on the ethics of childhood obesity interventions elicited this interesting question from Megan:

I am curious as to what your thoughts are on individuals giving food to the homeless.

I used to give them a granola bar or a piece of fruit (whatever I happened to have in my lunch), but a friend of mine said she gives McDonald’s coupons for a free hamburger because she can carry the coupons with her more easily than a box of granola bars or a bag of apples.

Since I, myself, do not eat McDonald’s I find it hard to give anyone else McDonald’s food.  However, my friend argues that it’s a caloric dense meal and that makes it better than my one apple.  Any suggestions?

I’d like to see readers responses to this.  Giving food to the poor can solve the immediate problem, but is not sustainable in the long term and diverts attention from policy solutions to hunger problems (for a clear explanation of this dilemma, I highly recommend taking a look at Janet Poppendieck’s Sweet Charity).

But the homeless are a special case.   In my NYU neighborhood, many of us try to take care of a clearly deranged but charming homeless man who is very precise about what he asks for and will accept.  He becomes outraged if offered food.  He occasionally asks for a dollar and will not accept one penny more.

But other homeless people might be grateful for a McDonald’s handout.

Is it ethical to give food to the homeless that you would not eat yourself?  Is it ethical not to give food to the homeless?  How can you do the most good in this situation?

Weigh in, please.

 

Aug 15 2011

Interventions in childhood obesity: ethical considerations

Imagine this.  A professional journal, Preventing Chronic Disease: Public Health Research, Practice and Policy (Vol 8, Issue 5, Sep 2011) has published a series of papers on the ethics of childhood obesity interventions. 

It is about time that these kinds of ethical issues are getting focused attention.  Applause for the journal’s editors and authors!

Ethical Issues In Interventions For Childhood Obesity

A92: Protecting Children From Harmful Food Marketing: Options for Local Government to Make a Difference
  Jennifer L. Harris, Samantha K. Graff

A93: Childhood Obesity: A Framework for Policy Approaches and Ethical Considerations
  Rogan Kersh, Donna F. Stroup, Wendell C. Taylor

A94: Childhood Obesity: Issues of Weight Bias
  Reginald L. Washington

A95: Children With Special Health Care Needs: Acknowledging the Dilemma of Difference in Policy Responses to Obesity
  Paula M. Minihan, Aviva Must, Betsy Anderson, Barbara Popper, Beth Dworetzky

A96: Public Policy Versus Individual Rights in Childhood Obesity Interventions: Perspectives From the Arkansas Experience With Act 1220 of 2003
  Martha M. Phillips, Kevin Ryan, James M. Raczynski

A97: A Question of Competing Rights, Priorities, and Principles: A Postscript to the Robert Wood Johnson Foundation Symposium on the Ethics of Childhood Obesity Policy
  Shiriki K. Kumanyika

A98: The Ethical Basis for Promoting Nutritional Health in Public Schools in the United States
  Patricia B. Crawford, Wendi Gosliner, Harvey Kayman

A99: Ethical Family Interventions for Childhood Obesity
  Mandy L. Perryman

A100: Public Policy Versus Individual Rights and Responsibility: An Economist’s Perspective
  Frank J. Chaloupka

A101: State Requirements and Recommendations for School-Based Screenings for Body Mass Index or Body Composition, 2010
  Jennifer Linchey, Kristine A. Madsen

A91: Ethical Concerns Regarding Interventions to Prevent and Control Childhood Obesity
  John Govea