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Sawhney S, Luyckx VA. Justifying access to kidney care in low resource and humanitarian settings. Curr Opin Nephrol Hypertens 2024; 33:641-646. [PMID: 39225786 DOI: 10.1097/mnh.0000000000001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
PURPOSE OF REVIEW Access to and quality of kidney care is not equitable between or within countries. A natural question is whether global kidney care inequities are always unjustifiable and unfair, or are sometimes due to unavoidable competing or conflicting ethical duties or responsibilities. RECENT FINDINGS Health is a fundamental right for all people. People with kidney conditions should have the same claim on this human right as others. Countries have an obligation to progressively fulfil this right and a duty to do so equitably, but global progress has been slow. Countries with limited resources or faced with humanitarian emergencies must set priorities to allocate resources fairly. This process involves trade-offs and often people requiring kidney replacement therapy are left out because of costs, logistics and lack of data. Major burdens are placed on clinicians who grapple between their duty to their patient and professional codes and their responsibility to a 'greater good'. These dilemmas apply also to industry, governments and the international community who must recognize their share in these duties. SUMMARY Inequities in kidney health and care must be acknowledged and sustainable and collaborative solutions urgently found such that right to kidney care is progressively upheld for everyone everywhere.
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Affiliation(s)
- Simon Sawhney
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK
| | - Valerie A Luyckx
- University Children's Hospital, University of Zurich, Zurich, Switzerland
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzlerland
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
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2
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Wai MC. Drug Shortage and Ethical Issues: Integrating Multidisciplinary Perspectives with a Shared Ethical Framework. PHARMACY 2024; 12:136. [PMID: 39311127 PMCID: PMC11417769 DOI: 10.3390/pharmacy12050136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 08/30/2024] [Accepted: 09/02/2024] [Indexed: 09/26/2024] Open
Abstract
Drug shortages can cause ethical dilemmas when no systematic, equitable allocation, or utilization schema is in place. During the COVID-19 pandemic, an ethical framework outlining moral values was proposed as way to approach allocating limited resources to patients. In addition to an ethical perspective, it is prudent to consider costs. Examining existing economic frameworks and combining them with an ethical perspective may provide a practical, systematic process for decision makers when allocating drugs in short supply. Drug shortages continue to impact multiple areas across different subspecialties of medicine due to multiple factors, including limited manufacturers, regulatory issues, and costs. All of these factors make it difficult to anticipate and manage drug shortages effectively, but developing a combined framework may reduce some of the ethical and equitable ambiguity with regards to patient care.
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Affiliation(s)
- Maya C Wai
- College of Pharmacy, Department of Pharmacy Practice, Northwest Regional Campus, University of Arkansas for Medical Sciences, 1125 N. College Ave., Fayetteville, AR 72703, USA
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Shi L, Tang W, Zhang H, Zhang Y, Yang H, Wu D, Li X, Liu L, Liu L, Chen X, Wang M. The relationship between socioeconomic status, medical accessibility, hope and psychological resilience of caregivers of children with chronic kidney disease in China: structural equation model. BMC Psychol 2024; 12:457. [PMID: 39198911 PMCID: PMC11360847 DOI: 10.1186/s40359-024-01901-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/11/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is the third most common cause of death after cancer and heart disease. The continuous treatment of children with CKD was greatly challenged during the COVID-19 pandemic, which significantly impacted the CKD children's prognosis and the caregivers' psychological status. However, the influence mechanism of socioeconomic status, medical delay duration, traffic pressure, and online consultation duration on caregivers' hope and psychological resilience still lacks relevant evidence. METHODS This study investigated the general social information, hope, and psychological resilience of 247 caregivers with CKD in 13 provinces of China in March 2020. Factor analysis and an exploratory Structural Equation Model ( SEM ) were used to find the best-fit model, and Bootstrapping was used to calculate the 95% CI of indirect effects. RESULTS The factor analysis obtained four common factors, namely, socioeconomic status (annual family income, education, and career stability), medical accessibility (online consultation duration, medical delay duration, and traffic pressure), hope (positive attitude, positive action, and intimate relationship) and psychological resilience (optimism, tenacity, and strength), with the cumulative contribution rate of 65.34%. Bootstrapping obtains the socioeconomic status β = 0.30 (95% CI [0.14, 0.47], P = 0.002), medical accessibility β = 0.31 (95% CI [0.12, 0.47], P = 0.002), and hope β = 0.40 (95% CI [0.27, 0.52], P = 0.002) has a direct impact on psychological resilience of CKD children caregivers, followed by medical accessibility β = 0.20 (95% CI [0.10, 0.38], P = 0.001) and hope β = 0.23 (95% CI [0.16, 0.32], P = 0.001) plays a mediating role between socioeconomic status and psychological resilience. The indirect impact effect β = 0.35 (95% CI [0.25, 0.50], P = 0.001) is greater than the direct impact effect β = 0.30 (95% CI [0.14, 0.47], P = 0.002). CONCLUSIONS Sufficient attention should still be given to children with immunodeficiency after the COVID-19 pandemic, such as CKD, to avoid infection of deadly. Secondly, the government should vigorously develop Primary medical institutions to ensure efficient treatment of severe patients in tertiary hospitals; Finally, the professional literacy of medical workers in remote diagnosis and treatment should be improved to enhance the country's emergency response capacity for similar major public events and the requirements for normalised epidemic prevention and control.
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Affiliation(s)
- Lin Shi
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Wenyi Tang
- Department of Clinical Data Research, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing University Central Hospital, Chongqing University, Chongqing, China
| | - Hengci Zhang
- Department of Otolaryngology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yunzhi Zhang
- Department of Infectious Diseases of The Second, Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiping Yang
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Daoqi Wu
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Xiaoqin Li
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Lu Liu
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Lijie Liu
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
| | - Xuelan Chen
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China.
| | - Mo Wang
- Department of Nephrology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China.
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4
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Mensah MO, Freitas DJ, Cartwright JR. Fair Allocation of GLP-1 and Dual GLP-1-GIP Receptor Agonists. N Engl J Med 2024; 391:775. [PMID: 39167820 DOI: 10.1056/nejmc2407932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
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5
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Sommerlatte S, Hense H, Nadolny S, Kraeft AL, Lugnier C, Schmitt J, Schoffer O, Reinacher-Schick A, Schildmann J. What does "urgency" mean when prioritizing cancer treatment? Results from a qualitative study with German oncologists and other experts during the COVID-19 pandemic. J Cancer Res Clin Oncol 2024; 150:352. [PMID: 39009898 PMCID: PMC11249432 DOI: 10.1007/s00432-024-05863-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Cancer care in Germany during the COVID-19 pandemic was affected by resource scarcity and the necessity to prioritize medical measures. This study explores ethical criteria for prioritization and their application in cancer practices from the perspective of German oncologists and other experts. METHODS We conducted fourteen semi-structured interviews with German oncologists between February and July 2021 and fed findings of interviews and additional data on prioritizing cancer care into four structured group discussions, in January and February 2022, with 22 experts from medicine, nursing, law, ethics, health services research and health insurance. Interviews and group discussions were digitally recorded, transcribed verbatim and analyzed using qualitative content analysis. RESULTS Narratives of the participants focus on "urgency" as most acceptable criterion for prioritization in cancer care. Patients who are considered curable and those with a high level of suffering, were given a high degree of "urgency." However, further analysis indicates that the "urgency" criterion needs to be further distinguished according to at least three different dimensions: "urgency" to (1) prevent imminent harm to life, (2) prevent future harm to life and (3) alleviate suffering. In addition, "urgency" is modulated by the "success," which can be reached by means of an intervention, and the "likelihood" of reaching that success. CONCLUSION Our analysis indicates that while "urgency" is a well-established criterion, its operationalization in the context of oncology is challenging. We argue that combined conceptual and clinical analyses are necessary for a sound application of the "urgency" criterion to prioritization in cancer care.
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Affiliation(s)
- Sabine Sommerlatte
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany.
| | - Helene Hense
- Center for Evidence-Based Healthcare, Medical Faculty and University Hospital Carl Gustav Carus , TUD Dresden University of Technology, Dresden, Germany
| | - Stephan Nadolny
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany
- Institute for Educational and Health-Care Research in the Health Sector, Faculty of Health, Hochschule Bielefeld - University of Applied Sciences and Arts, Interaktion 1, 33619, Bielefeld, Germany
| | - Anna-Lena Kraeft
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Celine Lugnier
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty and University Hospital Carl Gustav Carus , TUD Dresden University of Technology, Dresden, Germany
| | - Olaf Schoffer
- Center for Evidence-Based Healthcare, Medical Faculty and University Hospital Carl Gustav Carus , TUD Dresden University of Technology, Dresden, Germany
| | - Anke Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle (Saale), Germany
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Persad G, Largent EA. Fairly Incorporating Vaccination Status into Scarce Resource Allocation Frameworks. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:80-83. [PMID: 38913487 DOI: 10.1080/15265161.2024.2353827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
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7
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Emanuel EJ, Dellgren JL, McCoy MS, Persad G. Fair Allocation of GLP-1 and Dual GLP-1-GIP Receptor Agonists. N Engl J Med 2024; 390:1839-1842. [PMID: 38630999 DOI: 10.1056/nejmp2400978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Ezekiel J Emanuel
- From the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.J.E., J.L.D., M.S.M.); the Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway (E.J.E., J.L.D., M.S.M., G.P.); and the Sturm College of Law, University of Denver, Denver (G.P.)
| | - Johan L Dellgren
- From the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.J.E., J.L.D., M.S.M.); the Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway (E.J.E., J.L.D., M.S.M., G.P.); and the Sturm College of Law, University of Denver, Denver (G.P.)
| | - Matthew S McCoy
- From the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.J.E., J.L.D., M.S.M.); the Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway (E.J.E., J.L.D., M.S.M., G.P.); and the Sturm College of Law, University of Denver, Denver (G.P.)
| | - Govind Persad
- From the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.J.E., J.L.D., M.S.M.); the Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway (E.J.E., J.L.D., M.S.M., G.P.); and the Sturm College of Law, University of Denver, Denver (G.P.)
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Osoro CB, Ochodo E, Kwambai TK, Otieno JA, Were L, Sagam CK, Owino EJ, Kariuki S, Ter Kuile FO, Hill J. Policy uptake and implementation of the RTS,S/AS01 malaria vaccine in sub-Saharan African countries: status 2 years following the WHO recommendation. BMJ Glob Health 2024; 9:e014719. [PMID: 38688566 PMCID: PMC11085798 DOI: 10.1136/bmjgh-2023-014719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/31/2024] [Indexed: 05/02/2024] Open
Abstract
In October 2021, the WHO recommended the world's first malaria vaccine-RTS,S/AS01-to prevent malaria in children living in areas with moderate-to-high transmission in sub-Saharan Africa (SSA). A second malaria vaccine, R21/Matrix-M, was recommended for use in October 2023 and added to the WHO list of prequalified vaccines in December 2023. This study analysis assessed the country status of implementation and delivery strategies for RTS,S/AS01 by searching websites for national malaria policies, guidelines and related documents. Direct contact with individuals working in malaria programmes was made to obtain documents not publicly available. 10 countries had documents with information relating to malaria vaccine implementation, 7 referencing RTS,S/AS01 and 3 (Burkina Faso, Kenya and Nigeria) referencing RTS,S/AS01 and R21/Matrix-M. Five other countries reported plans for malaria vaccine roll-out without specifying which vaccine. Ghana, Kenya and Malawi, which piloted RTS,S/AS01, have now integrated the vaccine into routine immunisation services. Cameroon and Burkina Faso are the first countries outside the pilot countries to incorporate the vaccine into national immunisation services. Uganda plans a phased RTS,S/AS01 introduction, while Guinea plans to first pilot RTS,S/AS01 in five districts. The RTS,S/AS01 schedule varied by country, with the first dose administered at 5 or 6 months in all countries but the fourth dose at either 18, 22 or 24 months. SSA countries have shown widespread interest in rolling out the malaria vaccine, the Global Alliance for Vaccines and Immunization having approved financial support for 20 of 30 countries which applied as of March 2024. Limited availability of RTS,S/AS01 means that some approved countries will not receive the required doses. Vaccine availability and equity must be addressed even as R21/Matrix-M becomes available.
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Affiliation(s)
- Caroline Bonareri Osoro
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Jenifer Akoth Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lisa Were
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Caleb Kimutai Sagam
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Eddy Johnson Owino
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Emanuel EJ, Persad G. Manufactured scarcity and the allocation of scarce resources - Authors' reply. Lancet 2024; 403:532. [PMID: 38341253 DOI: 10.1016/s0140-6736(23)02885-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/21/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Ezekiel J Emanuel
- Healthcare Transformation Institute, Department of Medical Ethics and Health Policy, Perelman School of Medicine and Wharton School, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Govind Persad
- Strum College of Law, University of Denver, Denver, CO, USA
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Berger M. Manufactured scarcity and the allocation of scarce resources. Lancet 2024; 403:531. [PMID: 38341252 DOI: 10.1016/s0140-6736(23)02887-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/21/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Mitchell Berger
- US Department of Health & Human Services, Rockville, MD 20857, USA.
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Miranda SP, Clapp JT. Manufactured scarcity and the allocation of scarce resources. Lancet 2024; 403:531-532. [PMID: 38341251 DOI: 10.1016/s0140-6736(23)02888-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/21/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Stephen P Miranda
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Justin T Clapp
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA 19104, USA
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12
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Smith J. Manufactured scarcity and the allocation of scarce resources. Lancet 2024; 403:530-531. [PMID: 38341250 DOI: 10.1016/s0140-6736(23)02886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/21/2023] [Indexed: 02/12/2024]
Affiliation(s)
- James Smith
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK.
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Hantel A, Spence R, Camacho P, Bradbury AR, Denburg AE, Jagsi R, Moy B, Rathmell WK, Rosenberg AR, Symington B, Marron JM, Peppercorn J. ASCO Ethical Guidance for the Practical Management of Oncology Drug Shortages. J Clin Oncol 2024; 42:358-365. [PMID: 38061010 DOI: 10.1200/jco.23.01941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 01/19/2024] Open
Affiliation(s)
| | | | - Polo Camacho
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Reshma Jagsi
- Emory University School of Medicine, Atlanta, GA
| | | | | | | | - Banu Symington
- Memorial Hospital of Sweetwater County, Rock Springs, WY
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