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Cardenas-Iniguez C, Gonzalez MR. Recommendations for the responsible use and communication of race and ethnicity in neuroimaging research. Nat Neurosci 2024; 27:615-628. [PMID: 38519749 DOI: 10.1038/s41593-024-01608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
The growing availability of large-population human biomedical datasets provides researchers with unique opportunities to conduct rigorous and impactful studies on brain and behavioral development, allowing for a more comprehensive understanding of neurodevelopment in diverse populations. However, the patterns observed in these datasets are more likely to be influenced by upstream structural inequities (that is, structural racism), which can lead to health disparities based on race, ethnicity and social class. This paper addresses the need for guidance and self-reflection in biomedical research on conceptualizing, contextualizing and communicating issues related to race and ethnicity. We provide recommendations as a starting point for researchers to rethink race and ethnicity choices in study design, model specification, statistical analysis and communication of results, implement practices to avoid the further stigmatization of historically minoritized groups, and engage in research practices that counteract existing harmful biases.
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Affiliation(s)
- Carlos Cardenas-Iniguez
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
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2
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Jansen SNG, Kamphorst BA, Mulder BC, van Kamp I, Boekhold S, van den Hazel P, Verweij MF. Ethics of early detection of disease risk factors: A scoping review. BMC Med Ethics 2024; 25:25. [PMID: 38443930 PMCID: PMC10913641 DOI: 10.1186/s12910-024-01012-4] [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: 07/19/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture. METHODS To identify key ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher's Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers. RESULTS After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals. CONCLUSIONS The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies.
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Affiliation(s)
- Sammie N G Jansen
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, RIVM, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands.
- Department of Social Sciences, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706 KN, The Netherlands.
| | - Bart A Kamphorst
- Department of Social Sciences, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706 KN, The Netherlands
| | - Bob C Mulder
- Department of Social Sciences, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706 KN, The Netherlands
| | - Irene van Kamp
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, RIVM, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Sandra Boekhold
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, RIVM, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Peter van den Hazel
- International Network on Children's Health, Environment & Safety (INCHES), Ellecom, the Netherlands
| | - Marcel F Verweij
- Ethics Institute, Utrecht University, Janskerkhof 13a, Utrecht, 3512 BL, The Netherlands
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3
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Frank DM. What is the environment in environmental health research? Perspectives from the ethics of science. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2021; 88:172-180. [PMID: 34218158 DOI: 10.1016/j.shpsa.2021.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/17/2021] [Accepted: 05/20/2021] [Indexed: 05/10/2023]
Abstract
Environmental health research produces scientific knowledge about environmental hazards crucial for public health and environmental justice movements that seek to prevent or reduce exposure to these hazards. The environment in environmental health research is conceptualized as the range of possible social, biological, chemical, and/or physical hazards or risks to human health, some of which merit study due to factors such as their probability and severity, the feasibility of their remediation, and injustice in their distribution. This paper explores the ethics of identifying the relevant environment for environmental health research, as judgments involved in defining an environmental hazard or risk, judgments of that hazard or risk's probability, severity, and/or injustice, as well as the feasibility of its remediation, all ought to appeal to non-epistemic as well as epistemic values. I illustrate by discussing the case of environmental lead, a housing-related hazard that remains unjustly distributed by race and class and is particularly dangerous to children. Examining a controversy in environmental health research ethics where researchers tested multiple levels of lead abatement in lead-contaminated households, I argue that the broader perspective on the ethics of environmental health research provided in the first part of this paper may have helped prevent this controversy.
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Affiliation(s)
- David M Frank
- Department of Philosophy, Cogut Institute for the Humanities, Brown University, Providence, RI 02902, USA.
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4
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Lohse S, Wasmer MS, Reydon TAC. Integrating Philosophy of Science into Research on Ethical, Legal and Social Issues in the Life Sciences. ACTA ACUST UNITED AC 2020. [DOI: 10.1162/posc_a_00357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This paper argues that research on normative issues in the life sciences will benefit from a tighter integration of philosophy of science. We examine research on ethical, legal and social issues in the life sciences (“ELSI”) and discuss three illustrative examples of normative issues that arise in different areas of the life sciences. These examples show that important normative questions are highly dependent on epistemic issues which so far have not been addressed sufficiently in ELSI, RRI and related areas of research. Accordingly, we argue for the integration of research on the epistemic aspects of the relevant areas of science into ELSI research to provide a better basis for addressing normative questions.
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Affiliation(s)
- Simon Lohse
- Centre for Ethics and Law in the Life Sciences (CELLS) and the Institute of Philosophy, Leibniz University Hannover, Germany
| | - Martin S. Wasmer
- Centre for Ethics and Law in the Life Sciences (CELLS) and the Institute of Philosophy, Leibniz University Hannover, Germany
| | - Thomas A. C. Reydon
- Centre for Ethics and Law in the Life Sciences (CELLS) and the Institute of Philosophy, Leibniz University Hannover, Germany
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GRADE-Leitlinien zu Gerechtigkeit 4. Berücksichtigung der Gerechtigkeit im Gesundheitswesen bei der Entwicklung von GRADE-Leitlinien: von der Evidenz zur Empfehlung. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 156-157:105-112. [PMID: 32863163 DOI: 10.1016/j.zefq.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this paper is to provide detailed guidance on how to incorporate health equity within the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evidence to decision process. STUDY DESIGN AND SETTING We developed this guidance based on the GRADE evidence to decision frame-work, iteratively reviewing and modifying draft documents, in person discussion of project group members and input from other GRADE members. This is a German translation of the original paper published in English. RESULTS Considering the impact on health equity may be required, both in general guidelines and guide-lines that focus on disadvantaged populations. We suggest two approaches to incorporate equity considerations: (1) assessing the potential impact of interventions on equity and (2) incorporating equity considerations when judging or weighing each of the evidence to decision criteria. We provide guidance and include illustrative examples. CONCLUSION Guideline panels should consider the impact of recommendations on health equity with attention to remote and underserviced settings and disadvantaged populations. Guideline panels may wish to incorporate equity judgments across the evidence to decision framework. This is the fourth and final paper in a series about considering equity in the GRADE guideline development process. This series is coming from the GRADE equity subgroup.
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Cabrera LY, Bluhm R. Fostering neuroethics integration: disciplines, methods, and frameworks. AJOB Neurosci 2020; 11:194-196. [PMID: 33868762 DOI: 10.1080/21507740.2020.1778128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Laura Y Cabrera
- Center of Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, MI
| | - Robyn Bluhm
- Lyman Briggs College, Michigan State University, East Lansing, MI.,Philosophy Department, Michigan State University, East Lansing, MI
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Nußbaumer-Streit B, Teufer B, Langer G, Meerpohl JJ, Ebenberger A, Gartlehner G. [GRADE equity guidelines 2: Considering health equity in GRADE guideline development - equity extension of the guideline development checklist]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2019; 147-148:120-126. [PMID: 31757658 DOI: 10.1016/j.zefq.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To provide guidance for guideline developers on how to consider health equity at key stages of the guideline development process. STUDY DESIGN AND SETTING Literature review followed by group discussions and consensus building. RESULTS The key stages at which guideline developers could consider equity include setting priorities, guideline group membership, identifying the target audience(s), generating the guideline questions, considering the importance of outcomes and interventions, deciding what evidence to include and searching for evidence, summarizing the evidence and considering additional information, wording of recommendations, and evaluation and use. We provide examples of how guidelines have actually considered equity at each of these stages. CONCLUSION Guideline projects should consider the aforementioned suggestions for recommendations that are equity sensitive.
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Affiliation(s)
- Barbara Nußbaumer-Streit
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich.
| | - Birgit Teufer
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Gero Langer
- Institut für Gesundheits- und Pflegewissenschaft, German Center for Evidence-based Nursing »sapere aude«, Halle (Saale), Deutschland
| | - Joerg J Meerpohl
- Cochrane Deutschland / Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Agnes Ebenberger
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Gerald Gartlehner
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich; RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
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Wami WM, Dundas R, Molaodi OR, Tranter M, Leyland AH, Katikireddi SV. Assessing the potential utility of commercial 'big data' for health research: Enhancing small-area deprivation measures with Experian™ Mosaic groups. Health Place 2019; 57:238-246. [PMID: 31125848 PMCID: PMC6686722 DOI: 10.1016/j.healthplace.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/21/2019] [Accepted: 05/03/2019] [Indexed: 12/21/2022]
Abstract
In contrast to area-based deprivation measures, commercial datasets remain infrequently used in health research and policy. Experian collates numerous commercial and administrative data sources to produce Mosaic groups which stratify households into 15 groups for marketing purposes. We assessed the potential utility of Mosaic groups for health research purposes by investigating their relationships with Indices of Multiple Deprivation (IMD) for the British population. Mosaic groups showed significant associations with IMD quintiles. Correspondence Analysis revealed variations in patterns of association, with Mosaic groups either showing increasing, decreasing, or some mixed trends with deprivation quintiles. These results suggest that Experian's Mosaics additionally measure other aspects of socioeconomic circumstances to those captured by deprivation measures. These commercial data may provide new insights into the social determinants of health at a small area level. Mosaic groups showed a significant association with IMD quintiles. Trend patterns varied between different Mosaic groups across IMD quintiles. Mosaic groups have potential to enhance routinely used socioeconomic measures in research.
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Affiliation(s)
- Welcome M Wami
- MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, University of Glasgow, Glasgow, G2 3AX, UK.
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, University of Glasgow, Glasgow, G2 3AX, UK
| | - Oarabile R Molaodi
- MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, University of Glasgow, Glasgow, G2 3AX, UK
| | - Mette Tranter
- Directorate of Public Health and Health Policy, Lothian National Health Service (NHS) Board, Edinburgh, UK
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, University of Glasgow, Glasgow, G2 3AX, UK
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9
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McCartney G, Bartley M, Dundas R, Katikireddi SV, Mitchell R, Popham F, Walsh D, Wami W. Theorising social class and its application to the study of health inequalities. SSM Popul Health 2019; 7:015-15. [PMID: 31297431 PMCID: PMC6598164 DOI: 10.1016/j.ssmph.2018.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 01/24/2023] Open
Abstract
The literature on health inequalities often uses measures of socio-economic position pragmatically to rank the population to describe inequalities in health rather than to understand social and economic relationships between groups. Theoretical considerations about the meaning of different measures, the social processes they describe, and how these might link to health are often limited. This paper builds upon Wright's synthesis of social class theories to propose a new integrated model for understanding social class as applied to health. This model incorporates several social class mechanisms: social background and early years' circumstances; Bourdieu's habitus and distinction; social closure and opportunity hoarding; Marxist conflict over production (domination and exploitation); and Weberian conflict over distribution. The importance of discrimination and prejudice in determining the opportunities for groups is also explicitly recognised, as is the relationship with health behaviours. In linking the different social class processes we have created an integrated theory of how and why social class causes inequalities in health. Further work is required to test this approach, to promote greater understanding of researchers of the social processes underlying different measures, and to understand how better and more comprehensive data on the range of social class processes these might be collected in the future.
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Affiliation(s)
- Gerry McCartney
- NHS Health Scotland, 5th Floor, Meridian Court, 5 Cadogan Street, Glasgow, Scotland, UK
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10
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Ichihara MYT, Ramos D, Rebouças P, Oliveira FJ, Ferreira AJF, Teixeira C, Allik M, Katikireddi SV, Barreto ML, Leyland AH, Dundas R. Area deprivation measures used in Brazil: a scoping review. Rev Saude Publica 2018; 52:83. [PMID: 30183845 PMCID: PMC6122878 DOI: 10.11606/s1518-8787.2018052000933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/30/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe and assess currently used area-based measures of deprivation in Brazil for health research, to the purpose of informing the development of a future small area deprivation index. METHODS We searched five electronic databases and seven websites of Brazilian research institutions and governmental agencies. Inclusion criteria were: studies proposing measures of deprivation for small areas (i.e., finer geography than country-level) in Brazil, published in English, Portuguese or Spanish. After data-extraction, results were tabulated according to the area level the deprivation measure was created for and to the dimensions of deprivation or poverty included in the measures. A narrative synthesis approach was used to summarize the measures available, highlighting their utility for public health research. RESULTS A total of 7,199 records were retrieved, 126 full-text articles were assessed after inclusion criteria and a final list of 30 articles was selected. No small-area deprivation measures that have been applied to the whole of Brazil were found. Existing measures were mainly used to study infectious and parasitic diseases. Few studies used the measures to assess inequalities in mortality and no studies used the deprivation measure to evaluate the impact of social programs. CONCLUSIONS No up-to-date small area-based deprivation measure in Brazil covers the whole country. There is a need to develop such an index for Brazil to measure and monitor inequalities in health and mortality, particularly to assess progress in Brazil against the Sustainable Development Goal targets for different health outcomes, showing progress by socioeconomic groups.
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Affiliation(s)
- Maria Yury Travassos Ichihara
- Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil
| | - Dandara Ramos
- Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil
| | - Poliana Rebouças
- Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Flávia Jôse Oliveira
- Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Andrêa J F Ferreira
- Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Camila Teixeira
- Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Mirjam Allik
- University of Glasgow. MRC/CSO Social and Public Health Sciences Unit. Glasgow, Scotland
| | | | - Mauricio L Barreto
- Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Centro de Integração de Dados e Conhecimentos para a Saúde. Salvador, BA, Brasil.,Universidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Alastair H Leyland
- University of Glasgow. MRC/CSO Social and Public Health Sciences Unit. Glasgow, Scotland
| | - Ruth Dundas
- University of Glasgow. MRC/CSO Social and Public Health Sciences Unit. Glasgow, Scotland
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Aldridge RW, Story A, Hwang SW, Nordentoft M, Luchenski SA, Hartwell G, Tweed EJ, Lewer D, Vittal Katikireddi S, Hayward AC. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet 2018; 391:241-250. [PMID: 29137869 PMCID: PMC5803132 DOI: 10.1016/s0140-6736(17)31869-x] [Citation(s) in RCA: 449] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 06/23/2017] [Accepted: 07/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inclusion health focuses on people in extremely poor health due to poverty, marginalisation, and multimorbidity. We aimed to review morbidity and mortality data on four overlapping populations who experience considerable social exclusion: homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals. METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library for studies published between Jan 1, 2005, and Oct 1, 2015. We included only systematic reviews, meta-analyses, interventional studies, and observational studies that had morbidity and mortality outcomes, were published in English, from high-income countries, and were done in populations with a history of homelessness, imprisonment, sex work, or substance use disorder (excluding cannabis and alcohol use). Studies with only perinatal outcomes and studies of individuals with a specific health condition or those recruited from intensive care or high dependency hospital units were excluded. We screened studies using systematic review software and extracted data from published reports. Primary outcomes were measures of morbidity (prevalence or incidence) and mortality (standardised mortality ratios [SMRs] and mortality rates). Summary estimates were calculated using a random effects model. FINDINGS Our search identified 7946 articles, of which 337 studies were included for analysis. All-cause standardised mortality ratios were significantly increased in 91 (99%) of 92 extracted datapoints and were 11·86 (95% CI 10·42-13·30; I2=94·1%) in female individuals and 7·88 (7·03-8·74; I2=99·1%) in men. Summary SMR estimates for the International Classification of Diseases disease categories with two or more included datapoints were highest for deaths due to injury, poisoning, and other external causes, in both men (7·89; 95% CI 6·40-9·37; I2=98·1%) and women (18·72; 13·73-23·71; I2=91·5%). Disease prevalence was consistently raised across the following categories: infections (eg, highest reported was 90% for hepatitis C, 67 [65%] of 103 individuals for hepatitis B, and 133 [51%] of 263 individuals for latent tuberculosis infection), mental health (eg, highest reported was 9 [4%] of 227 individuals for schizophrenia), cardiovascular conditions (eg, highest reported was 32 [13%] of 247 individuals for coronary heart disease), and respiratory conditions (eg, highest reported was 9 [26%] of 35 individuals for asthma). INTERPRETATION Our study shows that homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals experience extreme health inequities across a wide range of health conditions, with the relative effect of exclusion being greater in female individuals than male individuals. The high heterogeneity between studies should be explored further using improved data collection in population subgroups. The extreme health inequity identified demands intensive cross-sectoral policy and service action to prevent exclusion and improve health outcomes in individuals who are already marginalised. FUNDING Wellcome Trust, National Institute for Health Research, NHS England, NHS Research Scotland Scottish Senior Clinical Fellowship, Medical Research Council, Chief Scientist Office, and the Central and North West London NHS Trust.
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Affiliation(s)
- Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK.
| | - Alistair Story
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK; University College London NHS Foundation Trust, London, UK
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Merete Nordentoft
- Mental Health Centre Copenhagen and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Serena A Luchenski
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Greg Hartwell
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily J Tweed
- Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Dan Lewer
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Srinivasa Vittal Katikireddi
- Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Andrew C Hayward
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK
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12
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Haire B, Whitford K, Kaldor JM. Blood donor deferral for men who have sex with men: still room to move. Transfusion 2017; 58:816-822. [PMID: 29250781 DOI: 10.1111/trf.14445] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/04/2017] [Accepted: 11/11/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Like a number of other countries, Australia mandates that a man who has had sex with men is deferred from donation until 12 months has elapsed since the sexual activity. This review examined whether this deferral period is justified by current evidence. STUDY DESIGN AND METHODS Databases (Medline, EMBASE, Scopus) were searched using terms "blood donation" and "gay" or "MSM" and "HIV risk" from the mid-1980s to the present to investigate the history of donor deferral policy and its rationale in Australia. RESULTS Gay and bisexual men in Australia face a higher risk of human immunodeficiency virus and other blood-borne viruses (BBVs) than other populations. All blood donations, however, are tested for BBVs, and with current testing technologies the window period during which infection may be present but not detected is now less than 1 week. While there is a moral imperative to maintain blood safety, there is also a moral imperative to ensure that differential treatment of population groups with regard to donation eligibility is scientifically justified. Potential social harms that may flow from a dissonance between deferral policy and its evidence base include loss of trust and increased nonadherence to policy. CONCLUSIONS A 12-month deferral for gay and bisexual men exceeds what is required to maintain blood safety. This disparity potentially causes social harm without any additional benefit to public health. Reducing the deferral period to 3 months will not increase health risk to recipients and may have the social benefit of increasing inclusiveness.
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Affiliation(s)
- Bridget Haire
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Kate Whitford
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Pottie K, Welch V, Morton R, Akl EA, Eslava-Schmalbach JH, Katikireddi V, Singh J, Moja L, Lang E, Magrini N, Thabane L, Stanev R, Matovinovic E, Snellman A, Briel M, Shea B, Tugwell P, Schunemann H, Guyatt G, Alonso-Coello P. GRADE equity guidelines 4: considering health equity in GRADE guideline development: evidence to decision process. J Clin Epidemiol 2017; 90:84-91. [PMID: 28802675 PMCID: PMC6538528 DOI: 10.1016/j.jclinepi.2017.08.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/03/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The aim of this paper is to provide detailed guidance on how to incorporate health equity within the GRADE (Grading Recommendations Assessment and Development Evidence) evidence to decision process. STUDY DESIGN AND SETTING We developed this guidance based on the GRADE evidence to decision framework, iteratively reviewing and modifying draft documents, in person discussion of project group members and input from other GRADE members. RESULTS Considering the impact on health equity may be required, both in general guidelines and guidelines that focus on disadvantaged populations. We suggest two approaches to incorporate equity considerations: (1) assessing the potential impact of interventions on equity and (2) incorporating equity considerations when judging or weighing each of the evidence to decision criteria. We provide guidance and include illustrative examples. CONCLUSION Guideline panels should consider the impact of recommendations on health equity with attention to remote and underserviced settings and disadvantaged populations. Guideline panels may wish to incorporate equity judgments across the evidence to decision framework. This is the fourth and final paper in a series about considering equity in the GRADE guideline development process. This series is coming from the GRADE equity subgroup.
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Affiliation(s)
- Kevin Pottie
- Departments of Family Medicine and Epidemiology and Community Medicine, Bruyere Research Institute University of Ottawa, Ottawa, Ontario, Canada; Epidemiology and Community Medicine, Bruyere Research Institute University of Ottawa, Ottawa, Ontario, Canada.
| | | | - Rachael Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Lebanon
| | - Javier H Eslava-Schmalbach
- Group of Equity in Health, Faculty of Medicine, Universidad Nacional de Colombia, Technology Development Center, Sociedad Colombiana de Anestesiologia y Reanimacion, Bogotá, Colombia
| | - Vittal Katikireddi
- Public Health, MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | | | - Lorenzo Moja
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Eddy Lang
- Division of Emergency Medicine, Department of Family Medicine, University of Calgary, Calgary, Canada
| | - Nicola Magrini
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Roger Stanev
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Philosophy, Ottawa, Ontario, Canada
| | | | - Alexandra Snellman
- Swedish Agency for Health Technology Assessment and Assessment of Social Services
| | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Switzerland; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Beverly Shea
- Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Holger Schunemann
- Department of Health Research Methods, Evidence, and Impact and of Medicine, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact and of Medicine, McMaster University Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Centro Cochrane Iberoamericano, Instituto de Investigación Biomédica (CIBERESP-IIB Sant Pau), Barcelona, España
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14
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Dwyer-Lindgren L, Stubbs RW, Bertozzi-Villa A, Morozoff C, Callender C, Finegold SB, Shirude S, Flaxman AD, Laurent A, Kern E, Duchin JS, Fleming D, Mokdad AH, Murray CJL. Variation in life expectancy and mortality by cause among neighbourhoods in King County, WA, USA, 1990–2014: a census tract-level analysis for the Global Burden of Disease Study 2015. LANCET PUBLIC HEALTH 2017; 2:e400-e410. [DOI: 10.1016/s2468-2667(17)30165-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/27/2017] [Accepted: 07/20/2017] [Indexed: 10/18/2022]
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15
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Akl EA, Welch V, Pottie K, Eslava-Schmalbach J, Darzi A, Sola I, Katikireddi SV, Singh J, Murad MH, Meerpohl J, Stanev R, Lang E, Matovinovic E, Shea B, Agoritsas T, Alexander PE, Snellman A, Brignardello-Petersen R, Gloss D, Thabane L, Shi C, Stein AT, Sharaf R, Briel M, Guyatt G, Schünemann H, Tugwell P. GRADE equity guidelines 2: considering health equity in GRADE guideline development: equity extension of the guideline development checklist. J Clin Epidemiol 2017; 90:68-75. [PMID: 28499847 DOI: 10.1016/j.jclinepi.2017.01.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/09/2017] [Accepted: 01/19/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To provide guidance for guideline developers on how to consider health equity at key stages of the guideline development process. STUDY DESIGN AND SETTING Literature review followed by group discussions and consensus building. RESULTS The key stages at which guideline developers could consider equity include setting priorities, guideline group membership, identifying the target audience(s), generating the guideline questions, considering the importance of outcomes and interventions, deciding what evidence to include and searching for evidence, summarizing the evidence and considering additional information, wording of recommendations, and evaluation and use. We provide examples of how guidelines have actually considered equity at each of these stages. CONCLUSION Guideline projects should consider the aforementioned suggestions for recommendations that are equity sensitive.
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Affiliation(s)
- Elie A Akl
- Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon; Department of Medicine, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon; AUB GRADE Center, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
| | - Vivian Welch
- Bruyére Research Institute, Bruyére Continuing Care and University of Ottawa, Bruyère St., Ottawa, Ontario, K1N 5C8, Canada
| | - Kevin Pottie
- Centre for Global Health, Institute of Population Health, University of Ottawa, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada
| | - Javier Eslava-Schmalbach
- Group of Equity in Health, Faculty of Medicine, Universidad Nacional de Colombia, Edif. Uriel Gutiérrez, Bogotá D.C., Colombia; Technology Development Center, Sociedad Colombiana de Anestesiologia y Reanimacion, Sociedad Colombiana de Anestesiología y ReanimaciónCra, 15 A No 120-74, Piso 4y5, Edif. Concord Center, Santa Fe de Bogotá, Colombia
| | - Andrea Darzi
- Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon; AUB GRADE Center, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Ivan Sola
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Srinivasa Vittal Katikireddi
- Public Health MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200, Renfield Street, Glasgow G2 3QB, Scotland
| | - Jasvinder Singh
- Department of Medicine, School of Medicine, Birmingham VA Medical Center, 700 19th St S, Birmingham, AL 35233, USA; Division of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), 1720 2nd Ave S, Birmingham, AL 35294, USA; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - M Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Preventive Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Joerg Meerpohl
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité-U1153, Inserm/Université Paris Descartes, 1 place du Parvis Notre-Dame, 75004 Paris, France; Cochrane France, Hôpital Hôtel-Dieu, 1 place du Parvis Notre Dame, 75181 Paris, Cedex 04, France; Cochrane Germany, Medical Center-University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Roger Stanev
- Institute of Technology, University of Washington, Tacoma, Washington, USA
| | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW Calgary, Alberta, T2N 4N1, Canada
| | - Elizabeth Matovinovic
- Faculty of Medicine, Chiang Mai University, Su Thep, Mueang Chiang Mai District, Chiang Mai 50200, Thailand
| | - Beverley Shea
- Ottawa Hospital Research Institute, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | - Paul E Alexander
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | | | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada; Evidence Based Dentistry Unit, Faculty of Dentistry, University of Chile, Av. Libertador Bernardo O'Higgins, Santiago 1058, Chile
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, 1201 Washington Street East, Suite 100, Charleston, WV 25301, USA
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | - Chunhu Shi
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester M13 9PL, UK
| | - Airton T Stein
- Public Health Ufcspa, Ulbra and Conceicao Hospital, Av. Farroupilha, 8001, Bairro São José, Canoas (RS), Brasil
| | - Ravi Sharaf
- Long Island Jewish Medical Center North Shore University Hospital, 270-05 76th Ave, Queens, NY 11040, USA
| | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 21, 4056 Basel, Switzerland
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada; McMaster GRADE Center, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada; Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
| | - Peter Tugwell
- The Centre for Global Health, Institute of Population Health, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada
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16
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Katikireddi SV, Dundas R. Relative poverty still matters. Lancet Public Health 2017; 2:e126-e127. [PMID: 29253383 DOI: 10.1016/s2468-2667(17)30029-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 12/15/2022]
Affiliation(s)
- S Vittal Katikireddi
- Medial Research Council and Chief Scientist's Office Social and Public Health Sciences Unit, Glasgow G2 3QB, UK.
| | - Ruth Dundas
- Medial Research Council and Chief Scientist's Office Social and Public Health Sciences Unit, Glasgow G2 3QB, UK
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Valles SA. The challenges of choosing and explaining a phenomenon in epidemiological research on the "Hispanic Paradox". THEORETICAL MEDICINE AND BIOETHICS 2016; 37:129-148. [PMID: 26754488 DOI: 10.1007/s11017-015-9349-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
According to public health data, the US Hispanic population is far healthier than would be expected for a population with low socioeconomic status. Ever since Kyriakos Markides and Jeannine Coreil highlighted this in a seminal 1986 article, public health researchers have sought to explain the so-called "Hispanic paradox." Several candidate explanations have been offered over the years, but the debate goes on. This article offers a philosophical analysis that clarifies how two sets of obstacles make it particularly difficult to explain the Hispanic paradox. First, different research projects define the Hispanic paradox phenomenon in substantially different ways. Moreover, using Bas van Fraassen's pragmatic theory of explanation and Sean Valles's extension of it with the concept of "phenomenon choice," it also becomes clear that there are also multiple ways of explaining each individual definition of the phenomenon. A second set of philosophical and methodological challenges arises during any attempt to study "Hispanic" phenomena, with one key challenge being that the "Hispanic" panethnic concept was intentionally made vague as it was developed and popularized during the 1960s-1970s. After comparing this case with similar cases in the philosophical literature, the article concludes with observations on what makes this problem unique, particularly its ethical features.
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Affiliation(s)
- Sean A Valles
- Lyman Briggs College and Department of Philosophy, Michigan State University, Holmes Hall, 919 E. Shaw Lane, Room E35, East Lansing, MI, 48825, USA.
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