209 results on '"Richard Ashcroft"'
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2. Racial categories in medicine: a failure of evidence-based practice?
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George T H Ellison, Andrew Smart, Richard Tutton, Simon M Outram, Richard Ashcroft, and Paul Martin
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Medicine - Published
- 2007
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3. Ethical and information governance considerations for promoting digital social interventions in primary care (Preprint)
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Georgios Dimitrios Karampatakis, Helen Wood, Chris Griffiths, Nathan Lea, Richard Ashcroft, Bill Day, Neil Walker, Neil Coulson, and Anna De Simoni
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UNSTRUCTURED Promoting online peer support beyond the informal sector to statutory health services, requires ethical considerations and evidence-based knowledge about its impact on patients, healthcare professionals and the wider healthcare system. Evidence on the effectiveness of digital interventions in primary care is sparse, and definitive guidance is lacking on the ethical concerns arising from the use of social media as a means for health-related interventions and research. Existing literature examining ethical issues with digital interventions in healthcare mainly focuses on apps, electronic health records, wearables, telephone/video consultations etc., without necessarily covering digital social interventions, and/or does not always account for primary care settings specifically. Here we address the ethical and information governance aspects of undertaking research on the promotion of online peer support to patients by primary care clinicians, related to medical and public health ethics.
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- 2022
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4. Lockdown texts
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Des Fitzgerald, Richard Ashcroft, Greg Hollin, Katrina Karkazis, Nicholas B. King, Hannah Landecker, Nicolas Langlitz, Filippa Lentzos, Todd Meyers, Jörg Niewöhner, Carlos Novas, Anne Pollock, Nikolas Rose, Chloe Silverman, Hallam Stevens, Banu Subramaniam, Ayo Wahlberg, and Elizabeth A. Wilson
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Health (social science) ,Health Policy ,Books Forum - Published
- 2020
5. Improving Development of Drug Treatments for Pregnant Women and the Fetus
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Anna L. David, Homa Ahmadzia, Richard Ashcroft, Christina Bucci-Rechtweg, Rebecca N. Spencer, and Steve Thornton
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RM ,Cardiotonic Agents ,Placenta ,Public Health, Environmental and Occupational Health ,HA ,Infant, Newborn ,Fetus ,Pregnancy ,Humans ,Pharmacology (medical) ,Female ,Pregnant Women ,RNA, Messenger ,RG ,Child ,Pharmacology, Toxicology and Pharmaceutics (miscellaneous) - Abstract
The exclusion of pregnant populations, women of reproductive age, and the fetus from clinical trials of therapeutics is a major global public health issue. It is also a problem of inequity in medicines development, as pregnancy is a protected characteristic. The current regulatory requirements for drugs in pregnancy are being analyzed by a number of agencies worldwide. There has been considerable investment in developing expertise in pregnancy clinical trials (for the pregnant person and the fetus) such as the Obstetric-Fetal Pharmacology Research Centers funded by the National Institute of Child Health and Human Development. Progress has also been made in how to define and grade clinical trial safety in pregnant women, the fetus, and neonate. Innovative methods to model human pregnancy physiology and pharmacology using computer simulations are also gaining interest. Novel ways to assess fetal well-being and placental function using magnetic resonance imaging, computerized cardiotocography, serum circulating fetoplacental proteins, and mRNA may permit better assessment of the safety and efficacy of interventions in the mother and fetus. The core outcomes in women’s and newborn health initiative is facilitating the consistent reporting of data from pregnancy trials. Electronic medical records integrated with pharmacy services should improve the strength of pharmacoepidemiologic and pharmacovigilance studies. Incentives such as investigational plans and orphan disease designation have been taken up for obstetric, fetal, and neonatal diseases. This review describes the progress that is being made to better understand the extent of the problem and to develop applicable solutions.
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- 2022
6. A Philosopher Looks at ‘Law and Medical Ethics’
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Richard Ashcroft
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- 2022
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7. S39 Is the treatment of latent tuberculosis infection amongst recent migrants safe and effective in primary care?
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Ibrahim Abubakar, H Haghparast-Bidgoli, Adrian R. Martineau, V. Hickson, Richard Ashcroft, Andrew Copas, Matthew Burman, Peter J White, Heinke Kunst, Lara Goscé, Dominik Zenner, O Greyson, D. Trathen, and CJ Griffiths
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medicine.medical_specialty ,Latent tuberculosis ,business.industry ,medicine ,Primary care ,medicine.disease ,Intensive care medicine ,business - Published
- 2021
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8. Law, biomedical technoscience, and imaginaries
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Mark Flear, Richard Ashcroft, Flear, Mark L., and Ashcroft, Richard
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Introduction ,AcademicSubjects/SCI01050 ,AcademicSubjects/LAW00490 ,Medicine (miscellaneous) ,Sociology ,Technoscience ,Law ,Biochemistry, Genetics and Molecular Biology (miscellaneous) ,Epistemology - Abstract
The first law-led collection of papers on imaginaries. This inaugural special issue advances discussion between law and science and technology studies.
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- 2021
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9. Professional Discourse across Medicine, Law, and Other Disciplines: Issues and Perspectives
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Girolamo Tessuto, Editor, Richard Ashcroft, Editor, Vijay K. Bhatia, Editor, Girolamo Tessuto, Editor, Richard Ashcroft, Editor, and Vijay K. Bhatia, Editor
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- Medicine--Language, Law--Language, Discourse analysis
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This volume provides a stage for an extensive exploration of the interface between medicine, law and other disciplines or professions. It offers the reader opportunities to understand how this integrative, interactive interdisciplinary process can be examined through the lenses of language, discourse and communication. Contributions cover cross-wise issues raised by paradigmatic cases of bioethics and law, nursing ethics and law, pharmacy ethics and law, bioethics and religion, risk management and ethics, social inclusion and bioethics, and environmental ethics.
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- 2023
10. Ethics and Harm Reduction Approaches in Tobacco Control
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Tessa Langley and Richard Ashcroft
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Harm reduction ,Environmental health ,Tobacco control ,Public Health, Environmental and Occupational Health ,Psychology - Published
- 2020
11. Better off, as judged by themselves: do people support nudges as a method to change their own behavior?
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Magda Osman, Yiling Lin, Natalie Gold, and Richard Ashcroft
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Government ,Sociology and Political Science ,Social Psychology ,Nudge theory ,BF Psychology ,05 social sciences ,Behavior change ,Psychological intervention ,050109 social psychology ,Context (language use) ,Transparency (graphic) ,0502 economics and business ,Political Science and International Relations ,0501 psychology and cognitive sciences ,Behavioral interventions ,050207 economics ,Psychology ,Alcohol consumption ,Social psychology ,Social Sciences (miscellaneous) ,Applied Psychology - Abstract
In this study, we investigated how people evaluate behavioral interventions (BIs) that are targeted at themselves, aiming to promote their own health and wellbeing. We compared the impact on people's assessments of the acceptability of using BIs to change their own behavior of: the transparency of the BI (transparent or opaque); the designer of the BI (researchers, government policy-makers, advertisers); and three types of arguments regarding their efficacy (positive, positive + negative, negative). Our target BIs were actual interventions that have been used in a range of policy domains (diet, exercise, alcohol consumption, smoking, personal finances). We found that transparent BIs were considered more acceptable than opaque BIs. On average, all BIs were considered acceptable for changing participants’ own behavior, except for the opaque BI in the finance context; there was differential acceptability of BIs across contexts, with finance clearly least acceptable. However, the perceived effectiveness of the BIs was at least as influential a predictor of acceptability ratings as the ease of identification of the behavior change mechanism across the five contexts. Furthermore, effectiveness was partially mediated by desire to change, suggesting that people do think BIs make them better off, ‘as judged by themselves’.
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- 2020
12. Liminality in practice: A case study in life sciences research
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Megan Clinch, Sara Shaw, Deborah Swinglehurst, and Richard Ashcroft
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Pragmatism ,Health (social science) ,Community engagement ,Process (engineering) ,Health Policy ,media_common.quotation_subject ,05 social sciences ,050905 science studies ,Research initiative ,03 medical and health sciences ,0302 clinical medicine ,Situated ,Relevance (law) ,Engineering ethics ,030212 general & internal medicine ,0509 other social sciences ,Liminality ,Complex problems ,media_common - Abstract
Contemporary health challenges (e.g., diabetes, climate change, antimicrobial resistance) are underpinned by complex interrelationships between behavioural, cultural, social, environmental and biological processes. Current experimental systems are only partially relevant to the problems they investigate, but aspirations to embed interdisciplinary working and community engagement into life scientists’ work in response to this partiality have proven difficult in practice. This paper explores one UK university-based life sciences research initiative as it seeks to develop modes of working which respond to this complexity. Drawing on ‘liminal hotspots’ as a sensitising concept, we explore how participating academics articulate complex problems, knowledge-making, interdisciplinary working and community engagement. Our analysis shows they become recurrently ‘trapped’ (institutionally and epistemologically) between fixed/universalised cosmologies of biology/disease, and more contemporary cosmologies in which biology and disease are conceptualised as situated and evolving. Adopting approaches to community organising based on ‘process pragmatism’, we propose ways in which life scientists might radically reorganise their practice and move beyond current limiting enactments of interdisciplinary and community engaged working. In doing so, we claim that the relevance and ‘humanness’ of life science research will be increased.
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- 2018
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13. Nudge: Concept, Effectiveness, and Ethics
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Yiling Lin, Richard Ashcroft, and Magda Osman
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03 medical and health sciences ,0302 clinical medicine ,Social Psychology ,Nudge theory ,05 social sciences ,Well-being ,Behavior change ,0501 psychology and cognitive sciences ,030212 general & internal medicine ,Psychology ,Social psychology ,050105 experimental psychology ,Applied Psychology - Abstract
Nudges are psychologically informed tools designed to promote behavioral change in order to improve health and well-being. In this review, we focus on three areas of concern: theory, evidence base,...
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- 2017
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14. Nudging: A Lesson in the Theatrics of Choice
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Yiling Lin, Magda Osman, and Richard Ashcroft
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Social Psychology ,Nudge theory ,Volition (linguistics) ,05 social sciences ,Key (cryptography) ,050109 social psychology ,0501 psychology and cognitive sciences ,Psychology ,Social psychology ,050105 experimental psychology ,Applied Psychology ,Epistemology ,Domain (software engineering) - Abstract
The aim of this piece is to clarify three key matters: (a) the extent to which, as citizens, our volition is impacted as a result of the implementation of nudges in the health domain; (b) the efficacy of educational campaigns as a means of behavioral change relative to other nudges as well as typical regulatory instruments; and (c) the empirical, theoretical, and practical details that ethical debates concerning nudges might want to consider.
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- 2017
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15. Protocol for a cluster randomised control trial evaluating the efficacy and safety of treatment for latent tuberculosis infection in recent migrants within primary care: the CATAPuLT trial
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Matthew Burman, V. Hickson, Heinke Kunst, Adrian R. Martineau, Lara Goscé, Dominik Zenner, Ibrahim Abubakar, Richard Ashcroft, Andrew Copas, Chris Griffiths, and D. Trathen
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medicine.medical_specialty ,Tuberculosis ,Cost-Benefit Analysis ,Antitubercular Agents ,Respiratory medicine ,03 medical and health sciences ,Study Protocol ,0302 clinical medicine ,Superiority Trial ,Patient satisfaction ,Latent Tuberculosis ,London ,medicine ,Cluster Analysis ,Humans ,Mass Screening ,030212 general & internal medicine ,Randomized Controlled Trials as Topic ,Transients and Migrants ,Public health ,Latent tuberculosis ,Primary Health Care ,business.industry ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,medicine.disease ,Primary care ,Checklist ,Treatment Outcome ,030228 respiratory system ,Family medicine ,Implementation research ,Biostatistics ,business - Abstract
Background The identification and treatment of LTBI is a key component of the WHO’s strategy to eliminate TB. Recent migrants from high TB-incidence countries are recognised to be at risk TB reactivation, and many high-income countries have focused on LTBI screening and treatment programmes for this group. However, migrants are the group least likely to complete the LTBI cascade-of-care. This pragmatic cluster-randomised, parallel group, superiority trial investigates whether a model of care based entirely within a community setting (primary care) will improve treatment completion compared with treatment in specialist TB services (secondary care). Methods The CATAPuLT trial (Completion and Acceptability of Treatment Across Primary Care and the community for Latent Tuberculosis) randomised 34 general practices in London, England, to evaluate the efficacy and safety of treatment for LBTI in recent migrants within primary care. GP practices were randomised to either provide management for LTBI entirely within primary care (GPs and community pharmacists) or to refer patients to secondary care. The target recruitment number for individuals is 576. The primary outcome is treatment completion (defined as taking at least 90% of antibiotic doses). The secondary outcomes assess adherence, acceptance of treatment, the incidence of adverse effects including drug-induced liver injury, the rates of active TB, patient satisfaction and cost-effectiveness of LTBI treatment. This protocol adheres to the SPIRIT Checklist. Discussion The CATAPuLT trial seeks to provide implementation research evidence for a patient-centred intervention to improve treatment completion for LTBI amongst recent migrants to the UK. Trial registration NCT03069807, March 2017, registered retrospectively.
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- 2019
16. Autism, Family Life, and Epistemic Injustice
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Richard Ashcroft
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mental disorders ,medicine ,Epistemic injustice ,Autism ,medicine.disease ,Psychology ,behavioral disciplines and activities ,Family life ,Developmental psychology - Abstract
This case study explores the experiences of the father of a child with autism.
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- 2019
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17. The need for ethics as well as evidence in evidence-based medicine
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Stuart G. Nicholls, Richard Ashcroft, and Ainsley J Newson
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medicine.medical_specialty ,Evidence-Based Medicine ,Epidemiology ,030503 health policy & services ,MEDLINE ,Evidence-based medicine ,03 medical and health sciences ,0302 clinical medicine ,Family medicine ,medicine ,Humans ,Ethics, Medical ,030212 general & internal medicine ,0305 other medical science ,Psychology - Published
- 2016
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18. Ethics and social acceptability of a proposed clinical trial using maternal gene therapy to treat severe early-onset fetal growth restriction
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MK Sheppard, Rebecca Spencer, Anna L. David, and Richard Ashcroft
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0301 basic medicine ,medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Genetic enhancement ,education ,Alternative medicine ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Clinical trial ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Reproductive Medicine ,Intervention (counseling) ,Social acceptability ,Fetal growth ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Psychiatry ,Early onset - Abstract
Objective To evaluate the ethical and social acceptability of a proposed clinical trial using maternal uterine artery vascular endothelial growth factor (VEGF) gene therapy to treat severe early-onset fetal growth restriction (FGR) in pregnant women. Methods We conducted a literature review on the ethics and legality of experimental treatments in pregnant women, in particular advanced therapeutics. Issues that were identified from the literature helped develop interview guides for semistructured, qualitative interviews, carried out in four European countries, with 34 key stakeholders (disability groups, professional bodies and patient support groups) and 24 women/couples who had experienced a pregnancy affected by severe early-onset FGR. Results The literature review identified two main questions: ‘is it ethical to give a pregnant woman a potentially risky treatment from which she does not benefit directly?’ and ‘is it ethical to treat a condition of the unborn child, who may then be born with a serious disability when, without treatment, they would have died?’. The review concluded that there were no ethical or legal objections to the intervention, or to a trial of this intervention. Overall, respondents viewed the proposed trial in positive terms. Women were generally interested in participating in clinical trials that conferred a potential benefit to their unborn child. The risk of disability of the premature child was a concern, but not considered a major stumbling block for maternal VEGF gene therapy. Conclusions This study did not identify any fundamental or insurmountable objections to a trial of maternal gene therapy for severe early-onset FGR. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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- 2016
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19. Multiple Autisms: Spectrums of Advocacy and Genomic Science
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Richard Ashcroft
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Focus (computing) ,History and Philosophy of Science ,Genomic research ,medicine ,Autism ,medicine.disease ,Psychology ,Data science - Abstract
This useful study charts the recent history of genetic and genomic research in autism, with a focus on the role of parent activism in organizing, enabling and supporting such research. It is based ...
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- 2017
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20. Neuropsychiatry: brain injury, mental health–substance use
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John Richard Ashcroft
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medicine.medical_specialty ,education.field_of_study ,Traumatic brain injury ,business.industry ,Population ,Neuropsychiatry ,medicine.disease ,Mental health ,Increased risk ,medicine ,Substance use ,Medical prescription ,Psychiatry ,education ,business ,Alcohol consumption - Abstract
This chapter aims to increase awareness of the prevalence of brain injury within the substance misuse population. It discusses issues surrounding the management of substance use problems in people with established injury, and particularly how this may differ to those without injury. Substance use is associated with an increased risk of sustaining traumatic brain injury with the vast majority of people testing positive for alcohol or illicit drugs at the time of hospital admission. However, symptoms of mild traumatic brain injury are often indistiguishable from those of substance use and individuals with mild brain injury and substance use problems are often unrecognised. Alcohol and illicit substances may interact with prescription medication or exacerbate symptoms of pre-existing medical conditions. Since Martin increased alcohol consumption there was a noticeable deterioration in both his physical and mental health. Psychiatric disorder may also be precipitated by drugs and alcohol in those predisposed.
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- 2018
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21. Symptom Management Framework
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Laura Henry and John Richard Ashcroft
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medicine.medical_specialty ,business.industry ,Symptom management ,Medicine ,business ,Intensive care medicine - Published
- 2018
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22. Cohort Profile: East London Genes & Health (ELGH), a community based population genomics and health study of British-Bangladeshi and British-Pakistani people
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Zaheer Ahmed, Ahsan Nabi Khan, Richard C. Trembath, David A. van Heel, Sarah Finer, Beverley MacLaughlin, Chris Griffiths, Hilary C. Martin, Richard Ashcroft, Ceri Durham, John Robson, Karen A. Hunt, Daniel G. MacArthur, Bhavi Trivedi, Mark I. McCarthy, and John Wright
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0301 basic medicine ,Gerontology ,Epidemiology ,MEDLINE ,Ethnic group ,Disease ,White People ,Cohort Studies ,Population genomics ,03 medical and health sciences ,0302 clinical medicine ,Asian People ,London ,Ethnicity ,medicine ,Humans ,Pakistan ,030212 general & internal medicine ,QH426 ,Cohort Profiles ,030304 developmental biology ,Bangladesh ,0303 health sciences ,Clinical study design ,Medical record ,Genomics ,General Medicine ,Mental illness ,medicine.disease ,3. Good health ,030104 developmental biology ,Geography ,Scale (social sciences) ,Cohort ,Metagenomics ,Cohort study - Abstract
Cohort profile in a nutshellEast London Genes & Health (ELGH) is a large scale, community genomics and health study (to date >34,000 volunteers; target 100,000 volunteers).ELGH was set up in 2015 to gain deeper understanding of health and disease, and underlying genetic influences, in British-Bangladeshi and British-Pakistani people living in east London.ELGH prioritises studies in areas important to, and identified by, the community it represents. Current priorities include cardiometabolic diseases and mental illness, these being of notably high prevalence and severity. However studies in any scientific area are possible, subject to community advisory group and ethical approval.ELGH combines health data science (using linked UK National Health Service (NHS) electronic health record data) with exome sequencing and SNP array genotyping to elucidate the genetic influence on health and disease, including the contribution from high rates of parental relatedness on rare genetic variation and homozygosity (autozygosity), in two understudied ethnic groups. Linkage to longitudinal health record data enables both retrospective and prospective analyses.Through Stage 2 studies, ELGH offers researchers the opportunity to undertake recall-by-genotype and/or recall-by-phenotype studies on volunteers. Sub-cohort, trial-within-cohort, and other study designs are possible.ELGH is a fully collaborative, open access resource, open to academic and life sciences industry scientific research partners.
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- 2018
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23. 78 A critical interpretive synthesis of recommendations for de-intensification and de-implementation from population screening (dimples)
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Lesley Dunfield, Pearl Atwere, Angus Dawson, Stuart G. Nicholls, Marcel Verweij, Zahra Montazori, John N. Lavis, Jeff Botkin, Lindsey Sikora, Jeremy M. Grimshaw, Doug Coyle, Ian D. Graham, Beth K. Potter, Jamie C. Brehaut, Richard Ashcroft, and Tammy Clifford
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medicine.medical_specialty ,Systematic review ,Specific-information ,Transparency (graphic) ,Family medicine ,Cancer screening ,medicine ,De implementation ,Population screening ,Evidence-based medicine ,Psychology ,Citation - Abstract
Objectives Screening has generally been met with enthusiasm, and, in some cases, has been associated with demonstrable reductions in morbidity and mortality. In other cases, the balance of benefits and harms may be less clear and may evolve over time. Recommendations to reduce (de-intensify) or stop screening altogether (de-implementation) have occurred, but have proved to be controversial. The goal of this study was to review existing recommendations to better understand the stated rationales for de-intensification or de-implementation of established population screening programs. In doing so we: Identify examples of population screening programs recommended for de–intensification or de–implementation and describe the characteristics of these program changes Describe the stated reasons for de–intensification or de–implementation Explore the information cited for justification of recommendations Method We conducted a Critical Interpretive Synthesis (CIS) of published literature. This included an extensive search (websites of major screening organizations, reference searches, and content expert input) in addition to an electronic search of standard data bases. Data were analysed, coded and labeled in an inductive manner, and thus allowed for further searches that explicitly sought out contrasting or conflicting evidence. The review has been registered with International Prospective Register of Systematic Reviews PROSPERO (CRD42016035279). Results Of 9570 titles total of 66 documents, were included for analyses. Of these, 55 covered adult screening conditions and were largely cancer-related. Infant conditions included congenital toxoplasmosis (1), Down syndrome (1), fetal movement count (2), hearing test (1), urinalysis (3) and neuroblastoma (3). Of 107 recommendations, 50 related to de-intensification (e.g. increase of start age, extension of screening interval), 33 called for de-implementation, and 24 called for changes to the screening modality (often due to reduction in invasiveness or in association with increased periodicity). Explicit reasons were provided for 49 recommendations, while only 41 recommendations cited specific information in the justification. Conclusion We identified examples of programs across jurisdictions, age ranges, and clinical areas. Cancer screening dominates the examples identified. Recommendations to de-intensify or de-implement programs varied in terms of the level of evidence cited, as well as the stated rationales. Only around half of the identified recommendations provided an explicit rationale, and less than half of all recommendations were supported by a specific citation of evidence. Given the contested nature of de-implementation decisions, there is a greater need for transparency regarding the rationale behind recommendations and clearer articulation of the evidence used to support specific recommendations.
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- 2018
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24. The legal frameworks that govern fetal surgery in the United Kingdom, European Union, and the United States
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Anna L. David, Alice Booth, Kevin Cao, Sebastien Ourselin, and Richard Ashcroft
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Modern medicine ,Legislation, Medical ,Human Rights ,media_common.quotation_subject ,Specialty ,MEDLINE ,Obstetric Surgical Procedures ,Reviews ,Legislation ,Review ,K1 ,THERAPY ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Political science ,Fetal intervention ,GROWTH RESTRICTION ,media_common.cataloged_instance ,Humans ,030212 general & internal medicine ,European union ,Genetics (clinical) ,media_common ,Genetics & Heredity ,Fetal Therapies ,KF ,030219 obstetrics & reproductive medicine ,Science & Technology ,Human rights ,KD ,Obstetrics and Gynecology ,Obstetrics & Gynecology ,16. Peace & justice ,Maturity (finance) ,3. Good health ,Fetal Diseases ,Law ,Female ,TRIAL ,RG ,Life Sciences & Biomedicine - Abstract
The specialty of fetal surgery or fetal intervention is one of the most exciting emerging fields of modern medicine. It is made possible by decades of major developments in antenatal imaging, obstetric anaesthesia, fetal medicine, paediatric surgery, and of course by the bold and novel practitioners willing to take new steps to advance the field. Beginning in the 1970s, it has now reached a stage of maturity where there are several established in utero procedures and countless clinical trials and studies to develop more. But what is the legal situation that fetal surgeons find themselves in? What are the rights and legal protections for the fetus and the mother, both of which are arguably the patient? This article will address this question, discussing and summarising the current legal frameworks governing fetal surgery in the jurisdictions of the United Kingdom, European Court of Human Rights, and the United States of America as well as discuss what the future may hold and how researchers and physicians in the specialty can best navigate the legal environment., What's already known about this topic? Fetal surgery is entering mainstream clinical care as a specialty that introduces an exciting range of new treatments for mothers and their unborn babies.The conflict between maternal autonomy and interests in fetal health is relatively well known. How does fetal surgery affect this issue? What does this study add? Clarifies the legal frameworks that govern fetal surgery in the United Kingdom, European Union, and the United States.Examines how fetal surgery may influence the legal position.Discusses clinical best practice and how physicians can influence future laws that govern this specialty.
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- 2018
25. Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial
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Fern Terris-Prestholt, Sally Kerry, Richard Ashcroft, S Creighton, Valerie Delpech, D Millett, Jane Anderson, Andreia Santos, Maria Sampson, Alison E Brown, Adrian R. Martineau, Nadine Marlin, Sifiso Mguni, Graham Hart, Graeme Rooney, Werner Leber, Heather McMullen, Jose Figueroa, Chris Griffiths, Stephen Bremner, and Kambiz Boomla
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Epidemiology ,Immunology ,MEDLINE ,HIV Infections ,Health Promotion ,law.invention ,Young Adult ,Randomized controlled trial ,law ,Virology ,London ,Humans ,Medicine ,Cluster randomised controlled trial ,Young adult ,Adverse effect ,Primary Health Care ,business.industry ,Middle Aged ,CD4 Lymphocyte Count ,Early Diagnosis ,Infectious Diseases ,Health promotion ,Clinical trials unit ,Relative risk ,Female ,business - Abstract
Summary Background Many people with HIV are undiagnosed. Early diagnosis saves lives and reduces onward transmission. We assessed whether an education programme promoting rapid HIV testing in general practice would lead to increased and earlier HIV diagnosis. Methods In this cluster randomised controlled trial in Hackney (London, UK), general practices were randomly assigned (1:1) to offer either opt-out rapid HIV testing to newly registering adults or continue usual care. All practices were invited to take part. Practices were randomised by an independent clinical trials unit statistician with a minimisation program, maintaining allocation concealment. Neither patients nor investigators were masked to treatment allocation. The primary outcome was CD4 count at diagnosis. Secondary outcomes were rate of diagnosis, proportion with CD4 count less than 350 cells per μL, and proportion with CD4 count less than 200 cells per μL. This study is registered with ClinicalTrials.gov, number ISRCTN63473710. Findings 40 of 45 (89%) general practices agreed to participate: 20 were assigned to the intervention group (44 971 newly registered adult patients) and 20 to the control group (38 464 newly registered adult patients), between April 19, 2010, and Aug 31, 2012. Intervention practices diagnosed 32 people with HIV versus 14 in control practices. Mean CD4 count at diagnosis was 356 cells per μL (SD 254) intervention practices versus 270 (SD 257) in control practices (adjusted difference of square root CD4 count 3·1, 95% CI −1·2 to 7·4; p=0·16);); in a pre-planned sensitivity analysis excluding patients diagnosed via antenatal care, the difference was 6·4 (95% CI, 1·2 to 11·6; p=0·017). Rate of HIV diagnosis was 0·30 (95% CI 0·11 to 0·85) per 10 000 patients per year in intervention practices versus 0·07 (0·02 to 0·20) in control practices (adjusted ratio of geometric means 4·51, 95% CI 1·27 to 16·05; p=0·021). 55% of patients in intervention practices versus 73% in control practices had CD4 count less than 350 cells per μL (risk ratio 0·75, 95% CI 0·53 to 1·07). 28% versus 46% had CD4 count less than 200 cells per μL (0·60, 0·32 to 1·13). All patients diagnosed by rapid testing were successfully transferred into specialist care. No adverse events occurred. Interpretation Promotion of opt-out rapid testing in general practice led to increased rate of diagnosis, and might increase early detection, of HIV. We therefore recommend implementation of HIV screening in general practices in areas with high HIV prevalence. Funding UK Department of Health, NHS City and Hackney.
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- 2015
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26. Ethics and Depression
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Richard Ashcroft
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education - Abstract
This chapter discusses the ethics of depression from a personal perspective. The author, an academic who has worked in the field of medical ethics or bioethics, has suffered episodes of depression throughout his life, some lasting several months. Here he shares a few quite informal things about how these two facts about him are connected. He first considers the paradigm of autonomy and autonomous decision-making, as well as the problem with functional accounts of autonomy with regard to depression. He then reflects on an approach to ethics and depression that involves thinking about the ethics of being depressed. He also highlights two aspects of the ‘ethics of depression’: treatment and the ethical obligation to talk about it.
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- 2017
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27. Equipoise, Knowledge And Ethics In Clinical Research And Practice
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Richard Ashcroft
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- 2017
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28. Electroconvulsive therapy
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Siân Bensa and John Richard Ashcroft
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- 2017
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29. Practice
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John Richard Ashcroft and Siân Bensa
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- 2017
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30. The eSexual Health Clinic system for management, prevention, and control of sexually transmitted infections: exploratory studies in people testing for Chlamydia trachomatis
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Voula Gkatzidou, Pam Sonnenberg, Emma M. Harding-Esch, L Tickle, Ala Szczepura, Anthony Nettleship, Lorna J Sutcliffe, Kate Hone, Catherine R H Aicken, Jo Gibbs, Claudia Estcourt, S Tariq Sadiq, Pippa Oakeshott, Andrew Copas, Sue Eaton, Catherine M Lowndes, and Richard Ashcroft
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Adult ,Male ,medicine.medical_specialty ,Pediatrics ,020205 medical informatics ,Pharmacy ,Chlamydia trachomatis ,02 engineering and technology ,medicine.disease_cause ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,eHealth ,Humans ,030212 general & internal medicine ,Reproductive health ,Chlamydia ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Chlamydia Infections ,Partner notification ,medicine.disease ,Telemedicine ,3. Good health ,Anti-Bacterial Agents ,Health promotion ,Treatment Outcome ,Family medicine ,Feasibility Studies ,Female ,business - Abstract
Background\ud \ud Self-directed and internet-based care are key elements of eHealth agendas. We developed a complex online clinical and public health intervention, the eSexual Health Clinic (eSHC), in which patients with genital chlamydia are diagnosed and medically managed via an automated online clinical consultation, leading to antibiotic collection from a pharmacy. Partner notification, health promotion, and capture of surveillance data are integral aspects of the eSHC. We aimed to assess the safety and feasibility of the eSHC as an alternative to routine care in non-randomised, exploratory proof-of-concept studies.\ud Methods\ud \ud Participants were untreated patients with chlamydia from genitourinary medicine clinics, untreated patients with chlamydia from six areas in England in the National Chlamydia Screening Programme's (NCSP) online postal testing service, or patients without chlamydia tested in the same six NCSP areas. All participants were aged 16 years or older. The primary outcome was the proportion of patients with chlamydia who consented to the online chlamydia pathway who then received appropriate clinical management either exclusively through online treatment or via a combination of online management and face-to-face care. We captured adverse treatment outcomes.\ud Findings\ud \ud Between July 21, 2014, and March 13, 2015, 2340 people used the eSHC. Of 197 eligible patients from genitourinary medicine clinics, 161 accessed results online. Of the 116 who consented to be included in the study, 112 (97%, 95% CI 91–99) received treatment, and 74 of those were treated exclusively online. Of the 146 eligible NCSP patients, 134 accessed their results online, and 105 consented to be included. 93 (89%, 95% CI 81–94) received treatment, and 60 were treated exclusively online. In both groups, median time to collection of treatment was within 1 day of receiving their diagnosis. 1776 (89%) of 1936 NCSP patients without chlamydia accessed results online. No adverse events were recorded.\ud Interpretation\ud \ud The eSHC is safe and feasible for management of patients with chlamydia, with preliminary evidence of similar treatment outcomes to those in traditional services. This innovative model could help to address growing clinical and public health needs. A definitive trial is needed to assess the efficacy, cost-effectiveness, and public health impact of this intervention.\ud Funding\ud \ud UK Clinical Research Collaboration.
- Published
- 2017
31. International Perspectives on Resource Allocation
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Solomon R. Benatar and Richard Ashcroft
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HRHIS ,Actuarial science ,Public economics ,business.industry ,010102 general mathematics ,International health ,01 natural sciences ,03 medical and health sciences ,0302 clinical medicine ,Health promotion ,Political science ,Health care ,Resource allocation ,030212 general & internal medicine ,Justice (ethics) ,0101 mathematics ,business ,Distributive justice ,Health policy - Abstract
The improvement of health globally is arguably one of the most significant health policy and global strategic issues of the twenty-first century. What resources should be allocated to improve health and access to health care is contentious. Resource allocation choices are inevitable and those choices are complex, difficult, and morally problematic. Distributive justice, a primary moral concern of health systems, requires that the benefits and burdens of health-related services be prioritized according to morally relevant criteria. Knowing what resource allocation decisions to make would be quite simple if we could agree on both the need to do so and the criteria to guide allocations. However, examination of international experience has shown that there is no consensus about what and how allocation decisions should be made.
- Published
- 2017
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32. Euthanasia and the nature of suffering in addiction
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Richard Ashcroft
- Subjects
medicine.medical_specialty ,Addiction ,media_common.quotation_subject ,05 social sciences ,Medicine (miscellaneous) ,Stigma (botany) ,06 humanities and the arts ,0603 philosophy, ethics and religion ,Criminal behavior ,Psychiatry and Mental health ,Mental capacity ,050501 criminology ,medicine ,060301 applied ethics ,Psychiatry ,Psychology ,0505 law ,media_common - Published
- 2018
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33. Ethical Issues in Statistical Genetics
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Richard Ashcroft and Susan E. Wallace
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Information privacy ,Ethical issues ,Informed consent ,Management science ,Statistical genetics ,Political science ,Confidentiality ,Engineering ethics ,Stewardship ,Therapeutic privilege ,Social issues - Published
- 2019
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34. Does Vascular Endothelial Growth Factor Gene Therapy Safely Improve Outcome in Severe Early-Onset Fetal Growth Restriction? (EVERREST)
- Author
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Kurt Hecher, Karel Marsal, Francesc Figueras, Richard Ashcroft, David Campbell, Sara Sleigh, Jocelyn Brookes, Seppo Ylä-Herttuala, and Anna L. David
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Vascular Endothelial Growth Factor A ,Fetal Growth Retardation ,business.industry ,Placenta ,Genetic enhancement ,Genetic Vectors ,Infant, Newborn ,Genetic Therapy ,Dependovirus ,Bioinformatics ,Vascular endothelial growth factor ,Uterine Artery ,chemistry.chemical_compound ,chemistry ,Pregnancy ,Immunology ,Fetal growth ,Animals ,Humans ,Medicine ,Female ,Rabbits ,business ,Genetics (clinical) ,Early onset - Published
- 2015
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35. Ethics and Global Health Inequalities
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Richard Ashcroft
- Published
- 2013
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36. An open letter to The BMJ editors on qualitative research
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Katherine Checkland, Göran Tomson, Sally Thorne, Margarete Sandelowski, Terry Young, Janice M. Morse, Jan-Kees Helderman, Lorelei Lingard, Trisha Greenhalgh, Ruth Boaden, Brian Hodges, Robert Dingwall, Celia Roberts, Martin Marshall, Sue Wilkinson, Warrren Pearce, Catherine Pope, Lorna McKee, Ruth Garside, Nicholas Mays, David G. Morgan, Celia Kitzinger, Pierre Pluye, Glyn Elwyn, Jenny Kitzinger, Sue Ziebland, Alexander M. Clark, Benjamin F. Crabtree, Deborah Swinglehurst, Penny Hawe, Andrée le May, Sharon E. Straus, Brian Williams, Sarah Nettleton, Mary Ellen Macdonald, Gerd Westert, Dariusz Galasiński, Naomi Fulop, Nick Black, Ellen Annandale, Mary Dixon-Woods, Jeffrey Braithwaite, Ayelet Kuper, Paul G. Shekelle, Sandy Oliver, Huw Davies, Lucy Gilson, Glenn Robert, Frances S. Mair, Simon Cohn, John Gabbay, Steven Cummins, James Barlow, Jill Maben, Marie-Pierre Gagnon, Jack Coulehan, Franco A. Carnevale, Saville Kushner, Jo Rycroft-Malone, Carl May, Julianne Cheek, Peter Griffiths, Eivind Engebretsen, Russell Mannion, Frank Davidoff, Richard Ashcroft, Marissa Miraldo, Stefania Rodella, Margaret H. Kearney, Alan Bleakley, Ewan Ferlie, Fiona Stevenson, David J. Hunter, Nicky Britten, and Louise Locock
- Subjects
Michigan ,Population ,MEDLINE ,CHILDREN ,law.invention ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,Randomized-trials ,03 medical and health sciences ,MORBIDITY ,0302 clinical medicine ,Medicine, General & Internal ,Randomized controlled trial ,Mordibity ,law ,General & Internal Medicine ,STATISTICS NOTES ,MICHIGAN ,Health care ,PROGRAM ,Medicine ,Humans ,030212 general & internal medicine ,Mortality ,education ,Children ,GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries) ,POPULATION ,Qualitative Research ,education.field_of_study ,Medical education ,Program ,Science & Technology ,business.industry ,030503 health policy & services ,MORTALITY ,Statistics notes ,General Medicine ,RANDOMIZED-TRIAL ,ComputingMilieux_GENERAL ,HEALTH-CARE ,Health-care ,Periodicals as Topic ,0305 other medical science ,business ,Life Sciences & Biomedicine ,Editorial Policies ,Qualitative research - Abstract
Seventy six senior academics from 11 countries invite The BMJ ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority. They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission
- Published
- 2016
37. Hanging around with Jackson
- Author
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Richard Ashcroft
- Published
- 2016
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38. Autism and the Good Life:A New Approach to the Study of Well-Being
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Richard Ashcroft, Katrine Krause-Jensen, and Raffaele Rodogno
- Subjects
Health (social science) ,Autism, Well-Being, Good Life ,media_common.quotation_subject ,Psychological intervention ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Arts and Humanities (miscellaneous) ,Behavior Therapy ,medicine ,Humans ,0501 psychology and cognitive sciences ,Autistic Disorder ,The good life ,media_common ,Health Policy ,Research ,05 social sciences ,Beneficence ,medicine.disease ,Sketch ,Issues, ethics and legal aspects ,Knowledge ,Well-being ,Happiness ,Quality of Life ,Autism ,Psychology ,Social psychology ,030217 neurology & neurosurgery ,050104 developmental & child psychology - Abstract
Medical, psychological, educational and social interventions to modify the behaviour of autistic people are only justified if they confer benefit on those people. However, it is not clear how 'benefit' should be understood. Most such interventions are justified by referring to the prospect that they will effect lasting improvements in the well-being and happiness of autistic people, so they can lead good lives. What does a good life for an autistic person consist in? Can we assume that his or her well-being is substantively the same as the well-being of non-autistic individuals? In this paper, we argue that, as it stands, the current approach to the study of well-being is for the most part unable to answer these questions. In particular, much effort is needed in order to improve the epistemology of well-being, especially so if we wish this epistemology to be 'autism-sensitive'. Towards the end of the paper, we sketch a new, autism-sensitive approach and apply it in order to begin answering our initial questions.
- Published
- 2016
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39. Ethical Issues in a Trial of Maternal Gene Transfer to Improve Foetal Growth
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Richard Ashcroft
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Pregnancy ,medicine.medical_specialty ,Research ethics ,030219 obstetrics & reproductive medicine ,business.industry ,Therapeutic misconception ,Vulnerability ,Gene transfer ,06 humanities and the arts ,0603 philosophy, ethics and religion ,medicine.disease ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,Clinical research ,Intervention (counseling) ,embryonic structures ,Medicine ,060301 applied ethics ,business ,Psychiatry ,Intensive care medicine ,reproductive and urinary physiology - Abstract
This chapter investigates the ethical issues associated with a proposed European gene transfer trial which would recruit pregnant women with severe early onset foetal growth restriction (Details of the research programme may be found on the programme website, http://everrest-fp7.eu . The clinical trial is building on ongoing preclinical studies, and is likely to begin recruitment towards the end of 2016. The trial has been registered with the US ClinicalTrials.gov (NCT02097667) and the UK Clinical Research Network (ID 15717)). The gene transfer is targeted on the pregnant woman, rather than her foetus, and seeks to improve blood flow and promote vascularisation of the uterus. Transfer of the vector across the placenta to the foetal blood supply should not occur in clinically significant quantities, and no modification of the foetal genome is planned or foreseen. In this chapter, I consider first whether such an intervention is in theory ethically acceptable. I then consider whether a trial of such an intervention meets regulatory guidelines. The core ethical issue here is how to weigh maternal and foetal interests. There is scant regulatory or legal guidance on this point. Here I assess the one- and two-patient models of foetal interests that dominate the ethics literature and find that neither model adequately captures the uniqueness of the pregnancy. The interests of the pregnant woman and her foetus are, in the vast majority of cases, co-dependent and intertwined. In this proposed trial (as in many other trials in conditions affecting foetal growth and development), the primary risk is potential exploitation of the pregnant woman’s vulnerability, derived from her desire to undertake significant risks in order to gain potential benefits for the foetus.
- Published
- 2016
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40. Why National eHealth Programs Need Dead Philosophers: Wittgensteinian Reflections on Policymakers’ Reluctance to Learn from History
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Jill Russell, Richard Ashcroft, Wayne Parsons, and Trisha Greenhalgh
- Subjects
business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Information technology ,Context (language use) ,Sensemaking ,Public relations ,Social marketing ,Bounded rationality ,Blueprint ,eHealth ,Health care reform ,Sociology ,business - Abstract
Context: Policymakers seeking to introduce expensive national eHealth programs would be advised to study lessons from elsewhere. But these lessons are unclear, partly because a paradigm war (controlled experiment versus interpretive case study) is raging. England's $20.6 billion National Programme for Information Technology (NPfIT) ran from 2003 to 2010, but its overall success was limited. Although case study evaluations were published, policymakers appeared to overlook many of their recommendations and persisted with some of the NPfIT's most criticized components and implementation methods. Methods: In this reflective analysis, illustrated by a case fragment from the NPfIT, we apply ideas from Ludwig Wittgenstein's postanalytic philosophy to justify the place of the "n of 1" case study and consider why those in charge of national eHealth programs appear reluctant to learn from such studies. Findings: National eHealth programs unfold as they do partly because no one fully understands what is going on. They fail when this lack of understanding becomes critical to the programs' mission. Detailed analyses of the fortunes of individual programs, articulated in such a way as to illuminate the contextualized talk and action ("language games") of multiple stakeholders, offer unique and important insights. Such accounts, portrayals rather than models, deliver neither statistical generalization (as with experiments) nor theoretical generalization (as with multisite case comparisons or realist evaluations). But they do provide the facility for heuristic generalization (i.e., to achieve a clearer understanding of what is going on), thereby enabling more productive debate about eHealth programs' complex, interdependent social practices. A national eHealth program is best conceptualized not as a blueprint and implementation plan for a state-of-the-art technical system but as a series of overlapping, conflicting, and mutually misunderstood language games that combine to produce a situation of ambiguity, paradox, incompleteness, and confusion. But going beyond technical "solutions" and engaging with these language games would clash with the bounded rationality that policymakers typically employ to make their eHealth programs manageable. This may explain their limited and contained response to the nuanced messages of in-depth case study reports. Conclusion: The complexity of contemporary health care, combined with the multiple stakeholders in large technology initiatives, means that national eHealth programs require considerably more thinking through than has sometimes occurred. We need fewer grand plans and more learning communities. The onus, therefore, is on academics to develop ways of drawing judiciously on the richness of case studies to inform and influence eHealth policy, which necessarily occurs in a simplified decision environment. © 2011 Milbank Memorial Fund.
- Published
- 2011
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41. Financial incentives to encourage healthy behaviour: an analysis of UK media coverage
- Author
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Theresa M Marteau, Hannah L Parke, Clive Seale, Rebecca C H Brown, and Richard Ashcroft
- Subjects
business.industry ,Media strategy ,media_common.quotation_subject ,Public Health, Environmental and Occupational Health ,Public relations ,Public opinion ,Newspaper ,Harm ,Incentive ,Political science ,Law ,business ,Seriousness ,News media ,Mass media ,media_common - Abstract
Background Policies to use financial incentives to encourage healthy behaviour are controversial. Much of this controversy is played out in the mass media, both reflecting and shaping public opinion. Objective To describe UK mass media coverage of incentive schemes, comparing schemes targeted at different client groups and assessing the relative prominence of the views of different interest groups. Design Thematic content analysis. Subjects National and local news coverage in newspapers, news media targeted at health-care providers and popular websites between January 2005 and February 2010. Setting UK mass media. Results The study included 210 articles. Fifteen separate arguments favourable towards schemes, and 19 unfavourable, were identified. Overall, coverage was more favourable than unfavourable, although most articles reported a mix of views. Arguments about the prevalence and seriousness of the health problems targeted by incentive schemes were uncontested. Moral and ethical objections to such schemes were common, focused in particular on recipients such as drug users or the overweight who were already stereotyped as morally deficient, and these arguments were largely uncontested. Arguments about the effectiveness of schemes and their potential for benefit or harm were areas of greater contestation. Government, public health and other health-care provider interests dominated favourable coverage; opposition came from rival politicians, taxpayers’ representatives, certain charities and from some journalists themselves. Conclusions Those promoting incentive schemes for people who might be regarded as ‘undeserving’ should plan a media strategy that anticipates their public reception.
- Published
- 2011
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42. Acceptability of financial incentives to improve health outcomes in UK and US samples
- Author
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Marianne Promberger, Theresa M. Marteau, Richard Ashcroft, and Rebecca C H Brown
- Subjects
Male ,Health (social science) ,medicine.medical_treatment ,Psychological intervention ,Global Medical Ethics ,0302 clinical medicine ,Surveys and Questionnaires ,Medicine ,030212 general & internal medicine ,behaviour modification ,media_common ,Aged, 80 and over ,030503 health policy & services ,Health Policy ,Middle Aged ,Preference ,3. Good health ,Pill ,Female ,0305 other medical science ,Clinical psychology ,Adult ,medicine.medical_specialty ,Adolescent ,Patients ,media_common.quotation_subject ,Context (language use) ,Health Promotion ,Young Adult ,03 medical and health sciences ,Patient Education as Topic ,Reward ,Arts and Humanities (miscellaneous) ,Humans ,Psychiatry ,Aged ,Quality of Health Care ,Internet ,Motivation ,Allocation of health care resources ,business.industry ,Addiction ,population policy ,Patient Acceptance of Health Care ,Mental illness ,medicine.disease ,United Kingdom ,United States ,Issues, ethics and legal aspects ,Health promotion ,Smoking cessation ,business - Abstract
In an online study conducted separately in the UK and the US, participants rated the acceptability and fairness of four interventions: two types of financial incentives (rewards and penalties) and two types of medical interventions (pills and injections). These were stated to be equally effective in improving outcomes in five contexts: (a) weight loss and (b) smoking cessation programmes, and adherence in treatment programmes for (c) drug addiction, (d) serious mental illness and (e) physiotherapy after surgery. Financial incentives (weekly rewards and penalties) were judged less acceptable and to be less fair than medical interventions (weekly pill or injection) across all five contexts. Context moderated the relative preference between rewards and penalties: participants from both countries favoured rewards over penalties in weight loss and treatment for serious mental illness. Only among US participants was this relative preference moderated by perceived responsibility of the target group. Overall, participants supported funding more strongly for interventions when they judged members of the target group to be less responsible for their condition, and vice versa. These results reveal a striking similarity in negative attitudes towards the use of financial incentives, rewards as well as penalties, in improving outcomes across a range of contexts, in the UK and the USA. The basis for such negative attitudes awaits further study.
- Published
- 2011
- Full Text
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43. Book reviews
- Author
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Alexander Howard, Richard Ashcroft, Elizabeth Rosen, Michael Hallam, Katie Reid, Bethany Layne, and Yugin Teo
- Subjects
Space (punctuation) ,History ,Literature and Literary Theory ,Humanities ,Law and economics - Abstract
Karin Ikas and Gerhard Wagner (eds), Communicating in the Third Space (Abingdon, Oxon, and New York: Routledge, 2009), 203pp., £75.00 (hbk)
- Published
- 2011
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44. Personal financial incentives in health promotion: where do they fit in an ethic of autonomy?
- Author
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Richard Ashcroft
- Subjects
business.industry ,030503 health policy & services ,media_common.quotation_subject ,Public Health, Environmental and Occupational Health ,Agency (philosophy) ,Context (language use) ,Coercion ,Public relations ,Paternalism ,03 medical and health sciences ,0302 clinical medicine ,Health promotion ,Incentive ,030212 general & internal medicine ,Business ,0305 other medical science ,Social responsibility ,Autonomy ,media_common - Abstract
Aim This paper reviews the ethical controversy concerning the use of monetary incentives in health promotion, focussing specifically on the arguments relating to the impact on personal autonomy of such incentives. Background Offering people small amounts of money in the context of health promotion and medical care has been attempted in a number of settings in recent years. This use of personal financial incentives has attracted a degree of ethical controversy. One form of criticism is that such schemes interfere with the autonomy of the patient or citizen in an illegitimate way. Methods This paper presents a thematic analysis of the main arguments concerning personal autonomy and the use of monetary incentives in behaviour change. Results The main moral objections to the uses of incentives are that they may be in general or in specific instances paternalistic, coercive, involve bribery, or undermine the agency of the person. Conclusion While incentive schemes may engage these problems on occasion, there is no good reason to think that they do so inherently and of necessity. We need better behavioural science evidence to understand how incentives work, in order to evaluate their moral effects in practice.
- Published
- 2011
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45. Could Human Rights Supersede Bioethics?
- Author
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Richard Ashcroft
- Subjects
Sociology and Political Science ,Human rights ,Corporate governance ,media_common.quotation_subject ,Doctrine ,Bioethics ,Scholarship ,Politics ,International human rights law ,Law ,Public sphere ,Sociology ,media_common - Abstract
Bioethics and human rights are now well-established sets of norms, practices, institutions and methods for regulating the life sciences and medicine in the public sphere. Recent scholarship, and to some extent states' practice, in the governance of the life sciences and medicine have suggested that the field of bioethics may become subsumed into human rights law and practice. In this article, I discuss the current relationship between bioethics and human rights as public discourses and practices of governance of the life sciences and medicine, focussing particularly on human biomedicine. I analyse the thesis, notably associated with Australian health lawyer Thomas Faunce, that interna- tional human rights law will subsume bioethics. I argue that there are various theoretical and practical difficulties in the way of this thesis, but that these may be overcome. My claim is that if they are overcome, it will not be due to intellectual necessity, but to do with historical and political contingencies. Both bioethics and human rights must be understood as messy practices emerging from the interplay of doctrine, intellectual debate, institutional form, political interests and the actions of interested parties. The question will be not, could human rights supersede bioethics, but rather, which interests would be served by such a convergence?
- Published
- 2010
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46. Acceptability of offering financial incentives to achieve medication adherence in patients with severe mental illness: a focus group study
- Author
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Mike Firn, Stefan Priebe, John Larsen, Alexandra Burton, Richard Ashcroft, Stamatina Marougka, and Julia Sinclair
- Subjects
Adult ,Male ,medicine.medical_specialty ,Health (social science) ,financial incentives ,Cost-Benefit Analysis ,Coercion ,applied and professional ethics ,Medication Adherence ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Empirical research ,Reward ,Arts and Humanities (miscellaneous) ,Nursing ,medicine ,Humans ,030212 general & internal medicine ,Psychiatry ,behaviour modification ,Aged ,Clinical Ethics ,Motivation ,Government ,business.industry ,Mental Disorders ,Health Policy ,Focus Groups ,Middle Aged ,Mental illness ,medicine.disease ,Focus group ,United Kingdom ,3. Good health ,030227 psychiatry ,Therapeutic relationship ,Issues, ethics and legal aspects ,Incentive ,philosophy of the health professions ,Female ,business ,qualitative research ,Medical ethics ,Antipsychotic Agents - Abstract
Background Offering financial incentives to achieve medication adherence in patients with severe mental illness is controversial. Aims To explore the views of different stakeholders on the ethical acceptability of the practice. Method Focus group study consisting of 25 groups with different stakeholders. Results Eleven themes dominated the discussions and fell into four categories: (1) ‘wider concerns’, including the value of medication, source of funding, how patients would use the money, and a presumed government agenda behind the idea; (2) ‘problems requiring clear policies’, comprising of practicalities and assurance that incentives are only one part of a tool kit; (3) ‘challenges for research and experience’, including effectiveness, the possibility of perverse incentives, and impact on the therapeutic relationship; (4) ‘inherent dilemmas’ around fairness and potential coercion. Conclusions The use of financial incentives is likely to raise similar concerns in most stakeholders, only some of which can be addressed by empirical research and clear policies.
- Published
- 2010
- Full Text
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47. Retaining Older People in Longitudinal Research Studies: Some Ethical Issues
- Author
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Gill Mein, Clive Seale, Suneeta Bhamra, Richard Ashcroft, and Anthea Tinker
- Subjects
Gerontology ,Longitudinal study ,Ethical issues ,medicine.disease ,Civil servants ,Focus group ,Education ,Philosophy ,medicine ,Research studies ,Attrition ,Cognitive impairment ,Older people ,Psychology - Abstract
The increase in drop-out rates, especially among older people, in longitudinal studies is a matter for concern if the results are to be valid. The research reported here contains a number of pieces of evidence that might help address the problem. These include a literature review, a survey of some longitudinal studies, secondary (quantitative and qualitative) analysis of the data from a longitudinal study of civil servants (the Whitehall II study), and new data from focus groups and telephone interviews with participants from this current study. The findings relate to reasons why older people continue to take part in such studies, why they drop out and what might encourage them to continue participating. The main reasons for drop out relate to being older, having cognitive impairment and poor functioning, living alone, being a woman and being less educated. There were also a range of practical reasons including the study being too time-consuming and problems with transport.
- Published
- 2009
- Full Text
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48. Epistemologic Inquiries in Evidence-Based Medicine
- Author
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Benjamin Djulbegovic, Gordon H. Guyatt, and Richard Ashcroft
- Subjects
Philosophy of science ,Evidence-Based Medicine ,business.industry ,Instrumentalism ,Nature of Science ,Hematology ,General Medicine ,Evidence-based medicine ,Epistemology ,Scientific evidence ,Philosophy ,Knowledge ,Oncology ,Research Design ,Humans ,Medicine ,Holism ,Philosophical theory ,business ,Underdetermination - Abstract
Background: Since the term “evidence-based medicine” (EBM) first appeared in the scientific literature in 1991, the concept has had considerable influence in many parts of the world. Most professional societies, the public, and funding agencies have accepted EBM with remarkable enthusiasm. The concept of evidence-based practice is now applied in management, education, criminology, and social work. Yet, EBM has attracted controversy: its critics allege that EBM uses a narrow concept of evidence and a naive conception of the relationships between evidence, theory, and practice. They also contend that EBM presents itself as a radical restructuring of medical knowledge that discredits more traditional ways of knowing in medicine, largely in the interests of people with a particular investment in the enterprise of large-scale clinical trials. Because EBM proposes a specific relationship between theory, evidence, and knowledge, its theoretical basis can be understood as an epistemological system. Undertaking epistemological inquiry is important because the adoption of a particular epistemological view defines how science is conducted. Methods: In this paper, we challenge this critical view of EBM by examining how EBM fits into broad epistemological debates within the philosophy of science. We consider how EBM relates to some classical debates regarding the nature of science and knowledge. We investigate EBM from the perspective of major epistemological theories (logical-positivism/inductivism, deductivism/falsificationism/theory-ladeness of observations, explanationism/holism, instrumentalism, underdetermination theory by evidence). Results: We first explore the relationship between evidence and knowledge and discuss philosophical support for the main way that evidence is used in medicine: (1) in the philosophical tradition that “rational thinkers respect their evidence,” we show that EBM refers to making medical decisions that are consistent with evidence, (2) as a reliable sign, symptom, or mark to enhance reasonableness or truthfulness of some particular claim (“evidence as a guide to truth”), and (3) to serve as a neutral arbiter among competing views. Our analysis indicates that EBM does not have a rigorous epistemological stance. In fact, EBM enthusiastically draws on all major traditions of philosophical theories of scientific evidence. Conclusions: Our findings indicate that EBM should not be construed as a new scientific or philosophical theory that changes the nature of medicine or our understanding thereof. Rather, we should consider EBM as a continuously evolving heuristic structure for optimizing clinical practice.
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- 2009
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49. Doing accountability: a discourse analysis of research ethics committee letters
- Author
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Michelle O’Reilly, Alan Bryman, Emma Angell, Richard Ashcroft, and Mary Dixon-Woods
- Subjects
Social Responsibility ,Research ethics ,Biomedical Research ,Health (social science) ,business.industry ,Health Policy ,Discourse analysis ,Ethical decision ,Public Health, Environmental and Occupational Health ,Abuse of power ,Public relations ,Correspondence as Topic ,United Kingdom ,Ethics, Research ,Power (social and political) ,Research Support as Topic ,Law ,Accountability ,Humans ,Sociology ,business ,Social responsibility ,Legitimacy ,Ethics Committees, Research - Abstract
Research ethics committees (RECs) are charged with adjudicating the ethical status of research projects, and determining the conditions necessary for such projects to proceed. Both because of their position in the research process and because of the controversial nature of ethical judgements, RECs' views and decisions need to be accountable. In this paper we use techniques of discourse analysis to show how REC decision letters 'do' accountability. Using a sample of 260 letters from three datasets, we identify a range of discursive devices used in letters written by RECs. These include drawing attention to: the process behind the decision, including its collaborative nature; holding the applicants accountable, by implying that any decision made by the REC can be attributed to the performance of the applicants; referring to specialist expertise; and calling upon external authorities. These tactics 'do' accountability by showing that routines of ethical assessment have been enacted, by establishing the factuality of claims, and by managing questions of fault and blame attribution. They may, however, also risk undermining legitimacy by failing to acknowledge the inherent contestability of ethical decision making or the limited nature of the cultural authority accorded to RECs, and thus may appear as an illegitimate exercise of power.
- Published
- 2009
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50. The place for harm reduction and product regulation in UK tobacco control policy
- Author
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Richard Ashcroft, Deborah Arnott, Anna Gilmore, Martin J. Jarvis, and John Britton
- Subjects
Tobacco harm reduction ,Nicotine ,Harm reduction ,business.industry ,medicine.medical_treatment ,Smoking ,Tobacco control ,Public Health, Environmental and Occupational Health ,Public Policy ,General Medicine ,Tobacco industry ,United Kingdom ,Harm ,Harm Reduction ,Smokeless tobacco ,Tobacco in Alabama ,Environmental health ,Humans ,Medicine ,Smoking cessation ,business - Abstract
Tobacco use remains the leading cause of preventable death in this country and more needs to be done to reduce smoking rates. Harm reduction is one policy option. Smokers smoke for the nicotine, but die from the other toxins in cigarette smoke. Harm reduction in tobacco control aims to reduce the harm arising from nicotine use by shifting smokers, who are unable to quit, to using far less hazardous sources of nicotine, notably medicinal nicotine, in place of cigarettes. This article argues that for harm reduction to work in the UK, a nicotine product regulation authority is first needed. This would regulate nicotine products in proportion to harm to ensure that, contrary to the current paradoxical arrangements, the most harmful source of nicotine, the cigarette, becomes the most highly regulated (and thus the least easily accessible, available and attractive). It goes onto explore how a harm reduction strategy might be further developed, exploring controversies and potential pitfalls. It argues that the public health community needs to own and drive this debate because failure to do so would let the tobacco industry gain the upper hand and see thousands of more unnecessary deaths from tobacco use.
- Published
- 2008
- Full Text
- View/download PDF
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