Human Values as Normative Propositions in Design of Pharmacotherapy Processes: a conversational workshop
with David Healy, speaking on:
The Eclipse of Medical Care
Leslie Dan Faculty of Pharmacy, Joint Center for Bioethics, and Knowledge Media Design Institute.
Monday, March 12 4:00-6:00
Fitzgerald Building, 150 College St, rm 103
to be followed by reception 6:00-7:00
in Leslie Dan Bldg Atrium 144 College St
contact: Peter Pennefather; 416-978-6607, firstname.lastname@example.org
In all sectors of society, there are calls for innovation and re-design of core processes. Value driven, holistic, integrative, conceptual, approaches to exploring the ecology in which those processes function are called for. The health care sector is no different. But what values should be applied?
This workshop examines how human values such as intrinsic rights, public value, and social equity can be conceptualized and studied within the context of the design and delivery of medicine based systems of therapy. It is proposed that human values as necessary normative propositions that should guide design of pharmacotherapy, especially when it influences that which make us human.
A plenary talk by David Healy on “The Eclipse of Medical Care” will address values currently driving clinical prescribing and the problems that an emphasis on procedures have generated. This will be preceded by short presentations that explore research strategies related to evaluation of the value of prescribed medicines that put human values at the center but come from different perspectives: legal (Trudo Lemmens), economic (Paul Grootendorst) and philosophical (Alison Thompson).
4:10-4-16 Welcome & Introduction Peter Pennefather
4:16-4:22 Legal Values Trudo Lemmens
4:22-4:28 Economic Values Paul Grootendorst
4:28-4:34 Philosophical Values Alison Thompson
4:34-4:36 Introduction of David Healy Lawrence Librach
4:36-5:30 The Eclipse of Medical Care David Healy
5:30-5:45 Conversation with panel Panel
5:45-6:00 Conversation with audience Audience
THE ECLIPSE OF MEDUCAL CARE
David Healy, M.D.
We live in an Evidence Based Medicine world. Almost everyone assumes this means Data Based Medicine and that if the data point in a particular direction this should trump the values and experience of individual doctors and produce the best outcome for patients. But there is increasing evidence of a mismatch between the so called evidence and the real data from studies. Pharmaceutical companies sequester clinical trial data and publish only the material that suits them.
This ‘evidence’ is then embodied in guidelines that have all but taken over clinical prescribing in a manner comparable to the way that GPS takes over the driving of a car. As a result, both patient and doctor are increasingly invisible in the clinical encounter and the ability of Doctors to Care is being lost. More to the point, adverse events on drugs in some areas of medicine are now the leading cause of death.
This situation hinges on the current patent laws for drugs, on the prescription only status for drugs, and on company trials – protections that were all put in place to save us from another Thalidomide. Treating the growing crisis in medicine will require remedies targeting one or more of these factors. In the meantime, doctors or others need to speak up for patients who are being injured by treatments – but increasingly this will appear to pit us against the ‘science’ and the question for each of us is whether we remain to take this stand or not.
Biography – David Healy
David Healy is a Professor of Psychiatry at Cardiff University. He studied medicine in University College Dublin, Ireland, and at Cambridge University. He is a former Secretary of the British Association for Psychopharmacology, and author of over 150 peer reviewed articles, 200 other pieces and 20 books, including The Antidepressant Era, and The Creation of Psychopharmacology from Harvard University Press, The Psychopharmacologists Volumes 1-3, Let Them Eat Prozac from NYU Press, & Mania from Johns Hopkins U Press and Pharmageddon. His main areas of research are clinical trials in psychopharmacology, the history of psychopharmacology, and the impact of both trials and psychotropic drugs on our culture.
He has been involved as an expert witness in homicide and suicide trials involving psychotropic drugs, and in bringing problems with these drugs to the attention of American and British regulators, as well raising awareness of how pharmaceutical companies sell drugs by marketing diseases and co-opting academic opinion-leaders, ghost-writing their articles.
With colleagues he has helped set up a patient adverse event reporting website – www.RxISK.org.
Peter Pennefather is a professor in the Leslie Dan Faculty of Pharmacy and is is a director of the Laboratory for Collaborative Diagnostics (www.lcd.utoronto.ca). His training is in pharmacology, neuroscience and biophysics. His current research focuses on the process of collaborative diagnostics and data sharing infrastructure used in health systems, with a particular focus on mapping physical signature data associated with attributes and qualities of biological systems as well as medicinal products. He is also outreach director for the UofT Knowledge Media and Design Institute (www.kmdi.utoronto.ca).
Alison Thompson is an Assistant Professor in the Leslie Dan Faculty of Pharmacy and is affiliated with the Joint Centre for Bioethics. She has a background in philosophy (applied ethics) and social science. She focuses on the public understanding of science, and on public health ethics and policy. Her current research focuses on the social and ethical issues in public participation in health policy-making and emergency preparedness, and on public understanding of science issues that relate to pharmacy.
Trudo Lemmens is Associate Professor at the Faculty of Law of the University of Toronto, where he holds the Dr. William M. Scholl Chair in Health Law and Policy. He is also cross-appointed to the Faculty of Medicine and is affiliated with the Joint Centre for Bioethics and the Centre for Ethics. He obtained law degrees, including a Master’s in Laws and Bioethics (LLM) and a Doctorate in Law (DCL), from the KULeuven and McGill University. His publications include the co-edited volume Law and Ethics in Biomedical Research: Regulation, Conflict of Interest, and Liability (University of Toronto Press, 2006) as well as numerous chapters and articles on the role and impact of law and regulation in the context of medical research and biotechnological innovation. He is particularly interested in the interaction between law regulation and ethical norms in the context of health care and medical research and health product development,
Paul Grootendorst is the Director of the Division of Clinical, Social and Administrative Pharmacy in the Leslie Dan Faculty of Pharmacy. He also holds faculty appointments in the UofT School of Public Policy and Governance and in the Department of Economics, McMaster University. An economist by training, he is interested in various aspects of pharmaceuticals use, insurance and reimbursement; intellectual property and other policies to promote pharmaceutical innovation; and methods for program evaluation using observational (health survey and administrative health care claims and vital statistics) data.