Baruch Brody

(1943 - 2018)

BACKGROUND: Many published accounts of clinical trials report no differences between the treatment arms, while being underpowered to find differences. This study determined how the authors of these reports interpreted their findings. STUDY DESIGN: We examined 54 reports of surgical trials chosen randomly from a database of 110 influential trials conducted in 2008. Seven that reported having adequate statistical power were excluded from further analysis, as were the 32 that reported significant differences between the treatment arms. We examined the remaining 15 to see whether the authors interpreted their negative findings appropriately. Appropriate interpretations discussed the lack of power and/or called for larger studies. RESULTS: Three of the 7 trials that did not report an a priori power calculation offered inappropriate interpretations, as did 3 of the 8 trials that reported an a priori power < 0.90. However, we examined only a modest number of trial reports from 1 year. CONCLUSIONS: Negative findings in underpowered trials were often interpreted as showing the equivalence of the treatment arms with no discussion of the issue of being underpowered. This may lead clinicians to accept new treatments that have not been validated.

A traditional ethic of medicine asserts that physicians have special obligations to individual patients with whom they have a clinical relationship. Contemporary trends in US healthcare financing like bundled payments seem to threaten traditional conceptions of special obligations of individual physicians to individual patients because their population-based focus sets a tone that seems to emphasise responsibilities for groups of patients by groups of physicians in an organisation. Prior to undertaking a cogent debate about the fate and normative weight of special obligations and a traditional ethic for contemporary healthcare, we need a deeper examination of what the traditional ethic of special obligations really means. Here we offer a conception of ‘doubly distributed’ special obligations. Physicians and similarly minded healing professionals abiding by a traditional ethic have always spread their devotion and attention across multiple patients and have shared responsibilities with physician and non-physician colleagues in much the same way devoted parents have frequently distributed their special obligations across multiple children and across multiple parents. By taking up the extended analogy of parent we argue that doubly distributing special obligations need not contradict the possibility of special obligations in restructured collective forms of healthcare delivery and financing.

Public statements by various international groups emphasize that decisions to undergo genetic screening, either for disease-carrier status or for predisposition-to-disease status, and decisions about the use of the resulting information should be made voluntarily by the party to be screened. For example, the World Medical Association, in its Declaration on the Human Genome Project, says, “One should respect the will of persons screened and their right to decide about participation and about the use of the information obtained.” Giving this principle a name, “voluntarism,” the Council for International Organizations of Medical Sciences, in its Declaration of Inuyama, announced that “voluntarism should be the guiding principle in the provision of genetic services.

"When it comes to morality as it is practiced in medicine, Brody makes clear that the ethical issues are never as simple as black and white - that there are myriad factors and fine nuances that can and should challenge decision making as it is commonly practiced in difficult medical cases. In this collection, delving thoughtfully and systematically into methodology, research ethics, clinical ethics, and Jewish medical ethics, he tackles thorny life-and-death questions head-on and fearlessly. He casts a light into all the corners of end-of-life decisions - a field in which he has exemplary credentials - while illuminating a new understanding of morality and ethics." "The introduction outlines much of Brody's approach, defines the terminology used, and contrasts his ethical positions with much of the competing literature, Taking Issue will be invaluable to students and scholars in medical ethics, bioethics, and the philosophy of medicine." "Baruch A. Brody is the Leon Jaworski Professor Biomedical Ethics and director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine. He is also a professor of philosophy at Rice University and director of the Ethics program at the Methodist Hospital."--BOOK JACKET.

I will, in this paper, set out the philosophical foundations and the basic structure of a new theory of justice. I will argue that both these foundations and the theory which is based upon them are intuitively attractive and theoretically sound. Finally, I will argue that both are supported by the fact that they lead to attractive implications such as the following: One can justify at least some governmental redistributive programs which presuppose that those receiving the wealth have a right to it, without being committed to any form of egalitarianism. The justification for these redistributive programs respects property entitlements; it argues, in effect, that property entitlements and rights to some redistribution of wealth presuppose each other, rather than being in conflict with each other. The amount of redistribution to which each indigent person is entitled is directly proportional to the wealth of the society in question and inversely proportional to the number of indigents in the society in question. There are at this stage in the history of Western thought few entirely new ideas in philosophy. Too much has been written about the important issues to allow for entirely new approaches. My theory is no exception to these generalizations, for it draws upon the tradition of John Locke, of the agrarian reforms such as Paine, Spence, and Ogilvie, and of libertarian writers such as Robert Nozick. Nevertheless, I will argue, the resulting theory is a significant advance over the ideas of these earlier writers

: Continuing the discussion begun in the March 2006 issue of the Kennedy Institute of Ethics Journal, this paper further documents the failure of the United States to adequately consider possible modifications in the traditional robust system of intellectual property rights as applied to biotechnology. It discusses concrete suggestions for alternative disclosure requirements, for exemptions for research tools, and for improved access to clinical advances. In each of these cases, the modifications might be more responsive to the full set of relevant values

: Pharmacogenetics offers the prospect of an era of safer and more effective drugs, as well as more individualized use of drug therapies. Before the benefits of pharmacogenetics can be realized, the ethical issues that arise in research and clinical application of pharmacogenetic technologies must be addressed. The ethical issues raised by pharmacogenetics can be addressed under six headings: regulatory oversight, confidentiality and privacy, informed consent, availability of drugs, access, and clinicians' changing responsibilities in the era of pharmacogenetic medicine. We analyze each of these categories of ethical issues and provide policy approaches for addressing them