Introduction Placebos have been used in medical treatments since the dawn of medicine. The placeboeffect is referred to as a beneficial effect of a treatment which cannot be attributed to thepharmacological component of the treatment given. Aim and Method We attempt to understand the current research regarding the placebo effect, its mechanismsand driving factors. We utilize hermeneutics, text-based analytics and argument analysis toanswer our ethical questions regarding the usage of placebo and the placebo effect. Results Classical conditioning and expectation have been accredited as the two most prominentfactors driving a placebo effect. Recent research focuses on identifying minor factorsinfluencing these prominent factors. Through modern imaging techniques researchers haveidentified physiological responses to the placebo effect.We pose four different ways in which a placebo treatment option could be considered ineveryday medicine. We also discuss whether the placebo effect should be used for itsbeneficial effects in all medical treatments, and how this could affect medicine and healthcarepractitioners. Conclusion Current research provides us with substantial evidence that the placebo effect has aphysiological component. It also provides us with explanations as to how this effect can beutilized in every day medical care. The placebo effect can even be utilized without deceivingthe patient which has always been the biggest argument against incorporating it in day to daymedicine. However, there is still lacking evidence of when a placebo effect can be utilized toits full potential which limits its current clinical applications.

abstract: In the last 200 years, advancements in science and technology have made understanding female sexual function and the female body more feasible; however, many women throughout the US still lack fundamental understanding of the reproductive system in the twenty-first century. Many factors contribute to the lack of knowledge and misconceptions that women still have. Discussing sexual health tends to make some people uncomfortable and this study aims to investigate what aspects of somewhat recent US history in women’s health care may have led to that discomfort. This thesis examines the question: what are some of the factors that shaped women’s reproductive medicine in the US from the mid 1800s and throughout the 1900s and what influence could the past have had on how women and their physicians understand female sexuality in medicine and how physicians diagnose their female patients in the twenty-first century. A literature review of primary source medical texts written at the end of the 1800s provides insight about patterns among physicians at the time and their medical practice with female patients. Factors like gendered expectations in medical practice, misconceptions about the female body and behaviors, and issues of morality in sex medicine all contributed to women lacking understanding of sex female reproductive functions. Other factors like a physician’s role throughout history and non-medical reproductive health providers and solutions likely also influenced the reproductive medicine women received. Examining the patterns of the past provides some insight into some of the outdated and gendered practices still exhibited in healthcare. Expanding sexual education programs, encouraging discussion about sex and reproductive health, and checking gendered implicit bias in reproductive healthcare could help eliminate echoes of hysteria ideology in the twenty-first century medicine. / Dissertation/Thesis / Masters Thesis Biology 2019

The partnership between medical academia and the pharmaceutical industry has been scrutinized for issues associated with research bias. As a result of this scrutiny, the Institute of Medicine (IOM) issued policy recommendations in 2009 directing academia to adopt comprehensive conflict of interest (COI) policies. During the same time, a slowdown of funded research into academia occurred, and it is not clear whether the IOM recommendations contributed to this problem. The purpose of this case study was to determine the extent to which compliance with the IOM policy resulted in a reduction in funded research. The Advocacy Coalition Framework (ACF) was the theoretical lens used for study. COI policy statements (n = 15) were analyzed from American Association of Medical Colleges member schools that engage in medical research. In addition, in-depth interviews were conducted with 4 medical academic researchers. Data were inductively coded and organized around key themes. Key findings indicated that medical academia is compliant with IOM recommendations and COI policies did not appear to have a direct effect on research placement by industry. Interestingly, a possible explanation for reductions in industry funding relate to inefficient institutional review board processes. Additionally, the ACF construct was validated via an observed complex and slowly evolving COI policy process. The positive social change implications of this study include recommendations to academia to continue to monitor and report on COI and explore efficiency improvements related to IRB oversight in order to support important pharmaceutical research that ultimately improves the health and wellbeing of people.

An estimated 300,000 people contract Lyme disease in the USA every year, 10-20% of whom will experience long-term symptoms even after antibiotic treatment. These patients are said to have Chronic Lyme Disease (CLD). However, diagnostic guidelines, treatment protocols, and the etiological existence of CLD have been the subject of much controversy in the biomedical field, leading to negative mental and physical health outcomes for of patients with CLD. Patient support networks focused on illness experience, known as biosocialities, have formed in response to this controversy. CLD biosocialities create opportunities for patients to participate in biomedical activism and the scientific research process. A historical precedent for biosocial impact on biomedical knowledge and improved health outcomes has been established from patient activists with HIV/AIDS, breast cancer, and PTSD. The impact of CLD patients’ biosocial activism on a scientific and sociological level is evaluated through an examination of the publications of CLD support networks and biomedical research publications. CLD biosocial activism has resulted in more patient-centered research endeavours, etiological proof of CLD, improved diagnostic technologies, and new treatment protocols. These biomedical results have implications for improved CLD patient health outcomes and credibility for CLD as a legitimate disease on a biological and sociological level.

With advancements in CRISPR-cas9 broadening the potential paths for clinical usage of genetic editing, conversations about genetic editing have grown to outside simply scientific communities and into mainstream conversations. This study focuses specifically on Christian discourse of genetic editing and locates four major tensions for many Christians when they think about genetic editing: beginning of life, Creator-human relationship, imago Dei, and stewardship. With these major concerns in mind, I identify epigenetics, somatic cell genetic editing, and in vivo genetic editing research as important research paths to pursue as they can potentially produce techniques that more Christian individuals would feel comfortable using. I pursue one of these paths and conclude with an experimental proposal for an analysis of in vivo and in vitro CIRSPR-Cas9 efficiency in regards to on- and off-target rates.

In the recent political climate, the debate regarding undocumented immigrants and what, if anything, they are entitled to in the US has been incredibly contentious. In the bioethics portion of this thesis, I examine two of the major frameworks for distributive justice, cosmopolitanism and the political conception, address the criminal aspect of undocumented immigration, and suggest a switch from a focus on criminality to focusing on the forces that incentivize undocumented immigration to determine the type of claim undocumented immigrants have to health resources. In the biology portion, I examine three case studies: respiratory tract infection, HIV/AIDS, and tuberculosis to illustrate health disparities among undocumented populations. I conclude that based on their participation in shared social cooperation and the unspoken shadow contract of companies incentivizing undocumented immigrants to come to the US to provide cheap labor, undocumented immigrants do have a right to access healthcare in the US. However, we should account for risk factors such as other marginalized identities, country of origin, and rate and methods of disease transmission when determining exactly what that care should look like.

In today's climate of consumer consultation in the development of client sensitive hospital and community based services, some voices have remained silent. Among this group are disabled children and young people, who receive professional care in a climate of 'in their best interest', firmly based on notions of abnormality and the inherent tragedy of disability. New paradigm childhood research and the social model of disability provide the theoretical framework for this qualitative study into the health and health care experiences of disabled children and young people. Both approaches demand a flexible and participatory approach in order to challenge the traditional relations of research production. Twenty young people aged 9-18 years met with the researcher up to four times, with a choice after the initial meeting of individual or group meetings. All had a physical disability, some also had communication or learning difficulties. Conversations with the young people covered a range of topics. The obvious ones related to hospitals, appointments, splints and therapy. About what it is like having a carer. Commonly held assumptions that hospitalisation is a significant feature of disabled childhoods is challenged by the data, appointments however reflect an ongoing surveillance. The young people spoke of experiences of empowerment and of powerlessness within a triad of parent:professional:young person. Concern that many treatments are an experiment and that outcomes are hard to balance with the pain and inconvenience of surgery or therapeutic devices raises questions regarding professional versus young person's definitions of success. It also demands debate regarding how much remedial intervention is enough. This is a difficult issue in a medical and social climate that idealises normality, but normality is not often an option. Health care constitutes only a narrow perspective of health and made up only a part of the discussion. It is the day to day health experiences that are more prominent in the lives of participants than intermittent professional services. The young people showed a recognition of factors that contributed to their health and sense of well being. Commonly the talk was about living in a world that considers them as different and the effect that has on them. These young people are making links between racism and their own disability experience, however they have no contact with disabled adults, some with no other disabled young people and no understanding of disability history or politics. This lack became even more evident when the participants talked about who understands what their life is like, of role models, realistic aspirations and dreams for quiet moments. School issues raised concerns such as equity in access, being different, having to prove oneself, limited school sport involvement and issues of friendship and teasing. One very powerful finding is that just like anyone else they are all different but that stereotypes of disability limit the lives of disabled young people and influence the responses of other people to them. This demanded from the researcher an interaction with the different experiences and responses to experiences of participants or risk creating another, albeit different stereotype. / thesis (PhD)--University of South Australia, 2001.

This thesis explores, through critical dialogue and personal experience, various aspects of rehabilitation in the context of Myalgic Encephalomyelitis or Chronic Fatigue Syndrome. The journey visits broad, in principle, government policy reports. It touches on insurance and political aspects of health care; the separation between medical, convalescent and tertiary divisions of the rehabilitation professions; and, most importantly, it is concerned with the personal struggle to find some ‘meaning’ in the experience of a chronic illness for which there is, at this stage, no cure. From this arises the complexity of the inter-relationships between professionals and clients and the vexed question of ethics. The writing or methodology is first-person narrative, with deep roots in natural philosophy, and the dissertation can be read on several levels. It can also be read as a meta-thesis, that is, as an illustration of the process of researching/writing in an experiential methodology / Master of Science (Hons) Social Ecology

This thesis is an exploration of professional behaviour in health care settings, using a Model of Treatment Engagement that is developed as a tool for ethics critique. The Model is tested and refined using data on: a psychiatric ???treatment??? carried out on over 1,127 occasions in a 15 - 40 bed non-acute hospital during the period 1961-1979; the problematic withdrawal of all life-support from a 37 year old man who had suffered acute brain trauma some five days previously, in a tertiary hospital in March 2000; and a clinical experiment recently proposed for the emergency setting and intended to encompass five hospitals and the NSW Ambulance Service. In each case, the Model proves useful in identifying the shift from the treatment paradigm and the ethical imperative of ensuring the patient (or his/her agent) appreciates the difference between what is proposed and what would normally be done. It reveals how doctors who dealt with the patient but did not decide on treatment contributed to ethically troublesome practice. It clarifies how having multiple doctor players in the treatment situation gave rise to the need to suppress dissenting views. Doctors who were close enough to the action to comprehend its nature, by not dissenting, reinforced the problematic choice for the actor and validated it in the eyes of observers. The lack of dissent at the level of doctors working under supervision, appeared to be a function of institutional arrangements. At the consultant level, there was evidence of pressure to concur from other consultants and indirect evidence of a fear of ostracism. The public responses in the two modern cases point to there being a strong idea in Sydney???s medical community that dissent should not be publicly displayed once a decision on how to treat has been made. I conclude there are two steps to reviewing ethically problematic treatment situations. The first consists of identifying the shift from the treatment paradigm. The second consists of establishing why the problematic choice is translated into action. The Treatment Engagement Model is put forward as a useful tool for both these analyses.

The provision of medical care to top-level athletes in New Zealand comes with a number of challenging ethical issues. Some of these arise out of the commercial interest present in sport that links sporting success with funding, sponsorship deals and media interest. The requirement that athletes stay at peak physical function in order to be successful can, at times, be at odds with concepts of well-being and good health. The employment structure under which doctors are engaged by teams and the employment contracts which define these relationships can be the source of divided loyalty for doctors. For example, sharing health information beyond the doctor-athlete relationship may be in line with contractual obligations, but at odds with what the athlete requests. Divided loyalties also exist when athletes wish to participate in sport despite high risk of harm. Here there is a difference between what the doctor understands as the athlete�s best interest, and the athlete�s consideration of best interest. This thesis adopts two strategies for examining the area of sports medicine in elite athletes in New Zealand. The first section utilizes qualitative research. Sixteen sports doctors were interviewed and the data analysed. The next section involves normative reflection. Here two issues (where a range of behaviours were exhibited by participants) selected from the data are considered and discussion is presented on how doctors should respond to these issues. An examination of the level of guidance offered to sports doctors from the Australasian College of Sports Physician�s Code of Ethics follows. The level of guidance offered is considered inadequate and the thesis ends with a call to attend to these concerns.