PROFESSIONAL ETHICS REPORT

ANTHRAX, CIPRO AND DRUG RESISTANCE: HOW TACTICS FOR FIGHTING AN ENEMY MAY HAVE LOST US A FRIEND

By Kristina Schaefer

Kristina Schaefer is Program Associate in AAAS’s Scientific Freedom, Responsibiltiy & Law Program. She is also Managing Editor of Professional Ethics Report.

The recent Anthrax scare and the public and government response led to unguarded decisions prompted by fear and haste. Policies regarding the prescription of Cipro have pushed the boundaries of good medical practice regarding the use of prescription drugs and drug compliance, boundaries that have been difficult to enforce even in normal times.

Two behaviors are largely responsible for the ever-increasing development of drug resistance: taking antibiotics when you don’t need them and not taking the full course of treatment when you do need them. Actions and reactions regarding Cipro illustrate these behaviors clearly. The federal government issued Cipro prescriptions to 48,000 people who may have been exposed to anthrax. In New York, 32,000 Cipro prescriptions were issued in October, up 434 percent from the previous month.(1) Overall, for the third week in October, 62,747 more Cipro prescriptions were sold by stores and via mail than in that week in 2000.(2) Most of these prescriptions were based on an extreme overreaction to the possibility of exposure, rather than actual exposure.

The cause of our brief, but torrid, affair with Cipro was quite simply fear. It is a fear of not knowing how many letters there were and of a believed 90% mortality rate for inhalation anthrax. In the general public, fear, feeding off of official misinformation and uncertainty, created overwhelmed emergency rooms and a demand for a drug that before September 11, few people knew by name.(3)

Cipro (ciprofloxacin) is one of the fluroquinolones, the first line of entirely synthetic antibiotics, sits on the back lines of the fight against infectious diseases. Because it is new, it is one of the drugs that medical professionals turn to when the others don’t work. For example, it is one of two kinds of antibiotics that pneumoccus (a common bacterium that causes pneumonia, ear infections, meningitis, among others) hasn’t yet learned to resist.

Cipro is becoming the preferred treatment of medical professionals for several infectious diseases, including gastrointestinal and urinary tract infections and pneumonia, as older antibiotics become useless. However, it was the FDA, not the medical community, that somewhat arbitrarily named Cipro the preferred treatment for anthrax when clinical trials showed the drug cured anthrax in animals. It was this ruling that led to the recent “run” on Cipro prescriptions. However, as shown by the imposed switch to docxycycline for government employees after concerns expressed by health officials about increasing drug resistance, Cipro was never the only option. Unfortunately, the general public, unregulated by such restrictions, had already developed a one-track mind with regards to the drug.

Regarding government issued prescriptions, one can argue that the reason so few cases of inhalation anthrax were diagnosed in government and postal workers was because of their prophylactic use of the antibiotic. However, one cannot say the same for those thousands of New Yorkers who weren’t exposed. In fact, one cannot be sure of what these people did with their Cipro. Some may have taken it; some may be hoarding it. One person guilty of hoarding compares hoarding Cipro to hoarding food or water in the case of an emergency, and it is likely that opinion is shared by many.(4)

As previously mentioned, keeping antibiotics on hand just in case, is one of the major causes of the evolution of drug resistant bacteria. Even during normal times when terrorism and anthrax were not a concern, people have insisted on a prescription whether they needed one on or not.(5) The reason for this attitude may have been a number of factors —perhaps a lack of knowledge about the difference between a bacterial and a viral infection or the need to feel the trip to the doctor or hospital was worth it. For example, a 1996 Journal of Family Practice survey of pediatricians reported that 40% of children walk away with a prescription after a visit to the doctor, often thanks to very insistent, obstreperous parents.(6) Unfortunately, once the patient — child or adult — feels better the antibiotic is often stopped and the remaining medication is left in the medicine cabinet for the next sore throat that comes along. In the meantime, the bacteria that weren’t killed yet by the antibiotic learned how to reinforce themselves against it and have survived to pass that ability on. It takes only two genetic mutations for bacteria to develop resistance and, with a new generation multiplying in minutes, these mutations can happen very quickly. Then, it takes one cough or sneeze for these “super bugs” to find themselves in another person’s body. The impact of people taking Cipro unnecessarily is still probably a few months off, but an even greater impact may be seen once those hoarding Cipro use it to medicate themselves for what is probably a bad cold.

Research and production of new antibiotics has been slow, even though they are some of the most often prescribed medications. This sluggishness on the part of the pharmaceutical community may be due to complacency regarding the potency of our current drugs or perhaps because antibiotics are largely based in naturally occurring chemicals that fight bacteria, although these chemicals can be difficult to find. The current research emphasis is on the use the recent genomic discoveries to produce drugs that affect the bacteria’s DNA, not only killing them, but perhaps preventing these type of mutations, but that development may be further off than we can wait.

Although the federal government recognized the drug resistance issue fairly early and stopped the Cipro for some and switched others over to doxycycline, the damage is largely done. The transition was difficult, as people suspected the doxycycline was an inferior drug to Cipro. This change in policy had no effect on the thousands who sought prescriptions out of panic. For those who take any antibiotic prophylactically, the normal bacteria present in their system, especially after being attacked by it for 60 days, will likely become resistant to it. Now, to compound the problem, confusion over the efficacy and safety of the anthrax vaccine has led most government and postal workers, having been offered another round of prophylactic treatment, to opt for more of antibiotics over the vaccine.(7)

The response to the anthrax scare is likely, if not certainly, to do more harm than good. Cystic fibrosis patients find themselves hospitalized for weeks as antibiotic after antibiotic is tried to find one that is stronger than the bacteria. Over 40,000 people die from pneumoccocus infections each year. Staph infections, once limited to hospitals, are popping up increasingly in outpatient clinics and the usual drugs are no longer working.(8) Since the 1980s, medical professionals have been wondering when antibiotics would stop working. By using Cipro as we have done, the life expectancy of one of our most potent and useful antibiotics has been severely shortened. Now, the day when an ear infection requires hospitalization may be closer than we think.

1 Ricks, Delthia. 32,000 Nyers were prescribed Cipro. Newsday. 13 Dec. 2001: Sec. A, p.8. Printed from the Lexis database, December 14, 2001.

2 Anthrax-fighting drugs apt to spur resistance in common bugs. Medical Letter to the CDC & FDA. 25 Nov. 2001: p.18. Printed from the Lexis database, December 10, 2001.

3 Wickham, DeWayne. What’s really scary today. USA Today. 7 Nov. 2001. p. 15A. Printed from the Lexis database, December 10, 2001.

4 Cohen, Randy. The Way We Live. The New York Times, 2 Dec. 2001, Sec. 6, p. 54. Printed from the Lexis database, December 10, 2001.

5 Elliot, Victoria Stagg. Doctors warn of Cipro resistance. American Medical News. 10 Dec. 2001. http://www.ama-assn.org/sci-pubs/amnews/pick_01/h1111210.htm

6 Parker-Pope, Tara. Pediatric doctors fear overuse of antibiotics may worsen. The Lexington Herald Leader. 11 Dec. 2001. Sec. Living Well, p.6. Printed from the Lexis database, December 12, 2001.

7 Connolly, Cecil. Workers exposed to anthrax shun vaccine.The Washington Post.8 Jan. 2002. Sec. A, p.6.

8 Dworkin, Andy. For bacteria in a Cipro world, resistance is not futile. The Oregonian. 28 Nov. 2001. Dec. C, p.11. Printed from the Lexis database, December 10, 2001.

COURT DISMISSES FELTEN CASE

On November 28, Federal District Court Judge Garret Brown dismissed the case of Ed Felten vs. the Recording Industry Association of America (RIAA) after less than 25 minutes of debate and without discussing First Amendment considerations. The case began last April, when a team of computer scientists from Princeton University sued the recording industry for the latter’s application of the Digital Millennium Copyright Act (DMCA). [See PER In the News, Spring 2001]

Since its adoption in 1998, the DMCA has spurred a wide range of lawsuits both from companies attempting to protect their products and from tech gurus vying for freedom of speech. Designed to protect such groups as the recording industry, the law prohibits providing technology and information that can be used to gain access to a copyrighted work. Many scientists and software security specialists, who are accustomed to writing software for research and security purposes, worry that they might be unintentionally violating this law.

Felten and his team had attempted to publish their findings on cracking digital watermarks after winning a contest sponsored by the Secure Digital Music Initiative (SDMI). The SDMI hoped to subvert future difficulties with the technology by encouraging experts to find flaws before the technology was distributed. However, instead of accepting the prize, Felten’s group decided to publish their findings, at which point SDMI sent them a letter warning that they were in violation of copyright laws and legal action would be taken if they did so.

The group responded by filing their own suit under representation by the Electronic Frontier Foundation (EFF) for protection to publish their work. The suit alleged that the interpretation of the DMCA by the Recording Industry Association of America (RIAA) and SDMI would inhibit scientific progress by denying them the right to share academic information. The RIAA quickly backed down saying, “we have no intention of bringing a lawsuit against Professor Felten or his colleagues.” Attorney General John Ashcroft then filed for dismissal stating that the DMCA explicitly states that free speech for activities using consumer electronics, telecommunication, and computing products shall not be diminished and criminal penalties under the statute do not apply to educational institutions. The EFF intends to appeal the decision to dismiss.

The decision to dismiss does not indicate whether or not the laws set up by the DMCA are in violation of First Amendment rights. According to the DMCA, “good faith encryption research” is permitted under certain conditions (Title 17 Ch. 12 Sec. 1201 (g)). However, it also states that the legitimate distinction rests on how the information is disseminated. Research that is disseminated “in a manner reasonably calculated to advance the state of knowledge” is permitted, while dissemination “in a manner that facilitates infringement” under the DMCA is not. It is unclear whether these stipulations are mutually exclusive; it is not difficult to imagine a situation in which a research facility unintentionally does both. Other cases, such as the one of Russian programmer Dmitri Skylarov, who was arrested for cracking the Adobe Systems’ e-book, will highlight this distinction and possible violation of First Amendment rights in subsequent trials. *EL

NIH PUBLISHES STEM CELL REGISTRY

The National Institutes of Health published its registry of human embryonic stem cells in early November. The registry lists the 72 stem cell lines that meet the President’s criteria for federal funding of embryonic stem cell research. Since August 9, 2001, when President Bush made his announcement, the science community has been awaiting the NIH registry.

The President’s mandate allowed federal funding for research on existing human embryonic stem cell lines as long as the derivation process had been initiated prior to his announcement and the embryo from which the stem cell line was derived no longer had the possibility of developing as a human being. Additionally, stem cells must have been derived from an embryo created for reproductive purposes; the embryo must no longer have been needed for these purposes; informed consent must have been obtained for the donation of the embryo; and financial inducements must not have been given for the donation of the embryo.

The current list of 72 stem cell lines is eight more than the 64 originally reported in August. The new cell lines were derived from stem cell colonies approved for federal grants. The number of cell lines that meet the criteria for federal funding could grow again, since it is possible to derive more new lines from existing colonies.

Some patient-advocacy groups, scientists, and lobbyists were not pleased with the lack of information in the registry. They had hoped for more details concerning the quality of the cell lines, since many of the lines may need more testing before scientists are certain they are viable lines. These groups were also expecting to learn more about the availability of the colonies. Private companies or laboratories outside the U.S. control many of the cell lines. In total, there are 11 laboratories or companies that possess stem cell lines that are eligible for federal grants. Five of these are in the United States, and account for 27 of the 72 cell lines.

The NIH registry can be found at http://escr.nih.gov/ *PM

HHS PUBLISHES STUDY ON FOREIGN CLINICAL TRIALS

In September 2001, the Department of Health and Human Services (HHS) completed a study on the growing contribution of non-U.S. clinical drug trials to New Drug Applications for the Food and Drug Administration (FDA). The study documented the use of foreign trials and assessed the FDA’s ability to assure human subject protections in those trials.

A recent HHS audit of the FDA found that the number of reported international drugs trials has increased sixteen-fold (from 271 to 4458) in the past decade. An overwhelming majority of these foreign drug trials escape FDA oversight. Although most of the foreign clinical drug research submitted to the FDA are conducted in countries with long histories of drug research, countries with less experience, such as Latin America and countries in Eastern Europe and Russia, are becoming more desirable places to conduct trials. Among the reasons for this are readily accessible human subjects, potential new markets for approved drugs, and international agreements that facilitate FDA acceptance of foreign research data.

The HHS also discovered that the FDA could not assure an acceptable level of human subject protections in foreign trials, due to a lack of information about both the subjects taking part in the research and the institutional review boards overseeing the research. Consequently, many violations of research ethics were not discovered until after the studies were conducted. Several groups, such as the World Health Organization and the pharmaceutical industry, have expressed concerns about the lack of experience of the foreign boards and their insufficient monitoring practices. Recent investigations and reports have drawn attention to the exploitation of human subjects by researchers in loosely regulated clinical studies. For example, a Washington Post series entitled “Body Snatchers” documents the abuses of poor and uneducated populations.

The HHS report made several recommendations, both to the FDA and to the Office of Human Research Protection (OHRP). These included increasing information about the performance of foreign IRBs and helping them build capacity, encouraging sponsors of the New Drug Applications (NDA) to obtain attestations of compliance from foreign investigators, increasing monitoring of NDA sponsors, and tracking the growth and location of foreign research facilities. At the same time, it hopes not to discourage the submission of non-U.S. data. The OHRP was asked to encourage foreign institutional review boards to participate in a voluntary accreditation system. Activists groups, such as Public Citizen, have expressed their impatience and criticized the recommendations as being too weak.

The full text of the study, entitled Globalization of Clinical Trials – A Growing Challenge in Protecting Human Subjects (OEI-01-00-00190) including responses from FDA, OHRP, and other outside agencies can be viewed at http://www.os.dhhs.gov/oig/oei/whatsnew.html. Information regarding FDA guidance on foreign clinical trials can be found at http://fda.gov/cder/fstud.htm.

“Body Snatchers” is a six-part Washington Post series examining abuses in under-regulated international clinical testing. The full special report is available at http://www.washingtonpost.com/wp-dyn/world/issues/bodyhunters. *SL and EL

NSPE PUBLISHES ETHICS IN EMPLOYMENT TASK REPORT

In response to increasing member concern, the National Society of Professional Engineers (NSPE) released a new report stating its position on the effective assertion and resolution of ethical dilemmas in the engineering workplace.

The NSPE Ethics in Employment Task Force Report draws on company policies of America’s Energy Partner (AEP), Daimler Chrysler, and Eastman Chemical, offering guidance to employees concerning the responsibility to report ethical dilemmas. The statement responds to employee apprehension associated with the potential consequences of reporting a professional concern, such as litigation or losing one’s job.

NSPE believes in preserving the reputations of the employee and the employer. This preservation requires the employee to act professionally in raising issues and obliges the employer to respond effectively in resolving them. Many companies have policies in place that not only protect the employee but also make mandatory the announcement of ethical concerns to management. However, resolving ethical issues in companies, or any institution, that do not have policies in place to alleviate employee apprehension, is not as clear. In such cases, NSPE encourages employees to seek advice from trusted professionals in the community. NSPE can refer engineers to resources e.g., licensed engineers, the NSPE Board of Review, and staff for advice about sensitive issues. As a last resort, the employee may need to seek legal counsel.

Regardless of company policy, state laws generally require licensed professional engineers to act in the interest of the public health and safety. The Task Force report reinforces the prominence of these values stating, “the employee has an obligation and a responsibility to promptly bring to the company’s attention any actions, situations, or conditions that the employee believes are or may be violations of the company guidelines or the law. The employee has an obligation to protect the life, health, and property of the public.” NSPE hopes to help employees meet these responsibilities by offering guidance and professional advice via its report and ongoing services. *MD

AAAS AND AMP Co-SPONSOR CANCER FORUM

On November 7, 2001 in Washington, DC, Americans for Medical Progress Educational Foundation (AMP) and the American Association for the Advancement of Science (AAAS) held a public forum, 30 Years of Fighting Cancer- Reflections on the Past, Challenges for the Future. The half-day forum commemorated the 30-year anniversary (December 23, 1971) of the passing of the National Cancer Act of 1971. Renowned speakers, respected for their leadership roles in the fight against cancer, addressed issues ranging from basic research to policy initiatives.

The Honorable Paul G. Rogers, co-sponsor of the 1971 National Cancer Act, kicked off the event recounting the public sentiment that demanded a concerted effort to wage what has been commonly called the ‘War on Cancer’. America wanted and expected a cure for cancer within seven years following the Act, which allocated large amounts of government money for comprehensive cancer centers and mandated that the head of the National Cancer Institute (NCI) be appointed by the President.

Brian Druker, developer of the targeted leukemia therapy, Gleevec, reviewed the successes in basic cancer research. Sam Broder, past NCI Director and current Vice President of Medical Affairs at Celera Genomics, detailed relevant statistics in cancer mortality. Mortality rates due to testicular cancer, Hodgkin’s Disease, and cancer of the cervix have declined since 1971. However, despite such hopeful remedies as Druker’s Gleevec, the eradication of human cancers has certainly not happened as anticipated with the signing of the National Cancer Act. Mortality due to lung cancer, non-Hodgkin’s lymphoma, and brain cancer has increased.

Otis Brawley of Emory University illuminated some of the shortcomings in our treatment of cancer. Disparities in treatment and care continue to affect the rates of incidence, mortality, and survival for cancer patients in minority populations. In addition, Ellen Stovall, a 23-year survivor of cancer, spoke to the many challenges that continue to concern patient advocates, such as management and oversight of research, reimbursement of cancer care, and access to quality care.

To conclude the forum, Anna Barker of Bio-Nova Inc., described policy recommendations for the next 30 years, released in the report by the National Cancer Legislation Advisory Committee in September 2001. The complex task of eliminating cancer, which will require at least hundreds of viable therapies, will require what Barker calls ‘translational centers’, designed to promote patient therapy from laboratory research. She addressed this as well as the need for a concerted effort to reconcile the socioeconomic and sociopolitical challenges of fighting cancer. For further information, see the post-forum report at http://www.aaas.org/waroncancer. *MD

AAU EXAMINES CONFLICTS OF INTEREST

The Association of the American Universities (AAU) Task Force on Research Accountability released a report on individual and institutional financial conflicts of interest in early October 2001. The purpose of the report is to identify how university leaders can ensure the integrity of their institutions and increase public trust and support of research universities.

A priority for the Task Force was to define both individual and institutional financial conflicts of interest in science. Individual conflict of interest occurs when “financial considerations may compromise, or have the appearance of compromising, an investigator’s professional judgement in conducting or reporting research.” Institutional conflict of interest takes place “when the institution, any of its senior management or trustees, or a department, school, or other sub-unit, or an affiliated foundation or organization, has an external relationship or financial interest in a company that itself has a financial interest in a faculty research project.”

The Task Force determined that the conflict itself is seldom the actual problem, but rather how the conflict is approached and dealt with in the end. To combat this, the Task Force concluded that, with individual conflict of interest, universities need to focus on improving the existing procedures and management protocols; whereas, with institutional conflicts of interest, the focus is on developing policies and procedures, since this area is unregulated.

Recommendations for dealing with individual financial conflict include guidelines for managing conflict with an emphasis on disclosure and review processes, as well as a checklist of questions that can assess the current policies and procedures of the university. For institutional conflicts, the Task Force developed a three-fold approach for universities to follow. The approach recommended is to “1) disclose always, 2) manage the conflict in most cases, and 3) prohibit the activity when necessary to protect the public interest or the interest of the university.”

The Task Force states that “universities are accountable for the research they perform,” and believes that through the review and implementation of its recommendations, universities will be able to secure the confidence of the public and maintain research integrity.

A PDF version of the report can be accessed at http://www.aau.edu/research/COI.01.pdf *PM

AAAS EXAMINES SCIENCE AND TERRORISM

On December 18, 2001, the American Association for the Advancement of Science hosted a public symposium on, “The War on Terrorism: What Does it Mean for Science?” The one-day event examined issues of scientists’ and engineers’ responsibilities, in addition to scientific freedom and human rights in America after the September 11 attacks. The purpose of the public symposium was to engage the scientific community and others in evaluating new national security measures being considered or adopted by the government, as well as the focus of research priorities, and their impacts on the environment for research. The symposium also challenged scientists and engineers to reflect on their own professional and personal roles in this very dynamic and highly charged political environment.

The morning keynote address was given by John Marburger, III, Director of the White House Office of Science and Technology Policy. Marburger stressed that terrorism would not deflect the United States’ position as a leader in science, and the pursuit of science would forge ahead in spite of terrorism with increased budgets and continued advances and discoveries. He also reconfirmed the administration’s determination to win the war against terrorism, and explained how science and technology would aid the process.

Marburger was followed by a panel discussion about “Doing Science After September 11: Scientific Freedom and Responsibility Issues.” The panel included Dr. Rashid Chotani from Johns Hopkins School of Medicine, Dean Louis Goodman of the School of International Service at American University, Robert O’Neil from The Thomas Jefferson Center for the Protection of Free Expression at the University of Virginia, and Anne Witkowsky, Director of the CSIS Committee on Science and Security.

William Wulf, President of the National Academy of Engineering, gave the afternoon keynote address. He told the audience that the solution to terrorism will require a serious science and technology component and academic scientists and engineers will be involved very differently than in past wars. He also called for more research in biology, medicine, bioterrorism against our food supply, and social and behavioral sciences. Wulf was followed by a panel discussion involving Eric Drexler, Founder of the Foresight Institute, Kevin McCurley, President of the International Association for Cryptologic Research, Jonathan Moreno, Director of the Center for Biomedical Ethics at the University of Virginia, and Gerold Yonas, Vice President and Principal Scientist at Sandia National Laboratories. Panel members addressed the topic of “Revisiting Scientists’ Responsibilities,” with several speakers stressing the importance of involving the scientific and engineering communities in assessing the threat posed by terrorists and in developing a research agenda for investigating the roots of terrorism.

More information on this symposium can be found at http://www.aaas.org/spp/scifree/terrorism/. A transcript of Marburger’s speech is posted and a post-symposium report summarizing the event are forthcoming. *PM

Methods in Medical Ethics, Edited by Jeremy Sugarman and Daniel P. Sulmasy, Georgetown University Press, 2001, $39.95, 314 pages

Recent advancements in biomedical research have spurred increased interest in the examination of social and ethical implications of these new technologies. Although many new “medical ethics” and “bioethics” programs have sprung up amidst schools of medicine and public health, interest in this subject matter extends far beyond clinicians, researchers and ethicists into disciplines not traditionally associated with medical practice, challenging the boundaries in conventional definitions of “medical ethics.”

Jeremy Sugarman and Daniel Sulmasy assert that “medical ethics is a single field of inquiry of great interest to many disciplines, not a discipline in its own rights…medical ethicists share a common subject matter, not a common disciplinary mode of investigating that subject.” Their new book, Methods in Medical Ethics, is an extensive examination of the methods employed across a variety of disciplines in their analyses and investigations related to medical ethics.

This volume contains articles authored by professionals representing eleven distinct disciplines: philosophy, religion/theology, professional codes, legal, casuistry, history, qualitative, ethnographic, quantitative survey, experimental, economics and decision science. Each chapter contains a historical and systematic assessment of the methods unique to that discipline as well as resources for further research. For example, David DeGrazia and Tom Beauchamp describe the most prominent contribution of the field of philosophy to the study of medical ethics as providing “critical resources of ethical theory and methodology in ethics.” Details of the various ethical theories and methods are followed by an objective critique of the strengths and weaknesses of these approaches and a list of resources for investigation and training.

Sugarman and Sulmasy’s central arguement can be appreciated in the chapter on “Physician Assisted Suicide (PAS) and Euthanasia.” Sulmasy summarizes the importance of contributions from each of the disciplines to the development of a collective understanding of the topic. But while the value of a multidisciplinary approach lies in the increased body of knowledge, its weakness is in the lack of consensus on action. If this study of PAS is any indication of the future of medical ethics, it is an indication that public policy produced from these discussions will surely be as fragmented and diverse as the disciplines from which they arise.

True to the claim that medical ethics is indeed potentially the most interdisciplinary field, this volume provides students of medical ethics from all disciplines with insight into the methodologies and theories employed by their counterparts. Though it does not suggest means of practical partnerships, its authors have taken the first step towards developing inter-disciplinary discourse. *SL

Meeting- The AAAS Annual Meeting will be held in Boston, 14-19 February 2002. The event offers a unique, exciting, interdisciplinary blend of more than 130 symposia, plenary and topical lectures, Genome and Nanotechnology seminars, poster presentations, Career Workshops and a Career Fair, and an Exhibit Hall. Scientific sessions, business meetings, and special events will be held at the Marriott Copley Place, Sheraton Boston, and the Hynes Convention Center. Visit http://www.aaas.org/meetings/index.html.

Conference- The Fifth International Bioethics Conference, “Bioethics Update 2002,” will be hosted in Honolulu, Hawaii, February 14-15, 2002. The conference focuses on the ethical issues facing health care in the new millennium. The program features topics in four general areas: genetics, the ethics of research, patient rights, and money matters in health care. Presented by The St. Francis International Center for Healthcare Ethics; Tel: (808) 547-6050; Fax: (808) 547-6049; Email: janicemi@sfhs-hi.org.

Conference- The Bioethics Society of Boston University is sponsoring the Fifth Annual International Student Bioethics Conference to be held at Boston University on March 29 & 30, 2002. Wishing to ignite interest in the study and discussion of bioethics at the undergraduate level, students at Princeton University held the First National Undergraduate Bioethics Conference in 1999. The first day of the 2002 conference will be a series of educational workshops on areas ranging from the role of the National Institutes of Health, to the science of stem cells, to human rights around the globe. The second day of the conference will be devoted to discussion of the current and future impact of developments in medicine, biotechnology, and social justice. Visit http://people.bu.edu/mwparker/index2.html.

Call for Papers and Conference- The 30th Annual Conference on Value Inquiry: “Values in Health Care: Past, Present, and Future” will be held April 4-6, 2002 in Milwaukee, WI. Keynote Speakers include Dan W. Brock, Brown University, R.G. Frey, Bowling Green State University, Bernard Gert, Dartmouth College. Topics will cover questions in health care broadly defined, including: moral, political or legal issues in health care; the role of values in clinical practice; genetics; technology; research ethics; reproductive issues; public health issues; and health care policy. Contact Thomas May, 30th Annual Conference on Value Inquiry, Center for the Study of Bioethics, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509; E-mail tmay@mcw.edu.

Conference- This past May the Kennedy Institute of Ethics began celebrating its 30th anniversary year. As a way of concluding this year-long celebration, the Institute is hosting a conference on the role that seminal works have played and continue to play in the field of bioethics. “The State of Bioethics: From Seminal Works to Contemporary Explorations” will take place on the Georgetown campus on April 5-7, 2002. Speakers include Tom Beauchamp, Lisa Sowle Cahill, James Childress, Charles Curran, H. Tristram Engelhardt, Jr., Ruth Faden, Patricia King, William F. May, Edmund Pellegrino, Robert Veatch and LeRoy Walters. Visit http://www.georgetown.edu/research/kie/courses/sympos02.htm.

Faculty Summer Institute- The Ethics Institute at Dartmouth College announces a Faculty Summer Institute, “Teaching The Ethical, Legal, and Social Implications of the Human Genome Project,” for faculty from liberal arts colleges and universities who are interested in developing a course on the ethical, legal, and social implications (ELSI) of the Human Genome Project (HGP). The institute offers an intensive two-week ELSI teaching program on June 16-28, 2002. The Faculty Summer Institute will be an intensified version of a successful program offered at Dartmouth during past summers. Faculty participants will collaborate with leading experts on the social implications of the HGP, examine cutting-edge issues in human genetics research, learn new skills of multidisciplinary teaching, and acquire the knowledge, material, and support needed to successfully teach this course at their home institutions. Institute participants will be competitively selected from a pool of applicants demonstrating excellent teaching skills and a commitment to multidisciplinary teaching. Applications are being solicited from two-person interdisciplinary teams as well as from individual faculty. Every effort will be made to ensure diversity among the participants in terms of academic discipline, gender, race, and ethnicity. Participants receive a modest stipend to attend. In addition, all materials, and many meals are provided. This program is funded by the National Human Genome Research Institute. Visit http://www.dartmouth.edu/~ethics/ or Tel: (603) 646-1263. Fax: (603) 646-2652. Email: ethics.institute@dartmouth.edu. Mail: Ethics Institute, 6031 Parker House, Dartmouth College, Hanover NH 03755.

Workshop- Teaching Research Ethics Ninth Annual Workshop will be held May 15-18, 2002 at the Indiana Memorial Union on the campus of Indiana University in Bloomington, Indiana. Registrations accepted until March 18, 2002. Session topics will include an overview of ethical theory, using animal subjects in research, using human subjects in clinical and non-clinical research, and responsible data management. Many sessions will feature techniques for teaching and assessing the responsible conduct of research. The workshop schedule, information on travel and lodging, the registration form, and complete information on the workshop can be found at http://poynter.indiana.edu/tre.html. Participation in the workshop is limited to 45 individuals. For more information: Kenneth D. Pimple, Teaching Research Ethics, Poynter Center, Indiana University, 618 East Third Street, Bloomington IN 47405-3602; Tel: (812) 855-0261; Fax 855-3315;E-mail pimple@indiana.edu.

Summer Seminar- The NEH Summer Seminar, “Justice, Equality, and the Challenge of Disability,” will be held June 24-July 26 at Sarah Lawrence College in Bronxville, NY. The event is co-directed by Eva Feder Kittay and Anita Silvers. The seminar will last for five weeks and address philosophical questions important to understanding, assessing the adequacy of, and reforming or rejecting, traditional approaches to justice. These questions relate to: (1) conceptions of normality and disability, (2) equality and disability rights, (3) virtue theory and the ethics of care, (4) well-being and the quality of life, and (5) the intersectionality of roles and relationships constitutive of identity. Seminar participants will receive a stipend of $3,250 for the seminar, whether or not they reside on campus. College and university teachers and qualified independent scholars are eligible to apply. Successful applicants will be at various career stages, with background experience at different kinds of academic or non-academic institutions, and with different perspectives both on disability and moral philosophy. We encourage applications from scholars of philosophy, literature and the arts, religious studies, communications theory, history, political theory and jurisprudence, and the humanistic social sciences (including philosophy of economics), and from faculty members who work with students interested in medicine or other health care careers. Email Anita Silvers at asilvers@sfsu.edu or write to Chris Anderson, NEH Seminar Information Officer, Dept. of Philosophy, San Francisco State University, San Francisco CA, 94132. Applications are due March 1, 2002. Successful applicants will be notified inApril, 2002.

Call for Papers and Conference- The Ethics Center at Oklahoma State University is sponsoring a conference, “The End of Natural Motherhood? The Artificial Womb and Designer Babies,” to be held in Tulsa, Oklahoma, February 22-23, 2002. Featured Speakers include: Thomas Murray, President of the Hastings Center, Gregory Pence, University of Alabama, and Jeremy Rifkin, President of the Foundation on Economic Trends, Rosemarie Tong, Center for Professional & Applied Ethics, UNC-Charlotte. Topics will include artificial womb technology, genetic engineering, and the impact of reproductive technologies on social relationships and values. Visit http://philosophy.okstate.edu/ethicscenter.htm

Call for Papers- Submissions are being requested for a new online journal, The Journal of Philosophy, Science & Law. The journal is an interdisciplinary forum that seeks to stimulate research and publish articles in areas including philosophical issues associated with science policy and the growth of technology, philosophy, the legal system, and scientific evidence, the effect of legal and ethical guidelines on scientific research, and educational issues relating to how legal and ethical guidelines are taught within scientific fields. Submissions of scholarly articles, book reviews, profiles of legal cases, conference reports, and policy proposals will be considered for publication. Accepted articles will be available online following the journal’s peer review process. Submissions, preferably via e-mail, should be sent to Jason Borenstein, Editor, Georgia Tech School of Public Policy, 685 Cherry Street, Atlanta, GA 30332, E-mail editor@psljournal.com.

Conference- The Department of Philosophy, Delft University of Technology, will be holding a conference, "Research in Ethics and Engineering," on April 25- 26, 2002. It will explore the most pressing questions for research in the field of ethics and engineering as a basis for developing a solid basis for teaching initiatives in this area, and assess what philosophical ethics, applied ethics, and ethics and engineering can learn from each other. Conference themes include Autonomy and Professional Context, Risk, Ethics and Engineering, and other Applied Ethics. Visit http://www.ethiek.tudelft.nl/conference2002.

Conference- Saint Louis University is hosting a one-day conference on “Ethics in the Education of Scientists, Clinicians, and Engineers” on February 8, 2002. The conference will be held on the Health Sciences Campus at Saint Louis University in St. Louis, Missouri. Faculty, students, research fellows, and research staff are encouraged to attend. Keynote Address: “Fostering Integrity in Research: Why, How, and theCost,” Nicholas Steneck, University of Michigan, Consultant, Office of Research Integrity. Visit http://www.slu.edu/centers/ethics/activities.html.

Conference - Washington University School of Law’s Center for Interdisciplinary Studies and the School of Medicine will co-sponsor a program entitled “Law and the Human Genome Project: Research, Medicine, and Commerce”. The Program, consisting of a two-hour symposium introducing the fundamentals of the Human Genome; a major conference and three subsequent colloquia focusing on a variety of interdisciplinary topics, will address the legal, ethical, and regulatory advances in genetic science and technology emerging from the Human Genome Project. The first colloquium, scheduled for March 22, 2002, “Professional, Ethical, Legal, and Social Challenges for Genetic Counseling,” will speak to the new challenges for genetic counseling posed by the extensive information revealed by the Human Genome Project. The second colloquium is scheduled for April 5, 2002, and entitled “Germ Line Interventions and Human Research Ethics.” This colloquium will address the difficult ethical and policy questions associated with proposals to conduct research on germ line interventions in humans. The final colloquium, “Patenting Genetic Products,” will be held April 12-13, 2002, and address the patenting of genetic products—such as research tools and processes widely used in academia and industry. Intellectual property experts and prominent leaders in business and government will be invited to participate in this final segment of the Program. Contact Leslie Kerr, Associate Director of the Center for Interdisciplinary Studies at Tel (314)935.6161; e-mail, lkerr@wulaw.wustl.edu.

Conference -Public Responsibility in Medicine and Research (PRIM&R) and Applied Research Ethics National Association (ARENA), along with the Office of Laboratory Animal Welfare (OLAW) and the Association for Assessment and Accreditation of Laboratory Animal Care International (AAALAC International), will sponsor PRIM&R and ARENA’s 2002 annual IACUC Conference on “Decisions on Animal Care and Use: Dealing with Differences.” For the first time, the PRIM&R and ARENA IACUC meetings will be combined into one three-day conference. Conference attendees will gain an increased understanding of the various interests at stake; strategies for improving communication among stakeholders; strategies for improving negotiation techniques and practices; and strategies for enhancing opportunities to collaborate with other stakeholders. The conference will be held at Boston Park Plaza Hotel, Boston, Massachusetts – March 24-26, 2002. Visit http://www.primr.org, Tel (617) 423.4112, E-mail info@primr.org.