Guatemala, the GDR and Research Ethics Policy Development

Note: The Bioethics Program blog will be moving to its new home on April 1, 2015. Be sure to change your bookmarks to http://bioethics.uniongraduatecollege.edu/blog/

by Andrei Famenka, Bioethics Program Alum (2013)

When it was first announced, I was particularly intrigued by a recent webinar called, ‘Gonorrhea, Guatemala and Gung-Ho Researchers: The Role of Controversy in Shaping Research Ethics Practice and Policy’. This particular topic was of special interest to me because of my interests in research ethics policymaking and the role of social, cultural, and economic factors in this process.

As good as the webinar was, it highlighted a peculiar fact: although a good deal of attention has been paid to unfair research conducted in developing countries, such as Guatemala Gonorrhea study, such analyses have primarily focused on the impact of these controversial studies on research ethics policy development in the United States. Missing from these analyses is the impact that the scandals have had on research ethics policies in developing and transitional countries where the unfair practices have occurred. This lack of analysis is significant because these controversies often fail to lead to policy changes in developing and transitional countries.

One of the latest examples of unethical research which didn’t result in any policy modification comes from Eastern Europe. It has recently come to light that just before the fall of the ‘iron curtain’, some major Western pharmaceutical companies conducted hundreds of controversial drug trials in the German Democratic Republic (GDR, the Communist former country of East Germany), in which more than 50,000 East German patients served as guinea pigs—many without their knowledge or consent. More than 600 drugs were tested on unwitting East German patients, including prematurely born infants, alcohol addicts, and people diagnosed with depression. Moreover, despite suspicions that some of the trials resulted in several fatalities, the participating hospitals were reluctant to investigate.

Despite hot debates in the media, the controversy over this unethical research didn’t push policymakers in the countries of Eastern and Central Europe to revise the current policies and programs on the protection of human subjects. And yet, recent research on Baltic countries, Belarus, and Poland clearly demonstrates these policies are lacking.

Although it has become almost a proverb that research ethics was ‘born in scandal’, a closer look at the history of research ethics provides evidence that no matter how big a scandal might be, it can result in policy change only if it resonates with broader social movements or shifts in public views, ideas, and values. In fact, outrageous scandals, hot debates, and profound controversy can serve only as triggers or catalyzers of change under the right socio-political, cultural, and economic conditions. This reflects the views presented by Ezekiel Emanuel and Christine Grady when they argue that over the past 70 years, the system of research oversight in the United States has evolved through four distinct stages. These stages embodied different values and perspectives on research and reflect dominant views in general society. Research oversight changed as these dominant views evolved over time.

Central and Eastern European countries still lack a strong civil society and sufficient levels of political freedom, economic and social opportunities, and transparency guarantees. The enabling conditions for a strong set of research ethics policies is not sufficiently in place. Attempts to force these policies would only create confusion about the underlying ethical values and the goals of the research oversight.

The way to ensuring the protection of human research subjects in transitional countries is most likely to be a long and difficult one, as it involves efforts to reshape some basic elements of society. In this regard, training programs are an important part of the process, but these will only be successful when they are coupled with broader social changes.

[The contents of this post are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

Understanding the Latino Patient with Cancer

by Beatriz Lorena Hurtado, Bioethics Program Alumna (MSBioethics 2014)

As a Latina working in healthcare I have always felt the responsibility to provide education about my culture, and to clarify cultural differences and misconceptions. It is always surprising to witness how eliminating misconceptions eventually translates into an increase in patient satisfaction, and less apprehension about cultural differences from the healthcare team. This is one of the reasons why, in my view, education on Cultural Competence in healthcare is probably the most appropriate way to avoid generalizations and achieve equality in healthcare.

Latinos currently constitute seventeen percent (17%) of the nation’s population, making them the largest racial and ethnic minority in the US. They are also amongst the fastest growing minorities the United States. Should current demographic trends continue, it is estimated there will be 41 million Latinos in the United States by 2020.

These numbers should not only indicate the rising presence of Latinos in the United States, but also highlight the need for developing pathways to improve language and cultural services in the healthcare arena.

This need is particularly in oncology: as the American Cancer Society notes, cancer is the second leading cause of death for Latinos. It is also important to add that the most common cancer diagnosis in Latino women is breast cancer, while prostate cancer is the most common diagnosis in Latino men (with colon, lung, melanoma, stomach, and liver cancer following closely behind).Therefore, as it happens with any chronic disease, the medical visits are usually recurrent and the treatments involve an extensive group of healthcare professionals.

As a Latina I believe there are three important characteristics of Latino cultural expressions, meanings, and value systems that warrant specific attention:

First, family is the foundation that supports life for Latinos in general. Medical decisions are in most cases a family affair. The presence of family signifies emotional support, empathy, and togetherness, and is always favored in a difficult medical situation. Moreover, if facing a difficult moment or vulnerability, like a cancer diagnosis, family support is at the top of the list of necessities of the Latino patient. Latinos place much of their identity and self-worth into the family structure and customs.

Although it is recognized that the Latin American family has undergone changes in its structure in recent decades, it is important to note that these changes haven’t shifted the sense of group, affective value, and financial support in the immigrant family. Latinos are gregarious, often moving in culturally-defined groups. They also identify themselves within their group and by the role they play in it. Failing to recognize the place family has in medical decisions for Latino patients could be viewed as a lack of acknowledgement of who they are as persons, and their position in the micro universe that is their family life.

Second, in the Latino culture, talking about death is commonly viewed as summoning it. Acknowledging death can be seen as giving up hope, limiting a patient’s chances of surviving and a threat to their recovery. This has obvious implications for conversations about death, end-of-life issues, living wills and advance directives. Also, because of the substantial Catholic background and deep religious roots, most Latinos believe that talking about the possibility of a negative outcome is an expression of limited faith in God. It can symbolize doubt on God’s abilities to heal the sick.

Third, even though Latinos share many characteristics, they are also a very diverse group. They are united in their diversity. For instance, a Latino patient from South America may have a specific cultural response towards the healthcare team (e.g., a more entitled behavior) that may be very different from the cultural response of a Latino patient from Central America (e.g. a more humble and unassuming attitude).

Despite all the similarities that unite Latinos (language, religion, family union, etc.), there are several particular cultural conventions that vary depending on the country from where the person comes. Identifying that the patient may speak Spanish or may come from Latin America represents merely the basic steps in beginning a successful communication, but it does not contribute significantly towards building a strong a fruitful rapport with a Latino patient. To achieve this, establishing a conversation free of narrowly defined cultural assumptions is crucial. Even though Latinos share many characteristics, like the general value placed on family and the inclination to avoid discussions of death, there is a rich diversity of Latino cultures and healthcare providers must make it a point to avoid generalizations.

In the context of the Latino culture, to achieve a culturally competent treatment is to understand their culture and demonstrate respect for their differentiating traits while they are in treatment. This means providing care that recognizes and caters to those cultural differences. By acknowledging their gregarious behavior towards family and group, by attributing their reluctance to plan for the worse to their unceasing hope in their interpretation of death and dying, and by respecting the differences among these common traits, the healthcare team can provide culturally competent care. In turn, this will help the patient feel acknowledged and less intimidated by the medical environment, resulting in a more effective relationship, better care, and better outcomes.

[The contents of this post are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

Protecting Transgender Students

by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership

Two nights ago, the Shenendehowa Board of Education voted 4 to 2 in favor of a new policy designed to protect the rights and safety of transgender students. High school students in the district will now be allowed to use bathrooms and locker rooms that correspond to their gender identity. The new policy also allows all students, regardless of sex or gender, to access single-user bathrooms and private changing areas.

Located just north of Albany, New York, Shenendehowa Central School District is now one of but a few districts nationwide that provide recognition and support to transgendered youth. Only California has passed a statewide law that allows transgender students to use bathroom and locker facilities that match their gender identities. While the New York City Board of Education released new guidelines in support of transgender students earlier this year – including a recommendation that students never be made to use a locker room or restroom that conflicts with their gender identity – these are only suggestions and not binding policies. Sadly, the New York State Board of Education has been largely silent on this issue.

The US Federal government has also been relatively quiet on the topic of transgendered youth. The US Department of Education’s Office for Civil Rights has stated that Title IX of the Education Amendments of 1972, which protects students from sex discrimination, also applies to transgender students. This allows transgendered students to file legal action in federal court should local authorities fail to protect them from discrimination and violence while at school. But the US Department of Education failed to provide specific examples of Title IX-prohibited discrimination or provide school districts with clear guidance on how to create trans-inclusive policies. Finally, the Obama Administration has been reluctant to push Congress to pass legislation that will protect transgendered youth, such as the Safe Schools Improvement Act and the Student Non-Discrimination Act.

Such laws and policies are desperately needed. Lesbian, gay, bisexual and transgendered (LGBT) youth are at increased risk of bullying, physical violence and sexual assault at school. In 2011, for instance, a survey conducted by the Gay, Lesbian & Straight Education Network (GLSEN) found more than half of LGBT youth report being harassed at school. For transgendered students in particular, however, the problem is much much worse.

The National Transgender Discrimination Survey, a study of over 6,000 people, found that transgender and gender-nonconforming students experienced very high rates of harassment (78 percent), physical violence (35 percent) and sexual assault (12 percent). Alarmingly, a third of this harassment and violence occurred at the hands of teachers, staff and school officials themselves. It should come as no surprise, therefore, that many transgendered students drop out of school. Still more report having suicidal thoughts, and a quarter have attempted to take their own lives.

This is a tragedy of considerable proportion, one that can only be addressed by implementing and enforcing policies that prohibit discrimination on the basis of gender identity. That is what makes the recent vote by the Shenendehowa Board of Education so groundbreaking. But it is also what makes the acrimonious nature of the debate over this policy so disheartening.

When local news stations posted the story on their websites and Facebook pages, for example, a majority of the comments submitted online were in opposition to Shenendehowa’s new policy. Many people posted comments that made it clear that they did not understand the new policy. Others made rude statements that were based on ill-informed stereotypes of transgendered kids: that they are confused, that they need to see psychiatrists, that they should use the staff bathrooms, or that they are sexual predators who are only interested in seeing other children naked.

I’m chalking up most of the opposition to fear, ignorance and campaigns that falsely claim that students and staff will exploit these policies to use opposite-sex restrooms in order to sexually harass and assault other children. When California’s legislature was debating the School Success and Opportunity Act, which gave transgender students the same rights and protections covered by Shenendehowa’s new policy, the conservative Pacific Justice Institute invented a now discredited story about a transgender student harassing her peers in a Colorado school restroom. Similarly, when the town of Fayetteville, Arkansas was considering a law that prohibit discrimination on the basis of gender identity, reality TV star Michelle Duggar falsely claimed that the law would allow men “with past child predator convictions to claim they are female [and] use womens’ and girls’ restrooms, locker rooms and showers.“

Nothing could be further from the truth. Consider what is happening in California. In the year since they passed the School Success and Opportunity Act, not a single school district in that state has reported an instance of inappropriate behavior, harassment or physical assault stemming from the new law. The experience of the Shenendehowa Central School District is likely to be the same.

Kudos to the Shenendehowa Board of Education for standing up for the rights of transgendered kids. Now if the rest of the school districts in the US could do the same.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on December 4, 2014, and is available on the WAMC website. The contents of this post are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

Fear and Loathing in Liberia

by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership

Two weeks ago, I wrote a commentary decrying the current hysteria in the US over Ebola. It was ironic, I argued, that so many people were demanding the federal government take immediate steps to address the perceived threat of Ebola while simultaneously ignoring the real public health threats that we face.

A seasonal disease like influenza, for example, takes the lives of tens of thousands of Americans every winter. Still, far too many people refuse to get an annual flu shot. Similarly, outbreaks of preventable (and potentially deadly) diseases like measles, mumps and whooping cough are becoming more and more common as childhood vaccination rates plummet.

Moreover, the politicians and pundits calling on the Obama administration to take radical steps to combat Ebola are the same individuals who have repeatedly criticized efforts to combat the main causes of mortality in the US. Plans to tax junk food or limit the size of sugary sodas are seen as unwelcome government intrusions into the private lives of Americans, despite the fact that over 300,000 Americans die of obesity-related illness every year.

This isn’t to say that Ebola shouldn’t be a concern for public health officials in the US. I previously criticized both the US Centers for Disease Control and Prevention (CDC) and US Customs and Border Protection for their initially tepid response to the crisis.

CDC officials, for instance, were slow to update guidelines for treating patients with Ebola, initially recommending a level of training and use of protective gear that was woefully inadequate. As a result, two nurses who cared for an Ebola patient in Dallas are now infected with the virus. Thankfully, these women are likely to recover.

The CDC has now released new guidelines for clinicians that are similar to those used by Doctors Without Borders, the charitable organization at the forefront of combatting the Ebola epidemic in West Africa. These guidelines, along with new screening procedures for travelers arriving from countries affected by the Ebola epidemic, make it even more unlikely that we will have a serious outbreak here in the US.

Unfortunately, our public response to Ebola is marked by ignorance, fear and panic. Parents of students at Howard Yocum Elementary School, located in a bucolic suburb of Philadelphia, recently protested the fact that two students from Rwanda were enrolled. Rwanda is a small East African country that is 3,000 miles away from the epicenter of the Ebola crisis, and has no reported cases of the disease. Nevertheless, frightened parents threatened to boycott classes. In response, school officials asked the parents of these two young children to “voluntarily” quarantine their kids.

What happened at Howard Yocum Elementary School is not an isolated case. A teacher in Maine was put on mandatory leave simply for attending a conference in Dallas, where the first US cases of Ebola were reported. A middle-school principal in Mississippi was suspended after returning from a family funeral in Zambia, another East African country located many thousands of miles from the heart of the Ebola outbreak.

Cruise ships have been put on lock down, subway stations closed, family vacations cancelled, and buses and planes decommissioned because of public fear about Ebola and the risks it poses.

The sad thing is this much of irrational fear is driven by xenophobia and racism. Since the Ebola outbreak began, over 4,500 people have died in West Africa. However, the mainstream Western media only began to report on the epidemic once an American doctor became infected. The level of care and treatment offered to infected patients from the US and Spain – including access to experimental drugs and vaccines – is also far greater what is provided to patients in affected countries.

Finally, African immigrants to the US are being increasingly ostracized and stigmatized, even if they come from countries unaffected by Ebola. Their kids are being denied admission to school, their parents denied service at restaurants, and their friends potentially denied entry to this country.

Many US politicians, mostly conservative lawmakers but also some progressive policymakers facing tough reelection campaigns, have called for a travel ban to affected countries in West Africa. This is despite statements from the World Health Organization, Red Cross and CDC that such a travel ban will be ineffective. This is also rather disproportionate compared with lawmakers’ reactions to past outbreaks of mad cow disease in England, SARS in Canada and bird flu in China. No travel bans were proposed in those situations.

Rather than fear West Africans, now is the time to embrace them. We could learn a lot from them. Consider the recent piece by Helene Cooper, a New York Times correspondent and native of Liberia. In that country, where over 2,000 people have died, few families have been left untouched by Ebola. At great personal risk, Liberians have banded together to fight the disease rather than isolating and ostracizing those who are sick. Unlike the average American, they are responding not with fear and loathing but with compassion and love. It’s time for us to do the same.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on October 22, 2014, and is available on the WAMC website. The contents of this post are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

Income Inequality and Health: Can the Poor Have Longer and Better Lives?

by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership

The issue of income inequality has been in the news a lot lately. The gap between rich Americans and poor Americans has grown considerably since the 1970s. The United States now ranks first among the developed nations of the world in terms income inequality as measured by the Gini coefficient, a way of describing the distribution of wealth in a society. Globally, we’re fourth overall, surpassed only by Lebanon, Russia and the Ukraine.

Income inequality is a serious problem, so much so that Nobel Prize-winning economist Robert Shiller called it, “the most important problem that we are facing today.” Income inequality negatively affects economic growth, social mobility, political stability and democratic participation. It also affects the public health.

Quite simply, wealthier Americans tend to live healthier and longer lives. As the income gap has grown, so has the longevity gap. For example, consider the report recently released by the Brookings Institute that looked at income and differential mortality.

Between 1977 and 2007, Brookings economists Barry Bosworth and Kathleen Burke found that life expectancy increased an average of five years for men and one year for women.  But the gains in life expectancy accrued primarily to the rich. The richest 10% of Americans gained 5.9 and 3.1 years of life for men and women, respectively.  For men in the poorest 10%, the increase in life expectancy was less than two years.  The poorest women actually lost two years of life.

To really get a sense of how stark this divide is, however, consider the recent article by New York Times Reporter Annie Lowrey. She compared average life expectancy in Fairfax County, Virginia with that of McDowell County, West Virginia. A suburb of Washington, DC, Fairfax has one of the highest median incomes in the country:  $107,000. Men in Fairfax also have a mean life expectancy of 82 years. By contrast, the coal mining communities in McDowell have one of the lowest median incomes: $23,000. Men in that county only live to 64 on average.

There are a myriad of reasons why this longevity gap exists. The most obvious is access to health care. Wealthier individuals are more likely to have health insurance, a fact that the Obama Administration is trying to change through the Affordable Care Act.

But even if the Affordable Care Act succeeds in reducing the number of under- or uninsured Americans — which now seems likely, given that 8 million people signed up for one of the new health insurance exchanges — inequities in access will still exist.

For example, wealthier Americans will have far more choice in the types and numbers of doctors they can see.  Many clinicians are now refusing to accept any insurance plan, particularly publicly funded plans like Medicaid. Others are setting up concierge practices that guarantee same day appointments to those willing to pay. By contrast, poorer patients will have to wait for treatment, assuming they can find a doctor willing to see them.

The quality of care that the poor receive is also lower. Numerous studies have shown that lower-income patients are more likely to be misdiagnosed, prescribed the wrong medication, or suffer from complications of treatment. This is not because their doctors are incompetent or don’t care about their poorer patients. Rather, doctors that serve lower-income communities often do not have the time to adequately examine patients, take a full medical history, properly explain treatment options, or prescribe the newest drugs; they simply have too many patients to see and insurance reimbursement rates are too low to provide a full range of services.

Finally, wealthier individuals tend to live healthier lives overall. They are less likely to smoke, to drink to excess, and to be overweight. Part of this is due to differences in education, but part of it is due to time and resources. The investment banker who works in Manhattan can afford to buy fresh produce and other healthy meals at the local Whole Foods. He can also afford a gym membership, and he likely lives in a neighborhood that offer safe opportunities for exercising out-of-doors. By contrast, the single mother of four who lives in the Bronx must feed her family on a limited income, buying pre-packaged food at the corner market. She also probably lacks the time to exercise, assuming that the local playground isn’t overrun with drug dealers and gang members.

As we struggle with the issue of health care in America — expanding access to treatment while controlling costs — it is important to remember that the current health care crisis is not just about medical insurance. There are other problems in our society that will affect the outcome of the current debate. The Affordable Care Act will help address some of the current inequities in our health care system. Until we attack the fundamental issue of poverty and the income gap, however, we are probably just putting a small bandage on a large and gaping wound.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on April 24, 2014. It is also available on the WAMC website. Its contents are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

Health Disparities: They’re Not Just for Patients Anymore

by Jacob Dahlke, Bioethics Program Alum (MSBioethics 2012)

Much is written – and justifiably so – about the disparities that exist in our healthcare system in the U.S. The CDC, for example, reports a few: non-Hispanic blacks die more frequently from stroke and coronary heart disease than whites; homicide deaths are 2.5 times higher for men than women, and over 6.5 times higher for non-Hispanic blacks than whites; non-Hispanic whites and American Indian/Alaska Natives than other ethnic groups. Health disparity can be viewed as a sort of volatility risk of the healthcare system: as the difference in health among various groups of patients increases, so does the possibility (or likelihood) than people within the system will be treated more unjustly or unfairly. This leads to likely further social disparities, increasing the likelihood that these groups will not be able to manage their health effectively. A vicious cycle, indeed.

A primary stakeholder in the health disparity discussion in the U.S. is the Centers for Medicare and Medicaid Services (CMS). This government agency manages the healthcare for nearly a third of the entire U.S. population – about 100 million people. They even covered me and my family for about four years. They play a deep role in American healthcare, and so it is usually when a group like that provides data in the name of transparency. This is just what they did, releasing Medicare payment records for physicians for 2012. It was a controversial move, opposed primarily by the American Medical Association (AMA). The AMA’s position was based on a concern that the data’s release would “mislead the public into making inappropriate and potentially harmful treatment decisions and will result in unwarranted bias against physicians that can destroy careers”. While I understand that view from the perspective of protecting the interests of it constituents – physicians – I think this view in particular comes off as condescending and paternalistic. Perhaps that can be discussed another time…

The data release shows some dramatic differences that is not unlike American society at large. The data includes payment information for 880,000 physicians who received Medicare payments from CMS in 2012, totaling $77 billion. To make simple comparisons about the disparity within this particular system, consider a ‘flat’ disparity, where every one of those physicians received an equal amount of payments. Payments would be $87,500 to each physician. To contrast, then: the top recipient of Medicare payments in 2012 earned $20.8 million. This comparison is far too simplistic, of course: it presumes that all physicians saw an equal number of patients with the same health conditions, and charged the same price for those services. None of these hold for every physician in the U.S. (I am waiting for Nate Silver to run some numbers on this- it could be another bestseller for him.) 

This report – over 10 million lines of text – highlights a massive disparity in payments. $1.5 billion of the (almost 2% of the total payouts) was distributed to only 344 physicians (0.038% of the total number of physicians). About 1 out 4 of the physicians practice in the state of Florida. Over half of these top physicians (193 of the 344) practice in just five states – FL, CA, TX, NJ, and NY – whose populations account for only a third of the total US population. (Those states account for less than 16% of the total U.S. Medicare population.)

Whether all of this is a fair characterization remains to be seen. It is obvious that a physician that simply sees more payments ought to be compensated more than a physician who doesn’t.  But the numbers appear so skewed – at this point, at least – that further scrutiny is surely warranted. If we as a nation are truly interested in maintaining or improving our social systems – and most of us are – then this improvement on transparency at CMS can lead to better things, and I hope that it continues.

As an alternative, though, we could just follow Vermont’s lead.

[This blog entry was originally posted in a slightly different form on Mr. Dahlke’s blog on April 9, 2014. Its contents are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]

Safety Shutdown

by Sean Philpott, Director of the Center for Bioethics and Clinical Leadership

Unless a miracle happens, by the time this commentary airs on Northeast Public Radio the US federal government will enter its tenth day of shutdown. Nearly 800,000 workers will remain furloughed, important social service and educational programs will remain unfunded, national parks and monuments will remain closed, and the National Zoo’s panda cam will remain offline.

Some already have been directly affected by the shutdown — the furloughed workers, the disadvantaged children whose Head Start programs were forced to close due to a lack of funds, the grieving widows of fallen soldiers whose death benefits were delayed, and the desperate cancer patients whose enrollment in NIH-run clinical trials has been postponed. For most of us, however, the impact of the shutdown has been fairly minimal. Our mail is still being delivered, our courts of law are still open and our prisons are still full, our police and firemen remain on duty, and our social security checks continue to arrive.

For the average American then, all is currently okay in the land of the free and the home of the brave. And it will stay that way, so long as you don’t eat anything, drink anything, take any new medications, or fly anywhere. Unbeknownst to many, the very safety of the public is at risk during the shutdown.Consider the issue of food safety. Locally produced meat, poultry and seafood should remain safe, no matter the length of the shutdown. The United States Department of Agriculture (USDA) continues to inspect domestic meat and poultry plants. The National Oceanic and Atmospheric Administration’s (NOAA) domestic seafood inspection program is also up and running.

But the US Food and Drug Administration (FDA), which is responsible for monitoring the remaining 80% of domestic food production, as well as ensuring the safety of all food imports (including meat and seafood), has been largely shuttered. Given that 10% of the beef, 20% of the vegetables, 50% of the fruit and 90% of the seafood eaten by Americans comes from overseas, that’s a lot of uninspected food. So be sure to wash your fruits and vegetables carefully in the coming weeks.

Moreover, if an outbreak of food-borne illness should happen, the government response is likely to be tepid. When such outbreaks occur — particularly those that cross state lines, such as the current outbreak of Salmonella that has sickened over 300 people in 18 states — the FDA, USDA and the US Centers for Disease Control and Prevention (CDC) work with local and state health agencies to trace the source of the contamination and stop any further cases of illness. For the most part, that’s no longer happening.

In fact, the government shutdown poses a myriad of threats to the health and safety of all Americans. Not only is the CDC no longer actively investigating outbreaks of foodborne illness, it has also suspended its flu surveillance and vaccination program. The emergence of a new strain of influenza — such as the H1N1 strain that caused a global pandemic in 2009 — could go largely unnoticed until it is too late to prevent its deadly spread.

Similarly, not only have food inspections stopped at the FDA, so have drug approval and safety inspections. New drugs to treat deadly diseases like hepatitis C may be delayed, and unsafe drugs that pose a danger to US consumers may remain on the market. Thousands of Federal Aviation Administration (FAA) employees have also been furloughed, including air safety inspectors. As a result, in the past week safety inspections of planes and pilots have largely ceased. Most of the staff of the federal Occupational Safety and Health Administration (OSHA) have also been sent home. They are no longer conducting workplace safety inspections, except in cases where there is “a high risk of death or serious physical harm”.

The only Americans who remain safe during this government shutdown are the politicians themselves, most of who are comfortably ensconced in gerrymandered districts that ensure continued re-election despite universal disgust with their partisan hijinks. The rest of us are at risk, whether we know it or not. And it seems that is little that we can do to combat the continued political posturing that prevents our Congressmen from working together to address our nation’s pressing needs … at least, that is, until the 2014 midterm elections.

[This blog entry was originally presented as an oral commentary on Northeast Public Radio on October 10, 2013. It is also available on the WAMC website. Its contents are solely the responsibility of the author alone and do not represent the views of the Bioethics Program or Union Graduate College.]