The Harm of Bioethics: A Critique of Singer and Callahan on Obesity

Debate concerning the social impact of obesity has been ongoing since at least the 1980s. Bioethicists, however, have been relatively silent. If obesity is addressed it tends to be in the context of resource allocation or clinical procedures such as bariatric surgery. However, prominent bioethicists Peter Singer and Dan Callahan have recently entered the obesity debate to argue that obesity is not simply a clinical or personal issue but an ethical issue with social and political consequences. This article critically examines two problematic aspects of Singer and Callahan's respective approaches. First, there is an uncritical assumption that individuals are autonomous agents responsible for health‐related effects associated with food choices. In their view, individuals are obese because they choose certain foods or refrain from physical activity. However, this view alone does not justify intervention. Both Singer and Callahan recognize that individuals are free to make foolish choices so long as they do not harm others. It is at this point that the second problematic aspect arises. To interfere legitimately in the liberty of individuals, they invoke the harm principle. I contend, however, that in making this move both Singer and Callahan rely on superficial readings of public health research to amplify the harm caused by obese individuals and ignore pertinent epidemiological research on the social determinants of obesity. I argue that the mobilization of the harm principle and corresponding focus on individual behaviours without careful consideration of the empirical research is itself a form of harm that needs to be taken seriously.     

Analysis and assessment of heavy metals pollution in soils around a Pb and Zn smelter in Baoji City,Northwest China

Soil heavy metal pollution from mining activities is potentially harmful to human health through the food chain. In this study, a total of 43 soil samples were collected from a depth of 0–20 cm from fields close to a Pb and Zn smelter. The samples were used to: 1) analyze the pollution level of heavy metals (Pb, Zn, Cr, and Cu) and spatial distribution pattern; 2) evaluate the degree of accumulation and enrichment, potential ecological risk, and human health risk; and 3) perform source apportionment in Fengxiang County, Shaanxi Province of China. The results showed that the concentration ranged from 43.67 to 189.55, 131.43 to 239.53, 74.77 to 112.25, and 24.69 to 37.71 mg·kg^?1 for Pb, Zn, Cr, and Cu, respectively, and the mean concentration for Pb, Zn, Cr, and Cu was 129.46, 192.85, 91.98 and 31.67 mg·kg^?1, respectively. The concentrations were greater than the Shaanxi Province background values, while they were lower than the second-level limits of Environmental Quality Standard for Soils of China (EQSS). The spatial distribution of heavy metal contents showed a banded in soil except Cu. The spatial distribution pattern and pollution assessment indexes (I_geo, EF) indicated that the investigated metals had been accumulated in the study areas, and implied significant influences from anthropogenic activities, local meteorological situation, and soil properties. The ecological risk assessment showed that the risks were relatively low (RI<150). Compared with the exposure risk for adults, that for children was significantly greater. The ingestion of heavy metals in the soils by humans was the main exposure pathway compared with the dermal exposure. There may be a risk of noncarcinogenic adverse health effects (HQ < 1, 0.377 ≤ HI≤1.553) on children, but the adults were unlikely to experience obvious adverse health effects (HQ < 1, HI < 1). The carcinogenic risk of Cr for adults and children was at an unacceptable level. The carcinogenic and noncarcinogenic risks were in the order of children > adults. The correlation analysis showed that Pb, Cr, and Cu have identical anthropogenic and natural sources, while Zn has another identical source. This study could provide a basis for the sustainable management of this region by reducing metal inputs and to protect soils from long-term heavy metal accumulation.     

Health risk assessment of heavy metals in soils and maize (Zea mays L.) from Yushu,Northeast China

To investigate heavy metal accumulation in soils and evaluate health risk through maize consumption, a total of 196 soils and 55 maize samples were collected from Yushu, China, one of the most important maize production bases. The mean contents of Cd, Cr, Cu, Zn and Pb were 0.119, 56.51, 19.21, 70.58, and 34.42 mg kg^?1 for soils and were 0.014, 0.68, 1.33, 17.15 and 0.02 mg kg^?1 for maize, respectively. The contents of Cr, Cu, Zn and Pb in all soil and maize samples did not exceed safety thresholds, but the percentages of Cd content above guideline values of Chinese Environmental Quality Standards for Soil and maximum permissible limits for maize were 6.6% and 1.8%, respectively. The spatial distribution and correlation analysis suggested that Cr and Cu in soil were of lithogenic origin, while Zn and Pb were associated with coal combustion exhausts and chemical fertilizer application. The main source of Cd may be phosphate fertilizer application. The average target hazard quotients were all less than 1 and the average hazard index for adults was 0.065, indicating that there was not a potential health risk through maize.     

Health risk assessment via consumption of Pb and Cd contaminated vegetables collected from fresh markets in the lower north of Thailand

This study aimed to investigate the Pb and Cd contamination and health risk assessment for population via consumption of vegetables sold in fresh markets around the lower north of Thailand. The concentrations of Pb and Cd in various vegetables such as root/tuber, stem, inflorescence, fruit, and leaf vegetables were analyzed using an atomic absorption spec-trophotometer. Human health risks of these metals in vegetables were assessed based on target hazard quotient (THQ). The results indicated that more than 80% of the Pb and Cd in almost all vegetable samples exceeded the maximum allowable concentration by National Food Institute criteria with an average range of 0.96–3.39 and 0.48–1.40 mg/kg, respectively. The estimated daily intakes (EDI) of Pb and Cd via dietary consumption of vegetables were between 0.001–0.010 and 0.002–0.008 mg/kg/d, respectively. All EDIs of Pb contaminated vegetables were higher than the reference dose recommended by the USEPA except for leaf edible vegetables, while all EDIs of Cd contaminated vegetables were higher than the reference dose recommended by the USEPA. THQ indicated that the consumption of Pb contaminated root/tuber, stem, inflorescence, and fruit edible vegetables and Cd contaminated leaf vegetable for the local population in the lower north of Thailand could be a severe health risk problem.     

基于指标自动筛选的新疆开孔河流域生态健康评价

生态健康评价对了解区域生态健康状况和促进区域可持续发展具有重要意义,如何自动筛选出能反映生态系统特性的重要指标,是生态健康定量评估的关键问题。基于压力-状态-响应(PSR,Press-State-Response)框架和生态等级网络框架(EHN,Ecological Hierarchy Network),通过文献调研和因果分析建立要素层与指标层之间的交叉联系,构建了生态健康评价"网状"指标体系;在保证指标体系完备性基础上,通过结合主成分分析和熵权法的候选指标权重的客观计算,基于目标优化理论构建了评价指标的自动筛选模型,并基于中选指标计算了新疆开孔河流域2001—2017年生态健康指数(EHCI,Ecological Health Comprehensive Indexes),分析其空间分异和时间变化特征。结果表明:利用所建立的评价指标自动筛选模型,开孔河流域生态健康评价指标由31个候选指标自动筛选出了17个中选指标,用54.8%的指标表达了85.98%的信息,中选的17个指标在干旱/半干旱区域有关文献中应用较多,使用频次比例都在20%以上,其中归一化植被指数(NDVI,Normalized Difference Vegetation Index)、年降水量和植被覆盖度(FVC,Fractional Vegetation Coverage)3个指标的使用频次百分比均超过了50%,说明指标自动筛选模型的合理性;开孔河流域空间分布差异显著,总体上西北高、东南低,东南部和中部绿洲区外围生态健康状况较差,西北部河谷地带和中部两大绿洲区生态健康状况较好;17年来,流域生态质量整体趋于改善,显著改善区域占10.26%,远高于显著退化的1.61%,显著改善区域以孔雀河绿洲最为明显。开孔河流域生态健康的总体好转趋势说明区域生态综合治理取得一定成效。     

Lessons learned from the 2019-nCoV epidemic on prevention of future infectious diseases

Only a month after the outbreak of pneumonia caused by 2019-nCoV, more than forty-thousand people were infected. This put enormous pressure on the Chinese government, medical healthcare provider, and the general public, but also made the international community deeply nervous. On the 25th day after the outbreak, the Chinese government implemented strict traffic restrictions on the area where the 2019-nCoV had originated—Hubei province, whose capital city is Wuhan. Ten days later, the rate of increase of cases in Hubei showed a significant difference (p = 0.0001) compared with the total rate of increase in other provinces of China. These preliminary data suggest the effectiveness of a traffic restriction policy for this pandemic thus far. At the same time, solid financial support and improved research ability, along with network communication technology, also greatly facilitated the application of epidemic prevention measures. These measures were motivated by the need to provide effective treatment of patients, and involved consultation with three major groups in policy formulation—public health experts, the government, and the general public. It was also aided by media and information technology, as well as international cooperation. This experience will provide China and other countries with valuable lessons for quickly coordinating and coping with future public health emergencies.     

Does austerity really kill?

A growing body of the literature has argued that austerity has been bad for health, though without directly measuring austerity. This paper explicitly distinguishes the association of mortality with macroeconomic fluctuations from that with fiscal policy measures, using data for 28 European Union (EU) countries covering the period 1991–2013. The main results present a nuanced, complex picture about the mortality impact of fiscal policies. We confirm the mortality decreasing (increasing) effect of recessions (booms), with the exception of suicide mortality, which shows the opposite effects. Austerity regimes are associated with an increase in all-cause mortality (0.7%). At the same time, fiscal stimuli tend to significantly increase death rates due to cirrhosis or chronic liver disease (3%) and those due to vehicle accidents (4.3%). Our results are sensitive to the set of countries included: when excluding the Baltics, Romania and Hungary, austerity policies turn out to significantly increase suicide-related mortality (2.8%), while the effect on all-cause mortality remains unaffected (0.7%). Overall, however it appears that the austerity-increasing effects are mostly compensated by the (mostly) mortality-decreasing effects of recessions. A notable exception appears to be suicides, which receive a ‘double-boost’ from both recessions and austerity.     

Evaluating the Usefulness of Compulsory Licensing in Developing Countries: A Comparative Study of Thai and Brazilian Experiences Regarding Access to Aids Treatments

While compulsory licensing (CL) is described in the TRIPS agreement as flexibility to protect public health by improving access to medicines in developing countries, a recent literature contends adversely that CL may harm public health. Therefore, this article intends to evaluate the usefulness of CL in the South through the prism of obligations and goals entrusted to patent holders (the effective and non‐abusive exploitation of patents in order to achieve industrial and health developments) and in light of experiences in Thailand and Brazil regarding access to antiretroviral drugs. In this way, it shows that the obligations assigned to patent holders were better served by the recipients of CL and brought significant health and industrial benefits in the two high middle‐income countries. In particular, CL allowed the scaling‐up of free and universal access to antiretroviral drugs by assuring the financial sustainability of these public health programs endangered by monopolistic practices from patent holders.     

What constitutes fair shared decision-making in global health research collaborations?

Funders (located primarily in high-income countries) and high-income country researchers have historically dominated decision-making within global health research collaborations: from setting agendas and research design to determining how data are collected and analysed and what happens with findings and outputs. The ethical principle of shared decision-making has been proposed as a way to help address these imbalances within collaborations and to reduce semicolonial and exploitative forms of global health research. It is important to be clear about what shared decision-making means in order to ensure that it is not done in a tokenistic, shallow way. Thus far, the principle’s content has not been examined and articulated in detail. This paper aims to start the process of delineating a concept of fair shared decision-making as a minimum standard for global health research. Using two hypothetical case examples, the paper will demonstrate that global health research practice is often inconsistent with ideal shared decision-making. In such instances, it can be difficult to decide whether shared decision-making within collaborations is fair. The paper describes how the two cases do not meet criteria for unfair or non-ideal shared decision-making, despite having potentially morally troubling features. The nuances of these examples of research practice help to generate clearer ideas about how to judge fairness in shared decision-making. The paper concludes by presenting ideas about when soft power can be fairly employed between high-income-country and low- and middle-income-country partners and what fair compromise agreements may look like in shared decision-making.