Ethical assessment of hepatitis C virus treatment: The lesson from first generation protease inhibitors
Abstract Since chronic hepatitis C has mostly become curable, issues concerning choice and allocation of treatment are of major concern. We assessed the foremost ethical issues in hepatitis C virus therapy with 1st generation protease inhibitors using the personalist ethical framework within the health technology assessment methodology. Our aim was to identify values at stake/in conflict and to support both the physicians’ choices in hepatitis C therapy and social (macro-) allocation decision-making. The ethical assessment indicates that: (1) safety/effectiveness profile of treatment is guaranteed if its use is restricted to the patients subgroups who may benefit from it; (2) patients shoul…
Sustainability of national health services and justice: the case of new DAAs for HCV in Italy
Background - Direct acting antivirals (DAAs) for hepatitis C virus (HCV) have quite changed the therapeutic routine in the last few years. Reported rates of sustained virological response (SVR), exceed 90% in all patients subgroups. Other, even more effective, DAAs combinations are being developed for use in the most difficult to treat and advanced patients, aiming for 100% of SVR in 100% of cases. The perspective is the eradication of HCV and reduction of main complications: liver cirrhosis and hepatocellular carcinoma. Aim and Methodology - Dealing with justice issues related to DAAs for HCV in Italy through the anlysis of available literature and documentation. Results - The ethical prin…
A return to humane medicine: Osler's legacy.
Sir William Osler is celebrated today not only for his contributions to the advancement of medical education, but also for the humanism he brought to the practice of medicine. He was a doctor whose bedside skills and manners were emulated, and can legitimately be called an infectious diseases specialist. Nonetheless, he was also a humanist in the broader sense of the term, a student of human affairs and human nature, who emphasised compassion for the individual. To what extent, if any, are today's challenges influenced by departures from the paradigms created by Osler? In this paper we sought to ascertain whether such a tradition is still relevant to current practice and may foster a new pe…
Ripartire dall'uomo: il futuro delle Medical Humanities
Medical humanities can be a useful approach to empower trust in the patient-physician relationship and to avoid a strongly biologized approach to medicine. Today we have to face a new challenge: letting Medical Humanities be not only a maid discipline, but a inter-disciplinary subject that will give a new shape to medical courses.
Ethical aspects of Fecal Microbiota Transplantation (FMT).
The importance of human microbiota in preserving human organism healthy is nowadays well acknowledged. The alteration of the microbiota can be the consequence of a persistent use of antibiotics or immunosuppressive medications or abdominal irradiation or surgery, wrong diet, or can be caused by surgery or anatomical condition. These alterations can cause many infections and diseases that today can be treated with Fecal Microbiota Transplantation (FMT), also called Bacteriotherapy, that is the administration of a fecal solution from a donor into the intestinal tract of a recipient. Although to date, FMT appears to be safe and without serious adverse effects, there are some ethical issues tha…