COURSE TITLE

I209: Diseases, Debates and Dilemmas: A Case-Based Exploration of Contemporary Health Issues

PROFESSOR(S)

Sarah Bacon, sbacon@mtholyoke.edu
Lynn Morgan, lmmorgan@mtholyoke.edu
John Rapoport, rapoport@mtholyoke.edu
Craig Woodard, cwoodard@mtholyoke.edu

LECTURE

TuTh 75 mins, F 50 mins

TEXTS

There are no required texts for this class. A reading packet will be available for purchase, and readings will also be available on electronic or hard copy reserve. Reading assignments are specified below; other reading assignments may be added during the semester.

COURSE DESCRIPTION

This interdepartmental course was developed jointly by Professors Sarah Bacon (Biological Sciences), Lynn Morgan (Anthropology), John Rapoport (Economics) and Craig Woodard (Biological Sciences). We gratefully acknowledge the assistance of Nicole Walsh, '04 during course development. The instructors for Spring 2004 are Ms. Bacon and Ms. Morgan.

Through analysis and discussion of cases, this speaking-intensive interdisciplinary course draws on the perspectives of science and social science to examine issues that raise policy questions or present ethical dilemmas around medical care and health. Examples of case topics include women’s health and pharmaceutical marketing, alcoholism and liver disease, organ transplantation, disease as a social construct, public health strategies, and treatment of HIV. This speaking-intensive course requires substantial student participation.

COURSE WORK & GRADING

Attendance: Attendance at each class meeting is required and will be recorded. Excessive absences will reduce your grade.

Course work and grading: The following will be the basis for grading: speaking and participation in group work (30%), two case papers (20% each), a scrapbook proposing a new case from current events (10%), and three short (2-4 page) papers that respond to specific readings and/or study questions (with a cumulative total of 20%).

Speaking and participation: This includes your performance as a participant in class discussion, preparation and presentation of speaking assignments such as debates and reports, and contribution to small group projects (evaluated in part by peer evaluation).

Case papers: Following class discussion of each major case, you will be given a question which should be answered in a paper of 3-5 pages. You will write two such papers during the term: one on either the PMDD or HIV case, and the other on either the Liver or Parkinson’s case.

Scrapbook: This assignment will ask you to find news article(s) which may serve as the basis for cases such as the ones in the course and to write a commentary on each article.

Response papers: These short papers will ask you to respond to a specific question based on one of the readings or class discussions.

LECTURE SCHEDULE

Class	Topic & Reading
1	Introductory Meeting
2	CASE: MAD COW DISEASE Fact sheet about BSE and vCJD from the Centers for Disease Control and Prevention: http://www.cdc.gov/ncidod/diseases/cjd/bse_cjd_qa.htm For a beef industry perspective, see the BSE FAQs page of the National Cattelemen's Beef Association: http://www.bseinfo.org/pr9.htm For a critique of the beef industry and the USDA, see Eric Schlosser. 2004. The cow jumped over the USDA. New York Times, January 2, p. A19. Available online at LexisNexis through the Mount Holyoke library website.
3	CASE: PREMENSTRUAL DYSPHORIC DISORDER (PMDD): What is a disease? Beauchamp, Tom L., 1989, "Concepts of health and disease" in Contemporary Issues in Bioethics, 3rd edition, Tom L. Beauchamp and LeRoy Walters eds, pp. 73-79 (Belmont, Ca: Wadsworth Pub Co); Elliott, Carl. 2003. Amputees by choice. IN Better Than Well: American Medicine Meets the American Dream. Pp. 208-236.
4	PMDD continued: evaluating the evidence. Greenhalgh, Trisha. 1997. How to read a paper: getting your bearings (deciding what the paper is about). British Medical Journal 315(26 July):243-246. Lewontin, Richard. 1991. A reasonable skepticism. In Biology as Ideology New York:HarperCollins.
5	PMDD continued: SSRIs Nelson, Randy J. 1995. Hormones and mood. IN An Introduction to Behavioral Endocrinology, pp. 511-29, 539-41. Chrisler, Joan C. and Ingrid Johnston-Robledo. 2002. Raging hormones? Feminist perspectives on premenstrual syndrome and postpartum depression. IN Rethinking Mental Health and Disorder. M. Ballous and L. S. Brown, eds., pp. 174-97.
6	PMDD continued: engaging the controversy. Moynihan, Ray. 2002. Selling sickness: The pharmaceutical industry and disease mongering. British Medical Journal 324(13April):886-91. Also available online at: http://bmj.com/cgi/content/full/324/7342/886 Spartos, Carla. 2000. Sarafem Nation. The Village Voice (December 6-12). Parry, Barbara L. 1999. A 45-year old woman with premenstrual dysphoric disorder. Journal of the American Medical Association 281(4):368-73, and Letters, JAMA 281(24):2283. Steiner, Meir, Susanne Steinberg, Donna Stewart, et al. 1995. Fluoxetine in the treatment of premenstrual dysphoria. New England Journal of Medicine 332(23):1529-34, and relevant Letters.
7	PMDD continued: The debate.
8	LIBRARY WORKSHOP: class meets in the library.
9	OVERVIEW OF THE US HEALTH SYSTEM McKinlay, John B. A case for refocusing upstream: The political economy of illness. Philip Jacobs and John Rapoport, The Economics of Health and Medical Care, 5th edition, chapter 2 "Economics Dimensions of the Health Care.
10	CASE: IT'S HER CHOICE ISN'T IT? A CASE OF NON-ADHERENCE TO ANTI-HIV MEDICATION How HIV Causes AIDS, National Institute of Allergy and Infectious Diseases (NIAID) - October 2001 Overview of Antiretroviral Drugs, Laurence Peiperl, MD, Published January 25, 2002 http://hivinsite.ucsf.edu/InSite.jsp?page=ar-drugs Denberg, Thomas, Melissa Welch, and Mitchell D. Feldman. 2003. Cross-cultural communication. IN Behavioral Medicine in Primary Care: A Practical Guide, 2nd edition. M.D. Feldman and J. F. Christensen, eds., pp. 103-113.
11	HIV continued. Farmer, Paul. 1999. Invisible women: class, gender, and HIV. IN Infections and Inequalities, pp. 59-93. Berkeley: University of California Press.
12	HIV continued. Fogarty, L et al. 2002. Patient adherence to HIV medication regimens: A review of published and abstract reports. Patient Education and Counseling 46:93-108.
13	HIV continued.
	Spring Break
14	Begin reading for liver case. Silverthorn, D.U. "Focus on…The Liver" in Human Physiology 2nd ed. Upper Saddle River, NJ: Prentice Hall, 2001. Sherwood, L. "The liver performs various…" In Human Physiology, 4th ed. Pacific Grove, CA: Brooks/Cole, 2001. Hauptman PJ, O'Connor KJ. Procurement and allocation of solid organs for transplantation. N Engl J Med 336(6):422-431, 1997. Steinbrook, R. Allocating livers-devising a fair system. N Engl J Med 336(6): 436-438, 1997.
15	CASE: LIVER DISEASE AND TRANSPLANTS Beauchamp & Childress, Principles of Biomedical Ethics, 5th ed "Rationing scarce treatments to patients" pp. 264-272 (Oxford: Oxford Univ Press, 2001) Recommended: Gibbard, Allan, "The Prospective Pareto Principle and Equity of Access to Health Care", Milbank Memorial Fund Quarterly/Health and Society, Vol 60,l No. 3, 1982. Recommended: In Beauchamp and Childress, Principles of Biomedical Ethics, 5th edition, Chapter 6, "Justice" pp. 225 - 282.
16	LIVER CASE: the shortage & one approach to address it. United Network for Organ Sharing website for statistics on waiting list time for cadaveric organs. http://unos.org Fentiman, L.C. Organ donations: the failure of altruism. Issues in Science and Technology, Fall 1994, pp. 43-48. Joralemon, D. and Cox, P. Body values: the case against compensating for transplant organs. Hastings Center Report, January-February 2003, pp 27-33.
17	LIVER CASE continued. Is health a right or a privilege?
18	LIVER CASE continued. Ethics questions, for example: Should organs be sold? Is "brain death" an ethically justifiable basis for harvesting organs? Lock, Margaret. 1996. Death in technological time: Locating the end of meaningful life. Medical Anthropology Quarterly 10(4):575-600. Recommended: Author offers guidelines on diagnosing brain death: Wijdicks EFM. 2001. The diagnosis of brain death. NEJM 344(16):1215-21. Available online: http://www.aoneuro.on.ca/HTML/BrainDeath.pdf Recommended: Author opposes brain death criteria: Truog R. 1997 Is it time to abandon brain death? Hastings Center Report. Author supports brain death criteria: DuBois, JM. 2002. Is organ procurement causing the death of patients? Issues in Law & Medicine 18(1):21-41.
19	LIVER CASE continued. Reports of fact-finding commissions
20	PARKINSON'S DISEASE CASE The placebo effect Talbot, M. The placebo prescription. NYTimes Jan 9 2000. Moseley et al. 2002. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. NEJM 347(2):81-88.
21	PARKINSON'S CASE continued. Ethical decisions within the structure of clinical research. Beauchamp and Childress, Principles of Biomedical Ethics, 5th ed. Chapter 7, "Professional-patient relationships," pp. 283-336. Especially "The dual roles of physician and investigator," pp. 319-328.
22	PARKINSON'S CASE continued. What is it like to have Parkinson's? What are the treatments available? Olanow, CW. A 61-year-old man with Parkinson;s Disease. JAMA 275(9): 716-722, 1996. Delbanco TL, Daley J, Hartman EE. A 61-year-old man with Parkinson's Disease, one year later. JAMA 276(14): 1171, 1996. Enker WE. A 61-year-old man with Parkinson"s Disease, one year later. JAMA 277(3): 212-213, 1997.
23	PARKINSON'S CASE continued. Macklin, Ruth. 1999. The ethical problems with sham surgery in clinical research. NEJM341(13):992-96. Dekkers, S. and G. Boer. 2001. Sham neurosurgery in patients with Parkinson's disease: is it morally acceptable? Journal of Medical Ethics 27:151-56. Albin RL. 2002. Sham surgery controls: intracerebral grafting of fetal tissue for Parkinson's disease and proposed criteria for use of sham surgery controls. Journal of Medical Ethics 28:322-325.
24	PARKINSON'S CASE continued. Presentations
25	PARKINSON'S CASE continued.
26	To Be Announced

Last Modified: March 11, 2005