PBHL 2001 1st Edition Lecture 5Ethics in Public HealthCause and EffectLimits to experimentation with human subjectsEpidemiology deals in probabilities and associationsDemonstrating cause and effect•Large number of subjects increases generalizability and confidence•Strength of association (If someone does X, does Y occur?)•Dose-response•Time relationship•Known biological explanation•Consistency across studies Sources of Error•Random Variation: Association is due to chance not the result of change in a variableLarge sample sizeRepresentative samplesRandom assignment •Confounding Variable: Logic and anticipation •Selection Bias: Systematic differences among those who participate in a study and those who don’tAttrition due to worsening or improving conditionOnly disgruntled or happy volunteerTypes of Qualitative DataInformation on materials that either are not, or cannot be expressed in the form of a number, for example (anything that can’t be explained by a number):Physical objectsStill imagesSoundsMoving images/videoWords (text)Qualitative TechniquesInterviewsObservationCollecting documents and artifactsMapping concepts or space or relationshipsMaking sound and visual recordings; taking still-images Free listing and pile sortsLists and inventories DiariesContrasts and Complementarily •Numbers condense limited amount of information about a large number of cases•Qualitative data in all its forms expand the amount of information about a limited number of cases Qualitative MethodsSystematic data collectionAccurate recording (what is not recorded is lost)Openness to new informationRole of the researcher: reflexive, participatory Smaller number of cases chose purposively (generally)Analysis and data collection and incorporation of theory may occur simultaneously and iteratively Writing is a key component of analysis Use of Qualitative InquiryExplorationDescriptionComparisonTesting assumptions, developing models, and generating theory (concepts, variables, and relationships)Authority, Accountability, and Responsibility •The most important asset that public health can have is the public’s trust that work is being done on its own behalf •Ethical principles guide public health, research, interventions, and actions•Ideally, these principles are based on shared, collectively agreed upon ideas about what is good, right, and important. Havasupai Indian Tribe has a 50% diabetes rate among their tribe - no genetic link Their blood samples were used widely not only for diabetic studies, without their permission. The tribe sued ASU and got their blood back.Community-Based Participatory Research•Ideal: Community involvement at all phases of the project (research or intervention)Identification of research question or interventionDesign of the project or studyCollection and analysis of data or implementation of interventionEvaluation and dissemination of resultsPublic policy Conflict of InterestFinancial or professional gain from the results of research or interventionsPharmaceutical and medical device companiesResearchersDevelopers of interventions Loss of financial Bioethics (Individual Protection) and Public Health (Community Protection) Shared EthicsBeneficenceRespect for personsJusticeEthics in Public HealthFocus is on population level surveillance, intervention, and research, and groups or communities as subjectsNeed to acknowledge collective rights, benefits, and protectionsProviders of public health interventions are governments States have “police power” to protect the public