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Investigation What Wrong With This Picture

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					            What's Wrong with This Picture?




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
      Where are we and where are we going?
             1                                                        2
   How is this disease             Hypotheses                     Is there
      distributed?                                            an association?
      What’s                                                        Did the exposure and
  my hypothesis?                                                     the disease turn up
                                                                          together?
                                         3
                                Is the association
                                      causal?




                                          4
                               What should be done
                              to prevent the disease?




                                         5
                                Did the prevention
                                  strategy work?


Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                                  Review


 Descriptive                                                  Analytical
Epidemiology                    Hypothesis                   Epidemiology

   What is                                                       What is
 descriptive             What is a hypothesis?                  analytical
epidemiology?                                                 epidemiology?

                          An Educated Guess




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                                  Review
                       What is a control group?
            People who participate in a trial
              but do not get the treatment.
   Their results are compared to results of the group
               that does get the treatment.




             “Exposed”                            “Not Exposed”
            Experimental                            Control
               Group                                 Group

Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                                Scenario




                               Poor Grades

                                 Drug Use                Smoking marijuana
 Epidemiologist
                                                        causes memory loss.
Board of Education




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                                Scenario
                      200 High School Students
                           Measure Memory




            100 Students                         100 Students
            Experimental                           Control
               Group                                Group
                                 4 Months
                        Measure Memory Loss
        2 x 2 Table, Calculate Risks, and Relative Risk
Detectives in the Classroom - Investigation 2-3: What’s Wrong With This Picture?
                                 Epi Talk


                              Ethical

                             In accordance with the
                             accepted principles of right and
                             wrong governing the conduct
                             of a group.




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                       Epi Log Worksheet




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                  Nazi Human Experiments




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                      Accepted Principles

       What happened after World War II was over?

                               Doctors Trial




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                      Accepted Principles
               Highlights of the Nuremberg Code

       Totally voluntary, informed consent

       Based on prior animal experiments

       Justification of benefit to individuals or society




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                      Accepted Principles
               Highlights of the Nuremberg Code

       Totally voluntary, informed consent

       Based on prior animal experiments

       Justification of benefit to individuals or society

       Absolute avoidance of physical and mental suffering
       and injury

       Conducted only by qualified scientists

       Ability of subjects to withdraw at any time

Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                       Epi Log Worksheet




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                    Tuskegee Syphilis Study




Nothing Learned Will Prevent, Find, or Cure a Single Case.

 Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                   Tuskegee Syphilis Study




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                       Accepted Principles

                             What happened?

  1972: Newspaper article and public outcry
  1973: Senate hearings on human experiments
          Study stopped
          Lifetime medical treatment guaranteed for survivors
  1974: National Commission for the Protection of Human Subjects
  1975: Affected wives and children given medical treatment
  1979: Belmont Report




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                      Accepted Principles

                        Clinton Regrets “Clearly Racist” U.S. Study
                                 New York Times, May 17, 1997




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                       Epi Log Worksheet




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                      Accepted Principles


                         The Belmont Report
                          Office of the Secretary

                Ethical Principles and Guidelines for the
               Protection of Human Subjects of Research

            The National Commission for the Protection of
            Human Subjects of Biomedical and Behavioral
                            Research

                               April 18, 1979




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                       Accepted Principles



                            Belmont Report

                        Basic Ethical Principles

                          Respect for Persons

                               Beneficence

                                   Justice



Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                                 Epi Talk


                             Respect for Persons

                             Respect individual autonomy
                             (independence, freedom,
                             capacity for self direction)

                              Provides extra protection for
                              those with less autonomy.




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                   Basic Ethical Principles


        Rules for Ensuring “Respect for Persons”
                           Informed Consent

   Complete information about study and potential risks

                       Understand information

                        Voluntary participation

                         Withdraw at any time



Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                       Epi Log Worksheet




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                                 Epi Talk


                             Beneficence

                              An effort to secure people’s
                              well-being.

                              A decision about when it is
                              justifiable to seek certain
                              benefits despite the risks
                              involved.




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                   Basic Ethical Principles


               Rules for ensuring “Beneficence”

                     Risk / Benefit Assessment

              Consider all types of potential harms

           Benefits to participants and / or to society

        Brutal or inhumane treatment is never justified




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                       Epi Log Worksheet




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                                 Epi Talk


                              Justice

                             Fair distribution of the benefits
                             of research and the burdens of
                             being a research subject.




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                    Basic Ethical Principles



                    Rules for Ensuring “Justice”
                             Subject Selection

            Selection process and outcome must be fair
           Avoid cultural, racial, social or other biases
Avoid choosing convenient or easy to manipulate participants




 Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                       Epi Log Worksheet




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                      Accepted Principles

                          Accepted Principles



       RFP            Need to let people know about study.




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                       Epi Log Worksheet




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                       Epi Log Worksheet




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
                       Epi Log Worksheet




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?
            What's Wrong with This Picture?

                        Investigation
                             2-3
                         has ended.




Detectives in the Classroom - Investigation 2-3: What's Wrong with This Picture?

				
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