Books by Jean-Christophe Bélisle-Pipon
Dans ce livre, des chercheurs, des administrateurs, des
décideurs et des professionnels de la san... more Dans ce livre, des chercheurs, des administrateurs, des
décideurs et des professionnels de la santé se penchent
sur les problèmes de justice distributive engendrés par
le manque de ressources dans le système de santé au
Québec.
Listes d’attente, pénurie de personnel et coûts élevés des
médicaments menacent l’équité du système et l’égalité
d’accès aux soins. De grands enjeux se dessinent, dont
le plus important consiste à assurer l’équilibre entre les
besoins de la population, les moyens et les techniques
accessibles pour y répondre et les objectifs sociaux.
Devant la nécessité d’une réforme en profondeur du
système public et pour en assurer la pérennité et l’efficacité,
les auteurs dressent l’état des lieux et proposent des
pistes de solution.
Papers by Jean-Christophe Bélisle-Pipon
Citizen Science: Theory and Practice, 2019
Citizen Science refers to the consultation, participation, engagement or involvement of the gener... more Citizen Science refers to the consultation, participation, engagement or involvement of the general public in research. Rationales for this interaction include increased public access and involvement of citizens in research, immersion of community values relevant to research, outreach, and educational potential with the public, and ultimately, the democratization of science. This paper focuses on the specific subset of citizen science that seeks to engage “patient partners” in health research to gain the valuable experiential knowledge of those living with a disease. Greater patient engagement in research (PER) can provide researchers with insights about citizen values and needs relevant to determining research priorities, methodology, applications, and ethical parameters; this would ideally lead to more effective real-world applications. Over the last decade, projects involving patients partners in research (PPRs) have varied from mere tokenism and undervaluation to full involvement and empowerment of patient participants – the former, a subject of criticism, and the latter, promoted as an ideal. In this article, we will argue that the value of that experiential knowledge from PPRs should not only be acknowledged through its ongoing use, but also through recognition of participants who contribute to the creation and application of new knowledge. We will explore types of recognition that might be attributed to PPRs, including scientific recognition; financial recognition or reward; personal and altruistic recognition; and the beneficial outcomes of research applications. We also will consider whether such types of recognition could be applied to the broader field of citizen science.
There has been increasing attention to financial conflicts of interest (COI) in public health res... more There has been increasing attention to financial conflicts of interest (COI) in public health research and policy making, with concerns that some decisions are not in the public interest. One notable problematic area is expert advisory committee (EAC). While COI management has focused on disclosure, it could go further and assess experts’ degree of (in)dependence with commercial interests. We analyzed COI disclosures of members of Québec’s immunization EAC (in Canada) using (In)DepScale, a tool we developed for assessing experts’ level of (in)dependence. We found great variability of independence with industry and that companies with the highest vaccine sales were predominantly associated with disclosed COIs. We argue that EACs can use the (In)DepScale to better assess and disclose the COIs that affect their experts. Going forward our scale could help manage risk and select members who are less conflicted to foster a culture of transparency and trust in advisors and policy-makers.
Canadian Journal of Bioethics / Revue canadienne de bioéthique, 2018
Engaging patients in research conduct and agenda setting is increasingly considered as an ethical... more Engaging patients in research conduct and agenda setting is increasingly considered as an ethical imperative, and a way to transcend views of patients as passive subjects by fostering their empowerment. However, patient engagement in research (PER) is still an emerging approach with debated definitional and operational frameworks. This song addresses the sometimes difficult encounter and elusive mutual understanding between researchers and patients. “What is PER?” is an impressionistic illustration of the challenges and issues that can be found in the universe of patient engagement in research.
Like most jurisdictions, Canada prohibits direct-to-consumer advertising (DTCA) of prescribed dru... more Like most jurisdictions, Canada prohibits direct-to-consumer advertising (DTCA) of prescribed drugs. However, direct-to-consumer information (DTCI) is permitted, allowing companies to inform the public about medical conditions. An analysis of Eli Lilly's 40over40 promotion campaign for erectile dysfunction (ED), which included a quiz on ED, shows that DTCI, like DTCA, can be an effective means of drug familiarization. The pharmaceutical industry is "playing by the rules" currently in effect in Canada. Regulators should thus seriously consider whether existing rules permitting DTCI actually meet stated objectives of protecting the public from marketing campaigns (i.e., DTCA) that may deliver misleading information.
There has been increasing interest in vaccinating populations against serogroup B meningococcus (... more There has been increasing interest in vaccinating populations against serogroup B meningococcus (MenB) which is now responsible for the majority of invasive meningococcal disease in developed countries. In 2014, public health authorities in Québec (Canada) launched the world's first regional vaccination program using Bexsero® (4CMenB) to reduce the transmission of an endemic clone of MenB. The cost-effectiveness of a vaccination campaign is crucial to assessing the choice of a specific vaccine. Yet in Québec, the cost of the vaccination program has not been released to the public despite a legal obligation to disclose major government's expenses; and this decision was justified on the grounds that the information is an industrial secret. Greater effort must be made to ensuring that transparency is a cardinal value in all population health interventions, so that citizens can hold their governments accountable for decisions that are made in the public interest.
When decision-makers are engaged in a polarized discourse and leaving aside evidence-based recomm... more When decision-makers are engaged in a polarized discourse and leaving aside evidence-based recommendations, is there a role for researchers in the dissemination of this scientific evidence to the general public as a means to counterbalance the debate? In response to the controversial Bill 10 in Quebec, we developed and posted a knowledge transfer video on YouTube to help stimulate critical public debate. This article explains our approach and methodology, and the impact of the video, which, in the space of two weeks, had more than 9,500 views, demonstrating the pertinence of such initiatives. We conclude with recommendations for other research groups to engage in public debates.
Over the last decade there has been a noticeable increase in attention, on the part of public hea... more Over the last decade there has been a noticeable increase in attention, on the part of public health scholars and professionals, to the important ethical challenges that arise in the context of public health policy, practice and research. This has arguably been a driver for the development of public health ethics (PHE) as both a specialized field of study in bioethics and a subject for professional education. But how is PHE taught in public health programs and schools? Are current educational approaches sufficient to provide future professionals with the necessary tools to address the diverse ethical challenges they will encoun-ter? In this article, we examine the international public health and bioethics literatures regarding PHE education in public health programs and schools. Specifically, we 1) summarize the results from studies that describe PHE education in the United States, Europe, Canada and in some developing countries , 2) explore current attitudes and educational approaches toward ethics curricula in public health, and 3) identify and discuss reported barriers to PHE education. We conclude with some general recommendations and a research agenda to guide future work on implementing PHE into different public health programs.
Comment engager le public dans une réflexion sur les enjeux éthiques de notre époque? Guidés par ... more Comment engager le public dans une réflexion sur les enjeux éthiques de notre époque? Guidés par cette question, nous avons développé une plateforme d'échange avec la communauté sur des questions bioéthiques à travers une exposition artistique ainsi qu'une série d'activités de médiation culturelle et scientifique pour les adultes et les enfants. Ce dossier thématique dresse le compte-rendu de ce projet. Art + Bioéthique repose sur une stratégie interdisciplinaire et collaborative qui a amené six jeunes chercheurs en bioéthique à être jumelés à six artistes de la relève afin d'échanger et d'apporter un nouvel éclairage sur une variété d'enjeux éthiques liés à la santé. Ces duos artistes-chercheurs ont chacun développé une oeuvre et un essai sur un thème commun. Notre objectif était de décloisonner l'art et la recherche académique en bioéthique afin de créer des formes hybrides et inédites de diffusion, d'éducation, d'expérimentation et de rencontre. L'expression de la bioéthique à travers l'art constitue une façon innovatrice de transmettre l'aspect sensible de tant de questions éthiques touchant à la santé et au bien-être. À travers ses divers volets, Art+Bioéthique a su rejoindre plusieurs centaines de personnes et les engager dans une réflexion éthique sur des enjeux au coeur de notre société.
How should one engage the public in a reflection on the ethical issues of our time? Guided by this question, we developed a platform for exchange with the community on bioethical issues via an art exhibition and a series of cultural and scientific mediation activities for adults and children. This thematic dossier presents the report of the project. Art + Bioethics is based on an interdisciplinary and collaborative strategy that paired six young bioethics researchers with six emerging artists to share and shed new light on a variety of ethical issues related to health. These artist-researcher duos each developed a work and an essay on a common theme. Our goal was to break down barriers between art and academic research in bioethics and to create hybrids and new forms of dissemination, education, experimentation and meeting. The expression of bioethics through art represents an innovative way to transmit the sensitive aspect of so many ethical issues of health and well-being. Through its various components, Art + Bioethics was able to join several hundred people and engage in ethical reflection on issues that are at the heart of our society.
Le recours au rayonnement ionisant en radiodiagnostic est essentiel dans la pratique médicale act... more Le recours au rayonnement ionisant en radiodiagnostic est essentiel dans la pratique médicale actuelle. Cependant, des scientifiques commencent à s’alarmer de l’augmentation du nombre d’examens d’imagerie inutiles et évitables. C’est principalement la tomodensitométrie (ou scanner) qui est l’examen d’imagerie responsable de la majeure partie de l’irradiation médicale à laquelle est exposée la population. Elle entraîne une irradiation à des doses que l’on peut corréler à un risque excessif de mortalité attribuable à des cancers radio-induits. L’article fait une revue des enjeux éthiques relatifs aux problèmes de radioprotection posés par des examens d’imagerie dont la justification n’est pas adéquate dans le but de porter une réflexion sur l’encadrement de l’exposition de la population des pays développés au rayonnement ionisant. La tension éthique, que génère la difficulté de considérer, lors de l’épisode de prescription d’examens, les effets à long terme par rapport à l’importance prépondérante qui est donnée aux intérêts individuels et au bien-être immédiat, sera mise en lumière par une approche par principes. De cette analyse découle l’impératif d’une vision nouvelle et holistique permettant de proposer des pistes de solution aux controverses liées à l’utilisation actuelle de l’imagerie.
The use of ionizing radiation in diagnostic radiology is essential in today's medical practice. However, scientists are increasingly alarmed about the growing use of non-necessary and avoidable imaging tests, which seems to become a reality in radiology practice. Specifically, CT-scan (responsible for most of the radiation dose to which the population is exposed through medical examinations) causes irradiation at doses that can be correlated to undue risk of mortality from radiation-induced cancers. The article provides an overview of the ethical issues related to radiation protection posed by the inadequate justification of imaging tests with the aim to bear a reflection on the framing of ionizing radiation exposure of the population in developed countries. The ethical conflict generated by the difficulty of considering, during the episode of medical prescription of tests, the long-term effects compared to the overriding importance given to the individual interests and immediate well-being will be highlighted by a principle-based approach. From this analysis, stems the imperative of a new and holistic vision to propose solutions to the controversies related to the current use of medical imaging.
Although there is consensus on the fact that ionizing radiation used in radiological examinations... more Although there is consensus on the fact that ionizing radiation used in radiological examinations can affect health, the stochastic (random) nature of risk makes it difficult to anticipate and assess specific health implications for patients. The issue of radiation protection is peculiar as any dosage received in life is cumulative, the sensitivity to radiation is highly variable from one person to another, and between 20 % and 50 % of radiological examinations appear not to be necessary. In this context, one might reasonably assume that information and patient consent would play an important role in regulating radiological practice. However, there is to date no clear consensus regarding the nature and content of—or even need for—consent by patients exposed to ionizing radiation. While law and ethics support the same principles for respecting the dignity of the person (inviolability and integrity), in the context of radiology practice, they do not provide a consistent message to guide clinical decision-making. This article analyzes the issue of healthcare professionals’ duty to inform and obtain patient consent for radiological examinations. Considering that both law and ethics have as one of their aims to protect vulnerable populations, it is important that they begin to give greater attention to issues raised by the use of ionizing radiation in medicine. While the situation in Canada serves as a backdrop for a reflective analysis of the problem, the conclusions are pertinent for professional practice in other jurisdictions because the principles underlying health law and jurisprudence are fairly general.
The American Journal of Bioethics (AJOB), Aug 16, 2013
Chapters by Jean-Christophe Bélisle-Pipon
Jean-Christophe Bélisle-Pipon, Louise Ringuette, and Bryn Williams-Jones describe a five-step app... more Jean-Christophe Bélisle-Pipon, Louise Ringuette, and Bryn Williams-Jones describe a five-step approach for managing conflicts of interest in public health decision-making.
Jean-Christophe Bélisle-Pipon and Stanislav Birko consider how unregulated forms of direct-to-con... more Jean-Christophe Bélisle-Pipon and Stanislav Birko consider how unregulated forms of direct-to-consumer marketing of prescription drugs using social media might be prevented by amending Canada’s Food and Drug Regulations.
Case Studies by Jean-Christophe Bélisle-Pipon
This case, based on personal experiences and on those found in the literature, highlights the del... more This case, based on personal experiences and on those found in the literature, highlights the delicate tension faced by drug development companies having to balance research integrity and their profitability. | Ce cas, basé sur des expériences personnelles ainsi que sur celles trouvées dans la littérature, met en évidence la tension délicate à laquelle sont confrontées les entreprises vouées au développement des médicaments soit d'équilibrer l'intégrité de la recherche et leur rentabilité.
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Books by Jean-Christophe Bélisle-Pipon
décideurs et des professionnels de la santé se penchent
sur les problèmes de justice distributive engendrés par
le manque de ressources dans le système de santé au
Québec.
Listes d’attente, pénurie de personnel et coûts élevés des
médicaments menacent l’équité du système et l’égalité
d’accès aux soins. De grands enjeux se dessinent, dont
le plus important consiste à assurer l’équilibre entre les
besoins de la population, les moyens et les techniques
accessibles pour y répondre et les objectifs sociaux.
Devant la nécessité d’une réforme en profondeur du
système public et pour en assurer la pérennité et l’efficacité,
les auteurs dressent l’état des lieux et proposent des
pistes de solution.
Papers by Jean-Christophe Bélisle-Pipon
How should one engage the public in a reflection on the ethical issues of our time? Guided by this question, we developed a platform for exchange with the community on bioethical issues via an art exhibition and a series of cultural and scientific mediation activities for adults and children. This thematic dossier presents the report of the project. Art + Bioethics is based on an interdisciplinary and collaborative strategy that paired six young bioethics researchers with six emerging artists to share and shed new light on a variety of ethical issues related to health. These artist-researcher duos each developed a work and an essay on a common theme. Our goal was to break down barriers between art and academic research in bioethics and to create hybrids and new forms of dissemination, education, experimentation and meeting. The expression of bioethics through art represents an innovative way to transmit the sensitive aspect of so many ethical issues of health and well-being. Through its various components, Art + Bioethics was able to join several hundred people and engage in ethical reflection on issues that are at the heart of our society.
The use of ionizing radiation in diagnostic radiology is essential in today's medical practice. However, scientists are increasingly alarmed about the growing use of non-necessary and avoidable imaging tests, which seems to become a reality in radiology practice. Specifically, CT-scan (responsible for most of the radiation dose to which the population is exposed through medical examinations) causes irradiation at doses that can be correlated to undue risk of mortality from radiation-induced cancers. The article provides an overview of the ethical issues related to radiation protection posed by the inadequate justification of imaging tests with the aim to bear a reflection on the framing of ionizing radiation exposure of the population in developed countries. The ethical conflict generated by the difficulty of considering, during the episode of medical prescription of tests, the long-term effects compared to the overriding importance given to the individual interests and immediate well-being will be highlighted by a principle-based approach. From this analysis, stems the imperative of a new and holistic vision to propose solutions to the controversies related to the current use of medical imaging.
Chapters by Jean-Christophe Bélisle-Pipon
Commentaries by Jean-Christophe Bélisle-Pipon
Case Studies by Jean-Christophe Bélisle-Pipon
décideurs et des professionnels de la santé se penchent
sur les problèmes de justice distributive engendrés par
le manque de ressources dans le système de santé au
Québec.
Listes d’attente, pénurie de personnel et coûts élevés des
médicaments menacent l’équité du système et l’égalité
d’accès aux soins. De grands enjeux se dessinent, dont
le plus important consiste à assurer l’équilibre entre les
besoins de la population, les moyens et les techniques
accessibles pour y répondre et les objectifs sociaux.
Devant la nécessité d’une réforme en profondeur du
système public et pour en assurer la pérennité et l’efficacité,
les auteurs dressent l’état des lieux et proposent des
pistes de solution.
How should one engage the public in a reflection on the ethical issues of our time? Guided by this question, we developed a platform for exchange with the community on bioethical issues via an art exhibition and a series of cultural and scientific mediation activities for adults and children. This thematic dossier presents the report of the project. Art + Bioethics is based on an interdisciplinary and collaborative strategy that paired six young bioethics researchers with six emerging artists to share and shed new light on a variety of ethical issues related to health. These artist-researcher duos each developed a work and an essay on a common theme. Our goal was to break down barriers between art and academic research in bioethics and to create hybrids and new forms of dissemination, education, experimentation and meeting. The expression of bioethics through art represents an innovative way to transmit the sensitive aspect of so many ethical issues of health and well-being. Through its various components, Art + Bioethics was able to join several hundred people and engage in ethical reflection on issues that are at the heart of our society.
The use of ionizing radiation in diagnostic radiology is essential in today's medical practice. However, scientists are increasingly alarmed about the growing use of non-necessary and avoidable imaging tests, which seems to become a reality in radiology practice. Specifically, CT-scan (responsible for most of the radiation dose to which the population is exposed through medical examinations) causes irradiation at doses that can be correlated to undue risk of mortality from radiation-induced cancers. The article provides an overview of the ethical issues related to radiation protection posed by the inadequate justification of imaging tests with the aim to bear a reflection on the framing of ionizing radiation exposure of the population in developed countries. The ethical conflict generated by the difficulty of considering, during the episode of medical prescription of tests, the long-term effects compared to the overriding importance given to the individual interests and immediate well-being will be highlighted by a principle-based approach. From this analysis, stems the imperative of a new and holistic vision to propose solutions to the controversies related to the current use of medical imaging.
Scope. In the absence of strong evidence regarding the efficiency of the vaccination to prevent nosocomial influenza infection, where should we draw the line? In order to empower decision-makers with pragmatic ethical rationales, we suggest a working model to support institutional decision-making.
Methodology. Using a public health ethics framework, we analyse the applicability of mandatory influenza vaccination programmes (MVP) for everyone within health institutions.
Results. Two conditions must be met in order to vaccinate: 1) enforceability of vaccination policies, and 2) proximity with patients.
Discussion. Underlying the two conditions is the requirement that a MVP be always applied with the patients’ best interests in mind. The model’s strengths are that: 1) it builds on fair application by targeting for vaccination only those people who need to be included for patient protection, and 2) it is easily adaptable to the particular realities of different institutions.
Conclusion. To avoid getting onto a slippery slope, health institution decision-makers will have to reflect on the particular risks posed by clinical and non-clinical staff. Considering the risks at stake, we need to remain cognisant that mandatory programmes are not designed to be punitive or to restrict unduly individual liberty; rather, they should focus on what precaution demands in a health institution, ensuring patient safety."