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1.  Using Client Reminders to Increase Colorectal Cancer Screening in Montana, 2012 
Colorectal cancer (CRC) is the third leading cause of cancer death for men and women in the United States. CRC screening can save lives by detecting precancerous polyps that are then removed or by detecting cancer early when treatment is most effective.
Community Context
CRC screening participation in Montana is low. To increase screening participation among Montanans with health insurance, the Montana Cancer Control Programs (MCCP) partnered with a small association health organization (AHO). This partnership implemented a postcard campaign to increase CRC screening participation among the AHO’s enrollees.
Postcards were sent to 1,011 people insured through the AHO; 504 people were mailed 1 postcard and 507 people were mailed 2 postcards. Evaluation of the campaign assessed recall of the campaign among people who received 1 postcard versus people who received 2 postcards.
Women were 60% more likely to recall receiving the postcards than were men. People who received 2 postcards were 2.3 times as likely to recall receiving them as were people who received 1 postcard.
The MCCP considers this collaborative project with an AHO a promising approach to implementing evidence-based colorectal cancer screening interventions. The MCCP plans to partner with additional AHOs in Montana to evaluate CRC screening participation among their enrollees.
PMCID: PMC3976229  PMID: 24698529
2.  Destigmatizing Alcohol Dependence: The Requirement for an Ethical (Not Only Medical) Remedy 
The disease model of alcohol dependence or “alcoholism” is often presented as the linchpin in addressing the condition successfully. It has been argued, for example, that adopting a medical approach will reduce the stigma that impedes the provision and acceptance of treatment. However, the medical paradigm has existed for many years without significantly affecting the negative social attitudes that surround dependence.
I argue that a reductive scientific approach is not equipped to address the socioethical tensions that dependence creates.
To lessen the stigmatization of dependence, it is important to integrate ethical analysis into policy debates on the condition.
PMCID: PMC3341606  PMID: 22494005
4.  Alcohol dependence in public policy: towards its (re)inclusion 
Clinical ethics  2009;4(2):74-78.
Public policy on alcohol in the UK relies on health promotion campaigns that encourage individuals who misuse alcohol to make healthier choices about their drinking. Individuals with alcohol-dependence syndrome have an impaired capacity to choose health. As a result, individuals with the worst alcohol misuse problems lie largely outside the reach of choice-based policy. However, such policy has been widely criticized and efforts to reform it are underway. This paper argues that the British Medical Association’s recent attempt to improve policy on alcohol in the UK by introducing strategies which have been shown to control drinking within populations still gives insufficient attention to alcohol dependence. This is because it fails accurately and consistently to characterize alcohol dependence and gives insufficient attention to the social challenges it presents.
PMCID: PMC3188374  PMID: 21984871
5.  The demise of UKXIRA and the regulation of solid‐organ xenotransplantation in the UK 
Journal of Medical Ethics  2007;33(7):373-375.
The new regulations on xenotransplantation pay insufficient attention to the broad ethical (and legal) problems raised by this technique and that the abandonment of a national body with overall regulatory authority in this area is a mistake.
PMCID: PMC2598150  PMID: 17601860
6.  Public policy on alcohol in the United Kingdom: Towards a safety net for the alcohol-dependent 
Journal of law and medicine  2009;17(3):386-399.
Public policy on alcohol in the United Kingdom fails to support, and may even undermine, the wellbeing of those with the worst alcohol misuse problems, the alcohol-dependent. This is partly because it evades the thorny issue of impaired control that characterises dependence. In addition, until recently, all United Kingdom alcohol policy focused on improving individualised treatment for the dependent, rather than attending to the wider social and environmental factors that influence the condition. The efforts of policy to normalise “sensible” drinking, while stigmatising drunkenness, also risk exacerbating the social vulnerability of the alcohol-dependent. The article examines these issues and concludes by pointing to a number of developments that are required to help ensure that the dependent do not continue to fall through policy that claims to be inclusive.
PMCID: PMC2875108  PMID: 20169799
7.  Empirical assessments of clinical ethics services: implications for clinical ethics committees 
Clinical ethics  2007;2(4):187-192.
The need to evaluate the performance of clinical ethics services is widely acknowledged although work in this area is more developed in the United States. In the USA many studies that assess clinical ethics services have utilized empirical methods and assessment criteria. The value of these approaches is thought to rest on their ability to measure the value of services in a demonstrable fashion. However, empirical measures tend to lack ethical content, making their contribution to developments in ethical governance unclear. The steady increase of clinical ethics committees in the UK must be accompanied by efforts to evaluate their performance. As part of this evaluative work it is important to examine how the practice of clinical ethics committees can be informed by empirical measures.
PMCID: PMC2493408  PMID: 18677421
Medical law international  2007;8(3):221-238.
In the United Kingdom there is a growing conviction that CECs have an important role to play in helping health care professionals address ethical dilemmas. For example, the Royal College of Physicians, the Nuffield Trust and the unofficial Clinical Ethics Network, which has received financial support from the Department of Health, commend the use of CECs in the UK. The growth of such committees has been influenced by the legal and policy support they have received in the United States. However, there is increasing concern about both the benefits and the quality of work produced by CECs. In addition, despite the rapid increase in the number of CECs in the UK, outside of the United States they remain under-researched and no formal mechanism exists to assess their performance. As a result we know little about the structure, function, impact and effectiveness of CECs. We are currently conducting a research project funded by the Wellcome Trust that seeks to interrogate the competing claims regarding the benefits and disbenefits of CECs. This initial account of our research provides a detailed analysis of theoretical issues that surround the development and use of CECs and points towards the questions that lie at the heart of the social science strand of our project.
PMCID: PMC2239247  PMID: 18270545
9.  Patient and Citizen Participation in Health: The Need for Improved Ethical Support 
Patient and citizen participation is now regarded as central to the promotion of sustainable health and health care. Involvement efforts create and encounter many diverse ethical challenges that have the potential to enhance or undermine their success. This article examines different expressions of patient and citizen participation and the support health ethics offers. It is contended that despite its prominence and the link between patient empowerment and autonomy, traditional bioethics is insufficient to guide participation efforts. In addition, the turn to a “social paradigm” of ethics in examinations of biotechnologies and public health does not provide an account of values that is commensurable with the pervasive autonomy paradigm. This exacerbates rather than eases tensions for patients and citizens endeavoring to engage with health. Citizen and patient participation must have a significant influence on the way we do health ethics if its potential is to be fulfilled.
PMCID: PMC4160284  PMID: 24809598
decision making; primary care; public health; health policy

Results 1-9 (9)