Public Attitudes to Xenotransplantation: A National Survey in the United States.

PURPOSE: Xenotransplantation presents a potential clinical alternative to the shortage of human organs for transplantation. Before clinical trials occur in the United States, public assessments are crucial to understand potential barriers to acceptance. The purpose of this study was to explore barriers, and identify characteristics associated with attitudes toward xenotransplantation. METHODS: A survey assessing demographic characteristics and attitudes toward xenotransplantation was distributed to a nationally representative sample of adults ≥ 18 years old in the United States. Regression analysis was employed to identify characteristics associated with attitudes toward xenotransplantation. FINDINGS: Between May 25 and June 14, 2023, 5008 respondents completed the survey. Importantly, half of respondents expressed low or no knowledge of either transplantation or xenotransplantation. Approximately 40% expressed discomfort with receiving a pig organ for themselves or a loved one. Despite a lack of xenotransplant outcome data, 36% were open to experimental xenotransplantation if they needed a transplant. However, 57% rated lack of current evidence of success or fear complications as top concerns. Regression models consistently associated being younger, female, not needing an organ, or being member of a racially minority group with lower acceptance. CONCLUSION: This survey is the largest to date exploring public attitudes toward xenotransplantation. Despite overall acceptance, concerns persist. Increasing public acceptance is key as the field progresses advances.

Examining the Ethics and Impacts of Laws Restricting Transgender Youth-Athlete Participation.

As of this writing, twenty-one states have passed laws barring transgender youth-athletes from competing on public-school sports teams in accordance with their gender identity. Proponents of these regulations claim that transgender females in particular have inherent physiological advantages that threaten a "level playing field" for their cisgender competitors. Existing evidence is limited but does not support these restrictions. Gathering more robust data will require allowing transgender youth to compete (rather than preemptively barring them), but even if trans females are shown to retain some advantage, this would not have greater moral significance than the many other "fair" physical and economic advantages found across sports. These regulations deprive transgender youth, an exceptionally vulnerable population, from the vast physical, mental, and social benefits of sports. While we advocate for transgender inclusion under our current, gender-segregated model of sport, we propose changes to the overarching structure that would promote a more inclusive and fairer athletic environment.

Public perceptions of US for-profit, nonprofit, and public hospitals.

Nonprofit hospitals have been criticized for behaving like for-profit hospitals. One prominent defense of nonprofit hospitals is contract failure theory, which suggests that nonprofits are important in markets defined by information asymmetries. Unlike for-profits, nonprofit hospitals' inability to distribute profits may provide patients with an important assurance that they will not be exploited in the course of receiving care. We investigated support for this theory using a sample of 2569 US adults. We assessed (1) relevance of hospital ownership status; (2) respondent preferences for nonprofit, for-profit, or public hospitals; and (3) respondent ability to correctly identify hospital ownership status. We found little evidence that hospital nonprofit status influenced Americans' decisions about where to seek care. Ownership status was relevant for fewer than 30% of respondents and preference was greatest overall for public hospitals. Only 30-45% of respondents could correctly identify the ownership status of nationally recognized hospitals, and fewer than 30% could identify their local hospitals. These findings suggest that contract failure does not currently provide a justification of nonprofit hospitals' value; further scrutiny of tax exemption for nonprofit hospitals is warranted.

What HIRTS athletes? Establishing a unified public policy understanding of Head Impact-Related Trauma in Sport.

Globally, concussions in sport now attract far greater concern than several decades ago. Yet, no international scientific consensus exists for defining 'concussion,' or for determining how many brain injuries caused by a contact sport constitute a sufficient public health threat to warrant improving policies. How can policymakers help coaches, players, and parents work with public health authorities and clinicians to identify concussions, and prevent and treat head injuries? Doing so will require language that helps distinguish among the multitude of conditions related to Head Impact-Related Trauma in Sport (HIRTS), including sport-related concussion, post-concussion syndrome, second impact syndrome, and neurodegenerative diseases such as chronic traumatic encephalopathy. We propose a 'HIRTS framework' to advance public policy pertaining to head impacts and their effects. Given the scientific ambiguities regarding the definition, diagnosis, and markers of concussion and resulting complications, we encourage international policymakers, clinicians, and public health officials to adopt the following working definitions and concomitant policy recommendations to safeguard athletes' health and optimize tracking efforts, public education, funding, and government services.

Adverse event management in mass drug administration for neglected tropical diseases.

The ethical challenges of reporting and managing adverse events (AEs) and serious AEs (SAEs) in the context of mass drug administration (MDA) for the treatment of neglected tropical diseases (NTDs) require reassessment of domestic and international policies on a global scale. Although the World Health Organization has set forth AE/SAE guidelines specifically for NTD MDA that incorporate suspected causality, and recommends that only SAEs get reported in this setting, most regulatory agencies continue to require the reporting of all SAEs exhibiting even a merely temporal relationship to activities associated with an MDA program. This greatly increases the potential for excess "noise" and undue risk aversion and is not only impractical but arguably unethical where huge proportions of populations are being treated for devastating diseases, and no good baseline exists against which to compare possible AE/SAE reports. Other population-specific variables that might change the way drug safety ought to be assessed include differing efficacy rates of a drug, background morbidity/mortality rates of the target disease in question, the growth rate of the incidence of disease, the availability of rescue or salvage therapies, and the willingness of local populations to take risks that other populations might not. The fact that NTDs are controllable and potentially eradicable with well-tolerated, effective, existing drugs might further alter our assessment of MDA safety and AE/SAE tolerability. At the same time, diffuseness of population, communication barriers, lack of resources, and other difficult surveillance challenges may present in NTD-affected settings. These limitations could impair the ability to monitor an MDA program's success, as well as hinder efforts to obtain informed consent or provide rescue therapy. Denying beneficial research interventions and MDA programs intended to benefit millions requires sound ethical justification based on more than the identification of and rote response to AEs and SAEs.