Càtedra de Bioètica Fundació Grífols

Course at COMB: Iatrogenesis and ethics

9 and 10 July 2018

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9 and 10 July 2018

College of Doctors of Barcelona.  Free of charge.


Scientific progress has spectacularly increased the range of medical interventions, and has delivered great health benefits. Unfortunately, however, there has also been an increase in adverse effects, which are not always related to errors or negligence on the part of health professionals, and are instead often the consequence of more remote or latent causes, among which we can point to a trivialization of medicine and health which, paradoxically, goes hand in hand with unreasonable expectations of medicine and of the health system.


8-hour course for doctors and health professionals interested in preventing adverse effects in their practice.

From 16:00 to 20:00.
Centro de Estudios Colegiales (Colegio de Médicos)
Paseo de la Bonanova, 47
08017 Barcelona

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Ezekiel Emanuel (video)

Lecture by Ezekiel Emanuel

Lecture by Ezekiel Emanuel


The chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania delivered a lecture on Josep Egozcue Cycle.

How advertising influences our health

How advertising influences our health

The Foundation promotes ethical debate in a world in which our communication processes are being transformed

The transformation we have witnessed in the world of communication over the last two decades – which affects information sources, formats, distribution channels, access devices and participants in the communication process – means we need to review the role of advertising and its impact on health, not only from the perspective of health and medicines (drugs, care services and providers, different treatment options and therapies, institutional health promotion campaigns) but also any campaign that could have an impact on people's health or is related to diet and lifestyle. To address these topics and stimulate dialogue, on 5 June – in partnership with Pompeu Fabra University (UPF) – we held a seminar that brought together experts and professionals from a wide range of backgrounds to consider the impact of advertising on health.


The opening address was given by Gema Revuelta, director of the Centre for the Study of Science, Communication and Society at UPF,  in which she provided an overview of the new media landscape and the transformation the sector has undergone.  She argued that our consumption of media content is not just passive but is also an active process. These changes mean that further regulation is required in the field of health, and this in turn entails far-reaching ethical considerations.


Jordi Pérez, a member of the Scientific Educational Research Group at UPF, reflected on the influence of advertising on attitudes and behaviours. Pérez looked at how advertising messages are constructed, starting with a persuasive intention, based on a message's credibility and attractiveness and its capacity to connect with the potential audience.


Patrici Calvo, lecturer in bioethics at Universitat Jaume I, Castellón, summarized the current digital transformation. In particular, he warned of the potential dangers – particularly with regard to health issues – for vulnerable groups in this new scenario. The use of techniques based on artificial intelligence offers huge benefits but also poses considerable risks such as undermining privacy or the possibility of algorithm-based decision-making which, in the case of marketing and advertising, can give rise to serious errors and to aggressive and inappropriate campaigns. To address this issue, Calvo argued that we need to strengthen our control systems, promoting mechanisms based on systems to monitor ethical compliance in advertising, the creation of codes of ethics, and the expansion of ethical audits.


Legislation was a key focus of discussion throughout the day. Nuria Amarilla, senior partner at Eupharlaw, summarized the legislation that currently governs advertising activity. She stressed that there is already adequate legislation to regulate advertising activity, but argued that it is essential to keep this under constant review to fill any legal vacuums that may arise as a result of ongoing changes.


The discussion also covered the issues of self-regulation and control. Charo Fernández, assistant directory general of Autocontrol, explained what her organization does. This is a nonprofit body created by the industry in response to society's calls for guarantees to ensure that advertising is accurate and trustworthy. It brings together advertisers, advertising agencies and media organizations, and is designed to ensure compliance with advertising legislation. Fernández argued that "it is precisely the stakeholders in the advertising industry who have the biggest interest in ensuring that the rules are respected." The number of inquiries from companies, agencies and media organizations continues to grow and, during the course of 2018, Autocontrol expects to receive almost 5,000 requests to review campaigns, the majority of which correspond to advertising for healthcare, health products and food. 


Carlos Mateos, coordinator of the platform #SaludSinBulos (#HealthWithoutRumours) used some examples to demonstrate how easily fake news can spread. This is particularly dangerous when it affects people's health, as it can give rise to beliefs and behaviours which harm people's health. To address this problem, Mateos explained the various initiatives promoted by his platform, which involve developing materials to encourage people to take a critical approach to information, revealing the sources of fake news, sharing knowledge of credible sources and, more generally, promoting a more sophisticated knowledge culture.


The seminar ended with a session dedicated to analyzing advertising's influence on the construction of people's self-image. Mónika Jiménez of the UPF's Observatorio MediaCorp explained the research activity of this organization in recent years, to empirically demonstrate that advertising offers a distorted image of the body. Jiménez pointed out that advertising aimed at adults is also consumed by minors, who absorb stereotypes that do not reflect reality. According to a study conducted in 2015 analyzing the 150 adverts with the highest viewing figures among children in Spain, 72% of these featured people with near-perfect bodies. This has a major effect, as it generates a distorted body image and the pursuit of impossible aesthetic ideals. Jiménez explained that MediaCorp, in addition to research, also promotes materials to encourage children to read information critically and organizes workshops to help counter-act the false body image often offered by advertising.


The final contribution of the day came from Begoña Román, lecturer in Ethics at the School of Philosophy (UB) and Chair of the Social Services Ethics Committee of Catalonia, who offered some philosophical reflections on the contents of the seminar. She argued that we need an ethical commitment to underpin the stance that advertising should not be a free-for-all. "Health-related advertising does not generate self-confidence, respect and self-esteem, despite the fact that this is precisely what its proponents often claim."

Ethics and research

Ethics and research

Leading researchers debate the latest challenges

The second day of the 11th Egozcue Lectures was dedicated to the subject of ethics in research. Such activity aims to improve human health, and the participants in any study are a means to achieving this goal. However, if people are used to this end and no significant benefits are obtained, then the result is exploitation. The role of ethics is to minimize such risks.


According to Ezekiel Emanuel, Chair of Medical Ethics at the University of Pennsylvania, ethics in research needs to be given far higher priority, instead of its current limited role, and it needs to be more rigorous. Ethics committees have many guidelines to help them analyze whether research is ethical – the Nuremberg Code, the Helsinki Declaration, the Belmont Report, CIOs, Common Rule, etc. – but these agreements are often contradictory and, having been created to address specific situations, frequently lack a general perspective.


Ezekiel Emanuel's team has worked over recent years to develop a series of ethical principles that should be considered before undertaking any research procedure: studies should contribute value to society; their results should have significant scientific value; the fair selection of trial participants is essential; the risk–benefit ratio must clearly favour the benefits; the informed consent of patients is essential; and participants must be respected. Emanuel argues that only if all of these principles are satisfied should the research go ahead.


The most important principle is the one that refers to the risk–benefit ratio. He argues that it is essential not to base the risk analysis for any study on intuition, and that it should instead be subject to systematic evaluation. To achieve this, he proposes a detailed data analysis from which to extract risk–benefit conclusions for any research project. To analyze these variables, the group has established a set of guidelines which stipulate that an investigation project with minimum risks is one in which the difficulty or harm it may pose for participants is no greater than what might be encountered in daily living. Risk is a part of daily life (domestic accidents, traffic accidents, sporting injuries etc.). This statistical analysis should then be used to determine the percentage of daily risk in the specific environment, and to compare it with the objective risks of the research. If the risk this entails is equal to or lower than the minimum daily risk of the environment in which the study is to be performed, the research can be conducted; otherwise, it should be ruled out.


Biomedical research in Spain


The final event was a penal discussion with leading researchers Manel Esteller (researcher at Bellvitge Institute of Biomedical Research), Bonaventura Clotet (director of IrsiCaixa), Mercè Boada (medical director at Fundació Ace) and Joan MV Pons (scientific coordinator at Aquas health evaluation and quality agency). They all agreed on the importance of research as a generator of knowledge, wealth and health. In general, the outlook is positive, with Spain boasting plenty of world-class research talent. However, researchers emphasize the need for public bodies to back research and not to reduce budgets in the face of crises such as that seen in recent years. They also argue for continued support for projects such as ICREA, which attracts talent from across the globe but in recent years has suffered budget cuts.


Participants in the panel discussion advocated the need to promote a culture of research, which should start by teaching people about the benefits of such activity for the territory where it is located. We also need to promote fundraising at the individual and corporate level, explaining the economic benefits that may derive from the research. These practices are commonplace in some countries, but there is little tradition of them in Spain. Finally, researchers noted the need to take a more balanced approach to the issue of publication, as recent years have seen the withdrawal of numerous publications as a result of failure to satisfy scientific research standards. It is important to find other ways of recognizing the work of doctors and scientists, ensuring that such recognition does not take the exclusive form of the number of publications in prestigious journals and mentions in the literature.



Winners of BIYSC Awards 2017

Winners of BIYSC Awards 2017

Víctor Torrecillas and David Belda are the winners of the awards given by the Victor Grifols i Lucas Foundation and Catalunya la Pedrera Foundation.

Senior high school students Víctor Torrecillas and David Belda are the winners of the BIYSC Awards 2017, a prize given by the Victor Grifols i Lucas Foundation and Fundación Catalunya la Pedrera to recognize research projects presented at the Barcelona International Youth Science Challenge (BIYSC) 2017. This international programme is designed to promote interest in science and educational excellence among young people aged from 16 to 18, across the world. The winners received a grant to enable them to participate in the London International Youth Science Forum (LIYSF), a scientific event for students from different countries, to be held in London this summer.


Víctor Torrecillas is in his second year of the baccalaureate at Centre d'Estudis Montseny-Poblenou, Barcelona. Torrecillas' entry for BIYSC 2017 was an essay titled "Mutating LAE5 through bioinformatics tools to obtain a source for high-yield geraniol production". David Belda studies at Kings College, Alicante, and submitted a project on biomedicine and ethics with the title "Is animal immunostaining efficient and ethical?"


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