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Paul Komesaroff

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Papers

11β-Hydroxysteroid Dehydrogenase Type II Inhibition Causes Cerebrovascular Remodeling and Increases Infarct Size after Cerebral Ischemia

Endocrinology, 2009

Direct mineralocorticoid receptor (MR) activation with deoxycorticosterone acetate has deleteriou... more Direct mineralocorticoid receptor (MR) activation with deoxycorticosterone acetate has deleterious effects on the cerebral vasculature. Inhibition of 11β-hydroxysteroid dehydrogenase type II (11βHSD2) mimics the detrimental effects of elevated mineralocorticoids in the heart, but the effect of enzyme inactivation on the cerebral vasculature is unknown. Therefore, we hypothesized that systemic 11βHSD2 inhibition with carbenoxolone (CBX) would cause remodeling of the middle cerebral artery (MCA) and increase the damage caused by cerebral ischemia. Six-week-old male Sprague Dawley rats were divided into control and CBX (2.5 mg/d) + 0.9% NaCl treated. After 4 wk treatment, rats were used to assess either structure and reactivity of the MCA or the response to cerebral ischemia using the MCA occlusion technique. Cerebral damage was assessed by 2,3,5-triphenyltetrazolium chloride staining and expressed as a percentage of the hemisphere infarcted. CBX treatment increased systolic blood pres...

Medicine and the Ethical Conditions of Modernity

Ethical Intersections

COVID-19—Extending Surveillance and the Panopticon

Journal of Bioethical Inquiry

Lead Essay—Inside the Pandemic

Journal of Bioethical Inquiry

Symposium Lead Essay—Conflict of Interest: Opening Up New Territories

Journal of Bioethical Inquiry

A Continent Aflame: Ethical Lessons From the Australian Bushfire Disaster

Journal of Bioethical Inquiry

Raising Rates of Childhood Vaccination: The Trade-off Between Coercion and Trust

Journal of bioethical inquiry, 2018

Vaccination is a highly effective public health strategy that provides protection to both individ... more Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitor vaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through "herd immunity," which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergo vaccination for medical or other reasons. Australia is unique in employing financial incentives to increase vaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriate vaccination. Despite relatively high compliance with the childhood vaccination schedule, however, the Australian government has determined that rates should be higher and has recently introduced policy that includes removing certain tax and childcare benefits for non-vaccinators and formally disallowing con...

The Role of Relational Knowing in Advance Care Planning

The Journal of clinical ethics, 2017

Medical decision making when a patient cannot participate is complicated by the question of whose... more Medical decision making when a patient cannot participate is complicated by the question of whose voice should be heard. The most common answer to this question is that "autonomy" is paramount, and therefore it is the voice of the unwell person that should be given priority. Advance care planning processes and practices seek to capture this sentiment and to allow treatment preferences to be documented and decision makers to be nominated. Despite good intentions, advance care planning is often deficient because it is unable to facilitate a relational approach to decision making in cases when the patient's competence is reduced. In this article we present findings from a study of the ways in which older people and their significant others understand decision making in such circumstances. Critical to the participants' understanding was the emergent concept of "relational knowing," a concept that is poorly articulated in the advance care planning literature. ...

Conflicts of interest in medicine: taking diversity seriously

Internal Medicine Journal

Conflicts of interest (COI) are considered ubiquitous in many healthcare arrangements,1 but there... more Conflicts of interest (COI) are considered ubiquitous in many healthcare arrangements,1 but there is disagreement on how COI should be defined, whether non-financial conflicts deserve attention and the relationship between COI and harm. We conducted a study of Australian healthcare professionals and students to gain a better understanding of the way that COI are understood in practice. In this paper, we outline an empirically derived taxonomy of the understanding of, and attitudes towards, COI. We carried out 25 semistructured interviews with clinicians working in several fields across Australia and held six focus group discussions with medical students in New South Wales. Interviewees and focus groups followed similar question routes investigating participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; understanding of COI and views of management. All data were compared and analysed using a matrix of pre-determined questions. There were, broadly, two views of COI: that COI were potentially harmful and morally compromising and another that saw COI as less serious and easily managed through existing structures. Definitions of COI varied widely and were both financial and non-financial. Causes of COI were, variously, systemic, individual and/or relational. Some participants associated COI with moral wrongdoing, and a variety of potential harms was identified. Views on how COI should be managed were similarly varied. We found considerable heterogeneity in how COI are understood in practice. This has implications for management systems that are currently in place, and we suggest a more sophisticated system for considering and mitigating COI.

Public health and obesity prevention campaigns – a case study and critical discussion

Communication Research and Practice, 2017

ABSTRACT Social marketing campaigns play a key role in responses to obesity. We examine a recent ... more ABSTRACT Social marketing campaigns play a key role in responses to obesity. We examine a recent Australian obesity prevention campaign as a case study to explore public health values, and in particular consider the implications of the use of fear, risk, stigma, disgust, and personal responsibility in such campaigns. We examine the broader implications of such campaigns as forms of social control that promote certain images of body weight while problematising other body types. We consider the intended and unintended consequences of these campaigns. Responses to obesity are influenced by the political environment. The intended and unintended consequences and the political environment should be considered in the development of alternative models.

Obese Adults’ Perceptions of News Reporting on Obesity

SAGE Open, 2015

News reporting, in channels such as broadcast and print media, on obesity as an issue has increas... more News reporting, in channels such as broadcast and print media, on obesity as an issue has increased dramatically in the last decade. A qualitative study, in which we used in-depth interviews and thematic analysis, was undertaken to explore 142 obese individuals’ perceptions of, and responses to, news reporting about obesity. Participants believed that news reporting on obesity focused on personal responsibility and blame, and portrayed obese people as “freaks.” They described being portrayed as “enemies” of society who were rarely given a voice or identity in such news coverage unless they were seen to be succeeding at weight loss. They were also critical of the simplistic coverage of obesity, which was in contrast with their personal experiences of obesity as complex and difficult to address. Participants believed that obesity news reporting added to the discrimination they experienced. We consider how this news reporting may act as a form of “synoptical” social control, working in...

Watching the Responsibility Clock: Medical Care, Ethics, and Medical Shift Work

The American Journal of Bioethics, 2016

The Practice of Ethics: A Manifesto

Abandoning clinical trial safeguards won't boost local industry

Sexuality and Ethics in the Medical Encounter

Big debts in small packages — the dangers of pens and post-it notes

Pan1b (17�HSD11)-enzymatic activity and distribution in the lung

Mol Cell Endocrinol, 2001

The Many Faces of the Clinic

Chinese Medicine in Australia

The Journal of Alternative and Complementary Medicine, 2016

At the Gates of the Labyrinth: A Meditation on Suffering

11β-Hydroxysteroid Dehydrogenase Type II Inhibition Causes Cerebrovascular Remodeling and Increases Infarct Size after Cerebral Ischemia

Endocrinology, 2009

Direct mineralocorticoid receptor (MR) activation with deoxycorticosterone acetate has deleteriou... more Direct mineralocorticoid receptor (MR) activation with deoxycorticosterone acetate has deleterious effects on the cerebral vasculature. Inhibition of 11β-hydroxysteroid dehydrogenase type II (11βHSD2) mimics the detrimental effects of elevated mineralocorticoids in the heart, but the effect of enzyme inactivation on the cerebral vasculature is unknown. Therefore, we hypothesized that systemic 11βHSD2 inhibition with carbenoxolone (CBX) would cause remodeling of the middle cerebral artery (MCA) and increase the damage caused by cerebral ischemia. Six-week-old male Sprague Dawley rats were divided into control and CBX (2.5 mg/d) + 0.9% NaCl treated. After 4 wk treatment, rats were used to assess either structure and reactivity of the MCA or the response to cerebral ischemia using the MCA occlusion technique. Cerebral damage was assessed by 2,3,5-triphenyltetrazolium chloride staining and expressed as a percentage of the hemisphere infarcted. CBX treatment increased systolic blood pres...

Medicine and the Ethical Conditions of Modernity

Ethical Intersections

COVID-19—Extending Surveillance and the Panopticon

Journal of Bioethical Inquiry

Lead Essay—Inside the Pandemic

Journal of Bioethical Inquiry

Symposium Lead Essay—Conflict of Interest: Opening Up New Territories

Journal of Bioethical Inquiry

A Continent Aflame: Ethical Lessons From the Australian Bushfire Disaster

Journal of Bioethical Inquiry

Raising Rates of Childhood Vaccination: The Trade-off Between Coercion and Trust

Journal of bioethical inquiry, 2018

Vaccination is a highly effective public health strategy that provides protection to both individ... more Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitor vaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through "herd immunity," which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergo vaccination for medical or other reasons. Australia is unique in employing financial incentives to increase vaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriate vaccination. Despite relatively high compliance with the childhood vaccination schedule, however, the Australian government has determined that rates should be higher and has recently introduced policy that includes removing certain tax and childcare benefits for non-vaccinators and formally disallowing con...

The Role of Relational Knowing in Advance Care Planning

The Journal of clinical ethics, 2017

Medical decision making when a patient cannot participate is complicated by the question of whose... more Medical decision making when a patient cannot participate is complicated by the question of whose voice should be heard. The most common answer to this question is that "autonomy" is paramount, and therefore it is the voice of the unwell person that should be given priority. Advance care planning processes and practices seek to capture this sentiment and to allow treatment preferences to be documented and decision makers to be nominated. Despite good intentions, advance care planning is often deficient because it is unable to facilitate a relational approach to decision making in cases when the patient's competence is reduced. In this article we present findings from a study of the ways in which older people and their significant others understand decision making in such circumstances. Critical to the participants' understanding was the emergent concept of "relational knowing," a concept that is poorly articulated in the advance care planning literature. ...

Conflicts of interest in medicine: taking diversity seriously

Internal Medicine Journal

Conflicts of interest (COI) are considered ubiquitous in many healthcare arrangements,1 but there... more Conflicts of interest (COI) are considered ubiquitous in many healthcare arrangements,1 but there is disagreement on how COI should be defined, whether non-financial conflicts deserve attention and the relationship between COI and harm. We conducted a study of Australian healthcare professionals and students to gain a better understanding of the way that COI are understood in practice. In this paper, we outline an empirically derived taxonomy of the understanding of, and attitudes towards, COI. We carried out 25 semistructured interviews with clinicians working in several fields across Australia and held six focus group discussions with medical students in New South Wales. Interviewees and focus groups followed similar question routes investigating participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; understanding of COI and views of management. All data were compared and analysed using a matrix of pre-determined questions. There were, broadly, two views of COI: that COI were potentially harmful and morally compromising and another that saw COI as less serious and easily managed through existing structures. Definitions of COI varied widely and were both financial and non-financial. Causes of COI were, variously, systemic, individual and/or relational. Some participants associated COI with moral wrongdoing, and a variety of potential harms was identified. Views on how COI should be managed were similarly varied. We found considerable heterogeneity in how COI are understood in practice. This has implications for management systems that are currently in place, and we suggest a more sophisticated system for considering and mitigating COI.

Public health and obesity prevention campaigns – a case study and critical discussion

Communication Research and Practice, 2017

ABSTRACT Social marketing campaigns play a key role in responses to obesity. We examine a recent ... more ABSTRACT Social marketing campaigns play a key role in responses to obesity. We examine a recent Australian obesity prevention campaign as a case study to explore public health values, and in particular consider the implications of the use of fear, risk, stigma, disgust, and personal responsibility in such campaigns. We examine the broader implications of such campaigns as forms of social control that promote certain images of body weight while problematising other body types. We consider the intended and unintended consequences of these campaigns. Responses to obesity are influenced by the political environment. The intended and unintended consequences and the political environment should be considered in the development of alternative models.

Obese Adults’ Perceptions of News Reporting on Obesity

SAGE Open, 2015

News reporting, in channels such as broadcast and print media, on obesity as an issue has increas... more News reporting, in channels such as broadcast and print media, on obesity as an issue has increased dramatically in the last decade. A qualitative study, in which we used in-depth interviews and thematic analysis, was undertaken to explore 142 obese individuals’ perceptions of, and responses to, news reporting about obesity. Participants believed that news reporting on obesity focused on personal responsibility and blame, and portrayed obese people as “freaks.” They described being portrayed as “enemies” of society who were rarely given a voice or identity in such news coverage unless they were seen to be succeeding at weight loss. They were also critical of the simplistic coverage of obesity, which was in contrast with their personal experiences of obesity as complex and difficult to address. Participants believed that obesity news reporting added to the discrimination they experienced. We consider how this news reporting may act as a form of “synoptical” social control, working in...

Watching the Responsibility Clock: Medical Care, Ethics, and Medical Shift Work

The American Journal of Bioethics, 2016

The Practice of Ethics: A Manifesto

Abandoning clinical trial safeguards won't boost local industry

Sexuality and Ethics in the Medical Encounter

Big debts in small packages — the dangers of pens and post-it notes

Pan1b (17�HSD11)-enzymatic activity and distribution in the lung

Mol Cell Endocrinol, 2001

The Many Faces of the Clinic

Chinese Medicine in Australia

The Journal of Alternative and Complementary Medicine, 2016

At the Gates of the Labyrinth: A Meditation on Suffering