Stone, T. Howard, J.D., LL.M.
B.A. Political Science, 1991, University of California at Los Angeles.
J.D. Law, 1994, New York Law School.
LL.M. Health Law, 1995, University of Houston Law Center.
Health disparities affecting disadvantaged and marginalized populations; bioethics pertaining to vulnerable persons; human subject protection in medical research; and health law and policy related to behavioral sciences and health care.
- Cardiovascular Disease Research Ethics (CADRE) Program (NIH HL075759).
- Law & Ethics of Drug Addiction Genetics Research (LEDGER) project (NHGRI/NIDA R01DA020119).
- Stigma of substance use and mental health disorders in vulnerable population groups.
- Bioethics Program Website
It is widely acknowledged that our system of human subject protection “has vulnerabilities that threaten its effectiveness” (U.S. Department of Health and Human Services Office of the Inspector General (“OIG”), 1998). The OIG has determined that there is “little educational outreach to investigators to help them become informed and sensitized” about human subject protections, and that “nationally, in the context of the numbers of investigators and the complexity of the issues, such [educational] efforts are minimal.” A NIH-commissioned study reinforces the OIG’s findings: a majority (between 76% and 90%) of research review committee chairs and administrators surveyed indicates that “more or much more effort is needed in the education of investigators,” and that “more or much more effort should go to the education of IRB members and staff” (Bell et al., 1998). The NIH observed at the time that “while all investigators need education in the basics of human subject research, some may elect a more intensive study if their work involves especially difficult topics or special populations.” The inadequacy of clinical investigators’ education in the protection of human participants research was reiterated in a report to the current President’s Council on Bioethics; that report stated that “even now, neither clinical researchers nor IRB members nor IRB staff are systematically educated on the ethics of human participants research” (Emanuel et al., 2002). One of the experts’ recommendations pertaining to research ethics education is that investigators, as well as IRB members and other key study personnel, should have appropriate training, including training in “more advanced” and “specific” courses. This is the case with cardiovascular disease research. A national survey that we conducted indicates that cardiovascular disease investigators have a significant interest in obtaining research ethics training that is tailored to their particular field and needs. In response, we have developed a Cardiovascular Disease Research Ethics training program that is funded by the NIH (HL075759) through 2009.
Increasingly, molecular genetic techniques are being used to identify associations between genotypes and disorders that may contribute to certain behaviors; once individual polymorphisms are associated with certain disorders and behaviors, genetic testing can identify whether particular individuals have the polymorphism. Among the most contentious of all genetic research has been research in behavioral traits that are regarded as anti-social or criminal such as substance use (e.g., drug abuse and dependence). One reason for controversy is based upon concerns about the quality of science behind such research and about subsequent claims of heritability or genetic vulnerability; another reason for concern is the lack of appropriate, ethically defensible responses when such science turns out to be good. Special concern is raised by the prospect of genetic research that may involve prisoners or other persons who are criminal justice-involved, such as probationers, parolees and juvenile offenders, or by the use of a person’s genetic information in the criminal justice setting. Some of the issues that Professor Stone would like to examine include: What would constitute effective or informed consent to take part in genetic epidemiologic research? What are acceptable research risks? Are there defensible uses of genetics in criminal justice settings, including sentencing, probation, evidence or court-ordered treatment decisions? To study some of these issues, we have undertaken the Law & Ethics of Drug Addiction Genetics Research project, co-funded by the National Institute on Drug Abuse and National Human Genome Research Institute (DA020119) through 2011.
Stigma of substance use
Illicit drug use may be one of the most profound and confounding health problems facing American society. Despite its prevalence and human toll, adequate treatment is extraordinarily difficult to provide, owing to—among a number of factors—the stigma attached to persons who abuse or may be addicted to drugs. The case for offenders who reside in rural settings, including persons who have been released from prisons or who have been sentenced to probation in lieu of incarceration, may be worse, owing to the stigma attached to persons convicted of crimes as well as to other factors associated with rural life. Professor Stone is interested in studies to examine and elucidate how stigma and discrimination affects access to or outcomes of drug abuse services and treatment among rural released offenders and probationers who abuse or who are addicted to illicit drugs.
Selected Papers and Abstracts:
- Boisaubin EV, Duarte AG, Blair P, Stone, TH. “Well enough to execute”: The health professional’s responsibility to the death row inmate. Journal of Correctional Health Care, 11(1): 31-43 (2005).
- Stone TH. Discerning minimal risk in research involving prisoners as human subjects. Journal of Law, Medicine & Ethics, 32(3): 535-537 (2004).
- Stone TH. The invisible vulnerable: The economically & educationally disadvantaged subjects of clinical research. The Journal of Law, Medicine & Ethics, 31(1): 149-153 (2003).
- Stone TH. Federal training requirements for responsible research: not going far enough. Journal of Law, Medicine & Ethics, 29:1, 94-99 (2001).
- Stone TH, Winslade WJ, Klugman CM. Sex offenders, sentencing laws and pharmaceutical treatment: a prescription for failure. Behavioral Sciences & the Law 18:1, 83-110 (2000).
- Stone TH. Patient health information confidentiality in telehealth applications. Journal of Healthcare Information Management, 13:4, 79-88 (1999).
- Stone TH, Winslade WJ. Report on a national survey of correctional health facilities: A needs assessment of health issues. Journal of Correctional Health Care, 5(1): 5-49 (1998).
- Winslade WJ, Stone TH, Bell M, Webb D. Castrating pedophiles convicted of sex offenses against children: New treatment or old punishment? SMU Law Review, 51(2): 349-412 (1998).
- Stone TH. Therapeutic implications of incarceration for persons with severe mental disorders: searching for rational health policy. American Journal of Criminal Law, 24(2): 283-358 (1997).
- Stone TH, Winslade WJ. Physician-assisted suicide and euthanasia in the United States: legal and ethical observations. The Journal of Legal Medicine, 16(4): 481-507 (1995).