Pak J Med Sci. 2013 Sep;29(5):1094-8.

The touch of madness: Manto as a psychiatric case study.

M Hashmi A1, Awais Aftab M2.

Author information

• 1Ali M. Hashmi, MD, Foreign Professor III (HEC), Psychiatry, King Edward Medical University/Mayo Hospital, Lahore, Pakistan.
• 2Muhammad Awais Aftab, MBBS, Department of Psychiatry, King Edward Medical University/Mayo Hospital, Lahore, Pakistan.

Abstract

Saadat Hasan 'Manto' is widely acknowledged as one of the greatest short story writers in the world. He died at the age of forty three from complications of alcoholism. All of his life, he suffered from symptoms of anxiety and depression and his alcohol abuse was intimately linked both to his mental distress as well as his creative genius. This paper examines the life of Manto from a psychiatric perspective and the link between creativity and mental illness. We show how Manto's particular family circumstances led to the development of restlessness and later anxiety in his life; how his substance abuse, especially alcohol abuse exacerbated this mental distress and how it eventually led to his death and how all of these factors were intimately linked to his creative genius and were the source of so many of his literary masterpieces. 

Methods: We reviewed seventy five short stories considered to be his best. Writings about Manto's life including his own were reviewed to construct a picture of his life as well as find clues to his mental distress and alcohol abuse. A literature search for articles related to creativity and mental illness was conducted using Google Scholar containing the search terms 'creativity and madness' and 'creativity and mental illness' in the titles of the articles. References most relevant to our case study were identified. 

Conclusion: Manto suffered from symptoms of anxiety and depression which today would meet the diagnostic criteria for Alcohol Dependence and, in later life, Alcohol-induced Psychosis. Appropriate treatment may have prolonged his life although that may have come at the expense of his creativity.

"...an increasing prevalence of asthma in Africa over the past two decades."

Croat Med J. 2013 Dec 28;54(6):519-31.

An estimate of asthma prevalence in Africa: a systematic analysis.

Adeloye D, Chan KY, Rudan I, Campbell H.

Author information

• Davies Adeloye, WHO Collaborative Centre for Population Health Research and Training, Centre for Population Health Sciences, University of Edinburgh Medical School, Edinburgh, EH8 9AG, UK, Davies.Adeloye@ed.ac.uk.

Abstract

Aim. To estimate and compare asthma prevalence in Africa in 1990, 2000, and 2010 in order to provide information that will help inform the planning of the public health response to the disease. 

Methods. We conducted a systematic search of Medline, EMBASE, and Global Health for studies on asthma published between 1990 and 2012. We included cross-sectional population based studies providing numerical estimates on the prevalence of asthma. We calculated weighted mean prevalence and applied an epidemiological model linking age with the prevalence of asthma. The UN population figures for Africa for 1990, 2000, and 2010 were used to estimate the cases of asthma, each for the respective year. 

Results. Our search returned 790 studies. We retained 45 studies that met our selection criteria. In Africa in 1990, we estimated 34.1 million asthma cases (12.1%; 95% confidence interval [CI] 7.2-16.9) among children <15 years, 64.9 million (11.8%; 95% CI 7.9-15.8) among people aged <45 years, and 74.4 million (11.7%; 95% CI 8.2-15.3) in the total population. In 2000, we estimated 41.3 million cases (12.9%; 95% CI 8.7-17.0) among children <15 years, 82.4 million (12.5%; 95% CI 5.9-19.1) among people aged <45 years, and 94.8 million (12.0%; 95% CI 5.0-18.8) in the total population. This increased to 49.7 million (13.9%; 95% CI 9.6-18.3) among children <15 years, 102.9 million (13.8%; 95% CI 6.2-21.4) among people aged <45 years, and 119.3 million (12.8%; 95% CI 8.2-17.1) in the total population in 2010. There were no significant differences between asthma prevalence in studies which ascertained cases by written and video questionnaires. Crude prevalences of asthma were, however, consistently higher among urban than rural dwellers. 

Conclusion. Our findings suggest an increasing prevalence of asthma in Africa over the past two decades. Due to the paucity of data, we believe that the true prevalence of asthma may still be under-estimated. There is a need for national governments in Africa to consider the implications of this increasing disease burden and to investigate the relative importance of underlying risk factors such as rising urbanization and population aging in their policy and health planning responses to this challenge.

College of American Pathologists: ""Our advocacy work on your behalf will never be done."

Dr. Gene Herbek, President of the College of American Pathologists, responds

january 3, 2014 by the pathology blawg

"Our advocacy work on your behalf will never be done. CAP continues to fight against changes to 88342 and will remain vigilant on this and all payment matters effecting pathologists. For example, CAP officials will be meeting with CMS this month to discuss immunohistochemistry payments."

Ann Intern Med. 2013 Dec 31. doi: 10.7326/M13-2771. [Epub ahead of print]

Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement.

Moyer VA.

Abstract

DESCRIPTION:

Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for lung cancer.

METHODS:

The USPSTF reviewed the evidence on the efficacy of low-dose computed tomography, chest radiography, and sputum cytologic evaluation for lung cancer screening in asymptomatic persons who are at average or high risk for lung cancer (current or former smokers) and the benefits and harms of these screening tests and of surgical resection of early-stage non-small cell lung cancer. The USPSTF also commissioned modeling studies to provide information about the optimum age at which to begin and end screening, the optimum screening interval, and the relative benefits and harms of different screening strategies.

POPULATION:

This recommendation applies to asymptomatic adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

RECOMMENDATION:

The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curativelung surgery.

Ann Intern Med. 2013 Dec 31. doi: 10.7326/P14-9009. [Epub ahead of print]

Screening for Lung Cancer: Recommendations from the U.S. Preventive Services Task Force.

[No authors listed]

"The USPSTF found 4 randomized trials that studied LDCT and chest x-ray for lung cancer screening. The largest and best trial showed fewer lung cancer deaths and deaths from any cause in adults with at least 30 pack-years of smoking who had yearly LDCT than in those who had yearly chest x-rays. The other 3 trials were too small to reach definite conclusions.

Harms of screening include radiation exposure, overdiagnosis, and a high rate of false-positive results. “Overdiagnosis” is finding and treating cases of cancer that may never have caused a problem for the patient. “False-positive” means that the test suggests that a patient has lung cancer when he or she does not. False-positive results can lead to unnecessary worry, additional tests, and even surgery."

Ann Intern Med. 2013 Dec 31. doi: 10.7326/M13-2904. [Epub ahead of print]

Screening for Lung Cancer: Moving Into a New Era.

Detterbeck FC, Unger M.

"Effective implementation of lung cancer screening hinges on reaching high-risk individuals; studies show that those at higher risk (smokers) are less interested in being screened despite recognizing that they are at risk (5). Another issue, as seen in studies of adherence to colon cancer screening (6), is whether we can achieve adequate adherence and follow-up in persons who are at highest risk for lung cancer. It is unlikely that sporadic CT screening will achieve results identical to those seen in the NLST (where adherence was 95%) (7)."

Sleep Med. 2013 Nov;14(11):1221-3. doi: 10.1016/j.sleep.2013.07.005. Epub 2013 Sep 8.

Dante's description of narcolepsy.

Plazzi G.

Author information

• Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna and IRCCS delle Scienze Neurologiche, Bologna, Italy. Electronic address: giuseppe.plazzi@unibo.it.

Abstract

Sleep, sleepiness, and dreaming are expressed throughout Dante Alighieri's (1265-1321) the Divine Comedy from the start of his journey through the afterlife. In the book, Dante complains that he is "full of sleep," and he experiences sudden wake-dreaming transitions, short and refreshing naps, visions and hallucinations, unconscious behaviors, episodes of muscle weakness, and falls which are always triggered by strong emotions. Taken together these signs are highly reminiscent of narcolepsy, a term coined in 1880 by Gélineau to define a disease consisting of daytime irresistible sleep episodes with remarkable dream mentation, sleep paralysis, hallucinations, and cataplexy (falls triggered by strong emotions). Sleep, sleepiness, and episodes of sudden weakness triggered by emotions are Dante's literary fingerprints from his earliest works, pointing to a lifelong autobiographic trait. In the 19th century, Cesare Lombroso speculated that Dante had epilepsy, as he had suffered from frequent spells and hallucinations. However, the multiple emotionally triggered falls Dante experienced in the Divine Comedy contrast with the epileptic seizure he depicted in one of the damned individuals. It is possible that Dante may have intuitively grasped the main features of narcolepsy, but it also is plausible that Dante's sleep, dreams, hallucinations, and falls are clues to a lifelong pathologic trait and that Dante may have known of or had narcolepsy.

Clin Biochem. 2013 Dec 28. pii: S0009-9120(13)00605-X. doi: 10.1016/j.clinbiochem.2013.12.020. [Epub ahead of print]

Lung inflammation in Cystic Fibrosis: Pathogenesis and novel therapies.

Dhooghe B1, Noël S1, Huaux F1, Leal T2.

Author information

• 1Louvain Centre for Toxicology and Applied Pharmacology (LTAP), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium.
• 2Louvain Centre for Toxicology and Applied Pharmacology (LTAP), Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium. Electronic address: teresinha.leal@uclouvain.be.

Abstract

Despite remarkable progress following the identification of the causing gene, the final outcome of Cystic Fibrosis (CF) remains determined mainly by the progressive reduction of lung function. Inflammation of the airways is one of the key elements of the pathogenesis of the disease: it is responsible for the destruction of lung architecture, resulting in progressive loss of respiratory function. Bronchial infection induces an intense inflammatory reaction characterized by a massive invasion of neutrophils, the properties of which seems altered in CF. Moreover, the inflammatory process is also marked by a profuse release of soluble pro-inflammatory mediators, such as interleukin (IL)-6, IL-1β and IL-8 cytokines. In contrast, release of the anti-inflammatory mediator IL-10 is reduced, thus reflecting a pro-/anti-inflammatory imbalance. The inflammation/infection pair seems hard to dissociate, and the origin of the baneful consequences of the persisting excessive inflammatory responses remains to be cleared up: does inflammation follow or rather precede infection? Recent data suggest that uncontrolled inflammation is constitutive in CF. Countering it at early stages of the disease in order to prevent irretrievable damages in lungs remains a major priority in treating patients with CF. In this review, we discuss the usefulness and limitations of mouse models of CF to study the pathogenesis of human lung inflammatory disease, and the development of new potential strategies to reduce the inflammatory burden in the airways.

Patient Educ Couns. 2013 Dec 11. pii: S0738-3991(13)00513-2. doi: 10.1016/j.pec.2013.11.013. [Epub ahead of print]

Measuring critical deficits in shared decision making before elective surgery.

Ankuda CK1, Block SD2, Cooper Z3, Correll DJ4, Hepner DL4, Lasic M4, Gawande AA5, Bader AM6.

Author information

• 1Department of Family Medicine, University of Washington, Seattle, USA.
• 2Department of Psychiatry, Harvard Medical School, USA; Department of Medicine, Harvard Medical School, USA; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, USA.
• 3Harvard Medical School, Department of Surgery, Brigham and Women's Hospital, Boston, USA.
• 4Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, USA.
• 5Harvard Medical School, USA; Department of Health Policy and Management, Harvard School of Public Health, USA; Department of Surgery, Brigham and Women's Hospital, Boston, USA.
• 6Harvard Medical School, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, USA. Electronic address: abader@partners.org.

Abstract

OBJECTIVE:

Identifying patient factors correlated with specific needs in preoperative decision making is of clinical and ethical importance. We examined patterns and predictors of deficiencies in informed surgical consent and shared decision-making in preoperative patients.

METHODS:

Validated measures were used to survey 1034 preoperative patients in the preoperative clinic after signed informed consent. Principal component analysis defined correlated groupings of factors. Multivariable analysis assessed patient factors associated with resultant groupings.

RESULTS:

13% of patients exhibited deficits in their informed consent process; 33% exhibited other types of deficits. Informed consent deficits included not knowing the procedure being performed or risks and benefits. Other deficits included not having addressed patient values, preferences and goals. Non-English language and lower educational level were factors correlated with higher risk for deficits.

CONCLUSION:

Deficits exist in over a third of patients undergoing preoperative decision-making. Sociodemographic factors such as language and educational level identified particularly vulnerable groups at risk for having an incomplete, and possibly ineffective, decision-making process.

PRACTICE IMPLICATIONS:

Interventions to identify vulnerable groups and address patient centered surgical decision making in the pre-operative setting are needed. Focused interventions to address the needs of at-risk patients have potential to improve the surgical decision-making process and reduce disparities.

The effect of antihypertensive agents on sleep apnea

Trials. 2014 Jan 2;15(1):1. [Epub ahead of print]

The effect of antihypertensive agents on sleep apnea: protocol for a randomized controlled trial.

Cichelero FT, Martinez D, Fuchs SC, Gus M, Moreira LB, Fuchs FD.

Abstract

BACKGROUND:

Obstructive sleep apnea (OSA) and hypertension are well-known cardiovascular risk factors. Their control could reduce the burden of heart disease across populations. Several drugs are used to control hypertension, but the only consistently effective treatment of OSA is continuous positive airway pressure. The identification of a drug capable of improving OSA and hypertension simultaneously would provide a novel approach in the treatment of both diseases.

Methods/design: This is a randomized double-blind clinical trial, comparing the use of chlorthalidone with amiloride versus amlodipine as a first drug option in patients older than 40 years of age with stage I hypertension (140 to 159/90 to 99 mmHg) and moderate OSA (15 to 30 apneas/hour of sleep). The primary outcomes are the variation of the number of apneas per hour and blood pressure measured by ambulatory blood pressure monitoring. The secondary outcomes are adverse events, somnolence scale (Epworth), ventilatory parameters and C reactive protein levels. The follow-up will last 8 weeks. There will be 29 participants per group. The project has been approved by the ethics committee of our institution.

DISCUSSION:

The role of fluid retention in OSA has been known for several decades. The use of diuretics are well established in treating hypertension but have never been appropriately tested for sleep apnea. As well as testing the efficacy of these drugs, this study will help to understand the mechanisms that link hypertension and sleep apnea and their treatment.

Connective Tissue Disease-Associated Interstitial Lung Disease

J Intensive Care Med. 2013 Dec 25. [Epub ahead of print]

Connective Tissue Disease-Associated Interstitial Lung Disease: A Focused Review.

Solomon JJ, Fischer A.

Author information

• Department of Medicine, National Jewish Health, Denver, Colorado, USA.

Abstract

The connective tissue diseases (CTDs) are a group of systemic disorders characterized by autoimmunity and autoimmune-mediated organ damage. The lung is a frequent target and all components of the respiratory system are at risk. Interstitial lung disease (ILD) represents a broad group of diffuse parenchymal lung injury patterns characterized by varying degrees of inflammation and fibrosis, is a common manifestation of CTD particularly common in systemic sclerosis, polymyositis/dermatomyositis, and rheumatoid arthritis, and is a leading cause of significant morbidity and mortality. The lung injury patterns of CTD-associated ILD (CTD-ILD) mirror those of idiopathic interstitial pneumonia and may arise at any time during the course of the CTD or may be the first manifestation of CTD. Patients with CTD that present with respiratory failure often present significant diagnostic dilemmas. Thorough and comprehensive assessments to exclude respiratory *infection, acute interstitial pneumonia, medication toxicity, pulmonary embolism, cardiac dysfunction, and diffuse alveolar hemorrhage are the fundamental components for the evaluation of such patients. Furthermore, patients with CTD are also at risk of acute exacerbations of underlying ILD. Acute exacerbations are manifested by subacute respiratory deterioration with worsening hypoxemia in the setting of new radiographic abnormalities. The prognosis of patients with CTD having respiratory failure is often quite poor, highlighting the need for prompt and thorough clinical assessments to determine the underlying etiology and implementation of appropriate therapeutic strategies.

From the WHO: Why do health labor market forces matter?

Bull World Health Organ. 2013 Nov 1;91(11):841-6. doi: 10.2471/BLT.13.118794.

Why do health labour market forces matter?

McPake B1, Maeda A2, Araújo EC2, Lemiere C2, El Maghraby A3, Cometto G4.

Author information

• 1Institute for International Health and Development, Queen Margaret University, Edinburgh, Scotland .
• 2The World Bank, 1818 H Street, NW, Washington, DC, 20433, United States of America .
• 3African Development Bank, Tunis, Tunisia.
• 4Global Health Workforce Alliance, World Health Organization, Geneva, Switzerland .

Abstract

in English, Arabic, Chinese, French, Russian, Spanish

Human resources for health have been recognized as essential to the development of responsive and effective health systems. Low- and middle-income countries seeking to achieve universal health coverage face human resource constraints - whether in the form of health worker shortages, maldistribution of workers or poor worker performance - that seriously undermine their ability to achieve well-functioning health systems. Although much has been written about the human resource crisis in the health sector, labour economic frameworks have seldom been applied to analyse the situation and little is known or understood about the operation of labour markets in low- and middle-income countries. Traditional approaches to addressing human resource constraints have focused on workforce planning: estimating health workforce requirements based on a country's epidemiological and demographic profile and scaling up education and training capacities to narrow the gap between the "needed" number of health workers and the existing number. However, this approach neglects other important factors that influence human resource capacity, including labour market dynamics and the behavioural responses and preferences of the health workers themselves. This paper describes how labour market analysis can contribute to a better understanding of the factors behind human resource constraints in the health sector and to a more effective design of policies and interventions to address them. The premise is that a better understanding of the impact of health policies on health labour markets, and subsequently on the employment conditions of health workers, would be helpful in identifying an effective strategy towards the progressive attainment of universal health coverage.

"Nurses regularly experience incivility, particularly from their patients and patients' families."

J Nurs Manag. 2013 Dec 30. doi: 10.1111/jonm.12201. [Epub ahead of print]

Incivility from patients and their families: can organisational justice protect nurses from burnout?

Campana KL, Hammoud S.

Author information

• Minnesota State University, Mankato, MN, USA.

Abstract

AIM:

To determine whether interpersonal and informational justice influence the association between daily experiences of incivility and burnout among nurses.

BACKGROUND:

Research has suggested that incivility is a concern for managers. Nurses regularly experience incivility, particularly from their patients and patients' families. Incivility, in turn, can increase symptoms of burnout.

METHOD:

Seventy-five nurses provided data on interpersonal and informational justice within their organisation. During five working days, nurses completed a twice-daily survey assessing incivility and burnout. Hierarchical linear modelling analyses examined the main effects and interaction effects of the three variables on burnout.

RESULT:

Incivility was positively associated with burnout. In addition, interpersonal justice strengthened the incivility-burnout relationship. Informational justice did not significantly affect the incivility-burnout relationship.

CONCLUSION:

Incivility is associated with more burnout. The work environment also influences burnout; when organisations provide informational justice, nurses experience less burnout. In organisations where interpersonal justice is high, nurses are more likely to experience burnout.

IMPLICATIONS FOR NURSING MANAGEMENT:

Nursing managers can help employees by ensuring that management's decisions are transparent. In addition, managers should be aware that in organisations with higher interpersonal justice, nurses might be more likely to experience symptoms of burnout as a result of incivility from patients and their families.

From U Hertfordshire: Undergraduate Research Involving Human Subjects Should not be Granted Ethical Approval Unless it is Likely to be of Publishable Quality

HEC Forum. 2013 Dec 30. [Epub ahead of print]

Undergraduate Research Involving Human Subjects Should not be Granted Ethical Approval Unless it is Likely to be of Publishable Quality.

Gallagher CT, McDonald LJ, McCormack NP.

Author information

• Department of Pharmacy, University of Hertfordshire, College Lane, Hatfield, AL10 9AB, UK, c.t.gallagher@herts.ac.uk.

Abstract

Small-scale research projects involving human subjects have been identified as being effective in developing critical appraisal skills in undergraduate students. In deciding whether to grant ethical approval to such projects, university research ethics committees must weigh the benefits of the research against the risk of harm or discomfort to the participants. As the learning objectives associated with student research can be met without the need for human subjects, the benefit associated with training new healthcare professionals cannot, in itself, justify such risks. The outputs of research must be shared with the wider scientific community if it is to influence future practice. Our survey of 19 UK universities indicates that undergraduate dissertations associated with the disciplines of medicine, dentistry and pharmacy are not routinely retained in their library catalogues, thus closing a major avenue to the dissemination of their findings. If such research is unlikely to be published in a peer-reviewed journal, presented at a conference, or otherwise made available to other researchers, then the risks of harm, discomfort or inconvenience to participants are unlikely to be offset by societal benefits. Ethics committees should be satisfied that undergraduate research will be funnelled into further research that is likely to inform clinical practice before granting ethical approval.

The Age of Molecular Medicine: "Only 68% of the schools taught about elder abuse."

Age Ageing. 2013 Dec 29. [Epub ahead of print]

UK medical teaching about ageing is improving but there is still work to be done: the Second National Survey of Undergraduate Teaching in Ageing and Geriatric Medicine.

Gordon AL, Blundell A, Dhesi JK, Forrester-Paton C, Forrester-Paton J, Mitchell HK, Bracewell N, Mjojo J, Masud T, Gladman JR.

Author information

• Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.

Abstract

Introduction: in 2008, a UK national survey of undergraduate teaching about ageing and geriatric medicine identified deficiencies, including failure to adequately teach about elder abuse, pressure ulcers and bio- and social gerontology. We repeated the survey in 2013 to consider whether the situation had improved.

Method: the deans of all 31 UK medical schools were invited to nominate a respondent with an overview of their undergraduate curriculum. Nominees were invited by email and letter to complete an online questionnaire quantifying topics taught, type of teaching and assessment undertaken, and the amount of time spent on teaching.

Results: one school only taught pre-clinical medicine and declined to participate. Of the 30 remaining schools, 20 responded and 19 provided analysable data. The majority of the schools (95-100%) provided teaching in delirium, dementia, stroke, falls, osteoporosis, extra-pyramidal disorders, polypharmacy, incontinence, ethics and mental capacity. Only 68% of the schools taught about elder abuse. Thirty-seven per cent taught a recognised classification of the domains of health used in Comprehensive Geriatric Assessment (CGA). The median (range) total time spent on teaching in ageing and geriatric medicine was 55.5 (26-192) h. There was less reliance on informal teaching and improved assessment:teaching ratios compared with the 2008 survey.

Conclusions: there was an improvement in teaching and assessment of learning outcomes in ageing and geriatric medicine for UK undergraduates between 2008 and 2013. However, further work is needed to increase the amount of teaching time devoted to ageing and to improve teaching around elder abuse and the domains of health used in CGA.

Cluster Randomized Trials: Another Look. ("...whether "research" is occurring at all.")

Hastings Cent Rep. 2013 Dec 20. doi: 10.1002/hast.238. [Epub ahead of print]

Cluster Randomized Trials: Another Look.

Macklin R.

Abstract

The type of research known as cluster randomized trials raises ethical questions not readily answered within the standard understanding of researchethics. What distinguishes a CRT is that it randomizes at the level of social groups rather than at the level of individual research participants: in a CRT, the regimen under study might be assigned to a village, hospital, or school. The organizational schemes of CRTs raise an assortment of fundamental ethical problems. In certain CRTs, the question of whether it is possible to obtain individual informed consent is central. Also, if the intervention is offered at the level of a sizable social group, there is usually no realistic possibility for individuals to opt out of the trial. Other ethical questions raised by CRTs have to do with identifying the subjects of research, and indeed with whether "research" is occurring at all.

From Georgetown U: "...policies designed to activate reputational and ethical concerns will motivate advisors to avoid conflicts of interest."

Psychol Sci. 2013 Dec 30. [Epub ahead of print]

Nothing to Declare: Mandatory and Voluntary Disclosure Leads Advisors to Avoid Conflicts of Interest.

Sah S, Loewenstein G.

Author information

• 1McDonough School of Business, Georgetown University.

Abstract

Professionals face conflicts of interest when they have a personal interest in giving biased advice. Mandatory disclosure-informing consumers of the conflict-is a widely adopted strategy in numerous professions, such as medicine, finance, and accounting. Prior research has shown, however, that such disclosures have little impact on consumer behavior, and can backfire by leading advisors to give even more biased advice. We present results from three experiments with real monetary stakes. These results show that, although disclosure has generally been found to be ineffective for dealing with unavoidable conflicts of interest, it can be beneficial when providers have the ability to avoid conflicts. Mandatory and voluntary disclosure can deter advisors from accepting conflicts of interest so that they have nothing to disclose except the absence of conflicts. We propose that people are averse to being viewed as biased, and that policies designed to activate reputational and ethical concerns will motivate advisors to avoid conflicts of interest.

From U Chicago: "...the collaboration of surgeons and device companies raises the potential for significant harmful conflicts of interest."

Int J Surg. 2013 Dec;11S1:S2-S5. doi: 10.1016/S1743-9191(13)60003-5.

Ethics and surgical innovation: challenges to the professionalism of surgeons.

Angelos P.

Author information

• Linda Kohler Anderson Professor of Surgery and Surgical Ethics, Chief, Endocrine Surgery, Associate Director, MacLean Center for Clinical MedicalEthics, The University of Chicago, USA.

Abstract

The future of surgical progress depends on surgeons finding innovative solutions to their patients' problems. Surgical innovation is critical to advances in surgery. However, surgical innovation also raises a series of ethical issues that challenge the professionalism of surgeons. The very criteria for defining surgical progress have changed as patients may value more than simply reductions in morbidity and mortality. The requirement for informed consent prior to surgery is difficult when an innovative surgical procedure is planned since the risks of the novel operation may not be known. In addition, even if the risks are known in the hands of the innovator, the actual risks to patients when surgeons are learning the new technique are unknown. New techniques often depend on new technology which may be significantly more expensive than traditional techniques. There are no clear criteria to decide which new innovative techniques are going to turn out to be truly beneficial to patients. Many surgical innovations depend on new products which may have been developed as collaborative efforts between surgical device companies and surgeons. Although many currently accepted therapies were developed in this fashion, the collaboration of surgeons and device companies raises the potential for significant harmful conflicts of interest. In the decades to come, careful attention to these and other ethical issues will help to define the future professional standing of surgeons.

Theor Med Bioeth. 2014 Jan 1. [Epub ahead of print]

Intervening in the psychopath's brain.

Glannon W.

Author information

• Department of Philosophy, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada, wglannon@ucalgary.ca.

Abstract

Psychopathy is a disorder involving personality and behavioral features associated with a high rate of violent aggression and recidivism. This paper explores potential psychopharmacological therapies to modulate dysfunctional neural pathways in psychopaths and reduce the incidence of their harmful behavior, as well as the ethical and legal implications of offering these therapies as an alternative to incarceration. It also considers whether forced psychopharmacological intervention in adults and children with psychopathic traits manifesting in violent behavior can be justified. More generally, the paper addresses the question of how to weigh the psychopath's presumptive right to non-interference in his brain and mind against the public interest in avoiding harm.

Ed Uthman: "...the paraffin curtain, that zone of comfort at the microscope, where the well-trained pathologist can relax with a cup of coffee and a stack of slide folders."

Edward O. Uthman (2014) Getting Out From Behind the Paraffin Curtain. Archives of Pathology & Laboratory Medicine: January 2014, Vol. 138, No. 1, pp. 12-13.

EDITORIALS

Getting Out From Behind the Paraffin Curtain

Edward O. Uthman , MD

From Brown & Associates Medical Laboratories, LLP, Houston, Texas.

"I can summarize the most desirable of these as an eagerness to get out from behind the paraffin curtain, that zone of comfort at the microscope, where the well-trained pathologist can relax with a cup of coffee and a stack of slide folders. As viewed from behind the curtain, the ideal workday is one in which the biopsies are adequate, the histologic findings pathognomonic, and the diagnoses brief, definitive, and powerful.

As we all know, those ideal workdays are infrequent." 

From Joe Saad: The Future of Pathology Is Now

A. Joe Saad (2014) The Future of Pathology Is Now. Archives of Pathology & Laboratory Medicine: January 2014, Vol. 138, No. 1, pp. 9-11.

EDITORIALS

The Future of Pathology Is Now

A. Joe Saad , MD

From the Department of Pathology, Methodist Dallas Medical Center, Dallas, Texas.