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AMA Journal of Ethics. March 2015, Volume 17, Number 3: 265-267.
The Importance of Good Communication in Treating Patients’ Pain
Anita Gupta, DO, PharmD
Friday at 4 p.m. our pain clinic phone rang; it was the daughter of one of my patients, crying and telling me that her mother had died following a grueling course of treatment only a year before for widely metastatic breast cancer. The daughter had called me to share the news, saying she was truly grateful for all of the care I had given during her mother’s struggle with intractable cancer pain.
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ABSTRACT
This Review summarizes and draws connections between diverse streams of empirical research on privacy behavior. We use three themes to connect insights from social and behavioral sciences: people’s uncertainty about the consequences of privacy-related behaviors and their own preferences over those consequences; the context-dependence of people’s concern, or lack thereof, about privacy; and the degree to which privacy concerns are malleable—manipulable by commercial and governmental interests. Organizing our discussion by these themes, we offer observations concerning the role of public policy in the protection of privacy in the information age.
ABSTRACT
This Review summarizes and draws connections between diverse streams of empirical research on privacy behavior. We use three themes to connect insights from social and behavioral sciences: people’s uncertainty about the consequences of privacy-related behaviors and their own preferences over those consequences; the context-dependence of people’s concern, or lack thereof, about privacy; and the degree to which privacy concerns are malleable—manipulable by commercial and governmental interests. Organizing our discussion by these themes, we offer observations concerning the role of public policy in the protection of privacy in the information age.
Relación clínica con el paciente : No habrá reclusión indefinida de personas con trastorno mental o discapacidad
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El Gobierno ha anunciado la retirada de la reforma del Código Penal del capítulo de medidas de seguridad según las cuales el tiempo de internamiento de ciudadanos contrastornos mentales o discapacidad intelectual podía prorrogarse indefinidamente atendiendo a su supuesta ‘peligrosidad’.
El Gobierno ha anunciado la retirada de la reforma del Código Penal del capítulo de medidas de seguridad según las cuales el tiempo de internamiento de ciudadanos contrastornos mentales o discapacidad intelectual podía prorrogarse indefinidamente atendiendo a su supuesta ‘peligrosidad’.
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Em preocupa l’ús cada cop menys seriós que fem de la historia clínica… Estem fent-la malbé com a eina essencial per donar continuïtat a l’atenció clínica. Hem entrat en una espiral en la qual sembla que tot el que sigui compartir la informació és bo…!
Em preocupa l’ús cada cop menys seriós que fem de la historia clínica… Estem fent-la malbé com a eina essencial per donar continuïtat a l’atenció clínica. Hem entrat en una espiral en la qual sembla que tot el que sigui compartir la informació és bo…!
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Two years ago, you finished a trial that took 5 years of your life. You'd had an idea for a new indication for a marketed drug. After cajoling the drug maker and pleading with your colleagues around the world, you put together, on a shoestring budget, an active-comparator–controlled trial with more than 1000 patients, with each followed for more than 2 years. The results were positive but not stunning: people with the condition under study now had another option for treatment that was equally effective but a little less toxic than existing therapies. You were able to get the work published in a major medical journal. With the primary work published, you had hoped to analyze the data further and prepare additional reports. But another year has gone by with no more publications. Your data lie dormant, providing no benefit for anyone.
Two years ago, you finished a trial that took 5 years of your life. You'd had an idea for a new indication for a marketed drug. After cajoling the drug maker and pleading with your colleagues around the world, you put together, on a shoestring budget, an active-comparator–controlled trial with more than 1000 patients, with each followed for more than 2 years. The results were positive but not stunning: people with the condition under study now had another option for treatment that was equally effective but a little less toxic than existing therapies. You were able to get the work published in a major medical journal. With the primary work published, you had hoped to analyze the data further and prepare additional reports. But another year has gone by with no more publications. Your data lie dormant, providing no benefit for anyone.
ANOTACIONES Y ACOTACIONES AL NUEVO PATERNALISMO MÉDICO
Germán Méndez Sardina
Mtr. Biomedicina, Biotecnología y Derecho de la UE
Esp. Biomedicina y Derecho
Exp. Bioderecho
Diplomado en Bioética
RESUMEN: La idea de un Nuevo Paternalismo en la relación médico paciente (RMP) ha sido criticada más desde un punto de vista formal que del propio contenido, lo que deja entrever que es la propia expresión “paternalismo” la que provoca rechazo. En definitiva nos encontramos ante una logomaquia. A tal fin se ha revisado parte de estas críticas demostrando que la idea que subyace de una nueva visión de la RMP es asumida y aceptada íntegramente como una manera de dotarla de las herramientas que salvaguarden el fin primordial de la misma.
PALABRAS CLAVE: Nuevo Paternalismo, Relación Médico-Paciente, Paternalismo, Autonomía
Germán Méndez Sardina
Mtr. Biomedicina, Biotecnología y Derecho de la UE
Esp. Biomedicina y Derecho
Exp. Bioderecho
Diplomado en Bioética
RESUMEN: La idea de un Nuevo Paternalismo en la relación médico paciente (RMP) ha sido criticada más desde un punto de vista formal que del propio contenido, lo que deja entrever que es la propia expresión “paternalismo” la que provoca rechazo. En definitiva nos encontramos ante una logomaquia. A tal fin se ha revisado parte de estas críticas demostrando que la idea que subyace de una nueva visión de la RMP es asumida y aceptada íntegramente como una manera de dotarla de las herramientas que salvaguarden el fin primordial de la misma.
PALABRAS CLAVE: Nuevo Paternalismo, Relación Médico-Paciente, Paternalismo, Autonomía
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At birth, your data trail began. You were given a name, your height and weight were recorded, and probably a few pictures were taken. A few years later, you were enrolled in day care, you received your first birthday party invitation, and you were recorded in a census. Today, you have a Social Security or national ID number, bank accounts and credit cards, and a smart phone that always knows where you are. Perhaps you post family pictures on Facebook; tweet about politics; and reveal your changing interests, worries, and desires in thousands of Google searches. Sometimes you share data intentionally, with friends, strangers, companies, and governments. But vast amounts of information about you are collected with only perfunctory consent—or none at all. Soon, your entire genome may be sequenced and shared by researchers around the world along with your medical records, flying cameras may hover over your neighborhood, and sophisticated software may recognize your face as you enter a store or an airport.
At birth, your data trail began. You were given a name, your height and weight were recorded, and probably a few pictures were taken. A few years later, you were enrolled in day care, you received your first birthday party invitation, and you were recorded in a census. Today, you have a Social Security or national ID number, bank accounts and credit cards, and a smart phone that always knows where you are. Perhaps you post family pictures on Facebook; tweet about politics; and reveal your changing interests, worries, and desires in thousands of Google searches. Sometimes you share data intentionally, with friends, strangers, companies, and governments. But vast amounts of information about you are collected with only perfunctory consent—or none at all. Soon, your entire genome may be sequenced and shared by researchers around the world along with your medical records, flying cameras may hover over your neighborhood, and sophisticated software may recognize your face as you enter a store or an airport.
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Personalised medicine is about tailoring treatment and care to the individual patient and their specific disease. However, oncology has so far largely resisted the idea of personalising dose levels, despite what is known about wide variations in individual pharmacokinetics, which govern how patients’ bodies absorb, metabolise, distribute and clear therapeutic drugs.
Conventionally, dosage of anti-cancer drugs has been calculated according to the patient’s body surface, which can be estimated by weight and height or more simply by weight alone.
Leading pharmacologists, such as Silvio Garattini of the Mario Negri Institute in Italy, have been arguing for some time that oncologists need to pay more attention to pharmacokinetics (eg EJC 2007, 43:271–282). Poor responses – or indeed unexpectedly severe side-effects – they argue could be the result of a conventional approach to dosing that fails to take this into account.
Personalised medicine is about tailoring treatment and care to the individual patient and their specific disease. However, oncology has so far largely resisted the idea of personalising dose levels, despite what is known about wide variations in individual pharmacokinetics, which govern how patients’ bodies absorb, metabolise, distribute and clear therapeutic drugs.
Conventionally, dosage of anti-cancer drugs has been calculated according to the patient’s body surface, which can be estimated by weight and height or more simply by weight alone.
Leading pharmacologists, such as Silvio Garattini of the Mario Negri Institute in Italy, have been arguing for some time that oncologists need to pay more attention to pharmacokinetics (eg EJC 2007, 43:271–282). Poor responses – or indeed unexpectedly severe side-effects – they argue could be the result of a conventional approach to dosing that fails to take this into account.
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