Philosophy & Ethics

By Chaim M. Bell and Wendy Levinson Most doctors feel that they provide good to above-average patient care. However, Canadian physicians rarely receive feedback about their clinical performance or patient outcomes. Although both of us believe that we provide excellent patient care, we have never received any data on our clinical performance or patient outcomes compared with other physicians or benchmarks. How can we learn to improve our provision of care without objective measures of our performance? Measurement is a key first step toward improving quality. In the last decade, there have…

By Christopher Millett, Jeremy Gray, Sonia Saxena, Gopalakrishnan Netuveli and Azeem Majeed Many people with diabetes continue to smoke despite being at high risk of cardiovascular disease. We examined the impact of a pay-for-performance incentive in the United Kingdom introduced in 2004 as part of the new general practitioner contract to improve support for smoking cessation and to reduce the prevalence of smoking among people with chronic diseases such as diabetes. Methods: We performed a population-based longitudinal study of the recorded delivery of cessation advice and the prevalence of…

Euthanasia for newborn babies with lethal and disabling conditions is illegal worldwide, but in reality, its acceptance and practice vary between different countries. In the Netherlands, about 200,000 live births occur annually; of these, 10-20 babies – mostly with severe congenital malformations – are thought to be actively killed. Yet between 1997 and 2004 only 22 such deaths were reported to the authorities, writes Kate Costeloe, Professor of Paediatrics at the University of London. To regulate neonatal euthanasia, clinicians in the Netherlands have argued that all cases should be…

Children's exposure to alcohol advertising during early adolescence appears to influence both beer drinking and their intentions to drink a year later, according to a RAND Corporation study issued today. The study of children in the sixth and seventh grades found that those exposed to alcohol advertising at high levels – from television, magazines, in-store displays and promotional items like T-shirts and posters – were 50 percent more likely to drink and 36 percent more likely to intend to drink than children whose exposure to alcohol advertising was very low. Previous studies have found…

Fairness of kidney allocation is essential for public trust. While the field of transplantation is quite young, substantial advancements and success have led to the current imbalance between the supply of organs and the demand for them. The United Network for Organ Sharing (UNOS) coordinates the nation's transplant system through a point system based primarily on wait time, sensitization and HLA matching. When a match occurs, the kidney is offered to the person at the top of the national list. A recent editorial in the American Journal of Transplantation discusses the fairness and equality…

Just because someone decides not to participate in a research project doesn't necessarily mean that they fundamentally object to taking part, a study published online in BMC Health Services Research suggests. Misunderstandings about the nature and process of a study often contribute to expressions of non-consent, a factor that should be incorporated in the design of future studies. Low participation rates are a problem in human subject research because they can lead to delays, sampling bias and increased costs. Most studies to date have focussed on participants' motives for participation,…

Genomic research has the potential to improve global health by elucidating basic mechanisms of disease, susceptibility, and resistance, thereby guiding the development of preventive interventions [1]. Recently developed methods for exploring how human genetic variation affects resistance are likely to provide strategic clues about vaccine development for researchers working on malaria, HIV, tuberculosis, and other diseases of the developing world [2]. A key scientific challenge facing the genomic epidemiology of common diseases is the vast number of genetic and environmental factors…

Scientists using one of the nation's newest and most capable research aircraft are launching a far-reaching field project this month to study plumes of airborne dust and pollutants that originate in Asia and journey to North America. The plumes are among the largest such events on Earth, so great in scope that scientists believe they might affect clouds and weather across thousands of miles while interacting with the sun's radiation and playing a role in global climate. Known as PACDEX (PACific Dust EXperiment), the project will be led by scientists at Scripps Institution of Oceanography at…

Most basic science is performed using animal models on the assumption that we can learn something about humans by studying how other animals work. Obviously, the ethical issues surrounding human experimentation necessitates the use of animals models. It wasn't always this way though, and the history of science is littered with examples of human experimentation. Nowadays, the use of humans and animals in science is highly regulated. Human experimentation is restricted to clinical trials only, and basic experimentation using animals is done in such a way as to minimize their use and to assure…

A new climate modeling study forecasts the complete disappearance of several existing climates in tropical highlands and regions near the poles, while large swaths of the tropics and subtropics may develop new climates unlike any seen today. In general, the models show that existing climate zones will shift toward higher latitudes and higher elevations, squeezing out the climates at the extremes--tropical mountaintops and the poles--and leaving room for unfamiliar climes and new ecological niches around the equator. The work, by researchers at the University of Wisconsin-Madison and the…