: Protection of human subjects from investigators' conflicts of interest is critical to the integrity of clinical investigation. Personal financial conflicts of interest are addressed by university policies, professional society guidelines, publication standards, and government regulation, but "intrinsic conflicts of interest"—conflicts of interest inherent in all clinical research—have received relatively less attention. Such conflicts arise in all clinical research endeavors as a result of the tension among professionals' responsibilities to their research and to their patients and both academic and financial (...) incentives. These conflicts should be disclosed to research subjects and managed as assiduously as are financial conflicts of interest. (shrink)

The accelerating adoption of electronic health record systems will have profound impacts on clinical care. It will also have far-reaching implications for public health research and surveillance, which in turn could lead to changes in public policy, statutes, and regulations. The public health benefits of EHR use can be significant. However, researchers and analysts who rely on EHR data must proceed with caution and understand the potential limitations of EHRs.Much has been written about the risk of EHR privacy breaches. This (...) paper focuses on a different set of concerns, those relating to data quality. Unlike clinical trial data, EHR data is not recorded primarily to meet the needs of researchers. Because of clinicians’ workloads, poor user-interface design, and other factors, EHR data is surprisingly likely to be erroneous, miscoded, fragmented, and incomplete. Although EHRs eliminate the problem of cryptic handwriting, other kinds of errors are more common with EHRs than with paper records. (shrink)

Comparative effectiveness research (CER) is one of the Patient Protection and Affordable Care Act's significant initiatives that aims to improve treatment outcomes and lower health care costs. This article takes CER a step further and suggests a novel clinical application for it. The article proposes the development of a national framework to enable physicians to rapidly perform, through a computerized service, medically sound personalized comparisons of the effectiveness of possible treatments for patients' conditions. A treatment comparison for a given patient (...) would be based on data from electronic health records of a cohort of clinically similar patients who received the treatments previously and whose outcomes were recorded. This framework has unique potential to simultaneously improve the quality of health care, reduce its cost, and alleviate public concerns about rationing and “one size fits all” medicine. (shrink)

The unsustainable growth in U.S. health care costs is in large part attributable to the rising costs of pharmaceuticals and medical devices and to unnecessary medical procedures. This fact has led health reform advocates and policymakers to place considerable hope in the idea that increased government support for research on the comparative effectiveness of medical treatments will eventually help to reduce health care expenses by informing patients, health care providers, and payers about which treatments for common conditions are effective and (...) which are not. Comparative effectiveness research has shown in some cases that expensive but commonly used treatments are significantly less effective than relatively inexpensive alternatives. Critics warn, however, that CER will homogenize patient care, limit patient choices, and lead to improper health care rationing and even to the denial of lifesaving treatments. (shrink)

Not long ago I visited the Personal Genome Project's website. The PGP describes its mission as “creating public genome, health, and trait data.” In the “Participant Profiles” section, I found several entries that disclosed the names of individuals along with their date of birth, sex, weight, height, blood type, race, health conditions, medications, allergies, medical procedures, and more. Other profiles did not feature names but provided all of the other details. I had no special access to this information. It is (...) available to absolutely anyone with Internet access. The PGP is part of a trend known as “open data.” Many government and private entities have launched initiatives to compile very large data resources and to make them available to the public. President Obama himself has endorsed open data by issuing a May 2013 executive order directing that, to the extent permitted by law, the federal government must release its data to the public in forms that make it easy to locate, access, and use. (shrink)

The American Medical Association Council on Ethical and Judicial Affairs (CEJA) has written a position paper on physicians’ ethical responsibilities in the event that the security of patients’ electronic health information has been breached. The report offers compelling ethical and practical justifications for notification requirements and articulates guidelines for clinicians. This commentary addresses a gap in the report. It outlines the new legal duty to disclose security breaches, established by the 2009 HITECH Act, which is only briefly mentioned in the (...) report. The commentary also analyzes the CEJA recommendations in light of the legal mandate and suggests that the guidance would benefit from further clarification. (shrink)

Contemporary developments in reproductive technology hold great promise for those who have difficulty conceiving naturally. However, they have generated extensive debate among lawyers, ethicists, legislators, the media, and the public. Concern has intensified recently in light of claimed attempts to clone human beings. One implication of the new reproductive technologies upon which few commentators have focused is their effect on inheritance rights and on the notorious Rule Against Perpetuities. For example, what impact should the possible existence of frozen sperm or (...) frozen embryos have upon the execution of wills and implementation of the Rule? If one leaves property to one’s children but has frozen sperm or embryos that might produce children the Rule? If one leaves property to one’s children but has frozen sperm or embryos that might produce children decades after one’s death, what should be done about the distribution of the estate? These difficult questions can no longer be ignored. (shrink)

Contemporary developments in reproductive technology hold great promise for those who have difficulty conceiving naturally. However, they have generated extensive debate among lawyers, ethicists, legislators, the media, and the public. Concern has intensified recently in light of claimed attempts to clone human beings. One implication of the new reproductive technologies upon which few commentators have focused is their effect on inheritance rights and on the notorious Rule Against Perpetuities. For example, what impact should the possible existence of frozen sperm or (...) frozen embryos have upon the execution of wills and implementation of the Rule? If one leaves property to one’s children but has frozen sperm or embryos that might produce children the Rule? If one leaves property to one’s children but has frozen sperm or embryos that might produce children decades after one’s death, what should be done about the distribution of the estate? These difficult questions can no longer be ignored. (shrink)

In law school we often focus on the importance of carefully crafting statutory and regulatory language. Textual ambiguities or sloppiness can significantly impair the efficacy of laws and regulations. Just as important as meticulous drafting, however, is the government’s ability to enforce its rules. In the absence of adequate enforcement resources, the government’s regulatory initiatives may well fail. The ability to promote public welfare depends as much on regulatory compliance as it does on the text of the regulations themselves.

Health information technology is becoming increasingly prevalent in medical offices and facilities. Like President George W. Bush before him, President Obama announced a plan to computerize all Americans’ medical records by 2014. Computerization is certain to transform American health care, but to ensure that its benefits outweigh its risks, the federal government must provide appropriate oversight.President Obama’s stimulus legislation, the American Recovery and Reinvestment Act of 2009, dedicated $27 billion to the promotion of health information technology. It provides payments of (...) up to $44,000 per clinician under the Medicare incentive program and $63,750 per clinician under the Medicaid program. (shrink)

Health information technology is becoming increasingly prevalent in medical offices and facilities. Like President George W. Bush before him, President Obama announced a plan to computerize all Americans’ medical records by 2014. Computerization is certain to transform American health care, but to ensure that its benefits outweigh its risks, the federal government must provide appropriate oversight.President Obama’s stimulus legislation, the American Recovery and Reinvestment Act of 2009, dedicated $27 billion to the promotion of health information technology. It provides payments of (...) up to $44,000 per clinician under the Medicare incentive program and $63,750 per clinician under the Medicaid program. (shrink)

Physician burnout is receiving more attention in the medical literature, and deservedly so. For example, in October of 2019, the National Academies of Sciences, Engineering, and Medicine published a lengthy report called Taking Action against Clinician Burnout: A Systems Approach to Professional Well‐Being. The report is comprehensive and well worth reading, and it offers a series of sound recommendations for addressing the burnout problem. However, the recommendations are quite ambitious, and implementing them would require a considerable investment of time, staffing, (...) and financial resources. The medical community should not be left to grapple with the phenomenon of physician burnout alone. The law has a significant role to play in addressing the problem. As a first step, it is useful to consider a few concrete interventions that regulators could realistically implement in the short term. (shrink)

Artificial intelligence holds great promise for improved health‐care outcomes. But it also poses substantial new hazards, including algorithmic discrimination. For example, an algorithm used to identify candidates for beneficial “high risk care management” programs routinely failed to select racial minorities. Furthermore, some algorithms deliberately adjust for race in ways that divert resources away from minority patients. To illustrate, algorithms have underestimated African Americans’ risks of kidney stones and death from heart failure. Algorithmic discrimination can violate Title VI of the Civil (...) Rights Act and Section 1557 of the Affordable Care Act when it unjustifiably disadvantages underserved populations. This article urges that both legal and technical tools be deployed to promote AI fairness. Plaintiffs should be able to assert disparate impact claims in health‐care litigation, and Congress should enact an Algorithmic Accountability Act. In addition, fairness should be a key element in designing, implementing, validating, and employing AI. (shrink)

Among the many components of legal preparedness for public health emergencies is the assurance that the public health workforce and its private sector partners are competent to use the law to facilitate the performance of essential public health services and functions. This is a significant challenge. Multiple categories of emergencies, stemming from natural disasters to emerging infectious diseases, confront public health practitioners. Interpreting, assessing, and applying legal principles during emergencies are complicated by the changing legal environment and differences in governmental (...) organization of emergency management functions. While law and legal competencies are essential to routine public health practices, once government declares a state of public health emergency or disaster, the legal landscape changes. Typical legal responses to protect the public's health may no longer be the norm. Public health practitioners, legal counsel, health care partners, and others need to be able to assess changing laws and policies and apply them in real-time. (shrink)

Among the many components of legal preparedness for public health emergencies is the assurance that the public health workforce and its private sector partners are competent to use the law to facilitate the performance of essential public health services and functions. This is a significant challenge. Multiple categories of emergencies, stemming from natural disasters to emerging infectious diseases, confront public health practitioners. Interpreting, assessing, and applying legal principles during emergencies are complicated by the changing legal environment and differences in governmental (...) organization of emergency management functions. While law and legal competencies are essential to routine public health practices, once government declares a state of public health emergency or disaster, the legal landscape changes. Typical legal responses to protect the public's health may no longer be the norm. Public health practitioners, legal counsel, health care partners, and others need to be able to assess changing laws and policies and apply them in real-time. (shrink)

Can a corporation have a conscience? What is wrong with reverse discrimination? Can ethical management and managed care coexist? Hoffman, Frederick, and Schwartz address these and many other current, intriguing, often complex issues in corporate morality. This introductory business ethics text contains a thorough general introduction on ethical theory, 54 readings, and 25 cases. Divided into five parts, each with an introduction that presents the major themes of its articles and cases, the text contains an impartial, point-counterpoint presentation of (...) different perspectives on the most important issues being debated in business ethics. Each chapter ends with questions that can be used for student discussion, review, tests/quizzes, or for student assignments. The fourth edition has 27 new readings, 15 new cases, and 10 new mini-cases. (shrink)

Mystery: the scalpel that split consciousness -- Beauty: sirens of the gene -- Reality: capers of the unseen sun -- Sensory: fitness beats truth -- Illusory: the bluff of a desktop -- Gravity: spacetime is doomed -- Virtuality: inflating a holoworld -- Polychromy: mutations of an interface -- Scrutiny: you get what you need, in both life and business -- Community: the network of conscious agents -- Precisely: the right to be wrong.

Faith Physics maintains a sublime timeless 'Supreme Consciousness' is the catalyst of all material creation as a 'great thought' via pure white 'light' in zero-point quantum fields. In the quantum wave/particle mass duality paradigm, energy itself traveling below the speed of light becomes particulate physical matter in accord with Einstein's famous equation of E=mc2. Using the natural laws of classical physics, quantum mechanics, and the dark matter/energy that composes 95% of our known universe, a Supreme Consciousness or Godhead manifests physical (...) creation from eternal quantum fields in a remarkable myriad of forms. This is an intellectually sound and spiritually satisfying ToE. (shrink)

Individuation -- Will -- Continuity -- Freedom.

Exceptionally Common Courage provides an extended, close reading of Fear and Trembling, Kierkegaard's well-known, pseudonymous book about Abraham's sacrifice of Isaac. It then fits this (in)famous work into the broader and puzzling corpus that includes both other pseudonymous works and signed discourses by this same mercurial author. Though not the first to tackle Kierkegaard from the direction of either a single work or the whole authorship, this two-in-one book relates whole and part to whole and part in a way that (...) reads like a genuine musical counterpoint. The scholarly debates inevitably generated by any treatment of Fear and Trembling are here addressed in ways that arise from a detailed interpretation of the text itself without letting secondary material interrupt the primary train of thought. Along the way, Kierkegaard's ideas are brought into conversation with a much broader than usual cannon of interlocutors, including such figures as Elizabeth Stuart Phelps and James Baldwin, R.H. Tawney and Wendell Berry. And by the end, the complex movement of the entire authorship becomes audible above the various isolated and doctrinaire notes typically highlighted in comparable studies. The recurring melody is about existential courage, about the risk of emotionally investing in earthly goods against the ambiguous inevitability of their loss. Woven throughout Kierkegaard's so-called esthetic and religious writings, this common task of facing threats to the integral meaning of human experience stands out in arresting color. As the chapters unfold, this understanding of faith as a form of courage provides not just direction, but a topographical score for what is originally a highly indirect and elusive textual arrangement. (shrink)

In its attempt to come to grips with the nature of the human mind idealism employs such terms as "pure self," "transcendental apperception," "pure con sciousness" and so on.

In the past, Wonder Woman and Superman were depicted as good friends, but as of 2016, in New 52 Wonder Woman comic books, the Amazon princess and the man of steel are in a romantic relationship. The implication seems to be that romantically compatible people cannot be just friends. Thankfully, philosophy can help to debunk this notion and shed some light on the nature of friendship and romance as well. In consuming works of popular culture, people learn what is expected (...) of them in their interpersonal lives: cross‐gender relationships must be romantic, and friendship cannot be as important as romance. The loss of Wonder Woman and Superman as an example of a stable non‐romantic cross‐gender friendship therefore represents not just a change in the treatment of the characters, but a loss of support for the idea that such friendships are possible. (shrink)

Flirtations: Rhetoric and Aesthetics This Side of Seduction, opens by asking a fundamental first question: What is flirtation, and how does it differ from seduction? The essays thereby address the under-theorized terrain of flirtation not as a subgenre of seduction but rather as a phenomenon in its own right.

Opposition and particularity -- Opposition and intersubjectivity -- Opposition and temporality.

This book is a Christian introduction to Boethius's Consolation of Philosophy.

Michel Foucault is one of the most preeminent theorists of power, yet the relationship between his militant activities and his analysis of power remains unclear. The book explores this relationship to explain the development of Foucault's thinking about power. Using newly translated and unpublished materials, it examines what led Foucault to take on the question of power in the early 1970s and subsequently refine his thinking, working through different models (war and government) and modalities (sovereign, disciplinary, biopolitical, pastoral and governmental). (...) Looking at Foucault's political trajectory, from his involvement with the prisoner support movement and Solidarity to his controversial engagement with the Iranian revolution, the book shows the militant underpinning of his interest in the question of power and its various shifts and mutations. This thorough account, which includes the first translation of a report edited by Foucault on prison conditions, will provide students in contemporary political theory with a better understanding of Foucault's thinking about power and of the interplay between political activities and theoretical productions. (shrink)

AimBased on the Theory of Reasoned Action, we examined whether attitudes of nurses from different ethnic groups, subjective norms, behavioral intentions, assessments of relationships and communication were associated with their perceptions of the quality of perinatal care provided to lesbian women.BackgroundNurses administer healthcare, provide pertinent information and consultation to lesbians from pregnancy planning through birth.IntroductionDuring the past few decades, worldwide, there has been a rise in lesbian-parenting. Despite the changes in Israeli society’s public and legal reality, intolerance and discrimination to (...) the homosexual population is still prevalent in Israel’s healthcare system.MethodsA cross-sectional study conducted between 12/2015-4/2016. Of the 270 nurses approached, 184 completed a self-report anonymous questionnaire.FindingsThis is an important and timely study reflecting nurses’ perceptions of the quality of perinatal care provided to lesbians. The study findings reflect that attitudes, subjective norms, behavioral intentions, assessments of relationships and communication of nurses from different ethnic groups are associated with their perceptions of the quality of perinatal care provided to the lesbians. The hierarchical regression analysis demonstrated that attitudes, subjective norms, behavioral intentions, assessments of relationships and communication of nurses contributed 56% to the variance of nurses’ perception of their own quality of perinatal care.DiscussionTRA conceptualization predicted the quality of care of nurses from different ethnic groups treating lesbians in a perinatal setting.ConclusionTRA provides a useful framework for understanding and predicting the motivational effect of health care personnel with the lesbian population, being at risk for stigmatization and receiving less quality perinatal care.Implications for nursing and heath policyOur findings revealed the importance of formulating a recognized policy in the field of LGBT medicine at the national level. Further training of nurses as to the lesbians’ unique health needs, might improve the nurses’ relationships and communication as well as the quality of perinatal nursing care. (shrink)

An unprecedented recollection -- A purportedly anonymous rhetorical flourish -- The major interruption in a minor key -- A taciturn commentary by the actual author -- An inconclusive word from the present reader.

This book addresses two basic questions: What is the proper philosophical analysis of the concept of substance? and What kinds of compound substances are there? The second question is mainly addressed by asking what relations among objects are necessary and sufficient for their coming to compose a larger whole. The first 72 pages of the book contain a short history of attempts to answer the first question, and a brief presentation of the analysis the authors defend at length in their (...) earlier book, Substance Among Other Categories. In the remaining 119 pages, the authors take up the second question. This order of presentation makes sense; but it may help to create a false impression in those who only glance at the first few pages—that this book is just a simplified version of the earlier one, with a little bit of history thrown in. It would be quite unfortunate, however, if very many potential readers get this impression; for it might discourage them from looking closely at the bulk of the book, which is new. The issues discussed in the later chapters are at the center of one of the most lively debates in contemporary metaphysics; and the position Hoffman and Rosenkrantz stake out is appealing and carefully articulated. Their views deserve careful attention from philosophers working on the metaphysics of persistence through time, personal identity, artifact identity, and mereology. (shrink)