Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver “educational” talks to groups of physicians in the community to help market the company's brand-name drugs.Although presented as educational, and even though they provide educational content, these events are intended to influence decisions about drug selection in ways that are not based on the suitability and effectiveness of the product, but on the prestige and persuasiveness of the speaker. A number of state legislatures and most academic medical (...) centers have attempted to restrict physician participation in pharmaceutical marketing activities, though most restrictions are not absolute and have proven difficult to enforce. This article reviews the literature on why Speakers' Bureaus have become a lightning rod for academic/industry conflicts of interest and examines the arguments of those who defend physician participation. It considers whether the restrictions on Speakers' Bureaus are consistent with principles of academic freedom and concludes with the legal and institutional efforts to manage industry speaking. (shrink)

Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver educational talks to groups of physicians in the community to help market the company's brand-name drugs. These speakers receive substantial compensation to lecture at events sponsored by pharmaceutical companies, a practice that has garnered attention, controversy, and scrutiny in recent years from legislators, professional associations, researchers, and ethicists on the issue of whether it is appropriate for academic physicians to serve in a promotional role. These relationships have (...) become so contentious that three years ago the pharmaceutical industry trade association, the Pharmaceutical Research and Manufacturers of America, adopted voluntary guidelines stating that drug companies should stop giving doctors free pens, calendars, sports bags, or tickets to entertainment events. Further, numerous medical associations, such as the Association of American Medical Colleges, the American Board of Internal Medicine and the Institute on Medicine as a Profession, and government bodies such as the Institute of Medicine have recommended that medical schools and teaching hospitals prohibit or strongly discourage faculty from participating in so-called industry Speakers Bureaus — promotional events designed solely to market pharmaceutical products. (shrink)

The framing of the risks of experiencing mild traumatic brain injury in American football and ice hockey has an enormous impact in defining the scope of the problem and the remedies that are prioritized. According to the prevailing risk frame, an acceptable level of safety can be maintained in these contact sports through the application of technology, rule changes, and laws. An alternative frame acknowledging that these sports carry significant risks would produce very different ethical, political, and social debates.

Children in North America, some as young as eleven or twelve, routinely don helmets and pads and are trained to move at high-speed for the purpose of engaging in repeated full-body collisions with each other. The evidence suggests that the forces generated by such impacts are sufficient to cause traumatic brain injury among children. Moreover, there is only limited evidence supporting the efficacy of interventions typically used to reduce the risks of such hazards. What kind of risk assessment enables such (...) activities to be a relatively common feature of childhood in Canadian and American society?In order to understand this state of affairs, we must examine the particular risk frame under which such hazards are commonly assumed. Risk assessments are embedded in the cultures in which they are situated and must be evaluated in their social contexts. (shrink)

The prevailing view in bioethics is that the relationship between doctors and their patients was largely a silent one before the landmark court decisions of the twentieth century. Some have proposed that this was not always the case. This paper provides historical evidence of consent and negotiation in one nineteenth century gynecological practice. The Clinical Records and writings of Dr. Alexander J.C. Skene, who practiced in Brooklyn, New York from 1863 to 1900, have been examined for evidence of discussion, consent (...) and even negotiation with patients. Although this evidence comes from only one practice, it is especially significant because it was largely a gynecological practice with women who were varied in socioeconomic status and ethnic origin. The importance of documenting physician-patient relationships which included patients in decision-making before Schloendorff established the legal doctrine of informed consent cannot be underestimated. (shrink)

I explore gender messages in Boy Scout and Girl Scout handbooks through an analysis of how gender is infused in the context and content of Scout activities as well as in instructions about how the Scouts are to approach these activities. I find that girls are offered more activities intended to be performed in group contexts than are boys. Boys are offered proportionately more activities with scientific content and proportionately fewer artistic activities than are girls. The girls’ handbook conveys messages (...) about approaching activities with autonomous and critical thinking, whereas the boys’ handbook facilitates intellectual passivity through a reliance on organizational scripts. Taken together, girls’ messages promote an “up-to-date traditional woman” consistent with the Girl Scouts’ organizational roots; boys’ messages promote an assertive heteronormative masculinity that is offset by facilitating boys’ intellectual passivity. (shrink)

We present evidence disputing the hypothesis that memories are processed or consolidated in REM sleep. A review of REM deprivation (REMD) studies in animals shows these reports to be about equally divided in showing that REMD does, or does not, disrupt learning/memory. The studies supporting a relationship between REM sleep and memory have been strongly criticized for the confounding effects of very stressful REM deprivation techniques. The three major classes of antidepressant drugs, monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and (...) selective serotonin reuptake inhibitors (SSRIs), profoundly suppress REM sleep. The MAOIs virtually abolish REM sleep, and the TCAs and SSRIs have been shown to produce immediate (40–85%) and sustained (30–50%) reductions in REM sleep. Despite marked suppression of REM sleep, these classes of antidepressants on the whole do not disrupt learning/memory. There have been a few reports of patients who have survived bilateral lesions of the pons with few lingering complications. Although these lesions essentially abolished REM sleep, the patients reportedly led normal lives. Recent functional imaging studies in humans have revealed patterns of brain activity in REM sleep that are consistent with dream processes but not with memory consolidation. We propose that the primary function of REM sleep is to provide periodic endogenous stimulation to the brain which serves to maintain requisite levels of central nervous system (CNS) activity throughout sleep. REM is the mechanism used by the brain to promote recovery from sleep. We believe that the cumulative evidence indicates that REM sleep serves no role in the processing or consolidation of memory. Key Words: antidepressant drugs; brain stem lesions; dreams; functional imaging; memory consolidation; REM deprivation; REM sleep; theta rhythm. (shrink)

We believe that this has been a constructive debate on the topic of memory consolidation and REM sleep. It was a lively and spirited exchange – the essence of science. A number of issues were discussed including: the pedestal technique, stress, and early REMD work in animals; REM windows; the processing of declarative versus procedural memory in REM in humans; a mnemonic function for theta rhythm in waking but not in REM sleep; the lack of cognitive deficits in patients on (...) antidepressant drugs that suppress or eliminate REM sleep; the disposition of conscious (dreams) and nonconscious material of REM sleep; and finally our theory of REM sleep. Although our position was strongly challenged, we still hold that REM sleep serves no role in the processing and consolidation of memory. (shrink)

This paper presents the use of the Giving Voice To Values pedagogical approach for educating entrepreneurial leaders. First, we introduce a new framework for entrepreneurial leadership and review the three principles of this framework. Second, we discuss how the GVV pedagogical approach provides a unique way to educate entrepreneurial leaders. Finally, we describe how Babson College plans to use the GVV approach in our curricula.

This paper presents the use of the Giving Voice To Values pedagogical approach for educating entrepreneurial leaders. First, we introduce a new framework for entrepreneurial leadership and review the three principles of this framework. Second, we discuss how the GVV pedagogical approach provides a unique way to educate entrepreneurial leaders. Finally, we describe how Babson College plans to use the GVV approach in our curricula.

Functional theories posit that emotions are elicited by particular goal-related situations that represented adaptive problems and that emotions are evolved features of coordinated responses to those situations. Yet little theory or research has addressed the evolutionary aspects of these theories. We apply five criteria that can be used to judge whether features are adaptations. There is evidence that sadness, anger, and anxiety relate to unique changes in physiology, cognition, and behavior, those changes are correlated, situations that give rise to emotions (...) are consistent, and emotions are complex. To date, there is little experimental evidence regarding whether discrete emotions resolve adaptive problems and do so relatively efficiently. Evidence supporting all criteria is required to claim that discrete emotions are evolved features. (shrink)

"Cluster randomized trials," in which groups of patients are randomly assigned to different therapeutic interventions, provide a powerful way of evaluating drugs. CRTs have not been widely used, in good part because of concerns about whether patients must give informed consent to participate in them. A better understanding of how CRTs fit into clinical practice resolves the concerns.

In two studies, 5- and 6-year-old children were questioned about the status of the protagonist embedded in three different types of stories. In realistic stories that only included ordinary events, all children, irrespective of family background and schooling, claimed that the protagonist was a real person. In religious stories that included ordinarily impossible events brought about by divine intervention, claims about the status of the protagonist varied sharply with exposure to religion. Children who went to church or were enrolled in (...) a parochial school, or both, judged the protagonist in religious stories to be a real person, whereas secular children with no such exposure to religion judged the protagonist in religious stories to be fictional. Children's upbringing was also related to their judgment about the protagonist in fantastical stories that included ordinarily impossible events whether brought about by magic or without reference to magic . Secular children were more likely than religious children to judge the protagonist in such fantastical stories to be fictional. The results suggest that exposure to religious ideas has a powerful impact on children's differentiation between reality and fiction, not just for religious stories but also for fantastical stories. (shrink)