The use of platelet rich plasma as a novel treatment is discussed in the context of a qualitative research study comprising 38 interviews with sports medicine practitioners and other stakeholders working within the English Premier League during the 2013–16 seasons. Analysis of the data produced several overarching themes: conservatism versus experimentalism in medical attitudes; therapy perspectives divergence; conflicting versions of appropriate evidence; subcultures; community beliefs/practices; and negotiation of medical decision-making. The contested evidence base for the efficacy of PRP is presented (...) in the context of a broader professional shift towards evidence based medicine within sports medicine. Many of the participants while accepting this shift are still committed to casuistic practices where clinical judgment is flexible and does not recognize a context-free hierarchy of evidentiary standards to ethically justifiable practice. We also discuss a tendency in the data collected to consider the use of deceptive, placebo-like, practices among the clinician participants that challenge dominant understandings of informed consent in medical ethics. We conclude that the complex relation between evidence and ethics requires greater critical scrutiny for this emerging specialism within the medical community. (shrink)

It is often assumed that the central problem in a medical ethics issue is determining which course of action is morally correct. There are some aspects of ethical issues that will yield to such analysis. However, at the core of important medical moral problems is an irreducible dilemma in which all possible courses of action, including inaction, seem ethically unsatisfactory. When facing these issues ethical behaviour depends upon an individual's understanding and acceptance of this painful dilemma without recourse to external (...) moral authority. (shrink)

In order to resolve the cosmological constant problem, the notion of reference frame is re-examined at the quantum level. By using a quantum non-linear sigma model (Q-NLSM), a theory of quantum spacetime reference frame is proposed. The underlying mathematical structure is a new geometry endowed with intrinsic second central moment (variance) or even higher moments of its coordinates, which generalizes the classical Riemannian geometry based on only first moment (mean) of its coordinates. The second central moment of the coordinates directly (...) modifies the quadratic form distance which is the foundation of the Riemannian geometry. At semi-classical level, the second central moment introduces a flow which continuously deforms the Riemannian geometry driven by its classical Ricci curvature, which is known as the Ricci flow. A generalized equivalence principle of quantum version is also proposed to interpret the new geometry endowed with at least second moment. As a consequence, the spacetime is stabilized against quantum fluctuation, and the cosmological constant problem is resolved within the framework. With an isotropic positive curvature initial condition, the long flow time solution of the Ricci flow exists, the accelerating expansion universe at cosmic scale is an observable effect of the spacetime deformation of the normalized Ricci flow. A deceleration parameter − 0.67 consistent with measurement is obtained by using the reduced volume method introduced by Perelman. Effective theory of gravity within the framework is also discussed. (shrink)