The spatial spread of altruism versus the evolutionary response of egoists.
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Several recent models have shown that altruism can spread in viscous populations, i.e. in spatially structured populations within which individuals interact only with their immediate neighbours and disperse only over short distances. I first confirm this result with an individual-based model of a viscous population, where an individual can vary its level of investment into a behaviour that is beneficial to its neighbours but costly to itself. Two distinct classes of individuals emerge: egoists with no or very little investment into altruism, and altruists with a high level of investment; intermediate levels of altruism are not maintained. I then extend the model to investigate the consequences of letting interaction and dispersal distances evolve along with altruism. Altruists maintain short distances, while the egoists respond to the spread of altruism by increasing their interaction and dispersal distances. This allows the egoistic individuals to be maintained in the population at a high frequency. Furthermore, the coevolution of investment into altruism and interaction distance can lead to a stable spatial pattern, where stripes of altruists (with local interactions) alternate with stripes of egoists (with far-reaching interactions). Perhaps most importantly, this approach shows that the ease with which altruism spreads in viscous populations is maintained despite countermeasures evolved by egoists. (+info)
Rape in war: the humanitarian response.
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Women and children are vulnerable to sexual violence in times of conflict, and the risk persists even after they have escaped the conflict area. The impact of rape goes far beyond the immediate effects of the physical attack and has long-lasting consequences. We describe the humanitarian community's response to sexual violence and rape in times of war and civil unrest by drawing on the experiences of Medecins Sans Frontieres/Doctors Without Borders and other humanitarian agencies. Health care workers must have a keen awareness of the problem and be prepared to respond appropriately. This requires a comprehensive intervention protocol, including antibiotic prophylaxis, emergency contraception, referral for psychological support, and proper documentation and reporting procedures. Preventing widespread sexual violence requires increasing the security in refugee camps. It also requires speaking out and holding states accountable when violations of international law occur. The challenge is to remain alert to these often hidden, but extremely destructive, crimes in the midst of a chaotic emergency relief setting. (+info)
Vaccines as tools for advancing more than public health: perspectives of a former director of the National Vaccine Program office.
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With application of new technologies and licensing of new vaccines, vaccines will soon be better by several orders of magnitude. Yet barriers impede the introduction and wide use of new vaccines. Most of the diseases for which we will have vaccines in the future have not evoked enthusiasm from public health professionals, but not consumer demand, despite ongoing high rates of disease and death. Furthermore, the public's attention turns from the now rarely occurring vaccine-preventable diseases to reports of fears and confirmed adverse events associated with the same vaccines that so effectively continue to prevent disease. New vaccines will be held to a much higher standard; thus we will need more capacity for disease studies, vaccine trials, and surveillance systems. Vaccines and immunization programs contribute to the societal fabric and are an expression of social responsibility. Vaccine research and implementation programs must have the foundation and capacity to keep pace with evolving scientific and societal realities so that their broad benefits can be fully realized. (+info)
Tracking managed care: the importance of a cash incentive for medical director response to a survey.
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OBJECTIVE: To assess the impact of a monetary incentive in a survey mailed to medical directors of large medical groups and independent practice associations (IPAs). STUDY DESIGN: Mailed survey. METHODS: We mailed a survey to the medical directors of all medical groups and IPAs contracted with Blue Cross California Care, a large California managed care health plan (n = 174). After 2 mailings without any monetary incentive, we included a $50 bill in the third mailing to increase the response rate. RESULTS: Only 46 medical directors responded to the first and second mailings (response rates of 17% and 13%, respectively). The third mailing, which included a $50 bill attached to the front of the survey, yielded 78 responses (66%), for an overall total of 124 (76%). We found no significant differences in the physician organizations of medical directors who responded to the mailing with the $50 incentive compared with the physician organizations of those who responded to 1 of the first 2 mailings, although medical directors who responded without the financial incentive were more likely to report that their organization had staff for quality assurance (96% vs 82%; P < or = .03). CONCLUSION: Including a $50 bill improved the rate of response to a survey mailed to medical directors from 13%-17% to 66%. (+info)
How should doctors approach patients? A Confucian reflection on personhood.
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The modern doctor-patient relationship displays a patient-centred, mutual-participation characteristic rather than the former active-passive or guidance-cooperation models in terms of medical decision making. Respecting the wishes of patients, amounting to more than mere concern for their welfare, has become the feature central to certain modern bioethics theories. A group of ethical principles such as respect for autonomy, beneficence, non-maleficence, and justice has been proposed by bioethicists and widely adopted by many medical societies as an ethical guide to how doctors, in their daily practice, should treat their patients. However, seeing patients as persons who are rational, self-conscious beings capable of valuing their own lives, and who are consequently entitled to the liberty and rights to choose for themselves, is in general the backbone of Western bioethical principles. Since Confucian philosophy has long been a representative of the East-Asia cultural tradition and Confucian bioethics has recently been developed as a theory of applied ethics, examining Confucius's idea of "persons" may shed some light on the current bioethical debates. Confucius's concept of persons, which is best interpreted via his theories of "chun-tze", (the morally ideal person) encapsulating a two-dimensional approach, (the "autonomous person" and the "relational person"), provides a more comprehensive model regarding what a person is and how he/she should be treated. This two-dimensional approach sees a person not only as a rational, autonomous agent but also as a relational, altruistic identity whose self actualisation involves incessant participating in and promoting of the welfare of his fellow persons. Hence this may balance the current bioethical trend whereby "respect for autonomy" often triumphs. (+info)
Kin recognition and the evolution of altruism.
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In 1964, Hamilton formalized the idea of kin selection to explain the evolution of altruistic behaviours. Since then, numerous examples from a diverse array of taxa have shown that seemingly altruistic actions towards close relatives are a common phenomenon. Although many species use kin recognition to direct altruistic behaviours preferentially towards relatives, this important aspect of social biology is less well understood theoretically. I extend Hamilton's classic work by defining the conditions for the evolution of kin-directed altruism when recognizers are permitted to make acceptance (type I) and rejection (type II) errors in the identification of social partners with respect to kinship. The effect of errors in recognition on the evolution of kin-directed altruism depends on whether the population initially consists of unconditional altruists or non-altruists (i.e. alternative forms of non-recognizers). Factors affecting the level of these error rates themselves, their evolution and their long-term stability are discussed. (+info)
Comments on an obstructed death -- a case conference revisited: commentary 1.
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The paper comments on Scott Dunbar's "An obstructed death and medical ethics," arguing contra Dunbar that we should not view truth-telling to the terminally ill as primarily governed by principles of veracity and respect for autonomy. All such rules are of limited value in medical ethics. We should instead turn to an ethics deriving from the centrality of moral relationships and virtues. A brief analysis of the connections between moral relationships and moral rules is offered. Such an ethics would lower the value that philosophical fashion places on truth-telling and autonomy and leave decisions about truth-telling and the terminally ill more dependent on the circumstances of particular cases. (+info)