Altria means tobacco: Philip Morris's identity crisis.
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Philip Morris Companies, the world's largest and most profitable tobacco seller, has changed its corporate name to The Altria Group. The company has also embarked on a plan to improve its corporate image. Examination of internal company documents reveals that these changes have been planned for over a decade and that the company expects to reap specific and substantial rewards from them. Tobacco control advocates should be alert to the threat Philip Morris's plans pose to industry focused tobacco control campaigns. Company documents also suggest what the vulnerabilities of those plans are and how advocates might best exploit them. (+info)
GPs facing reluctant and demanding patients: analysing ethical justifications.
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BACKGROUND: Several studies have explored the physicians' preferred actions when facing a reluctant or a demanding patient, but only a few studies have explored the physicians' justifying reasons. OBJECTIVE: The aim of this study was to assess how GPs would act and how they would justify their choice. METHOD: A postal questionnaire with questions about preferred actions and justifying reasons was sent to a random sample of GPs in Slovenia (n = 160) and Sweden (n = 200) using four vignettes: (i). a healthy patient reluctant to quit smoking; (ii). a healthy patient demanding an X-ray; (iii). a pulmonary cancer patient reluctant to quit smoking; and (iv). a pulmonary cancer patient demanding immunotherapy. RESULTS: The majority of GPs would bring up the question about smoking with the patients reluctant to quit. They justified their choice by referring to promotion of medical benefit and to protection from harm. Swedish GPs were less inclined to bring up smoking than were their Slovenian colleagues. Those who would not bring up the question referred to respect for self-determination and an enhanced relationship as their justifying reasons. With reference to the demanding patients, a minority of GPs would grant the healthy patient's request for an X-ray that was not medically motivated. The answers were similar with respect to the seriously ill patient requesting non-medically motivated immunotherapy. Slovenian GPs were much more inclined to grant the request than were their Swedish colleagues. Enhancing the relationship and respect for self-determination were the most important reasons for granting the demands. When the demands were denied, the GPs mostly referred to promotion of fair distribution of resources. CONCLUSION: Many of the GPs considered their patients' right to self-determination less important than other values, e.g. the obligation to promote medical benefit, to protect from harm, to distribute public resources fairly and to enhance the patient-physician relationship. (+info)
Water water everywhere.
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During the last decade of the 20th century the world was exposed to increasing episodes of extreme weather. Figures reveal a 0.6 degrees C rise in average temperatures since records began in 1860, with the 1990s being the warmest decade and 1998 the warmest year. Experts believe that these rising temperatures, or global warming, are in part due to human influences. (+info)
Polio eradication--global initiative; strategy challenged in Kerala, India.
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The 'polio eradication initiative' launched by the World Health Assembly in 1988, although successfully implemented in several countries, could not achieve the goal of global eradication by the year 2000. It has components on strengthening routine immunization system, observance of National Immunization Days (NIDs) and strengthening of surveillance for Acute Flaccid Paralysis (AFP). Recently, this strategy was challenged in Kerala, India. Kerala has excellent health indicators compared with other Indian states. In 1999, Intensified Pulse Polio Immunization (IPPI) was introduced with four NIDs throughout India. More than 2000 doctors working under the Kerala Government challenged the strategy, demanding its redesign. Zero prevalence of polio for 2 years, near-complete coverage of children by the routine system, probable business interests of vaccine manufactures and suppliers, dubious interests of officials, and weakening of the routine system by concentrating more on NIDs were all cited as reasons for discontinuing current strategy. The authorities, citing the success stories of polio eradication by the global initiative in several countries, discard the allegations as baseless. They alleged that the medical officers who were on strike demanding higher pay and better conditions were using the 'polio issue' to win their strike. The incidence of two polio cases in Malappuram in northern Kerala during September 2000 has further complicated the issue. As the controversy continues it is felt that the 'eradication initiative' will have to be revisited. (+info)
Ethical dilemmas in a cross-cultural context. A Chinese example.
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Considerable attention is now being given to ethical conflicts raised by such issues as the disclosure of diagnosis and prognosis, the role of the family in making medical decisions, and the withholding or withdrawing of treatment of terminally ill patients. Already complicated, these issues take on added complexity in contexts where medical professionals and patients have differing cultural beliefs and practices. Ethical dilemmas that develop in multicultural settings have been largely unaddressed. Through the analysis of a case involving the hospital admission and death of a Chinese woman with metastatic lung cancer, we examine some of these dilemmas and their effect on the patient, family, and physicians. Many issues were raised by this case regarding the relationships among ethnic background, bioethics, and medical care. (+info)
Life support withdrawal: communication and conflict.
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BACKGROUND: Skillful communication between and among clinicians and patients' families at the patients' end of life is essential for decision making. Yet communication can be particularly difficult during stressful situations such as when a family member is critically ill. This is especially the case when families are faced with choices about forgoing life-sustaining treatment. OBJECTIVES: Data from a larger study on treatment withdrawal (n = 74) indicated that the family members (n = 20) of some patients experienced conflict with clinicians during decision making. This secondary analysis was done to examine and describe the communication difficulties from the perspectives of patients' family members who experienced conflict with clinicians about the care and treatment of the patients during withdrawal of life support. METHODS: A qualitative descriptive analysis of family members (n = 20, representing 12 decedents) who experienced conflict. RESULTS: Families described several unmet communication needs during the often rapid shift from aggressive treatment to palliative care. These needs included the need for timely information, the need for honesty, the need for clinicians to be clear, the need for clinicians to be informed, and the need for clinicians to listen. CONCLUSIONS: Although family members who experienced conflict were in the minority of the larger study sample, their concerns and needs are important for clinicians to examine. Paying careful attention to these communication needs could reduce the occurrence of conflict between clinicians and patients' families in caring for dying patients and reduce stress for all involved. (+info)
Pro/con clinical debate: isolation precautions for all intensive care unit patients with methicillin-resistant Staphylococcus aureus colonization are essential.
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Antibiotic-resistant bacteria are an increasingly common problem in intensive care units (ICUs), and they are capable of impacting on patient outcome, the ICU's budget and bed availability. This issue, coupled with recent outbreaks of illnesses that pose a direct risk to ICU staff (such as SARS [severe acute respiratory syndrome]), has led to renewed emphasis on infection control measures and practitioners in the ICU. Infection control measures frequently cause clinicians to practice in a more time consuming way. As a result it is not surprising that ensuring compliance with these measures is not always easy, particularly when their benefit is not immediately obvious. In this issue of Critical Care, two experts face off over the need to isolate patients infected with methicillin-resistant Staphylococcus aureus. (+info)
Sources of evidence in HIV/AIDS care: pilot study comparing family physicians and AIDS service organization staff.
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BACKGROUND: The improvement of the quality of the evidence used in treatment decision-making is especially important in the case of patients with complicated disease processes such as HIV/AIDS for which multiple treatment strategies exist with conflicting reports of efficacy. Little is known about the perceptions of distinct groups of health care workers regarding various sources of evidence and how these influence the clinical decision-making process. Our objective was to investigate how two groups of treatment information providers for people living with HIV/AIDS perceive the importance of various sources of treatment information. METHODS: Surveys were distributed to staff at two local AIDS service organizations and to family physicians at three community health centres treating people living with HIV/AIDS. Participants were asked to rate the importance of 10 different sources of evidence for HIV/AIDS treatment information on a 5-point Likert-type scale. Mean rating scores and relative rankings were compared. RESULTS: Findings suggest that a discordance exists between the two health information provider groups in terms of their perceptions of the various sources of evidence. Furthermore, AIDS service organization staff ranked health care professionals as the most important source of information whereas physicians deemed AIDS service organizations to be relatively unimportant. The two groups appear to share a common mistrust for information from pharmaceutical industries. CONCLUSIONS: Discordance exists between medical "experts" from different backgrounds relating to their perceptions of evidence. Further investigation is warranted in order to reveal any effects on the quality of treatment information and implications in the decision-making process. Possible effects on collaboration and working relationships also warrant further exploration. (+info)