Evolution of Ethical Principles in the Practice of Pharmaceutical Medicine From a UK Perspective.

Pharmaceutical medicine has evolved to be a distinct medical scientific discipline over time. Pharmaceutical medicine has distinctive features related to complex innovative medicines development activities in an often commercially focused competitive environment. This sometimes uneasy mix of professionalism and commercialisation demands of its medical and scientific researchers alike, a focus on strict adherence to ethical standards, guidelines, practices and behaviors in the interest of delivering new, effective, high-quality lifesaving and life-enhancing medicines quickly and reliably to patients in need. To support the speciality, codes of ethical standards and practices have been developed, with several being recently updated. These various codes are outlined in this paper along with relevant historical perspectives and interrelationship with concepts of professionalism. Reflecting the longer history of pharmaceutical medicine as a speciality in the UK and experience of the authors, there is a focus on the UK for the historical perspectives.

Doing Good, Choosing Freely: How Moral Enhancement Can Be Compatible with Individual Freedom.

Moral enhancement has been accused of curtailing human freedoms. In this article, I suggest the opposite: moral enhancement and individual freedom can go hand in hand. The first section defines freedom, enhancement, and morality and argues that only a naturalistic account of morality allows for the concept of enhancement. The second section looks at ways that freedom may be threatened by moral enhancement, especially by the method of implementation, the creation of new externalities, or the limitation of volitional options. I argue that virtue ethics offers the safest model for moral enhancement. The third section describes ways in which moral enhancement can be achieved while maintaining, or even increasing, individual freedom. Such methods include shifting of the moral axis, replacing vicious options with virtuous ones, and increasing the number of volitional options available. The article concludes in the fourth section by arguing that the technology and techniques that allow us moral enhancement are likely to be the same ones that allow greater freedom than we already enjoy.

Henoch-Schonlein Purpura with thrombocythaemia: an abnormality in Smad4 expression?

We discuss a patient with Henoch-Schonlein Purpura (HSP) and a thrombocythaemia which was diagnosed as a coincidental Essential Thrombocythaemia. We suggest that deficiencies in Smad4 expression may allow for escape thrombocythaemia under the influence of the high levels of TGF-beta found in HSP. With normal Smad4 expression TGF-beta provides inhibition of thrombocyte proliferation. While this needs further elucidation, it could lead to a new approach to classification and management of HSP.

Photosensitivity, corneal scarring and developmental delay: Xeroderma Pigmentosum in a tropical country.

We present the case of an 8 year-old girl in a developing country with significant corneal scarring and multiple cutaneous skin lesions in sun-exposed areas. Neuro-developmental delay had been present since 3 months of age, and taken as a whole the consensus was that this clinical picture was consistent with Xeroderma Pigmentosum (XP). We highlight the difficulties encountered due to the lack of diagnostic and treatment modalities for this child, and offer a brief review of XP, including emerging treatments that show potential.

Carbon monoxide poisoning in a patient with carbon dioxide retention: a therapeutic challenge.

We present the case of a 70 year-old man with carbon monoxide poisoning following a house fire. A significant smoking history and likely underlying chronic lung pathology complicated treatment, as due to symptomatic retention of carbon dioxide we were unable to use high-flow oxygen to facilitate the elimination of carbon monoxide. We suggest that patients with risk factors for obstructive lung disease be monitored extremely carefully during treatment for carbon monoxide toxicity.

Primary Biliary Cirrhosis with a normal Alkaline Phosphatase: a case report.

A 78 year-old lady presented with abdominal swelling and fatigue. She was anaemic with mild hypoalbuminaemia, and had a normal alkaline phosphatase. Computed tomography showed hepatosplenomegaly and mild ascites. Anti mitochondrial antibodies were strongly positive, as were anti nuclear antibodies, and the gamma glutamyl-transferase was shown to be elevated. A diagnosis of primary biliary cirrhosis was made. A brief discussion of treatment of primary biliary cirrhosis follows. The case is notable for the fact that primary biliary cirrhosis can manifest clinically without an elevation in alkaline phosphatase - normally the hallmark of the disease.

Late venous outflow obstruction after liver transplant: The 'piggy-back' syndrome.

Late hepatic vein and inferior vena cava obstruction after orthotopic liver transplant is unusual. Prolonged venous obstruction may lead to graft failure and reduced patient survival. Direct hepatic venography and pressure studies are essential for diagnosis. We described a patient who developed combined venous outflow obstruction 6 years after liver transplant and was successfully treated with metallic stent placement. Mechanical 'torsion' is a rare cause of venous outflow obstruction.

An unusual cause of fever and rash in an adult.

A 29-year-old hospital doctor presented with a febrile illness and a rash that began shortly after commencing a course of oral antibiotics. Initially thought to be a drug reaction, changes in the nature of the rash led to a confirmed diagnosis of measles. An immunisation history revealed that the patient had never received the MMR vaccine. A high index of suspicion is required to diagnose measles in an immunocompetent adult, and we suggest that occupational health departments should be more rigorous in screening for vaccinations in health workers.