ABSTRACT
This paper argues that the National Institute for Health and Clinical Excellence should not offer guidance in situations where there is insufficient evidence equipoise about the potential benefit of the treatment in question. This is broadly for two reasons. First, without knowing if the treatment is effective no cost-effectiveness judgement can be logically made. Second, the implementation of a population wide change in treatment where there is equipoise amounts to a de facto clinical trial that falls outside the Clinical Trials Regulations. As such there are strong ethical and possibly legal grounds for preventing such an outcome. Guidance based upon insufficient evidence equipoise also impacts upon the clinical discretion possessed by individual medical professionals.
Subject(s)
Antibiotic Prophylaxis/methods , Clinical Trials as Topic , Endocarditis/prevention & control , Practice Guidelines as Topic , Therapeutic Equipoise , Antibiotic Prophylaxis/economics , Cost-Benefit Analysis , Endocarditis/economics , Humans , Risk Factors , United KingdomABSTRACT
This paper introduces the medical factual matrix as a new and potentially valuable tool in medical ethical analysis. Using this tool it demonstrates the idea that a defined medical intervention can only be meaningfully declared futile in relation to a defined goal(s) of treatment. It argues that a declaration of futility made solely in relation to a defined medical intervention is inchoate. It recasts the definition of goal futility as an intervention that cannot alter the probability of the existence of the important outcome states that might flow from a defined intervention. The idea of value futility and the extent of physician obligations in futile situations are also addressed. It also examines the source of substantive conflicts which commonly arise within the doctor-patient relationship and the ensuing power relations that operate between doctor and patient when questions of futility arise.
Subject(s)
Ethics, Medical , Medical Futility/ethics , Dissent and Disputes , Humans , Models, Theoretical , Physician's Role , Physician-Patient RelationsABSTRACT
For planning experiments for neutron activation analysis investigations at 14 MeV, suitable induced beta activities in Bq/g/neutron flux have been computed via appropriate reactions for the estimation of 19F, 23Na, 24Mg, 31P, 32S, 35,37Cl, 39K, 40Ca, 55Mn, 56Fe, 66Zn, 63,65Cu, 107,109Ag and 208Pb. The computational work for (n,p); (n, alpha); (n,n') and (n,2n) reactions induced with 14 MeV neutrons are based on the pre-equilibrium emission mechanism and also the compound nucleus theory with otpical model potential and pairing energy corrections. The cross-sections obtained by pre-equilibrium computer codes are reasonable and have been used in the present computations.
Subject(s)
Dental Enamel/chemistry , Neutron Activation Analysis , Neutrons , Skin/chemistry , HumansABSTRACT
Seventeen cancer patients with monoclonal gammapathy on serum protein electrophoresis are described. Thirteen of these patients were proved to have multiple myeloma, while four patients had "benign" monoclonal gammapathy. In all the cases where bone marrow aspiration was done, an increase in plasma cells was revealed. A majority of the myeloma patients had osteolytic lesions, while all the patients with "benign" monoclonal gammapathy had normal bone survey. A relationship between the solid tumors and monoclonal gammapathy is discussed. The difficulty of detecting multiple myeloma in patients who are previously known to have cancer is presented.
