Background: Notwithstanding near-universal agreement on the theoretical importance of truthfulness, empirical research has documented gaps between ethical norms and physician behaviors. Although prior research has explored situations in which physicians may not be truthful with patients, it has focused on contexts within specialty practice. In this article, we report on a qualitative study of truthfulness in primary care. Methods: We conducted a qualitative study during December 2014–March 2015 involving both focus groups and in-depth, semistructured interviews with 32 primary care physicians (...) from the Boston, MA, and Baltimore, MD, metro areas in three specialties: internal medicine, family practice, and pediatrics. Interviews and focus groups were led using a semistructured guide, which explored situations in which primary care physicians find it difficult to be honest with patients; factors shaping truthfulness; and rationales for truthful and untruthful communication. Results: While physicians described outright lying to patients as rare, other deviations from truthfulness were not uncommon, including slanting and deliberately withholding information. Physicians described a range of factors as influencing truthfulness, from patient-level characteristics such as educational background to societal considerations including avoiding unnecessary tests and procedures. Physicians described truthfulness as an ethical requirement, deviations from which required further justification. Perceived justifications included promoting patient well-being and avoiding harm. Conclusions: Our results suggest a potential need to augment opportunities for training in “everyday ethics” challenges, such as the appropriateness of deception in response to patient requests for inappropriate tests or pain medications. Furthermore, they indicate that, in various circumstances encountered in primary care, physicians perceive other moral duties as potentially in conflict with the duty of truthfulness. Further ethical analysis should focus on identifying when deviations from complete truthfulness do and do not serve patients' interests, to guide physicians in striking a reasonable balance among principles of medical ethics that may conflict with one another. (shrink)

BackgroundRandomized controlled trials (RCTs) are often complex and expensive to perform. Less than one third achieve planned recruitment targets, follow-up can be labor-intensive, and many have limited real-world generalizability. Designs for RCTs conducted using cohorts and routinely collected health data, including registries, electronic health records, and administrative databases, have been proposed to address these challenges and are being rapidly adopted. These designs, however, are relatively recent innovations, and published RCT reports often do not describe important aspects of their methodology in (...) a standardized way. Our objective is to extend the Consolidated Standards of Reporting Trials (CONSORT) statement with a consensus-driven reporting guideline for RCTs using cohorts and routinely collected health data.MethodsThe development of this CONSORT extension will consist of five phases. Phase 1 (completed) consisted of the project launch, including fundraising, the establishment of a research team, and development of a conceptual framework. In phase 2, a systematic review will be performed to identify publications (1) that describe methods or reporting considerations for RCTs conducted using cohorts and routinely collected health data or (2) that are protocols or report results from such RCTs. An initial “long list” of possible modifications to CONSORT checklist items and possible new items for the reporting guideline will be generated based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statements. Additional possible modifications and new items will be identified based on the results of the systematic review. Phase 3 will consist of a three-round Delphi exercise with methods and content experts to evaluate the “long list” and generate a “short list” of key items. In phase 4, these items will serve as the basis for an in-person consensus meeting to finalize a core set of items to be included in the reporting guideline and checklist. Phase 5 will involve drafting the checklist and elaboration-explanation documents, and dissemination and implementation of the guideline.DiscussionDevelopment of this CONSORT extension will contribute to more transparent reporting of RCTs conducted using cohorts and routinely collected health data. (shrink)

Sports medicine clinicians face conflicts of interest in providing medical care to athletes. Using a survey of college football players, this study evaluates whether athletes are aware of these conflicts of interest, whether these conflicts affect athlete trust in their health care providers, or whether conflicts or athletes' trust in stakeholders are associated with athletes' injury reporting behaviors.

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

This study of the relationships of the concept of freedom to other allied notions is written from the libertarian point of view. It is based upon the author's Ph.D. dissertation at Emory University in 1962. While the present version is a revised and improved one, it remains somewhat narrow in the scope of historical materials used, concentrating on works available in English, and giving particular attention to Sir David Ross, Hastings Rashdall, C. A. Campbell, P. Nowell-Smith, and Charles Hartshorne. (...) The author locates freedom primarily in choice and argues that the key to choice-making is the ability actively to focus attention. Theories that argue for psychological determinism on the basis of motives are found to conflict with the phenomena of paying attention and trying. At the same time, Campbell's sharp distinction between the freedom of moral and non-moral choices is rejected, and also denied is the metaphysical grounding of freedom in a personality or self as agent distinct from the activity. The author is at his best in dealing with arguments of determinists concerning particular points; many of the distinctions and clarifications proposed are serious objections often overlooked by those defending determinism. Edwards is especially helpful in showing that determinist arguments generally assume universal determinacy of action on the ground of particular and/or partial determinacy, which libertarians need not deny. The examination of the relations between freedom and responsibility is intended to show that the "plain man's" views on moral responsibility cannot be adequately accounted for by a utilitarian theory of praise and blame and a determinist theory of action. The weakness of this study is its lack of an integrated metaphysical position. Thus, while Edwards rightly argues that nothing can be chosen unless it is first desired, he confusingly suggests that the function of choice is to supplement the strength of desires too weak to make themselves effective. An integrated metaphysical study might have raised questions about the commensurability of desires and goods. Again, the process-theory of agency is assumed too easily. Still, this is a useful study, and those interested in the problem will find much of value in it.--G. G. G. (shrink)

By the courtesy of the editors I have been allowed to see Mr. A. Y. Campbell's “observations on two emendations of Ausonius suggested by me in C.Q. XXVII. 178 ff. Meanwhile I have learned from Mr. E. Harrison, of Trinity College, Cambridge, that, in the Cambridge Philological Society's Proceedings, 1924, p. 27, since Alcestis is meant, cp. Juv. 6, 652 spectant subeuntem fata mariti / Alcestim et, similis si permutatio detur, morte viri cupiant animam servare catellae, he had already (...) proposed to ‘read pro nece functa viri,’ thus anticipating my pro nece and Mr. Campbell's funere. As the Cambridge Phil. Soc. Proc. are inaccessible to me and are not to be discovered in theBodleian Library, I was ignorant of Mr. Harrison's proposal. I am glad that we concur. (shrink)

In this paper I start discussing "originalism" as a practice of interpretation purporting the intent of the framers as "the" governing factor in interpretation. My first step is to contrast it with the approach of non-interpretivism. Then I discuss "interpretation" itself as a package to depict social practices of meaning production, focusing on three peculiar historical settings : Alexandria, Scholasticism, and the "birth" of Hermeneutics. My aim is to show the "essentialist" move of posing the concept of "meaning" as a (...) key factor in the "ideology" of interpretation. Such a discussion is introductory to a reappraisal of the current debate about criticism and of the distinction between interpretation and use-of-the-texts. I then examine archeology as a radical alternative to interpretive practices. But my final step will be to shift away from the blunt opposition between interpretivism and non interpretivism, to suggest a more complex arrangement based on an ironic misuse of interpretivism, and a framing of interpretation as an antagonistic process. (shrink)

The words I wish to delete in 48-9 spoil a ‘tricolon crescendo’ whose three members are clearly marked and whose verbs are perhaps deliberately varied in person and tense. The parataxis by means of hic is awkward, and the words seem to be a versified gloss. The Scholiast says : id est: to nobilis tantum et imperitus. nam de plebe, id est de humili familia, eloquentes exeunt, qui nobilium imperitorum causas defendunt; but that could be a paraphrase based on the (...) text as it stands in our manuscripts. (shrink)

The text of Euripides' Troades depends mainly upon the versions preserved in two manuscripts, viz. Palatinus 287 and Vaticanus 909 . Both these manuscripts are well known and have been several times collated. Their importance in relation to one another and to the other existing manuscripts for the study of the text of Euripides in general has been frequently discussed and is no longer a subject of major controversy. The notes which follow are designed to put on record a number (...) of corrections to the readings ascribed to P and V for the Troades in the apparatus criticus of Prinz-Wecklein and later editors; and to correct and amplify the general descriptions of P and to call attention to certain difficulties in the current views of its relationship to Laurentianus xxxii. (shrink)