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  • Perspective

    Bioethics has long approached cost containment under the heading of "allocation of scarce resources." Having thus named the nail, bioethics has whacked away at it with the theoretical hammer of distributive justice. But in the United States, ethical debate is now shifting from rationing to the…

    • May 24, 2012
    • Brody H.
    • N Engl J Med 2012; 366:1949-1951
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    Waste in U.S. health care — spending on interventions that don't benefit patients — amounts to at least 30% of health care spending and is a major driver of cost increases. So the ethical debate about cost containment is shifting focus from rationing to waste avoidance.

  • Perspective

    Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help…

    • February 16, 2012
    • Neumann P.J.
    • N Engl J Med 2012; 366:585-586
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    New ethics guidelines from the American College of Physicians calling for physicians to practice “parsimonious care” have reignited a debate about the role and responsibility of physicians in addressing problems with health care costs.

  • Perspective

    The relationship between patients and doctors is at the core of medical ethics, serving as an anchor for many of the most important debates in the field. Over the past several decades, this relationship has evolved along three interrelated axes — as it is defined in clinical care, research, and…

    • February 16, 2012
    • Truog R.D.
    • N Engl J Med 2012; 366:581-585
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    The relationship between patients and doctors is at the core of medical ethics, anchoring many important debates in the field. Over the past several decades, this relationship has evolved along three axes — as it is defined in clinical care, research, and society.

  • Perspective

    On December 1, 2011, in Flynn v. Holder, the U.S. Court of Appeals for the Ninth Circuit held that the ban on selling "bone marrow" that is part of the National Organ Transplant Act (NOTA) of 1984 does not encompass "peripheral blood stem cells" obtained through apheresis. This ruling means that…

    • January 26, 2012
    • Cohen I.G.
    • N Engl J Med 2012; 366:296-297
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    On December 1, 2011, in Flynn v. Holder, the U.S. Ninth Circuit Court of Appeals held that the ban on selling “bone marrow” that is part of the National Organ Transplantation Act of 1984 does not encompass “peripheral blood stem cells” obtained through apheresis.

  • Perspective

    The World Health Organization (WHO) estimates that the world faces a shortage of 4.3 million health professionals required for delivering essential health care services to populations in need. This shortage constitutes a major barrier to the provision of essential lifesaving health services, such…

    • December 22, 2011
    • Taylor A.L., Hwenda L., Larsen B.-I., Daulaire N.
    • N Engl J Med 2011; 365:2348-2351
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    The world faces a shortage of about 4.3 million health professionals required for delivering essential services. The WHO Global Code of Practice on the International Recruitment of Health Personnel addresses the migration of health workers from lower-income countries.

  • Editorial

    Liver transplantation for alcoholic liver disease has been controversial since the advent of the procedure. The perception that alcohol-related liver disease is self-inflicted, combined with concerns about recidivism to alcohol use and poor adherence to post-transplantation care, has led the public…

    • November 10, 2011
    • Brown R.S.
    • N Engl J Med 2011; 365:1836-1838

      Liver transplantation for alcoholic liver disease has been controversial since the advent of the procedure. The perception that alcohol-related liver disease is self-inflicted, combined with concerns about recidivism to alcohol use and poor adherence to ...

    • Perspective

      The question of whether a duty exists to recontact patients about new genetic information has been debated for several decades without consensus, but the emergence of new technologies compels us to reconsider this complex matter. Ordering a "genetic test," such as a chromosome analysis or a search…

      • October 13, 2011
      • Pyeritz R.E.
      • N Engl J Med 2011; 365:1367-1369

        The question of whether a duty exists to recontact patients about new genetic information has been debated for decades without consensus, but new technologies compel us to reconsider this complex matter, weighing ethical, legal, and practical considerations.

      • Health Law, Ethics, and Human Rights

        Pharmaceutical manufacturers spend billions of dollars each year sending sales representatives, known as detailers, into physicians' offices. To promote their drugs, detailers show up at medical offices bearing product information and valuable drug samples. They also wield a third critical tool:…

        • September 29, 2011
        • Mello M.M. and Messing N.A.
        • N Engl J Med 2011; 365:1248-1254
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        A Vermont law prohibited the sale of physicians' prescribing data. These data facilitate pharmaceutical companies' marketing efforts and increase the use of brand-name drugs over less expensive generics. On June 23, the Supreme Court ruled that the law was unconstitutional.

      • Sounding Board

        In the wake of the scandal surrounding the Tuskegee syphilis study, Congress established the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The commission investigated and made recommendations regarding basic ethical principles guiding research with…

        • September 22, 2011
        • Emanuel E.J. and Menikoff J.
        • N Engl J Med 2011; 365:1145-1150
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        The federal policy regulating research with human subjects, known as the Common Rule, has not been modified since its publication in 1991. A working group convened by the OMB has drafted a proposal to revise the Common Rule and seeks public comment.

      • Perspective

        The centrality of antiretroviral therapy for people with human immunodeficiency virus (HIV) infection is an established feature of the clinical response to HIV–AIDS. Now there is compelling evidence that such treatment can have a profound impact at the population level by reducing viral loads and…

        • August 25, 2011
        • Fairchild A.L. and Bayer R.
        • N Engl J Med 2011; 365:685-687
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        The U.S. HIV surveillance system was built with robust firewalls ensuring that data can go in but not come out. Now, gaps in continuity of HIV care and the improved ability to reduce transmission argue for opening up HIV registries for public health use.

      • Perspective

        Most physicians want to deliver "appropriate" care. Most want to practice "ethically." But the transformation of a small-scale professional service into a technologically complex sector that consumes more than 17% of the nation's gross domestic product makes it increasingly difficult to know what…

        • August 18, 2011
        • Fuchs V.R.
        • N Engl J Med 2011; 365:585-587
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        Escalating health care costs threaten the viability of the economy, forcing physicians to reexamine the choices they make in caring for patients. How can a commitment to cost-effective care be reconciled with a fundamental principle of primacy of patient welfare?

      • Case Records of the Massachusetts General Hospital

        Presentation of Case. Dr. Britta Panda (Obstetrics and Gynecology): A 40-year-old woman was seen by the maternal–fetal medicine service at this hospital at 22 weeks 2 days' gestation because of placenta previa and placenta accreta. Beginning at 12 weeks 1 day's gestation, the patient had received…

        • July 28, 2011
        • Barth W.H., Kwolek C.J., Abrams J.L., Ecker J.L., Roberts D.J.
        • N Engl J Med 2011; 365:359-366
        • CME

        A 40-year-old woman was seen by the maternal–fetal medicine service of this hospital at 22 weeks 2 days' gestation because of placenta previa and placenta accreta. She declined transfusions of blood products because of her religious beliefs. Management decisions were made.

      • Editorial

        On April 26, the Supreme Court heard oral arguments in a case that, when it is decided this spring, will have important repercussions for the practice of medicine. At issue in William H. Sorrell, Attorney General of Vermont, et al. Petitioners v. IMS Health Inc. et al. is whether detailed…

        • May 26, 2011
        • Curfman G.D., Morrissey S., Drazen J.M.
        • N Engl J Med 2011; 364:2053-2055
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        On April 26, the Supreme Court heard oral arguments in a case that, when it is decided this spring, will have important repercussions for the practice of medicine. At issue in William H. Sorrell, Attorney General of Vermont, et al., Petitioners v. IMS ...

      • Perspective

        This year marks the 50th anniversary of the Kefauver hearings, the pivotal 1961 Senate debate that transformed prescription drug approval and use. When Senator Estes Kefauver (D-TN) introduced legislation to regulate the drug industry, the Food and Drug Administration (FDA) still did not have legal…

        • March 31, 2011
        • Avorn J.
        • N Engl J Med 2011; 364:1185-1187
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        In 1961, U.S. legislation transformed prescription drug approval and use. One question it raised was how and by whom information about drugs should be evaluated and communicated to physicians. Half a century later, the question is still hotly contested.

      • Sounding Board

        In the 1980s, bioethics scholars defined the dilemma of randomized clinical trials as a central problem in clinical research ethics. How can physicians offer their patients optimal medical care at the same time that their treatment is selected by chance in the context of a randomized clinical…

        • February 3, 2011
        • Miller F.G. and Joffe S.
        • N Engl J Med 2011; 364:476-480

          Clinical equipoise, or uncertainty about which treatment is best for a patient, is widely viewed as essential for an ethical RCT. The authors argue that clinical trials that violate equipoise are ethical and necessary to inform societal decisions about drug approval and coverage.

        • Perspective

          Since the introduction of the first vaccine, there has been opposition to vaccination. In the 19th century, despite clear evidence of benefit, routine inoculation with cowpox to protect people against smallpox was hindered by a burgeoning antivaccination movement. The result was ongoing smallpox…

          • January 13, 2011
          • Poland G.A. and Jacobson R.M.
          • N Engl J Med 2011; 364:97-99
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          Today, the most recent in a long line of antivaccinationists are using modern media to sway public opinion and distract attention from scientific evidence. But there are steps we can take to avert the ill effects of these campaigns.

        • Perspective

          In the federal judicial system and the U.S. Congress, the fight over the military's "don't ask, don't tell" policy regarding homosexuality goes on. In September, Judge Virginia Phillips banned enforcement of the policy, ruling that it violates gay, lesbian, and bisexual service members' equal…

          • December 16, 2010
          • Katz K.A.
          • N Engl J Med 2010; 363:2380-2381

            While U.S. courts consider a lawsuit alleging that the military's “don't ask, don't tell” policy violates the rights of gay and lesbian service members, the policy continues to jeopardize the health of those service members, the military, and the country at large.

          • Perspective

            First I will define what I conceive medicine to be. In general terms, it is to do away with the sufferings of the sick, to lessen the violence of their diseases, and to refuse to treat those who are overmastered by their disease, realizing that in such cases medicine is powerless. — The…

            • November 18, 2010
            • Shaner D.M.
            • N Engl J Med 2010; 363:1988-1989
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            First I will define what I conceive medicine to be. In general terms, it is to do away with the sufferings of the sick, to lessen the violence of their diseases, and to refuse to treat those who are overmastered by their disease, realizing that in such ...

          • Editorial

            In this issue of the Journal, we publish the results of a clinical trial investigating step-up control in adult patients with asthma whose disease was not well controlled by low-dose inhaled glucocorticoids. This study, which compared the utility of treating such patients with inhaled tiotropium…

            • October 28, 2010
            • Curfman G.D., Morrissey S., Drazen J.M.
            • N Engl J Med 2010; 363:1763
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            In this issue of the Journal, we publish the results of a clinical trial investigating step-up control in adult patients with asthma whose disease was not well controlled by low-dose inhaled glucocorticoids.1 This study, which compared the utility of ...

          • Perspective

            Embryo research was born political. Expressions of shock and surprise at the August 23 ruling of federal district court judge Royce Lamberth enjoining federal funding of stem-cell research — which was based largely on his reading of an amendment to an appropriations bill — are thus not terribly…

            • October 28, 2010
            • Annas G.J.
            • N Engl J Med 2010; 363:1687-1689
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            Embryo research was born political. Expressions of shock and surprise at the August 23 ruling of federal district court judge Royce Lamberth enjoining federal funding of stem-cell research — which was based largely on his reading of an amendment to an ...

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          Medical Meetings Pediatrics Conferences and Meetings

          2012 Certifying Examinations of the American Board of Pediatrics

          The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

          Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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