Proton beam and prostate cancer: An evolving debate

This paper evaluates the reasons behind the rise in the use of proton beam for prostate cancer, the economics drivers behind it, and the evidence that exists to support it. It concludes that clinical outcome data underlying the notion that this is a superior treatment remains sparse and discusses what is needed to fill in the gaps.     

Computers in the surgery. The patient's view.

A postal survey sent to 350 patients from two rural practices confirmed that an appreciable minority of patients (17%) were opposed to doctors using computers. The questionnaire distributed had been carefully designed to identify their opposition more specifically. Most of the general concern was accounted for by the 91 patients (31%) who feared that confidentiality of information would be reduced. The sensitive nature of medical information alerts patients to the possibility of diminished security of records and obliges practices considering acquiring a computer to ensure that these fears are not realised. Smaller proportions of patients were found to oppose computers on other grounds--namely, impersonality, economy, and general anxiety.     

The logic of noncompliance: Management of epilepsy from the patient's point of view

Culture, Medicine, and Psychiatry - Studies of patient compliance with medical regimens reveal that one-quarter to one-half of patients act at variance with their physician's suggestions. Using...     

Spartina alternifloramarshes on dredged material: a critical review of the ongoing debate over success

After three decades ofexperience, environmental managers continue toquestion the use of dredged material for creation andrestoration of Spartina alternifloramarshes. Different uses of the term `success' have led to someconfusion, and poor recognition of the limitations ofresearch design have contributed to confusion instudies comparing dredged material and naturalmarshes. This paper uses data from a number ofsources to compare dredged material and naturalmarshes. Quantitative analyses based on dataavailable in the scientific literature suggest thatmean values for aboveground and belowground biomass,organic carbon in sediments, polychaete densities, andcrustacean densities may differ in dredged materialand natural marshes. There is not sufficient evidenceto conclude that differences are present for othervariables, such as densities of stems, oligochaetes,or fish. Cumulative quantitative data do not supportthe contention that dredged material sites becomeincreasingly similar to nearby natural marshes overtime as a general rule, although some attributes ofindividual dredged material marshes may becomeincreasingly similar to some natural marshes. Although it is clear that dredged material marshesprovide habitat for birds, limited data suggest thatdredged material marshes may provide habitat for adifferent community of birds than natural marshes. Similarly, limited data suggest that geomorphologicalfeatures found in natural marshes are not duplicatedin dredged material marshes. In short, datasummarized from the literature suggest that dredgedmaterial marshes provide some of the functions ofnatural marshes but probably do not replace all of thefunctions of lost natural marshes.     

Science policy and society: the British debate over GM agriculture

The outcome of 'GM Nation?'--a public debate on genetic modification and the commercial growing of GM crops in Britain--was published in 2003. The objective of this public consultation was 'to promote an innovative, effective and deliberative programme of debate, against the background of the possible commercial production of GM crops in the UK...[and] provide meaningful information to Government about the nature and spectrum of the public's views, particularly at the grass roots level, to inform decision making'. Complementing an independent evaluation of GM Nation?, this article puts the debate into context, comments on the legitimacy of this, and similar exercises in public consultation, and develops some ideas on the future of public consultation on technological innovation.     

The debate over risk-related standards of competence

This discussion paper continues the debate over risk-related standards of mental competence which appears in Bioethics 5. Dan Brock there defends an approach to mental competence in patients which defines it as being relative to differing standards, more or less rigorous depending on the degree of risk involved in proposed treatments. But Mark Wicclair raises a problem for this approach: if significantly different levels of risk attach, respectively, to accepting and refusing the same treatment, then it is possible, on this account, for a patient to be considered competent to accept, but not refuse, the treatment, or vice versa. I argue that this puzzle does not constitute a genuine problem for a risk-related standard.
To this end I focus on the situation where, of two mutually exclusive options, one is riskier, but offering more pronounced benefit, while the other is safer, but offering less benefit. I argue for this proposition: it can take far less insight to know that the safe option is good than to know that the risky option is better. Now say one is actually informed enough to know that the safe option is good, but not enough to know whether the risky option is better; in such a case one is competent to say yes to that first option (the safe one), but not to say yes to the other. (I argue in passing that Pascal's Wager can be interpreted as having precisely this deliberative structure.)
I thus conclude that cases do indeed exist where one can be competent to say yes but not no, or vice versa; and that it is thus not an anomaly in the risk-related standard that it entails the existence of such cases.