Lainie Friedman Ross
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780199273287
- eISBN:
- 9780191603655
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0199273286.003.0002
- Subject:
- Philosophy, Moral Philosophy
This chapter examines the changes in policies regarding children in research between 1966 and 2003. It reviews Henry Beecher’s famous article, Ethics and Clinical Research, which described 22 ...
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This chapter examines the changes in policies regarding children in research between 1966 and 2003. It reviews Henry Beecher’s famous article, Ethics and Clinical Research, which described 22 projects published after World War II that he found to be of questionable ethics; Paul Ramsey’s examination of the ethical problems in medicine; debates over the moral permissibility of children’s participation in nontherapeutic research; the government’s policy shift from an exclusive focus on protecting children from research risks to promoting greater access by children in research during the early 1990s; and international research ethics. It is shown that new policies have encouraged pediatric pharmacological testing and have led to some improved pediatric labeling.Less
This chapter examines the changes in policies regarding children in research between 1966 and 2003. It reviews Henry Beecher’s famous article, Ethics and Clinical Research, which described 22 projects published after World War II that he found to be of questionable ethics; Paul Ramsey’s examination of the ethical problems in medicine; debates over the moral permissibility of children’s participation in nontherapeutic research; the government’s policy shift from an exclusive focus on protecting children from research risks to promoting greater access by children in research during the early 1990s; and international research ethics. It is shown that new policies have encouraged pediatric pharmacological testing and have led to some improved pediatric labeling.
Lainie Friedman Ross
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780199273287
- eISBN:
- 9780191603655
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0199273286.003.0009
- Subject:
- Philosophy, Moral Philosophy
This chapter examines the ethics of payment in pediatric research that does not offer the prospect of direct benefit (nontherapeutic research). It addresses the ethical objection that payment ...
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This chapter examines the ethics of payment in pediatric research that does not offer the prospect of direct benefit (nontherapeutic research). It addresses the ethical objection that payment perverts motivation, and that this can have two adverse consequences: it may distort the voluntariness of the parent’s permission and the child’s assent; and it may lead to an unjust recruitment or selection of subjects. It is argued that it is morally permissible to provide payment for participation in pediatric research. Related issues that need to be resolved to decide what is a fair price for the participation of children in nontherapeutic research are discussed.Less
This chapter examines the ethics of payment in pediatric research that does not offer the prospect of direct benefit (nontherapeutic research). It addresses the ethical objection that payment perverts motivation, and that this can have two adverse consequences: it may distort the voluntariness of the parent’s permission and the child’s assent; and it may lead to an unjust recruitment or selection of subjects. It is argued that it is morally permissible to provide payment for participation in pediatric research. Related issues that need to be resolved to decide what is a fair price for the participation of children in nontherapeutic research are discussed.
Lainie Friedman Ross
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780199273287
- eISBN:
- 9780191603655
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0199273286.003.0003
- Subject:
- Philosophy, Moral Philosophy
This chapter examines the extent to which pediatric researchers reported race and ethnicity (R/E) data; the representation of Black, Hispanic, and Asian children and their parents in pediatric ...
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This chapter examines the extent to which pediatric researchers reported race and ethnicity (R/E) data; the representation of Black, Hispanic, and Asian children and their parents in pediatric medical research; the extent to which language may be a barrier in pediatric research; and how R/E data were collected in pediatric research. Collecting R/E data in medical research was difficult because the data were not presented in a standardized format. Black children and their parents were overrepresented, while Hispanic children and their parents were underrepresented in pediatric research. Black subjects had greater overrepresentation in clinical trials than in nontherapeutic research, and a greater representation in research that was potentially stigmatizing. Language barriers existed in pediatric research, and the most number of Hispanic and Asian participants were enrolled in research in which translation services are available.Less
This chapter examines the extent to which pediatric researchers reported race and ethnicity (R/E) data; the representation of Black, Hispanic, and Asian children and their parents in pediatric medical research; the extent to which language may be a barrier in pediatric research; and how R/E data were collected in pediatric research. Collecting R/E data in medical research was difficult because the data were not presented in a standardized format. Black children and their parents were overrepresented, while Hispanic children and their parents were underrepresented in pediatric research. Black subjects had greater overrepresentation in clinical trials than in nontherapeutic research, and a greater representation in research that was potentially stigmatizing. Language barriers existed in pediatric research, and the most number of Hispanic and Asian participants were enrolled in research in which translation services are available.
Lainie Friedman Ross
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780199273287
- eISBN:
- 9780191603655
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0199273286.001.0001
- Subject:
- Philosophy, Moral Philosophy
This book examines the ethical issues in pediatric medical research. It argues that policies and practices on the participation of children must focus primarily on minimizing risks. It offers ...
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This book examines the ethical issues in pediatric medical research. It argues that policies and practices on the participation of children must focus primarily on minimizing risks. It offers specific recommendations to revise Subpart D of the federal regulations to provide greater protection where necessary and remove obstacles that do not provide additional protection but interfere with access. The book is divided into four sections. Section 1 focuses on the issue of access versus protection in pediatric research. Section 2 deals with challenges to regulations. Section 3 discusses the strengths and limits of current regulations, while different case studies are examined in Section 4.Less
This book examines the ethical issues in pediatric medical research. It argues that policies and practices on the participation of children must focus primarily on minimizing risks. It offers specific recommendations to revise Subpart D of the federal regulations to provide greater protection where necessary and remove obstacles that do not provide additional protection but interfere with access. The book is divided into four sections. Section 1 focuses on the issue of access versus protection in pediatric research. Section 2 deals with challenges to regulations. Section 3 discusses the strengths and limits of current regulations, while different case studies are examined in Section 4.
Lainie Friedman Ross
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780199273287
- eISBN:
- 9780191603655
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0199273286.003.0008
- Subject:
- Philosophy, Moral Philosophy
Institutional review board (IRB) review is required for all federally funded research involving human subjects regulated by the Food and Drug Administration, or performed at an institution that ...
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Institutional review board (IRB) review is required for all federally funded research involving human subjects regulated by the Food and Drug Administration, or performed at an institution that accepts federal funds. The requirement to document IRB review and the procurement of informed consent (IC) in published research reports is more recent. This chapter examines to what extent research published in three peer-reviewed pediatric journals documented IRB approval and IC, and to what extent the researchers who failed to document IRB and IC stated that they had obtained appropriate IRB review and consent from subjects. It was observed that a small but significant number of pediatric research protocols failed to obtain IRB approval or a waiver.Less
Institutional review board (IRB) review is required for all federally funded research involving human subjects regulated by the Food and Drug Administration, or performed at an institution that accepts federal funds. The requirement to document IRB review and the procurement of informed consent (IC) in published research reports is more recent. This chapter examines to what extent research published in three peer-reviewed pediatric journals documented IRB approval and IC, and to what extent the researchers who failed to document IRB and IC stated that they had obtained appropriate IRB review and consent from subjects. It was observed that a small but significant number of pediatric research protocols failed to obtain IRB approval or a waiver.
Priscilla Alderson
- Published in print:
- 2012
- Published Online:
- May 2012
- ISBN:
- 9780199652501
- eISBN:
- 9780191739217
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199652501.003.0012
- Subject:
- Law, Family Law, Human Rights and Immigration
The idea of children's ‘assent’ to medical research became part of English law in 2004. However, this overrides English legal traditions of children's consent. Although this chapter concentrates on ...
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The idea of children's ‘assent’ to medical research became part of English law in 2004. However, this overrides English legal traditions of children's consent. Although this chapter concentrates on English law and guidance, it has international relevance. English law integrates with European law and also has influence over more than a billion people in the fifty-four British Commonwealth countries. Ethics guidance in England on consent to research influences international projects, based in Britain and conducted in Europe and in every other continent. Discussions about children's consent and assent illuminate meeting points between law and childhood studies across the world. This chapter examines contrasting meanings of consent and ‘assent’, and reviews the related law and ethics. It discusses whether children's consent or their assent offers them best support and protection while they are considering whether to take part in research, and while they are research subjects. It gives examples of some present problems, which indicate the need for broader understanding of children's consent.Less
The idea of children's ‘assent’ to medical research became part of English law in 2004. However, this overrides English legal traditions of children's consent. Although this chapter concentrates on English law and guidance, it has international relevance. English law integrates with European law and also has influence over more than a billion people in the fifty-four British Commonwealth countries. Ethics guidance in England on consent to research influences international projects, based in Britain and conducted in Europe and in every other continent. Discussions about children's consent and assent illuminate meeting points between law and childhood studies across the world. This chapter examines contrasting meanings of consent and ‘assent’, and reviews the related law and ethics. It discusses whether children's consent or their assent offers them best support and protection while they are considering whether to take part in research, and while they are research subjects. It gives examples of some present problems, which indicate the need for broader understanding of children's consent.
Lainie Friedman Ross
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780199273287
- eISBN:
- 9780191603655
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0199273286.003.0005
- Subject:
- Philosophy, Moral Philosophy
This chapter examines whether Subpart D of the federal regulations on human subject protections provides appropriate protection for all children, when research offers no prospect of direct benefit ...
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This chapter examines whether Subpart D of the federal regulations on human subject protections provides appropriate protection for all children, when research offers no prospect of direct benefit (also known as ‘nontherapeutic research’). It shows that Subpart D provides greater protection for healthy children and allows children who have a disorder or condition to be exposed to greater risk of harm. This double standard is unjust because the distribution of burdens falls disproportionately on children with a disorder or condition. Suggestions for revising the federal regulations are presented.Less
This chapter examines whether Subpart D of the federal regulations on human subject protections provides appropriate protection for all children, when research offers no prospect of direct benefit (also known as ‘nontherapeutic research’). It shows that Subpart D provides greater protection for healthy children and allows children who have a disorder or condition to be exposed to greater risk of harm. This double standard is unjust because the distribution of burdens falls disproportionately on children with a disorder or condition. Suggestions for revising the federal regulations are presented.
Lainie Friedman Ross
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780199273287
- eISBN:
- 9780191603655
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0199273286.003.0006
- Subject:
- Philosophy, Moral Philosophy
This chapter presents an overview of the informed consent requirements and waivers in pediatric research under current federal regulations. These consent policies were adopted by the Food and Drug ...
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This chapter presents an overview of the informed consent requirements and waivers in pediatric research under current federal regulations. These consent policies were adopted by the Food and Drug Administration in April 2001 with the exception of parental waivers under Code of Federal Regulations section 46.408. The moral bases for these requirements are examined: whether the current policies are consistent with these moral foundations, and if not, how the policies should be modified.Less
This chapter presents an overview of the informed consent requirements and waivers in pediatric research under current federal regulations. These consent policies were adopted by the Food and Drug Administration in April 2001 with the exception of parental waivers under Code of Federal Regulations section 46.408. The moral bases for these requirements are examined: whether the current policies are consistent with these moral foundations, and if not, how the policies should be modified.
Lainie Friedman Ross
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780199273287
- eISBN:
- 9780191603655
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0199273286.003.0014
- Subject:
- Philosophy, Moral Philosophy
This chapter examines four ethical issues raised by clinical asthma research involving children subjects: (1) to what extent are clinical asthma trials designed as placebo-controlled trials as ...
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This chapter examines four ethical issues raised by clinical asthma research involving children subjects: (1) to what extent are clinical asthma trials designed as placebo-controlled trials as opposed to active-drug controlled trials?; (2) do placebo-controlled trials in a condition like asthma place the research subjects at increased risk of harm?; (3) are the new guidelines promoting increased access of children to research changing the enrollment pattern of children in research?; and (4) are the new guidelines achieving their goal of garnering useful information about medication safety, efficacy, and dosing for children as a class? It is argued that children are a vulnerable population in clinical research and need additional protection. This means that the former recommendations of the National Commission to perform research first on animals, second on adults, and only then on children should be maintained. It also means that when children are involved, highest scientific and ethical standards must be maintained.Less
This chapter examines four ethical issues raised by clinical asthma research involving children subjects: (1) to what extent are clinical asthma trials designed as placebo-controlled trials as opposed to active-drug controlled trials?; (2) do placebo-controlled trials in a condition like asthma place the research subjects at increased risk of harm?; (3) are the new guidelines promoting increased access of children to research changing the enrollment pattern of children in research?; and (4) are the new guidelines achieving their goal of garnering useful information about medication safety, efficacy, and dosing for children as a class? It is argued that children are a vulnerable population in clinical research and need additional protection. This means that the former recommendations of the National Commission to perform research first on animals, second on adults, and only then on children should be maintained. It also means that when children are involved, highest scientific and ethical standards must be maintained.
Rebecca J. Cook, Bernard M. Dickens, and Mahmoud F. Fathalla
- Published in print:
- 2003
- Published Online:
- October 2011
- ISBN:
- 9780199241323
- eISBN:
- 9780191696909
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199241323.003.0025
- Subject:
- Philosophy, Moral Philosophy
This chapter outlines the provisions of the World Medical Association's Declaration of Helsinki, which was developed as a statement of ethical principles to provide guidance to physicians and other ...
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This chapter outlines the provisions of the World Medical Association's Declaration of Helsinki, which was developed as a statement of ethical principles to provide guidance to physicians and other participants in medical research involving human subjects. Medical research involving human subjects includes research on identifiable human material or identifiable data.Less
This chapter outlines the provisions of the World Medical Association's Declaration of Helsinki, which was developed as a statement of ethical principles to provide guidance to physicians and other participants in medical research involving human subjects. Medical research involving human subjects includes research on identifiable human material or identifiable data.
Lainie Friedman Ross
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780199273287
- eISBN:
- 9780191603655
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0199273286.003.0007
- Subject:
- Philosophy, Moral Philosophy
This chapter examines the issue of whether phase I pediatric oncology trials offer the prospect of direct benefit. Phase I research is carried out to determine toxicity; the possibility of direct ...
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This chapter examines the issue of whether phase I pediatric oncology trials offer the prospect of direct benefit. Phase I research is carried out to determine toxicity; the possibility of direct benefit is secondary to the objectives of the study. Focusing exclusively on whether phase I trials could be interpreted as offering the prospect of direct benefit fails to acknowledge the moral relevance of the researchers’ intent. If intentions matter, then phase I studies cannot be said to offer the prospect of direct benefit.Less
This chapter examines the issue of whether phase I pediatric oncology trials offer the prospect of direct benefit. Phase I research is carried out to determine toxicity; the possibility of direct benefit is secondary to the objectives of the study. Focusing exclusively on whether phase I trials could be interpreted as offering the prospect of direct benefit fails to acknowledge the moral relevance of the researchers’ intent. If intentions matter, then phase I studies cannot be said to offer the prospect of direct benefit.
Lainie Friedman Ross
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780199273287
- eISBN:
- 9780191603655
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0199273286.003.0016
- Subject:
- Philosophy, Moral Philosophy
Fourteen 407 panels have been convened in the more than two decades since passage of Subpart D. The first two were in the early 1990s, and the remainder since 2001. This chapter provides a brief ...
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Fourteen 407 panels have been convened in the more than two decades since passage of Subpart D. The first two were in the early 1990s, and the remainder since 2001. This chapter provides a brief history of the first ten 407 panels, and then examines three of the last four panels. It concludes with several observations that can be gleaned from an historical and ethical analysis of the 407 process: observations that may be instructive for future 407 panels and for the protection of pediatric research subjects.Less
Fourteen 407 panels have been convened in the more than two decades since passage of Subpart D. The first two were in the early 1990s, and the remainder since 2001. This chapter provides a brief history of the first ten 407 panels, and then examines three of the last four panels. It concludes with several observations that can be gleaned from an historical and ethical analysis of the 407 process: observations that may be instructive for future 407 panels and for the protection of pediatric research subjects.
Ruth W. Grant
- Published in print:
- 2011
- Published Online:
- October 2017
- ISBN:
- 9780691151601
- eISBN:
- 9781400839742
- Item type:
- chapter
- Publisher:
- Princeton University Press
- DOI:
- 10.23943/princeton/9780691151601.003.0006
- Subject:
- Business and Management, Knowledge Management
This chapter explores in more detail four very different domains where incentives have been controversial: plea bargaining, recruiting medical research subjects, the loan policies of the ...
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This chapter explores in more detail four very different domains where incentives have been controversial: plea bargaining, recruiting medical research subjects, the loan policies of the International Monetary Fund, and motivating children to learn. Each of these cases illuminates a web of concerns surrounding the ethics of incentives and illustrates how legitimate and illegitimate incentives can be differentiated. The chapter argues for the usefulness of taking up the question of the ethical use of incentives in very different contexts. Sensitivity to context increases the complexity of the issues but never in exactly the same ways in every case. Despite this diversity, the controversies in each case revolve around the same central questions identified in the last chapter on evaluating incentives.Less
This chapter explores in more detail four very different domains where incentives have been controversial: plea bargaining, recruiting medical research subjects, the loan policies of the International Monetary Fund, and motivating children to learn. Each of these cases illuminates a web of concerns surrounding the ethics of incentives and illustrates how legitimate and illegitimate incentives can be differentiated. The chapter argues for the usefulness of taking up the question of the ethical use of incentives in very different contexts. Sensitivity to context increases the complexity of the issues but never in exactly the same ways in every case. Despite this diversity, the controversies in each case revolve around the same central questions identified in the last chapter on evaluating incentives.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0002
- Subject:
- History, American History: 20th Century
Typically regarded as a quiet time in American medical education, the interwar period was in fact highly dynamic. Medical research advanced and medical schools grew in size, wealth, and complexity. ...
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Typically regarded as a quiet time in American medical education, the interwar period was in fact highly dynamic. Medical research advanced and medical schools grew in size, wealth, and complexity. The values associated with the Flexnerian revolution became generalized—particularly the commitment of medical schools to research. If American medical schools after World War II were to grow so large as to dwarf pre-World War II medical schools, that was because a solid institutional infrastructure was already in place that could effectively utilize the massive infusion of federal and private funds.Less
Typically regarded as a quiet time in American medical education, the interwar period was in fact highly dynamic. Medical research advanced and medical schools grew in size, wealth, and complexity. The values associated with the Flexnerian revolution became generalized—particularly the commitment of medical schools to research. If American medical schools after World War II were to grow so large as to dwarf pre-World War II medical schools, that was because a solid institutional infrastructure was already in place that could effectively utilize the massive infusion of federal and private funds.
Lainie Friedman Ross
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780199273287
- eISBN:
- 9780191603655
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0199273286.003.0004
- Subject:
- Philosophy, Moral Philosophy
The Code of Federal Regulations (CFR) 45 part 46, Federal Policy for the Protection of Human Subjects, were developed based on reports published by the National Commission (for the Protection of ...
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The Code of Federal Regulations (CFR) 45 part 46, Federal Policy for the Protection of Human Subjects, were developed based on reports published by the National Commission (for the Protection of Human Subjects of Biomedical and Behavioral Research). Subpart A of 45 CFR 46 is known as the Common Rule since it has been adopted by sixteen federal agencies and departments of the US government. Subpart D provides additional protections for research involving children. This chapter examines in detail 45 CFR Part 46 as it applies to children subjects. It argues that even after 20 years, the regulations to protect human subjects remain quite viable and useful, although a few modifications may be necessary.Less
The Code of Federal Regulations (CFR) 45 part 46, Federal Policy for the Protection of Human Subjects, were developed based on reports published by the National Commission (for the Protection of Human Subjects of Biomedical and Behavioral Research). Subpart A of 45 CFR 46 is known as the Common Rule since it has been adopted by sixteen federal agencies and departments of the US government. Subpart D provides additional protections for research involving children. This chapter examines in detail 45 CFR Part 46 as it applies to children subjects. It argues that even after 20 years, the regulations to protect human subjects remain quite viable and useful, although a few modifications may be necessary.
Franklin G. Miller
- Published in print:
- 2009
- Published Online:
- February 2010
- ISBN:
- 9780195335149
- eISBN:
- 9780199866335
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195335149.003.0015
- Subject:
- Philosophy, Moral Philosophy
This chapter considers the scope and limits of consent to participate in research. Following discussion of a famous historical case of clinical research without informed consent, it examines the ...
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This chapter considers the scope and limits of consent to participate in research. Following discussion of a famous historical case of clinical research without informed consent, it examines the therapeutic misconception and the justifiability of research without consent.Less
This chapter considers the scope and limits of consent to participate in research. Following discussion of a famous historical case of clinical research without informed consent, it examines the therapeutic misconception and the justifiability of research without consent.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0008
- Subject:
- History, American History: 20th Century
The ties formed between the federal government and academic medical centers during World War II irrevocably altered the scale of medical research in the United States. Over the next two decades, ...
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The ties formed between the federal government and academic medical centers during World War II irrevocably altered the scale of medical research in the United States. Over the next two decades, staggering growth in the research enterprise occurred, the result of a massive infusion of federal dollars. Although some schools received much more money than others, ultimately all were transformed. To many observers, the 1950s and 1960s were lithe days for the “researcher”, as research grew to overshadow teaching and clinical practice at many academic medical centers. The ascendancy of American medical research occurred as part of the more generalized expansion of science and higher education in the United States produced after the the war by federal spending.Less
The ties formed between the federal government and academic medical centers during World War II irrevocably altered the scale of medical research in the United States. Over the next two decades, staggering growth in the research enterprise occurred, the result of a massive infusion of federal dollars. Although some schools received much more money than others, ultimately all were transformed. To many observers, the 1950s and 1960s were lithe days for the “researcher”, as research grew to overshadow teaching and clinical practice at many academic medical centers. The ascendancy of American medical research occurred as part of the more generalized expansion of science and higher education in the United States produced after the the war by federal spending.
Eric J. Cassell
- Published in print:
- 1997
- Published Online:
- November 2011
- ISBN:
- 9780195113235
- eISBN:
- 9780199999828
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195113235.001.0001
- Subject:
- Palliative Care, Patient Care and End-of-Life Decision Making, Pain Management and Palliative Pharmacology
This book shows how much better fitted advanced concepts of primary care medicine are to America's health-care needs. It offers insights into how primary care physicians can be better trained to meet ...
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This book shows how much better fitted advanced concepts of primary care medicine are to America's health-care needs. It offers insights into how primary care physicians can be better trained to meet the needs of their patients, both well and sick, and to keep these patients as the focus of their practice. Modern medical training, the book notes, arose at a time when medical science was in ascendancy. Thus the ideals of science — objectivity, rationality — became the ideals of medicine, and disease — the target of most medical research — became the logical focus of medical practice. When clinicians treat a patient with pneumonia, they are apt to be thinking about pneumonia in general — which is how they learn about the disease — rather than this person's pneumonia. This objective, rational approach has its value, but when it dominates a physician's approach to medicine, it can create problems. Most important, this book argues that primary care medicine should become a central focus of America's health care system, not merely a cost-saving measure as envisioned by managed care organizations. Indeed, the book shows that the primary care physician can fulfill a unique role in the medical community, and a vital role in society in general. It shows that primary care medicine is not a retreat from scientific medicine, but the natural next step for medicine to take in the coming century.Less
This book shows how much better fitted advanced concepts of primary care medicine are to America's health-care needs. It offers insights into how primary care physicians can be better trained to meet the needs of their patients, both well and sick, and to keep these patients as the focus of their practice. Modern medical training, the book notes, arose at a time when medical science was in ascendancy. Thus the ideals of science — objectivity, rationality — became the ideals of medicine, and disease — the target of most medical research — became the logical focus of medical practice. When clinicians treat a patient with pneumonia, they are apt to be thinking about pneumonia in general — which is how they learn about the disease — rather than this person's pneumonia. This objective, rational approach has its value, but when it dominates a physician's approach to medicine, it can create problems. Most important, this book argues that primary care medicine should become a central focus of America's health care system, not merely a cost-saving measure as envisioned by managed care organizations. Indeed, the book shows that the primary care physician can fulfill a unique role in the medical community, and a vital role in society in general. It shows that primary care medicine is not a retreat from scientific medicine, but the natural next step for medicine to take in the coming century.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0007
- Subject:
- History, American History: 20th Century
Medical schools had long been responsible for the quality of care rendered civilians, but during World War II they took direct responsibility for the military's medical care as well. The proportion ...
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Medical schools had long been responsible for the quality of care rendered civilians, but during World War II they took direct responsibility for the military's medical care as well. The proportion of faculty that enlisted in the armed services was much higher than that of the general profession. At the country's 52 general hospital units and 20 evacuation hospital units, the medical personnel, which numbered about 2,500, came almost entirely from academic medical centers. At home, schools were extremely short-staffed, but they nonetheless increased the production of doctors to meet both military and civilian needs. In addition, they conducted an extraordinary amount of war-related medical research, which enabled a dramatic reduction in death and suffering among troops in combat.Less
Medical schools had long been responsible for the quality of care rendered civilians, but during World War II they took direct responsibility for the military's medical care as well. The proportion of faculty that enlisted in the armed services was much higher than that of the general profession. At the country's 52 general hospital units and 20 evacuation hospital units, the medical personnel, which numbered about 2,500, came almost entirely from academic medical centers. At home, schools were extremely short-staffed, but they nonetheless increased the production of doctors to meet both military and civilian needs. In addition, they conducted an extraordinary amount of war-related medical research, which enabled a dramatic reduction in death and suffering among troops in combat.
Jerome P. Kassirer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195300048
- eISBN:
- 9780199850518
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195300048.003.0008
- Subject:
- Economics and Finance, Economic Systems
Medical research has become an enormous enterprise in the United States. The federal government spent approximately 20 billion dollars in 2001 on it, and private industry spent even more: in the ...
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Medical research has become an enormous enterprise in the United States. The federal government spent approximately 20 billion dollars in 2001 on it, and private industry spent even more: in the range of $30 billion. The pharmaceutical industry's share of investment in biomedical research and development, now approximately 60%, has doubled since 1980. Today, approximately one-quarter of academic biomedical researchers receive industry funding. This chapter discusses how competing financial interests can hurt research subjects, embarrass researchers, and severely damage an institution's reputation. Even one or two widely publicized research fiascos involving financial conflicts can spoil the trust of the public in the entire research enterprise. It goes without saying that without the trust of the public, clinical research could not proceed.Less
Medical research has become an enormous enterprise in the United States. The federal government spent approximately 20 billion dollars in 2001 on it, and private industry spent even more: in the range of $30 billion. The pharmaceutical industry's share of investment in biomedical research and development, now approximately 60%, has doubled since 1980. Today, approximately one-quarter of academic biomedical researchers receive industry funding. This chapter discusses how competing financial interests can hurt research subjects, embarrass researchers, and severely damage an institution's reputation. Even one or two widely publicized research fiascos involving financial conflicts can spoil the trust of the public in the entire research enterprise. It goes without saying that without the trust of the public, clinical research could not proceed.
