With a growing number of genetic tests becoming available to the health and consumer markets, genetic health care providers in Canada are faced with the challenge of developing robust decision rules or guidelines to allocate a finite number of public resources. The objective of this study was to gain Canadian genetic health providers' perspectives on factors and criteria that influence and shape resource allocation decisions for publically funded predictive genetic testing in Canada. The authors conducted semi-structured interviews with 16 senior (...) lab directors and clinicians at publically funded Canadian predictive genetic testing facilities. Participants were drawn from British Columbia, Alberta, Manitoba, Ontario, Quebec and Nova Scotia. Given the community sampled was identified as being relatively small and challenging to access, purposive sampling coupled with snowball sampling methodologies were utilized. Surveyed lab directors and clinicians indicated that predictive genetic tests were funded provincially by one of two predominant funding models, but they themselves played a significant role in how these funds were allocated for specific tests and services. They also rated and identified several factors that influenced allocation decisions and patients' decisions regarding testing. Lastly, participants provided recommendations regarding changes to existing allocation models and showed support for a national evaluation process for predictive testing. Our findings suggest that largely local and relatively ad hoc decision making processes are being made in relation to resource allocations for predictive genetic tests and that a more coordinated and, potentially, national approach to allocation decisions in this context may be appropriate. (shrink)

In 2003, Nick Bostrom published his highly influential “Simulation Argument” in _Philosophical Quarterly_(Bostrom, 2003), an idea taken so seriously that even Bank of America has sent out alerts to its clients. But what, exactly, would that mean? And, more importantly, why is the idea of a simulated universe not being pursued in regard to cancer—and every other disease? We understand, in magnificently precise, granular ways, exactly what is going wrong in the body. But do we understand, in a coarser way, (...) what the granules are made of? In a holographic universe, the images we perceive are not necessarily what they appear to be; they might exist against a background. But the background would create a context that participates in the image that emerges. Green can be rendered as green. Or as “blue yellow blue” or “yellow blue yellow.” Perhaps the act of rendering generates variables that have been overlooked in our understanding of illness: scale and spin. (shrink)

The holographic principle was proposed by Nobel laureate Gerard ‘t Hooft in the 1990s and it has also been modeled by Leonard Susskind and Stephen Hawking. We’ve heard light mentioned with regard to the fundamental nature of reality for a long time; God said Let there be light, we are the light of the world, etc. But we haven’t investigated a possible role for the speed of light in our illnesses. This paper will do just that. The central premise is (...) that light’s “speed” is a reflection of the degree to which the observer is removed from its source. In its Platonic state, light’s speed is zero. It is light from which time, by degrees, emerges. The Big Bang can be envisioned as a sphere, the center of which is a point, Alpha. Via expansion, Alpha becomes a sphere, Omega, by degrees, where each degree is c. For any given Alpha, the circumference of a circle on the sphere, Omega, is a set of resonant points that represent the speed of light or “end of time.” Every radius—every line drawn from Alpha to Omega—is an arrow of time, a parallel universe. Alpha and Omega increase in tandem, maintaining the degree of separation required by special relativity, E=mc^2. The holographic sphere of points equidistant from the Big Bang on which we find ourselves is not the only sphere of points equidistant from the Big Bang. There are spheres that are smaller and larger than ours. Where an arrow of time intersects a sphere-brane of light’s speed will be treated here as a “2D hologram.” For an observer behind the hologram, reality will appear to be accelerating/expanding. For an observer in front of it, reality will appear to be decelerating/contracting. For an observer at the speed of light, time is no longer a variable. (shrink)

This article presents the case against immigration controls. Nation states, which are giving up controls on the movement of goods and capital, nevertheless still try to control the movement of people. Like controls under apartheid, immigration controls will eventually become untenable. They are also a relatively recent phenomenon. The actions of the governments of the rich countries, their international agencies and corporations increase both the opportunities and the need for migration. Together with arms sales and support for right-wing repressive regimes, (...) they bear much responsibility for the wars and persecution from which people are forced to flee. The strongest reason for abolishing immigration controls is the increasingly harsh suffering they impose on refugees and migrants, largely to deter others. In the process, they undermine many human rights, including potentially those of existing residents. (shrink)

Medical student shows are a prominent feature of medical student life around the world. Following a traditional vaudeville format of skits and songs, the shows are notorious for their exuberance, bawdiness, and lack of political correctness. Despite their widespread prevalence and sometimes hostile reactions, there has been no previous study of these shows. Based on research of scripts, programs, reviews, and oral history, this article explores their history and content and argues that, far from being irrelevant frivolities, these shows serve (...) several important functions. These include the fostering of communal spirit, the development of skills in teamwork, and the collective ventilation of emotional reactions to the process of becoming a doctor. They are one offshoot of the ancient and important tradition of misrule in Western society. (shrink)

Obstetric Fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour. Studies indicate that delays in accessing maternal care and home birth contribute to the development of fistula. Survivors are usually women of low socioeconomic status residing in rural locations. This study explores the birthing experiences of 15 fistula survivors through a narrative inquiry approach at a repair centre in North‐central Nigeria. Using structural violence as a lens, it describes the role of social, political (...) and health systems in the inequitable access to care for women. For women opting for home births, preference for home delivery was mainly due to lack of finances, poor health systems and cultural practices. Rural location inhibited access as women seeking facility delivery faced transfer delays to referral centres when complications developed. Inequitable maternal health services in rural locations in Nigeria are inherently linked to access to health care, and these contribute to the increased incidence of fistulae. Structural intervention is a health policy priority to address poor health systems and achieve universal health coverage to address maternal health issues in Nigeria. (shrink)

Background:Psychological abuse of older people is difficult to recognise; specifically, nursing home residents have been documented to be at higher risk of psychological abuse during daily care, such as during feeding. Healthcare professionals adopt positive and negative verbal prompts to maintain residents’ eating independence; however, negative prompts’ purposes and implications have never been discussed to date.Research aims:To critically analyse negative verbal prompts given during mealtimes as forms of abuse of older individuals and violation of ethical principles.Research design:This is a secondary (...) analysis of three cases of negative prompts that emerged in a large descriptive study based upon focus group methodology and involving 13 nursing homes and 54 healthcare professionals.Participants and research context:This study included 3 out of 13 nursing homes caring for residents with moderate/severe functional dependence in self-feeding mainly due to dementia; in these nursing homes, we conducted three focus groups and 13 healthcare professionals participated.Ethical considerations:This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after being approved by the Review Board of the Trust.Findings:With the intent of maintaining self-feeding independence, negative verbal prompts have been reported as being used by nursing home teams. By critically analysing these negative prompts, it turned out they could trigger intimidation, depression and anxiety and thus could be considered as forms of abuse; moreover, negative prompts can threaten the ethical principles of autonomy using a paternalist approach, beneficence and non-maleficence as with the intent to act in the best interests of residents they are harmed in their dignity and justice, given that residents who received negative prompts are treated differently from those who received positive prompts.Discussion:Eating should be a pleasant experience with a positive impact on physiological, psychological and social well-being. However, negative prompting can lead to abuse and violation of basic ethical principles, destroying the healthcare professional resident and relative relationships strongly dependent on trust.Conclusion:Negative verbal prompting must be avoided. (shrink)

Through the ages, ritual dances have been part of human culture. Although artistic, the _umxhentso_ dance is a ritual dance performed by the Xhosa _amagqirha _(traditional healers) to establish connections with supernatural beings. During the dance performance, the amagqirha enter a state of trance and connect with the spiritual realm. During this state of trance, they seek guidance and vision from their ancestors. The _amagqirha_, in all the Xhosa communities, perform these dance rituals at initiation and healing ceremonies. The objectives (...) of this study were to examine the religious and social purposes of _umxhentso_ dance in amagqirha rituals and determine how it assists amagqirha in establishing connections with their ancestors during ceremonies. This study adopted the naturalistic research approach in studying the _umxhentso_ dance during the amagqirha ceremonies. The researchers examined, evaluated and assessed the research participants’ actions and behaviours in a natural setting within a societal and cultural framework. (shrink)

This essay explores the idea of experience and its epistemological and practical role in maintaining the health of a household among early modern English Royalists. A number of prominent royalists during the mid-seventeenth century British Civil Wars expended quite some effort in the collection of medical recipes, including Queen Henrietta Maria herself, as well as William and Margaret Cavendish, and the Talbot sisters—Elizabeth Grey and Alethea Howard. This essay looks at these Royalists and four of their collections: three published (...) (Henrietta Maria, Grey, Howard), and one manuscript (the Caven­dishes), in order to determine how they conceptualized experience and its role in medical practice. The claim that such recipe collections represent a new, anti-Aristotelian idea of experience as a specific, particular event is disputed through a quantitative and qualitative analysis of these collections. Instead, it is argued that there a number of related conceptions of experience found in these Royalist recipe collections, but the basic idea is one where experience indicates long experience or expertise, an idea that can traced back at least to humanist medicine of the Renaissance, and likely back to Galen. (shrink)

This essay explores the idea of experience and its epistemological and practical role in maintaining the health of a household among early modern English Royalists. A number of prominent royalists during the mid-seventeenth century British Civil Wars expended quite some effort in the collection of medical recipes, including Queen Henrietta Maria herself, as well as William and Margaret Cavendish, and the Talbot sisters—Elizabeth Grey and Alethea Howard. This essay looks at these Royalists and four of their collections: three published (...) (Henrietta Maria, Grey, Howard), and one manuscript (the Caven­dishes), in order to determine how they conceptualized experience and its role in medical practice. The claim that such recipe collections represent a new, anti-Aristotelian idea of experience as a specific, particular event is disputed through a quantitative and qualitative analysis of these collections. Instead, it is argued that there a number of related conceptions of experience found in these Royalist recipe collections, but the basic idea is one where experience indicates long experience or expertise, an idea that can traced back at least to humanist medicine of the Renaissance, and likely back to Galen. (shrink)

In the past 250 years, David Hume probably had a greater impact on the field of philosophy of religion than any other single philosopher. He relentlessly attacked the standard proofs for God's existence, traditional notions of God's nature and divine governance, the connection between morality and religion, and the rationality of belief in miracles. He also advanced radical theories of the origin of religious ideas, grounding such notions in human psychology rather than in divine reality. In the last decade of (...) his life Hume wrote 'I cou'd cover the Floor of a large Room with Books and Pamphlets wrote against me'. Indeed, most of these targeted his writings on religion. This, the third part of the Early Responses to Hume series, and perhaps the most eagerly awaited, collects responses to Hume's writings on religion published during his life, namely, 'Of Miracles', 'Of a Particular Providence and a Future State', The Natural History of Religion , and the posthumously published works Dialogues Concerning Natural Religion , 'Of Suicide' and 'Of the Immortality of the Soul'. The set covers a wide range of the replies Hume's writings provoked, including contributions by Philip Skelton, William Adams, Thomas Rutherforth, William Warburton, Anthony Ellys, John Douglas, John Leland, Thomas Stona, Voltaire, George Campbell, Herman Andrew Pistorius, Duncan Shaw, William Samuel Powell, Thomas Hayter, Joseph Milner, William Paley, Charles Moore, Richard Joseph Sulivan, John Hey, Samuel Vince, Lord Brougham and Thomas De Quincey. (shrink)