This article’s aim is to understand if and how the efforts to accumulate and organize clinical data transformed the regulation of pharmaceutical care. The authors analyze how the employment of databases by collectives of physicians and researchers shape both clinical and policy practice—and thereby reshape the relation between clinical work and policy. Since the late 1990s, Dutch government has supported the development of clinical databases for specific expensive medicines to gain oversight about actual medicine use. To be able to produce (...) evidence for appropriate medicine use, the collectives set regulations in clinical practice. These internal regulations provide a framework for establishing “appropriate medicine use”, steering reimbursement decisions. However, internal regulation and policy rules differ in how quickly they can change. While the employment of databases in clinical practices results in a constant adjustment of the protocols, policy makers require the databases to provide for static moments of “proven appropriate medicine use” in order to account for and define a fixed and closed formulary. Subsequently, the employment of the databases did not deliver on the promise of oversight and control due to different clinical and policy requirements. Nevertheless, the databases did stimulate appropriate medicine use and reimbursement in clinical practice. (shrink)

Background When anti-cancer treatments have been given market authorization, but are not (yet) reimbursed within a healthcare system, physicians are confronted with ethical dilemmas. Arranging access through other channels, e.g., hospital budgets or out-of-pocket payments by patients, may benefit patients, but leads to unequal access. Until now, little is known about the perspectives of physicians on access to non-reimbursed treatments. This interview study maps the experiences and moral views of Dutch oncologists and hematologists.Methods A diverse sample of oncologists and hematologists (...) (n = 22) were interviewed. Interviews were analyzed thematically using Nvivo 12 qualitative data software.Results This study reveals stark differences between physicians’ experiences and moral views on access to anti-cancer treatments that are not (yet) reimbursed: some physicians try to arrange other ways of access and some physicians do not. Some physicians inform patients about anti-cancer treatments that are not yet reimbursed, while others wait for reimbursement. Some physicians have principled moral objections to out-of-pocket payment, while others do not.Conclusion Oncologists and hematologists in the Netherlands differ greatly in their perspectives on access to expensive anti-cancer treatments that are not (yet) reimbursed. As a result, they may act differently when confronted with dilemmas in the consultation room. Physicians working in different healthcare systems may face similar dilemmas. (shrink)

A model for the ideal state includes discussions of the nature and application of justice, the role of the philosopher in society, the goals of education, and the effects of art upon character.

'The most thorough and scrupulous of contemporary students of induction' (the execrable Quinton 1993, p. 172).

The papers in this volume, first published in 1982, deal with a number of different aspects of Marx's ideas and the varying constructions put on them by later Marxists. Based on a lecture series, they examine Marxist views of the nature of philosophy, of history and historical explanation, the role and importance of politics, and of literature and the place of ethics. Among the Marxists considered are Lukacs, Sartre, Habermas, Althusser and Macherey. A continuous concern through the volume is the (...) relation within Marxist thought of fact and value, with the implications that will have for our actions. (shrink)

In "Realism and Reason" Hilary Putnam has offered an apparently strong argument that the position of metaphysical realism provides an incoherent model of the relation of a correct scientific theory to the world. However, although Putnam's attack upon the notion of the "intended" interpretation of a scientific theory is sound, it is shown here that realism may be formulated in such a way that the realist need make no appeal to any "intended" interpretation of such a theory. Consequently, it can (...) be shown that realism is immune to Putnam's criticism and that attempts at reformulating this criticism are not likely to meet with success. (shrink)

This bilingual volume—English and German on facing pages—brings together the writings Wittgenstein composed during his stay in Dublin between October 1948 and March 1949, one of his most fruitful periods. He later drew more than half of his remarks for Part II of Philosophical Investigations from this Dublin manuscript. A direct continuation of the writing that makes up the two volumes of Remarks on the Philosophy of Psychology, this collection offers scholars a glimpse of Wittgenstein's preliminary thinking on one of (...) his most important works. G. H. von Wright and Heikki Nyman both teach at the University of Helsinki. (shrink)

Cultural boundaries in Islam based on Hadith (Islamic traditions).

To understand the endogenous components of the event-related brain potential (ERP), we must use data about the components' antecedent conditions to form hypotheses about the information-processing function of the underlying brain activity. These hypotheses, in turn, generate testable predictions about the consequences of the component. We review the application of this approach to the analysis of the P300 component. The amplitude of the P300 is controlled multiplicatively by the subjective probability and the task relevance of the eliciting events, whereas its (...) latency depends on the duration of stimulus evaluation. These and other factors suggest that the P300 is a manifestation of activity occurring whenever one's model of the environment must be revised. Tests of three predictions based on this “context updating” model are reviewed. Verleger's critique is based on a misconstrual of the model as well as a partial and misleading reading of the relevant literature. (shrink)