Objectives: To report the attitudes and opinions of subjects in US clinical trials about whether or not, and why, they should receive post-trial access (PTA) to the trial drug, care and information. Design: Focus groups, short self-administered questionnaires. Setting: Boston, Dallas, Detroit, Oklahoma City. Participants: Current and recent subjects in clinical trials, primarily for chronic diseases. Results: 93 individuals participated in 10 focus groups. Many thought researchers, sponsors, health insurers and others share obligations to facilitate PTA to the trial drug, (...) if it benefited the subject, or to a therapeutic equivalent. Some thought PTA obligations include providing transition care (referrals to non-trial physicians or other trials, limited follow-up, short-term drug supply) or care for long-term adverse events. Others held, in contrast, that there are no PTA obligations regarding drugs or care. However, there was agreement that former subjects should receive information (drug name, dosage received, market approval date, long-term adverse effects, trial results). Participants frequently appealed to health need, cost, relationships, reciprocity, free choice and sponsor self-interest to support their views. Many of their reasons overlapped with those commonly discussed by bioethicists. Conclusion: Many participants in US trials for chronic conditions thought there are obligations to facilitate PTA to the trial drug at a “fair” price; these views were less demanding than those of non-US subjects in other studies. However, our participants’ views about informational obligations were broader than those of other subjects and many bioethicists. Our results suggest that the PTA debate should expand beyond the trial drug and aggregate results. (shrink)

Biologically, pain is neither intrinsically good nor bad, but is a communication mechanism designed to serve organismal ends. Pain for any given person at any given time should be evaluated on the basis of “success” (or not) in serving those purposes. Yet, the physiological, psychological, and cultural complexity of the experience makes moral consideration of pain complicated. This is especially the case with infants in pain. The competence of the infant as a “decision maker” cannot, of course, be assumed. Even (...) if the child “thinks” about pain, an epistemological barrier exists in that the child cannot clearly communicate about the pain experience. Furthermore, any expressions of pain from the child may be necessary for diagnosis. Just coercion criteria provide a means of evaluating when and to what extent pain in infants should be controlled under the authority of surrogate decision makers. (shrink)

5-43 This article aims to consider the robust field of environmental history as a whole, as it stands and as it has developed over the past twenty-five years around the world. It necessarily adopts a selective approach but still offers more breadth than depth. It treats the links between environmental history and other fields within history, and with other related disciplines such as geography. It considers the precursors of environmental history, its emergence since the 1970s, its condition in several settings (...) and historiographies. Finally it touches on environmental history’s relationship to social theory and to the natural sciences as they have evolved in recent decades. It concludes that while there remains plenty of interesting work yet to do, environmental history has successfully established itself as a legitimate field within the historical profession, and has a bright future, if perhaps for discouraging reasons. (shrink)

In a recent article, C. H. Kahn addresses an ‘old scholarly myth’, namely the idea that Book I of the Republic began life as an earlier, independent dialogue and was subsequently adapted to serve as a prelude to the much longer work that we know. The case for this hypothesis rests both on stylometric considerations and on the many ‘Socratic’ features that Book I, unlike the rest of the Republic, shares with Plato's earlier works. Having disposed of the positive arguments (...) in favour of the ‘myth’, Kahn turns to the contrary—and in his view overwhelming—evidence that Book I was composed from the start as an integral part of the longer Republic. He catalogues 12 passages in Book I, accounting for roughly half its length, whose full significance will, he argues, only emerge if they are seen as instances of prolepsis, deliberate anticipations of what is to come in later books. (shrink)

The object of this article is to examine the letter from which Plutarch quotes in the above passage from the twenty-eighth chapter of his life of Alexander; to attempt to prove, particularly by a comparison of the letter with the Sidypafifia sent in 319 B.C. by Polyperchon to the Greek cities, that it is a genuine part of Alexander's correspondence; and further to consider what light the letter, if genuine, throws upon the person of Alexander himself.