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)

Local geographical terms play an important role in the formation of a toponymic system of a geographical region. Archaic vocabulary roots in the mists of time and and serves as the evidence of ancient contacts of the local population. Identification, systemic description and comprehensive analysis of toponyms contributes to linguistic and historic reseach. In this article, the substrate local geographical terminology of the Indo-Iranian origin involved in the formation of the Bashkir place names and ethnonyms is discussed. By allocating place (...) name formants, place name bases, toponymic types, the autor attempts to identify the Indo-Iranian substratum in Bashkir geographical terminology and to define its role in formation of place names. As the study shows, substrate geographic appellatives of the Indo-Iranian origin are abundantly represented in the Bashkir toponymy. Some of them are preserved only as the part of Bashkir geographical names, for example, the Bashkir hydronyms Abdon, Avzyan, Avryuz and many others originated from a geographical appellative av/aw ‘water‘. Some geographical terms of Indo-Iranian origin have survived in the dialects of the Bashkir language and are currently spoken by dialect speakers, e. g., beshә, and bÒ¯zhәk. The basis of the Bashkir toponymic system is comprised mainly by substrate geographical terms of Indo-Iranian origin, which became toponyms during their functioning in the language. (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.

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)

The influence of Nazism on German culture was a key concern for many Anglo-American writers, who struggled to reconcile the many contributions of Germany to European civilization, with the barbarity of the new regime. In _German Literature Through Nazi Eyes_, H.G. Atkins gives an account of how the Nazis undertook a re-evaluation of German literature, making it sub-ordinate to their own interests. All reference to Jewish writers and influence was virtually eliminated, and key writers such as Goethe and Lessing were (...) re-interpreted. What was left was a military history that was avowedly militant and propagandist. (shrink)

At first sight, the philosophy of Spinoza may seem wholly alien to what is now generally regarded as philosophy in the English-speaking world. For some decades, the dominant trend in that philosophy has been linguistic and anti-metaphysical; the philosopher is held to be concerned with the analysis of language, and not with speculative system-building. Spinoza, on the other hand, is very much a system-builder; as to the analysis of language, he says explicitly that this is of no interest to him. (...) ‘It is not my intention’, he says, ‘to explain the meanings of words; it is my intention to explain the nature of things’. However, the paper which follows will attempt to show that Spinoza’s philosophy is not wholly without relevance today. It will try to do this by placing one of Spinoza’s most important doctrines, his theory of human freedom, within the context of recent discussions. (shrink)

It is argued that Hempel's original rejection of the prediction criterion of confirmation in [8] (on the grounds that it leads to a circular definition of confirmation) was ill-conceived, and that his own approach exhibits undesirable consequences to the degree that it deviates from this criterion. A version of the prediction criterion is formulated which, in addition to being-non circular, escapes the criticisms advanced against Hempel's satisfaction criterion, offers certain clear advantages over alternative approaches, and may serve as the basis (...) for a theory of qualitative confirmation. The definition of confirmation developed here violates two of Hempel's three criteria of adequacy, and in showing why it should do so some light is shed on various issues in the debate concerning the acceptability of these criteria. (shrink)

Given Conciliar Christology and a compositionalist metaphysics of the incarnation, I explore whether ‘qua-propositions’ are capable of solving the coherence problem in Christology. I do this by probing the metaphysical aspect of qua-propositions, since ‘semantics presupposes metaphysics’. My proposal focuses on the fact that the Word accidentally owns an individual human nature. Due to that individuality, the human properties first characterise the individual human nature and, in a ‘next step’, this individual human nature characterises the Word. I call this ‘stepped (...) characterisation’. Subsequently, I show that stepped characterisation validates the use of qua-propositions in Conciliar Christology. Hence, qua-propositions are not merely ‘muddling the waters of logic’. (shrink)