Despite advances in medical knowledge regarding pain management, pain continues to be significantly undertreated in the United States. There are many drug and nondrug treatments, but the use of controlled substances, particularly the opioid analgesics, is universally accepted for the treatment of pain from cancer. Although opioid analgesics are safe and effective in treating chronic pain, there is continued research and discussion about patient selection and long-term effects. A number of barriers in the health care and drug regulatory systems account (...) for the gap between what is known about pain management and what is practiced. Among the barriers are physicians’ fears of being disciplined by state regulatory boards for inappropriate prescribing.State medical boards are in a unique position not only to address physicians’ concerns about being investigated, but also to encourage pain management. Prior to 1989, a few state medical boards had policies relating to controlled substances or pain. Subsequently, state medical boards began adopting policies regarding the prescribing of opioids for the treatment of pain; many of these specifically addressed physicians’ fear of regulatory scrutiny. (shrink)

Despite advances in medical knowledge regarding pain management, pain continues to be significantly undertreated in the United States. There are many drug and nondrug treatments, but the use of controlled substances, particularly the opioid analgesics, is universally accepted for the treatment of pain from cancer. Although opioid analgesics are safe and effective in treating chronic pain, there is continued research and discussion about patient selection and long-term effects. A number of barriers in the health care and drug regulatory systems account (...) for the gap between what is known about pain management and what is practiced. Among the barriers are physicians’ fears of being disciplined by state regulatory boards for inappropriate prescribing.State medical boards are in a unique position not only to address physicians’ concerns about being investigated, but also to encourage pain management. Prior to 1989, a few state medical boards had policies relating to controlled substances or pain. Subsequently, state medical boards began adopting policies regarding the prescribing of opioids for the treatment of pain; many of these specifically addressed physicians’ fear of regulatory scrutiny. (shrink)

If a manager is evangelical, does it color the style he uses in his relationship with his subordinates? The paper sketches briefly the two familiar, historical ethical positions... the Protestant ethic and humanism and relates them to two styles of management. Then it points up the recent healthy growth of the evangelical movement, and the basic beliefs of evangelicals; then relates elements of these beliefs to the manager. A comparison of the three management ethics (Protestant, humanist, and evangelical) suggests some (...) differences in the characteristics of managers who follow each ethic. There is increased evidence of the effect of the evangelical ethic in political, medical, and judicial life. Is it not logical to assume it is also affecting business and management? (shrink)

In this paper, we challenge one of the criticisms against the idea of a universal basic income, namely, that people will waste the support on high-end consumption. We rely on the literature from various disciplines from which we developed high- and low-UBI scenarios for respondents to decide what they would do if the state were to provide an unconditional stipend. We analyzed the multiple-choice responses, using an ordered probit, and the written explanations of the respondents’ choices, using content analysis. The (...) results suggest that while a higher UBI would increase consumption, it would likely be done responsibly. People with low incomes showed restraint in all categories. The qualitative analysis captures some of the complexities of people’s socioeconomic circumstances that support the notion of responsible consumption. The policy implication is that a UBI could be introduced at a low level and gradually increased to a level that maximizes societal benefits. (shrink)

Book reviewed in this article: Recreating Motherhood: Ideology and Technology in Patriarchal Society. By Barbara Katz Rothman. Surrogate Motherhood: The Legal and Human Issues. By Martha A. Field.

Near the homes of photographers John Willis and Tom Young is a paper mill that sits in the otherwise pristine and picturesque climes of western Massachusetts. For Willis and Young, this site is one of both aesthetic and philosophical contradictions: despite its verdant locale, the mill—with its ominous smoke stacks and countless bales of discarded paper—brings to mind the dreariness of industrialization and the impermanence of life itself. But the factory is actually one where such litter is reborn as reusable (...) paper. Willis and Young’s stunning black-and-white images, collected in this unforgettable volume, transform this mill and the innumerable mounds of recyclable waste it processes daily into an indelible and evocative landscape. Recycled Realities is not a jeremiad foretelling the consequences of excessive waste, rampant pollution, or unbridled consumption, but rather a profound meditation on the hidden meanings and connections that linger beneath the debris and detritus of everyday life. These astonishing and often surreal photos of discarded paper from the printed world trace the processes of emergence, revelation, and redemption that make the cycle of life possible. In their photographs, Willis and Young take that which we have discarded and create new forms of being in and of themselves: vibrant and ultimately life-affirming portraits of who we are as people and the realities that we constantly build—and rebuild—all around us. (shrink)

Background: The factors influencing parents’ willingness to enroll their children in biobanks are poorly understood. This study sought to assess parents’ willingness to enroll their children, and their perceived benefits, concerns, and information needs under different consent and data-sharing scenarios, and to identify factors associated with willingness. Methods: This large, experimental survey of patients at the 11 eMERGE Network sites used a disproportionate stratified sampling scheme to enrich the sample with historically underrepresented groups. Participants were randomized to receive one of (...) three consent and data-sharing scenarios. Results: In total, 90,000 surveys were mailed and 13,000 individuals responded (15.8% response rate). 5737 respondents were parents of minor children. Overall, 55% (95% confidence interval 50–59%) of parents were willing to enroll their youngest minor child in a hypothetical biobank; willingness did not differ between consent and data-sharing scenarios. Lower educational attainment, higher religiosity, lower trust, worries about privacy, and attitudes about benefits, concerns, and information needs were independently associated with less willingness to allow their child to participate. Of parents who were willing to participate themselves, 25% were not willing to allow their child to participate. Being willing to participate but not willing to allow one’s child to participate was independently associated with multiple factors, including race, lower educational attainment, lower annual household income, public health care insurance, and higher religiosity. Conclusions: Fifty-five percent of parents were willing to allow their youngest minor child to participate in a hypothetical biobank. Building trust, protecting privacy, and addressing attitudes may increase enrollment and diversity in pediatric biobanks. (shrink)

William James once replied to the critics of the new pragmatic philosophy with the caution not to be too sharp or logic-chopping but to evaluate pragmatism as a whole, and especially weigh it against its possible alternatives. This is fair advice indeed. All too often the opponents of pragmatism have seized upon one of its formulations and, oblivious of its context and surrounding qualifications, have proclaimed the absurdity of the whole enterprise. James himself admitted that some of his expressions were (...) infelicitous and misleading, but he believed that the intelligent and indulgent reader would grasp his meaning and not impute to him doctrines he never held. Indeed, the reader of James soon comes to realize that he cannot stop at any one formulation of pragmatism but must hurry on to the next in order to see it in a broader and fuller context. He is aware, then, that pragmatism in James’s view is not a doctrine or system but a method and spirit of philosophizing, or, as we would say today, a way of doing philosophy. It is this spirit and perspective that must be appreciated if one is to do justice to the pragmatism of William James. (shrink)

Current treatments for chronic pain have limited benefit. We describe a resilience intervention for individuals with chronic pain which is based on a model of viewing chronic pain as dysregulated homeostasis and which seeks to restore homeostatic self-regulation using strategies exemplified by survivors of extreme environments. The intervention is expected to have broad effects on well-being and positive emotional health, to improve cognitive functions, and to reduce pain symptoms thus helping to transform the suffering of pain into self-growth. A total (...) of 88 Veterans completed the pre-assessment and were randomly assigned to either the treatment intervention or control. Fifty-eight Veterans completed pre- and post-testing. The intervention covered resilience strengths organized into four modules: engagement, social relatedness, transformation of pain and building a good life. A broad set of standardized, well validated measures were used to assess three domains of functioning: health and well-being, symptoms, and cognitive functions. Two-way Analysis of Variance was used to detect group and time differences. Broadly, results indicated significant intervention and time effects across multiple domains: Pain decreased in present severity [F = 5.02, p < 0.05, η2p = 0.08], total pain over six domains [F = 14.52, p < 0.01, η2p = 0.21], and pain interference [F = 6.82, p < 0.05, η2p = 0.11]; Affect improved in pain-related negative affect [F = 7.44, p < 0.01, η2p = 0.12], fear [F = 7.70, p < 0.01, η2p = 0.12], and distress [F = 10.87, p < 0.01, η2p = 0.16]; Well-being increased in pain mobility [F = 5.45, p < 0.05, η2p = 0.09], vitality [F = 4.54, p < 0.05, η2p = 0.07], and emotional well-being [F = 5.53, p < 0.05, η2p = 0.09] Mental health symptoms and the cognitive functioning domain did not reveal significant effects. This resilience intervention based on homeostatic self-regulation and survival strategies of survivors of extreme external environments may provide additional sociopsychobiological tools for treating individuals with chronic pain that may extend beyond treating pain symptoms to improving emotional well-being and self-growth.Clinical Trial Registration: Registered with ClinicalTrials.gov. (shrink)

Theories of social justice are necessarily abstract, reaching beyond the particular and the immediate to the general and the timeless. Yet such theories, addressing the world and its problems, must respond to the real and changing dilemmas of the day. A brilliant work of practical philosophy, Frontiers of Justice is dedicated to this proposition. Taking up three urgent problems of social justice neglected by current theories and thus harder to tackle in practical terms and everyday life, Martha Nussbaum seeks (...) a theory of social justice that can guide us to a richer, more responsive approach to social cooperation. The idea of the social contract--especially as developed in the work of John Rawls--is one of the most powerful approaches to social justice in the Western tradition. But as Nussbaum demonstrates, even Rawls's theory, suggesting a contract for mutual advantage among approximate equals, cannot address questions of social justice posed by unequal parties. How, for instance, can we extend the equal rights of citizenship--education, health care, political rights and liberties--to those with physical and mental disabilities? How can we extend justice and dignified life conditions to all citizens of the world? And how, finally, can we bring our treatment of nonhuman animals into our notions of social justice? Exploring the limitations of the social contract in these three areas, Nussbaum devises an alternative theory based on the idea of capabilities. She helps us to think more clearly about the purposes of political cooperation and the nature of political principles--and to look to a future of greater justice for all. (shrink)

Nanomaterials have the promise of revolutionizing current treatment and diagnosis of diseases, which has led to 33 nanotherapeutics drugs currently on the market and many more in various stages of clinical trials. With an increasing number of products available and in development, along with the unique, emergent properties of the nanoparticle therapeutics themselves, regulatory agencies are now faced with decisions regarding the regulation of such novel technologies. Regulatory guidance, particularly in pre-clinical stages, has the potential to facilitate quick and safe (...) development of these novel materials, but new regulation beyond what is currently in place must be justified in a clear and distinctive toxic response. Herein, we examine literature that compares and correlates in vivo and in vitro nanotoxicity studies to gain a deeper understanding of the modes of nanoparticle toxicity. Additionally, this comparison aims to identify clear and unique toxicity responses caused by nanoparticles, which informs our perspective on pre-clinical nanotherapeutic oversight. (shrink)