R&D collaborations between industry, government, civil society, and research ) have recently gained attention from R&D theorists and practitioners. In aiming to come to grips with their complexity, past models have generally taken a stakeholder-analytical approach based on stakeholder types. Yet stakeholder types are difficult to operationalise. We therefore argue that a processual model is more suited for studying the interaction in QHCs because it eschews matters of titles and identities. We develop such a model in which the QHC is (...) represented as a process of generating four types of value: research value, market value, political value, and societal value. We then apply this processual model in analysing real-life cases of friction in QHCs. Friction is seen, not as an interpersonal clash, but as a discrepancy between two or more value-creation processes that compete for limited resources. (shrink)

ABSTRACT In this brief article, we examine the document entitled Universal Draft Declaration on Bioethics and Human Rights, published by UNESCO in June 2005. We examine it in terms of its content and its appropriate role in global bioethics movements in the future. We make clear our view on the Declaration: the Declaration, despite a variety of serious problems, remains a valuable bioethical document and can contribute in substantial ways to the happiness of people throughout the world.

Recent studies on neural pathways in a broad spectrum of vertebrates suggest that, in addition to migration and an increase in the number of certain select neurons, a significant aspect of neural evolution is a “parcellation” (segregation-isolation) process that involves the loss of selected connections by the new aggregates. A similar process occurs during ontogenetic development. These findings suggest that in many neuronal systems axons do not invade unknown territories during evolutionary or ontogenetic development but follow in their ancestors' paths (...) to their ancestral targets; if the connection is later lost, it reflects the specialization of the circuitry.The pattern of interspecific variability suggests (1) that overlap of circuits is a more common feature in primitive (generalized) than in specialized brain organizations and (2) that most projections, such as the retinal, thalamotelencephalic, corticotectal, and tectal efferent ones, were bilateral in the primitive condition. Specialization of these systems in some vertebrate groups has involved the selective loss of connections, resulting in greater isolation of functions. The parcellation process may also play an important role in cell diversification.The parcellation process as described here is thought to be one of several underlying mechanisms of evolutionary and ontogenetic differentiation. (shrink)

This article seeks through Ejagham women’s experience in the ritual dances of Ngbokondem and Moninkim to engage the notion of patriarchal control of African women’s sexuality in ‘female genital mutilation’ discourses as postulated by second-wave feminist theorists such as Daly, Koedt, Hosken and so on. A firmly based patriarchy threatens culture, sexuality and identity; the article shows how women use varied coping mechanisms, including aid schemes, sexual insurgency and even breaking of bodies to define their place and identity in a (...) patriarchal society. However, some Ejagham women’s practices are themselves laced with patriarchal violence where women postulate as main participants. The article coins the term ‘triple patriarchy’ to capture this phenomenon. It portrays how Ejagham women, who are interrogating domination, also act in ways that reinforce patriarchy. Using womanist theological lens as the hermeneutic framework, the article concludes that women initiation practices are the foundations through which women grasp the meanings of Christian initiation rituals such as baptism, eucharist, marriage and so on. Hence, they should not be destroyed but fine-tuned; for there is more about the women’s practices that need to be engaged than labelled. (shrink)

科学技術の進展と共に、人間生存の理法が今新しく問われている。本書は、「思想的寛容」にもとづいて平和の砦を築こうとする異色の平和論を展開。.

In the influential 1995 article “Social Conditions as Fundamental Causes of Disease,” Bruce Link and Jo Phelan described social and political factors as “fundamental causes” of death and disease. Whitney Pirtle has recently declared racial capitalism another such fundamental cause. Using the case of the water crisis in Flint, Michigan, she has argued that racial capitalism's role in that situation meets each of the criteria Link and Phelan's article outlines: racial capitalism influenced multiple disease outcomes, affected disease outcomes through multiple (...) risk factors, involved access to flexible resources that can be used to minimize both risks and the consequences of disease, and was reproduced over time through the continual replacement of intervening mechanisms. We argue for Pirtle's conclusion using the extensive literature on racial capitalism and case studies concerning housing in the United States and Brazil and what Naomi Klein has termed “corona capitalism” in India. If races correspond to hierarchies of material security, as suggested by Ruth Wilson Gilmore, then these hierarchies and their causal effects are fundamental determinants of public health. (shrink)

"[A] careful and scholarly edition of an important early English poem, which scholars and students alike will welcome." _Modern Language Review_.

A case is described of a man who discovered years after donating sperm for artificial insemination, that he had a serious genetic disease, autosomal dominant cerebellar ataxia . This manifests itself only years after puberty and occurs in 50% of the progeny. The sperm had been used for the conception of 18 children in 13 women. The parents were only told three years after the insemination. This long time interval was unavoidable since many of the parents had to be found (...) and the hospital director wished first to discuss the matter with his legal advisors and other experts.In future, in agreement with the new law only 10 inseminations will take place with sperm from one donor. This will reduce still further the availability of donor sperm. (shrink)

Recently I reported in this journal1 how it became necessary for a judge to settle a dispute between the pharmaceutical industry and certain Dutch pharmacists. It considered the question of whether a pharmacist is permitted, without prior consultation, to give a patient a generic drug instead of the patent drug mentioned on the prescription.Another dispute has now arisen after the pharmaceutical industry discovered that healthcare insurers were paying general practitioners a bonus if they prescribed generic drugs, such as simvastatin or (...) omeprazol (which reduces the …. (shrink)

sirIn the January 4 issue of the New England Journal of Medicine three articles appeared on the unapproved use of Misoprostol , which raise an interesting ethical question. The synthetic prostaglandin analogue, Misoprostol, has been successfully used by obstetricians and gynaecologists for a number of years for the induction of a medical abortion in the first or second trimester, for the induction of labour, and for the prevention of postpartum haemorrhages.1 Strangely enough the pharmaceutical company which produces and markets the (...) drug, Searle, …. (shrink)

In the Netherlands the incidence of methicillin resistant Staphylococcus aureus infections in hospitals is surprisingly low when compared to that of neighbouring countries. It is believed that this favourable condition is caused by stringent precautionary measures such as complete isolation of the patients. In one case the nurse taking care of such patients was herself MRSA positive. This condition changed and she became MRSA negative after removal of her tonsils. The question is raised how far one should go to protect (...) patients when the preventive measures taken may endanger the health of those who take care of them. (shrink)

Although there are exceptions, the principle of primum nil nocere remains the cornerstone of the practice of medicine. In the well known handbook, Goodman and Gilman’s The Pharmacological Basis of Therapeutics1 a case is presented which raises doubts about the permissibility of off-label administration of certain drugs to healthy troops as a preventive measure. The following citation from this handbook gives a clear description of the problem:"Prophylaxis in cholinesterase inhibitor poisoning. Studies in experimental animals have shown that pretreatment with pyridostigmine (...) reduces the incapacitation and mortality associated with “nerve agent” poisoning, particularly for agents, such as soman, that … ". (shrink)

In 1998 a lawyer working for the Dutch consumer organisation, Consumentenbond, suggested that hospitals, like hotels, should be classified according to the quality of service they provide.1 For the establishment of such a register it would of course be necessary to determine various parameters, including the incidence of complications occurring in each hospital. It did not take long before this proposal was rejected by van Herk2 on the grounds that it would promote defensive medicine, which would not improve the ….

A case is described of a man who discovered years after donating sperm for artificial insemination, that he had a serious genetic disease, autosomal dominant cerebellar ataxia . This manifests itself only years after puberty and occurs in 50% of the progeny. The sperm had been used for the conception of 18 children in 13 women. The parents were only told three years after the insemination. This long time interval was unavoidable since many of the parents had to be found (...) and the hospital director wished first to discuss the matter with his legal advisors and other experts.In future, in agreement with the new law only 10 inseminations will take place with sperm from one donor. This will reduce still further the availability of donor sperm. (shrink)

In September 1998 the Dutch Ministry of Health together with the Dutch Society of General Practitioners , the Royal Dutch Society of Pharmacists , and the Dutch Patient and Consumer Federation published a pamphlet entitled: The same medicine in a different coat. Drugs without a trademark, equally effective, but cheaper. Patients could obtain a copy at the local pharmacy or in the waiting room of their general practitioner. It deals with the question whether the name of the patent drug should (...) be written on the prescription or only the active component. This is important because, according to the authors, the costs of health care can be reduced without reducing the quality of the care if the doctor prescribes the generic form. It is also mentioned that another advantage of prescribing the generic form is that, contrary to the …. (shrink)