Alternative facts and morcellation.

PURPOSE OF REVIEW: Since the recent black-box warning regarding the use of electromechanical morcellation, there has been a hesitancy to utilize the product and even to perform other types of morcellation by gynecologists. Unfortunately, this Food and Drug Administration action and the continued public criticisms of this procedure are grounded in poor data and faulty reasoning. To truly perform informed consent to patients considering procedures involving morcellation, a thorough review of the facts, not alternative facts, must be communicated. RECENT FINDINGS: Misrepresentation of the ethics surrounding this procedure, the role of informed consent and the risks and benefits as determined by evidence-based medicine have led to confusion and poor public policy. Today's evidence suggests that the procedure is indeed ethical when full disclosure of the risks and benefits is presented via informed consent. Risks of the procedure have been exaggerated significantly, and little attention has been paid to the risks of denying morcellation procedures to patients. Attempts to condemn gynecologists as acting contrary to established surgical principles do not coincide with facts. SUMMARY: Morcellation is a controversial technique which undoubtedly has a role as well as limitations. To appropriately determine if the procedure is indicated and acceptable to the patient, full disclosure of the best available evidence is necessary.

The Poly Implant Prothèse breast prostheses scandal: Embodied risk and social suffering.

This article examines the 2010 scandal surrounding the use and subsequent recall of adulterated Poly Implant Prothèse (PIP) silicone breast prostheses in France. It uses a mixed method approach that includes 12 interviews with French PIP prosthesis recipients, analyses of medical literature, policy documents of French and EU regulatory agencies, and an online forum for PIP recipients. These data are used to explain how the definition of "acceptable risk" in the silicone implants controversy of the 1990s in the US influenced the PIP scandal later on in France. Additionally, PIP recipients had an embodied experience of risk that clashed with the definition of risk used by authorities and some surgeons. The coverage of re-implantation was also defined at different policy levels, leading to variation in patients' suffering. The combination of fraud and lack of recognition from part of the medical system constitutes an example of social suffering for the patients involved. The PIP scandal is a useful case for analyzing the interconnection of embodied experience and professional and public policy definitions of medical risk through the concepts of moral economy and biological citizenship.

Discovering overtreatment: second-opinion dilemma.

An experienced vascular surgeon, Dr Al Wright, specializing in venous disease, often sees self-referred patients seeking second opinions primarily for ablation therapy and is deeply disturbed at what he finds. Some patients have no reflux on ultrasound examination and, thus, no treatment is indicated. Others were told they need a ludicrous three to seven ablations in each leg where only one or at most two are needed. Several advertise their services in the media. Dr Wright asked esteemed colleagues from the American Venous Forum what they recommended and they suggested sending a copy of his consultation to the first consultant with the goal of shaming him. He also notified the state medical board 2 years ago about one egregious repeat offender, without action. What should he do? A. Do as suggested, send your consult along with a harsh letter. B. Do nothing. It is none of your business. C. Notify the state medical board, again. D. Notify the insurance companies and regulators. E. There is no good venue to deal with the problem.

On a communitarian approach to bioethics.

A communitarian approach to bioethics adds a core value to a field that is often more concerned with considerations of individual autonomy. Some interpretations of liberalism put the needs of the patient over those of the community; authoritarian communitarianism privileges the needs of society over those of the patient. Responsive communitarianism's main starting point is that we face two conflicting core values, autonomy and the common good, and that neither should be a priori privileged, and that we have principles and procedures that can be used to work out this conflict but not to eliminate it. This discussion uses the debate in the US over funding for entitlements as a case study to apply the values of communitarian bioethics.

The ethics of expediency.

Socioeconomic pressures on medicine have redefined traditional relationships between physicians and patients, researchers and regulatory bodies, and consultants and device companies. Physicians are disheartened that the public perception of medicine, reinforced by the media, is often negative. Ethical lapses are frequently the focus of criticism. A recent example that received considerable attention is the inextricable link between physicians and medical device companies. Although both groups have clear codes defining the ethical interaction between them, expediency and loose adherence to those guidelines has been problematic. In a climate of skepticism, the house of medicine needs to reverse and not feed that skepticism.

Dental hygiene students' attitudes toward ethical dilemmas in practice.

This article reports the findings of a survey-based study conducted in 2006 to determine graduating dental hygiene students' attitudes toward ethical dilemmas in eight areas of practice: substandard care, overtreatment of patients, scope of practice, fraud, confidentiality, impaired professionals, sexual harassment, abuse, and health status. The findings, based on responses from 1,165 students at 141 U.S. dental hygiene programs, indicate that many dental hygiene students do not understand what behaviors in the patient care environment are consistent with ethical practice and which are not. Responding students believed that hygienists have a strong duty to report, intercede, or educate in areas of abuse, sexual harassment, detection of cancer, and smoking cessation. However, they were less likely to report concerns about ethical transgressions such as fraud, inadequate infection control, exceeding practice scope, and failure to diagnose disease when such disclosures could potentially threaten their employment status. Based on the results, we recommend that dental hygiene programs explore curriculum enhancements to improve students' comprehension of what constitutes fraud and other ethical transgressions and the proper reporting mechanisms.

Avaliação comparativa da qualidade físico-química de méis inspecionados e clandestinos, comercializados no estado do Rio de Janeiro, Brasil / Comparative evaluation of physicochemical properties of different types of honey, selected from inspected and non-inspected samples, on sale in Rio de Janeiro state, Brazil

Com o objetivo de comparar a qualidade físico-química dos méis inspecionados com méis adquiridos no mercado informal, comercializados no estado do Rio de Janeiro, analisaram-se 35 amostras de méis, sendo 25 inspecionados e 10 clandestinos. Os parâmetros avaliados foram: fraude por adição de amido, açúcares redutores em glicose e não redutores em sacarose, hidroximetilfurfural, determinação da acidez e proteínas. Os resultados obtidos demonstraram que 100% das amostras dos méis clandestinos estavam fora dos parâmetros em pelo menos uma das análises, apresentando os seguintes resultados: 70% das amostras demonstraram presença de amido; 30% encontravam-se abaixo dos padrões para proteína; na Prova de Fiehe, 30% apresentaram coloração vermelho cereja e 30% coloração salmão; 50% estavam abaixo do limite para açúcares redutores, 20% excederam os padrões para sacarose e 40% ultrapassaram a acidez estabelecida. Os resultados encontrados nos méis inspecionados foram mais satisfatórios, entretanto, apresentando alguns valores alterados: 12% positivos para adição de amido, 12% positivos para HMF, sendo 4% com coloração vermelha, sugestiva de presença de açúcar invertido e 8% com coloração salmão, que indica que o mel foi aquecido intensamente ou foi estocado por período prolongado em temperatura elevada, 4% fora dos padrões para açúcares redutores e 12% com acidez acima do estabelecido pela legislação.

Aiming at comparing the physicochemical quality of inspected honey with that of non-inspected honey from the informal market, both on sales in Rio de Janeiro State, Brazil, we have examined 35 samples of honey, among which 25 had been inspected and 10 were non-authorized. The following issues were investigated: fraud involving the addition of starch, of glucose (reducing sugar), of saccharose (non-reducing sugar) and of hydroxymethylfurfural (HMF), and determination of acidity and of protein. It so turned out that 100% of the non-inspected honey samples did not meet the parameters in at least one of our tests, the net result being expressed in the following terms: 70% of the samples contained starch; 30% had a protein content below the standard; 30% showed the red coloration for HMF and 30% for HMF showed the salmon coloration; 50% were below the floor for reducing sugars; 20% were above the ceiling for saccharose, and lastly 40% had an acidity level above the recommended. On the other hand, the results found in the samples of inspected honey were more satisfactory, the figures being as follows: 12% were positive for starch; 12% were positive for HMF, among which 4% showed the coloration typical for a concentration higher than 70mg/kg and 8% higher than 40mg/kg; 4% were below the standard for reducing sugars, and lastly 12% presented an acidity level above the legal recommendation.

Epidemiology of Medicare abuse: the example of power wheelchairs.

OBJECTIVES: To determine the effect of neighborhood ethnic composition on power wheelchair prescriptions. DESIGN: The 5% noncancer sample of Medicare recipients in the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, from 1994 to 2001. SETTING: SEER regions. PARTICIPANTS: Individuals covered by Medicare living in SEER regions without a cancer diagnosis. MEASUREMENTS: Individual characteristics (age, sex, ethnicity, justifying diagnosis, and comorbidity), primary diagnoses, neighborhood characteristics (percentage black, percentage Hispanic, percentage with <12 years education, and median income), and SEER region. RESULTS: The rate of power wheelchair prescriptions was 33 times greater in 2001 than in 1994, with a shift over time from justifying diagnoses more closely tied to mobility impairment, such as strokes, to less-specific medical diagnoses, such as osteoarthritis. In multilevel, multivariate analyses, individuals living in neighborhoods with higher percentages of blacks or Hispanics were more likely to receive power wheelchairs (odds ratios=1.09 for each 10% increase in black residents and 1.23 for each 10% increase in Hispanic residents) after controlling for ethnicity and other characteristics at the individual level. CONCLUSION: These results support allegations that marketers promoting power wheelchairs have specifically targeted minority neighborhoods.