Homeopath & patient--a dyad of harmony?

Within the last 20 yr, heterodox medicine has become increasingly popular in western societies. Critics and advocates argue that the physician-patient relationship is a key factor to this success. This study which is based on 20 semi-structured interviews with homeopathic physicians in Berlin questions the notion of a purely consensual interaction. While we can find a certain degree of partnership between homeopathic physicians and their patients, there is a significant amount of negotiation and disagreement as well: The arenas are the revelation of the prescribed homeopathic remedy, patients' expectations, the physicians' fees and differing views on the appropriate duration of consultation. Consequently, a rather complex picture of the physician-patient interaction emerges which challenges the notion of a purely harmony- and consumer-oriented consultation in heterodox medicine. It does not seem possible straightforwardly to apply any of the existing theoretical models to the physician-patient relationship.

What's a pharmacist to do?

KIE: A case study is presented in which a pharmacist in a Drug Information Center is queried by a patient about how to obtain a homeopathic medicine. There appear to be no scientific data regarding the efficacy or safety of the medication. The pharmacist has three options: to inform the patient how to obtain the medicine, to tell the patient that the medicine is ineffective and withhold information on how to obtain it, or to discuss its therapeutic uncertainty and provide ordering information. Resnik and Resnik recommend that the pharmacist choose the third option after balancing obligations to respect autonomy, avoid harm, and provide benefits. Arnold, Nissen, and Haupt comment on three models of pharmacist-consumer interaction: the librarian, the priestly, and the counselor. The authors favor the last option, to counsel the patient on appropriate care and tell her how to obtain the medication.^ieng

Limits on risks for healthy volunteers in biomedical research.

Healthy volunteers in biomedical research often face significant risks in studies that offer them no medical benefits. The U.S. federal research regulations and laws adopted by other countries place no limits on the risks that these participants face. In this essay, I argue that there should be some limits on the risks for biomedical research involving healthy volunteers. Limits on risk are necessary to protect human participants, institutions, and the scientific community from harm. With the exception of self-experimentation, limits on research risks faced by healthy volunteers constitute a type of soft, impure paternalism because participants usually do not fully understand the risks they are taking. I consider some approaches to limiting research risks and propose that healthy volunteers in biomedical research should not be exposed to greater than a 1% chance of serious harm, such as death, permanent disability, or severe illness or injury. While this guideline would restrict research risks, the limits would not be so low that they would prevent investigators from conducting valuable research. They would, however, set a clear upper boundary for investigators and signal to the scientific community and the public that there are limits on the risks that healthy participants may face in research. This standard provides guidance for decisions made by oversight bodies, but it is not an absolute rule. Investigators can enroll healthy volunteers in studies involving a greater than 1% chance of serious harm if they show that the research addresses a compelling public health or social problem and that the risk of serious harm is only slightly more than 1%. The committee reviewing the research should use outside experts to assess these risks.