Role of the Nasogastric Tube and Lingzhi (Ganoderma lucidum) in Palliative Care.

Decision-making on behalf of an incapacitated patient at the end of life is a complex process, particularly in family-centric societies. The situation is more complex when attempts are made to accommodate Eastern concepts of end-of-life care with more conventional Western approaches. In this case report of an incapacitated 74-year-old Singaporean man of Malay descent with relapsed Stage 4 diffuse large B cell lymphoma who was without an established lasting power of attorney, we highlight the difficult deliberations that ensue when the patient's family, acting as his proxy, elected to administer lingzhi through his nasogastric tube (NGT). Focusing on the questions pertaining to end-of-life decision-making in Asia, we consider the issues surrounding the use of NGT and lingzhi in palliative care (PC) and the implementation of NGT for administering lingzhi in a PC setting, particularly in light of a dearth of data on such treatment measures among PC patients.

Ethical considerations in clinical research on herbal medicine for prevention of cardiovascular disease in the ageing.

BACKGROUND: Cardiovascular disease (CVD) in the ageing is a major public health problem worldwide. The nature of most CVD is subclinical with pathological processes that can span over years. Use of preventive measures could be an appropriate approach to prevailing over CVD in the ageing, and herbal medicine is one of the promising preventive approaches and is currently of interest among medical societies. In the evidence-based era, herbal medicine is, however, often underestimated and approached with skepticism, mainly due to the paucity of scientific evidence. Properly designed clinical trials on herbal medicine for prevention of CVD in a geriatric population are thus of importance and of clinical value. PURPOSE: To review ethical issues and discuss considerations when such research is proposed. CHAPTERS/SECTIONS: Four ethical issues, including the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent, are structured and extensively discussed in this article. CONCLUSIONS: Ethical core considerations of prevention research of CVD on herbal medicine involve particular attention on the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent. These issues and considerations are keys, although they must be adapted to an individual research setting in which a clinical study is proposed.

Ética en la información, comercialización y uso de plantas medicinales y medicamentos herbarios / Ethics on information, trade, and use of medicinal plants and herbal drugs

La información y el mercadeo no éticos de los medicamentos son problemas muy debatidos en el contexto internacional,1,2 sin embargo, los usos con faltas éticas son menos tratados.3El editorial del último número de 2012 de la Revista Cubana de Salud Pública analizó las implicaciones de la publicidad comercial de medicamentos si no se efectúa de una manera ética.4 Su autor expone varios ejemplos de productos naturales y homeopáticos, a los cuales se les atribuyen efectos probados no demostrados en ensayos clínicos y no registrados para su uso como medicamentos; no obstante, es pertinente aclarar que existen requisitos para los registros sanitarios específicos de los productos naturales, incluidas las plantas, y los homeopáticos en Cuba y en el contexto internacional. Aunque no citó ejemplos de plantas o fitoterápicos, no podemos sentirnos ajenos al asunto; todos conocemos ejemplos múltiples en sitios web, prensa y personales, donde de manera intencionada o por desconocimiento se atribuyen efectos terapéuticos sin reacciones adversas y científicamente demostrados a plantas o sus preparados, que devienen curalotodo. También algunos médicos y otros profesionales de la salud caen en ese error al exponer una experiencia o al prescribir ¿Por qué no decir honestamente que lo que estamos recetando o informando está basado en la medicina tradicional y que aunque no haya ensayos clínicos, tiene o carece de algunos estudios preclínicos que pueden validar su posible uso? Esa manera sería éticamente correcta.¿Por qué no lo hacen algunos de esa forma? Un motivo pudiera ser la intención para promover ventas o reconocimientos personales; el otro sería el desconocimiento, que lleva implícito menospreciar el aval de seguridad y uso que brindan las medicinas tradicionales, aunque sabemos que tiene limitaciones. Ambos son éticamente inadmisibles y nos hemos referido en varias..

Ética en la información, comercialización y uso de plantas medicinales y medicamentos herbarios / Ethics on information, trade, and use of medicinal plants and herbal drugs

La información y el mercadeo no éticos de los medicamentos son problemas muy debatidos en el contexto internacional,1,2 sin embargo, los usos con faltas éticas son menos tratados.3El editorial del último número de 2012 de la Revista Cubana de Salud Pública analizó las implicaciones de la publicidad comercial de medicamentos si no se efectúa de una manera ética.4 Su autor expone varios ejemplos de productos naturales y homeopáticos, a los cuales se les atribuyen efectos probados no demostrados en ensayos clínicos y no registrados para su uso como medicamentos; no obstante, es pertinente aclarar que existen requisitos para los registros sanitarios específicos de los productos naturales, incluidas las plantas, y los homeopáticos en Cuba y en el contexto internacional. Aunque no citó ejemplos de plantas o fitoterápicos, no podemos sentirnos ajenos al asunto; todos conocemos ejemplos múltiples en sitios web, prensa y personales, donde de manera intencionada o por desconocimiento se atribuyen efectos terapéuticos sin reacciones adversas y científicamente demostrados a plantas o sus preparados, que devienen curalotodo. También algunos médicos y otros profesionales de la salud caen en ese error al exponer una experiencia o al prescribir ¿Por qué no decir honestamente que lo que estamos recetando o informando está basado en la medicina tradicional y que aunque no haya ensayos clínicos, tiene o carece de algunos estudios preclínicos que pueden validar su posible uso? Esa manera sería éticamente correcta.¿Por qué no lo hacen algunos de esa forma? Un motivo pudiera ser la intención para promover ventas o reconocimientos personales; el otro sería el desconocimiento, que lleva implícito menospreciar el aval de seguridad y uso que brindan las medicinas tradicionales, aunque sabemos que tiene limitaciones. Ambos son éticamente inadmisibles y nos hemos referido en varias..(AU)

Ethical implications of the increasing use of complementary and alternative medicine.

BACKGROUND: The increasing demand for complementary and alternative medicine (CAM) raises ethical questions about specific aspects of both CAM and conventional medicine (COM). METHODS: The present article provides a critical survey of the most important ethical aspects in the current debate about CAM. RESULTS: The relevant ethical issues arise mainly in 4 main areas: 1) patient information, 2) research ethics, 3) cost, and 4) education. Most of the contributions used for our purpose are based upon the implicit assumption that, in principle, the ethics of CAM and COM have to be identical because of the same underlying doctor-patient relationship. This premise is shared by the author. CONCLUSIONS: Substantial efforts on various levels will have to be made in order to create the conditions necessary for CAM to be ethically justified. But the ethical implications for COM also have to be considered.

Ethical quandaries in spiritual healing and herbal medicine: a critical analysis of the morality of traditional medicine advertising in southern African urban societies.

This paper critically examines the morality of advertising by practitioners in spiritual healing and herbal medicine heretofore referred to as traditional medicine, in southern African urban societies. While the subject of traditional medicine has been heavily contested in medical studies in the last few decades, the monumental studies on the subject have emphasised the place of traditional medicine in basic health services. Insignificant attention has been devoted to examine the ethical problems associated with traditional medicine advertising. Critical look at the worthiness of some advertising strategies used by practitioners in traditional medicine in launching their products and services on market thus has been largely ignored. Yet, though advertising is key to helping traditional medicine practitioners' products and services known by prospective customers, this research registers a number of morally negative effects that seem to outweigh the merits that the activity brings to prospective customers. The paper adopts southern African urban societies, and in particular Mozambique, South Africa and Zimbabwe as particular references. The choice of the trio is not accidental, but based on the fact that these countries have in the last few decades been flooded with traditional medicine practitioners/traditional healers from within the continent and from abroad. Most of these practitioners use immoral advertising strategies in communicating to the public the products and services they offer. It is against this background that this paper examines the morality of advertising strategies deployed by practitioners in launching their products and services. To examine the moral worthiness of the advertising strategies used by traditional medical practitioners, I used qualitative analysis of street adverts as well as electronic and print media. From the results obtained through thematic content analysis, the paper concludes that most of the practitioners in traditional medicine lack both business and medical ethics. That said, the paper urges practitioners to seriously consider the morality of their adverts as in most cases they (adverts) do more harm than good. Further to that, the piece recommends the governments of the affected countries to put in place stringent measures to address this mounting problem.

Análisis de la pervivencia, difusión y productividad de la Revista de Fitoterapia / Analysis of the survival, distribution and productivity of the Journal «Revista de Fitoterapia»

El objetivo principal de este trabajo es el estudio comparativo de los indicadores bibliométricos de pervivencia, circulación y productividad de la Revista de Fitoterapia hasta el año 2003, con una revisión hasta 2009, frente a otras revistas españolas de Farmacia y Farmacología; para ello se han efectuado revisiones en los directorios de publicaciones periódicas ISSN (International Standard Serial Number o Número Internacional Normalizado de Publicaciones Seriadas), el Ulrich’s Periodicals Directory, y la CDU (Clasificación Decimal Universal), así como en bases de datos especializadas, nacionales e internacionales: IME (Índice Médico Español), ICYT (Índice Español de Ciencia y Tecnología), IBECS (Índice Bibliográfico Español en Ciencias de la Salud), IPA (International Pharmaceutical Abstracts), SCI Expanded (Science Citation Index Expanded), MEDLINE (Index Medicus), EMBASE (Excerpta Medica data BASE), BIOSIS Previews, Analytical Abstracts, FSTA (Food Science and Technology Abstracts), Scifinder Scholar y Chemistry Citation Index, empleándose la adecuada estrategia de búsqueda para recuperar la información en cada una de las bases de datos utilizada. Según los resultados obtenidos, se puede considerar que la Revista de Fitoterapia, con 10 años de pervivencia y una notable difusión en las bases de datos analizadas, ocupa un lugar preferente entre las revistas científicas vigentes de su misma disciplina (AU)

The main objective of this work is the comparative study of bibliometric indicators of survival, circulation and productivity of the journal Revista de Fitoterapia until 2003, with a review until 2009, compared to other Spanish journals of Pharmacy and Pharmacology; for it have made revisions on the boards of journals ISSN (International Standard Serial Number), Ulrich’s Periodicals Directory, and UDC (Universal Decimal Classification), as well as specialized databases, national and international: IME (Spanish Medical Index), ICYT (Spanish Index on Science and Technology), IBECS (Spanish Bibliographic Index on Health Sciences), IPA (International Pharmaceutical Abstracts), SCI Expanded (Science Citation Index Expanded), MEDLINE (Index Medicus), EMBASE (Excerpta Medica Data Base), BIOSIS Previews, Analytical Abstracts, FSTA (Food Science and Technology Abstracts), SciFinder Scholar and Chemistry Citation Index, using the appropriate search strategy to retrieve the information in each of the databases used. According to our results, we can consider that the jornal Revista de Fitoterapia, with 10 years of survival and widely circulated in the databases analyzed, occupies a privileged place within the current scientific journals of their own discipline (AU)

O objectivo principal deste trabalho é o estudo comparativo dos indicadores bibliométricos da existência, da circulação e da produtividade da Revista Fitoterapia até 2003, com uma revisão até 2009, em comparação com outras revistas espanholas de Farmácia e Farmacologia. Para o efeito fizeram-se revisões nos directórios de publicações periódicas ISSN (International Standard Serial Number), Ulrich's Periodicals Directory, e CDU (Classificação Decimal Universal), assim como em bases de dados especializadas, nacionais e internacionais; IME (índice Médico Espanhol), ICYT (Índice Espanhol de Ciência e Tecnologia), IBECS (Índice Bibliográfico Espanhol em Ciências da Saúde), IPA (International Pharmaceutical Abstracts), SCI Expanded (Science Citation Index Expanded), Medicus MEDLINE (Index Medicus), EMBASE (Excerpta Medica Data Base), BIOSIS Previews, Analytical Abstracts, FSTA (Food Science and Technology Abstracts), SciFinder Scholar e Química Citation Index, usando a estratégia de busca adequada para recuperar as informações em cada uma das bases de dados utilizadas. Segundo os nossos resultados, podemos considerar que a revista de Fitoterapia com 10 anos de existência e amplamente divulgada nas bases de dados analisados, ocupa um lugar privilegiado entre as revistas científicas vigentes da mesma área disciplinar (AU)

Participation in dementia research: rates and correlates of capacity to give informed consent.

BACKGROUND: Many people participating in dementia research may lack capacity to give informed consent and the relationship between cognitive function and capacity remains unclear. Recent changes in the law reinforce the need for robust and reproducible methods of assessing capacity when recruiting people for research. AIMS: To identify numbers of capacitous participants in a pragmatic randomised trial of dementia treatment; to assess characteristics associated with capacity; to describe a legally acceptable consent process for research. METHODS: As part of a pragmatic randomised controlled trial of Ginkgo biloba for mild-moderate dementia, we used a consenting algorithm that met the requirements of existing case law and the exigencies of the new Mental Capacity Act. We decided who had capacity to give informed consent for participation in the trial using this algorithm and sought predictors of capacity. RESULTS: Most participants (76%) with mild-moderate dementia in this trial were unable to give informed consent according to the legal criteria. When adjusted for confounding, the Mini Mental State examination did not predict the presence of capacity. CONCLUSION: Cognitive testing alone is insufficient to assess the presence of capacity. Researchers and clinicians need to be aware of the challenging processes regarding capacity assessment. We outline a procedure which we believe meets the ethical and legal requirements.

Ethical and regulatory issues surrounding African traditional medicine in the context of HIV/AIDS.

It has been estimated that more than 80% of people in Africa use traditional medicine (TM). With the HIV/AIDS epidemic claiming many lives in Africa, the majority of people affected rely on TM mainly because it is relatively affordable and available to the poor populations who cannot afford orthodox medicine. Whereas orthodox medicine is practiced under stringent regulations and ethical guidelines emanating from The Nuremburg Code, African TM seems to be exempt from such scrutiny. Although recently there have been calls for TM to be incorporated into the health care system, less emphasis has been placed on ethical and regulatory issues. In this paper, an overview of the use of African TM in general, and for HIV/AIDS in particular, is given, followed by a look at: (i) the relative laxity in the application of ethical standards and regulatory requirements with regards to TM; (ii) the importance of research on TM in order to improve and demystify its therapeutic qualities; (iii) the need to tailor-make intellectual property laws to protect traditional knowledge and biodiversity. A framework of partnerships involving traditional healers' associations, scientists, policy makers, patients, community leaders, members of the communities, and funding organizations is suggested as a possible method to tackle these issues. It is hoped that this paper will stimulate objective and constructive debate that could enhance the protection of patients' welfare.

Ethical considerations in African traditional medicine: a response to Nyika.

Like other so-called 'parallel' practices in medicine, traditional medicine (TM) does not avoid criticism or even rejection. Nyika's article 'Ethical and Regulatory Issues Surrounding African Traditional Medicine in the Context of HIV/AIDS' looks at some of the issues from a traditional Western ethical perspective and suggests that it should be rejected. I respond to this article agreeing with Nyika's three major criticisms: lack of informed consent, confidentiality and paternalism. However, as traditional healers are consulted by over 70% of South Africans before any other type of healthcare professional, a blanket negation of TM is not possible, nor is it politically feasible. A pragmatic approach would be to work within the current structures for positive change. I point out that, as all cultural practices do, TM will change over time. Yet, until some regulations and change occur, the problem of harm to patients remains a major concern.

The use of medicinal plants as a therapeutical resource: from the influences of the professional formation to the ethical and legal implications of its applicability as an extension of nursing care practice.

This qualitative research aimed to analyze the biomedical influence in the context of nurses' formation and professional activities; to reflect about ethical and legal implications of using medicinal plants in nursing care; to argue about the need to configure and delimit this resource as a legitimate instrument for expanding nursing care practice. We used the creative-sensible method and developed dynamics with a group of nurses to produce data, analyzed in the categories "the biomedical influence in the academic-professional orientation of nursing" and "ethical and legal implications in the applicability of medicinal plants in care". Results indicated the need to advance in studies on the nursing diagnosis that implies the prescription of medicinal plants, so that the client is well taken care of by nurses, thus legitimizing it as an extension of their professional practice. Not as an exclusive territory, but as shared and interdisciplinary health care action.

Prescribing cannabis: freedom, autonomy, and values.

In many Western jurisdictions cannabis, unlike most other psychoactive drugs, cannot be prescribed to patients even in cases where medical professionals believe that it would ease the patient's pain or anxiety. The reasons for this prohibition are mostly ideological, although medical and moral arguments have been formulated to support it. In this paper, it is argued that freedom, properly understood, provides a sound ethical reason to allow the use of cannabis in medicine. Scientific facts, appeals to harm and autonomy, and considerations of symbolic value cannot consistently justify prohibitions.