It is Not Too Late for Reconciliation Between Israel and Palestine, Even in the Darkest Hour.

The conflict in Gaza and Israel that ignited on October 7, 2023 signals a catastrophic breakdown in the possibility of ethical dialogue in the region. The actions on both sides have revealed a dissolution of ethical restraints, with unimaginably cruel attacks on civilians, murder of children, destruction of health facilities, and denial of basic needs such as water, food, and shelter. There is a need both to understand the nature of the ethical singularity represented by this conflict and what, if any, options are available to allow the reconstruction of communication between the warring parties. This article seeks to address these tasks by analysing the conflict as inherently an ethical one, in the sense that it exposes a rupture in the fabric of communicative relationships that has evolved systematically out of the deep cultural structures from which all protagonists have emerged. Drawing on the work of Levinas, Habermas, Arendt, and others, and referring to the specific circumstances in the region, it examines the ethical sources of the crisis and tries to identify conditions for its resolution. The possibility of reconciliation-that is, of refiguring relationships to open up a space for dialogue to create pathways to heal the ruptures-is examined. The dark legacy of the Holocaust is identified as an abiding cultural vulnerability for both societies. It is concluded, however, that the rich history of partnerships and collaborations between Jews and Palestinians provides a robust infrastructure on the basis of which a sustainable peace might be built, providing a much-needed source of hope.

A qualitative study of overweight and obese Australians' views of food addiction.

The concept of food addiction is increasingly used in the academic literature and popular media to explain some forms of overweight and obesity. However, there is limited evidence on how this term is understood by and impacts overweight and obese individuals. This qualitative study investigated the views of overweight and obese individuals on food addiction, and its likely impact upon stigma, treatment-seeking, and support for public policies to reduce overeating. Semi-structured interviews were conducted with 23 overweight and obese individuals (Mage = 38, MBMI = 33, 74% female) and analysed thematically. The concept of food addiction was consistent with many participants' personal experiences, and was accompanied by high perceptions of control and personal responsibility. Some participants believed "sugar" or "fat" addiction to be more accurate. Others were reluctant to be described as an "addict" owing to perceived negative connotations and the belief that it would increase self-stigma. Food addiction was seen as a motivator for seeking psychological services, but not pharmaceutical or surgical treatments. In light of food addiction being perceived as plausible and relevant, participants supported targeted public health policies (e.g., taxes, regulations for junk food container sizes) but did not believe these would affect their own purchasing or consumption behaviours. Education for interpreting food labels and reducing the costs of healthy foods were endorsed, leading to positive changes in food-related behaviours. This research suggests discretionary use of the food addiction label in a supportive and educational manner to minimise stigma while encouraging treatment-seeking.

An unequivocal good? Acknowledging the complexities of advance care planning.

Over the past few decades advance care planning (ACP) has become the subject of debate, research and legislation in many countries. Encouraging people to express their preference for treatment in advance, ideally in written form, seems a natural way to identify what someone might have wanted when they can no longer participate in decision-making. The notion of ACP as an unequivocal good permeates much of the research and policy work in this area. For example, ACP is now actively encouraged in Australian federal and state government policies and the Victorian Government has recently published a practical ACP strategy for Victorian health services (2014-2018). However, advance care plan is ethically complex and the introduction of the Victorian health services strategy provides an opportunity to reflect on this complexity, particularly on the benefits and risks of ACP.

Practical aspects of telehealth: establishing telehealth in an institution.

The fifth in a series of papers on practical aspects of telehealth, this paper discusses telehealth models that can facilitate the provision of specialist services to rural and remote patients closer to home. Some of the barriers to successful implementation of these models relates to workforce, funding and infrastructure at rural sites, as well as the traditional mindset of healthcare professionals. Therefore, the rural sector needs to be adequately resourced for telehealth models to be substantive and successful. This paper describes the development of a large teleoncology network over a vast geographical area in North Queensland. Adequate resourcing for the rural sites and undertaking quality improvement activities has continually enhanced the model over a 5- to 6-year period. The benefits of this model of care are twofold: (i) patients received their care closer to home and (ii) the workforce, service capabilities and infrastructure for the hospital in Mt Isa (a rural town 900 km away from its tertiary centre) has improved.

Practical aspects of telehealth: doctor-patient relationship and communication.

The fourth in a series of articles about the practical aspects of telehealth, this paper provides advice and information for specialists to communicate effectively with patients during a telehealth video consultation.

Practical aspects of telehealth: set-up and preparation for video consultations.

The third in a series of articles about the practical aspects of telehealth, this paper gives guidance on suitable setup for video consultations, including layout of rooms, managing sound and image quality, scheduling, testing and best practice in telehealth videoconferencing.

The patient is the teacher: ambulatory patient-centred student-based interprofessional education where the patient is the teacher who improves patient care outcomes.

The patient's role as the key to medical student education was enunciated by Osler in 1903 and remains central to the broader imperative of interprofessional education. Interprofessional education needs to progress from the patient's passive bedside or office role to assume a more active and primary role by his/her participation as the teacher, immersed in student education. To date, the achievements in interprofessional education have been limited, but ambulatory patient-centred learning opportunities involving direct student to patient dialogues and mixed health professional student engagement with patients as teachers are emerging within various interprofessional student clinic formats. There is good evidence that such approaches lead to actual improvements in patient outcomes.

Practical aspects of telehealth: financial considerations.

The second in a series of articles about the practical aspects of telehealth, this paper includes information and a case history on the cost-benefits for patients and practitioners using telehealth. The case history demonstrates that telehealth can save travel time for patients, carers and specialists, and can reduce out-of-pocket expenses. The practical aspects of telehealth article series considers the contextual, clinical, technical and ethical components of online video consultations.

Practical aspects of telehealth: are my patients suited to telehealth?

The first in a series of articles that demonstrate the practical aspects of telehealth, this paper provides three case studies that examine the suitability of telehealth for patients living in rural and remote areas who require ongoing specialist care.

Cell adhesion molecules as pharmaceutical target in atherosclerosis.

Cell adhesion molecules (CAMs) are transmembrane proteins that mediate adhesion and interactions between cells or cell and extra-cellular matrix. Increased expression and activation of CAMs in vascular endothelial cells and circulating leukocytes, as occurring in the settings of inflammation, hypercholesterolemia, hypertension and diabetes, stimulates leukocyte recruitment into the vascular endothelium, an important step in the pathogenesis of atherosclerosis. CAMs are a potential therapeutic target in clinical practice and in recent years pharmaceutical agents with specific effects on the production and function of these molecules have been studied and developed. This article reviews recent progress regarding pathophysiology of CAMs in atherogenesis and pharmaceutical products or chemicals that are active against CAMs, and assesses the possibilities for clinical developments in this area that might enhance the prevention, monitoring and treatment of atherosclerotic cardiovascular diseases.

Between a rock and a hard place: exploring the conflict between respecting the privacy of patients and informing their carers.

BACKGROUND: A patient's right to privacy is considered fundamental to medical care, with physicians assuming the role of guardian of the clinical information which is conveyed to the patient. However, as a patient's health declines, physicians are often challenged by the need to protect patient privacy while addressing the expectations of the patient's carers, who seek medical information to provide appropriate care at home. AIMS: This study sought to explore the expectations of patients, their carers and physicians regarding the communication of clinical information to carers. METHODS: Surveys were distributed in outpatient clinics at a metropolitan quaternary hospital, with responses from 102 patients and carers, as well as 219 medical staff. RESULTS: The expectations of patients and carers differed from those of medical staff. Physicians typically believed discussions with carers should begin following the patient's permission and at the patient's request. Patients and carers, however, believed information should be automatically offered or provided when questioned. Further, carers generally felt information updates should occur regularly and routinely, whereas physicians indicated updates should occur with prompting either by a major clinical change or in response to a carer's concern. CONCLUSION: Physicians should be aware that the expectations of patients and carers regarding information communication to carers may not match their own. Meanwhile, patients and carers should be made aware of the constraints upon physicians and should be encouraged to convey their preferences for information sharing. These tasks could be facilitated by the development of a prompt sheet to assist the clinical encounter.

Do ethical Guidelines make a difference to decision-making?

BACKGROUND: The different levels of knowledge and understanding of attitudes to and use by physicians of the Royal Australasian College of Physicians (RACP) Guidelines for ethical relationships between physicians and the pharmaceutical industry are unknown. The aim of this study was to explore how physician Fellows of the RACP relate to and use the ethical Guidelines of the RACP regarding relationships with the pharmaceutical industry. METHODS: Focus group discussions and in-depth face-to-face interviews were used to gather information from physicians who responded to invitations placed in electronic newsletters or through word of mouth. RESULTS: Five focus groups and eight in-depth interviews were conducted with 56 practising physicians in Australia and New Zealand. Most physicians were aware of the RACP ethical Guidelines (3rd edition, 2006), but only a few used them to resolve ethical dilemmas or to influence their decision-making in relation to interacting with the pharmaceutical industry. Ethical standards used or approaches to decision-making practices related to interactions with the pharmaceutical industry were most likely to have been developed through past experiences, peer pressure or decisions that were considered to be 'in the best interests of their patients'. There were strong opinions expressed about relationships with the pharmaceutical industry and how these relationships often lead to feelings of humiliation. Some felt they were prostituting themselves for the sake of acquiring funding for staff positions, medical devices, research or attendance at conferences. Very few physicians recollected having any assistance on how to deal with the pharmaceutical industry during their training, and those few who did recollect such input through their curricula and education felt they did not benefit. CONCLUSION: RACP Guidelines on ethical guidance for relating to the pharmaceutical industry have not been used by most physicians, and very few had read or referred to the Guidelines. Reliance on 'previous' experience, opinions of peers and 'value to patients' had most influence on attitudes and behaviours in interactions with industry. Many physicians felt uncomfortable and embarrassed about interactions with industry, especially varying levels of dependence on industry for resources.