[Healthcare occupations are "different"]. / Gesundheitsberufe sind "anders"

Healthcare requires careful coordination of several occupations. In order to attain the best possible result, including effectiveness and cost-efficiency, the specific expertise of each of these occupations must be clearly defined. Healthcare occupations, physicians and nurses, are indeed professions as opposed to mere "jobs". They are concerned with living but ill human beings and not with things. Reliance on a personal capacity of judgment is a decisive aspect of professions. Healthcare professionals perform best if they are granted specific independence relative to their work.

Patients or customers: ethical limits of market economy in health care.

There is a move away from a market economy in health care in the United States and a move towards such a market in Germany. This article tries to make explicit what underlies the moral intuition that there is a tension between a market economy and health care. First, health care is analyzed in terms of the economic theory of the market and incompatibilities are described. The moral problem is identified as the danger of liquefying the distinction between persons and things. The basic moral intuition seems to be the classical social contract: as a functioning market is governed by the principle of commutative justice, free riders have to be kept away, which is achieved by coercion that is not provided by the market; coercion can be justified by a social contract. The special moral problems of a social contract for health care are discussed. It is argued that public coercion in order to collect contributions for essential health care is justified.

Moral strangers and the health care market.

In order to reflect on the morality of the health care market this paper critiques some of H.T. Engelhardt's presuppositions. Engelhardt has created the vivid term 'moral stranger' and suggested that there can be a 'morality of moral strangers'. However his position relies either on certain necessary presuppositions which he leaves unmentioned or on presuppositions that are--in a strict sense--not moral ones. Engelhardt advocates the market economy as the guiding principle of health care, and claims that the market needs no moral presuppositions. But when the preconditions of a functioning market are examined it turns out that a functioning market requires property and ownership, and that property and ownership are moral institutions. Therefore the application of the idea of the market to health care undoubtedly has morally serious consequences: most important, the difference between commodities and human beings is obscured.

A Kantian argument in favor of unimpeded access to health care.

The principle that everybody should have access to essential health care is in conflict with the notion that property rights should be respected. The Kantian doctrine of rights is explored in order to solve this conflict. Kant's notion of a legislative will is explained and used to show the inherent limits of the legal terms "property" and "ownership" (it can refer only to things external to subjects and to possible objects of choice). What is internal to the subject is outside of the realm of the legislative will. A law excluding those unable to pay from access to essential health care would not be just. A law granting that access would be just.

7-Alkoxyquinolines: new fluorescent substrates for cytochrome P450 monooxygenases.

A series of 7-alkoxyquinolines was synthesized and tested as substrates with hepatic microsomes prepared from male Wistar rats. Microsomal O-dealkylation rates and kinetic constants were determined for the 7-alkoxyquinolines with microsomes from control, 3-methylcholanthrene (MC)-pretreated, and phenobarbitone (PB)-pretreated rats. Structure-activity relationship studies indicated that the 7-benzyloxyquinoline was the most rapidly metabolized substrate for control microsomes and those from PB-pretreated rats, whereas the 7-ethoxy- and 7-propoxyquinolines were O-dealkylated more rapidly by microsomes of MC-pretreated animals. Differences in activities occurred in Vmax and apparent Km values; however, there does not appear to be a correlation between these two values for the different quinoline substrates. Apparent Km and Vmax values for the 7-alkoxyquinolines were: control microsomes, Km = 71-773 microM, Vmax = 0.37-8.4 nmol 7-quinolinol/min/mg protein; MC microsomes, Km = 0.5-14 microM, Vmax = 0.29-2.7 nmol 7-quinolinol/min/mg protein; PB microsomes, Km = 2.8-46 microM, Vmax = 0.9-12 nmol 7-quinolinol/min/mg protein. All of the quinoline substrates gave Type I binding spectra with control and MC microsomes. With PB microsomes, Type I. Reverse Type I, and a mixture of the two types of binding spectra were observed. Comparisons of the structure-activity relationships, levels of induction, and kinetic constants were made with 7-alkoxycoumarin and 7-alkoxyphenoxazone analogs. In addition, three new coumarin substrates (7-pentoxy-, 7-hexoxy-, and 7-benzyloxycoumarin) are described.

Differences between induction effects of 1,4-bis[2-(3,5-dichloropyridyloxy)]benzene and phenobarbitone.

The inductive effects of phenobarbitone (PB) and 1,4-bis[2-(3,5-dichloropyridyloxy)]benzene (TCPOBOP) were compared in C57BL/6J mice. Induction parameters included six substrates: ethylmorphine (EM), benzphetamine (Bph), biphenyl, ethoxycoumarin (EtoC), pentoxyresorufin and dichloro-p-nitroanisole (DPNA). In order to validate this descriptive approach the comparison was extended to diazepam, rifampicin, warfarin, and pregnenolone-16 alpha-carbonitrile (PCN). All inducers were clearly distinguishable from each other. Warfarin was similar to PB, rifampicin was similar to PCN. TCPOBOP differed significantly from PB in relative liver weight, cytochrome P-450 content of liver microsomes, EM-, Bph- and DPNA-demethylations, biphenyl-hydroxylations, EtoC de-ethylation and absorption maximum of reduced CO-cytochrome P-450. TCPOBOP, as an inducer, was less "specific" than PB: total metabolic rates were excessively increased due to microsomal protein (1.5 times) and cytochrome P-450 (4 times) augmentation, whereas cytochrome P-450-related metabolic rates were less increased than those after PB. Thus TCPOBOP does not seem to be as similar to PB as was suggested in the first description of its inducing potency.

Brief maternal deprivation of rats reduces hepatic mixed function oxidase activities.

Deprivation of pups from mother and sibs for 3 min daily from day 5 to day 41 of life reduced activities of 4 hepatic mixed function oxidases (MFO) expressed per mg protein in male rats compared to unhandled control rats. These decreases, though generally small, 22.4% and under, reached statistical significance for the substrates aminopyrine, benzphetamine and ethoxycoumarin. This handling procedure did not consistently affect the inductive response to phenobarbital. Previously ignored as a source of variability in response to xenobiotics, "handling" appears from these results to merit further investigation as such a factor in uninduced rats. Differences among rats in "handling" could contribute to large day-to-day variations in their metabolism of xenobiotics.

Is there a pleiotropic response in barbiturate induction?

C57BL/6J mice were treated with barbitone, phenobarbitone, thiopentone and hexobarbitone, respectively, for a period of 6 days, and the resulting induction effects compared. Among parameters measured were metabolic rates for ethylmorphine, biphenyl, ethoxycoumarin and pentoxyresorufin. Effects of inducers were easily distinguishable from each other. No fixed proportions were seen among increased metabolic rates, but increases of relative liver weight, cytochrome P450 per g liver and pentoxyresorufin metabolism were accompanied by a corresponding decrease of biphenyl-2-hydroxylation. Doubling the dose (NMRI mice) of hexobarbitone and thiopentone increased inductive responses, but did not render them more similar to each other. Pentoxyresorufin metabolism was increased 5- to 30-fold, calculated per nmol cytochrome P450. The results argue against the existence of one pleiotropic response--at least in a strict sense--in barbiturate induction.