Financial ties as part of informed consent to postmarketing research. Attitudes of American doctors and patients.

Postmarketing research, often called phase IV trials, is intended to familiarise doctors and patients with newly approved drugs. La Puma and colleagues, in Chicago, studied doctors' and patients' attitudes to whether doctors should receive payment for taking part in such research. We asked for commentaries on their findings from four ethical experts, who put the study in a British context, present the views of patients, and examine some methodological assumptions.

Community hospital ethics consultation: evaluation and comparison with a university hospital service.

BACKGROUND: Ethics consultants may improve patient care by responding to physician requests for assistance with problems they identify as ethical issues. OBJECTIVE: To examine three aspects of ethics consultation: the clinical questions asked; the helpfulness of the consultation to requesting physicians; and the differences between consultations performed at a community teaching hospital and those performed at a university hospital. SETTINGS: A community teaching hospital and a university teaching hospital. SUBJECTS: Physicians who formally requested ethics consultations in both hospitals and the patients for whom they requested them. METHODS: Over 2 years (January 1, 1988, to December 31, 1989), we prospectively evaluated a newly established clinical ethics consultation service in a community teaching hospital using confidentially completed, pretested, structured questionnaires, and compared our data with previously reported university hospital data. RESULTS: During the 2-year study, 104 consultation requests were received from 68 physicians in eight departments. Requesters most often requested consultation about deciding to forego life-sustaining treatment (74%), resolving disagreements (46%), and assessing patient competence (30%). Requesters found the consultation "very helpful" or "helpful" in one or more aspects of patient care in 86% of cases, or in one or more aspects of physician education in 86% of cases. These data are similar to university hospital data.

A perinatal ethics committee on abortion: process and outcome in thirty-one cases.

PIP: The US Supreme Court's June 1992 decision to uphold most of Pennsylvania's law restricting access to abortion confirms that while abortion is still permitted in the US, it is being increasingly regulated. Individual institutions may, however, find ways to permit access to abortion. One hospital formed a mandatory, prospective perinatal ethics committee (PEC) in May 1987 to develop clinical guidelines with which to consider and decide requests by physicians for their patients seeking abortions. The authors obtained the consent of this PEC to study its membership, processes, case outcomes, and clinical decision making. Understanding PEC processes and outcomes may help other institutions to decide whether to institute similar mechanisms. Specifically, the investigators determined the backgrounds and abortion-related beliefs of PEC members and obstetric and gynecology department members, whether the PEC affects the number of abortions performed, how PEC members decide in individual cases, and whether requesting physicians find the PEC helpful. All eleven PEC members and 58 of the 65 medical staff ob/gyn physicians returned background surveys. Study results are presented. Overall, the PEC appeared to function as an affirming regulatory body for second-trimester, medically-indicated terminations and for certain personal choice terminations. Institutional interests were well-served by the PEC and with the assurance of informed consent, the interests of some patients were also well served.^ieng

GLC determination of phenacemide in tablets.

A GLC procedure was developed for phenacemide and was shown to be less time consuming than the official assay without sacrificing accuracy. The procedure involves extraction from powdered tablets and addition of pentylenetetrazol as the internal standard. The amount of phenacemide is determined by comparison of the ratio of the area under the curves to that of a standard.

Anticonvulsant activity of alkyl-substituted N-benzylcyanoacetamides.

Thirteen new derivatives of 2-alkyl- and 2,2-dialkyl-N-benzylcyanoacetamide, a cyano analog of beclamide, were synthesized and tested for anticonvulsant activity. The unsubstituted compound was more active and more toxic than the derivatives. No activity was observed when the alkyl substituents in the symmetrically disubstituted derivatives contained a total of six or more carbon atoms or when benzyl was a substituent. The monosubstituted compounds were more toxic than the disubstituted compounds.

Rearrangement of N-benzyl-2-cyano-2-(hydroxyimino)acetamide.

The reduction of N-benzyl-2-cyano-2-(hydroxyimino)acetamide resulted in the formation of N-benzyl-1,2-ethanediamine and N-benzyl-N'-methyl-1,2-ethanediamine in approximately an equimolar ratio. The formation of the two unexpected products is explained by the migration of a cyano group in a Beckmann-type rearrangement.

Tetrazole analogs of phenylalanine derivatives as tyrosine hydroxylase inhibitors.

Eight new tetrazole analogs of phenylalanine derivatives in which the carboxyl group was replaced by a tetrazole ring were synthesized. At a concentration of 2.5 time 10(-5) M, each compound exhibited greater than 50% inhibition of tyrosine hydroxylase activity.

Synthesis of histamine analogs.

Nineteen histamine analogs were synthesized, and their biological actions were compared to those of histamine in blood pressure, gastric secretion, and nasal decongestant screens. The analogs include N-substituted 4-aminoethylimidazoles, N-substituted 2-pyridylethylamines, 2-pyridylcyclohexylamines, and 2-pyridylcyclopropylcarbamates. None of the compounds showed appreciable histamine agonist or antagonist properties.