Do we need USPs?

Australia is lacking the vital data relating to current practices needed to perform a meaningful evaluation of the quality of care in general practice. This article proposes that unannounced standardised patients (USPs) represent a valuable method of measuring actual performance in general practice. Constructive debate about the use of USPs may progress its acceptance as a valid tool for performance assessment and quality improvement.     

Do we need a threshold conception of competence?

On the standard view we assess a person’s competence by considering her relevant abilities without reference to the actual decision she is about to make. If she is deemed to satisfy certain threshold conditions of competence, it is still an open question whether her decision could ever be overruled on account of its harmful consequences for her (‘hard paternalism’). In practice, however, one normally uses a variable, risk dependent conception of competence, which really means that in considering whether or not to respect a person’s decision-making authority we weigh her decision on several relevant dimensions at the same time: its harmful consequences, its importance in terms of the person’s own relevant values, the infringement of her autonomy involved in overruling it, and her decision-making abilities. I argue that we should openly recognize the multi-dimensional nature of this judgment. This implies rejecting both the threshold conception of competence and the categorical distinction between hard and soft paternalism.     

Do we need to worry about eating wheat?

Wheat is a staple food throughout the temperate world and an important source of nutrients for many millions of people. However, the last few years have seen increasing concerns about adverse effects of wheat on health, particularly in North America and Europe, with the increasing adoption of wheat‐free or gluten‐free diets. This relates to two concerns: that wheat products are disproportionally responsible for increases in obesity and type 2 diabetes and that wheat gluten proteins cause a range of adverse reactions, including allergies, coeliac disease and ‘non‐coeliac gluten sensitivity’. The first concern has been refuted in previous publications, and we therefore focus on the second here. Current evidence indicates that allergy to ingested wheat and coeliac disease (and related intolerances) each occur in up to 1% of the population. The extent to which their prevalence has increased is difficult to quantify due to improved diagnosis and increased awareness. However, neither appears to be increasing disproportionally when compared with other immunologically mediated adverse reactions to food. Other adverse reactions to wheat are more difficult to define as their mechanisms are not understood and they are therefore difficult to diagnose. In particular, ‘non‐coeliac wheat sensitivity’ has been reported to occur in 6% or more of the population in the US. However, the application of more rigorous diagnostic criteria is likely to give substantially lower estimates of prevalence. It is therefore unlikely that the health of more than a small proportion of the population will be improved by eliminating wheat or gluten from the diet. In fact, the opposite may occur as wheat is an important source of protein, B vitamins, minerals and bioactive components.     

Do we need methodological theory to do qualitative research?

Positivism is frequently used to stand for the epistemological assumption that empirical science based on principles of verificationism, objectivity, and reproducibility is the foundation of all genuine knowledge. Qualitative researchers sometimes feel obliged to provide methodological alternatives to positivism that recognize their different ethical, ontological, and epistemological commitments and have provided three theories: phenomenology, grounded theory, and ethnography. The author argues that positivism was a doomed attempt to define empirical foundations for knowledge through a rigorous separation of theory and evidence; offers a pragmatic, coherent view of knowledge; and suggests that rigorous, rational empirical investigation does not need methodological theory. Therefore, qualitative methodological theory is unnecessary and counterproductive because it hinders critical reflection on the relation between methodological theory and empirical evidence.     

Do we really need SEVEN new aerosol particle sampling conventions?

The rationale behind recently proposed aerosol particle sampling conventions is discussed. The conventions are tailored toward estimation of dose to specific areas of the human respiratory tract prior to possible dissolution or clearance. Allowance is made for inter- and intra-person variation. Particle size from sub- to supermicrometer size is covered. The intent is to spur the development of personal sampling equipment for improved correlation between workplace assessment and health response.     

Do we need another randomized controlled trial of folic acid alone?

As a public health strategy to help prevent neural tube defect-affected pregnancies, enriched flour and pasta in the United States and Canada are being fortified with folic acid, and women are being advised to take supplementary folic acid around the time of pregnancy to ensure an adequate intake. But in spite of the recently published results of a public health campaign in China, the burden of proof that folic acid alone is responsible for a decreased risk of these birth defects rests on the results of a randomized controlled trial conducted by the Medical Research Council of the United Kingdom. Supporting evidence comes primarily from studies that have shown a protective effect of multivitamins containing folic acid as one of many nutrients. Based on a striking and potentially hazardous type of non-compliance observed in an earlier study in which a participant took multiple vitamin doses simultaneously and a suggestion of similar incidents in the Medical Research Council study, we conclude that a further randomized controlled trial of the protective effect of folic acid alone may be necessary.