Newborn circumcision: an economic perspective

The purpose of this study was to analyse the hypothesis that prophylactic circumcision of male newborns is economically beneficial to the health care system in Canada. The minimal dollar benefits that would justify this conclusion were determined. The cost of the procedure was calculated in three Hamilton, Ont. hospitals and found to average about $38. The health benefits of circumcision are uncertain, but a review of the literature suggested that penile carcinoma is the most serious (and costly) disease potentially prevented by circumcision. Published estimates of the incidence rates, age at onset and costs incurred as a result of this disease were used in calculations of the per-case cost of prevention: $13.6 million. The authors conclude that the monetary benefits of circumcising newborns will not exceed this cost. It is proposed that the procedure be regarded as cosmetic surgery and be paid for by parents who wish the procedure carried out rather than by taxpayer-funded health insurance plans.     

Muslim patients and cross-gender interactions in medicine: an Islamic bioethical perspective

As physicians encounter an increasingly diverse patient population, socioeconomic circumstances, religious values and cultural practices may present barriers to the delivery of quality care. Increasing cultural competence is often cited as a way to reduce healthcare disparities arising from value and cultural differences between patients and providers. Cultural competence entails not only a knowledge base of cultural practices of disparate patient populations, but also an attitude of adapting one's practice style to meet patient needs and values. Gender roles, relationship dynamics and boundaries are culture specific, and are frequently shaped by religious teachings. Consequently, religion may be conceptualised as a cultural repertoire, or dynamic tool-kit, by which members of a faith adapt and negotiate their identity in multicultural societies. The manner in which Islamic beliefs and values inform Muslim healthcare behaviours is relatively under-investigated. In an effort to explore the impact of Islam on the relationship between patients and providers, we present an Islamic bioethical perspective on cross-gender relations in the patient-doctor relationship. We will begin with a clinical scenario highlighting three areas of gender interaction that bear clinical relevance: dress code, seclusion of members of the opposite sex and physical contact. Next, we provide a brief overview of the foundations of Islamic law and ethical deliberation and then proceed to develop ethicolegal guidelines pertaining to gender relations within the medical context. At the end of this reflection, we offer some practice recommendations that are attuned to the cultural sensitivities of Muslim patient populations.     

Chinese Medicine in US: The Regulatory Perspective

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Critical care medicine in China: history and perspective

Critical care medicine began in 1982 in China and is still in a phase of rapid development.Despite the inadequate resources compared with those of developed countries,critical care medicine has been recognized as a specialty by the government and by other specialties.National critical care societies are dedicated to promoting professional education and the academic improvement of critical care medicine in China.Although critical care services and clinical research are still underdeveloped due to scarce resources,great improvement is expected in the near future.     

The need for perspective in evidence-based medicine

Research advances are generating a growing body of clinical trial and other data on the effects of tests and treatments on outcomes, but there is no information resource within the health care system that systematically puts that information in perspective. Policy makers, clinicians, and individuals lack a ready means to compare the relative effectiveness of various interventions in prolonging survival or preventing the occurrence or complications of a disease: information that is critical in setting priorities. A crude analysis of preventable deaths suggests that evidence-based primary prevention (getting the population to stop smoking, exercise, lower cholesterol levels, and control blood pressure) would prevent considerably more deaths per year than would various evidence-based treatments for cardiovascular disease. Examining evidence from this perspective calls attention to mismatched priorities-most health care expenditures in the United States go toward treatment of diseases and their late-stage complications and relatively few resources are devoted to primary prevention and health promotion. Similar analyses at the individual level can help patients put personal options in perspective. This article proposes a bibliographic evidence-collection center and simulation modeling program to estimate potential benefits and harms of competing interventions for populations and individuals. Such evidence-based projections would enable policy makers, clinicians, and patients to judge whether they give due priority to the interventions most likely to improve health. With the steady growth in research data, the need for a system that enables society and individuals to put evidence in perspective will become progressively more urgent.     

Suicide: an Indian perspective

Suicide, as an issue, has attracted the attention of society since time immemorial. Its situation in India and the socio-demographic variables have been discussed along with management profile. The education of physicians and general practitioners in suicide prevention has been stressed.     

Apoptosis: an ocular perspective

Apoptosis is a programmed and controlled form of cell death, which is distinct from necrosis. It is a non-inflammatory process and plays an important role in numerous physiological and pathological events. It has an indispensable role in the development and homeostasis in tissues of all higher organisms. Apoptosis can be identified by various methods such as electron microscopy, agarose gel electrophoresis, deoxyribonucleic acid fragmentation analysis, Tdt-dUTP terminal nick end labelling (TUNEL) assay, flow cytometry, annexin V staining and enzyme assays. A number of genes have been identified which are involved in this process. Many approaches for the control of apoptosis are being developed from the understanding of its molecular mechanisms. These include pharmacological inhibition or overexpression of the involved genes, gene therapy by viral transduction of apoptotic inhibitors, inhibition of proteases, inhibition of intracellular rise in calcium concentration and inhibition by scavenging mediators of apoptosis such as reactive oxygen species. In the eye, apoptosis seems to play a role starting from embryogenesis to diseases of all its components. Modulation of apoptosis using different inducers and inhibitors could be of great importance.     

Terminology Standardization in Chinese Medicine： The Perspective from UCLA Center for East-West Medicine（Ⅱ）

THE VIEW FROM UCLA CENTER FOR EAST-WEST MEDICINE by Ka-kit Hui, M.D., and Sonya Pritzker, M.S., M.A., L.Ac Center staff and faculty below provide their