Medicine and the media:

A paper that won a prize at a British Paediatric Association meeting (Anand, K.J.; Sippell, W.G.; and Aynsley-Green, A., "Randomised trial of fentanyl anaesthesia in preterm babies undergoing surgery," Lancet 1987 Jan; 1(8524): 243-248) has been condemned by some sections of the British press and by some members of Parliament. The critics charge that the reported research, which provided the first scientific evidence of the benefits of deeper anesthesia during operations on preterm infants, was unethical because the infants were subjected to pain. Forfar, president of the British Paediatric Association, and Campbell, chairman of the Association's Ethics Advisory Committee, commend the research because it was done with parental consent, was designed to reduce suffering in newborns, met high scientific standards, and will confer benefits on many infants. They criticize the parliamentary press release's intemperate language and inclusion of erroneous statements.     

Multiple myeloma: the present and the future

Major advances continue apace in therapy and in understanding its molecular pathogenesis.     

Placebos: the nurse and the iron pills

In sub‐Saharan Africa, a nurse gives iron pills as placebos to terminally ill patients. She tells them, acting in what she believes is in their best interests, “these will make you feel better”. The patients believe it will help their AIDS and their well‐being improves. Do the motive and the patient''s positive outcome in well‐being make the deceit justifiable when other issues such as consent, autonomy and potential consequences regarding the patient and the wider community are considered? Is there a difference between lying and non‐lying deception when the end result is the same? The patients feel better, but at what cost if the deceit was found out? It will be argued that although the actions of the nurse are understandable and to some extent defensible, they are unethical. It is not ethically acceptable to take away the patient''s autonomy and risk the health of the community even though the risk of deceit being discovered is a small one.This is a true case, witnessed first‐hand on a recent visit to sub‐Saharan Africa. A community HIV nurse visits a rural village to provide home‐based care for terminally ill patients with AIDS. The active treatment for AIDS (antiretroviral drugs) is either unavailable or unaffordable to her patients and the nurse cannot provide such treatment. Instead, she gives placebos in the form of iron tablets to her patients. She says to them “these will make you feel better”. The implication and the interpretation of these words from the patient''s perspective is that it will improve their AIDS.There are many moral and ethical issues surrounding this case. The nurse is knowingly giving the patients treatment that is ineffective for their condition. The nurse is very experienced in this field and believes that the act of taking medicines that are believed to be active, her patients feel an improvement in their health. She believes that she is doing the right thing as she is fulfilling what she sees as her role—making her patients feel better.However, independent of whether or not giving placebos is morally right, the underlying ethical issue in this case is the deception. Although the motive for the deception was in good faith, the nurse intentionally implies that the medicine is helping the AIDS. Do the motive and the patient''s positive outcome make the deceit justifiable when other issues such as consent, autonomy and potential consequences regarding the patient and the wider community are considered?     

泌尿外科的回顾和展望

近年来,随着泌尿外科相关领域的发展,泌尿外科得到了迅速发展,特别是在微创泌尿外科方面更是如此,包括激光、冷冻等新技术的应用与拓展,机器人腹腔镜及单孔腹腔镜技术在泌尿外科的应用等.至今大部分泌尿外科疾病都可以通过微创手术得到治疗.     

神经外科回顾与展望

1 神经外科的起源 1862年,美国埃及学家Edwin Smith发现了一本古埃及医学手抄文稿,该文稿诞生于公元前17世纪,采用症状形式的描述,首次记载了颅缝、脑膜、脑表面、脑脊液、颅内搏动、脑损伤后身体其他部位的功能变化以及偏瘫挛缩、颈椎脱位伴截瘫和尿失禁症状,被认为是人类史上第1本神经外科论著.