Progress: Its Glories and Pitfalls

Steven Pinker, a cognitive psychologist and linguist at Harvard and a savant of big ideas, is one of the latest to take on the idea of progress. He does it under the aegis of “enlightenment,” which comes down to a kind of holy trinity of reason, science, and humanism. His new book, Enlightenment Now: The Case for Reason, Science, Humanism, and Progress, is ambitious and cantankerous and heady with hope. On the whole, Pinker makes a good case for the benefits of progress, but with an overdose of feel‐good prose. His greatest failure comes in exaggerating the threats to science and in avoiding some problems altogether. He ignores its complexity, its shadows, its creation of new problems raised by its solutions to old ones. Pinker has a particular animus against bioethics, and he misses what has been, I would argue, at the heart of bioethics from its beginning fifty or so years ago. Bioethics was prompted by a new class of medical dilemmas that require a difficult balancing of harms and benefits. Most of them are still with us, and most of them are the result of the progress of postwar medical research and fast‐changing clinical practices.     

Noncomparative contraceptive efficacy of cellulose sulfate gel

OBJECTIVE: To estimate the 6-month cumulative probability of pregnancy, short-term adverse effects, and acceptability of cellulose sulfate vaginal contraceptive gel. METHODS: Two hundred fertile heterosexual couples were enrolled in this single-center, phase II, 6-month noncomparative study conducted at the California Family Health Council in Los Angeles, California. Couples did not desire pregnancy, were at low risk for sexually transmitted diseases, and agreed to use 3.5 mL of cellulose sulfate gel intravaginally before each coital act as their primary means of contraception. Scheduled follow-up visits took place after one menstrual cycle and at study completion, which occurred after 6 months and six menstrual cycles had elapsed. In addition, participants were instructed to call the site at the onset of each menses to review their diary cards. RESULTS: The cumulative probabilities of pregnancy during 6 months and six cycles of typical use were 13.4% (95% confidence interval [CI] 7.5-19.4%) and 13.9% (95% CI 7.7-20.2%), respectively, and during 6 cycles of correct and consistent ("perfect") use: 3.9% (95% CI 0.0-9.2%). Slightly over one fourth of the women and one man reported experiencing gel-related adverse events, two thirds of which were mild and only possibly related to the gel. Three quarters of women and men reported that they would buy cellulose sulfate gel for contraception. CONCLUSION: Cellulose sulfate vaginal gel yields pregnancy rates comparable to nonoxynol-9 and few adverse events among couples at low risk for sexually transmitted diseases.     

A comparison of client preferences for intervention empirical support versus common therapy variables

Client preferences have been identified as an essential part of evidence‐based practice in psychology. Further, client preferences have been found to play an important role in determining premature termination and therapy outcomes. However, our current understanding of this client variable is limited because of the methodologies that have previously been used to assess these preferences. In this study, 57 adult clients from a university‐based psychology department clinic completed an instrument weighing preferences for intervention specific empirical support against preferences for 4 other common factor variables. These clients were found to discount a significant amount of intervention empirical support to ensure the following: (a) a satisfactory therapeutic relationship could be developed, (b) their therapist would be empathetic and accepting, (c) their therapist would have a greater level of experience, and (d) they, as clients, would do more of the talking during sessions. These findings suggest that clients prefer treatment decisions to be based on variables other than intervention empirical support alone. Recommendations are made for assessing and including client preferences to provide more individually tailored interventions. © 2010 Wiley Periodicals, Inc. J Clin Psychol 66:1–15, 2010.