Limiting the access to direct-acting antivirals against HCV: an ethical dilemma

Introduction: Hepatitis C virus (HCV) infection affects about 200 million people worldwide and represents a leading cause of liver-related mortality. Eradication of HCV infection, achieved mainly through direct-acting antivirals (DAA), results in a decrease of mortality and an improvement of quality of life. These drugs have a maximal efficacy and an optimal tolerability. However, their high cost precludes a universal access even in wealthy countries.

Areas covered: This article deals with the policies adopted for the use of the new anti-HCV drugs, especially in Europe and most of all in Italy, supposedly the developed country with the highest HCV prevalence. The literature search was performed using Pubmed and Web of Science. Moreover, national regulatory institutional websites were consulted.

Expert commentary: The current policy of limitation to the access of the DAA presents a series of ethical issues that makes it non-applicable. A ‘treat-all’ strategy should resolve all ethical dilemmas, by virtue of the wide benefits of anti-HCV treatment not only for the advanced stage of infection, but also for the initial stages. A reduction in price of the drugs is the actual condition to achieve such a change.     

Oxytocin, but not vasopressin, increases both parochial and universal altruism

In today's increasingly interconnected world, deciding with whom and at what level to cooperate becomes a matter of increasing importance as societies become more globalized and large-scale cooperation becomes a viable means of addressing global issues. This tension can play out via competition between local (e.g. within a group) and global (e.g., between groups) interests. Despite research highlighting factors influencing cooperation in such multi-layered situations, their biological basis is not well understood. In a double-blind placebo controlled study, we investigated the influence of intranasally administered oxytocin and arginine vasopressin on cooperative behavior at local and global levels. We find that oxytocin causes an increase in both the willingness to cooperate and the expectation that others will cooperate at both levels. In contrast, participants receiving vasopressin did not differ from those receiving placebo in their cooperative behavior. Our results highlight the selective role of oxytocin in intergroup cooperative behavior.     

关于汤姆·雷根动物权利理论困境的解析

汤姆·雷根作为动物权利运动最杰出的代表,曾经用大量充满激情的语言呼吁动物权利,但由于对动物权利理论的来源?存在基础?保护范围的界定等方面缺乏具有说服力的论证,在实践层面其所主张的“空笼理论”也不具备现实的可行性?但不容否认,动物权利理论作为一种现实的理论表现形态,仍不失为人类伦理学发展史上一个具有重要意义的进步?     

Novelty and Inductive Generalization in Human Reinforcement Learning

In reinforcement learning (RL), a decision maker searching for the most rewarding option is often faced with the question: What is the value of an option that has never been tried before? One way to frame this question is as an inductive problem: How can I generalize my previous experience with one set of options to a novel option? We show how hierarchical Bayesian inference can be used to solve this problem, and we describe an equivalence between the Bayesian model and temporal difference learning algorithms that have been proposed as models of RL in humans and animals. According to our view, the search for the best option is guided by abstract knowledge about the relationships between different options in an environment, resulting in greater search efficiency compared to traditional RL algorithms previously applied to human cognition. In two behavioral experiments, we test several predictions of our model, providing evidence that humans learn and exploit structured inductive knowledge to make predictions about novel options. In light of this model, we suggest a new interpretation of dopaminergic responses to novelty.     

The placebo dilemma

Summary Placebos have been used since about 1950 in evaluation and interpretation of drug efficacy, especially of new drugs, and in comparison with existing compounds to establish their clinical therapeutic value. There are a number of problems connected with use of an inert nothing the informed consent, which is required in a human experiment, the doctor's consciousness of deceitful behaviour, the potential risk for the patient and the doctor, the high effect rate of placebos (± 35%), unexpected side-effects, dependency of patients on placebos, discovery by the patient of the placebo treatment, factors independent of the medication, such as the doctor's bias, the nurses influence, the significance of colour, the inconsistency of placebo-reactor or non-reactor types and the genetic state of the patient, as well as the problems associated with a double blind test, which can hardly be used when a patient has previously received a medicine, such as morphine, with its euphoric effect, and the colour change produced in urine by drugs like rifampicin or riboflavin. Only a well-trained and experienced clinical observer should employ a placebo in establishing the therapeutic value of drugs whilst avoiding undesirable pitfalls.     

Life course changes provoked by chronic disease: A study on everyday life for patients with systemic lupus erythematosus

ObjectiveThis study examined patients with systemic lupus erythematosus (SLE) as a means to explore the impacts of chronic disease on life courses.MethodsA semi-structured in-depth interviews were conducted with nine patients in China in 2017; participants were included based on their having or having had facial butterfly erythema.ResultsThe study focused on both the disease’s impact on the patients’ health and on their daily lives. Four core themes emerged: visible changes in the patient’s bodies, social dilemmas, “the encouragement of disease”, and a new perspective on the relationship between disease and health. One important finding was that the occurrence of a chronic disease did not have only negative repercussions; some patients felt that there were advantages to being sick. Chronic disease resulted in a reworking of daily life. The patients developed a self-referential model of healing.ConclusionThe distinct interpretations of the same disease offered by different patients served to yield a more complete understanding of the disease. People with SLE adjust their thinking about the disease based on personal feelings as well as experiences and pursue a dialogue on their illness based on the disease pattern unique to them. The meaning that disease had for the patients was not limited to negative connotations.     

心脏外科ICU护士道德困境、伦理决策、职业倦怠现状及其相关性分析

目的:探讨心脏外科重症监护室(ICU)护士道德困境、伦理决策、职业倦怠的现状并分析其相关性。方法:采用中文版护士道德困境量表、护士伦理决策量表和中文版护士职业倦怠量表对武汉市2所三级甲等医院的108名心脏外科ICU护士进行问卷调查。结果:心脏外科ICU护士道德困境总分为(66.46±35.81)分,伦理决策总分为(173.45±19.16)分,职业倦怠总分为(130.76±27.86)分。心脏外科ICU护士的道德困境与其职业倦怠呈正相关(r=0.312,P<0.05),护士伦理决策行动维度与其职业倦怠呈负相关(r=-0.258,P<0.05),且护士的伦理决策与其道德困境呈负相关(r=-0.232,P<0.05)。结论:心脏外科ICU护士的道德困境和伦理决策中的行动维度与其职业倦怠密切相关,且护士的伦理决策与其道德困境也存在明显相关性。护理管理者应该重视心脏外科ICU护士在工作中面临的各种道德困境问题,同时建议护理管理者从多个方面来培养和提高心脏外科ICU护士的伦理决策能力,从而减轻其职业倦怠。     

Heterotopic ossification in psammomatous spinal meningioma: a diagnostic controversy

Heterotopic ossification (HO), a synonym for osseous metaplasia, is a pathological phenomenon, characterized by abnormal bone formation outside the skeletal system observed commonly in various neoplastic and non-neoplastic diseases. HO occurring in meningioma is exceptionally rare. We reportherein an unusual case of spinal meningioma containing numerous calcified psammoma bodies and extensive HO in a 75-year-old woman, who presented with progressive worsening bilateral lower limb weakness and numbness. The presence of remarkable bone formation within a meningioma is controversial among pathologists; while some regard them as psammomatous meningioma as the primary diagnosis, others prefer osteoblastic meningioma, a form of metaplastic meningioma. There is compelling molecular data to advocate that HO is an active disease process involving metaplastic (osseous) differentiation of meningioma stroma mesenchymal stem-like cells, but not the meningothelial-derived tumor cells. Henceforth, the term “metaplastic meningioma” may not be appropriate in this context. A plausible designation as “psammomatous meningioma with osseous metaplasia” defines this entity more accurately. This paper highlights the need for a unifying nomenclature to reduce diagnostic controversy caused by conflicting terms in the literature. The possible pathogenesis of this intriguing phenomenon is discussed.     

Pediatric liver transplantation - ethical dilemmas in a disabled patient

Allocation of medical resources, especially resources with absolute scarcity such as organs for transplant, is a difficult task. Medical, surgical, and ethical considerations should be evaluated. In solid organ transplantation, ethics committees are the gate keepers that deal with moral philosophy when moral values are in conflict. Often, no good solution to a dilemma in these medical ethics exists. Our case presents split living liver donation for retransplantation in a mentally disabled girl, with few medical ethics principles at stake.     

Experimental Study on the Influence of Cognition and Emotion on Moral Judgment of College Students in Dilemma Situation

Objective: To study the influence of cognition and emotion on moral judgment of college students under thecircumstance of whether the cognitive resources are occupied and whether the emotion is induced. Methods: Thisexperiment uses a multi-factor mixed experiment method to divide experiments and groups. Experiment 1 uses atwo-factor mixed experimental design of 2 (cognitive resource occupancy group, cognitive resource non-occupiedgroup) × 3 (difficult situation type). Experiment 2 uses a two-factor mixed experimental design of 2 (emotioninduction group, emotion induction and cognitive resource occupation group) × 3 (three types of dilemma situation types) is adopted. The dependent variable of this experiment (including Experiment 1 and Experiment 2) isthe judgment response time and the judgment result is “Yes” (F) or “No” (J). Results: (1) The reaction time of thecognitive resource occupancy group was significantly higher than that of the cognitive resource non-occupiedgroup, and the cognitive resource occupancy group in the three types of dilemma situations of high personalinvolvement, low personal involvement, and non-personal participation. There is no significant differencebetween the results of moral judgments and the cognitive resource non-occupied group. (2) In the three dilemmasof high personal involvement, low personal involvement, and non-personal participation, the emotion-inducedgroup and the emotion-induced and cognitive resource occupation group have no significant differences in reaction time and moral judgment results. (3) In the three dilemmas of high personal involvement, low personalinvolvement, and non-personal participation, the reaction time difference between the cognitive resource occupation group and the emotionally induced and cognitive resource occupation is not significant, while In the dilemma of low personal involvement, the number of people in the cognitive resource occupation group whose moraljudgment is “Yes” was significantly higher than that in the emotionally induced and cognitive resource occupationgroup. (4) In the three dilemmas of high personal involvement, low personal involvement, and non-personal participation, the reaction time of the emotionally induced group was significantly higher than that of the cognitiveresource non-occupied group, and the moral judgment results of the two groups were both There is no significantdifference. Conclusion: When the occupation of cognitive resources and the induction of emotions will signifi-cantly affect the response of individual moral judgments, different types of dilemmas will significantly affect theresults of individual moral judgments.