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PubMed2002

Philosophy of public health: lessons from its history in England.

In a modern industrialized society it was essential for humankind to be protected by a strong medical presence, to establish a uniform system for public health everywhere in that society, to make public health independent from the welfare system, and to harmonize the relationship between personal hygienic rules and local authority rules. The society in Japan has developed on the basis of those four philosophical principles of public health, and has enabled the people to have the longest life expectancy in the world. However, the public health system in this society is now in a critical situation resulting from the long life expectancy. How can we rebuild the role of public health in this country? A society with a long life expectancy has to face a wide variety of health conditions. However, the health insurance system in Japan does not generally provide any service for a patient without specific symptoms. Consequently, to help people become aware of their own health condition, comprehensive public services such as general health check-ups, screening for cancers, and health counselling have been established locally by all 3250 municipal authorities. In promoting those services, people must learn how to draw the boundary-line between 'public' and 'private' in affairs of health to understand the importance of 'hygienic rules based on counsels for personal self-government', as Simon suggested 100 years ago, and health professionals must develop a public health system which depends not only on regulatory laws but also on scientific findings, as Rumsey advocated 150 years ago.

England↗
PubMed1989

A last call for self-regulation of biomedical research.

The indecisive response of the academic community to well-publicized cases of research fraud or serious misconduct has been characterized as a failure of self-regulation. The Institute of Medicine (IOM) Report on the Responsible Conduct of Research suggests measures for improving the research environment, by a combination of more explicit definition of standards of acceptable research practices, appointment of individuals to promote research standards and to respond to charges or complaints, improvement of supervision of research trainee, teaching of research ethics as well as technical skills, and reduction of the pressure to publish. The National Institutes of Health was asked to ensure that research institutions take such actions by requiring assurances as a condition of research funding. This essay discusses the recommendations and implications of the IOM report.

Biomedical Research↗
PubMed1993

Should the government assure scientific integrity?

The author argues that the somewhat Orwellian Office of Research Integrity needs careful scrutiny as to whether it should exist at all or whether its purported social benefits could be better achieved by other mechanisms. First, social issues specifically related to scientific misconduct need to be clarified so as to consider alternative regulatory measures. Constructive social policy requires balanced judgments that keep all goals in view and strives to promote science and to deal effectively with what may go awry (for example, falsification and fabrication, and plagiarism). Second, the regulation of scientific misconduct raises important questions, such as whether universities are able to police themselves. But is government regulation the best answer? The author suggests that a freestanding, nonprofit investigative foundation be formed and staffed by experts in investigations of scientific fraud as well as legal experts aware of investigative and due-process issues. Such a structure would remove the government from regulation (a boon) and relieve the university of the conflicts inherent in a duty to investigate and judge allegations. By the same token, the scientific community, including professional societies, would be at the center of the policing efforts of the foundation.

Academic Medical Centers↗
PubMed1993

Problems in research integrity arising from misconceptions about the ownership of research.

Many allegations of scientific misconduct result from activities that are perceived by the complainants as the "theft" of ideas, experimental results, or other intellectual property. The authors' thesis is that many of these allegations originate in misconceptions about the ownership of publicly supported scientific research. Some universities and medical schools may have their own codes for authorship, and journals and professional societies have codes or guidelines. In the NIH intramural programs, research data are considered to be the property of the institutes, not the individual researchers. In contrast, the training and experience of most scientists lead them to consider research data as being theirs. The paper discusses the origins of this attitude toward data and the ways that the structures of university laboratories and training programs lead to confusion and misunderstandings of researchers' "rights" to data. Also, emotional and personality factors often complicate these issues and lead to confrontations. Other misconceptions widely held among researchers: the false concepts of "my grant" and the "co-principal" investigator, ideas about who is and is not qualified to be an author, and ideas about sharing data. The authors emphasize the importance of scientifically literate legal advisers and the necessity for graduate students, postdoctoral fellows, and professors to understand their institutions' and grantors' guidelines and their obligations as scientists. At the heart of these obligations at all levels of research is honesty.

Academic Medical Centers↗
PubMed1993

A new perspective on scientific misconduct.

The level of social concern about any form of deviance reveals much about the society that disapproves of the behavior. In that light, why has scientific misconduct recently received so much public attention and opprobrium? Inquiring into this and related areas raises questions about the changing relationship between science and society. Rising concern about scientific misconduct may indicate that the state and other powerful actors see the value of science clearly, a perception perhaps intensified by a growing reliance upon science, the value of science as a resource for power, and the resulting desire of powerful social groups to control science. An important factor is the increased importance science has acquired within organizations (such as universities and businesses), requiring scientists to engage in more intense interactions with the professionals who work there, including lawyers, accountants, public relations specialists, and administrators. In itself, this tighter coupling of science to other social and organizational purposes would be expected to increase scrutiny and the likelihood of interventions. Also, this more frequent contact makes competition for dominance between professions more likely. Policies might be devised to renegotiate the relationship between science and society in a way that might alleviate the "pathogenic pressures" in the present environment. Specifically, the author suggests eight changes, including reducing and redistributing the financial rewards immediately available to scientists, their companies, and their universities by installing a form of "escrow" account to hold profits for a fixed period of time; decoupling graduate student and postdoctoral support from research grants; and resisting the trend to replace intrinsic rewards and controls with extrinsic ones.

Attitude↗
PubMed1993

Deviance in the practice of science.

The author discusses misconduct in biomedical research in terms of research about deviance. The ancient mantle of the sacred was transferred in the late nineteenth and early twentieth century from religious institutions to the scientists and the universities that they came to dominate. Universities were engaged in the pursuit of truth; and when science came to dominate universities, they became the hallowed ground of science. Many younger scientists consider that theirs is professional work like any other, but the general public, journalists, and policymakers still consider that scientists who break the rules are guilty of heinous offenses (violations of a sacred trust). This explains in part the different reactions of scientists and the public to recent scandals involving medical researchers. One of the most important points about deviance among scientists is the need to distinguish between rules imposed on the actor and rules that the individual is personally committed to. As government funding has come to dominate biomedical research, scientists have become part of huge bureaucratic entities with values, policies, and views often at variance from those of the scientific community. Increasingly, scientists find conflict between the values and mores of their community and the rules and mores of the federal and university bureaucracies that control modern science. Scientists can come to feel that they can violate the bureaucrats' rules and still be highly principled because they do not violate the values of science. The danger is that, by a process of drift, they can come to violate increasingly important, even primary, values of science.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗
PubMed2003

Gun control in the United States: ethical perspectives for the twenty-first century.

The current author will explore the way we should think about the ethical implications of gun control in the United States today. The generating pedagogy will be: (1) an explication of worldview perspectives, personal and community as per the author's recently published writings; (2) a discussion of the worldviews of both sides of the gun control debate; (3) a critical appraisal of the positions of each side; and (4) some suggestions about a future that is without ordinary citizen ownership of guns. The author argues that based on an ethical rights model of analysis, an ordinary citizen's right to bear arms is outweighed by other competing rights claims.

Attitude↗
PubMed1994

Posttraumatic stress disorder among Vietnam Theater Veterans. A causal model of etiology in a community sample.

Data from the National Vietnam Veterans Readjustment Study, conducted from 1986 to 1988, were used to develop and cross-validate a model of the etiology of posttraumatic stress disorder (PTSD) among a community sample of 1198 male Vietnam theater veterans. The initial model specified causal paths among five sets of variables, ordered according to their historical occurrence: a) premilitary risk factors and traumas, b) war-related and non-war-related traumas during the military, c) homecoming reception, d) postmilitary traumas, and e) PTSD. The initial model was refined and then cross-validated, leading to the specification of a final model with highly satisfactory fit and parsimony. In terms of the magnitude of their contribution to the development of PTSD, lack of support from family and friends at the time of the homecoming and exposure to combat were the two most influential contributors. Other contributing factors, in order of importance, were Hispanic ethnicity, societal rejection at the time of homecoming, childhood abuse, participation in abusive violence, and family instability. Exposure to war-related and non-war-related traumas occurred largely independently of each other, with war-related traumas contributing substantially more than non-war-related traumas to the development of PTSD. Limitations to interpretation of the results are noted due to the retrospective nature of the data and the inevitable omission of other etiological factors.

Adult↗
PubMed2002

Aggressive driving: a preliminary analysis of a serious threat to motorists in a large metropolitan area.

OBJECTIVE: Aggressive driving is consistently rated as the leading concern of motorists in our metropolitan area, ahead of even "drunken driving." Few objective data exist on the incidence of aggressive driving. The purpose of this study was to determine the incidence of selected aggressive driving behaviors and to establish a baseline for future interventions and research. METHODS: Speeding, traffic signal violations ("red-light running"), and stop-sign violations were studied. Speeding data were recorded by inductance loops embedded in major roadways (n = 10). Data were collected from red-light cameras (n = 73 cameras, 82 sites) and by trained observers at intersections with traffic signals (n = 15) or stop signs (n = 15). Data included total traffic volume, numbers of violations, and each violator's speed. RESULTS: The majority of motorists on major roadways drive at speeds exceeding the speed limit and between 40% and 80% of vehicles were traveling at 10 mph or more over the speed limit. Red-light running occurred at equivalent rates both by camera (1.5 violations/1,000 vehicles) and by observer (1.3 violations/1,000 vehicles). The absolute numbers of red-light violations were extremely high (approximately 30,000 per month), and 16% violated the signal at > 10 mph above the speed limit. The incidence of "at-speed" (i.e., without slowing) stop-sign violations was dramatic (17.5 violations/1,000 vehicles). These were confirmed by video review and represent high risk for crashes. CONCLUSION: Aggressive driving behaviors are frequent and often include very dangerous actions. Currently available deterrents appear to have limited impact in our congested area. Inadequate resources for enforcement and limited public awareness may be partially responsible. We have adopted a multidisciplinary approach to this serious problem including public education, stepped-up enforcement, and psychological treatments.

Accidents, Traffic↗
PubMed1975

Cost-sharing and prior authorization effects on Medicaid services in California: part I. The beneficiaries' reactions.

In January 1972, California initiated a cost-sharing "experiment" as a means of containing rising costs of the Medicaid program. Beneficiaries who had some personal assets were required to pay a token amount for each doctor visit or prescription. This was expected to deter unnecessary services without affecting really needed care. An interview survey was made of beneficiaries continuously in copayment status throughout the 18 months of the experiment. Most beneficiaries had poor knowledge of the program, and tended to confuse copayment with the concurrent constraint of prior authorization for certain classes of service. The beneficiaries reported that the copayment was almost always collected, and most thought it had not affected their health care, but a significant 17 per cent throught it had reduced the care available to them, and these 17 per cent were for the most part in households with high medical need.

Aged↗