Autonomy revisited: progress in medical ethics: discussion paper.
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Biomedical subjects
Publications and source records attributed to H Brody.
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The radiation sensitizers misonidazole (MISO) and desmethylmisonidazole (DMM) can produce central and peripheral neuropathy in patients and laboratory animals. Behavioral and pathological investigations have indicated that in the central nervous system this primarily involves the cochlear and vestibular systems. Nitroimidazoles can also interfere with glycolysis in vitro under aerobic and anaerobic conditions. In the present work we have studied the effect of MISO or DMM on lactate production and glucose utilization in mouse brain. It is observed that these compounds result in a 25% inhibition of lactate production in brain slices relative to the control at a 10 mM level. Additionally, MISO (1.0 mg/g/day) or DMM (1.4 mg/g/day) were administered daily (oral) for 1, 4, 7, or 14 days to examine the effect of these two drugs on the regional glucose utilization in C3Hf mouse brain. Five microcuries of 2-deoxy[14C]glucose was given following the last drug dose and autoradiographs of serial brain sections were made and analyzed by a densitometer. Following a single dose of either MISO or DMM, no significant differences in glucose uptake were observed when compared with controls. However, following 4, 7, and 14 doses the rate of glucose utilization was significantly reduced in the intoxicated animals. Larger reductions were measured in specific regions including the posterior colliculus, cochlear nuclei, vestibular nuclei, and pons with increasing effects observed at later stages. These results share a degree of correspondence with the regional brain pathology produced by these nitroimidazoles.
It has been argued that neither the biological or the moral justifications commonly given for adoption of brain-death criteria are adequate; and that the only argument that succeeds is an ontological justification based on the fact that one's personal identity terminates with the death of one's brain. But a more satisfactory ontological approach analyzes brain death in terms of the existence of a person in connection with a body, not personal identity. The personal-existence justification does not supplant the usual biological and moral arguments, but acts in concert with them.
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The 170-year-long debate in the medical literature about the ethics of prescribing placebos in medical therapeutics needs to be reevaluated in light of recent placebo research and improved understanding of the placebo effect as an integral part of the doctor-patient relationship. It has traditionally been assumed that deception is an indispensible component of successful placebo use. Therefore, placebos have been attacked because they are deceptive, and defended on the grounds that the deception is illusory or that the beneficent intentions of the physician justify the deception. However, a proper understanding of the placebo effect shows that deception need play no essential role in eliciting this powerful therapeutic modality; physicians can see nondeceptive means to promote a positive placebo response in their patients.
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Many currently accepted obstetrical practices exemplify a maximin strategy: making the best of the worst possible outcome, regardless of the actual probability of that outcome occurring. But a survey of recent obstetrical research fails to document superior clinical results when this strategy is employed in routine obstetrical care. Most research has studied obstetrical technologies in isolation rather than as parts of systems of interconnected interventions: this approach has tended to underestimate the risks of intervention and to overestimate the utility of a maximin strategy. Physicians practicing obstetrics should adopt a flexible approach and match the degree and type of intervention to actual patient needs. Better methods of assessing preventable prenatal risk are needed to allow identification of the rare-obstetrical patient requiring maximal intervention.
Hemophilus influenzae infections in adults are becoming more common but are often unsuspected in this age group by the primary care physician. Two case reports illustrate pharyngitis, and pharyngitis associated with cellulitis of the neck, in which H influenzae was cultured from the blood. The throat and skin are only two of the many sites for H influenzae infections in adults. As no physical signs are pathognomonic for this organism, its possible role should influence the choice of antibiotics while awaiting culture results. Newer cephalosporins, especially cefamandole and cefoxitin, appear promising in the treatment of these infections.