An extension of the concept of specific objectivity

Comparisons of subjects are specifically objective if they do not depend on the items involved. Such comparisons are not restricted to the 1-parameter logistic latent trait model, but may also be defined within ordinal independence models and even within the 2-parameter logistic model.     

Relativist ethics, scientific objectivity, and concern for human rights

This paper comments on the conflict between ethical relativism and anthropologists’ concerns with rights, and tries to show that neither scientific objectivity nor respect for cultural diversity require denying an extracultural stance for ethical judgments. An earlier version of this paper was presented at a symposium entitled “Ethics in Science: Special Problems in Anthropology and Archaeology” held at the 1998 Annual Meeting of the American Association for the Advancement of Science (AAAS), Philadelphia, PA, 15 February, 1998.     

Statistics and ethics in medical research

Ethical conduct is an essential component in research, especially in medical research. Statistical methods for design and analysis are powerful research tools if used properly. Abuse of these principles and methods are just as unethical as other laboratory or clinical misconduct. Inadequate research design can produce worthless results and thus wastes effort and valuable resources. For clinical research, patient resources are wasted. Inappropriate analysis of data can also produce misleading results and conclusions. For clinical research, inferior therapy might be given to patients as a consequence. These ethical concerns can have implications for and affect the individuals responsible for the statistical design and analysis. Examples are provided which illustrate some possible abuses and inappropriate pressures.     

Contributions of empirical research to medical ethics

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine.     

The logic of the medical research article

As do all forms of science, medical theories have a factual as well as a logical basis. New information is presented in medical research articles. These papers have three separate arguments: the argument of the hypothesis, the argument of the experimental protocol, and the argument of the hypothesis's judgment. These arguments may be examples of the hypothetico-deductive or confirmational model of scientific inference. The logical form of these arguments are informal and inductive rather than formal and deductive. Understanding the nature of the logic of the medical research article may help avoid erroneous conclusions.     

双向偏见引发冲突情境下自我归类对民族社会化觉察的影响——来自景颇族、傣族和汉族初中生的证据

采用情境实验法和故事补全任务,考察双向偏见引发冲突情境下的自我归类对景颇族、傣族与汉族初中生的民族社会化觉察的影响。结果表明,作为冲突事件的当事者,景颇族学生和傣族学生觉察到的促进和睦、文化社会化及促使不信任等民族社会化信息存在差异;景颇族、傣族和汉族学生的自我归类存在差异;自我归类对促进和睦、文化社会化与报告权威等信息的觉察的影响亦存在民族差异。在双向偏见冲突情境下,三族学生的自我归类与民族社会化觉察有一定关系:无论是做当事者/内群体归类、旁观者/外群体归类,还是做调解者/群际归类,被试对促进和睦的觉察均最多。偏见准备主要与当事者归类有关,而进行调解者归类的被试更容易觉察到"报告权威"。     

Ageism in Mental Health and Health Care: A Critical Review

Discussions of aging and mental health widely assume that ageism among mental health providers is an important factor limiting access to mental health services for older adults. Given the widespread citation of ageism as a problem, we critically review the history of the ageism construct, and evidence for its existence in both mental health and medical professionals. There is surprisingly little empirical evidence for age bias among mental health providers. Considerable evidence does suggest differential medical treatment for older adults in such diverse areas as physician–patient interaction, use of screening procedures, and treatment of varied medical problems, although it is unclear whether age bias accounts for these differences. We suggest that innovations in delivery of psychological services, such as collaborative medical/psychological care in primary care settings, may ultimately prove more useful in improving access to mental health services than efforts to combat ageism.     

Bows and ribbons,tape and twine: Wrapping the wraparound process for children with multi-system needs

The wraparound process for children with multi-system needs is one of the most innovative and popular reform efforts in children's services. Nonetheless, the articles in this special issue are indicative of a service reform process that is still maturing and evolving. In this commentary, three key questions regarding the wraparound process are posed: (a) What is wraparound? (b) What is the current state of research regarding wraparound services? and (c) What are the implications for the future? It is argued that the future of wraparound depends at least in part on: (a) carefully defining the wraparound process, including how to best integrate the process with reforms based on the principles of a comprehensive system of care; and (b) making a strong commitment at all levels to the process of cumulative knowledge, of building and creating innovative research and program efforts over time, one upon the other. It is concluded that a failure to invest in careful definition, refinement, implementation, and research on the wraparound process consitutes a failure to invest in children and families with multi-system needs.     

Ambiguity, trust, and the responsible conduct of research

Ambiguity associated with everyday practice of science has made it difficult to reach a consensus on how to define misconduct in science. This essay outlines some of the important ambiguities of practice such as distinguishing data from noise, deciding whether results falsify a hypothesis, and converting research into research publications. The problem of ambiguity is further compounded by the prior intellectual commitments inherent in choosing problems and in dealing with the skepticism of one's colleagues. In preparing a draft code of ethics for the American Society of Biochemistry and Molecular Biology (ASBMB), an attempt was made to take into account the ambiguities of practice. Also, the draft code adopted trust as its leading principle, specifically the importance of trust as a condition necessary for there to be science. During revision of the code, the focus on trust was changed. The new orientation was on trust as a consequence of carrying out science responsibly. By addressing the obligations necessary to engender trust, the ASBMB ethics code not only sets professional standards, but also makes a clear statement of public accountability.     

Ethically Allocating COVID-19 Drugs Via Pre-approval Access and Emergency Use Authorization

Abstract

Allocating access to unapproved COVID-19 drugs available via Pre-Approval Access pathways or Emergency Use Authorization raises unique challenges at the intersection of clinical care and research. In conditions of scarcity, prioritization approaches should minimize harm, maximize benefit, and promote fairness. To promote continued data collection, patients seeking access to unproven COVID-19 drugs should receive lower priority for allocation when they decline to participate in clinical trials, either of the requested drug or other investigational products, offering a comparable balance of risks and benefits; special attention should be paid to concerns of voluntariness and distrust. In addition, institutional treatment protocols that can contribute more robust real world data should be preferred to single patient requests for access, with priority for inclusion based on traditional clinical allocation criteria relying on available evidence. Fairness demands distribution of these protocols across a diverse range of sites, particularly those serving marginalized populations, among other protections.     

Psychology,behavioral sciences,and the challenge to medical education

It is generally agreed that the health care system is in crisis despite reform efforts over the past two decades. Evidence is presented which suggests that medical education has failed successfully to integrate medically relevant behavioral science research findings into medical school curricula or train physicians in the application of behaviorally based treatment technologies. Psychologists in medical education settings have the opportunity to impact medical education and foster psychology's role in health care. If psychology fails to respond to this opportunity, we cannot then complain of the inevitable consequences.An earlier version of this paper was presented at the annual meeting of the American Association of Medical Colleges, Washington, DC, November 1993.     

The Future of Psychology in Medical Specialities: Introduction to the Special Issue

The continuing evolution of the health care delivery system in the United States presents threats and opportunities to psychologists in medical settings. This special issue explores the future of psychology in psychiatry, family medicine, rehabilitation, geriatric medicine, and pediatric medicine. The challenges facing neuropsychology and pain management are explored also. Finally, the professional issues of ethics in managed care, psychology in the public sector, and training future psychologists are addressed. Each paper summarizes concerns and provides recommendations for clinical practice, research, and training.     

老龄化社会对老年人社会关怀对策的研究--对北京市老年人社会关怀调查的报告

我国进入老龄化社会的现实已经得到了全社会的广泛认同,但是社会缺乏必要的准备与对策;观念陈旧、重视不够、政策缺失、机构不足是当前急需解决的主要问题,应当引起全社会的极大关注,要集中力量,加强对策的研究与对策的实施,应对老龄化社会的挑战.     

健康公平--概念、影响因素与政策

长期以来健康不平等和不公平一直是卫生改革与发展所关注的重点,并已经成为了国际卫生政策的主要方向.在国家之间健康不平等和不公平也存在不同的理解.发达国家主要集中在产生疾病和导致死亡率差异的社会经济阶层的形成机制,将健康不平等作为疾病病原学的一个函数,关键措施是加强初级卫生保健;在中低收入国家,人们却趋向于通过提供基本的医疗保健服务来解决这一问题.     

医院的社会责任:伦理学视角

讨论了评价医院管理行动的伦理框架,严峻的卫生形势,医院的社会责任,其中着重讨论参与全面建设小康社会;向社会提供公平的卫生保健服务;重建医患信托关系以及调整与企业关系防止利益冲突.