The Hippocratic Oath and clinical ethics

Its obvious shortcomings aside, this study by H. Steven Moffic, John Coverdale, and Timothy Bayer is disquieting. It comes as no surprise that residents have lapses of cognitive recall. Every medical teacher knows this very well. What is worrisome is that their amnesia concerns the oldest, most revered, and most influential moral statement in the history of the profession...Purely apart from its content, the oath continues to have power as the solemnification of a physician's entry into the profession. It signifies a willingness to submit to a way of life that demands some suppression of self-interest. If studying the oath more explicitly reenforces this solemnification or strengthens the physician's dedication to the welfare of the patient, the effort will be worthwhile.     

Value, pleasure and choice in the ventral prefrontal cortex

Rapid advances have recently been made in understanding how value-based decision-making processes are implemented in the brain. We integrate neuroeconomic and computational approaches with evidence on the neural correlates of value and experienced pleasure to describe how systems for valuation and decision-making are organized in the prefrontal cortex of humans and other primates. We show that the orbitofrontal and ventromedial prefrontal (VMPFC) cortices compute expected value, reward outcome and experienced pleasure for different stimuli on a common value scale. Attractor networks in VMPFC area 10 then implement categorical decision processes that transform value signals into a choice between the values, thereby guiding action. This synthesis of findings across fields provides a unifying perspective for the study of decision-making processes in the brain.     

School psychologists' services in special education programs

Reviews school psychologists' services in special education programs. Fifty-eight credentialed school psychologists in 10 school districts were interviewed individually about background and training, professional duties, favored clinical techniques, and opinions and recommendations for improved services. According to self-reports, the bulk of time was devoted to activities directly related to assessment of pupils with little involvement in research, in-service training, or other clinical activities. Professional association memberships were primarily local. Assessment techniques tended to be limited to a few standardized tests. Overall findings support sample psychologists' expressed concerns as to need for changes in preservice and in-service training.     

Toward a reconstruction of medical morality

At the center of medical morality is the healing relationship. It is defined by three phenomena: the fact of illness, the act of profession, and the act of medicine. The first puts the patient in a vulnerable and dependent position; it results in an unequal relationship. The second implies a promise to help. The third involves those actions that will lead to a medically competent healing decision. But it must also be good for the patient in the fullest possible sense. The physician cannot fully heal without giving the patient an understanding of alternatives such that he or she can freely arrive--together with the physician--at a decision in keeping with his or her personal morality and values. In today's pluralistic society, universal agreement on moral issues between physicians and patients is no longer possible. Nevertheless, a reconstruction of professional ethics based on a new appreciation of what makes for a true healing relationship between patient and physician is both possible and necessary.     

Assessing the relationship between cold pressor pain responses and dimensions of the anxiety sensitivity profile in healthy men and women

Anxiety sensitivity (AS) has been shown previously to be an important factor in the perception and experience of experimentally induced pain within healthy adults. The aim of the current study was to extend this research by: (i) using the Anxiety Sensitivity Profile (ASP) as an alternative measure of AS; (ii) examining whether different coping instructions affect pain reports; and (iii) investigating potential differences between men and women. Participants were 50 healthy adults (23 males, 27 females) who were required to complete 2 versions of the cold pressor pain task; one version required the use of control instructions, whereas the other made use of acceptance-based instructions. Although the coping instructions were found to affect pain thresholds (acceptance resulted in lower thresholds), a similar pattern of correlations were found between the pain indexes and AS under both conditions. Of the ASP subscales, the gastrointestinal and cognitive concerns components were found to be the most strongly related to pain experiences. When the analysis was conducted separately for each sex, the ASP scales were related to the self-report measures of pain in women, whereas they were related to the behavioural measures of pain in men. These results not only confirm that AS is associated with experimental pain, but that there may be sex differences in this relationship.