Public Voices in Pharmaceutical Deliberations: Negotiating “Clinical Benefit” in the FDA’s Avastin Hearing

This article offers a hybrid rhetorical-qualitative discourse analysis of the FDA’s 2011 Avastin Hearing, which considered the revocation of the breast cancer indication for the popular cancer drug Avastin. We explore the multiplicity of stakeholders, the questions that motivated deliberations, and the kinds of evidence presented during the hearing. Pairing our findings with contemporary scholarship in rhetorical stasis theory, Mol’s (2002) construct of multiple ontologies, and Callon, Lascoumes, and Barthe’s (2011) “hybrid forums,” we demonstrate that the FDA’s deliberative procedures elides various sources of evidence and the potential multiplicity of definitions for “clinical benefit.” Our findings suggest that while the FDA invited multiple stakeholders to offer testimony, there are ways that the FDA might have more meaningfully incorporated public voices in the deliberative process. We conclude with suggestions for how a true hybrid forum might be deployed.     

The time course of semantic and associative priming effects is different in an attentional blink task

When two targets are presented using rapid serial visual presentation (RSVP) and the interval between the targets is 200–500 ms, report of the second target is impaired, a phenomena known as the attentional blink (AB). This study examined the time course of semantic-only and associate–semantic priming effects during an AB task. Three RSVP experiments were conducted using targets that shared either a semantic-only or an associative–semantic relationship. The results of the three experiments demonstrated semantic-only priming effects at the shortest stimulus onset asynchronies (SOAs). Associative–semantic priming was evident at shorter and longer SOAs. This suggests that priming in an AB task is driven by conceptual overlap facilitating lexical access at short SOAs and with longer SOAs lexical access benefits from word associations links between targets.     

Taking counselling and psychotherapy outside: Destruction or enrichment of the therapeutic frame?

This paper will explore emerging issues in the practice of counselling and psychotherapy in the outdoors, which the authors encountered when they took their clients outside of the traditional therapy room. The outdoors is defined as natural areas and spaces, such as woods and parks which have been termed ‘nearby nature’ (Kaplan &; Kaplan, 1989 Kaplan, R. Kaplan, S. (1989). The experience of nature a psychological perspective. New York: Cambridge University Press [Google Scholar]) and also more remote areas such as mountains and moors which are more isolated from civilisation, what some have termed wilderness (Mcfarlane, 2007). Particular emphasis will be given to the ‘frame’ of psychotherapy and how aspects of this are affected by moving outdoors, in particular contracting in relation to confidentiality and timing. The relationship in psychotherapy will be explored in relation to issues of mutuality and asymmetry alongside the role of nature in the therapeutic process. Lastly the challenges and therapeutic potential of psychotherapy in nature will be explored.     

Emotion recognition of static and dynamic faces in autism spectrum disorder

There is substantial evidence for facial emotion recognition (FER) deficits in autism spectrum disorder (ASD). The extent of this impairment, however, remains unclear, and there is some suggestion that clinical groups might benefit from the use of dynamic rather than static images. High-functioning individuals with ASD (n = 36) and typically developing controls (n = 36) completed a computerised FER task involving static and dynamic expressions of the six basic emotions. The ASD group showed poorer overall performance in identifying anger and disgust and were disadvantaged by dynamic (relative to static) stimuli when presented with sad expressions. Among both groups, however, dynamic stimuli appeared to improve recognition of anger. This research provides further evidence of specific impairment in the recognition of negative emotions in ASD, but argues against any broad advantages associated with the use of dynamic displays.     

The contribution of peer and media influences to the development of body satisfaction and self-esteem in young girls: a prospective study

This study aimed to prospectively examine the role of peer and media influences in the development of body satisfaction (incorporating the desire for thinness and satisfaction with appearance) in young girls, as well as the relationship between body satisfaction and self-esteem. A sample of 97 girls 5-8 years of age completed individual interviews at Time 1 and 1 year later at Time 2. Linear panel analyses found that Time 1 perception of peers' desire for thinness was temporally antecedent to girls' desire for thinness, appearance satisfaction, and self-esteem 1 year later. In addition, the watching of appearance-focused television programs was temporally antecedent to appearance satisfaction. Finally, girls' desire for thinness was found to temporally precede low self-esteem. Thus, as early as school entry, girls appear to already live in a culture in which peers and the media transmit the thin ideal in a way that negatively influences the development of body image and self-esteem.     

Stress and cytokine-elicited neuroendocrine and neurotransmitter sensitization: implications for depressive illness

Stressful events, by their effects on neurotransmitter and neuroendocrine processes, are thought to favor the development or exacerbation of depressive illness. In as much as immunological challenge, may provoke stressor-like neuroendocrine and central neurochemical changes, the view was offered that immune activation essentially acts like a stressor and may contribute to the evolution of affective illness. In this respect, viral and bacterial infections appear to influence behavioral/metabolic (e.g. fever, anorexia, somnolence) and neurotransmitter functioning through the release of cytokines, which act as messengers between the immune system and brain. The present report provides a brief overview of the neurochemical consequences of proinflammatory cytokine treatments, particularly the actions of interleukin (IL)-1beta and tumor necrosis factor-alpha. As well, synergy with psychogenic and neurogenic stressors are described, as are data showing that cytokines, like stressors, may have time-dependent proactive (sensitization) effects, so that reexposure to the treatments greatly augments hypothalamic-pituitary-adrenal activity, as well as central neurochemical changes. Indeed, the neurotransmitter alterations are not restricted to hypothalamic nuclei, but occur in several extrahypothalamic sites, including various limbic regions. It is suggested that by virtue of these neurochemical changes, cytokines may have both immediate and proactive effects on mood states.     

Physical Distance and AIDS: Too Close for Comfort?1

The purpose of the study was to assess attitudes toward AIDS as measured by physical distance. Fifty-two female students were told that they would be interviewing an AIDS patient, a homosexual, a cancer patient, or another student. While waiting, they arranged the two chairs for the interview. The distance between chairs was measured. Subjects placed the chairs significantly farther apart when they anticipated interviewing an AIDS patient than when they anticipated interviewing people under the other conditions. The results suggest that people are still uncomfortable with AIDS patients even under casual circumstances that require minimal physical contact. Implications for social interactions are discussed.     

Job orientations and the transition from school to work: A longitudinal study

This paper is concerned with the factors that influence career choice, job stability and job satisfaction. It uses longitudinal data collected from 450 grammar and secondary-modern schoolboys interviewed at ages 14 and 25 years. Examining job expectations at age 14 and initial career choice, it finds that school plays a major role, its importance deriving from structural rather than idiosyncratic considerations. Home, personal and chance factors are less important, mattering more in the case of secondary-modern than grammar pupils: they make their maximum impact at critical choice points when the school's influence is relatively weak. In adult life, the occupational structure takes over the role of school, job stability and satisfaction being largely associated with the training and career opportunities offered by particular jobs. An attempt is made throughout to identify the crucial periods and critical choice points where good counselling might make maximum impact.     

Decision-making capacity in elderly, terminally ill patients with cancer

Despite the importance and complexity of evaluating decision-making capacity at the end of life, little research has focused on terminally ill patients' decision-making ability. The purpose of this study was to explore the decision-making capacity of elderly, terminally ill patients and the psychological and physical factors that affect decision making. Decision-making capacity and cognitive abilities were assessed using four measures: the Hopkins Competency Assessment Kit, the Bechara Gambling Task, the Concept Assessment Kit, and the Mini Mental Status Exam. In addition, symptoms of depression, level of physical functioning, and extent of physical symptoms were evaluated in order to identify correlates of decision-making ability. Two samples were compared: elderly, terminally ill patients with cancer (n = 43) and elderly, physically healthy adults living in supportive community residence (n = 35). Results revealed significantly poorer decision-making abilities among the terminal ill sample compared with healthy comparisons, but no association between demographic variables (e.g., age, race, or education) or clinical variables (depression or physical symptoms) and decision making. Implications for evaluating decision-making capacity are addressed.