No Harm,No Foul? Justifying Bans On Safe Performance-Enhancing Drugs

Scholars such as Simon (2007; 2004) and Loland (2002) as well as the authors of the World Anti-Doping Code (2001) argue that using performance-enhancing substances is unhealthy and unfairly coercive for other athletes. Critics of the anti-doping position such as Hoberman (1995), Miah et al. (2005) and Tamburrini (2007) are quick to argue that such prohibitions, even though well-intended, constitute an unjustifiable form of paternalism. However, advocates for both of these positions assume that preserving good health and, conversely, avoiding health-related harms, lie at the centre of the debate. Given the apparent stalemate in the debate over the validity of health concerns on performance-enhancing drugs, in this essay, I investigate ethical issues of ‘harm-free’ pharmaceutical performance enhancement. Beginning with the hypothesis that a harm-free performance-enhancing drug may be produced in the future, I ask if there would still be compelling reasons for prohibiting such a drug. I address this question by providing two arguments against allowing athletes to use pharmaceutical performance-enhancing drugs – the damage to the testing and contesting of sport and the loss of internal goods that are intrinsically satisfying. These two arguments taken together, I argue, are sufficient to sustain the prohibition of pharmaceutical performance-enhancing drugs without citing their harmful side effects.     

Effects of MK-801 and ethanol combinations on memory consolidation in CD1 mice: involvement of GABAergic mechanisms

In the present research the effect of the noncompetitive N-methyl-d-aspartate receptor antagonist MK-801 and ethanol combinations on memory consolidation and the involvement of GABAergic mechanisms in this effect were investigated in CD1 mice injected intraperitoneally with the drugs immediately or 120 min after training in a one-trial inhibitory avoidance apparatus and tested for retention 24 h later. The results showed that (a) the retention performances of mice were impaired in a dose-dependent manner by immediate posttraining MK-801 (0.2 and 0.3, but not 0.1 mg/kg) and ethanol (1 and 2, but not 0.5 g/kg) administrations; (b) an otherwise ineffective dose of MK-801 (0.1 mg/kg) enhanced the deleterious effect exerted by ethanol (1 and 2 g/kg); (c) an otherwise ineffective dose of muscimol (0.5 mg/kg) enhanced, while otherwise ineffective doses of picrotoxin (0.25 mg/kg) or bicuculline (0.1 mg/kg) antagonized, this effect; and (d) no effect was observed when the treatments were carried out 120 min after training, suggesting that the effects observed following immediate posttraining administrations were due to the influence on the consolidation of memory. From these experiments it is evident that (a) MK-801 enhances ethanol's effects on memory consolidation and (b) GABAergic mechanisms are involved in this effect.     

Cognitive Behaviour Therapy for Schizophrenia in Patients with Mild to Moderate Substance Misuse Problems

Rates of substance misuse are high among patients with schizophrenia. Cognitive therapies have been developed separately for both problems but little is known about outcome for this group of dual diagnosed patients. Data from a major trial of cognitive behaviour therapy for psychosis was therefore sub‐analysed to determine whether this therapy is effective in those with schizophrenia and mild to moderate substance misuse. During the original study patients received a brief cognitive behaviour therapy‐based intervention for schizophrenia delivered by trained and supervised nurses. The control group received care as usual. The outcome measures included: total psychopathology using the Comprehensive Psychopathological Rating Scale (CPRS) and Health of the Nation Outcome Scale (HoNOS), change in schizophrenic positive symptoms using Schizophrenia Change Scale (SCR), anxiety using the Brief Scale for Anxiety (BAS), depression using the Montgomery‐Asberg Depression Rating Scale (MADRS) and insight using the Assessment of Insight Scale, at baseline and end of therapy. In the original study, patients who received cognitive behaviour therapy showed improvement in overall symptomatology (p = 0.01), insight (p = 0.00) and depression (p = 0.00) compared with the control group. In the present sub‐analysis, no interaction was found between treatment group and presence or absence of substance misuse. There was a reduction in substance misuse after treatment in both the cognitive behaviour therapy and control groups but this did not differ between them. It appears that mild to moderate degrees of substance misuse did not change the outcome of cognitive behaviour therapy for psychosis in this sub‐analysis.     

我国药品“含贿”问题的成因及治理

药品“含贿”是造成近年来我国药品价格虚高的重要原因,既增加了患者的负担,也造成了医患关系的紧张。其成因主要是医患间委托—代理关系下,医生得不到有效激励,劳动力消耗得不到完全补偿;患者无法有效监督医生,使医生产生了自身利益最大化而损害患者利益的行为。药品“含贿”造成了患者福利水平的降低和医生违法违规风险的加大,从如何有效监督医生和加强对医生的激励两个方面提出了相应的治理措施,以期提高医患双方的福利水平。     

“医药分业”改革的经济学分析

目前,我国药品监督管理机构正在推行“渐进式的医药分业”政策,目标是将药品价格总体下降26%～30%,将每年469亿元～547亿元的药品毛利化作医疗服务收费标准的调整幅度,以后医疗服务收费标准按物价指数逐年调整。但在现有条件下执行这一政策,表面上医疗机构是直接的利益受损者,但事实上广大的药品消费者或支付者将为之埋单而成为利益受损者,药品生产者和流通渠道才是这一政策的真正受益者,政府也将面临提高医疗服务收费标准或增加医疗机构补偿的两难抉择。     

抗感染治疗的今天和明天

抗菌药物治疗是临床医学界普遍关切的问题。滥用抗生素的问题引起社会和政府的重视。但解决这问题需要重视调查研究,充分应用科学研究成果,制定科学合理的政策和规定。本文还从医生的角度,对经验用药、社区获得性肺炎治疗中的几个问题,介绍了国外的做法,对应用药代动力学和最低抑菌浓度结合的研究方法,包括Monte Carlo模拟的实验和临床研究,以及防突变浓度（MPC）和突变选择窗（MEw）的概念作了介绍。     

红颜还是祸水——由Lybrel等控制月经引发的思考

本文追溯人类对月经的认识的演变,同时记录避孕药物的历史沿革,并分析其利弊。虽然通过药物方法减少甚至停止月经的安全性和伦理尚存争议,随着科技的进步和人们观念的改变,更多的女性仍会选择控制月经,来为其带来更健康、便捷的生活。“我的月经我做主”会成为未来女性的生活方式。     

静脉药物配置中心国内现状及存在问题

通过对国内多家医院静脉药物配置中心的实地参观、电话咨询及文献分析,了解静脉药物配置中心建设在国内医院的发展现状和工作中存在问题。为更多将要建设静脉药物配置中心项目的医院提供资料和建议,促进静脉药物配置中心项目更快、更好的发展。医院静脉药物配置中心的建设是必然趋势,但各医院应根据自己的实际情况制订合适的规模和建设方案。     

产前诊断中的伦理学问题

药价虚高已成为影响广大人民群众切身利益的突出的社会问题。国家有关部门通过政府行政手段进行了多次药品降价行动,但效果并不明显,"药价虚高"的现状并未得到根本扭转。影响药价虚高的因素归纳起来,就是医疗卫生体制因素和市场流通机制因素,从药品市场角度探讨药价虚高现象的成因和解决途径。     

Neighborhood and Individual Factors in Marijuana and Other Illicit Drug Use in a Sample of Low-income Women

Few studies have systematically evaluated whether contextual variables differ in their ability to explain the use of different drugs in the same sample. Our objective was to examine correlates of use for different illicit drugs at the individual and neighborhood level in a tri-ethnic sample of low-income women, an underrepresented sample in drug research. Women 18–31 were recruited from a low-cost family planning clinic in southeast Texas from December 2001 to May 2003. Neighborhood level indicators of disadvantage, family structure, and nativity status from U.S. Census 2000 were linked with individual survey data. Multilevel logistic regression was used to examine the effect of individual and neighborhood level measures on lifetime use of marijuana only and of other illicit drugs in 594 women. Only individual level variables (younger age, non-Hispanic White ethnicity, not being married, greater peer acceptance of substance use) increased odds of exclusive marijuana use, controlling for neighborhood level factors. However, both neighborhood and individual level variables significantly predicted other illicit drug use. Residence in less disadvantaged neighborhoods, non-Hispanic White ethnicity, higher levels of education, greater acceptance of substance use by peers, and a larger number of perceived neighborhood problems increased odds of illicit drug use. Use of other illicit drugs with or without marijuana may be more closely tied to area level factors whereas factors driving exclusive marijuana use may not rely on localized structures to the same extent. Thus, community-level interventions may need to customize their approaches according to the type of drug use targeted. The implication of using neighborhood level variables in substance use research is also discussed.