An empirical study of tissue banking in Australia: navigating regulatory and ethical challenges

Collections of tumour samples can be an invaluable resource for medical research. There are, however, numerous ethical and legal challenges associated with tumour banking. While there has been extensive discussion of these issues in the legal and ethical literature, there are few available empirical data in relation to the activities of tumour banks in Australia, their practices around ethically charged issues, and their success in implementing complex regulatory guidelines. The aim of this study was to gain more information about the activities of tumour banks in New South Wales, Australia, with a particular focus on their management of, and attitudes towards, ethical and regulatory issues. A survey of 27 tumour collection and research facilities was conducted using a 55-item questionnaire. There is significant heterogeneity of research methodologies as well as of methods for gaining consent and ensuring donor privacy, and there is general concern among the research community about ethical and regulatory issues related to tumour banking. Heterogeneity of practice and uncertainty about ethical and regulatory requirements is problematic in its potential to hinder research and its potential to generate the space for unethical practice, whether intentional or unintentional. There is a pressing need to address these issues so that tumour banks can be used in the most ethical and efficient way possible.     

Medical Ethics at Guantanamo Bay and Abu Ghraib: The Problem of Dual Loyalty

Although knowledge of torture and physical and psychological abuse was widespread at both the Guantanamo Bay detention facility and Abu Ghraib prison in Iraq, and known to medical personnel, there was no official report before the January 2004 Army investigation of military health personnel reporting abuse, degradation or signs of torture. Military medical personnel are placed in a position of a "dual loyalty" conflict. They have to balance the medical needs of their patients, who happen to be detainees, with their military duty to their employer. The United States military medical system failed to protect detainee's human rights, violated the basic principles of medical ethics and ignored the basic tenets of medical professionalism.     

Psychosocial treatment in the 21st century

Over the past 50 years, psychosocial treatment has played an increasingly prominent role in helping persons with mental illness live in communities rather than in institutions. This paper briefly reviews evidence for and discusses three forms of treatment-assertive community treatment, supported employment, and cognitive behavior treatment-which have been studied extensively and are widely accepted as effective interventions. Forces are discussed that have shaped these and other psychosocial treatment over the past five decades. Despite the accumulated evidence, many questions remain about the cost-effectiveness and applicability of these treatments in specific populations and service environments. The development of these and other treatments has been, and continues to be, shaped by concerns about rising health care costs, a heightened emphasis on evidence-based treatment and by consumers taking a more active role in determining the services, and outcomes that are most helpful to them.     

Asking the Gatekeepers: A National Survey of Judges on Judging Expert Evidence in a Post-Daubert World

Drawing on the responses provided by a survey of state court judges (N = 400), empirical evidence is presented with respect to judges' opinions about the Daubert criteria, their utility as decision-making guidelines, the level to which judges understand their scientific meaning, and how they might apply them when evaluating the admissibility of expert evidence. Proportionate stratified random sampling was used to obtain a representative sample of state court judges. Part I of the survey was a structured telephone interview (response rate of 71%) and in Part II, respondents had an option of completing the survey by telephone or receiving a questionnaire in the mail (response rate of 81%). Survey results demonstrate that judges overwhelmingly support the gatekeeping role as defined by Daubert, irrespective of the admissibility standard followed in their state. However, many of the judges surveyed lacked the scientific literacy seemingly necessitated by Daubert. Judges had the most difficulty operationalizing falsifiability and error rate, with only 5% of the respondents demonstrating a clear understanding of falsifiability and only 4% demonstrating a clear understanding of error rate. Although there was little consensus about the relative importance of the guidelines, judges attributed more weight to general acceptance as an admissibility criterion. Although most judges agreed that a distinction could be made between scientific and technical or otherwise specialized knowledge, the ability to apply the Daubert guidelines appeared to have little bearing on whether specific types of expert evidence were designated as science or nonscience. Moreover, judges' bench philosophy of science seemed to reflect the rhetoric, rather than the substance, of Daubert. Implications of these results for the evolving relationship between science and law and the ongoing debates about Frye, Daubert, Joiner, and Kumho are discussed.     

Looking for leverage in PAC markets: Corporate and labor contributions considered

In this paper we explore the popular perception that political action committees (PACs) have substantial influence over elected legislators. We question whether the leverage in the PAC market is on the side of the contribution-maker or the contribution-taker. Analysis of the structure of PAC markets suggests most markets are sellers' markets, not buyers' markets. PAC contributions then may be more like protection money than attempts to buy votes or access. The leverage of the politician (seller) may be tempered if a substantial number of large PACs have homogeneous interests, and the ability to concentrate their contributions to the same legislators. This contention is supported by analysis of differences in labor and corporate PAC giving in the 1980 and 1984 general elections. Labor PACs, which are much larger than corporate PACs, have more homogeneous interests, give virtually all of their money to one party, and appear to have more discretion in making contribution decisions than do corporate PACs. An implication of this analysis for corporate executives is that using political action committees at the federal level may not be a strategy where corporations have a comparative advantage. — Senator Robert Dole (R-Kan.) — Senator Thomas Eaglecton (D-Mo.)