Pharmacogenomics as an aspect of molecular autopsy for forensic pathology/toxicology: does genotyping CYP 2D6 serve as an adjunct for certifying methadone toxicity?

Pharmacogenomics, applied as an aspect of molecular autopsy, may be used as an adjunct for certifying methadone fatalities. Methadone is metabolized by cytochrome P-450 (CYP) 1A2, 3A4, and 2D6. We hypothesized that methadone toxicity may be partially due to CYP 2D6 *3, *4, and *5 variant alleles, resulting in poor drug metabolism. A retrospective analysis was performed on covariables and risk factors of 21 methadone cases from the Milwaukee County Medical Examiner's Office (1998-2000). PCR genotyping showed: one heterozygous for 2D6*3, two homozygous for 2D6*4, five heterozygous for 2D6*4, and one heterozygous for both 2D6*3 and *4. This limited number of cases showed that the prevalence of poor metabolizer was higher but not significantly different from that of a control group (n = 23) (P > 0.05, Fisher Exact Test). Thus, CYP 2D6 mutations may not yet be directly associated with methadone toxicity. However, pharmacogenomics, complementing other case findings, served as an adjunct in interpreting methadone toxicity of poor and intermediate metabolizers.     

The ongoing debate over Medicare: understanding the philosophical and policy divides

This Article examines the evolution and status of Medicare, as well as the myriad current efforts to reform this longstanding entitlement. The author analyzes why healthcare financing for the elderly follows an administered pricing, fee-for-service model, while the working population generally obtains its insurance under a competitive market model. As a non-means-tested program modeled after Social Security, Medicare embraces both a universal entitlement philosophy of government-provided basic health services, and a need-based entitlement philosophy of caring for the Medicare-eligible elderly.     

General practitioners' perspectives regarding competence and confidentiality in an adolescent with suspected anorexia nervosa: legal and ethical considerations

In Victoria, Australia, the legal position regarding young people's competence to make medical treatment decisions has not been clarified in legislation, and a number of often vague common law decisions must be relied on for guidance. This situation produces a degree of uncertainty about appropriate professional practice, while also potentially impeding young people's rights claims in health care settings. With this in mind, the present research explored general practitioners' competence and confidentiality decisions regarding a 17-year-old female who presented with symptoms of an eating disorder. Questionnaires were sent to a random sample of 500 Victorian general practitioners, of whom 190 responded. After reading a case vignette, general practitioners indicated whether they would find the hypothetical patient competent and if they would maintain her confidentiality. Seventy-three per cent of respondents found the patient competent and most would have maintained confidentiality, at least initially. However, subsequent analysis of the rationales supplied for these decisions revealed a wide diversity in general practitioners' understandings and implementations of extant legal authority. This research highlights the need for general practitioners to be exposed to up-to-date and clinically relevant explanations of contemporary legal positions.     

What Drives Machinery of Government Change? Australia,Canada and the United Kingdom, 1950–1997

Machinery of government arrangements attract a diverse and detailed literature, but surprisingly little comparative research. This article provides a graphically presented indication of functional changes in the architecture of national government in Australia, Canada and the United Kingdom between 1950 and 1997. An analysis finds interesting national differences, with sharp changes in practice in Australia and Canada, but more gradual incremental adjustment in the United Kingdom. The correlation between parties and machinery change is weak for Canada and the United Kingdom, but all countries demonstrate stronger links between elections, new prime ministers and machinery of government changes. Further, all tend to oscillate between many specialist departments and fewer, broader agencies
The explanation for such machinery change, we argue, is found in the political, policy and administrative calculations made by prime ministers in Westminster-style parliamentary systems     

Protective Orders and Domestic Violence: Risk Factors for Re-Abuse

One of the few legal tools for protecting victims of domestic violence is the civil Protection Order (PO). How effective they were in preventing re-abuse was analyzed by examining court and police records from 210 couples in which female victims (or applicants) filed POs against their violent partners. Police records for 2 years prior and two years following the issuance of a PO were reviewed. Results indicated a significant decline in the probability of abuse following a PO. Prior to filing a PO, 68% of the women reported physical violence. After filing, only 23% reported physical violence. Several risk factors were assessed and it was found that very low SES women were more likely to report re-abuse as were African-Americans.     

Citizenship,justice and indigenous group‐specific rights—citizenship and indigenous Australia

Indigenous Australians and those supporting the cause of Aboriginal justice have used the language of citizenship rights to demand redress for indigenous peoples’ relative disadvantage. In doing so they make an appeal to rights of full participatory citizenship which have their roots in T.H. Marshall's writings. Liberal political theory, however, has resisted conceptions of citizenship which entail rights of assistance from the state: rights to welfare are more readily conceived of as charitable acts towards those members of a society unable to care for themselves. Unless the assumptions implicit in liberal conceptions of citizenship are challenged, demands for positive citizenship rights may re‐enforce stereotypes of Aboriginal inferiority. Drawing on Will Kymlicka's recent work, this article critically examines liberal conceptions of citizenship, welfare and demands for indigenous group‐specific rights as they may apply to Aboriginal and Torres Strait Islander citizenship.