Provinces create centralized system for assessing new drugs

Provincial health ministers have created a common drug-review process for assessing whether new drugs should be place on provincial formularies. The new system will save money, but will it improve access?     

Regulators deny access to experimental hepatitis C drug

An application for access to an experimental hepatitis C drug under Canada's Special Access Programme has been turned down. In the process, Canada's drug regulators have created discomfort and uncertainty about how the Special Access Programme is managed.     

Pharmacokinetics of ethanol in patients with renal failure before and after hemodialysis

We studied the pharmacokinetics of ethanol in seven patients suffering from terminal renal failure before and after they underwent hemodialysis. Ethanol (0.40 g/kg) was administered in the morning after an overnight fast by a constant rate intravenous (IV) infusion over 45 min. After removing a mean fluid volume of 2.46±0.48 liters (±SD), span 1.76–3.43 liters by hemodialysis, the same subjects received a second IV infusion of ethanol after they had eaten lunch. At exactly timed intervals of 0, 45, 90, 105, 120, 135, 150, 165, and 180 min from the start of the infusion, two blood-samples were drawn and the plasma portion of one of them was obtained by centrifugation. The concentration of ethanol in blood and plasma was determined by headspace gas chromatography and the water-content of whole blood was determined from the change in weight after desiccation. Plasma always contained a higher concentration of ethanol than whole blood and the mean plasma/whole blood ratio in patients with renal failure was 1.07:1 (span 1.05–1.10). The rate of ethanol disappearance from blood (β-slope) was faster (0.185±0.013 versus 0.157±0.022 g/l/h), the C₀ value was higher (0.79±0.08 versus 0.73±0.10 g/l) and the apparent volume of distribution (V_d) of ethanol was lower (0.507±0.049 versus 0.558±0.078 l/kg) after hemodialysis. The water content of whole blood was significantly higher (P<0.001) before dialysis (88.6±1.97 g/100 ml) compared with after dialysis (87.4±2.01 g/100 ml). The higher V_d for ethanol and lower C₀ as well as higher blood-water content are to be expected for a over hydrated condition before hemodialysis. The swifter rate of ethanol elimination from blood (β-slope) after hemodialysis should be interpreted with caution because eating a meal before the second infusion of ethanol is a confounding factor. Nevertheless, the rate of elimination of ethanol from blood in patients with renal failure agreed reasonably well with values expected for healthy subjects, namely mean 0.15 g/l/h spanning from 0.10 to 0.20 g/l/h.     

Metaphysics Postponed: Liberalism, Pluralism, and Neutrality

Many recent liberal theorists have argued that state neutrality is supported by a metaphysical thesis about value, namely pluralism , which asserts that there are some conceptions of the good life which neither form a hierarchy nor represent versions of a single good. It is however doubtful whether neutrality is supported by pluralism; indeed, it may in some cases be precluded by it. Arguments for pluralism can, in many cases, be reconciled with a monistic metaphysics of value, and pluralism itself fails to support neutrality. This is particularly true of traditional liberal policy positions such as religious toleration and opposition to censorship, where attention to diverse conceptions of the good may favour, or demand, non–neutral policies. The political problems which neutrality addresses arise before we accept the metaphysical 'truth' of pluralism, and often remain even if the parties to a political conflict have false conceptions of value. A sharp question for the pluralist neutralist is why conflicting conceptions of the political cannot themselves feature in plural conceptions of the good life. Dispensing with pluralism may not, however, be enough to rescue neutrality, since the disputes which neutrality was designed to deal with may not be resolvable neutrally; and more particularly, some of the traditional liberal policies may be incapable of neutral justification. If so, liberals may find a more traditional form of non–neutral liberalism more attractive.     

Exploring cynicism toward prison administrations as a mediator of the association between quality of treatment and inmate misconduct

This study explores the ability of inmate cynicism to mediate the relationship between perceptions regarding quality of treatment and inmate misconduct in a prison setting. Using a sample of inmates from prisons in South Korea, the generalizability of the process-based model is tested. Also, the indirect effect of quality of treatment on inmate misconduct through cynicism is estimated using a bias-corrected bootstrapped mediation analysis. The findings show that quality of treatment was negatively and significantly associated with inmate misconduct in South Korean prisons. Additionally, results indicate that the quality of treatment and social support are significant predictors of inmate cynicism. Finally, a regression-based path analysis reveals that cynicism mediates the relationship between quality of treatment and inmate misconduct. While quality of treatment was found to predict inmate misconduct significantly, mediation analyses support the hypothesis that inmate cynicism partially mediates this association. The findings suggest that correctional policies should pay more attention to reducing inmates’ cynicism.

     

The political economy of the Trans-Pacific Partnership: a US perspective

The Trans-Pacific Partnership (TPP), signed in February 2016, is the most ambitious free trade deal of the postwar era. The 12 TPP countries account for nearly 40 percent of the world's economy. Coupled with the Transatlantic Trade and Investment Partnership—which is still being negotiated between the United States and the European Union—the TPP represents an attempt by the Obama Administration to lead in promoting regional trade and investment arrangements despite the failure of the Doha Round to reach a comprehensive global trade deal under the auspices of the World Trade Organization. Although the agreement among the 12 TPP countries has been reached, ratification by their legislatures is pending. Ratification by the US Congress remains uncertain due to complex economic and political factors in the United States, including the presidential election of 2016.