Access to expensive anti-cancer drugs

Expensive anti-cancer drugs expose controversy underlying the process for resource allocation decisions, and intermittently result in marked publicity, emotive discussions about access to novel and expensive treatments, and political involvement which may override existing processes. This column outlines the methods of determining whether or not a treatment is considered appropriate to fund, and focuses upon the evidence of patient and doctor wishes. The existing research illustrates the complexity of patient and oncologist decision-making when these drugs are to be considered. Past litigation to obtain access to expensive treatments is discussed, along with the interactions between patients, pharmaceutical companies, health services and oncologists. This evolving field is being transformed by developments in molecular biology enabling targeted drugs, and amply demonstrates the complexity of funding decisions and how expensive treatments are considered by a range of stakeholders.     

Death from minor head trauma and alcohol

Sudden death in association with minor or otherwise insignificant head injury is increasingly being recognised in the forensic medical literature. While the exact mechanism of the cardiorespiratory arrest that appears to occur in these cases is unclear, a number of mechanisms have been postulated. Animal studies have provided evidence that alcohol can be associated with an increased period of apnoea following minor physical brain injury and cardiac changes have also been identified. The limited information in the community about the risk of alcohol in association with minor head injury causing death may be relevant in homicide cases where this issue is raised.     

Predicting public support for the use of license plate recognition technology by police

The use of license plate recognition technology (LPR) by police is becoming increasingly common. LPR may be used for many purposes, ranging from stolen vehicle enforcement to more complex surveillance and predictive functions. Existing research does not examine community support for this technology, despite its potential to impact police legitimacy. Results from the first community LPR survey are presented and multinomial logistic regression models of citizen support for the technology are developed. Regression results suggest that a number of factors significantly predict citizen support for LPR use, including increased trust in police and the belief that LPR information is public information.     

Guidelines for Brief Focused Assessment: AFCC Task Force on Brief Focused Assessments.

The Association of Family and Conciliations Courts (AFCC) Task on Brief Focused Assessment was convened in 2007 to study the issues inherent in the use of brief focused assessment models in family courts. The resultant “Guidelines for Brief Focused Assessment” were approved by the AFCC Board of Directors in 2009 and are presented here to prompt discussion and further dialogue about this clearly needed practice.

Key Points for the Family Court Community
• Issue‐specific assessments are increasingly requested by family court judges
• Practice guidelines for clinicians conducting brief focused assessments (BFAs)
• Types of issues/questions appropriate for BFAs
• Advantages and pitfalls of BFAs
• Comparison of BFAs and comprehensive child custody evaluations

     

Psychological abuse of women: Six distinct clusters

This study was designed to identify patterns of psychological abuse (abuse) and determine whether different patterns mediate the effects of violence and sexual aggression. Interviews were completed with 578 (80.3%) of 720 women who volunteered for a study of “bad” or “stressful” heterosexual relationships. Cluster analysis with 51 items assessing many types of subtle and overt psychological abuse identified six groups. Cluster 1 sustained the most serious abuse, violence, and sexual aggression, but partners did not denigrate women or control finances. Cluster 2 sustained serious abuse which was more subtle than the dominating-controlling abuse discussed by others and had moderate violence and sexual aggression scores. Cluster 3 scored relatively low on abuse but reported controlling types (e.g., isolation, enforced secrecy) and relatively little violence and sexual aggression. Cluster 4 sustained the least abuse, violence, and sexual aggression but the abuse was overt (e.g., criticism, several types of control). Clusters 5 and 6 were similar with high abuse and moderate violence and sexual aggression scores but they experienced very different types of abuse. Total psychological abuse, threats of violence, acts of violence, and sexual aggression scores made different contributions to women's health, help seeking, and relationship perceptions depending on the pattern of abuse they sustained. Results for each type of harmful act are discussed separately.     

The Political Theory of Reinvention

In this article, we examine the implications of the reinvention movement for democratic governance, broadly defined. The most basic premise of the reinvention movement is a belief that the accumulation of the narrowly defined self-interests of many individuals can adequately approximate the public interest. By "narrowly defined," we mean the interests of individuals as they privately apprehend them, unmediated by participation in a process of civic discourse. To illustrate the centrality of this assumption to the implicit theory of reinvention, we consider three of its elements—its use of the market model, its emphasis on customers rather than citizens, and its glorification of entrepreneurial management. We then examine the implications of the self-interest assumption, which entails a rejection of democratic citizenship, civic engagement, and the public interest, broadly conceived.