ABSTRACT
Background: The right to
prescribe drugs remains a contentious issue within the chiropractic profession.
Nevertheless, drug prescription by manual therapy providers is currently an
important topic. Notably, physiotherapists in the United Kingdom were recently
granted limited independent prescribing rights. Reports suggest that
physiotherapists in Australia now want those same rights, and as such a review
of chiropractors? general attitudes toward drug prescription is needed.
Objective: To examine the
literature concerning chiropractors’ attitudes toward drug prescription rights
and to compare the opinions of chiropractors currently licensed to prescribe
medication with those in the profession who are not.
Methods: This was a
narrative review, consisting of a formal literature search and summary of
included articles. Electronic databases searched included the Cumulative Index
to Nursing and Allied Health Literature, PubMed, and the Index to Chiropractic
Literature. Inclusion criteria consisted of prospective studies published in
English in peer-reviewed journals. Studies were required to contain data on
chiropractors’ opinions toward medication prescription rights.
Results: Of 33 articles
identified, a total of seven surveys were included in the review. Of these,
there was a general split in opinion among chiropractors regarding the right to
prescribe drugs in chiropractic practice. Those supportive of prescribing
rights favoured a limited number of over-the-counter and/or prescription-based
medications such as analgesics, anti-inflammatories, and muscle relaxants. When
questioned on full prescribing rights, however, chiropractors were generally
opposed. In jurisdictions where chiropractors are currently licensed to
prescribe from a limited formulary, such as in Switzerland, the majority perceived
this right as an advantage for the profession. Moreover, continuing education
in pharmacology was viewed as a necessary component of this privilege.
Conclusions: Based on the
literature to date there is a general split in chiropractors? attitudes toward
drug prescription rights. This split is most pronounced in countries where
chiropractors are not licensed to prescribe medications. Notwithstanding, this
is an important topic in chiropractic currently and warrants both further
discussion and research to determine future directions and the implications of
either pursuit or denial of prescription rights by chiropractors. Future
surveys and/or qualitative studies of other chiropractors? opinions toward
gaining prescription privileges would be timely.
ABSTRACT
Background: Faculty
productivity is essential for academic medical centers striving to achieve
excellence and national recognition. The objective of this study was to
evaluate whether and how academic Departments of Medicine in the United States
measure faculty productivity for the purpose of salary compensation.
Methods: We surveyed the
Chairs of academic Departments of Medicine in the United States in 2012. We
sent a paper-based questionnaire along with a personalized invitation letter by
postal mail. For non-responders, we sent reminder letters, then called them and
faxed them the questionnaire. The questionnaire included 8 questions with 23
tabulated close-ended items about the types of productivity measured (clinical,
research, teaching, administrative) and the measurement strategies used. We
conducted descriptive analyses.
Results: Chairs of 78 of 152
eligible departments responded to the survey (51% response rate). Overall, 82%
of respondents reported measuring at least one type of faculty productivity for
the purpose of salary compensation. Amongst those measuring faculty
productivity, types measured were: clinical (98%), research (61%), teaching
(62%), and administrative (64%). Percentages of respondents who reported the
use of standardized measurements units (e.g., Relative Value Units (RVUs))
varied from 17% for administrative productivity to 95% for research
productivity. Departments reported a wide variation of what exact activities
are measured and how they are monetarily compensated. Most compensation plans
take into account academic rank (77%). The majority of compensation plans are
in the form of a bonus on top of a fixed salary (66%) and/or an adjustment of
salary based on previous period productivity (55%).
Conclusion: Our survey
suggests that most academic Departments of Medicine in the United States
measure faculty productivity and convert it into standardized units for the
purpose of salary compensation. The exact activities that are measured and how
they are monetarily compensated varied substantially across departments.
ABSTRACT
Background: International
documents on ethical conduct in clinical research have in common the principle
that potential harms to research participants must be proportional to
anticipated benefits. The anticipated benefits that can justify human research
consist of direct benefits to the research participant, and societal benefits,
also called social value. In first-in-human research, no direct benefits are
expected and the benefit component of the risks-benefit assessment thus merely
exists in social value. The concept social value is ambiguous by nature and is
used in numerous ways in the research ethics literature. Because social value
justifies involving human participants, especially in early human trials, this
is problematic.
Discussion: Our analysis and
interpretation of the concept social value has led to three proposals. First,
as no direct benefits are expected for the research participants in
first-in-human trials, we believe it is better to discuss a risk- value
assessment instead of a risk - benefit assessment. This will also make explicit
the necessity to have a clear and common use for the concept social value.
Second, to avoid confusion we propose to limit the concept social value to the
intervention tested. It is the expected improvement the intervention can bring
to the wellbeing of (future) patients or society that is referred to when we
speak about social value. For the sole purpose of gaining knowledge, we should
not expose humans to potential harm; the ultimate justification of involving
humans in research lies in the anticipated social value of the intervention.
Third, at the moment only the validity of the clinical research proposal is a
prerequisite for research to take place. We recommend making the anticipated
social value a prerequisite as well.
Summary: In this paper we
analyze the use of the concept social value in research ethics. Despite its
unavoidable ambiguity, we aim to find a best use of the concept, subject to its
role in justifying involving humans in first-in-human research.
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