In this paper we argue that the standard focus on problems of informed consent in debates about the ethics of human experimentation is inadequate because it fails to capture a more fundamental way in which such experiments may be wrong. Taking clinical trials as our case in point, we suggest that it is the moral offence of using people as mere means which better characterizes what is wrong with violations of personal autonomy in certain kinds of clinical trials. This account also helps bring out another important way in which the autonomy of the participants in clinical trials my be violated, even in cases where they have given informed consent to their involvement. Where relevant information about the trial is framed in such a way as to induce a patient's participation by appeal to their nonrational preferences, this is also a violation of their autonomy, and one which is distinct from a failure of informed consent. The underlying wrongness of both kinds of violations, we argue, is plausibly captured by the moral offence of using people as mere means.
MEDICAL EXPERIMENTATION, INFORMED CONSENT AND USING PEOPLE
DEAN COCKING 1 JUSTIN OAKLEY 1
1 Centre for Human Bioethics Monash University
Wednesday, February 16, 2011
Fake websites in the service of the ETS industry - who protects the patients?
Mia:
Many surgeons compete with each other for the attention of the 'costumer' in the saturated market of the www. Adaptations to a business model raises ethical questions that should have been explored long ago and should have raised the ire of the medical community. The occasional whimper of discord is silenced by the cacophony of (ignorant) enthusiasm. Not quite the scientific behavior one would expect.
How does the entrepreneurial aspect of medicine impact on the information patients are given? In the area of elective procedures, is it in the interest of the service provider to provide full disclosure? Does self-interest influence and modify how the information is conveyed? How information morphs into little facts and more emoting. to appeal to the irrational in all of us. To be seduced.
Fake websites that pretend to be independent, informative, with the sole raison d'etre to praise the surgeon's skill, expertise and experience, - and to hook the patient into reading more on the surgeons' website, with many obvious links to the surgeon on every page.
Why are predatory practices of medical professionals tolerated?
Many surgeons compete with each other for the attention of the 'costumer' in the saturated market of the www. Adaptations to a business model raises ethical questions that should have been explored long ago and should have raised the ire of the medical community. The occasional whimper of discord is silenced by the cacophony of (ignorant) enthusiasm. Not quite the scientific behavior one would expect.
How does the entrepreneurial aspect of medicine impact on the information patients are given? In the area of elective procedures, is it in the interest of the service provider to provide full disclosure? Does self-interest influence and modify how the information is conveyed? How information morphs into little facts and more emoting. to appeal to the irrational in all of us. To be seduced.
Fake websites that pretend to be independent, informative, with the sole raison d'etre to praise the surgeon's skill, expertise and experience, - and to hook the patient into reading more on the surgeons' website, with many obvious links to the surgeon on every page.
Why are predatory practices of medical professionals tolerated?
Monday, February 14, 2011
In 70 % compensatory sweating severe, recurrence rates were 15% and 19% at 1 and 2 years after surgery
In T2 and T3 resection, all patients experienced Compensatory Sweating and over 70% of the patients felt it was severe. Even in T2 resection, 90% of patients experienced CS and in 50% of these it was severe. High rates of CS are reported in Asian countries with hot and humid climates.
In T2 resection, recurrence rates were 15% and 19% at 1 and 2 years after surgery.It was not rare for a patient to experience recurrence more than 3 years after surgery.
Motoki Yano, MD, PhD and Yoshitaka Fujii, MD, PhD
Volume 138, Issue 1, Pages 40-45 (July 2005)
In T2 resection, recurrence rates were 15% and 19% at 1 and 2 years after surgery.It was not rare for a patient to experience recurrence more than 3 years after surgery.
Motoki Yano, MD, PhD and Yoshitaka Fujii, MD, PhD
Volume 138, Issue 1, Pages 40-45 (July 2005)
Sunday, February 13, 2011
The results of endoscopic sympathectomy deteriorate progressively from the immediate outcome
British Journal of Surgery ISSN 0007-1323
1999, vol. 86, no1, pp. 45-47 (12 ref.)
1999, vol. 86, no1, pp. 45-47 (12 ref.)
Saturday, February 12, 2011
a strong association of autonomic dysfunction and impaired cerebral autoregulation
Furthermore, we found a strong association of autonomic dysfunction and impaired autoregulation indicated by a correlation between the LF/HF ratio and Sx (p <>
Influences of autonomic dysbalance and mental state during withdrawal are suggested. The finding of an affected autoregulation during acute withdrawal might indicate an increased risk for cerebro-vascular disease.
Influences of autonomic dysbalance and mental state during withdrawal are suggested. The finding of an affected autoregulation during acute withdrawal might indicate an increased risk for cerebro-vascular disease.
Drug and Alcohol Dependence
Volume 110, Issue 3, 1 August 2010, Pages 240-246
Conditions arising after Sympathectomy
After stellate ganglion blockade: HORNER'S SYNDROME
- Drooping eyelid
- Constricted pupil (impaired vision in low light)
- Absent/reduced sweating one side of the face and head
- Redness of eyes
- Facial flushing
After regional sympathectomy: DUMPING SYNDROME:
- Rapid emptying of the stomach: lower end of small intestine fills too quickly
- Early dumping: nausea/vomiting/bloating/diarrhoea/shortness of breath
- Late dumping: 1-3 hours after eating: weakness/sweating/dizziness
- Both types may co-exist.
Friday, February 11, 2011
Surgical sympathectomy is one of the causes or Orthostatic Hypotension
Causes of Orthostatic Hypotension
Peripheral
Amyloidosis
Diabetic, alcoholic, or nutritional neuropathy
Familial dysautonomia (Riley-Day syndrome)
Guillain-Barré syndrome
Paraneoplastic syndromes
Pure autonomic failure (formerly called idiopathic orthostatic hypotension)
Surgical sympathectomy
http://www.merckmanuals.com/professional/sec07/ch069/ch069d.html
Thursday, February 10, 2011
Other causes of autonomic dysfunction: sympathectomy
Patients with progressive autonomic dysfunction (including diabetes) have little or no increase in plasma noradrenaline and this correlates with their orthostatic intolerance (Bannister, Sever and Gross, 1977). In patients with pure autonomic failure, basal levels of noradrenaline are lower than in normal subjects (Polinsky, 1988). Similar low values are observed in patients with sympathectomy and in patients with tetraplegia. (p.51)
The finger wrinkling response is abolished by upper thoracic sympathectomy. The test is also abnormal in some patients with diabetic autonomic dysfunction, the Guillan-Barre syndrome and other peripheral sympathetic dysfunction in limbs. (p.46)
Other causes of autonomic dysfunction without neurological signs include medications, acute autonomic failure, endocrine disease, surgical sympathectomy . (p.100)
Anhidrosis is the usual effect of destruction of sympathetic supply to the face. However about 35% of patients with sympathetic devervation of the face, acessory fibres (reaching the face through the trigeminal system) become hyperactive and hyperhidrosis occurs, occasionally causing the interesting phenomenon of alternating hyperhidrosis and Horner's Syndrome (Ottomo and Heimburger, 1980). (p.159)
The finger wrinkling response is abolished by upper thoracic sympathectomy. The test is also abnormal in some patients with diabetic autonomic dysfunction, the Guillan-Barre syndrome and other peripheral sympathetic dysfunction in limbs. (p.46)
Other causes of autonomic dysfunction without neurological signs include medications, acute autonomic failure, endocrine disease, surgical sympathectomy . (p.100)
Anhidrosis is the usual effect of destruction of sympathetic supply to the face. However about 35% of patients with sympathetic devervation of the face, acessory fibres (reaching the face through the trigeminal system) become hyperactive and hyperhidrosis occurs, occasionally causing the interesting phenomenon of alternating hyperhidrosis and Horner's Syndrome (Ottomo and Heimburger, 1980). (p.159)
Disorders of the Autonomic Nervous System
By David Robertson, Italo Biaggioni
Edition: illustrated
Published by Informa Health Care, 1995
ISBN 3718651467, 9783718651467
Wednesday, February 9, 2011
Bilateral sympathectomy produced fatal heart block in a few of their experiments
American Heart Journal
Volume 22, Issue 4, October 1941, Pages 545-548
bradycardia and other cardiac complications are common side effects?
The most common side effects of sympathectomy are compensatory sweating, gustatory sweating and cardiac changes including decreasing heart rate, systolic-diastolic and mean arterial pressure. The mechanism of bradycardia and other cardiac complications that develop after thoracic sympathectomy are still unclear.
http://tipbilimleri.turkiyeklinikleri.com/abstract_54802.html
http://tipbilimleri.turkiyeklinikleri.com/abstract_54802.html
Tuesday, February 8, 2011
"It is a lie that sympatholysis may specifically cure patients
with unqulified "reflex sympathetic dystrophy". This was already stated by the father of sympathectomy, Rene Leriche, more than half a century ago.
...it is not an error. but a lie. While conceptual errors are not only forgivable, but natural to inexact medical science, lies, particularly when entrepreneurially inspired are condemnable and call for a peer intervention.
J. Neurology (1999) 246: 875-879
...it is not an error. but a lie. While conceptual errors are not only forgivable, but natural to inexact medical science, lies, particularly when entrepreneurially inspired are condemnable and call for a peer intervention.
J. Neurology (1999) 246: 875-879
Monday, February 7, 2011
After thoracoscopic sympathectomy for hyperhidrosis, very severe discomfort and hyperhidrosis occurred with alarming frequency and intensity
"After thoracoscopic sympathectomy for hyperhidrosis, very severe discomfort and hyperhidrosis in the neighboring non-sympathectomized regions occurred with alarming frequency and intensity."
(p.879)
Cousins and Bridenbaugh's Neural Blockade in Clinical Anesthesia and Pain Medicine by Michael J Cousins, Phillip O Bridenbaugh, Daniel B Carr, and Terese T HorlockerWolters Kluwer Health
Edition: 4 - 2008
Thursday, February 3, 2011
Lack of disclosure to ETS patients is unethical and would be criminal in a just society
It is the doctor's moral and ethical duty to provide you with full and honest disclosure of the facts prior to surgery. The whole doctrine of informed consent is to prevent patients from having to realize they made a mistake in hindsight. You shouldn't have had to find out from a former patient's wife that the surgery would cause drenching sweating on your back. It was Garza's job to do that. He completely lied to you regarding the supposed reversibility. Anyone who goes through medical school knows that can't crush a nerve with a metal clamp, remove it later and have the nerve return to normal functioning.
Although it is not possible to predict exactly what will occur in each individual case, there is nearly 100 years of published scientific and medical research available on the effects of sympathectomy. That research paints a very different picture of the effects of this surgery than the one presented to patients considering this surgery. That's the issue. Generally, they lie and tell patients that CS is inconsequential in all but a tiny fraction of cases and simply fail to disclose a huge number of verified adverse effects of the surgery. They take advantage of the patient's ignorance on medical matter. It's unethical and would be criminal in a just society.
In short, you do have a way of knowing what will likely occur as a result of the surgery before you have it done. All the information necessary to make an informed decision exists. It's just not getting to patients.
http://etsandreversals.yuku.com/reply/22927/Would-you-do-it-again#reply-22927
Although it is not possible to predict exactly what will occur in each individual case, there is nearly 100 years of published scientific and medical research available on the effects of sympathectomy. That research paints a very different picture of the effects of this surgery than the one presented to patients considering this surgery. That's the issue. Generally, they lie and tell patients that CS is inconsequential in all but a tiny fraction of cases and simply fail to disclose a huge number of verified adverse effects of the surgery. They take advantage of the patient's ignorance on medical matter. It's unethical and would be criminal in a just society.
In short, you do have a way of knowing what will likely occur as a result of the surgery before you have it done. All the information necessary to make an informed decision exists. It's just not getting to patients.
http://etsandreversals.yuku.com/reply/22927/Would-you-do-it-again#reply-22927
Surgical sympathectomy listed as neurologic disorder
Other neurologic disorders
- Idiopathic orthostatic hypotension
- Multiple sclerosis
- Parkinsonism
- Posterior fossa tumor
- Shy-Drager syndrome
- Spinal cord injury with paraplegia
- Surgical sympathectomy
- Syringomyelia
- Syringobulbia
- Tabes dorsales (syphillis)
- Wernicke's encephalopathy
Dizziness: Classification and Pathophysiology
The Journal of Manual and Manipulative Therapy, Vol. 12, No 4 (2004)
- Idiopathic orthostatic hypotension
- Multiple sclerosis
- Parkinsonism
- Posterior fossa tumor
- Shy-Drager syndrome
- Spinal cord injury with paraplegia
- Surgical sympathectomy
- Syringomyelia
- Syringobulbia
- Tabes dorsales (syphillis)
- Wernicke's encephalopathy
Dizziness: Classification and Pathophysiology
The Journal of Manual and Manipulative Therapy, Vol. 12, No 4 (2004)
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