Fall 2007 Issue

The field of psychiatric medicine is observed to lag far behind physical medicine. The notion of how mental illness ought to be defined is still debated. This confusion reflects serious problems in the system by which mental disorders are classified. The utilitiy derived from the DSM-IV is, in some ways, undermined by the lack of scientific validity seen in the criteria employed therein. This paper suggests the use of a dimensional taxonomic model, onto which categorical criteria might be selectively superimposed. With such a system in place, a guide that expresses both utility for the clinician and va- lidity for the researcher might be found.

The Centers for Disease Control and Prevention (CDC) recently introduced new guidelines which will make HIV testing a routine part of a thorough medical evaluation. Given the high rates of incidence and transmission of the disease, and the startling number of people who are unknowingly infected, the number of people who seek testing on their own is unacceptably low. As this low testing rate can be attributed in many instances to an incorrect assessment of risk based on the common stigmas associated with HIV, routine testing will help to break down these barriers by normalizing the process and bringing to light the common misperceptions about risk factors. As a result, routine test- ing should lead to a better-informed public with lower rates of HIV transmission.

The rights and duties of the patient and the physician regarding the option of life-sustaining treatment is a hotly contested issue in American healthcare. When a patient suffers from severe disability or terminal illness, the patient’s quality of life may be so far reduced as to drive him or her to decide against such treatment. This scenario is not uncommon and it presents an ethical dilemma to the physician, who may be torn between his sympathy for the patient, his moral obligations as a healthcare professional, and his own personal beliefs. In this article, Kathryn Reiser explores arguments for and against the patient’s autonomy in this mater, arguing that with very few exceptions, the patient is entitled to refuse life-sustaining medical treatment and is not obligated to justify his or her decision.

The topic of race has long been controversial and misused, but does it have a role to play in medicine? In the past, corrupt and immoral reigns have often hid behind a veil of science to define the superiority and inferiority of different races. Now, the existence of the concept of race itself is in question, and the most common point of contention remains focused on the question of how to define various ethnicities or races. The use of geographical gradients, or ‘clines’, has been proposed as a solution to this problem. Many biological differences among racial groups have been shown, ranging from increased risks of genetic diseases to increased risk of dangerous drug side effects. The potential for preventative measures that would compensate for these risks and therefore save lives is drastic. As history has shown, the social implications that could potentially result from legitimizing the existence of racial differences cannot be ignored. However, this past exploitation should not have the result of excluding the potential role of ethnicity in identifying risk variation among different ethnic groups, and personalizing medicine in order to address and overcome these risks and differences.

Approval of the “abortion pill”, RU-486, in the United States occurred twelve years after France’s Ministry of Health approved the pill for medical abortions. For over a decade, a combination of conservative presidents and the mobilization of pro-life groups kept the pill off the market. These interest groups framed the debate surrounding the pill in the abortion arena, effectively hinging its approval on morals rather than the drug’s safety and efficacy. Anti-abortion groups wielded a variety of tactics to delay the drug’s approval including lobbying U.S. Congressmen, threatening a boycott of Hoescht products, pub- licly decrying the drug based on moral grounds and, in an interesting twist, framing the issue under women’s rights. RU-486 was eventually approved for use in the United States, demonstrating that interest groups’ influence is not omnipotent and politi- cal currents can often override vocal minorities. However, the case study of RU-486 provides substantial evidence that when safe scientific advances clash against powerful interest groups, these groups can significantly hinder the process of approval.