Annals of internal medicine
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Medical paternalism lies at the heart of traditional medicine. In an effort to counteract the effects of this paternalism, medical ethicists and physicians have proposed a model of patient autonomy for the physician-patient relationship. ⋯ Paternalism does not respect the rights of adults to self-determination, and autonomy does not respect the principle of beneficence that leads physicians to argue that acting on behalf of others is essential to their craft. A model of physician conscience is proposed that summarizes the best features of both models--paternalism and autonomy.
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Review Clinical Trial
Wegener's granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years.
Eighty-five patients with Wegener's granulomatosis were studied for 21 years at the National Institutes of Health. Patients were treated with a protocol consisting of cyclophosphamide, 2 mg/kg body weight d, together with prednisone, 1 mg/kg body weight d, followed by conversion of the prednisone to an alternate-day regimen. ⋯ Twenty-three patients are off all therapy for a mean duration of 35.3 (+/- 6.3) months without therapy. This study provides a prospective experience with Wegener's granulomatosis and shows that long-term remissions can be induced and maintained in an extremely high number of patients by the combination of daily cyclophosphamide and alternate-day prednisone therapy.
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Reports of an impending surplus of physicians have intensified economic incentives to exclude competing professionals from the hospital workplace. These conditions have led to a substantial increase in the number of private lawsuits instituted by the excluded physicians. ⋯ However, unreasonable denials of staff privileges, staff closures, and exclusive contracts can raise antitrust implications depending on the facts. The relevant factual and economic questions that should be asked about such conduct in order to determine the degree of antitrust risk are discussed.