Virtual Mentor. November 2008, Volume 10, Number 11: 689-778. Full Issue PDF

November 2008 Contents

Ethical Questions in Prevention

Ethics Poll

West Virginia has a pilot Medicaid program that gives enhanced benefits (e.g., weight-loss programs, chemical-dependency treatment, diabetes-management classes, and waiver of the cap on prescription-drug reimbursement) to patients who keep appointments, take their medications, and follow health-improvement plans. Patients who do not adhere to those specifications have to pay for the enhanced benefits. Which of the following best states what you think about this pilot "wellness promotion" plan?
It is an effective way to reward people who accept responsibility for lifestyle choices and penalize those who don’t.
It is an effective health promotion effort as long as it rewards attempts to improve health measures but does not penalize failure to achieve specific outcomes.
It is a cost-containment plan that cuts reimbursement for basic services that should be covered by Medicaid (e.g., diabetes-management classes).
It is counter-productive; it puts financial obstacles to care in the way of those who need care most.

Extremely traumatic events are thought to stimulate a large release of neurotransmitters, which produces a heightened, ongoing response to the memory of the event. Studies have shown that traumatized patients who take the beta-blocker propranolol have fewer symptoms of posttraumatic stress disorder than those who receive a placebo. Once treatment with propranolol is proven safe and effective, how would you feel about the possibility of preventing chronic symptoms in response to traumatic events by altering the memory of them pharmacologically?
Propranolol should be offered without reservation to all traumatized patients who desire it.
People who experience trauma should be treated for PTSD, but not by having their memories altered pharmacologically.
Memory of events—pleasant and painful—is an important contributor to personal identity. I don't believe in altering identity pharmacologically.

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From the Editor in Chief

Dedicated to Ronald M. Davis, MD
Audiey C. Kao
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Virtual Mentor. 2008; 10:S1-S2.

From the Editor

Prevention Finds a New Place in Medicine
Anna Shifrin
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Virtual Mentor. 2008; 10:691-693.

Educating for Professionalism

Clinical Cases

Practice Incentives and Professional Responsibility
Commentary by David Satin and Justin Miles
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Virtual Mentor. 2008; 10:694-699.

Balancing Health Promotion and Healing
Commentary by Michael F. Roizen, Iyaad M. Hasan, and David Clive
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Virtual Mentor. 2008; 10:700-707.

Ethics of Expedited Partner Therapy
Commentary by Matthew R. Golden, Matthew Hogben, and Mark A. Levine
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Virtual Mentor. 2008; 10:708-718.

Conley Contest Winning Essay

First, Do Not Punish: Individual Incentives in Health Policy
Benjamin M. Howard
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Virtual Mentor. 2008; 10:719-723.

Medical Education

A Larger Role for Preventive Medicine
Sharon K. Hull
Full Text | PDF
Virtual Mentor. 2008; 10:724-729.

Journal Discussion

Preventing Bad Memories: Is It Ethical?
Donald J. Phillips
Full Text | PDF
Virtual Mentor. 2008; 10:730-734.

Clinical Pearl

Managing Prehypertension
David S. Hatem
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Virtual Mentor. 2008; 10:735-739.

Law, Policy, and Society

Health Law

Practicing Preventive Medicine through Preventive Employment Practices
Kristin E. Schleiter
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Virtual Mentor. 2008; 10:740-746.

Policy Forum

Uncertainties in the Absence of Data: Use of Pravastatin in Young Children
Anna Shifrin and Darshak Sanghavi
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Virtual Mentor. 2008; 10:747-749.

Medicine and Society

Patients Are Hardly Too Thin or Too Rich: Doctors’ Preventive Medicine Duties
Henry S. Perkins
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Virtual Mentor. 2008; 10:750-755.

Op-Ed and Correspondence

Op-Ed

Motivating Prevention: from Carrots and Sticks to “Carrots” and “Sticks”
Nir Eyal
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Virtual Mentor. 2008; 10:756-762.

Resources

Suggested Readings and Resources
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Virtual Mentor. 2008; 10:763-775.

About the Contributors
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Virtual Mentor. 2008; 10:776-778.